Frontal EEG asymmetry and symptom response to cognitive behavioral therapy in patients with social anxiety disorder

Learning to be inventive in the face of statistics: A positive reappraisal intervention for statistics anxiety

BACKGROUND AND OBJECTIVES

The burden of statistics anxiety on students calls for effective interventions. This study investigated whether a cognitive reappraisal training designed to stimulate the generation of positive re-interpretations may yield behavioral changes in anxiety measures and changes in cerebral activation patterns reflecting the activation of approach/avoidance motivational tendencies (frontal EEG alpha asymmetry response).

METHODS

Three groups of female psychology students (n = 45) with statistics anxiety were tested. Two groups received a guided, two-week reappraisal training with either statistics-anxiety or general anxiety situations; the control group received no intervention.

RESULTS

Both training groups significantly increased their amount of positive re-interpretations from pre-to post-test compared to the control group. Increased habitual use of reappraisal in statistics situations and significant EEG changes reflecting more approach-oriented coping with anxiety occurred in the statistics-anxiety training group only. No changes in statistics anxiety and statistics attitudes were observed, suggesting that the training effects, though corroborated through neurophysiological changes, did not sufficiently translate to improving students' deep-rooted anxiety.

LIMITATIONS

Effects, though robust and following the same pattern, were observed in a small sample.

CONCLUSIONS

Our findings delineate a promising expandable approach for helping students' cope with statistics anxiety in a healthier way.

How Society Anxiety Influences Attention Control in College Students: The Moderated Mediation Effect of Cognitive Flexibility and Resting-state Electroencephalography Activity

Social anxiety is a prevalent issue among college students, adversely affecting their overall well-being. Drawing from the cognitive model of social anxiety and attention control theory, heightened levels of social anxiety may correspond to poorer attention control ability. However, little is known about the underlying cognitive mechanisms of the relationship between social anxiety and attention control. To address this research gap, the current study recruited a sample of 156 college students (56 women) who underwent self-report measures of social anxiety, cognitive flexibility, and attention control, followed by a resting-state EEG recording. The results revealed a significant negative predictive effect of social anxiety on attention control, with cognitive flexibility partially mediating this relationship. Furthermore, resting-state theta power emerged as a significant moderator, accentuating the negative impact of social anxiety on cognitive flexibility among individuals with lower theta power. In addition, frontal alpha asymmetry (FAA) demonstrated a moderating effect, with lower FAA intensifying the predictive influence of cognitive flexibility on attention control. Taken together, these results suggested that social anxiety can predict attention control either directly or indirectly via the mediating role of cognitive flexibility, and lower theta power and FAA has a risk amplification effect, which provide novel insights into the treatment and prevention of social anxiety and its negative impact on college students.

Event-related alpha power in early stage of facial expression processing in social anxiety: Influence of language context

Accurate interpretation of the emotional information conveyed by others' facial expressions is crucial for social interactions. Event-related alpha power, measured by time-frequency analysis, is a frequently used EEG index of emotional information processing. However, it is still unclear how event-related alpha power varies in emotional information processing in social anxiety groups. In the present study, we recorded event-related potentials (ERPs) while participants from the social anxiety and healthy control groups viewed facial expressions (angry, happy, neutral) preceded by contextual sentences conveying either a positive or negative evaluation of the subject. The impact of context on facial expression processing in both groups of participants was explored by assessing behavioral ratings and event-related alpha power (0-200 ms after expression presentation). In comparison to the healthy control group, the social anxiety group exhibited significantly lower occipital alpha power in response to angry facial expressions in negative contexts and neutral facial expressions in positive contexts. The influence of language context on facial expression processing in individuals with social anxiety may occur at an early stage of processing.

Efficacy of increasing levels of exposure therapy in the treatment of maladaptive behaviors and anxiety

The present study examined the effectiveness of increasing levels of exposure therapy, which is applied for the treatment of maladaptive behaviors and anxiety. A total of 16 sessions were applied to the study group in the experimental group three times a week for 10 weeks. Patients aged ≥18 years whom the referring clinician evaluated as meeting the criteria for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-V-TR) Generalized Anxiety Disorder were included in the study. For the control group, demographic characteristics and Spielberger's State-Trait Anxiety Inventory were applied in the first session, followed by Spielberger's State-Trait Anxiety Inventory as a post-test and follow-up. Electroencephalography (EEG) recordings of the study group were obtained at the cortical level. Electrodes for EEG measurements were recorded using the International 10/20 Electrode Placement System. EEG data were obtained using the EEG Analysis Program software. Following the data collection phase, all data were entered into cells based on items using SPSS 25 software. When the findings obtained in the study were examined, it was determined that the increasing levels of exposure and behavioral therapy applied for maladaptive anxiety decreased the anxiety levels compared to those before therapy. This finding can be interpreted as that the cortical function-oriented application method for anxiety effectively reduced the anxiety levels of the study group. However, EEG asymmetry revealed a change in the data before and after the application. These findings demonstrate that the application affects the EEG asymmetry changes at the cortical level.

Problematic social media use is associated with depression and similar to behavioral addictions: Physiological and behavioral evidence

While many studies have examined the relationship between problematic social media use (PSMU) and mental health disorders, little is known about reward responsiveness mechanisms that might be driving this relationship and the neurophysiological characteristics of PSMU. We surveyed 96 undergraduate students at a private liberal arts college in upstate NY. PSMU was assessed using the Social Media Disorder Scale. Fourteen Individuals endorsing in five or more and three or less categories on the Social Media Disorder Scale were offered and underwent resting state QEEG. Mental health was assessed with the Center for Epidemiological Studies Depression Scale Short Form, Social Interaction Anxiety Scale, Penn State Worry Questionnaire, the 10-item Perceived Stress Scale, and a locally developed measure of Substance Use Disorder. Reward and motivational systems were studied using the Brief Sensation Seeking Scale, Behavioral Inhibition/Behavioral Activation Scale, and Temporal Experience of Pleasure Scale. SMDS scores were associated with poorer mental health on all measures except substance use. SMDS scores were positively associated with the behavioral inhibition scale, and the anticipatory pleasure scale. QEEG results revealed a negative association of high PSMU and right central and frontal lobeta, right central beta, and a positive association with frontal alpha asymmetry. The study replicates findings that PSMU is associated with mental health issues. Further the pattern of reward response is different compared with other addictive behaviors. QEEG results are consistent with previous work in substance use and depression.

Resting-state EEG delta and alpha power predict response to cognitive behavioral therapy in depression: a Canadian biomarker integration network for depression study

Cognitive behavioral therapy (CBT) is often recommended as a first-line treatment in depression. However, access to CBT remains limited, and up to 50% of patients do not benefit from this therapy. Identifying biomarkers that can predict which patients will respond to CBT may assist in designing optimal treatment allocation strategies. In a Canadian Biomarker Integration Network for Depression (CAN-BIND) study, forty-one adults with depression were recruited to undergo a 16-week course of CBT with thirty having resting-state electroencephalography (EEG) recorded at baseline and week 2 of therapy. Successful clinical response to CBT was defined as a 50% or greater reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to post-treatment completion. EEG relative power spectral measures were analyzed at baseline, week 2, and as early changes from baseline to week 2. At baseline, lower relative delta (0.5-4 Hz) power was observed in responders. This difference was predictive of successful clinical response to CBT. Furthermore, responders exhibited an early increase in relative delta power and a decrease in relative alpha (8-12 Hz) power compared to non-responders. These changes were also found to be good predictors of response to the therapy. These findings showed the potential utility of resting-state EEG in predicting CBT outcomes. They also further reinforce the promise of an EEG-based clinical decision-making tool to support treatment decisions for each patient.

Acute and chronic stress alter behavioral laterality in dogs

Dogs are one of the key animal species in investigating the biological mechanisms of behavioral laterality. Cerebral asymmetries are assumed to be influenced by stress, but this subject has not yet been studied in dogs. This study aims to investigate the effect of stress on laterality in dogs by using two different motor laterality tests: the Kong™ Test and a Food-Reaching Test (FRT). Motor laterality of chronically stressed (n = 28) and emotionally/physically healthy dogs (n = 32) were determined in two different environments, i.e., a home environment and a stressful open field test (OFT) environment. Physiological parameters including salivary cortisol, respiratory rate, and heart rate were measured for each dog, under both conditions. Cortisol results showed that acute stress induction by OFT was successful. A shift towards ambilaterality was detected in dogs after acute stress. Results also showed a significantly lower absolute laterality index in the chronically stressed dogs. Moreover, the direction of the first paw used in FRT was a good predictor of the general paw preference of an animal. Overall, these results provide evidence that both acute and chronic stress exposure can change behavioral asymmetries in dogs.

Relationships between fear of flying, loudness dependence of auditory evoked potentials and frontal alpha asymmetry

Previous research has suggested that fear of flying, which is defined as a situational, specific phobia, could overlap with depressive and anxiety disorders. Whether the neuronal dysfunctions including altered serotonergic activity in the brain and altered neural oscillations observed for depressive and anxiety disorders also overlap with alterations in fear of flying is unclear. Here, thirty-six participants with self-reported fear of flying (FF) and forty-one unaffected participants (NFF) were recruited. The participants completed the Beck Depression Inventory (BDI-II), the State-trait Anxiety Inventory (STAI) and the Fear of Flying Scale (FFS). EEG-recording was conducted during resting-state and during presentation of auditory stimuli with varying loudness levels for analysis of the Loudness Dependence of Auditory Evoked Potentials (LDAEP), which is suggested to be inversely related to central serotonergic activity. Participants with fear of flying did not differ from the control group with regard to BDI-II and STAI data. The LDAEP was higher over F4 electrode in the FF group compared to controls, whereas exploratory analysis suggest that differences between groups were conveyed by female participants. Moreover, the FF group showed relatively higher right frontal alpha activity compared to the control group, whereas no difference in frequency power (alpha, beta and theta) was observed. Thus, this study brought the first hint for reduced serotonergic activity in individuals with fear of flying and relatively higher right frontal activity. Thus, based on the preliminary findings, future research should aim to examine the boundaries with anxiety and depressive disorders and to clarify the distinct neural mechanisms.

Central and peripheral nervous system responses to chronic and paced hyperventilation in anxious and healthy subjects

The aim of the present study was to examine self-report, peripheral nervous system, and central nervous system correlates of naturally-occurring, chronic hyperventilation (HV, assessed by hypocapnia or low resting state low end-tidal CO2), and to examine the additional effect of acute, experimentally-induced HV in anxious and healthy participants. By identifying the biomarkers of anxiety-related chronic HV and examining responses to acute HV, we hope to identify meaningful, mechanistic targets for further treatment development. Seventy anxious patients and 34 healthy control participants completed electroencephalogram (EEG) and peripheral nervous system recording at baseline and following a paced breathing task. Diagnosis x baseline hypnocapnia group analyses indicated that anxious/hypocapnic patients exhibited greater nonspecific skin conductance response amplitude than did anxious/normocapnic patients, and the anxious group reported greater HV-related symptoms and anxiety sensitivity than did the control group. However, no EEG abnormalities were noted as a function of anxiety group or baseline hypocapnia status. Following paced HV, anxious patients (but not controls) exhibited an increase in left-frontal alpha 1 power. Hypocapnic, but not normocapnic, participants exhibited an increase in skin conductance levels. Anxious patients reported an increase in negative cognitive appraisals of HV symptoms, and anxious/hypocapnic participants reported an increase in affective responses to HV. Thus, chronic HV is associated with greater arousal, and increased self-reported and physiological sensitivity to paced HV. Patients who chronically hyperventilate appear to be more sensitive to respiratory distress, responding with higher levels of anxiety and poorer tolerance of the physiological sensations accompanying acute HV.

A Two-Person Neuroscience Approach for Social Anxiety: A Paradigm With Interbrain Synchrony and Neurofeedback

Social anxiety disorder has been widely recognised as one of the most commonly diagnosed mental disorders. Individuals with social anxiety disorder experience difficulties during social interactions that are essential in the regular functioning of daily routines; perpetually motivating research into the aetiology, maintenance and treatment methods. Traditionally, social and clinical neuroscience studies incorporated protocols testing one participant at a time. However, it has been recently suggested that such protocols are unable to directly assess social interaction performance, which can be revealed by testing multiple individuals simultaneously. The principle of two-person neuroscience highlights the interpersonal aspect of social interactions that observes behaviour and brain activity from both (or all) constituents of the interaction, rather than analysing on an individual level or an individual observation of a social situation. Therefore, two-person neuroscience could be a promising direction for assessment and intervention of the social anxiety disorder. In this paper, we propose a novel paradigm which integrates two-person neuroscience in a neurofeedback protocol. Neurofeedback and interbrain synchrony, a branch of two-person neuroscience, are discussed in their own capacities for their relationship with social anxiety disorder and relevance to the paradigm. The newly proposed paradigm sets out to assess the social interaction performance using interbrain synchrony between interacting individuals, and to employ a multi-user neurofeedback protocol for intervention of the social anxiety.

Electroencephalographic Activity in Patients with Claustrophobia: A Pilot Study

Background

Exposure to small confined spaces evokes physiological responses such as increased heart rate in claustrophobic patients. However, little is known about electrocortical activity while these people are functionally exposed to such phobic situations. The aim of this study was to examine possible changes in electrocortical activity in this population.

Method

Two highly affected patients with claustrophobia and two healthy controls participated in this in vivo study during which electroencephalographic (EEG) activity was continuously recorded. Relative power spectral density (rPSD) was compared between two situations of being relaxed in a well-lit open area, and sitting in a relaxed chair in a small (90 cm × 180 cm × 155 cm) chamber with a dim light. This comparison of rPSDs in five frequency bands of EEG was intended to investigate possible patterns of change in electrical activity during fear-related situation. This possible change was also compared between claustrophobic patients and healthy controls in all cortical areas.

Results

Statistical models showed that there is a significant interaction between groups of participants and experimental situations in all frequency bands (P < 0.01). In other words, claustrophobic patients showed significantly different changes in electrical activity while going from rest to the test situation. Clear differences were observed in alpha and theta bands. In the theta band, while healthy controls showed an increase in rPSD, claustrophobic patients showed an opposite decrease in the power of electrical activity when entering the confined chamber. In alpha band, both groups showed an increase in rPSD, though this increase was significantly higher for claustrophobic patients.

Conclusion

The effect of in vivo exposure to confined environments on EEG activity is different in claustrophobic patients than in healthy controls. Most of this contrast is observed in central and parietal areas of the cortex, and in the alpha and theta bands.

Emerging biomarkers for child & family intervention studies: A review of EEG studies of parenting

Most interventions for childhood mental health problems require significant parental involvement, and treatment programs are increasingly incorporating components aimed at enhancing parents' own self-regulation in the context of potentially stressful parent-child interactions. This paper discusses the promise of EEG in examining the rapidly unfolding perceptual, cognitive, emotional, and regulatory processes that occur in parenting, in hopes of ultimately informing child and family interventions. First, we review two separate bodies of work that have used EEG with parents: one examining event-related potential (ERP) measures, and the other examining frontal alpha asymmetry (FAA). We discuss benefits of each within the study of parenting, and also suggest other EEG metrics (such as event-related time-frequency analyses) that can be leveraged to fill current gaps in our knowledge. Finally, we discuss the potential for these findings to inform clinical work with children and families, such as identifying biomarkers that could aid in assessment, treatment recommendations, and monitoring response to interventions.

Longitudinal investigation of shyness and physiological vulnerability: Moderating influences of attention biases to threat and safety

Shyness has long been identified as a vulnerability factor to developing psychosocial problems, but there is heterogeneity in these observed outcomes. One potential factor underlying these relations is individual differences in threat sensitivity. Using a longitudinal design, we examined whether attentional biases toward social threat and safety measured during adulthood moderated the association between shyness measured in emerging adulthood (N = 83, n_female = 48; M_age = 23.56 years, SD_age = 1.09 years) and frontal electroencephalogram (EEG) asymmetry at rest, a physiological index of vulnerability to psychopathology, measured nearly a decade later in adulthood (M_age = 31.68 years, SD_age = 2.27 years). We found that only biases to threat moderated the association between shyness and resting frontal EEG asymmetry longitudinally. In individuals who displayed relative vigilance to social threat, shyness was associated with greater relative right frontal EEG activity at rest (i.e., increased physiological vulnerability). These findings suggest that attentional biases to threat may play a role in understanding the relation between shyness and some known physiological vulnerabilities to psychopathology in adults.

Fronto-lateral alpha power asymmetry in panic disorder

Resting state alpha power asymmetry in frontal and temporal regions has been reported in various clinical populations, possibly indicating deficits in prefrontal control. In panic disorder (PD), results regarding alpha asymmetric activity to date have been mixed. This study compared 55 PD patients and 42 healthy controls (HC) with regards to resting state alpha power asymmetry. Our results show more right-than-left fronto-lateral alpha power in PD, whereas at other sites and in HC no significant differences were detected. These results support the notion of altered neurobiological processes in PD that possibly represent a vulnerability to the experience of panic attacks. Further studies are needed to clarify potential causal implications of this finding in the genesis of PD, as well as to specify the functional significance of fronto-lateral alpha power asymmetry in PD.

Diverging patterns of EEG alpha asymmetry in anxious apprehension and anxious arousal

Anxious apprehension and anxious arousal are central transdiagnostic anxiety dimensions and have been linked to divergent patterns of frontal and parietal alpha asymmetry. The present study examined the relationship between alpha asymmetry and anxiety dimensions in 130 individuals whose electroencephalogram (EEG) was recorded at rest. We applied a 2 (anxious apprehension: low vs. high) × 2 (anxious arousal, low vs. high) design to contrast brain lateralization in four groups. Results revealed that anxious apprehension was associated with more left-than-right frontal brain activity in the lower alpha band, an effect driven by decreased right frontal activity. Exploratory analyses showed more left-than-right brain activity at central sites associated with anxious apprehension. Parietal activity was not lateralized as a function of anxiety dimensions. Taken together, the current results support that anxious apprehension is associated with more left-than-right frontal and central activity, and suggest a broader distribution of alpha asymmetries associated with anxious apprehension than previously thought.

Computerized inhibitory control training reduces anxiety in preadolescent students

The study examined the relationship between anxiety, inhibitory control (IC), and resting-state electroencephalography (EEG) in a critical age-range for social and emotional development (8-12-year-olds). The participants were assigned to 4 weeks of either an emotional IC training program, a neutral IC training program, or a waitlisted control, and were tested using cognitive, emotional, and EEG measures. The training was computerized and completed remotely. At baseline, IC accuracy scores were negatively related to both anxiety and depression levels (N = 42). Additionally, increased right lateral frontal alpha asymmetry was predictive of increased anxiety/depression scores. A series of multivariate analyses of covariance and post-hoc tests were conducted to compare effects in the participants that completed the full 16 sessions of training (N = 32). Overall the emotional and neutral training conditions showed similar improvements in IC accuracy, as well as reductions in anxiety compared to the waitlist condition. Minimal neurophysiological changes occurred from pre-to-post; however, lateral frontal asymmetry shifted leftward in the emotional training group. These findings highlight the potential of computerized IC training for mitigating negative emotional functioning in preadolescents. Future research is necessary to determine the long-term effects of IC training and whether longer training intervals facilitate persisting impacts.

EEG Correlates of Cognitive Functions and Neuropsychiatric Disorders: A Review of Oscillatory Activity and Neural Synchrony Abnormalities

Background:

A large body of evidence suggested that disruption of neural rhythms and synchronization of brain oscillations are correlated with a variety of cognitive and perceptual processes. Cognitive deficits are common features of psychiatric disorders that complicate treatment of the motivational, affective and emotional symptoms.

Objective:

Electrophysiological correlates of cognitive functions will contribute to understanding of neural circuits controlling cognition, the causes of their perturbation in psychiatric disorders and developing novel targets for the treatment of cognitive impairments.

Methods:

This review includes a description of brain oscillations in Alzheimer’s disease, bipolar disorder, attention-deficit/hyperactivity disorder, major depression, obsessive compulsive disorders, anxiety disorders, schizophrenia and autism.

Results:

The review clearly shows that the reviewed neuropsychiatric diseases are associated with fundamental changes in both spectral power and coherence of EEG oscillations.

Conclusion:

In this article, we examined the nature of brain oscillations, the association of brain rhythms with cognitive functions and the relationship between EEG oscillations and neuropsychiatric diseases. Accordingly, EEG oscillations can most likely be used as biomarkers in psychiatric disorders.

Frontal Brain Asymmetry and the Trajectory of Shyness Across the Early School Years

Although resting right frontal electroencephalogram (EEG) asymmetry has been linked to avoidance and withdrawal-related behaviors such as shyness in previous cross-sectional studies, relatively little research has examined the influence of frontal brain electrical activity on the development of shyness in children using a prospective, longitudinal study design. Here, we tested whether resting frontal EEG asymmetry predicted the trajectory of children's shyness across five assessments. Children were enrolled in the study during the summer prior to grade 1 (N = 37; M_age = 6.39 years, S.D. = 0.15 years), at which time resting frontal EEG activity and maternal report of children's shyness were collected. Mothers then reported on their child's shyness over another four follow-up assessments, spanning 2 years (winter of grade 1, summer prior to grade 2 entry, winter of grade 2, and summer prior to grade 3). Growth curve analysis revealed that children displaying greater relative right frontal EEG activity had lower levels of shyness relative to children exhibiting greater relative left frontal EEG activity at study enrollment (i.e., age 6), but displayed statistically significant linear increases in shyness across time, with the highest levels of shyness by the summer prior to grade 3 (i.e., age 8). There was, however, no relation between left frontal EEG asymmetry and change in shyness across time. These preliminary findings suggest that right frontal EEG asymmetry may reflect a biological diathesis for the growth of shyness during the early school years.

Abnormal asymmetry of thalamic volume moderates stress from parents and anxiety symptoms in children and adolescents with social anxiety disorder

Social anxiety disorder (SAD) usually onsets in childhood or adolescence and is associated with brain development and chronic family stress during this period. As an information hub, the thalamus plays a crucial role in the development of emotion processing and stress regulation. Its structural and functional lateralization have been related to mental disorders. This study examined the age-dependent asymmetry of the thalamic volume in children and adolescents with SAD. We further examined the role of the thalamic asymmetry in moderating the relationships between parental alienation, which is a main source of familial stress for children and adolescents, and anxiety symptoms in this population. Fifty-three medication-free children and adolescents with SAD and 53 typical developing controls (age: 8-17) were included. Anxiety severity was measured using the Screen for Child Anxiety-Related Emotional Disorders (SCARED). We estimated the bilateral thalamic volume and examined diagnosis effect and age-group difference on the thalamic asymmetry. We further examined the moderation of the thalamic asymmetry on the associations between scores on the parental alienation, social phobia, and total SCARED. Compared with controls, the SAD group exhibited significantly abnormal asymmetry in thalamic volume. This asymmetry became more evident in the older age group. Furthermore, this asymmetry significantly weakened the relationships between parental attachment and total SCARED score. The asymmetry of the thalamic volume and its age-group difference provide novel evidence to support brain developmental abnormalities in children and adolescents with SAD. The findings further revealed interactions between physiological and chronic stress in children and adolescents with SAD. This article is part of the special issue on 'Stress, Addiction and Plasticity'.

Abnormal approach-related motivation but spared reinforcement learning in MDD: Evidence from fronto-midline Theta oscillations and frontal Alpha asymmetry

Major depression is characterized by abnormal reward processing and reinforcement learning (RL). This impairment might stem from deficient motivation processes, in addition to reduced reward sensitivity. In this study, we recorded 64-channel EEG in a large cohort of major depressive disorder (MDD) patients and matched healthy controls (HC) while they performed a standard RL task. Participants were asked to discover, by trial and error, several hidden stimulus-response associations having different reward probabilities, as enforced using evaluative feedback. We extracted induced fronto-midline Theta (FMT) power time-locked to the response and feedback as neurophysiological index of RL. Furthermore, we assessed approach-related motivation by measuring frontal alpha asymmetry concurrently. At the behavioral level, MDD patients and HCs showed comparable RL. At the EEG level, FMT power systematically varied as a function of reward probability, with opposing effects found at the response and feedback levels. Although this global pattern was spared in MDD, at the feedback level these patients showed however a steep FMT power decrease across trials when reward probability was low. Moreover, they showed impaired approach-related motivation during task execution, as reflected by frontal Alpha asymmetry. These results suggest a dissociation between (globally spared) RL and (impaired) approach motivation in MDD.

Unified protocol for anxiety disorders in two cities of Mexico measuring gamma activity: Study protocol for a randomized controlled trial

BACKGROUND

The Unified Protocol for Emotional Disorders (UP) for emotional regulation manifests effective results in a broad range of mental disorders. The UP efficacy was tested in several countries, but it has not been tested within Mexican population. It is crucial to do more research and implement effective protocols to intervene Mexican population with Anxiety Disorders (AD).

OBJECTIVE

This study aims to examine and describe the research procedures and treatment interventions of the UP in a Randomized Controlled Trial (RCT), to approach and treat AD in patients in 2 Mexican borderland cities, by applying the UP and an Electroencephalogram (EGG) neuro screening.

METHODS

The enrolled patients will be randomized in a two-arm control trial with repeated measures, comprising between 18 and 60 years, that were diagnosed with an AD, and low scored in depression symptoms and suicidal ideation. The study will comprise of two conditions: an intervention group clinical trial with the UP or a waiting list control. The primary outcome measures will be applied on AD quantitative self-reports and a gamma activity by EGG before and after the intervention and in follow-ups of 3 and 6 months. The participants in the waiting list group, will receive the treatment after the trial first group completes the treatment.

CONCLUSIONS

Processes and outcomes of this project, will provide evidence in order to apply the UP in a broader population with AD and other mental disorders also covered by this protocol, such as depression and borderline personality disorder in a broader Mexican population, a country that suffers with a major health issue with an increasing rate of mental disorders and scarce psychological and health coverage.

Review of EEG, ERP, and Brain Connectivity Estimators as Predictive Biomarkers of Social Anxiety Disorder

Social anxiety disorder (SAD) is characterized by a fear of negative evaluation, negative self-belief and extreme avoidance of social situations. These recurrent symptoms are thought to maintain the severity and substantial impairment in social and cognitive thoughts. SAD is associated with a disruption in neuronal networks implicated in emotional regulation, perceptual stimulus functions, and emotion processing, suggesting a network system to delineate the electrocortical endophenotypes of SAD. This paper seeks to provide a comprehensive review of the most frequently studied electroencephalographic (EEG) spectral coupling, event-related potential (ERP), visual-event potential (VEP), and other connectivity estimators in social anxiety during rest, anticipation, stimulus processing, and recovery states. A search on Web of Science provided 97 studies that document electrocortical biomarkers and relevant constructs pertaining to individuals with SAD. This study aims to identify SAD neuronal biomarkers and provide insight into the differences in these biomarkers based on EEG, ERPs, VEP, and brain connectivity networks in SAD patients and healthy controls (HC). Furthermore, we proposed recommendations to improve methods of delineating the electrocortical endophenotypes of SAD, e.g., a fusion of EEG with other modalities such as functional magnetic resonance imaging (fMRI) and magnetoencephalograms (MEG), to realize better effectiveness than EEG alone, in order to ultimately evolve the treatment selection process, and to review the possibility of using electrocortical measures in the early diagnosis and endophenotype examination of SAD.

Frontal cerebral oxygenation asymmetry: intersubject variability and dependence on systemic physiology, season, and time of day

Significance: Our study reveals that frontal cerebral oxygenation asymmetry (FCOA), i.e. a difference in the oxygenation between the right and left prefrontal cortex (PFC), is a real phenomenon in healthy human subjects at rest. Aim: To investigate FCOA, we performed a study with 134 healthy right-handed subjects with the systemic physiology augmented functional near infrared spectroscopy (SPA-fNIRS) approach. Approach: Subjects were measured 2 to 4 times on different days resulting in an unprecedented number of 518 single measurements of the absolute values of tissue oxygen saturation (StO 2 ) and total hemoglobin concentration ([tHb]) of the right and left PFC. Measurements were performed with frequency-domain functional near-infrared spectroscopy. In addition, the cardiorespiratory parameters were measured simultaneously. Results: We found that (i) subjects showed an FCOA (higherStO 2 on the right PFC), but not for tHb; (ii) intrasubject variability was excellent for bothStO 2 and tHb, and fair for FCOA; (iii) StO 2 correlated significantly with bloodCO 2 concentration, [tHb] with heart rate, respiration rate (RR), and the pulse-respiration quotient (PRQ), and FCOA with RR and PRQ; (iv) FCOA andStO 2 were dependent on season and time of day, respectively; (v) FCOA was negatively correlated with the room temperature; and (vi) StO 2 and tHb were not correlated with the subjects mood but with their chronotype, whereas FCOA was not dependent on the chronotype. Conclusion: Our study demonstrates that FCOA is real, and it provides unique insights into this remarkable phenomenon.

Anxiolytic Effect of Essential Oils and Their Constituents: A Review

Essential oils are usually used in aromatherapy to alleviate anxiety symptoms. In comparison to traditional drugs, essential oils have fewer side effects and more diversified application ways, including inhalation. This review provides a comprehensive overview of studies on anxiolytic effects of essential oils in preclinical and clinical trials. Most of the essential oils used in clinical studies have been proven to be anxiolytic in animal models. Inhalation and oral administration were two common methods for essential oil administration in preclinical and clinical trials. Massage was only used in the clinical trials, while intraperitoneal injection was only used in the preclinical trails. In addition to essential oils that are commonly used in aromatherapy, essential oils from many folk medicinal plants have also been reported to be anxiolytic. More than 20 compounds derived from essential oils have shown an anxiolytic effect in rodents, while two-thirds of them are alcohols and terpenes. Monoamine neurotransmitters, amino acid neurotransmitters, and the hypothalamic-pituitary-adrenal axis are thought to play important roles in the anxiolytic effects of essential oils.

Frontal brain maturation and the stability of children's shyness

Recent evidence suggests that relative to nonshy children, shy children exhibit a lower overall frontal EEG alpha/delta ratio (ADR) during middle childhood, possibly reflecting relatively less frontal brain maturation at this age. We examined this same ADR measure in relation to the stability of observed shyness and parent-reported child social anxiety measured across two laboratory visits separated by approximately 1 year during late childhood in 51 children (33% female, age range 10-16 years). We found that the overall frontal ADR score was significantly lower among children with high, stable observed shyness and parent-reported child social anxiety compared to children in the low, stable class. Findings provide convergent evidence suggesting that the stability of shyness in late childhood may be linked to relatively less overall frontal brain maturation at this age. We speculate on the adaptive function of delaying frontal brain maturation in the origins and maintenance of children's shyness.

Increased Frontal Gamma and Posterior Delta Powers as Potential Neurophysiological Correlates Differentiating Posttraumatic Stress Disorder from Anxiety Disorders

OBJECTIVE

Posttraumatic stress disorder (PTSD) is distinct from anxiety disorders in its etiology and clinical symptomatology, and was reclassified into trauma- and stressor-related disorders in DSM-5. This study aimed to find neurophysiological correlates differentiating PTSD from anxiety disorders using resting-state quantitative electroencephalography (qEEG).

METHODS

Thirty-six patients with either PTSD or acute stress disorder and 79 patients with anxiety disorder were included in the analysis. qEEG data of absolute and relative powers and patients' medication status on the day of qEEG examination were obtained. Electrodes were grouped into frontal, central, and posterior regions to analyze for regional differences. General linear models were utilized to test for group differences in absolute and relative powers while controlling for medications.

RESULTS

PTSD patients differed from those with anxiety disorders in overall absolute powers [F(5,327)=2.601, p=0.025]. Specifically, overall absolute delta powers [F(1,331)=4.363, p=0.037], and overall relative gamma powers [F(1,331)=3.965, p=0.047] were increased in PTSD group compared to anxiety disorder group. Post hoc analysis regarding brain regions showed that the increase in absolute delta powers were localized to the posterior region [F(1,107)=4.001, p=0.048]. Additionally, frontal absolute gamma powers [F(1,107)=4.138, p=0.044] were increased in PTSD group compared to anxiety disorder group.

CONCLUSION

Our study suggests increased overall absolute delta powers and relative gamma powers as potential markers that could differentiate PTSD from anxiety disorders. Moreover, increased frontal absolute gamma and posterior delta powers might pose as novel markers of PTSD, which may reflect its distinct symptomatology.

Leveraging After-School Programs to Minimize Risks for Internalizing Symptoms Among Urban Youth: Weaving Together Music Education and Social Development

This study examined a university-community partnership, focusing on mental health promotion within an after-school music program. We pursued two goals: (a) supporting staff around student engagement and behavior management; (b) integrating social-emotional activities into the curriculum. We assessed youth's mental health needs and examined feasibility of social-emotional activities delivered. One-hundred sixty-two youth participated in activities, while a subset of youth (n = 61) and their parents provided information on mental health need. Rates of anxiety and depression symptoms were high, and youth reported high satisfaction with the activities. Results suggest promise of this model for mental health promotion for urban youth.

Effects of Aerobic Exercise on Anxiety Symptoms and Cortical Activity in Patients with Panic Disorder: A Pilot Study

BACKGROUND

The effects of the aerobic exercise on anxiety symptoms in patients with Panic Disorder (PD) remain unclear. Thus, the investigation of possible changes in EEG frontal asymmetry could contribute to understand the relationship among exercise, brain and anxiety.

OBJECTIVE

To investigate the acute effects of aerobic exercise on the symptoms of anxiety and the chronic effects of aerobic exercise on severity and symptoms related to PD, besides the changes in EEG frontal asymmetry.

METHODS

Ten PD patients were divided into two groups, Exercise Group (EG; n=5) and Control Group (CG; n=5), in a randomized allocation. At baseline and post-intervention, they submitted the psychological evaluation through Panic Disorder Severity Scale (PDSS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), EEG frontal asymmetry, and maximal oxygen consumption (VO2max). On the second visit, the patients of EG being submitted to the aerobic exercise (treadmill, 25 minutes, and 50-55% of heart rate reserve) and the CG remained seated for the same period of time. Both groups submitted a psychological evaluation with Subjective Units of Distress Scale (SUDS) at baseline, immediately after (Post-0), and after 10 minutes of the rest pause (Post-10). The patients performed 12 sessions of aerobic exercise with 48-72 hours of interval between sessions.

RESULTS

In EG, SUDS increased immediately after exercise practice and showed chronic decrease in BAI and BDI-II as well as increased in VO2max (Post-intervention).

CONCLUSION

Aerobic exercise can promote increase in anxiety acutely and regular aerobic exercise promotes reduction in anxiety levels.

JAKE® Multimodal Data Capture System: Insights from an Observational Study of Autism Spectrum Disorder

Objective: To test usability and optimize the Janssen Autism Knowledge Engine (JAKE®) system's components, biosensors, and procedures used for objective measurement of core and associated symptoms of autism spectrum disorder (ASD) in clinical trials.

Methods: A prospective, observational study of 29 children and adolescents with ASD using the JAKE system was conducted at three sites in the United States. This study was designed to establish the feasibility of the JAKE system and to learn practical aspects of its implementation. In addition to information collected by web and mobile components, wearable biosensor data were collected both continuously in natural settings and periodically during a battery of experimental tasks administered in laboratory settings. This study is registered at clinicaltrials.gov, NCT02299700.

Results: Feedback collected throughout the study allowed future refinements to be planned for all components of the system. The Autism Behavior Inventory (ABI), a parent-reported measure of ASD core and associated symptoms, performed well. Among biosensors studied, the eye-tracker, sleep monitor, and electrocardiogram were shown to capture high quality data, whereas wireless electroencephalography was difficult to use due to its form factor. On an exit survey, the majority of parents rated their overall reaction to JAKE as positive/very positive. No significant device-related events were reported in the study.

Conclusion: The results of this study, with the described changes, demonstrate that the JAKE system is a viable, useful, and safe platform for use in clinical trials of ASD, justifying larger validation and deployment studies of the optimized system.

Putative EEG measures of social anxiety: Comparing frontal alpha asymmetry and delta-beta cross-frequency correlation

The goal of the present study was to examine whether frontal alpha asymmetry and delta-beta cross-frequency correlation during resting state, anticipation, and recovery are electroencephalographic (EEG) measures of social anxiety. For the first time, we jointly examined frontal alpha asymmetry and delta-beta correlation during resting state and during a social performance task in high (HSA) versus low (LSA) socially anxious females. Participants performed a social performance task in which they first watched and evaluated a video of a peer, and then prepared their own speech. They believed that their speech would be videotaped and evaluated by a peer. We found that HSA participants showed significant negative delta-beta correlation as compared to LSA participants during both anticipation of and recovery from the stressful social situation. This negative delta-beta correlation might reflect increased activity in subcortical brain regions and decreased activity in cortical brain regions. As we hypothesized, no group differences in delta-beta correlation were found during the resting state. This could indicate that a certain level of stress is needed to find EEG measures of social anxiety. As for frontal alpha asymmetry, we did not find any group differences. The present frontal alpha asymmetry results are discussed in relation to the evident inconsistencies in the frontal alpha asymmetry literature. Together, our results suggest that delta-beta correlation is a putative EEG measure of social anxiety.

Comorbid anxiety moderates the relationship between depression history and prefrontal EEG asymmetry

The internalizing spectrum of psychiatric disorders-depression and anxiety-are common, highly comorbid, and challenging to treat. Individuals with childhood onset depression have a particularly poor prognosis. There is compelling evidence that individuals with depression display reduced resting-state EEG activity at sensors overlying the left prefrontal cortex, even during periods of remission, but it remains unknown whether this asymmetry is evident among individuals with a comorbid anxiety disorder. Here, we demonstrate that women with a history of childhood onset depression and no anxiety disorder (n = 37) show reduced left lateral frontal activity compared to psychiatrically healthy controls (n = 69). In contrast, women with a history of childhood onset depression and pathological levels of anxious apprehension (n = 18)-as indexed by a current generalized anxiety disorder, obsessive compulsive disorder, or separation anxiety disorder diagnosis-were statistically indistinguishable from healthy controls. Collectively, these observations suggest that anxious apprehension can mask the relationship between prefrontal EEG asymmetry and depression. These findings have implications for understanding (a) prefrontal EEG asymmetry as a neurophysiological marker of depression, (b) the comorbidity of depression and anxiety, and (c) failures to replicate the relationship between prefrontal EEG asymmetry and depression. More broadly, they set the stage for developing refined interventions for internalizing psychopathology.

Cognitive behavioural therapy attenuates the enhanced early facial stimuli processing in social anxiety disorders: an ERP investigation

Background

Previous studies of patients with social anxiety have demonstrated abnormal early processing of facial stimuli in social contexts. In other words, patients with social anxiety disorder (SAD) tend to exhibit enhanced early facial processing when compared to healthy controls. Few studies have examined the temporal electrophysiological event-related potential (ERP)-indexed profiles when an individual with SAD compares faces to objects in SAD. Systematic comparisons of ERPs to facial/object stimuli before and after therapy are also lacking. We used a passive visual detection paradigm with upright and inverted faces/objects, which are known to elicit early P1 and N170 components, to study abnormal early face processing and subsequent improvements in this measure in patients with SAD.

Methods

Seventeen patients with SAD and 17 matched control participants performed a passive visual detection paradigm task while undergoing EEG. The healthy controls were compared to patients with SAD pre-therapy to test the hypothesis that patients with SAD have early hypervigilance to facial cues. We compared patients with SAD before and after therapy to test the hypothesis that the early hypervigilance to facial cues in patients with SAD can be alleviated.

Results

Compared to healthy control (HC) participants, patients with SAD had more robust P1–N170 slope but no amplitude effects in response to both upright and inverted faces and objects. Interestingly, we found that patients with SAD had reduced P1 responses to all objects and faces after therapy, but had selectively reduced N170 responses to faces, and especially inverted faces. Interestingly, the slope from P1 to N170 in patients with SAD was flatter post-therapy than pre-therapy. Furthermore, the amplitude of N170 evoked by the facial stimuli was correlated with scores on the interaction anxiousness scale (IAS) after therapy.

Conclusions

Our results did not provide electrophysiological support for the early hypervigilance hypothesis in SAD to faces, but confirm that cognitive-behavioural therapy can reduce the early visual processing of faces. These findings have potentially important therapeutic implications in the assessment and treatment of social anxiety.

Trial registration HEBDQ2014021

Right brain, left brain in depressive disorders: Clinical and theoretical implications of behavioral, electrophysiological and neuroimaging findings

The right and left side of the brain are asymmetric in anatomy and function. We review electrophysiological (EEG and event-related potential), behavioral (dichotic and visual perceptual asymmetry), and neuroimaging (PET, MRI, NIRS) evidence of right-left asymmetry in depressive disorders. Recent electrophysiological and fMRI studies of emotional processing have provided new evidence of altered laterality in depressive disorders. EEG alpha asymmetry and neuroimaging findings at rest and during cognitive or emotional tasks are consistent with reduced left prefrontal activity in depressed patients, which may impair downregulation of amygdala response to negative emotional information. Dichotic listening and visual hemifield findings for non-verbal or emotional processing have revealed abnormal perceptual asymmetry in depressive disorders, and electrophysiological findings have shown reduced right-lateralized responsivity to emotional stimuli in occipitotemporal or parietotemporal cortex. We discuss models of neural networks underlying these alterations. Of clinical relevance, individual differences among depressed patients on measures of right-left brain function are related to diagnostic subtype of depression, comorbidity with anxiety disorders, and clinical response to antidepressants or cognitive behavioral therapy.

Frontal brain asymmetry, childhood maltreatment, and low-grade inflammation at midlife

Frontal EEG asymmetry is thought to reflect variations in affective style, such that greater relative right frontal activity at rest predicts enhanced emotional responding to threatening or negative stimuli, and risk of depression and anxiety disorders. A diathesis-stress model has been proposed to explain how this neuro-affective style might predispose to psychopathology, with greater right frontal activity being a vulnerability factor especially under stressful conditions. Less is known about the extent to which greater relative right frontal activity at rest might be associated with or be a diathesis for deleterious physical health outcomes. The present study examined the association between resting frontal EEG asymmetry and systemic, low-grade inflammation and tested the diathesis-stress model by examining whether childhood maltreatment exposure interacts with resting frontal asymmetry in explaining inflammation. Resting EEG, serum inflammatory biomarkers (interleukin-6, C-reactive protein, and fibrinogen) and self-reported psychological measures were available for 314 middle-aged adults (age M=55.3years, SD=11.2, 55.7% female). Analyses supported the diathesis-stress model and revealed that resting frontal EEG asymmetry was significantly associated with inflammation, but only in individuals who had experienced moderate to severe levels of childhood maltreatment. These findings suggest that, in the context of severe adversity, a trait-like tendency towards greater relative right prefrontal activity may predispose to low-grade inflammation, a risk factor for conditions with inflammatory underpinnings such as coronary heart disease.

Assessing and conceptualizing frontal EEG asymmetry: An updated primer on recording, processing, analyzing, and interpreting frontal alpha asymmetry

Frontal electroencephalographic (EEG) alpha asymmetry is widely researched in studies of emotion, motivation, and psychopathology, yet it is a metric that has been quantified and analyzed using diverse procedures, and diversity in procedures muddles cross-study interpretation. The aim of this article is to provide an updated tutorial for EEG alpha asymmetry recording, processing, analysis, and interpretation, with an eye towards improving consistency of results across studies. First, a brief background in alpha asymmetry findings is provided. Then, some guidelines for recording, processing, and analyzing alpha asymmetry are presented with an emphasis on the creation of asymmetry scores, referencing choices, and artifact removal. Processing steps are explained in detail, and references to MATLAB-based toolboxes that are helpful for creating and investigating alpha asymmetry are noted. Then, conceptual challenges and interpretative issues are reviewed, including a discussion of alpha asymmetry as a mediator/moderator of emotion and psychopathology. Finally, the effects of two automated component-based artifact correction algorithms-MARA and ADJUST-on frontal alpha asymmetry are evaluated.

Reproductive Steroid Regulation of Mood and Behavior

In this article, we examine evidence supporting the role of reproductive steroids in the regulation of mood and behavior in women and the nature of that role. In the first half of the article, we review evidence for the following: (i) the reproductive system is designed to regulate behavior; (ii) from the subcellular to cellular to circuit to behavior, reproductive steroids are powerful neuroregulators; (iii) affective disorders are disorders of behavioral state; and (iv) reproductive steroids affect virtually every system implicated in the pathophysiology of depression. In the second half of the article, we discuss the diagnosis of the three reproductive endocrine-related mood disorders (premenstrual dysphoric disorder, postpartum depression, and perimenopausal depression) and present evidence supporting the relevance of reproductive steroids to these conditions. Existing evidence suggests that changes in reproductive steroid levels during specific reproductive states (i.e., the premenstrual phase of the menstrual cycle, pregnancy, parturition, and the menopause transition) trigger affective dysregulation in susceptible women, thus suggesting the etiopathogenic relevance of these hormonal changes in reproductive mood disorders. Understanding the source of individual susceptibility is critical to both preventing the onset of illness and developing novel, individualized treatments for reproductive-related affective dysregulation. © 2016 American Physiological Society. Compr Physiol 6:1135-1160, 2016e.

Prospective Pilot Investigation: Presurgical Depressive Symptom Severity and Anesthesia Response in Women Undergoing Surgery for Gynecologic Mass Removal

BACKGROUND

Anesthesia depth has been associated with mortality. The association between anesthesia depth and presurgery physical and health status, however, is currently debated. Depression is one comorbid condition that warrants investigation given its association to reduced frontal lobe activity and high prevalence in known surgery samples (e.g., gynecologic mass removal).

PURPOSE

This pilot study examined the hypothesis that severity of acute depressive symptoms would associate with greater sensitivity to anesthesia as measured by a frontal lobe electroencephalogram (EEG)-based monitor during the anesthesia induction phase among women undergoing gynecologic mass removal.

METHOD

This was a prospective and surgery anesthesia-controlled pilot investigation with 31 women undergoing surgery for removal of pelvic/gynecologic masses. Participants completed the Millon Behavioral Medicine Diagnostic (MBMD) inventory to assess depressive-related symptomatology. A Bispectral Index Score (BIS™) monitor (Aspect Medical Systems Inc., MA) was placed on the left frontal region to measure change in response from a set pre-anesthesia baseline point throughout the induction phase (6.5 min of the anesthetic). BIS™ change was calculated using a modified "area under the curve with respect to ground" formula.

RESULTS

Greater sensitivity to anesthesia during induction was significantly associated with higher MBMD future pessimism scores and marginally associated with higher MBMD depression scores. Depressive personality, anxiety severity, tumor type, age, medication use, and comorbidity scores were not found to be predictors of BIS score change.

CONCLUSION

These pilot findings suggest that preoperative psychological health and anesthesia response are not independent. Acute presurgery depression and anesthesia response warrant closer empirical examination.

Reappraisal writing relieves social anxiety and may be accompanied by changes in frontal alpha asymmetry

It is widely reported that expressive writing can improve mental and physical health. However, to date, the neural correlates of expressive writing have not been reported. The current study examined the neural electrical correlates of expressive writing in a reappraisal approach. Three groups of participants were required to give a public speech. Before speaking, the reappraisal writing group was asked to write about the current stressful task in a reappraisal manner. The irrelevant writing group was asked to write about their weekly plan, and the non-writing group did not write anything. It was found that following the experimental writing manipulation, both reappraisal and irrelevant writing conditions decreased self-reported anxiety levels. But when re-exposed to the stressful situation, participants in the irrelevant writing group showed increased anxiety levels, while anxiety levels remained lower in the reappraisal group. During the experimental writing manipulation period, participants in the reappraisal group had lower frontal alpha asymmetry scores than those in the irrelevant writing group. However, following re-exposure to stress, participants in the reappraisal group showed higher frontal alpha asymmetry scores than those in the irrelevant writing group. Self-reported anxiety and frontal alpha asymmetry of the non-writing condition did not change significantly across these different stages. It is noteworthy that expressive writing in a reappraisal style seems not to be a fast-acting treatment but may instead take effect in the long run.