Trait anxiety and probabilistic learning: Behavioral and electrophysiological findings

HIV/AIDS Knowledge, Depression, and HIV-Related Stigma Among Elderly Men in Rural China: A Hierarchical Regression Analysis

This study explored the current status and influencing factors of HIV-related stigma among elderly men (≥50 years old) in rural Chengdu, China. A structured face-to-face interview survey was conducted among 286 elderly males from three towns in Chengdu using convenience sampling, 240 men (83.9%) who had heard of HIV/AIDS were included in the analysis. Hierarchical regression was used to examine the associated factors of HIV-related stigma, including demographic variables, HIV/AIDS knowledge level, receiving HIV/AIDS-related health education in the past year, depression, and anxiety, and to examine the moderating effect of educational level on HIV/AIDS knowledge and HIV-related stigma. Hierarchical regression analysis showed that men with lower HIV/AIDS knowledge scores, primary school or below educated, and depression had higher HIV-related stigma total score and social stigma dimensional scores than their counterparts. In addition, living alone was associated with higher HIV-related stigma, and elderly men with lower monthly income and those without HIV/AIDS-related health education in the past year had higher levels of social stigma. Higher HIV/AIDS knowledge score was significantly associated with lower HIV-related stigma level among those with middle school or above education level, but no such effect in those with primary school or below. In conclusion, the HIV-related stigma level among elderly men in rural Chengdu was high and positively associated with depression. HIV/AIDS education should target elderly men with low education, living alone, and low income, and interventions to promote mental health may work together to reduce HIV-related stigma in the rural elderly population.

Explaining reversal learning deficits in anxiety with electrophysiological evidence

Reversal learning is a crucial aspect of behavioral flexibility that plays a significant role in environmental adaptation and development. While previous studies have established a link between anxiety and impaired reversal learning ability, the underlying mechanisms behind this association remain unclear. This study employed a probabilistic reversal learning task with electroencephalographic recording to investigate these mechanisms. Participants were divided into two groups based on their scores on Spielberger's State-Trait Anxiety Inventory: high trait-anxiety (HTA) and low trait-anxiety (LTA), consisting of 50 individuals in each group. The results showed that the HTA group had poorer reversal learning performance than the LTA group, including a lower tendency to shift to the new optimal option after rule reversals (reversal-shift). The study also examined event-related potentials elicited by reversals and found that although the N1 (related to attention allocation), feedback-related negativity (FRN: related to belief updating), and P3 (related to response inhibition) were all sensitive to the grouping factor, only the FRN elicited by reversal-shift mediated the relationship between anxiety and the number/reaction time of reversal-shift. From these findings, we suggest that abnormalities in belief updating may contribute to the impaired reversal learning performance observed in anxious individuals. In our opinion, this study sheds light on potential targets for interventions aimed at improving behavioral flexibility in anxious individuals.

The effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students: A pragmatic randomized controlled trial

AIM

This study aimed to examine the effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students.

BACKGROUND

Clinical simulation-based teaching implied a revolution in nursing education. Along with the many opportunities that simulation offers, some disadvantages, such as anxiety and stress experienced during simulation scenarios, could affect students' satisfaction and self-confidence in learning. Therefore, laughter yoga could be an alternative method that reduces students' anxiety and stress levels and increases their self-confidence and satisfaction with simulation training.

DESIGN

The study was designed as a pragmatic randomized controlled trial.

SETTING

This study was conducted at a university in Turkey.

PARTICIPANTS

A total of 88 undergraduate nursing students were randomized to the intervention group (n = 44) or control group (n = 44).

METHODS

The intervention group participated in the laughter yoga sessions just before the clinical simulation scenario, while the control group only performed the simulation training. The researchers examined the effect of laughter yoga on state anxiety, perceived stress levels, self-confidence and satisfaction in learning before and after the intervention. Data were collected between January - February 2022.

RESULTS

This study showed that the mean scores of state anxiety, perceived stress, mean pulse rate and arterial pressure of the intervention group were significantly lower than those of the control group (p < 0.05). In addition, there was also a significant group*time interaction between the groups on state anxiety, perceived stress, pulse, respiratory and mean arterial pressure scores (p < 0.05). Moreover, the mean scores of student satisfaction and self-confidence in the learning of the intervention group were significantly higher than those of the control group (p < 0.05).

CONCLUSION

The findings showed that laughter yoga helped nursing students reduce their state anxiety and perceived stress levels related to simulation training and improved their self-confidence and satisfaction with learning. Additionally, it enhanced the students' vital signs (including mean pulse rate and mean arterial pressure). These positive results are promising for using LY as an easy, safe and effective method to reduce undergraduate nursing students' stress and anxiety levels and to improve their learning satisfaction and self-confidence levels in clinical skills training such as simulation training.

Anterior cingulate and medial prefrontal cortex oscillations underlie learning alterations in trait anxiety in humans

Anxiety has been linked to altered belief formation and uncertainty estimation, impacting learning. Identifying the neural processes underlying these changes is important for understanding brain pathology. Here, we show that oscillatory activity in the medial prefrontal, anterior cingulate and orbitofrontal cortex (mPFC, ACC, OFC) explains anxiety-related learning alterations. In a magnetoencephalography experiment, two groups of human participants pre-screened with high and low trait anxiety (HTA, LTA: 39) performed a probabilistic reward-based learning task. HTA undermined learning through an overestimation of volatility, leading to faster belief updating, more stochastic decisions and pronounced lose-shift tendencies. On a neural level, we observed increased gamma activity in the ACC, dmPFC, and OFC during encoding of precision-weighted prediction errors in HTA, accompanied by suppressed ACC alpha/beta activity. Our findings support the association between altered learning and belief updating in anxiety and changes in gamma and alpha/beta activity in the ACC, dmPFC, and OFC.

Monitoring and Evaluation of Emotion Regulation by Aerobic Exercise and Motor Imagery Based on Functional Near-Infrared Spectroscopy

Objective: We sought to effectively alleviate the emotion of individuals with anxiety and depression, and explore the effects of aerobic exercise on their emotion regulation. Functional near-infrared spectroscopy (fNIRS) brain imaging technology is used to monitor and evaluate the process of aerobic exercise and imagination that regulates emotion.

Approach:Thirty participants were scored by the state-trait anxiety inventory (STAI) and profile of mood states (POMS), and fNIRS images were collected before, after, and during aerobic exercise and motor imagery. Then, the oxygenated hemoglobin (HbO), deoxygenated hemoglobin (HbR), and total hemoglobin (HbT) concentrations and their average value were calculated, and the ratio of HbO concentration in the left and right frontal lobes was determined. Spearman's correlation coefficient was used to calculate the correlation between variations in the average scores of the two scales and in blood oxygen concentrations.

Results: In comparison with motor imagery, STAI, and POMS scores decreased after 20 min of aerobic exercise. The prefrontal cortex had asymmetry and laterality (with the left side being dominant in emotion regulation). The increase in hemoglobin concentration recorded by fNIRS was negatively correlated with STAI and POMS scores. Aerobic exercise has a good effect on emotion regulation.

Significance:The study showed that portable fNIRS could be effectively used for monitoring and evaluating emotion regulation by aerobic exercise. This study is expected to provide ideas for constructing fNIRS-based online real-time monitoring and evaluation of emotion regulation by aerobic exercise.

Males with low risk-taking propensity overestimate risk under acute psychological stress

Arousing research has investigated stressed individuals' decision biases, but whether and how stress and individual traits interact to impact the underlying decision-making process is unknown. Here, we aim to explore the effect of acute stress on the interaction between the objective level of risk and subjective risk preference (i.e. risk-taking propensity). Eighty-three healthy males participated in the study. We adopted the Trier Social Stress Test (TSST) to induce acute psychological stress and categorized participants into the high or low risk-taking propensity (HRP/LRP) group according to their traits in daily life. The Balloon Analogue Risk Task (BART) was applied to measure their feedback processing in a risky decision task, while behavioral indexes and EEG signals were recorded. The results showed that stressful participants pumped fewer times than the controls, especially for the LRP under stress, indicating that they were more willing to avoid taking risks. Compared with the stressed HRP group, the stressed LRP showed higher salivary cortisol responses and a more positive FRN following positive feedback in higher risk levels. It implies that acute psychological stress leads the LRP to overestimate the risk probability and become more cautious in the sequential processing of risk. These findings highlight the role of the feedback process and individual traits in risky decision-making under stress.

Reward and Punishment Sensitivity in Borderline and Avoidant Personality Disorders

The authors compared self-reported and behavioral responses to reward and punishment in individuals diagnosed with borderline personality disorder (BPD) or avoidant personality disorder (APD) relative to a healthy comparison (HC) group. As predicted, self-reported sensitivity to reward was significantly higher in the BPD group than in the APD and HC groups. Also as predicted, self-reported sensitivity to punishment was significantly elevated in both disordered groups but significantly higher in APD than in BPD. These hypothesized patterns were also evident in responses to behavioral tasks: Participants with BPD made more errors of commission and fewer errors of omission than HC participants on a passive avoidance learning task, and participants with APD showed greater reactivity to losses than other participants on a probabilistic reversal learning task. Results help characterize differences between these two disorders.

Impaired probabilistic reversal learning in anxiety: Evidence from behavioral and ERP findings

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High and low anxious participants finish a probabilistic reversal learning task.

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High anxious participants showed a worse performance and less likely to lose-shift.

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Feedback-related negativity (FRN) was correlated with the frequency of lose-shift.

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High anxious participants showed a smaller FRN in response to lose-shift.

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Anxious people’s reversal learning is affected by impaired sensitivity to losses.

Background

Reversal learning reflects an individual’s capacity to adapt to a dynamic environment with changing stimulus–reward contingencies. This study focuses on the potential influence of anxiety on reversal learning skills.

Methods

We asked 40 participants with a high level of trait anxiety (HTA) and 40 counterparts with a low anxiety level (LTA) to finish a probabilistic reversal learning task with event-related potential (ERP) recording, during which stimulus–reward contingencies are reversed after players have learned the optimal choice.

Results

We found that compared to their LTA counterparts, the HTA participants showed worse learning performance and were less likely to make lose-shift choices. The FRN amplitude might help interpret these behavioral results, which is suggested to be associated with punishment sensitivity and was positively correlated with the number of lose-shift in this study. Seeing that anxiety level predicted the FRN amplitude for lose-shift, we explain that anxious individuals’ inflexible behavioral responses to losses are due to their impaired sensitivity to negative feedback.

Conclusions

A higher level of anxiety is associated with weaker reversal learning performance, possibly because of abnormal sensitivity to negative outcomes. These findings have implications for the understanding of behavioral symptoms in anxiety.

Emotional State and Feedback-Related Negativity Induced by Positive, Negative, and Combined Reinforcement

Reinforcement learning relies on the reward prediction error (RPE) signals conveyed by the midbrain dopamine system. Previous studies showed that dopamine plays an important role in both positive and negative reinforcement. However, whether various reinforcement processes will induce distinct learning signals is still unclear. In a probabilistic learning task, we examined RPE signals in different reinforcement types using an electrophysiology index, namely, the feedback-related negativity (FRN). Ninety-four participants were randomly assigned into four groups: base (no money incentive), positive reinforcement (presentation of money rewards), negative reinforcement (removal of money losses), and combined reinforcement (money rewards and removal of money losses) groups. In addition, in order to evaluate the engagement of emotional activity in the different reinforcement processes, Positive and Negative Affect Schedule-Expanded Form (PANAS-X) scales were applied before and after the experiment to detect the emotional changes. The results showed that there was no difference between groups in the dopamine-related learning bias. However, compared to the other three groups, negative reinforcement elicited smaller FRN (the difference-wave measure) during the learning, stronger positive affect and joviality, and less fatigue after the learning, in which the difference between the negative and positive reinforcement groups was smaller. The results indicated that pure avoidance motivation may induce distinct emotional fluctuations, which influence the feedback processing.

Anxiety increases sensitivity to errors and negative feedback over time

Anxiety is characterized by sensitivity to negative external and internal information, apparent both in symptoms (e.g., hypervigilance and worry) and neural performance monitoring measures (i.e., feedback- and error-related negativity (FRN and ERN)). Here we examine whether anxiety is associated with persistent neural sensitivity to negative performance markers reflected in both the FRN and ERN (n = 273). Higher anxiety was associated with larger responses to both negative feedback and errors as the task progressed compared to those with lower anxiety particularly in women, suggesting that anxiety makes reactions to negative cues more persistent. Similar hypotheses were investigated for depression, which is associated with similar negative cognitive biases and deficits in reward-related processing, but results were mixed. Together, the findings identify variation over time-in-task as an overlooked dimension by which FRN and ERN may serve as a biomarker of anxiety but suggest that depression is not consistently related to performance monitoring.

Can anxiety in undergraduate students in a high-fidelity clinical simulation be predicted? A randomized, sham-controlled, blinded trial

INTRODUCTION

High-fidelity clinical simulation has implied a revolution in health science training. Despite its benefits, some drawbacks could hinder the learning process, especially the anxiety produced during such scenarios.

OBJECTIVES

The aim of the present work is to develop a predictive model capable of determining which students will present high levels of anxiety.

DESIGN

We performed a randomized, sham-controlled, blinded trial in which students were randomly assigned to four scenarios and played one of two possible roles.

METHODS

Before and after the simulation we assessed the anxiety level along with physiological and analytical parameters. The main analyzed outcome was an increase of ≥25% in anxiety compared with baseline.

RESULTS

The type of scenario or the role played had no effect on anxiety. The predictive model presented an Area Under the Receiver Operating Characteristics of 0.798 (95% CI: 0.69-0.90; p < 0.001), with age and systolic blood pressure being protective factors against anxiety.

CONCLUSIONS

Our results showed that the anxiety level developed during simulation could be predicted. The application of this predictive model when associated to appropriate techniques to deal with increased anxiety levels could improve the learning process of medical students during simulations.

Stress and anxiety in nursing students between individual and peer simulations

BACKGROUND

The use of high-fidelity simulation practice as an educational tool is becoming increasingly prevalent in nursing education. Despite the learning effects of simulation practice, students have been shown to experience high levels of stress and anxiety during simulation. In recent years, peer learning has been defined as an acquisition of knowledge and skills through active support and support among equal or equal peers and has been shown to be an effective educational intervention for clinical health science students.

AIM

The purpose of this study was to incorporate peer learning into simulation learning and to clarify the differences between stress and anxiety during personal and peer simulations.

METHOD

Third-grade undergraduate students in a four-year course at two nursing universities participated in this study. In this study, the simulated patient was a 53-year-old man who had undergone gastrectomy for the treatment of gastric cancer. The scenario was that the patient had completely recovered consciousness in the operating room, and his tracheal tube had been removed one hour before the students examined him. Stress while simulation training was evaluated with heart rate variability. Anxiety was evaluated by the STAI after the simulations were complete.

RESULTS

Personal simulation practice (personal group; n = 50) and peer simulation practice (peer group, n = 59) was conducted. The personal group included 7 male students, and the peer group included 12 male students; the difference in male proportion was not significant. At the first patient assessment phase, stress of heart rate variability components at the peer group significantly increased relative to that of the personal. In addition, the personal had a significantly higher state anxiety score after simulation than the peer.

CONCLUSION

This study shows that in the face-to-face scene involving vital sign measurements, the presence of peers did not objectively alleviate stress.

Does Gender Matter in the Relationship between Anxiety and Decision-Making?

There is an ongoing debate about whether and how anxiety level affects behavioral performance in risk and/or ambiguous decision-making. According to the literature, we suggest that gender difference might be a confounding factor that has contributed to heterogeneous findings in previous studies. To examine this idea, 135 students who participated in this study were divided into six groups according to their gender (male/female) and trait anxiety level (high/medium/low; measured by the Trait form of Spielberger's State-Trait Anxiety Inventory). All groups finished the Iowa Gambling Task (IGT) for ambiguous decision-making, and the Game of Dice Task (GDT) for risk decision-making. Behavioral results revealed that the IGT but not the GDT showed an interaction between anxiety and gender. Specifically, men outperformed women in the IGT, but only when their trait anxiety levels were low. Meanwhile, the GDT showed a main effect of anxiety grouping, such that low anxious participants were more risk-seeking than their medium anxious counterparts. These findings indicate that gender selectively modulates the influence of anxiety on ambiguous decision-making, but not risk decision-making. The theoretical and practical implications of the current findings are discussed.