Differences between trait fear and trait anxiety: Implications for psychopathology

Thyroid Cancer-Related Fear & Anxiety in Patients With Benign Thyroid Nodules: A Mixed-Methods Study

INTRODUCTION

Thyroid cancer diagnosis often evokes strong negative emotions in patients, yet little is understood about such responses in those with benign thyroid nodules. This study explored the impact of a hypothetical cancer diagnosis, the provision of treatment information, and emotional support from surgeons on patients with benign nodules.

METHODS

Patients within 30 d of a thyroid nodule biopsy were asked to imagine their nodule was cancerous and write down their feelings about this diagnosis. They then viewed a video depicting a patient-surgeon discussion of thyroid cancer treatment options, with or without added emotional support (1:1 randomized allocation). Validated measures assessed anxiety and thyroid cancer-related fear before and after video-viewing. Thematic analysis evaluated participants' feelings about the hypothetical diagnosis.

RESULTS

Of 221 eligible patients, 118 participated (53.4%). While participants state anxiety increased after performing the thought exercise and watching the video (9 [6, 11]-12 [8, 14]; P < 0.001), thyroid cancer-related fear decreased over the same period (27 [22, 30]-25 [20, 29]; P < 0.001). Emotional support by the surgeon in the video did not affect anxiety or fear. Themes that emerged from participants imagining they have thyroid cancer included information seeking, trust in medicine, cancer experience, thyroid cancer knowledge, apprehension about surgery, and impact on family.

CONCLUSIONS

Patients with recently diagnosed benign thyroid nodules experience heightened anxiety when contemplating thyroid cancer. Provision of treatment and disease information mitigates cancer-related fear, while emotional support does not. Offering patients with thyroid nodules information about thyroid cancer before biopsy may offer emotional benefits.

Can pre-visit exposure to virtual tours of healthcare facilities help reduce child and parent anxiety during outpatient surgical procedures?

AIM

The study aims to evaluate the impact of exposure to a highly realistic virtual facility tour prior to the on-site visit on patients and their parent/care partner's self-reported anxiety and physiological measures on the day of the procedure.

BACKGROUND

Preoperative anxiety impacts pediatric surgical outcomes; therefore, it is important for healthcare providers to address and manage preoperative anxiety in pediatric patients to promote better outcomes and overall wellbeing. Providing patients with a preview of the care setting before the actual procedure can be highly beneficial in mitigating preoperative anxiety.

METHODOLOGY

In this pilot randomized experimental study, sixteen patient-care partner dyads scheduled to undergo a gastrointestinal procedure either received a virtual tour identical to the places experienced on the day of the procedure (experimental group) or received no virtual tour (control group). Self-reported measures of anxiety were collected from participants before and on the day of the procedure. Physiological measures of heart rate variability and skin conductance were collected on the day of the procedure from both groups.

RESULTS

There were no significant differences between the self-reported and physiological measures of anxiety between the child groups. However, parents in the control group reported lower levels of anxiety and demonstrated lower levels of stress based on their physiological measures.

CONCLUSION

Exposure to virtual facility tours days before the surgery was not helpful in positively impacting the psychological measures related to preoperative anxiety levels for the participants.

A novel brief questionnaire using a face rating scale to assess dental anxiety and fear

PURPOSE

This study aimed to evaluate the reliability and validity of a four-item questionnaire using a face rating scale to measure dental trait anxiety (DTA), dental trait fear (DTF), dental state anxiety (DSA), and dental state fear (DSF).

MATERIALS AND METHODS

Participants were consecutively selected from patients undergoing scaling (S-group; n = 47) and implant placement (I-group; n = 25). The S-group completed the questionnaire both before initial and second scaling, whereas the I-group responded on the pre-surgery day (Pre-day), the day of implant placement (Imp-day), and the day of suture removal (Post-day).

RESULTS

The reliability in the S-group was evaluated using the test-retest method, showing a weighted kappa value of DTA, 0.61; DTF, 0.46; DSA, 0.67; DSF, 0.52. Criterion-related validity, assessed using the State-Trait Anxiety Inventory's trait anxiety and state anxiety, revealed positive correlations between trait anxiety and DTA/DTF (DTA, ρ = 0.30; DTF, ρ = 0.27, ρ: correlation coefficient) and between state anxiety and all four items (DTA, ρ = 0.41; DTF, ρ = 0.32; DSA, ρ = 0.25; DSF, ρ = 0.25). Known-group validity was assessed using the initial data and Imp-day data from the S-group and I-group, respectively, revealing significantly higher DSA and DSF scores in the I-group than in the S-group. Responsiveness was gauged using I-group data, showing significantly lower DSA and DSF scores on post-day compared to other days.

CONCLUSION

The newly developed questionnaire has acceptable reliability and validity for clinical use, suggesting its usefulness for research on dental anxiety and fear and for providing patient-specific dental care.

The effect of magnesium sulfate on memory and anxiety-like behavior in a rat model: an investigation of its neuronal molecular mechanisms

BACKGROUND

Anxiety is an adaptive response to potentially threatening conditions. Excessive and uncontrolled anxiety responses become nonadaptive and cause anxiety disorders. To better understand the anxiety-modulating effects of Mg sulfate, behavioral test batteries in the assessment of anxiety and learning and memory functions were performed simultaneously over a time period. This study also examines the effects of Mg sulfate compared to diazepam, an anxiolytic drug with amnestic effects on anxiety-like behavior, as well as possible oxidative-nitrosative stress and hippocampal changes in male rats exposed to predator odor.

METHODS

Young adult Sprague-Dawley male rats were used. The rats were assessed using a comprehensive neurobehavioral test battery consisting of novel object recognition, open field, and successive alleys tasks. Anxiety was induced by cat odor, and diazepam and Mg were used as study drugs. Of the frontal cortex and hippocampus, the state of total oxidant and antioxidant and NO levels and histological examination of hippocampal CA1, CA2, CA3, and DG regions were performed.

RESULTS

Diazepam- and Mg-treated rats showed an improvement in anxiety-related behavior to predator odors. Furthermore, Mg treatment alleviated some of the increasing oxidative stress in the frontal cortex and hippocampus of rats, while diazepam treatment in particular enhanced hippocampal oxidant and antioxidant activity. In addition, brain NO increase induced by animal odor exposure or diazepam treatment was ameliorated by Mg administration.

CONCLUSIONS

Overall, our work suggests that Mg had a partial anxiolytic effect on anxiety-like behaviors, although not as much as diazepam, and this effect varied depending on the dose. Mg treatment might counteract increased oxidative stress and elevated NO levels in the brain.

The association of dispositional anxiety with the NoGo N2 under relaxation instruction vs. speed/accuracy instruction

Prior research suggests that cognitive control, indicated by NoGo N2 amplitudes in Go/NoGo tasks, is associated with dispositional anxiety. This negative association tends to be reduced in anxiety-enhancing experimental conditions. However, anxiety-reducing conditions have not yet been investigated systematically. Thus, the present study compares the effect of a relaxation instruction with the conventional speed/accuracy instruction in a Go/NoGo task on the correlation of the NoGo N2 with two subconstructs of dispositional anxiety, namely anxious apprehension and anxious arousal. As the test of differences between correlations needs considerable statistical power, the present study was included into the multi-lab CoScience Project. The hypotheses, manipulation checks, and the main path of pre-processing and statistical analysis were preregistered. Complete data sets of 777 participants were available for data analysis. Preregistered general linear models revealed that the different instructions of the task (speed/accuracy vs. relaxation) had no effect on the association between dispositional anxiety and the NoGo N2 amplitude in general. This result was supported by Cooperative-Forking-Path analysis. In contrast, a preregistered latent growth model with categorical variables revealed that anxious arousal was a negative predictor of the NoGo N2 intercept and a positive predictor of the NoGo N2 slope. Non-preregistered growth models, allowing for correlations of anxious apprehension with anxious arousal, revealed that higher anxious apprehension scores were associated with more negative NoGo N2 amplitudes with increased relaxation. Results are discussed in the context of the compensatory error monitoring hypothesis and the revised Reinforcement Sensitivity Theory.

Psychopathy measurement practices moderate psychopathy's association with anxiety and depression: A comprehensive meta-analysis

Theories of psychopathy development traditionally emphasize that individuals high in psychopathy experience diminished internalizing symptoms (e.g., anxiety and depression). However, many studies find null or even positive relationships between psychopathy and internalizing. The current meta-analysis therefore aimed to provide a comprehensive understanding of heterogeneity in psychopathy-anxiety/depression relationships by examining measurement and sample-related variables that may moderate these associations (e.g., psychopathy subdimensions assessed, different measures/operationalizations of psychopathy and anxiety/depression, and demographic characteristics). Results suggest that psychopathy demonstrates a small, positive overall association with anxiety/depression (r = 0.09), which may indicate that psychopathy is unrelated to subjective experiences of anxiety and sadness, but results could also reflect that varying psychopathy and anxiety/depression assessment practices contribute to heterogeneity in psychopathy-anxiety/depression associations. Most notably, results indicate that associations vary substantially across different measures/operationalizations of psychopathy, even when controlling for sample type and informant. Some psychopathy scales could therefore inadvertently capture anxiety/depression symptoms or broader psychopathology in addition to psychopathic traits. Findings from the current meta-analysis can inform future efforts to understand how measurement-related considerations influence relationships between psychopathy and anxiety/depression.

The impact of psychopathic traits on anxiety-related behaviors in a mixed reality environment

There is an ongoing debate about anxiety deficits in psychopathy and their possible impact on individual behavior. Data on actual anxiety- and threat-related behavior associated with psychopathy is still limited. We performed a mixed reality study using the elevated plus-maze (EPM) in a non-clinical sample (N = 160) to test anxiety-related behavior in relation to psychopathic personality traits measured through the Brief Questionnaire of Psychopathic Personality Traits (FPP). The psychopathy sum score correlated significantly with all measures of anxiety-related behavior on the EPM. Sensation seeking, but not general levels of acrophobia was moreover associated with psychopathic traits. Multivariate analyses revealed that the subscales Fearlessness and Lack of Empathy of the FPP predicted anxious behavior. Our findings are the first to demonstrate the relationship between psychopathic traits and actual behavior in an anxiety-inducing environment. This supports the low-anxiety hypothesis in psychopathy research. Implications for potentially harmful or risky behavior are discussed.

Global-brain functional connectivity related with trait anxiety and its association with neurotransmitters and gene expression profiles

BACKGROUND

Numerous studies have explored the neural correlates of trait anxiety, a predisposing factor for several stress-related disorders. However, the findings from previous studies are inconsistent, which might be due to the limited regions of interest (ROI). A recent approach, named global-brain functional connectivity (GBC), has been demonstrated to address the shortcomings of ROI-based analysis. Furthermore, research on the transcriptome-connectome association has provided an approach to link the microlevel transcriptome profile with the macroscale brain network. In this paper, we aim to explore the neurobiology of trait anxiety with an imaging transcriptomic approach using GBC, biological neurotransmitters, and transcriptome profiles.

METHODS

Using a sample of resting-state fMRI data, we investigated trait anxiety-related alteration in GBC. We further used behavioral analysis, spatial correlation analysis, and postmortem gene expression to separately assess the cognitive functions, neurotransmitters, and transcriptional profiles related to alteration in GBC in individuals with trait anxiety.

RESULTS

GBC values in the ventromedial prefrontal cortex and the precuneus were negatively correlated with levels of trait anxiety. This alteration was correlated with behavioral terms including social cognition, emotion, and memory. A strong association was revealed between trait anxiety-related alteration in GBC and neurotransmitters, including dopaminergic, serotonergic, GABAergic, and glutamatergic systems in the ventromedial prefrontal cortex and the precuneus. The transcriptional profiles explained the functional connectivity, with correlated genes enriched in transmembrane signaling.

LIMITATIONS

Several limitations should be taken into account in this research. For example, future research should consider using some different approaches based on dynamic or task-based functional connectivity analysis, include more neurotransmitter receptors, additional gene expression data from different samples or more genes related to other stress-related disorders. Meanwhile, it is of great significance to include a larger sample size of individuals with a diagnosis of major depression disorder or other disorders for analysis and comparison and apply stricter multiple-comparison correction and threshold settings in future research.

CONCLUSIONS

Our research employed multimodal data to investigate GBC in the context of trait anxiety and to establish its associations with neurotransmitters and transcriptome profiles. This approach may improve understanding of the neural mechanism, together with the biological and molecular genetic foundations of GBC in trait anxiety.

Differential correlates of fear and anxiety in salience perception: A behavioral and ERP study with adolescents

Anxiety disorders are the most common psychopathologies among adolescents. Their diagnostic criteria include both fear and anxiety symptomatology, although according to the literature, we can find evidence for some distinction between these two emotions. The present study contribute to this distinction, exploring the effects of trait fear and trait anxiety on behavioral and neural correlates. Thirty-two participants (aged 11-16 years) performed two experimental tasks of salient target detection, including visual stimuli that were manipulated to become salient, while reaction times and EEG were recorded. Results of both tasks revealed differential effects of trait fear and trait anxiety assessed through the Fear Survey Schedule for Children-Revised and the Youth Anxiety Measure for DSM-5 on reaction times and ERP components amplitudes. Specifically, higher symptoms from Separation Anxiety Disorder increased early neural visual processing and decreased reaction times for more salient stimuli. Also, trait fear reduced later neural visual processing of salient stimuli. These findings may provide a significant contribution to guiding psychological interventions, especially with adolescents presenting higher levels of anxiety-related symptomatology.

Assessment of Levels of Anxiety and Fear of Covid-19 in a Population of Pregnant Women in Spain

Objective

The aim of the study was to assess the levels of fear and anxiety in the particularly vulnerable population group of women during pregnancy.

Methods

Cross-sectional study between March 2022 and July 2022 involving 978 pregnant women aged 16 to 50 years. It was carried out based on the scale for the assessment of fear and anxiety in pregnant women (AMICO_Pregnant) and the collection of sociodemographic data. Normality analysis was performed prior to univariate and bivariate statistical analysis.

Results

The sample was composed of a total of 978 pregnant women. The mean of the AMICO_Pregnant scale was intermediate (5.04 points; SD=2.36). The bivariate analysis showed a statistically significant relationship between the AMICO_Pregnant scale and the following variables: vaccination schedule status, contact with the disease, weeks of gestation, altered delivery or birth plan.

Conclusion

Women with pregnancies closer to term, with no contact with the disease, without a complete vaccination schedule, or who had undergone changes in their delivery or birth plans, showed higher levels of fear and anxiety.

Childhood ADHD With and Without Co-occurring Internalizing/Externalizing Problems: Prospective Predictions of Change in Adolescent Academic and Social Functioning

OBJECTIVE

Internalizing and externalizing problems predict poor academic and social outcomes. However, ADHD co-occurs with internalizing and externalizing problems and is itself a risk factor, thus preventing precise inferences. This study evaluated childhood anxiety, depression, and aggression as predictors of change in adolescent academic and social outcomes, including moderation by childhood ADHD.

METHODS

182 ethnically-diverse 5- to 11-year-old youth with (54.7%) and without (45.3%) ADHD completed a separate baseline and 6- to 7-year prospective follow-up assessment, consisting of parallel measures across youth psychopathology, academic functioning (i.e., academic achievement, school competence), and friendship quality domains.

RESULTS

Whereas childhood ADHD inversely predicted academic competence, depression and aggression uniquely predicted worsening friendship quality. Interestingly, anxiety was unrelated to change in academic and friendship outcomes; similarly, neither ADHD, depression, nor aggression predicted change in objectively-measured academic achievement from a standardized assessment.

CONCLUSION

Implications for intervention and prevention are considered, including school-based approaches, within a developmental psychopathology framework.

Adaptation and psychometric study of the scale for the measurement of fear and anxiety of COVID-19 disease in pregnant women (AMICO_Pregnant)

Objective

The aim of this research was to adapt and explore the psychometric properties of a specific scale to assess the levels of fear and anxiety of COVID-19 disease in pregnant women.

Methods

An adaptation phase, by a panel of experts, and a psychometric descriptive cross-sectional study were carried out on the final version of the 16-item, self-administered AMICO_Pregnant scale. Univariate and bivariate analyses were carried out, followed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The consistency of the scale was assessed using the Omega coefficient and Cronbach's Alpha.

Results

With a sample of 1,013 pregnant women living in Spain and over 18 years of age, the mean age was 33 years. The scale showed a bifactor structure (anxiety and fear) that was confirmed with good fit parameters. Reliability was assessed in terms of internal consistency by calculating Cronbach's Alpha coefficient (0.95) and McDonald's Omega coefficient (0.94) as indicators of robustness of the scale's reliability.

Conclusion

The AMICO_Pregnant scale of 16 items with scores ranging from 1 to 10 is a valid and reliable tool to assess levels of anxiety and fear of COVID_19 in Spanish pregnant women. Pregnant women have shown moderate levels of anxiety and fear regarding the COVID_19 disease in the final phase of the pandemic.

Fearlessness as an Underlying Mechanism Leading to Conduct Problems: Testing the Intermediate Effects of Parenting, Anxiety, and callous-unemotional Traits

This study investigates whether the longitudinal association between fearlessness and conduct problems (CP) is mediated by warm and harsh parenting, parent-child conflict, anxiety, and callous-unemotional (CU) traits. The constructs under investigation were assessed at five different time points, spanning a period of eight years. A multi-informant approach was followed, collecting data from parents and teachers (N = 2,121; 47% girls). The structural equation model pointed to both direct and indirect pathways between fearlessness and CP. Specifically, findings suggested that Time 1 fearlessness (age 3-5 years) increased the likelihood of Time 2 (age 4-6 years) harsh parenting and Time 3 (age 5-7 years) parent-child conflict. Further, fearlessness was positively associated with Time 4 (age 8-10) callous-unemotional traits and Time 5 (age 11-13) CP. The total indirect effect from fearlessness to CP through these variables was significant, although the specific indirect effect from fearlessness to CU traits to CP accounted for most of the variance. Warm parenting and anxiety did not mediate the association between fearlessness and CP. In addition to the identified pathways connecting fearlessness to CP, findings pointed to the existence of multiple developmental pathways to future CP, as well as gender differences in longitudinal associations.

The reinforcement sensitivity theory affects questionnaire (RST-AQ). A validation study of a new scale targeting affects related to anxiety, approach motivation and fear

This paper presents the RST-AQ, a 22-item scale to measure the affective states related to the three motivational systems postulated by Reinforcement Sensitivity theory (RST-AQ): the Behavioral approach system (BAS), Behavioral inhibition system (BIS), and the Fight-Flight-Freeze system (FFFS). The three subscales are internally consistent. Results show an overall support for construct validity of our RST-AQ measure. The correlations of the RST-AQ subscales with other measures demonstrate a good convergent and divergent validity with regard to the subscales of BAS and BIS. The RTS-AQ Scale provides researcher with the first instrument to measures the affective states of the RST theory.

Amygdala-based functional connectivity mediates the relationship between thought control ability and trait anxiety

Thought control ability (TCA) refers to the ability to exclude unwanted thoughts. There has been consistent evidence on the protective effect of TCA on anxiety, that higher TCA is associated with lower anxiety. However, the underlying neural mechanism remains unclear. In this study, with a large sample (N = 495), we investigated how seed-based resting-state functional connectivity (RSFC) mediates the relationship between TCA and anxiety. Our behaviour results replicated previous findings that TCA is negatively associated with trait anxiety after controlling for gender, age, and depression. More importantly, the RSFC results revealed that TCA is negatively associated with the left amygdala - left frontal pole (LA-LFP), left amygdala - left inferior temporal gyrus (LA-LITG), and left hippocampus - left inferior frontal gyrus (LH-LIFG) connectivity. In addition, a mediation analysis demonstrated that the LA-LFP and LA-LITG connectivity in particular mediated the influence of TCA on trait anxiety. Overall, our study extends previous research by revealing the neural bases underlying the protective effect of TCA on anxiety and pinpointing specific mediating RSFC pathways. Future studies could explore whether targeted TCA training (behavioural or neural) can help alleviate anxiety.

Cognitive Avoidance Is Associated with Decreased Brain Responsiveness to Threat Distractors under High Perceptual Load

Cognitive coping strategies to deal with anxiety-provoking events have an impact on mental and physical health. Dispositional vigilance is characterized by an increased analysis of the threatening environment, whereas cognitive avoidance comprises strategies to inhibit threat processing. To date, functional neuroimaging studies on the neural underpinnings of these coping styles are scarce and have revealed discrepant findings. In the present study, we examined automatic brain responsiveness as a function of coping styles using functional magnetic resonance imaging. We administered a perceptual load paradigm with contemptuous and fearful faces as distractor stimuli in a sample of N = 43 healthy participants. The Mainz Coping Inventory was used to assess cognitive avoidance and vigilance. An association of cognitive avoidance with reduced contempt and fear processing under high perceptual load was observed in a widespread network including the amygdala, thalamus, cingulate gyrus, insula, and frontal, parietal, temporal, and occipital areas. Our findings indicate that the dispositional tendency to divert one's attention away from distressing stimuli is a valuable predictor of diminished automatic neural responses to threat in several cortical and subcortical areas. A reduced processing in brain regions involved in emotion perception and attention might indicate a potential threat resilience associated with cognitive avoidance.

Non-conscious processing of fear faces: a function of the implicit self-concept of anxiety

BACKGROUND

Trait anxiety refers to a stable tendency to experience fears and worries across many situations. High trait anxiety is a vulnerability factor for the development of psychopathologies. Self-reported trait anxiety appears to be associated with an automatic processing advantage for threat-related information. Self-report measures assess aspects of the explicit self-concept of anxiety. Indirect measures can tap into the implicit self-concept of anxiety.

METHODS

We examined automatic brain responsiveness to non-conscious threat as a function of trait anxiety using functional magnetic resonance imaging. Besides a self-report instrument, we administered the Implicit Association Test (IAT) to assess anxiety. We used a gender-decision paradigm presenting brief (17 ms) and backward-masked facial expressions depicting disgust and fear.

RESULTS

Explicit trait anxiety was not associated with brain responsiveness to non-conscious threat. However, a relation of the implicit self-concept of anxiety with masked fear processing in the thalamus, precentral gyrus, and lateral prefrontal cortex was observed.

CONCLUSIONS

We provide evidence that a measure of the implicit self-concept of anxiety is a valuable predictor of automatic neural responses to threat in cortical and subcortical areas. Hence, implicit anxiety measures could be a useful addition to explicit instruments. Our data support the notion that the thalamus may constitute an important neural substrate in biased non-conscious processing in anxiety.

Social-affective functioning and learning in psychopathy

Psychopathy is a personality construct for which impairments in multiple aspects of social and affective functioning are considered to be central. Individuals with elevated levels of psychopathic traits tend to exhibit maladaptive behaviors that are harmful to themselves and others, and seem to be limited in how they perceive and experience affective states. This chapter provides a brief overview of biopsychological theories and studies of psychopathy targeting impairments in affective processing and behavioral adaptation through learning. Also, current gaps in the literature will be discussed in addition to findings highlighting the need to routinely reexamine the validity and robustness of decades-old views on psychopathy in the light of recent multidisciplinary empirical research. The chapter ends with a short reflection on how alternative views may offer novel insights that may bring significant advances in the study of the biopsychological factors underlying psychopathy.

Adaptation and initial psychometric study of the anxiety and fear of COVID-19 scale in the United Kingdom population

OBJECTIVE

The aim of the study was the initial psychometric study to validate the anxiety and fear of COVID-19 (AMICO) assessment scale in the general population of the United Kingdom population.

MATERIALS AND METHODS

A descriptive, cross-sectional, psychometric validation and descriptive study was conducted, performing univariate and bivariate analyses, as well as exploratory and confirmatory factor analysis.

RESULTS

The sample was 658 people living in the United Kingdom over 16 years. Of the total, 80.5% were female, with a mean age of 48.25 years (SD = 14.861). A mean score for the AMICO scale of 4.85 (SD = 2.398) was obtained, with a range of scores from 1 to 10. The study of percentiles and quartiles allowed for the identification of three proposed levels of anxiety.

CONCLUSION

The AMICO_UK scale is reliable to measure the presence of anxiety and fear related to the COVID-19 disease in the United Kingdom population. The majority of the United Kingdom population presented low levels of anxiety and fear at the time the scale was administered.

The psychological and financial impacts of an emotional culture of anxiety and its antidote, an emotional culture of companionate love

RATIONALE

Anxiety is an increasingly common problem in society, including at work, yet the effects of an emotional culture of anxiety remain unexplored. We offer a new lens on anxiety in the workplace, examining its collective enactment in the form of an emotional culture of anxiety.

OBJECTIVE

This study examines the implications of an emotional culture of anxiety for psychological and financial outcomes within a poorly performing healthcare organization. We also examine whether an emotional culture of companionate love, which helps people "calm and connect", can counteract the negative effects of an emotional culture of anxiety.

METHODS

Drawing on survey data of 822 employees from 85 departments in a large US medical center and a time-lagged archival measure of financial performance across those departments, we used ordinary least squares regression and random coefficient regression modeling to examine the main effects of these two emotional cultures and the buffering effect of an emotional culture of companionate love on an emotional culture of anxiety for department costs, department psychological safety, and individual employee burnout and satisfaction.

RESULTS

We find significant direct relationships between an emotional culture of anxiety and an emotional culture of companionate love on employee burnout and satisfaction in the predicted directions. We also find a significant interaction between the two emotional cultures, with a culture of companionate love attenuating the relationship of a culture of anxiety on job satisfaction, burnout, and financial performance in the form of time-lagged department costs.

CONCLUSIONS

Our results indicate that a culture of companionate love can be a protective force against the negative outcomes of an emotional culture of anxiety. Examining these two emotional cultures concurrently offers a better understanding of how to address the pernicious effects of anxiety in organizations.

Investigate the role of positive and negative memories from dentistry in the anxiety of dental patients in Kerman, Iran

BACKGROUND AND AIM

Several research works show that anxiety is more common in women, low-income classes, and middle-aged and elderly populations. The present study aimed to investigate the role of positive and negative memories in patients' anxiety referred to the dental clinics, offices, and schools of Kerman, Iran, in 2018-2019.

MATERIALS AND METHODS

In this cross-sectional, descriptive, analytical study, the participants were selected among individuals referred to the dental offices, schools, and clinics of Kerman, Iran. In this study, 500 questionnaires were distributed among the participants (based on census method), and of these, 482 of which were reviewed (response rate = 96.4%). The questionnaire used in this study contained four categories of questions, including demographic information, general questions about dentistry, Corah's Dental Anxiety Scale, and Autobiographical Memory Questionnaire. Analysis of variance, t-test, and Chi-square test were used to analyze.

RESULTS

Overall, 281 participants were female, and 201 were male. Based on the findings, dental visits were enjoyable and pleasant experiences for 154 participants, and 165 patients were anxious while the dentist prepared for a restorative treatment. This study showed that people with negative memories had more anxiety. Anxiety was also significantly associated with positive memories, higher education, and gender (female) (P < 0.05). Also, the most negative memories of dental treatments were associated with increased anxiety about dental treatments in adults (P < 0.05), while positive memories did not have a relationship any with decreased anxiety (P > 0.05).

CONCLUSION

The most negative memories of dental treatments were associated with increased anxiety about dental treatments in adults, while positive memories did not have any expected inverse relationship with anxiety.

Maternal Anxiety and Its Associated Factors During the First and Second Wave of COVID-19 Pandemic in Serbia: A Cross-Sectional Study

Aim

The COVID 19-pandemic affects people differently, while pregnant women are among the most sensitive populations. The data about maternal mental health during the COVID-19 outbreak are in some ways consistent but also country-specific.

Purpose

The study aims to explore the impact of the COVID-19 pandemic on pregnant women's anxiety and identify its associated factors.

Patients and Methods

This cross-sectional study included a sample of 358 pregnant women during the first and second waves of the pandemic in Serbia. An anonymous survey included basic demographic questions, pregnancy-related background questions, the question of self-reported COVID-19-related fear, State-Trait Anxiety Inventory (STAI), and Multidimensional Scale of Perceived Social Support (MSPSS).

Results

The study revealed no pregnant women with low anxiety levels measured by STAI-T and STAI-S, while the STAI-S and STAI-T scores indicated high anxiety in 32.4% and 42.7% of pregnant women, respectively. The obtained results pointed out the nonlinear dependence of state anxiety on observed associated factors and their complex interactions, including the data collecting period.

Conclusion

Our findings reveal that COVID-19 affects pregnant women's mental health and makes it necessary for psychological monitoring and support for pregnant women, which may be reflected in their mental health but also the development of their offspring.

Difference analysis of multidimensional electroencephalogram characteristics between young and old patients with generalized anxiety disorder

Growing evidences indicate that age plays an important role in the development of mental disorders, but few studies focus on the neuro mechanisms of generalized anxiety disorder (GAD) in different age groups. Therefore, this study attempts to reveal the neurodynamics of Young_GAD (patients with GAD under the age of 50) and Old_GAD (patients with GAD over 50 years old) through statistical analysis of multidimensional electroencephalogram (EEG) features and machine learning models. In this study, 10-min resting-state EEG data were collected from 45 Old_GAD and 33 Young_GAD. And multidimensional EEG features were extracted, including absolute power (AP), fuzzy entropy (FE), and phase-lag-index (PLI), on which comparison and analyses were performed later. The results showed that Old_GAD exhibited higher power spectral density (PSD) value and FE value in beta rhythm compared to theta, alpha1, and alpha2 rhythms, and functional connectivity (FC) also demonstrated significant reorganization of brain function in beta rhythm. In addition, the accuracy of machine learning classification between Old_GAD and Young_GAD was 99.67%, further proving the feasibility of classifying GAD patients by age. The above findings provide an objective basis in the field of EEG for the age-specific diagnosis and treatment of GAD.

Classification and assessment of fear and anxiety in personality and psychopathology

We examine fear and anxiety in the context of structural models of personality (the five-factor model, or FFM) and psychopathology (the Hierarchical Taxonomy of Psychopathology, or HiTOP); we also highlight important issues related to their assessment. Anxiety is a sustained, future-oriented response to potential threat. Trait measures of anxiety represent a core facet within the broader domain of neuroticism in the FFM. Anxiety-related symptoms are indicators of the distress subfactor within the internalizing spectrum in HiTOP. In contrast, fear is a brief, present-focused response to an acute threat. We distinguish between two ways of assessing individual differences in fear. The first type assesses phobic responses to specific stimuli. Phobia measures are moderately correlated with measures of neuroticism in the FFM and define the fear subfactor of internalizing in HiTOP. The second type assesses individual differences in harm avoidance versus risk taking. Measures of risk taking (i.e., low fear) are moderately related to disinhibition/low conscientiousness and antagonism/low agreeableness in the FFM and are indicators of the externalizing superspectrum in HiTOP.

Mediation of Self-Compassion on Pathways from Stress to Psychopathologies among Japanese Workers

As awareness of mental health increases worldwide, how to improve mental health has begun to be discussed in many countries. Stress is known to cause diverse physical and mental health problems, including psychopathologies. On the other hand, our previous studies identified that self-compassion, kindness and understanding towards oneself are key components for good mental health in many populations, including Japanese workers. The government reports that Japanese workers suffer from high rates of mental health problems. However, the mechanism of how self-compassion helps their mental health remains to be evaluated. Accordingly, this study aimed to elucidate how self-compassion intervenes in pathways from stress to psychopathologies, namely depression and anxiety. One hundred and sixty-five Japanese workers completed an online survey regarding self-compassion, depression, anxiety and stress. Correlation and path analyses were conducted. These four variables were significantly inter-related. While self-compassion mediated the pathway from stress to depression, it did not mediate the pathway from stress to anxiety. These exploratory insights assist in understanding the mechanism of how self-compassion improves mental health and inform effective methods to implement self-compassion interventions to the Japanese workforce.

Dealing with COVID-19 stressful events, stress and anxiety: the mediating role of emotion regulation strategies in Italian women

BACKGROUND

This study aims to better understand the causal relationship between COVID-19 stressful events, perceived stress, emotion regulation strategies and anxiety symptoms in Italian women. Specifically, we assumed that: (i) different COVID-19 stressful events can directly or indirectly influence the manifestation of anxiety symptoms; (ii) perceived stress and emotion regulation strategies can mediate the relationship between COVID-19 stressful events and anxiety symptoms.

PARTICIPANTS AND PROCEDURE

An online survey was distributed during the Italian mandatory lockdown - between 18th and 28th April 2020 - across the national territory. The final sample was composed of 1132 women living in different Italian regions (North 63.30%, Centre 14.20%, South 18.50%, Islands 4.00%) with a mean age of 40.19 years, ranging from 19 to 83 years (SD = 12.87). Participants filled out the Perceived Stress Scale (PSS-10), Spielberger State-Trait Anxiety Inventory (STAI) X1/R, Emotion Regulation Questionnaire (ERQ-10), five dichotomous questions assessing the COVID-19 stressful events and a demographic form. Pearson correlation analyses were performed to examine whether associations between factors conformed to the prerequisites for path analysis. Path analysis was conducted to test the model.

RESULTS

"Having contracted the flu during the COVID-19 pandemic" and "having a family member infected by COVID-19" have a direct effect on the level of perceived stress and an indirect effect on the manifestation of anxiety symptoms. Finally, we found that emotion regulation strategies mediate the relationship between perceived stress and state anxiety symptoms.

CONCLUSIONS

Our results allow one to select the stressful events to which, in the pandemic era, it is necessary to pay particular attention in a clinical setting and suggest the implementation of psychological interventions that make emotion regulation an essential direct target of treatment in chronic stress-related pathology such as anxiety disorders.

Behavioral and neural responses during fear conditioning and extinction in a large transdiagnostic sample

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Behavioral and neural responses during Pavlovian fear learning were examined in a large sample of healthy and individuals with anxiety and depression.

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Latent profile models to threat were derived from behavioral and neural data.

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Demographic, cognitive, and psychological variables did not robustly characterize latent profiles.

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Neuroimaging data did not evidence functional role of amygdala in fear learning.

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Human fear learning recruited a distributed network of regions involved in interoceptive, cognitive, motivational, and psychomotor processes.

Background

Dysregulation of fear learning has been associated with psychiatric disorders that have altered positive and negative valence domain function. While amygdala-insula-prefrontal circuitry is considered important for fear learning, there have been inconsistencies in neural findings in healthy and clinical human samples. This study aimed to delineate the neural substrates and behavioral responses during fear learning in a large, transdiagnostic sample with predominantly depressive and/or anxious dysfunction.

Methods

Two-hundred and eighty-two individuals (52 healthy participants; 230 participants with depression and/or anxiety-related problems) from the Tulsa 1000 study, an ongoing, naturalistic longitudinal study based on a dimensional psychopathological framework, completed a Pavlovian fear learning task during functional magnetic resonance imaging. Linear mixed-effects analyses examined condition-by-time effects on brain activation (CS+, CS- across familiarization, conditioning, and extinction trials). A data-driven latent profile analysis (LPA) examined distinct patterns of behavioral and neural responses to threat across fear conditioning and extinction, while logistic regression analyses evaluated cognitive-affective predictors of latent profiles.

Results

Whole-brain analyses revealed a condition-by-time interaction in the anterior insula, postcentral gyrus, superior temporal gyrus, middle frontal gyrus, and cerebellum but not amygdala. The LPA identified distinct latent profiles across subjective and neural levels of measurement. Anterior insula profiles were characterized by marginal differences in age and state anxiety.

Conclusions

Our findings demonstrate that human fear learning recruits a distributed network of regions involved in interoceptive, cognitive, motivational, and psychomotor processes. Data-driven analyses identified distinct profiles of subjective and neural responses during fear learning that transcended clinical diagnoses, but no robust relationships to demographic or cognitive-affective variable were identified.

Health literacy and fear among Iranian medical students due to COVID-19: An observational study

INTRODUCTION

The coronavirus disease of the 2019 (COVID-19) pandemic has created a sense of fear due to uncertainties in medical students' personal and professional lives. Medical education is challenging and poses a more significant academic and emotional rigor when compared with other professional programs. With the COVID-19 having limited treatment options, health literacy (HL) is crucial for managing and responding to the pandemic. This research aims to examine the impact of HL on COVID-19-associated fear among Iranian medical students.

METHODS

A cross-sectional study was conducted measuring the HL and fear of COVID-19 using validated scales. Two hundred and seventy-eight survey responses were received and analyzed descriptively by using SPSS software inferential statistics.

RESULTS

Mean age of participants was 22.93 ± 5.427 years. The correlation between students' total health literacy (HELIA) scores and their fear of COVID-19 (FCV-19S) scores was -0.279 (p value = .019). The FCV-19S has a negative correlation with total HELIA in the group of females and males, single and married people, bachelor and MD students, and students living in rural areas and urban areas. The negative correlation of FCV-19S with total HELIA in males and students who reside in rural areas was the only one that was not significant. In associate degree students, the correlation between FCV-19S and total HELIA was positive but not significant. Education grades had a significant impact on FCV-19S. Furthermore, the place of residence also had a significant impact on FCV-19S. However, the gender and marital status did not significantly impact FCV-19S.

CONCLUSIONS

The present study showed that students with higher HL scores had lesser fear of COVID-19. The key stakeholders require several positive strategies to reduce fear and improve health, and such vital policies will assist in improving the students' health and achieving the sustainable developmental goals.

Employees' fear at work, job crafting, and work engagement on a daily basis: The case for fear of COVID-19

In the present study, we seek to understand how public sector employees that go to work to perform essential duties for the society and the economy cope with the fear of COVID-19 and maintain their motivation, energy, and enthusiasm for their work. We hypothesized that because employees are motivated to protect their health, an increase in daily fear of COVID-19 would be related to a daily increase in coping behaviors in the form of job crafting, which would consequently be related to employees' daily motivation. Data were based on 64 tenured employees working in public service organizations during the third wave of the COVID-19 pandemic (March 2021), who completed a quantitative diary for five consecutive workdays (N = 320 occasions). Results from multilevel analysis indicated that fear of COVID-19 had an indirect effect on work engagement through only one dimension of job crafting, seeking job resources. The study contributes to the ongoing theoretical extension of the beneficial role of job crafting by suggesting seeking social resources as an effective coping strategy for fear of COVID-19.

Chronic Pain and the Endocannabinoid System: Smart Lipids - A Novel Therapeutic Option?

The development of a high-end cannabinoid-based therapy is the result of intense translational research, aiming to convert recent discoveries in the laboratory into better treatments for patients. Novel compounds and new regimes for drug treatment are emerging. Given that previously unreported signaling mechanisms for cannabinoids have been uncovered, clinical studies detailing their high therapeutic potential are mandatory. The advent of novel genomic, optogenetic, and viral tracing and imaging techniques will help to further detail therapeutically relevant functional and structural features. An evolutionarily highly conserved group of neuromodulatory lipids, their receptors, and anabolic and catabolic enzymes are involved in a remarkable variety of physiological and pathological processes and has been termed the endocannabinoid system (ECS). A large body of data has emerged in recent years, pointing to a crucial role of this system in the regulation of the behavioral domains of acquired fear, anxiety, and stress-coping. Besides neurons, also glia cells and components of the immune system can differentially fine-tune patterns of neuronal activity. Dysregulation of ECS signaling can lead to a lowering of stress resilience and increased incidence of psychiatric disorders. Chronic pain may be understood as a disease process evoked by fear-conditioned nociceptive input and appears as the dark side of neuronal plasticity. By taking a toll on every part of your life, this abnormal persistent memory of an aversive state can be more damaging than its initial experience. All strategies for the treatment of chronic pain conditions must consider stress-related comorbid conditions since cognitive factors such as beliefs, expectations, and prior experience (memory of pain) are key modulators of the perception of pain. The anxiolytic and anti-stress effects of medical cannabinoids can substantially modulate the efficacy and tolerability of therapeutic interventions and will help to pave the way to a successful multimodal therapy. Why some individuals are more susceptible to the effects of stress remains to be uncovered. The development of personalized prevention or treatment strategies for anxiety and depression related to chronic pain must also consider gender differences. An emotional basis of chronic pain opens a new horizon of opportunities for developing treatment strategies beyond the repeated sole use of acutely acting analgesics. A phase I trial to determine the pharmacokinetics, psychotropic effects, and safety profile of a novel nanoparticle-based cannabinoid spray for oromucosal delivery highlights a remarkable innovation in galenic technology and urges clinical studies further detailing the huge therapeutic potential of medical cannabis (Lorenzl et al.; this issue).

Psychometric Evaluation of a Fear of COVID-19 Scale in China: Cross-sectional Study

BACKGROUND

At the very beginning of the COVID-19 pandemic, information about fear of COVID-19 was very limited in Chinese populations, and there was no standardized and validated scale to measure the fear associated with the pandemic.

OBJECTIVE

This cross-sectional study aimed to adapt and validate a fear scale to determine the levels of fear of COVID-19 among the general population in mainland China and Hong Kong.

METHODS

A web-based questionnaire platform was developed for data collection; the study instruments were an adapted version of the 8-item Breast Cancer Fear Scale ("Fear Scale") and the 4-item Patient Health Questionnaire. The internal construct validity, convergent validity, known group validity, and reliability of the adapted Fear Scale were assessed, and descriptive statistics were used to summarize the participants' fear levels.

RESULTS

A total of 2822 study participants aged 18 years or older were included in the analysis. The reliability of the adapted scale was satisfactory, with a Cronbach α coefficient of .93. The item-total correlations corrected for overlap were >0.4, confirming their internal construct validity. Regarding convergent validity, a small-to-moderate correlation between the Fear Scale and the 4-item Patient Health Questionnaire scores was found. Regarding known group validity, we found that the study participants who were recruited from Hong Kong had a higher level of fear than the study participants from mainland China. Older adults had a higher level of fear compared with younger adults. Furthermore, having hypertension, liver disease, heart disease, cancer, anxiety, and insomnia were associated with a higher fear level. The descriptive analysis found that more than 40% of the study participants reported that the thought of COVID-19 scared them. About one-third of the study participants reported that when they thought about COVID-19, they felt nervous, uneasy, and depressed.

CONCLUSIONS

The psychometric properties of the adapted Fear Scale are acceptable to measure the fear of COVID-19 among Chinese people. Our study stresses the need for more psychosocial support and care to help this population cope with their fears during the pandemic.

Symonds on fear and Post Traumatic Stress Disorder (PTSD)

Prominent English neurologist Sir Charles Symonds, during World War II service with the Royal Air Force, published a series of articles emphasizing the role of fear initiating psychological breakdown in combat airmen (termed Lack of Moral Fibre). Having served in a medical capacity in the previous war, Symonds re-presented the phylogenetic conceptualizations formed by his colleagues addressing 'shell shock'. In 2013, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) re-classified Post Traumatic Stress Disorder (PTSD), removing the diagnosis from the category of Anxiety Disorders. This was the view introduced a century ago by the trench doctors of World War I and affirmed by Symonds' clinical experience and studies in World War II.

Changes in consumption patterns during the COVID-19 pandemic: Analyzing the revenge spending motivations of different emotional groups

People tend to alleviate their negative emotions by shopping. Considering the change of shopping behavior during COVID-19 outbreak, negative emotions are the key contributors to this change. In this light, this study aims to investigate how negative emotions caused by COVID-19 affect shopping behaviors. This study classified consumer groups based on their perceived negative emotions (i.e., anxiety, fear, depression, anger, and boredom). By clustering analysis, four groups (i.e., group of anxiety, depression, anger, and indifference) were derived. Then, this study examined how each of the emotional groups differently affect the shopping-related motivations (i.e., mood alleviation, shopping enjoyment, socialization seeking, and self-control seeking) and shopping behaviors (i.e., shopping for high-priced goods and buying of bulk goods). Results revealed all emotional groups affect socialization seeking and influence high-priced shopping intentions. However, depression and indifference are positively associated with socialization seeking and influence bulk shopping intentions. In addition, other emotions except for anxiety affect mood alleviation and influence high-priced shopping intentions. Finally, anger is associated with self-control seeking and affects bulk shopping intentions. This study enables practitioners and researchers to better understand how people control negative emotions by shopping in pandemic situations such as the current COVID-19 crisis.

Skin Conductance Responses to a Discrete Threat in Virtual Reality: Associations with Psychopathy and Anxiety

People with high levels of psychopathic traits are often described as fearless and lacking in emotional depth, particularly when evaluating threats in their environments. Skin conductance responsivity (SCR) to negative emotional stimuli represents a robust autonomic correlate of conduct problem behavior in children (Fanti et al., in Neuroscience and Biobehavioral Reviews, 100, 98-107, 2019). However, studies that have examined threat-related processing in youth with conduct problems have tended to use a variety of negative stimuli that might induce various and unspecific negative emotions. Few studies have taken in to account the moderating effects of anxiety on the relationship of distinct psychopathic traits (e.g., narcissism, callousness, impulsivity) with SCR to a fear inducing stimulus. In this study, we examined SCR to a virtual reality rollercoaster drop - that is, a discrete fear inducing event - in a sample of 75 youths (61 males; M = 14 years, SD = 1.4) enrolled in a non-mainstream school. The rollercoaster drop was used to more clearly examine an event-related response to a discrete threat, rather than examining SCR throughout the rollercoaster ride. We used the teacher-reported Antisocial Process Screening Device (Frick & Hare, in Antisocial process screening device: APSD. Toronto: Multi-Health Systems, 2001) to examine the relations of distinct psychopathic traits with SCR and self-reported anxiety. Lower anxiety was associated with higher callousness, but only in youths with low SCR to discrete threat. These findings suggest that fear and anxiety show complex and interactive relations with distinct psychopathic traits.

COVID-19 Fear Association with Depression, Anxiety, and Insomnia: A National Web-Based Survey on the General Population

Objective: COVID-19 pandemic has influenced almost every country worldwide. Being in a pandemic situation can cause psychological distress to people, which can lead to sleep disorders. The present study aimed to assess prevalence of depression, anxiety, and insomnia among Iranian people and their relations with COVID-19 fear in the early stages of COVID-19 pandemic.

Method: A cross-sectional and population-based online study was designed. We created an online form and used Fear of COVID-19 scale (FCV-19), Generalized Anxiety Disorder 2 scale (GAD-2), Patient Health Questionnaire-2 (PHQ-2), and Insomnia Severity Index (ISI), to assess fear of COVID-19, anxiety, depression, and insomnia, respectively. We sent the link to the online survey to Iranians interested in participating in the study via social media, and 1223 Iranian completed the form.

Results: A total of 1223 individuals with a mean age of 39.82 ± 10.75 years participated in the study. Prevalence of insomnia, depression and anxiety among our participants were 55.2%, 61.5%, and 50.9%, respectively. The mean FCV-19 score among the participants was 19.70 ± 5.08. Insomnia was more common among those who were 50 years or older. Fear of COVID-19 was related to a more risk of progression toward depression, anxiety, and insomnia.

Conclusion: Fear of COVID-19 has a considerable association with depression, anxiety, and insomnia in the pandemic, and strategies to reasonably decrease people’s fears can help to reduce incidence of psychological issues during the pandemic.

FKBP51 in the Oval Bed Nucleus of the Stria Terminalis Regulates Anxiety-Like Behavior

The cochaperone FKBP51, encoded by the Fkbp5 gene, has been identified as central risk factor for anxiety-related disorders and stress system dysregulation. In the brain, the oval bed nucleus of the stria terminalis (ovBNST) has been implicated in stress-induced anxiety. However, the role of Fkbp5 in the ovBNST and its impact on anxiety-like behavior have remained unknown. Here, we show in mice that Fkbp5 in the ovBNST is reactive to acute stress and coexpressed with the stress-regulated neuropeptides Tac2 and Crh Subsequently, results obtained from viral-mediated manipulation indicate that Fkbp5 overexpression (OE) in the ovBNST results in an anxiolytic-like tendency regarding behavior and endocrinology, whereas a Fkbp5 knock-out (KO) exposed a clear anxiogenic phenotype, indicating that native ovBNST expression and regulation is necessary for normal anxiety-related behavior. Notably, our data suggests that a stress-induced increase of Fkbp5 in the ovBNST may in fact have a protective role, leading to a transient decrease in anxiety and suppression of a future stress-induced hypothalamic-pituitary-adrenal (HPA) axis activation. Together, our findings provide a first insight into the previously unknown relationship and effects of Fkbp5 and the ovBNST on anxiety-like behavior and HPA axis functioning.

The ERK phosphorylation levels in the amygdala predict anxiety symptoms in humans and MEK/ERK inhibition dissociates innate and learned defensive behaviors in rats

We demonstrate that the rate of extracellular signal-related kinase phosphorylation (P-ERK1,2/Total-ERK1,2) in the amygdala is negatively and independently associated with anxiety symptoms in 23 consecutive patients with drug-resistant mesial temporal lobe epilepsy that was surgically treated. In naive Wistar rats, the P-ERK1,2/Total-ERK1,2 ratio in the amygdala correlates negatively with innate anxiety-related behavior on the elevated plus maze (n = 20) but positively with expression of defensive-learned behavior (i.e., freezing) on Pavlovian aversive (fear) conditioning (n = 29). The microinfusion of ERK1/2 inhibitor (FR180204, n = 8-13/group) or MEK inhibitor (U0126, n = 8-9/group) into the basolateral amygdala did not affect anxiety-related behavior but impaired the evocation (anticipation) of conditioned-defensive behavior (n = 9-11/group). In conclusion, the P-ERK1,2/Total-ERK1,2 ratio in the amygdala predicts anxiety in humans and the innate anxiety- and conditioned freezing behaviors in rats. However, the ERK1/2 in the basolateral AMY is only required for the expression of defensive-learned behavior. These results support a dissociate ERK-dependent mechanism in the amygdala between innate anxiety-like responses and the anticipation of learned-defensive behavior. These findings have implications for understanding highly prevalent psychiatric disorders related to the defensive circuit manifested by anxiety and fear. HIGHLIGHTS: The P-ERK1,2/Total-ERK1,2 ratio in the amygdala (AMY) correlates negatively with anxiety symptoms in patients with mesial temporal lobe epilepsy. The P-ERK1,2/Total-ERK1,2 in the amygdala correlates negatively with the anxiety-like behavior and positively with freezing-learned behavior in naive rats. ERK1,2 in the basolateral amygdala is required for learned-defensive but not for the anxiety-like behavior expression in rats.

Loneliness and Mental Health: The Mediating Effect of Perceived Social Support

Social connectedness is a fundamental human need. The Evolutionary Theory of Loneliness (ETL) predicts that a lack of social connectedness has long-term mental and physical health consequences. Social support is a potential mechanism through which loneliness influences health. The present cross-sectional study examined the relationship between loneliness and mental health, and the mediating effects of social support in a Dutch adult sample (N = 187, age 20 to 70). The health variables included in the study are anxiety, depression, somatic symptoms as measured by the SCL-90, and the DSM-5 diagnosis somatic symptom disorder. The results indicated that social support partially mediated the relationship between loneliness and anxiety, depression, and somatic symptoms. These results indicate that social support partially explains the relationship between loneliness and physical and mental health issues. The relationship between loneliness and being diagnosed with somatic symptom disorder was not mediated by social support. This suggests that the mechanisms through which loneliness relates to either somatic symptoms or somatic symptom disorder are different.

Location-dependent threat and associated neural abnormalities in clinical anxiety

Anxiety disorders are characterized by maladaptive defensive responses to distal or uncertain threats. Elucidating neural mechanisms of anxiety is essential to understand the development and maintenance of anxiety disorders. In fMRI, patients with pathological anxiety (ANX, n = 23) and healthy controls (HC, n = 28) completed a contextual threat learning paradigm in which they picked flowers in a virtual environment comprising a danger zone in which flowers were paired with shock and a safe zone (no shock). ANX compared with HC showed 1) decreased ventromedial prefrontal cortex and anterior hippocampus activation during the task, particularly in the safe zone, 2) increased insula and dorsomedial prefrontal cortex activation during the task, particularly in the danger zone, and 3) increased amygdala and midbrain/periaqueductal gray activation in the danger zone prior to potential shock delivery. Findings suggest that ANX engage brain areas differently to modulate context-appropriate emotional responses when learning to discriminate cues within an environment.

Suarez-Jimenez and colleagues use a shock and safe zone experiment with fMRI imaging to examine how pathological anxiety disorders are manifested in the brain. Their findings suggest that safe and dangerous zones within the experiment alter activation in different brain regions.

Fear of childbirth: Validation study of the Chinese version of Wijma delivery expectancy/experience questionnaire version A

INTRODUCTION

Fear of childbirth causes significant distress and impact on women's wellbeing. It contributed to the rising trend of non-medically indicated Caesarean births worldwide. The objective of this study was to translate and validate the Chinese version of the Wijma Delivery Expectancy/Experience Questionnaire (Version A) (W-DEQ-A), which is a comprehensive instrument for the assessment of fear of childbirth among antenatal women.

METHODS

The translated questionnaire was finalised after back-translation and review by an expert panel. Hong Kong Chinese women at an antenatal clinic completed the translated questionnaire, Edinburgh Postpartum Depression Scale (EPDS), and State-trait Anxiety Inventory (STAI). The reliability of the translated questionnaire was analysed using Cronbach's alpha coefficient and intraclass correlation coefficient. Convergent validity was measured by Pearson's correlation between the W-DEQ-A and STAI or EPDS scores. The subscales of the questionnaire were determined using exploratory factor analysis.

RESULTS

One hundred and fifty women completed the study. The Cronbach's alpha coefficient and test-retest reliability of the Chinese version were 0.907 and 0.867, respectively. Convergent validity was demonstrated by the moderate correlation between the translated W-DEQ-A and STAI or EPDS. Exploratory factor analysis of the W-DEQ-A revealed a multi-dimensional structure with four factors: sense of isolation, moment of birth, negative emotion, and lack of positive self-evaluation. Using a standard cut-off of 85, 11.3% of women were found to suffer from fear of childbirth.

CONCLUSION

The Chinese version of the Wijma Delivery Expectancy/Experience Questionnaire (Version A) is a reliable and valid instrument to measure antenatal fear of childbirth among Chinese women.

Sense of coherence and dental fear/dental anxiety: A systematic review and meta-analysis

AIM

The aim of this systematic review and meta-analysis was to evaluate the association between sense of coherence (SOC) and dental fear/dental anxiety.

METHODS

Computerized searches were performed in six databases. Gray literature and manual searches were also conducted. Study selection, risk of bias assessment, and meta-analyses were performed. The results of meta-analyses were reported in odds ratio (OR), mean difference (MD), and confidence interval (CI).

RESULTS

After removing duplicates, 131 references were retrieved and the full texts of 12 were evaluated. Nine references met the eligibility criteria and were included. The results of meta-analyses demonstrated that individuals with a weaker SOC had a score in the dental anxiety/dental fear scale 6.04 times higher than individuals with a stronger SOC (OR = 6.04, CI = 2.62-13.91). Individuals with no dental anxiety/dental fear had a mean score of the SOC scale higher than individuals with dental anxiety/dental fear (MD = 5.39, CI = 2.21-8.56). Sensitivity analysis demonstrated that the result of a higher mean score of the SOC scale among individuals with no dental anxiety/dental fear remained (MD = 7.38, CI = 3.79-10.98). Risk of bias ranged from low to high. The certainty of evidence was very low.

CONCLUSION

Individuals with stronger SOC have lower levels of dental fear/dental anxiety.

Development and criterion validity of the COVID-19 anxiety and fear assessment scale: a cross sectional study

BACKGROUND

The emergence of the new severe acute respiratory syndrome coronavirus 2, which causes COVID-19 disease, has been a major public health challenge and an increase in the feeling of uncertainty of the population, who is also experiencing an increase in levels of anxiety and fear regarding the COVID-19 disease.

OBJECTIVE

The objective of the study was the construct and criterion validation of the Escala de evaluación de la Ansiedad y MIedo a COVID-19 (AMICO, for its acronym in Spanish) to measure both constructs in the general Spanish population.

METHODS

Descriptive study of psychometric validation. A field study was carried out to execute univariate and bivariate analyses, in addition to the exploratory and confirmatory factorial analysis of the scale. For the criteria validity study, the State-Trait Anxiety Inventory (STAI) and sensitivity and specificity values were calculated.

RESULTS

The study sample was composed of 1036 subjects over 18 years of age, who resided in Spain, where 56.3% were women with a mean age of 48.11 years (SD = 15.13). The study of construct validity reported two factors and 16 items, with a Cronbach's alpha value of 0.92. The scale was concurrently valid with the used gold standard and obtained sensitivity values of 90.48% and specificity values of 76%.

CONCLUSIONS

The AMICO scale is valid and reliable for assessing the level of anxiety and fear of COVID-19 in the adult Spanish population and is highly sensitive.

Trait anxiety predicts amygdalar responses during direct processing of threat-related pictures

Previous studies on the associations between trait anxiety and amygdalar responses to threat stimuli have resulted in mixed findings, possibly due to sample characteristics, specific tasks, and analytical methods. The present functional magnetic resonance imaging (fMRI) study aimed to investigate linear or non-linear associations between trait anxiety and amygdalar responses in a sample of participants with low, medium, and high trait anxiety scores. During scanning, participants were presented with threat-related or neutral pictures and had either to solve an emotional task or an emotional-unrelated distraction task. Results showed that only during the explicit task trait anxiety was associated with right amygdalar responses to threat-related pictures as compared to neutral pictures. The best model was a cubic model with increased amygdala responses for very low and medium trait anxiety values but decreased amygdala activation for very high trait anxiety values. The findings imply a non-linear relation between trait anxiety and amygdala activation depending on task conditions.

Distinctive Regulation of Emotional Behaviors and Fear-Related Gene Expression Responses in Two Extended Amygdala Subnuclei With Similar Molecular Profiles

The central nucleus of the amygdala (CeA) and the lateral division of the bed nucleus of the stria terminalis (BNST) are the two major nuclei of the central extended amygdala that plays essential roles in threat processing, responsible for emotional states such as fear and anxiety. While some studies suggested functional differences between these nuclei, others showed anatomical and neurochemical similarities. Despite their complex subnuclear organization, subnuclei-specific functional impact on behavior and their underlying molecular profiles remain obscure. We here constitutively inhibited neurotransmission of protein kinase C-δ-positive (PKCδ+) neurons-a major cell type of the lateral subdivision of the CeA (CeL) and the oval nucleus of the BNST (BNSTov)-and found striking subnuclei-specific effects on fear- and anxiety-related behaviors, respectively. To obtain molecular clues for this dissociation, we conducted RNA sequencing in subnuclei-targeted micropunch samples. The CeL and the BNSTov displayed similar gene expression profiles at the basal level; however, both displayed differential gene expression when animals were exposed to fear-related stimuli, with a more robust expression change in the CeL. These findings provide novel insights into the molecular makeup and differential engagement of distinct subnuclei of the extended amygdala, critical for regulation of threat processing.

How Can E-Cigarette Fear Appeals Improve the Perceived Threat, Fear, Anger, and Protection Motivation of Young People

The lack of awareness regarding the risks of e-cigarettes and the misleading business propaganda caused an increase in the popularity of e-cigarettes among young people. The effective communication of the risks associated with e-cigarettes is an important part of current work to control their usage, and the use of fear appeals is an effective method to achieve good control. Based on the Extended Parallel Process Model (EPPM) and Appraisal-Tendency Framework (ATF), this article presents a 2 × 2 control experiment to test the impact of fear appeals on the perception of risk, emotions, and behavioral motivation of young people aged 35 and less. A total of 333 valid samples of adolescents and young adults were included to investigate the different response paths to fear appeals among young people of different age, sex and smoking history. The results show that high-threat, high-efficacy fear appeals are able to: (1) significantly increase young people's perception of the e-cigarette-associated threats, (2) trigger fear and anger amongst young people, and (3) stimulate their self-protection motivation. Fear appeals do not have an impact on young people's perception of efficacy, regardless of their level of threat and efficacy. High fear appeals can also increase young people's perception of threat, which in turn enhances their anger and protection motivation. Furthermore, while this type of fear appeal can enhance young women's perception of efficacy, it cannot enhance the perception of e-cigarette risks in adolescents, young men and young smokers, regardless of their level of threat and efficacy. Young non-smokers have a higher perception of the risks involved in the use of e-cigarettes compared with young smokers.

Clinical symptoms of anxiety disorders as predictors of political attitudes: A prospective cohort study

Conservative political ideologies have been suggested to correlate with elevated sensitivity to threat. However, it is unclear whether the associations between threat sensitivity and political attitudes can be observed with clinical measures of mental health. We examined how anxiety disorders predicted attitudes on several political issues. Participants were 7253 individuals from the 1958 British Birth Cohort study. Symptoms of generalised anxiety disorder, phobia and panic were assessed in a clinical interview at age 44, and opinions about political issues were self-reported by the participants 6 years later. Anxiety symptoms were associated with higher concerns about economic inequality, preservation of the environment, distrust in politics and lower work ethic. No associations were observed with racist or authoritarian attitudes, or support for traditional family values. We also assessed how political attitudes at ages 33 and 42 predicted anxiety disorder symptoms at age 44, revealing a possible bidirectional association between concern for economic inequality and anxiety disorder symptoms. These findings do not support an association between conservative political attitudes and elevated threat sensitivity. Rather, elevated anxiety may increase concerns about social inequality and the environment.