Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective

Resilience in good outcome patients with fatigue after aneurysmal subarachnoid hemorrhage

Resilience is a psychological process that encompasses various facets of personality traits, behaviour, as well as coping, and it enhances the adjustment to adversities faced. Although a lot of interest has been devoted to the protective effects of resilience in handling affective disorders, little is known about the relationship between resilience and chronic fatigue, which is a common and potentially disabling sequel in survivors of aneurysmal subarachnoid hemorrhage (aSAH). Ninety-six good outcome patients with chronic post-aSAH fatigue answered the Resilience Scale for Adults (RSA) which assesses 6 distinct aspects of resilience. They also answered the Fatigue Severity Scale (FSS), Mental Fatigue Scale (MFS), Beck Depression Inventory (BDI-II), Beck's Anxiety Inventory (BAI), and the Brief COPE. The RSA scores were related to fatigue, emotional burden and coping. The prevailing resilience factor was "Social Resources". Patients with the highest scores for fatigue and emotional symptoms scored significantly lower for the factors "Perception of Self", "Perception of Future" and "Family Cohesion". Patients with clinically significant depression scored low across most RSA factors, with the weakest factors being "Perception of Self" and "Perception of Future". Resilience factors were positively associated with adaptive problem focused coping strategies, and in particular with the emotional coping strategy "Acceptance", whereas they correlated negatively with maladaptive avoidant coping. strategies. There is a close interaction between high resilience, adaptive coping strategies and lower burden of chronic fatigue and emotional symptoms.

An emotionally intelligent haptic system - An efficient solution for anxiety detection and mitigation

BACKGROUND

Anxiety is a psycho-physiological condition associated with an individual's mental state. Long-term anxiety persistence can lead to anxiety disorder, which is the underlying cause of many mental health problems. As such, it is critical to precisely identify anxiety by automated, effective, and user-bias-free ways.

OBJECTIVE

The objective of this study is to develop an innovative emotionally intelligent Haptic system for anxiety detection, which can be used to track and manage people's anxiety.

METHOD

The suggested approach incorporates a haptic feedback mechanism that is based on EEG data and is analysed by machine learning algorithms. This allows users to effectively control their emotional well-being by receiving timely feedback and assessments of their anxiety levels. First, the authors use publicly accessible data to present an experimental study for the categorization of human anxiety.

RESULTS

The ensemble model used for the classification produces results with a 97 % accuracy rate, 0.98 recall, 0.99 precision, and a 0.99 F1 score. Furthermore, self-curated data is subjected to an advanced spike analysis algorithm that identifies signal spikes and then quantifies the level of anxiety.

CONCLUSION

The results obtained demonstrate that haptic stimuli are produced smoothly, offering a comprehensive and innovative method of managing anxiety.

Pupil size as a biomarker of cognitive (dys)functions: Toward a physiologically informed screening of mental states

The objective assessment of cognitive processes is of critical importance to understanding the mechanisms underlying various mental functions and dysfunctions. In recent years, the technological innovations related to the eye-tracking industry made the time right to organically integrate pupillometry in the assessment of cognitive profiles. Here, we review evidence showing that pupillometry offers a uniquely sensitive biomarker of the functioning of several distinct networks, cognitive functions, emotional states, and individual differences in their instantiation. We outline why and how pupillometry can be effectively exploited to enrich current research and behavioral paradigms, including those designed for clinical testing. By making the cases of anxiety disorders (both generalized and specific - e.g., generalized anxiety vs. math anxiety) and substance use disorders, we then exemplify how pupillometry can be leveraged to obtain clinically meaningful variables. We finally conclude by arguing that measuring pupil size has the potential to complement more traditional, but coarse assessment methods, to return a more graded, objective, and physiologically informed picture of cognitive functioning.

"Warning-This Content May Trigger Temporary Discomfort, Which Is Expected and Manageable": The Effect of Modified Trigger-Warning Language on Reactions to Emotionally Provocative Content

A growing body of research suggests that trigger warnings do not actually reduce distress in those viewing emotionally provocative stimuli and may at times even worsen it. However, little is known regarding the potential benefits of modifying trigger-warning language so that it employs therapeutically consistent messaging to encourage adaptive coping. The current study explored whether a modified trigger warning might be more effective than a traditional trigger warning in reducing participants' negative affect (NA) when exposed to distressing content. University students (N = 606) participated in an online study and were randomly assigned to one of three conditions: traditional trigger warning, modified trigger warning, or a no-warning control group. NA was measured before and after display of two emotionally provocative stimuli (one article and one video). Anxiety sensitivity (AS) and posttraumatic stress symptoms (PTSS) were also measured to assess whether these preexisting individual vulnerabilities might moderate participants' responses to the different messages. Although the carefully pilot-tested stimuli were successful in increasing NA, there was no significant effect of trigger-warning condition, despite ample statistical power. AS and PTSS were associated with higher overall levels of NA but did not interact with study condition. These results add to the growing body of literature suggesting trigger warnings (whether traditional or modified) do not succeed in their goal of reducing the distress elicited by emotionally provocative content, including among vulnerable individuals. Alternative approaches to traditional trigger warnings are considered that may help individuals cope adaptively with potentially distressing material.

The Relationship between OCD and Depression in Adults: A Review of Recent Findings

PURPOSE OF REVIEW

We aimed to investigate the recent understanding of the frequent coexistence of obsessive-compulsive disorder (OCD) and major depression (MDD), exploring both clinical and mechanistic perspectives. Our focus was on deriving conclusions with therapeutic implications.

RECENT FINDINGS

While biological factors contribute to the development of OCD-MDD, the comorbidity seems to be primarily induced by the convergence of symptoms that complicate the course of OCD. Tailored cognitive-behavioral therapy programs, specifically addressing MDD, alongside SSRI medication, may prove beneficial for patients experiencing moderate to severe forms of this comorbidity. The review underscores the significance of comorbidity from both diagnostic and therapeutic perspectives. However, existing research has yet to offer a clear understanding of the underlying mechanisms. Further research in the field, notably coming from network studies, could enrich our practice by helping to target specific dimensions that underly OCD-MDD comorbidity.

Counteracting uncertainty: exploring the impact of anxiety on updating predictions about environmental states

Anxious emotional states disrupt decision-making and control of dexterous motor actions. Computational work has shown that anxiety-induced uncertainty alters the rate at which we learn about the environment, but the subsequent impact on the predictive beliefs that drive action control remains to be understood. In the present work we tested whether anxiety alters predictive (oculo)motor control mechanisms. Thirty participants completed an experimental task that consisted of manual interception of a projectile performed in virtual reality. Participants were subjected to conditions designed to induce states of high or low anxiety using performance incentives and social-evaluative pressure. We measured subsequent effects on physiological arousal, self-reported state anxiety, and eye movements. Under high pressure conditions we observed visual sampling of the task environment characterised by higher variability and entropy of position prior to release of the projectile, consistent with an active attempt to reduce uncertainty. Computational modelling of predictive beliefs, using gaze data as inputs to a partially observable Markov decision process model, indicated that trial-to-trial updating of predictive beliefs was reduced during anxiety, suggesting that updates to priors were constrained. Additionally, state anxiety was related to a less deterministic mapping of beliefs to actions. These results support the idea that organisms may attempt to counter anxiety-related uncertainty by moving towards more familiar and certain sensorimotor patterns.

COVID-19 affected elite track-and-field athletes' Olympic preparation before Tokyo 2020 compared to Rio 2016

The COVID-19 pandemic has had a significant impact on elite sport by postponing the Olympic Games Tokyo 2020 four months before the original start. This impacted athletes' macro-cycle periodization, psychological stressors and resources. We analyse whether track-and-field athletes were able to maintain their performance levels successfully across the last two Olympic cycles, controlling for age, gender and doping prevalence. For this, worldwide competition results (excluding multi-events & relays) of at least national level since London 2012 and up to Tokyo 2020 were retrieved. Individual performance curves were analysed using hierarchical multilevel modelling. Individual baselines (random intercept) and developments (random slope) were analysed. 2,383 athletes (52% male) recorded 15,766 outcomes since London 2012. The final conditional growth model (ICC = 48%) shows that performances increased in the wake of Olympic games, dropped significantly in 2020 and recovered beyond previous form in 2021. There was no significant difference between men's and women's developments. Age was a significant predictor (b = 0.17, SE = 0.02), but doping violations was not (b = 0.01, SE = 0.03). These results showcase performance trends in international athletics and their variability, present an overall successful periodization to achieve peak performance at Tokyo 2020, and discuss predictions for track and field at Paris 2024.

Integrating behavioral and neurophysiological insights: High trait anxiety enhances observational fear learning

Observational fear learning delineates the process by which individuals learn about potential threats through observing others' reactions. Prior research indicates that individuals with high trait anxiety (HTA) manifest pronounced fear responses in direct fear learning scenarios. However, the specific influence of trait anxiety on observational fear learning remains insufficiently explored. This study aimed to fill this gap by examining 64 university students, divided equally between those with HTA and low trait anxiety (LTA), selected from an initial pool of 483 participants. Participants were subjected to observational fear learning tasks, and their behavioral responses, physiological reactions, and brain activations were recorded. Results demonstrated that HTA participants exhibited differentiated skin conductance responses to threat and safety stimuli during the observational fear acquisition phase, notwithstanding prior assurances against shock delivery. Furthermore, during the direct test phase, HTA participants reported significantly elevated fear and shock expectancy ratings for both types of stimuli, in contrast to their LTA counterparts. Neuroimaging data, derived via functional near-infrared spectroscopy (fNIRS) revealed heightened medial prefrontal cortex activation in HTA participants when directly facing threats. This study systematically explores the influence of high trait anxiety on observational fear learning, uncovering that HTA individuals exhibit excessive fear responses. These findings highlight the critical role of trait anxiety as a significant risk factor in the development of anxiety disorders.

The projection from the rostral anterior cingulate cortex to the ventral tegmental area regulates 5-HT-induced itch aversion and scratching in rats

Many studies in humans and rodents have shown that the anterior cingulate cortex (ACC) plays a critical role in the regulation of pain-related aversion and that the projection from the rostral ACC (rACC) to the ventral tegmental area (VTA) is implicated in this modulation process. The ACC is also reported to be involved in the regulation of itch-scratch behavior. However, it remains unclear whether the ACC is involved in the modulation of the negative emotions induced by acute itch sensation. In this study, we investigated the pruritogen-induced conditioned place aversion (CPA) and itch-scratching behavior in rats after pharmacogenetic inhibition of the activities of rACC-VTA pathway or the rACC neurons, respectively. Pharmacogenetic inhibition of glutamatergic neurons of rACC projecting to the VTA alleviated the CPA responses and itch-scratching behavior induced by the subcutaneous injection of 5-HT, a nonhistamine-dependent pruritogen. However, pharmacogenetic inhibition of rACC neurons did not change the CPA behavior associated with itch and, conversely, increased itch-scratching behavior. These results reveal that a specific subpopulation of rACC neurons projecting to the VTA positively regulates itch sensation and the negative emotion accompanying itch, whereas the global rACC negatively modulates acute non-histaminergic itch in rats. Postsynaptic GABAergic neurons in the VTA may mediate emotion modulation of the rACC-VTA pathway. The current findings contribute to a better understanding of the circuit mechanisms underlying the processing of different components of itch, such as sensation and emotion.

How and Why Does Leader Anger Expression Influence Employees' Deviant Innovation? Ability-Based Mianzi Stress and Workplace Anxiety Explanations of the Curvilinear Moderated Relations

Leader anger expression affects leadership effectiveness and employees' work status. Based on the theory of emotion as social information, we theorized a serial curvilinear mediated moderation model that links leader anger expression to deviant innovation under weak versus strong supervisor's organizational embodiment. The results of our field of 289 employees showed that the mediated relationship between leader anger expression and deviant innovation was non-linear. Moreover, this non-linear mediated relationship was moderated by supervisor's organizational embodiment such that, under strong supervisor's organizational embodiment, the indirect effect via ability-based Mianzi stress and workplace anxiety was positive at high levels of leader anger expression, while, under conditions of supervisor's organizational embodiment, the indirect effect via ability-based Mianzi stress was insignificant at low levels of leader anger expression, the indirect effect via workplace anxiety was negative as low levels of leader anger expression and positive at intermediate to high levels. We discussed the theoretical and practical implications for current and future leader anger expression research.

Brain dynamics and spatiotemporal trajectories during threat processing

In the past decades, functional MRI research has investigated task processing in a largely static fashion based on evoked responses during blocked and event-related designs. Despite some progress in naturalistic designs, our understanding of threat processing remains largely limited to those obtained with standard paradigms with limited dynamics. In the present paper, we applied Switching Linear Dynamical Systems to uncover the dynamics of threat processing during a continuous threat-of-shock paradigm. First, we demonstrated that the SLDS model learned the regularities of the experimental paradigm, such that states and state transitions estimated from fMRI time series data from 85 regions of interest reflected threat proximity and threat approach vs. retreat. After establishing that the model captured key properties of threat-related processing, we characterized the dynamics of the states and their transitions. Importantly, we characterized both endogenous and exogenous contributions to dynamics. The results revealed how threat processing can be viewed in terms of dynamic multivariate patterns whose trajectories are a combination of intrinsic and extrinsic factors that jointly determine how the brain temporally evolves during dynamic threat. Furthermore, we developed a measure of region importance that quantifies the contributions of an individual brain region to system dynamics, which complements the system-level characterization that is obtained with the state-space SLDS formalism. Finally, we investigated the generalizability of the modelling approach. The successful application of the SLDS model trained on one paradigm to a separate experiment illustrates the potential of this approach to capture fMRI dynamics that generalize across related but distinct threat-processing tasks. We propose that viewing threat processing through the lens of dynamical systems offers important avenues to uncover properties of the dynamics of threat that are not unveiled with standard experimental designs and analyses.

Optimism and emergency preparedness self-efficacy: Moderators of the relationship between perceived threat of disasters and COVID-19 anxiety symptoms

Objectives: Despite research showing the impact of the threat of COVID-19 on mental health, scholars have failed to examine the relationship between perceived disaster threat and COVID-19 anxiety. Factors that buffer that positive relationship (e.g., optimism and emergency preparedness self-efficacy or EPSE) are also understudied. Thus, we examined the relationship between the perceived threat of disasters and COVID-19-related anxiety, as well as potential moderating factors of this relationship, including optimism and EPSE. Participants and methods: Participants were a representative sample of U.S. college students (N = 392) recruited through Prolific.co who completed measures in an online Qualtrics survey. Results: Both optimism and EPSE were significant moderators of the relationship between perceived threat and symptoms of anxiety related to COVID-19. When both moderators were included in a double moderation model analysis, only EPSE remained a significant moderator. Conclusions: These findings reflect the importance of cultivating protective psychological resources to protect college students' well-being during disasters.

A shared threat-anticipation circuit is dynamically engaged at different moments by certain and uncertain threat

Temporal dynamics play a central role in models of emotion: "fear" is widely conceptualized as a phasic response to certain-and-imminent danger, whereas "anxiety" is a sustained response to uncertain-or-distal harm. Yet the underlying neurobiology remains contentious. Leveraging a translationally relevant fMRI paradigm and theory-driven modeling approach in 220 adult humans, we demonstrate that certain- and uncertain-threat anticipation recruit a shared circuit that encompasses the central extended amygdala (EAc), periaqueductal gray, midcingulate, and anterior insula. This circuit exhibits persistently elevated activation when threat is uncertain and distal, and transient bursts of activation just before certain encounters with threat. Although there is agreement that the EAc plays a critical role in orchestrating responses to threat, confusion persists about the respective contributions of its major subdivisions, the bed nucleus of the stria terminalis (BST) and central nucleus of the amygdala (Ce). Here we used anatomical regions-of-interest to demonstrate that the BST and Ce exhibit statistically indistinguishable threat dynamics. Both regions exhibited activation dynamics that run counter to popular models, with the Ce showing sustained responses to uncertain-and-distal threat and the BST showing phasic responses to certain-and-imminent threat. For many scientists, feelings are the hallmark of fear and anxiety. Here we used an independently validated multivoxel brain 'signature' to covertly probe the moment-by-moment dynamics of anticipatory distress for the first time. Results mirrored the dynamics of neural activation. These observations provide fresh insights into the neurobiology of threat-elicited emotions and set the stage for more ambitious clinical and mechanistic research.

Intolerance of Uncertainty and Its Association With Cancer-Related Symptoms: A Scoping Review

BACKGROUND

Cancer-related symptoms have negative impacts on the health outcomes of adults with cancer. Thus, it is critical to identify who might be at risk. Intolerance of uncertainty (IU) could be the major contributor for cancer-related symptoms; however, this relationship is understudied in the context of cancer.

OBJECTIVE

The purpose of this scoping review was to map the literature that has investigated IU and its link to cancer-related symptoms.

METHODS

This scoping review used the framework proposed by Arksey and O'Malley and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A comprehensive search was conducted using 5 databases. English-language primary research published focusing on IU and cancer-related symptoms was included in this review.

RESULTS

Of 12 articles included in this review, 11 studies found a positive relationship of IU with affective symptoms, including anxiety, depression, stress, fear, worry, and distress. Additionally, one study showed that higher IU was associated with greater cognitive impairment and that association was mediated by anxiety.

CONCLUSION

Findings from this scoping review support the positive association between IU and cancer-related symptoms. This review further suggests that IU could be a potential risk factor for cancer-related affective and cognitive symptoms.

IMPLICATION FOR PRACTICE

The incidence of affective and cognitive symptoms in cancer survivors is high. Given that IU is associated with these symptoms, IU-focused treatments may be beneficial in this group.

More and Less Fear in Serotonin Transporter Knockout Mice

Recent theories suggest that reduced serotonin transporter (5-HTT) function, which increases serotonin (5-HT) levels at the synapse, enhances neural plasticity and affects sensitivity to environmental cues. This may promote learning about emotionally relevant events. However, the boundaries that define such emotional learning remain to be established. This was investigated using 5-HTT knockout (5-HTTKO) mice which provide a model of long-term elevated 5-HT transmission and are associated with increased anxiety. Compared to wild-type controls, 5-HTTKO mice were faster to discriminate between an auditory cue that predicted footshock (CS+) and a cue predicting no footshock (CS-). Notably, this enhanced discrimination performance was driven not by faster learning that the CS+ predicted footshock, but rather by faster learning that the CS- cue signals the absence of footshock and thus provides temporary relief from fear/anxiety. Similarly, 5-HTTKO mice were also faster to reduce their fear of the CS+ cue during subsequent extinction. These findings are consistent with facilitated inhibitory learning that predicts the absence of potential threats in 5-HTTKO mice. However, 5-HTTKO mice also exhibited increased generalisation of fear learning about ambiguous aversive cues in a novel context, different from the training context. Thus, 5-HTTKO mice can exhibit both more and less fear compared to wild-type controls. Taken together, our results support the idea that loss of 5-HTT function, and corresponding increases in synaptic 5-HT availability, may facilitate learning by priming of aversive memories. This both facilitates inhibitory learning for fear memories but also enhances generalisation of fear.

Startle potentiation to unpredictable threat predicts adolescent development of generalized anxiety disorder

BACKGROUND

An elevated startle reflex in anticipation of unpredictable threat has been associated with concurrent anxiety disorders. However, only one study to date has examined whether startle potentiation in anticipation of unpredictable threat predicts the development of anxiety disorders.

METHOD

In a community sample of 309 adolescents, we examined whether the startle reflex in anticipation of predictable or unpredictable threat at age 15 predicted onset of generalized anxiety disorder (GAD) and social anxiety disorder (SAD) at age 18. To evaluate the specificity of these relationships, we also examined the development of depressive disorders. Startle reflex was measured using the no, predictable, and unpredictable threat task at age 15. Semi-structured diagnostic interviews were administered at both waves to assess lifetime anxiety disorders and depression.

RESULTS

Average startle reflex and startle potentiation to unpredictable, but not predictable, threat at age 15 predicted GAD at age 18, independent of lifetime GAD through age 15 and lifetime depression through age 18. Startle responses at age 15 did not predict SAD or depression at age 18.

CONCLUSIONS

The present study suggests that elevated startle potentiation in anticipation of unpredictable threat is a risk factor for the development of GAD in adolescence.

Altered Effective Connectivity During Threat Anticipation in Individuals With Alcohol Use Disorder

BACKGROUND

A developing theory and recent research suggest that heightened reactivity to uncertain stressors or threats may be an important individual difference factor that facilitates excessive drinking as a means of avoidance-based coping and characterizes individuals with current and past alcohol use disorder (AUD). Neuroimaging studies of unpredictable threat processing have repeatedly demonstrated activation of the anterior insula, anteromedial thalamus, and dorsal anterior cingulate cortex. In the current study, we aimed to understand how these 3 regions function as a network during anticipation of unpredictable threat (and predictable threat).

METHODS

Participants were 43 adults (ages 21-30) with AUD and 26 healthy control participants. Functional magnetic resonance imaging and dynamic causal modeling were used to study interregional effective connectivities and predictable and unpredictable threat-related modulations thereof within this network. Parametric empirical Bayesian modeling was used to conduct between-group comparisons in effective connectivities.

RESULTS

During unpredictable threat trials, the increased projection from the right anteromedial thalamus to the right anterior insula was significantly present only in the AUD group. This directional influence was stronger among individuals who consumed more drinks per week on average. As expected, we found no group differences in modulatory changes to effective connectivities during predictable threat trials.

CONCLUSIONS

To our knowledge, this is the first study to examine directional interactions between key frontolimbic regions during anticipation of unpredictable and predictable threat and demonstrate the importance of bottom-up thalamic-insular projections during unpredictable threat processing in AUD. Prospective studies are warranted to determine whether this association is causal.

How is emotional evidence from multiple sources used in perceptual decision making?

Judging the emotional nature of a scene requires us to deliberately integrate pieces of evidence with varying intensities of emotion. Our existing knowledge about emotion-related perceptual decision-making is largely based on paradigms using single stimulus and, when involving multiple stimuli, rapid decisions. Consequently, it remains unclear how we sample and integrate multiple pieces of emotional evidence deliberately to form an overall judgment. Findings from non-emotion rapid decision-making studies show humans down-sample and downweight extreme evidence. However, deliberate decision-making may rely on a different attention mode than in rapid decision-making; and extreme emotional stimuli are inherently salient. Given these critical differences, it is imperative to directly examine the deliberate decision-making process about multiple emotional stimuli. In the current study, human participants (N = 33) viewed arrays of faces with expressions ranging from extremely fearful to extremely happy freely with their eye movement tracked. They then decided whether the faces were more fearful or happier on average. In contrast to conclusions drawn from non-emotion and rapid decision-making studies, eye movement measures revealed that participants attentionally sampled extreme emotional evidence more than less extreme evidence. Computational modeling results indicated that even though participants exhibited biased attention distribution, they weighted various emotional evidence equally. These findings provide novel insights into how people sample and integrate multiple pieces of emotional evidence, contribute to a more comprehensive understanding of emotion-related decision-making, and shed light on the mechanisms of pathological affective decisions.

Impact of problem-based learning on stigma toward epilepsy among medical students: An intervention verification study

INTRODUCTION

Stigma toward epilepsy is widespread not only among the general population but also among healthcare professionals. Therefore, the necessity of providing educational opportunities for epilepsy from an early stage in student education has been emphasized. Recently, problem-based learning (PBL) has gained importance in higher education, with reports indicating that it not only enhances knowledge but also reduces stigma.

OBJECTIVE

This study aimed to evaluate the effects of an epilepsy-related problem-based learning (E-PBL) program on medical students' stigma toward epilepsy. Additionally, we assessed whether the E-PBL program improved medical students' knowledge of epilepsy.

MATERIALS AND METHODS

Participants were fourth-year medical students. The E-PBL program was conducted over 5 days, from July 3, 2023 to July 7, 2023. The outcomes included the Japanese version of the Public Attitudes Toward Epilepsy (PATE-J) scale, which was used to assess stigma toward epilepsy before and after the E-PBL program. We also administered a short, structured questionnaire to assess participants' knowledge of epilepsy.

RESULTS

In total, 112 students were examined. The total PATE-J score was significantly lower after E-PBL (median: 18; interquartile range [IQR]: 14-20) than before PBL (median: 19; IQR: 16-23) (p = 0.013). Additionally, the number of correct responses to the short, structured questionnaire after the E-PBL program was significantly higher than before the program (p < 0.001).

CONCLUSIONS

E-PBL programs have the potential to decrease stigma toward epilepsy while enhancing knowledge about epilepsy among medical students. E-PBL represents a novel educational approach for medical students in the context of epilepsy education.

Exploring the Interplay Between Self-Identity, Affective Style, Emotion Regulation, and Anxiety: Based on Bayesian Network Model

OBJECTIVE

This study aimed to explore the complex relationships between self-identity, affective style, emotion regulation, and intolerance of uncertainty (IU) in predicting anxiety. A model was proposed to integrate these factors, investigating their combined influence on anxiety.

METHOD

Involving 608 university students who completed self-report measures of self-identity, affective style, emotion regulation, IU, and anxiety. Network analysis and Bayesian network modeling were used to identify direct and mediating effects among these variables.

RESULTS

Network analysis revealed that self-identity, affective style, and IU directly predicted trait anxiety, with adjusting affective style emerging as a central factor. Bayesian network modeling further showed that IU and affective style mediated the impact of self-identity on anxiety. Notably, emotion regulation did not mediate the relationship between affective style and anxiety, suggesting a possible spurious correlation. The model achieved a predictive accuracy of 90.13% for trait anxiety and 88.49% for state anxiety.

CONCLUSION

The findings highlight the central role of self-identity in anxiety interventions, while also emphasizing the importance of addressing affective styles and IU. The results suggest that emotion regulation strategies alone may not directly reduce anxiety, indicating a need for more comprehensive clinical approaches.

Infectious Illness Symptoms Are Associated with Elevated Anxiety in a Sample of Sexual and Gender Minority Young Adults During the COVID-19 Pandemic

BACKGROUND

To evaluate whether infectious illness symptoms (IIS) are associated with generalized anxiety symptoms during the COVID-19 pandemic in sexual/gender (SGM) minority young adults assigned male at birth (AMAB).

METHOD

Four hundred eighteen participants (median age = 25; range, 20-40) were recruited through RADAR, an ongoing Chicago-based cohort study of SGM-AMAB between September 2020 and February 2021. Participants completed online surveys. A subset (n = 145) provided dried blood spot samples to assess SARS-CoV-2 serostatus.

RESULTS

One hundred twenty participants (28.7%) had GAD-7 scores of 10 or greater, which indicates generalized anxiety symptoms that may be clinically significant. In a binomial logistic regression model adjusting age, gender identity, race/ethnicity, substance use, and HIV status, the authors found that having a higher IIS count since March 1, 2020, was associated with greater odds of having a GAD-7 score of 10 or greater (OR = 1.14; 95% CI, 1.04, 1.25; P = 0.007). This effect was more pronounced in a binomial logistic regression model adjusting for the same covariates but using current IIS count as the independent variable (OR = 1.39; 95% CI, 1.13, 1.74; P = 0.002).

CONCLUSION

Among SGM-AMAB young adults, those who experienced ISS reported higher scores on the GAD-7, a widely used and validated screening measure for generalized anxiety symptoms. These findings highlight the importance of screening for anxiety disorders when patients present with IIS in clinical settings and psychobehavioral health follow-ups when indicated.

Individual differences in intolerance of uncertainty is primarily linked to the structure of inferior frontal regions

Increased intolerance of uncertainty (IU), or distress felt when encountering situations with unknown outcomes, occurs transdiagnostically across various forms of psychopathology and is targeted in therapeutic intervention. Increased intolerance of uncertainty shows overlap with symptoms of internalizing disorders, such as depression and anxiety, including negative affect and anxious apprehension (worry). While neuroanatomical correlates of IU have been reported, previous investigations have not disentangled the specific neural substrates of IU above and beyond any overlapping relationships with aspects of internalizing psychopathology. The current study did so in a sample of 42 adults and 79 adolescents, who completed questionnaires assessing IU and internalizing symptoms, and underwent structural MRI. When controlling for internalizing symptoms, across adults and adolescents, specific associations of IU were found with the structure of the inferior frontal cortex and orbitofrontal cortex, regions implicated in cognitive control and emotional valuation/regulation. In addition, in adolescents, associations were observed with rostral middle frontal cortex and portions of the cingulate cortex. No associations were observed with threat-related regions, such as the amygdala. Potential cognitive/emotional mechanisms that might explain the association between individual differences in intolerance of uncertainty and morphology of the inferior frontal cortex are discussed.

Projection-targeted photopharmacology reveals distinct anxiolytic roles for presynaptic mGluR2 in prefrontal- and insula-amygdala synapses

Dissecting how membrane receptors regulate neural circuits is critical for deciphering principles of neuromodulation and mechanisms of drug action. Here, we use a battery of optical approaches to determine how presynaptic metabotropic glutamate receptor 2 (mGluR2) in the basolateral amygdala (BLA) controls anxiety-related behavior in mice. Using projection-specific photopharmacological activation, we find that mGluR2-mediated presynaptic inhibition of ventromedial prefrontal cortex (vmPFC)-BLA, but not posterior insular cortex (pIC)-BLA, connections produces a long-lasting decrease in spatial avoidance. In contrast, presynaptic inhibition of pIC-BLA connections decreases social avoidance and novelty-induced hypophagia without impairing working memory, establishing this projection as a novel target for the treatment of anxiety disorders. Fiber photometry and viral mapping reveal distinct activity patterns and anatomical organization of vmPFC-BLA and pIC-BLA circuits. Together, this work reveals new aspects of BLA neuromodulation with therapeutic implications while establishing a powerful approach for optical mapping of drug action.

Frequency-specific changes in prefrontal activity associated with maladaptive belief updating in volatile environments in euthymic bipolar disorder

Bipolar disorder (BD) involves altered reward processing and decision-making, with inconsistencies across studies. Here, we integrated hierarchical Bayesian modelling with magnetoencephalography (MEG) to characterise maladaptive belief updating in this condition. First, we determined if previously reported increased learning rates in BD stem from a heightened expectation of environmental changes. Additionally, we examined if this increased expectation speeds up belief updating in decision-making, associated with modulation of rhythmic neural activity within the prefrontal, orbitofrontal, and anterior cingulate cortex (PFC, OFC, ACC). Twenty-two euthymic BD and 27 healthy control (HC) participants completed a reward-based motor decision-making task in a volatile setting. Hierarchical Bayesian modelling revealed BD participants anticipated greater environmental volatility, resulting in a more stochastic mapping from beliefs to actions and paralleled by lower win rates and a reduced tendency to repeat rewarded actions than HC. Despite this, BD individuals adjusted their expectations of action-outcome contingencies more slowly, but both groups invigorated their actions similarly. On a neural level, while healthy individuals exhibited an alpha-beta suppression and gamma increase during belief updating, BD participants showed dampened effects, extending across the PFC, OFC, and ACC regions. This was accompanied by an abnormally increased beta-band directed information flow in BD. Overall, the results suggest euthymic BD individuals anticipate environmental change without adequately learning from it, contributing to maladaptive belief updating. Alterations in frequency-domain amplitude and functional connectivity within the PFC, OFC, and ACC during belief updating underlie the computational effects and could serve as potential indicators for predicting relapse in future research.

Distinct computational mechanisms of uncertainty processing explain opposing exploratory behaviors in anxiety and apathy

BACKGROUND

Decision-making in uncertain environments can lead to varied outcomes, and how we process those outcomes may depend on our emotional state. Understanding how individuals interpret the sources of uncertainty is crucial for understanding adaptive behavior and mental well-being. Uncertainty can be broadly categorized into two components: volatility and stochasticity. Volatility describes how quickly conditions change. Stochasticity, on the other hand, refers to outcome randomness. We investigated how anxiety and apathy influenced people's perceptions of uncertainty, and how uncertainty perception shaped explore-exploit decisions.

METHODS

Participants (N = 1001, non-clinical sample) completed a restless three-armed bandit task that was analyzed using both latent state and process models.

RESULTS

Anxious individuals perceived uncertainty as resulting more from volatility, leading to increased exploration and learning rates, especially after reward omission. Conversely, apathetic individuals viewed uncertainty as more stochastic, resulting in decreased exploration and learning rates. The perceived volatility-to-stochasticity ratio mediated the anxiety-exploration relationship post-adverse outcomes. Dimensionality reduction showed exploration and uncertainty estimation to be distinct but related latent factors shaping a manifold of adaptive behavior that is modulated by anxiety and apathy.

CONCLUSIONS

These findings reveal distinct computational mechanisms for how anxiety and apathy influence decision-making, providing a framework for understanding cognitive and affective processes in neuropsychiatric disorders.

Transcranial magnetic stimulation for obsessive-compulsive disorder and post-traumatic stress disorder: A comprehensive systematic review and analysis of therapeutic benefits, cortical targets, and psychopathophysiological mechanisms

Transcranial magnetic stimulation (TMS) is a safe non-invasive treatment technique. We systematically reviewed randomised controlled trials (RCTs) applying TMS in obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) to analyse its therapeutic benefits and explore the relationship between cortical target and psychopathophysiology. We included 47 randomised controlled trials (35 for OCD) and found a 22.7 % symptom improvement for OCD and 29.4 % for PTSD. Eight cortical targets were investigated for OCD and four for PTSD, yielding similar results. Bilateral dlPFC-TMS exhibited the greatest symptom change (32.3 % for OCD, N = 4 studies; 35.7 % for PTSD, N = 1 studies), followed by right dlPFC-TMS (24.4 % for OCD, N = 8; 26.7 % for PTSD, N = 10), and left dlPFC-TMS (22.9 % for OCD, N = 6; 23.1 % for PTSD, N = 1). mPFC-TMS showed promising results, although evidence is limited (N = 2 studies each for OCD and PTSD) and findings for PTSD were conflicting. Despite clinical improvement, reviewed reports lacked a consistent and solid rationale for cortical target selection, revealing a gap in TMS research that complicates the interpretation of findings and hinders TMS development and optimisation. Future research should adopt a hypothesis-driven approach rather than relying solely on correlations from imaging studies, integrating neurobiological processes with affective, behavioural, and cognitive states, thereby doing justice to the complexity of human experience and mental illness.

A novel analysis of interoceptive underpinnings of anxious psychopathology in COVID-19 survivors

INTRODUCTION

SARS-CoV-2 affects brain, body, and their interchange. We investigated interoceptive mechanisms in COVID-19 survivors focusing on their potential link with psychopathology and inflammatory biomarkers.

METHODS

We assessed interoceptive accuracy (IAc) and time-perceiving (TA) skills of 57 COVID-19 survivors one month after hospital discharge through, respectively, a heartbeats perception task and a time duration task. Each participant was assessed about his interoceptive awareness (IAw) through Multidimensional Assessment of Interoceptive Awareness questionnaire (MAIA) and then, screened for post-traumatic (Impact of Events Scale - IES-R), anxious (State-Trait Anxiety Inventory - STAI-Y1) and depressive (Zung Self-Rating Depression Scale - ZSDS; Beck Depression Inventory - BDI-13) symptoms. Biomarkers of inflammation (platelet count, PC; mean platelet volume, MPV and systemic immune-inflammation index, SII) were obtained in a subsample of 40 survivors by a blood sampling conducted at admission and discharge time from the hospital. Correlational, GLM, GLMZ, and mediation analyses were performed.

RESULTS

IAc did not correlate with TA confirming the reliability of interoceptive measure. IAc positively predicts MAIA's Trusting subscale and negatively predicts anxious psychopathology which fully mediates the effect of IAc on Trusting.PC at hospital admission predicts anxiety at one month after recovery. Again, a higher decrease of SII during hospitalization predicts higher IAc skill and lower anxiety state at one month. The link between SII change and anxiety is fully mediated by IAc.

CONCLUSIONS

Our results unveil a potential key role of interoception and brain-body interchange in the exacerbation and maintenance of anxiety psychopathology in COVID-19 survivors.

Hindbrain networks: Exploring the hidden anxiety circuits in rodents

Anxiety disorders are multifaceted conditions that engage numerous brain regions and circuits. While the hindbrain is pivotal in fundamental biological functions, its role in modulating emotions has been underappreciated. This review will uncover critical targets and circuits within the hindbrain that are essential for both anxiety and anxiolytic effects, expanding on research obtained through behavioral tests. The bidirectional neural pathways between the hindbrain and other brain regions, with a spotlight on vagal afferent signaling, provide a crucial framework for unraveling the neural mechanisms underlying anxiety. Exploring neural circuits within the hindbrain can help to unravel the neurobiological mechanisms of anxiety and elucidate differences in the expression of these circuits between genders, thereby providing valuable insights for the development of future anxiolytic drugs.

Neuromodulation of risk and reward processing during decision making in individuals with general anxiety disorder (GAD)

Individuals with general anxiety disorder (GAD) have an impaired future-oriented processing and altered reward perception, which might involve the ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC). Twenty-nine adults with GAD performed the balloon analogue risk-taking task (BART) and delay discounting task (DDT) during five sessions of transcranial direct current stimulation (tDCS) with different stimulation conditions. The stimulation conditions were: anodal dlPFC (F3)/cathodal vmPFC (Fp2), anodal vmPFC (Fp2)/cathodal dlPFC (F3), anodal dlPFC (F3)/cathodal right shoulder, anodal vmPFC (Fp2)/cathodal left shoulder, and sham stimulation. Cognitive modeling was used to extract process-based measures. The process-based modeling measures, rather than conventional outcome-based measures, showed a significant effect of stimulation condition. All real stimulation conditions improved the updating rate of prevalence, and risk taking in the BART. Moreover, for anodal dlPFC (F3)/cathodal vmPFC (Fp2), anodal vmPFC (Fp2)/cathodal dlPFC (F3), and anodal vmPFC (Fp2)/cathodal left shoulder stimulations we have observed an improvement in prior beliefs about the explosion. Also, for anodal dlPFC (F3)/cathodal vmPFC (Fp2), anodal dlPFC (F3)/cathodal right shoulder, anodal vmPFC (Fp2)/cathodal left shoulder we have observed more stable choice pattern. the DDT, exponential discounting rate and randomness were improved during anodal dlPFC and anodal vmPFC stimulation with extracranial return electrodes. Different roles of the targeted areas are discussed based on significant performance differences resulting from the specific electrode positions. The results suggest that different domains of reward processing are controlled by the vmPFC and dlPFC. The vmPFC is more relevant for value-based decision making with a positive expectation and chance-based randomness, whereas the dlPFC is more relevant for logic-based decision making.

Adolescent social anxiety is associated with diminished discrimination of anticipated threat and safety in the bed nucleus of the stria terminalis

Social anxiety-which typically emerges in adolescence-lies on a continuum and, when extreme, can be devastating. Socially anxious individuals are prone to heightened fear, anxiety, and the avoidance of contexts associated with potential social scrutiny. Yet most neuroimaging research has focused on acute social threat. Much less attention has been devoted to understanding the neural systems recruited during the uncertain anticipation of potential encounters with social threat. Here we used a novel functional magnetic resonance imaging paradigm to probe the neural circuitry engaged during the anticipation and acute presentation of threatening faces and voices in a racially diverse sample of 66 adolescents selectively recruited to encompass a range of social anxiety and enriched for clinically significant levels of distress and impairment. Results demonstrated that adolescents with more severe social anxiety symptoms experience heightened distress when anticipating encounters with social threat, and reduced discrimination of uncertain social threat and safety in the bed nucleus of the stria terminalis, a key division of the central extended amygdala (EAc). Although the EAc-including the bed nucleus of the stria terminalis and central nucleus of the amygdala-was robustly engaged by the acute presentation of threatening faces and voices, the degree of EAc engagement was unrelated to the severity of social anxiety. Together, these observations provide a neurobiologically grounded framework for conceptualizing adolescent social anxiety and set the stage for the kinds of prospective-longitudinal and mechanistic research that will be necessary to determine causation and, ultimately, to develop improved interventions for this often-debilitating illness. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Impact of behavioral inhibitory control and startle reactivity to uncertain threat on youth suicide risk

Poor inhibitory control and exaggerated threat reactivity are two well-established risk factors for suicide. Theory suggests that these two factors may interact to influence suicide risk, although few studies have directly tested these relationships. In the present study, we examined the unique and interactive effects of inhibitory control (IC) and threat reactivity on self-reported suicide risk in a sample of 132 youth, ages 16-19. The stop signal task was used as a behavioral index of IC. Threat reactivity was captured using a modified version of the No-Predictable-Unpredictable threat paradigm that includes threat of predictable (P-) and unpredictable (U-) mild electrical shock. Startle eyeblink potentiation was measured throughout the task as an index of aversive responding. All participants completed a battery of well-validated self-report measures including current suicide risk. Hierarchical linear regression analyses controlling for age and sex revealed no main effects of IC or threat reactivity. However, there was a significant IC by reactivity to uncertain threat (U-threat) interaction. At lower levels of IC, greater startle reactivity to U-threat was associated with greater suicide risk. At higher levels of IC, there was no association between reactivity to U-threat and suicide risk. These results suggest that individual differences in IC and reactivity to U-threat interact to influence suicide cognitions, shedding light on potential subgroups of individuals who might be at elevated risk.

The phobic brain: Morphometric features correctly classify individuals with small animal phobia

Specific phobia represents an anxiety disorder category characterized by intense fear generated by specific stimuli. Among specific phobias, small animal phobia (SAP) denotes a particular condition that has been poorly investigated in the neuroscientific literature. Moreover, the few previous studies on this topic have mostly employed univariate analyses, with limited and unbalanced samples, leading to inconsistent results. To overcome these limitations, and to characterize the neural underpinnings of SAP, this study aims to develop a classification model of individuals with SAP based on gray matter features, by using a machine learning method known as the binary support vector machine. Moreover, the contribution of specific structural macro-networks, such as the default mode, the salience, the executive, and the affective networks, in separating phobic subjects from controls was assessed. Thirty-two subjects with SAP and 90 matched healthy controls were tested to this aim. At a whole-brain level, we found a significant predictive model including brain structures related to emotional regulation, cognitive control, and sensory integration, such as the cerebellum, the temporal pole, the frontal cortex, temporal lobes, the amygdala and the thalamus. Instead, when considering macro-networks analysis, we found the Default, the Affective, and partially the Central Executive and the Sensorimotor networks, to significantly outperform the other networks in classifying SAP individuals. In conclusion, this study expands knowledge about the neural basis of SAP, proposing new research directions and potential diagnostic strategies.

Impact of post-traumatic stress disorder on epileptogenic networks: a functional connectivity study

Post-traumatic stress disorder (PTSD) is more common in patients with drug-resistant epilepsy. Some of these patients experience PTSD due to early psychotraumatic events. This study aims to assess the influence of PTSD on interictal functional connectivity using stereoelectroencephalography (SEEG) recordings in patients with temporal lobe DRE (TDRE). Two groups were considered: TDRE patients with PTSD (PTSD+, N = 11) and TDRE patients without PTSD (PTSD-, N = 12). All subjects had questionnaires measuring anxiety, depression, PTSD symptoms related to seizures, a diagnostic PTSD questionnaire, and a childhood trauma questionnaire. Resting state functional connectivity (FC) was evaluated on SEEG signals to analyze network characteristics. We mainly focused on brain regions involved in PTSD (amygdala, orbitofrontal cortex, hippocampus, insula, rhinal cortex, anterior cingulate cortex). Results revealed increased FC in PTSD + subjects in the brain regions involved in PTSD, but only in the hemisphere ipsilateral to the epileptogenic zone. In contrast, a decreased FC in the contralateral hemisphere was observed in the hippocampus. These findings support the existence of a PTSD-epilepsy-reinforced network, leading to FC alterations dependent on the epilepsy side and the region. Our study is the first to offer insights into the intricate dynamic linking PTSD and epilepsy and highlights the need for accounting for the influence of comorbidities on epileptogenic networks.

Computational Mechanisms of Information-Seeking in Anxiety

The drive to seek information through exploratory behavior is widespread in both humans and other animals. This can be adaptive in reducing uncertainty about the best course of action within novel or changing environments. However, exploratory behaviors can also become maladaptive if subjective uncertainty levels remain too high or too low, as may happen in states of elevated anxiety. In this article, we review recent studies investigating the influence of anxiety on information-seeking behavior. We focus primarily on studies using cognitive computational models and associated behavioral tasks designed to test specific exploratory strategies, which could each be affected by anxiety in distinct ways. Results of current studies remain mixed and highlight the importance of distinguishing potential effects of task, state vs. trait anxiety, somatic vs. cognitive anxiety, and clinical vs. sub-clinical anxiety. There are also a range of different information-seeking strategies that are necessary to consider. At present, many findings could be taken to support a picture in which cognitive anxiety, and/or trait anxiety more broadly, may increase information-seeking, while somatic and/or state anxiety could have opposing effects. However, a number of previous results also appear inconsistent or task-dependent. Future studies are needed to resolve these apparent inconsistencies and more directly disentangle effects of different dimensions of anxiety on the adaptive and maladaptive use of information-seeking.

The effects of emotional distress on attentional bias toward cigarette warnings according to smokers' anxiety levels

Anxiety is related with the substance use, including cigarette smoking. Avoidance is one of the strategies smokers with anxiety adopt to manage negative affect, which can be contradictory to a strategy of cigarette warnings that is used to induce negative affect to change smoking behaviors. Therefore, this study examined whether smokers' anxiety levels decrease their attentional biases toward cigarette warnings, especially in response to emotional distress. High-anxiety (n = 60) and low-anxiety (n = 60) smokers were randomly assigned to either a stress condition that utilized the PASAT-C task (Paced Auditory Serial Addition Task-Computer version) or a controlled condition. With the eye-tracking task that involved viewing 8 visual stimuli of cigarette packs composed of warnings and brandings, time to first fixation and fixation duration to warnings compared to brandings were measured both pre and post conditions. The results revealed that high-anxiety smokers detected warnings faster after stress conditions while low-anxiety smokers showed the consistent time to first fixation on warnings. In terms of fixation durations, high-anxiety smokers showed hypervigilance toward warnings that are considered to be a threat, but low-anxiety smokers showed avoidance under stress conditions, particularly toward social-focused warnings. These results indicate that high-anxiety smokers are more vulnerable to emotional distress and have an attentional bias toward fear appeals. Despite hypervigilance, they had greater psychological reactance toward warnings that the conflict between avoidance and hypervigilance might have contributed to, so the effectiveness of fear appeals may be limited regardless of the increased fixation duration.

The Six-Factor Cognitive Domino Model of Anxiety

Although humans have been exploring the mysteries of anxiety, relatively few specific cognitive pathways for generation of anxiety have been explored. We integrated many existing theories and experiences in clinical counseling to propose a new anxiety cognitive domino model of anxiety. The model suggests that there are six ordered cognitive factors that affect anxiety, which act like a domino effect, leading to the development and circulation of anxiety. On the one hand, this model provides a more comprehensive framework for understanding anxiety from the perspective of assessing abilities at different psychological stages. On the other hand, this model explores methods for pre managing anxiety before stressful events occur, which has practical significance for both individuals and organizations.

Assessing the Influence of Low Doses of Sucrose on Memory Deficits in Fish Exposed to Common Insecticide Based on Fipronil and Pyriproxyfen

Although pesticides have been a constant concern for decades, in the last ten years, public discussions and scientific research have emphasized their impact on human health and the environment, drawing increased attention to the problems associated with their use. The association of environmental stressors such as pesticides with a sugar-rich diet can contribute to the growing global metabolic disease epidemic through overlapping mechanisms of insulin resistance, inflammation, and metabolic dysregulation. The main aim of this study was to evaluate the behavioral effects of the exposure of Silver crucian carp (Carassius auratus gibelio) to a commercial insecticide formulation containing fipronil, pyriproxyfen, and other additives, as well as sucrose and their mixtures. The behavioral responses in the T-test showed significant abnormalities in the exploratory activity evocative of memory deficits and an increased degree of anxiety in the groups of fish treated with the insecticide formulation and the mixture of the insecticide with sucrose. Aggression, quantified in the mirror-biting test, as biting and the frequency of approaches to the mirror contact zone, was significantly decreased only in the insecticide and sucrose group. All three groups showed behavioral changes reflective of toxicity, but only the combination of the two stress factors, environmental (insecticide) and metabolic (sucrose intake), resulted in pronounced memory alterations.

Intricate mechanism of anxiety disorder, recognizing the potential role of gut microbiota and therapeutic interventions

Anxiety is a widespread psychological disorder affecting both humans and animals. It is a typical stress reaction; however, its longer persistence can cause severe health disorders affecting the day-to-day life activities of individuals. An intriguing facet of the anxiety-related disorder can be addressed better by investigating the role of neurotransmitters in regulating emotions, provoking anxiety, analyzing the cross-talks between neurotransmitters, and, most importantly, identifying the biomarkers of the anxiety. Recent years have witnessed the potential role of the gut microbiota in human health and disorders, including anxiety. Animal models are commonly used to study anxiety disorder as they offer a simpler and more controlled environment than humans. Ultimately, developing new strategies for diagnosing and treating anxiety is of paramount interest to medical scientists. Altogether, this review article shall highlight the intricate mechanisms of anxiety while emphasizing the emerging role of gut microbiota in regulating metabolic pathways through various interaction networks in the host. In addition, the review will foster information about the therapeutic interventions of the anxiety and related disorder.

Screening for Lung Cancer, Overdiagnosis, and Healthcare Utilization: A Nationwide Population-Based Study

INTRODUCTION

Guideline-discordant low-dose computed tomography (LDCT) screening may cause lung cancer (LC) overdiagnosis, but its extent and consequences are unclear. This study aimed to investigate the prevalence of self-initiated, non-reimbursed LDCT screening in a predominantly non-smoking population and its impact on LC epidemiology and healthcare utilization.

METHODS

This nationwide cohort study analyzed data from Korea's National Health Information Database and 11 academic hospital screening centers (1999-2022). The overall analysis encompassed the entire Korean population. For non-reimbursed LDCT screening prevalence, which the National Health Information Database does not capture, a separate analysis was conducted on a cohort of 1.7 million adults to extrapolate nationwide rates. Outcomes included trends in self-initiated, non-reimbursed LDCT screening, LC incidence, mortality, stage and age at diagnosis, 5-year survival, and LC-related healthcare utilization, including surgeries and biopsies. Joinpoint regression assessed trend changes.

RESULTS

Self-initiated, non-reimbursed LDCT screening during health check-ups increased from 29% to 60% in men and 7% to 46% in women, despite only 2.4% of men and 0.04% of women qualifying for risk-based screening. In women, localized-stage LC incidence nearly doubled (age-standardized incidence rate: from 7.6 to 13.7 per 100,000), whereas distant-stage incidence decreased (age-standardized incidence rate: from 16.1 to 15.0 per 100,000). LC mortality declined (age-standardized mortality rate: from 23.3 to 19.8 per 100,000), whereas 5-year survival rates improved substantially. LC diagnoses in women shifted towards earlier stages and younger ages. Lung surgeries for both malignant and benign lesions, frequently lacking nonsurgical biopsies, increased sharply in women.

CONCLUSIONS

Widespread guideline-discordant LDCT screening correlates with LC overdiagnosis and increased healthcare utilization, particularly in women. Randomized controlled trials are needed to assess the risks and benefits of screening in low-risk populations to determine its efficacy and consequences.

Assessing Barriers to Cancer Screening and Early Detection in Older Adults in Saudi Arabia: A Mixed-Methods Approach to Oncology Nursing Practice Implications

BACKGROUND

Access to cancer screening services is crucial for early detection and improved survival rates, yet older adults in Saudi Arabia face significant barriers. Recent data from the Saudi Health Ministry indicate that cancer incidence in this demographic is rising, underscoring the urgent need for enhanced screening efforts. This study explores the factors influencing cancer screening behaviors among older adults in Riyadh, using a mixed-methods approach to identify and address these barriers effectively.

METHODS

The study integrated quantitative data from 100 participants aged 60 and above who attended King Saud University-affiliated healthcare centers, and qualitative insights from 20 semi-structured interviews. The Barriers to Cancer Screening Scale (BCSS) quantitatively assessed barriers, while the thematic analysis of interview data helped identify key themes.

RESULTS

Findings revealed significant barriers, categorized into three primary themes: accessibility challenges, psychological barriers, and social influences. These include logistical difficulties related to transportation and service availability, fears and anxieties regarding cancer diagnoses, and a lack of family support and cultural stigma, all of which impact participants' willingness to engage in screening.

CONCLUSION

The study underscores the multifaceted barriers faced by older adults in accessing cancer screening in Saudi Arabia. Tailored interventions that address logistical, psychological, and social factors are essential to enhance screening uptake and ensure equitable access to preventive services. These findings contribute to the ongoing discussions on public health strategies and underscore the necessity for community and healthcare provider engagement to improve cancer screening rates in this population.

Excessive avoidance bias towards uncertain faces in non-clinical social anxiety individuals

Previous survey studies have consistently shown a strong link between social anxiety and intolerance for uncertainty. However, this association lacks empirical validation from laboratory investigations. To bridge this gap, we conducted a study utilizing the ultimatum game task to assign distinct social connotations (egoistic, altruistic, and uncertain) to three initially neutral faces. Subsequently, we utilized the Approach-Avoidance Task (AAT) paradigm to evaluate participants' approach-avoidance tendencies towards the faces with varying social meanings. Additionally, we collected data on participants' levels of social anxiety and trait anxiety. Our results indicate that both social anxiety and trait anxiety levels impact individuals' avoidance behaviors when faced with socially uncertain cues. This suggests that individuals with higher levels of social anxiety may demonstrate increased sensitivity to uncertainty in social contexts, leading to avoidance behaviors. Crucially, our findings directly underscore the heightened avoidance tendencies of non-clinical individuals with social anxiety towards socially uncertain stimuli, thereby providing new empirical support for research on anxiety disorders related to uncertainty.

Brain signatures of catastrophic events: Emotion, salience, and cognitive control

Anticipatory brain activity makes it possible to predict the occurrence of expected situations. However, events such as traffic accidents are statistically unpredictable and can generate catastrophic consequences. This study investigates the brain activity and effective connectivity associated with anticipating and processing such unexpected, unavoidable accidents. We asked 161 participants to ride a motorcycle simulator while recording their electroencephalographic activity. Of these, 90 participants experienced at least one accident while driving. We conducted both within-subjects and between-subjects comparisons. During the pre-accident period, the right inferior parietal lobe (IPL), left anterior cingulate cortex (ACC), and right insula showed higher activity in the accident condition. In the post-accident period, the bilateral orbitofrontal cortex, right IPL, bilateral ACC, and middle and superior frontal gyrus also showed increased activity in the accident condition. We observed greater effective connectivity within the nodes of the limbic network (LN) and between the nodes of the attentional networks in the pre-accident period. In the post-accident period, we also observed greater effective connectivity between networks, from the ventral attention network (VAN) to the somatomotor network and from nodes in the visual network, VAN, and default mode network to nodes in the frontoparietal network, LN, and attentional networks. This suggests that activating salience-related processes and emotional processing allows the anticipation of accidents. Once an accident has occurred, integration and valuation of the new information takes place, and control processes are initiated to adapt behavior to the new demands of the environment.

Computational modeling of social evaluative decision-making elucidates individual differences in adolescent anxiety

Adolescents experience significant developmental changes during a time of heightened sensitivity to social cues, particularly rejection by peers, which can be especially overwhelming for those with elevated levels of social anxiety. Social evaluative decision-making tasks have been useful in uncovering the neural correlates of information processing biases; however, linking youths' task-based performance to individual differences in psychopathology (e.g., anxiety symptoms) has proven more elusive. Here, we address this weakness with drift diffusion modeling to decompose youths' performance on the social judgment paradigm (SJP) to determine if this approach is useful in discovering individual differences in anxiety symptoms, as well as puberty, age, and sex. A sample of 103 adolescents (55 males, Mage = 14.49, SD = 1.69) completed the SJP and self-report measures of anxiety, as well as self- and parent-reported measures of puberty. The decision threshold parameter, reflecting the amount of evidence needed to make a social evaluative decision, predicted youth self-reported anxiety, above and beyond typical metrics of SJP performance. Our results highlight the potential advantage of parsing task performance according to the underlying cognitive processes. Future research would likely benefit from applying computational modeling approaches to social judgment tasks when attempting to uncover performance-based individual differences in psychopathology.

Patient-related predictors of post-operative pain following root canal treatment: A structural model analysis

AIM

The pathways to post-operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient-related predictors of post-operative pain following root canal treatment.

METHODOLOGY

A total of 154 patients received a single-visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post-operative pain was assessed using the Numeric Rating Scale at multiple time-points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient-related predictors on a theoretical model of post-operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%).

RESULTS

Dental anxiety (coefficient 0.028; p < .01), dental fear (coefficient 0.007; p = .02) and irrigant solution (coefficient 0.004; p = .03) exerted a direct effect on post-operative pain. SOC exerted an indirect effect on post-operative (coefficient 0.006; p = .01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p = .04) exerted an indirect effect on post-operative pain through dental anxiety.

CONCLUSIONS

Dental anxiety, dental fear, previous negative experiences and SOC are patient-related predictors of post-operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post-operative pain.

The unique face of comorbid anxiety and depression: Increased frontal, insula and cingulate cortex response during Pavlovian fear-conditioning

BACKGROUND

Dysregulation of fear processing through altered sensitivity to threat is thought to contribute to the development of anxiety disorders and major depressive disorder (MDD). However, fewer studies have examined fear processing in MDD than in anxiety disorders. The current study used propensity matching to examine the hypothesis that comorbid MDD and anxiety (AnxMDD) shows greater neural correlates of fear processing than MDD, suggesting that the co-occurrence of AnxMDD is exemplified by exaggerated defense related processes.

METHODS

195 individuals with MDD (N = 65) or AnxMDD (N = 130) were recruited from the community and completed multi-level assessments, including a Pavlovian fear learning task during functional imaging. Visual images paired with threat (conditioned stimuli: CS+) were compared to stimuli not paired with threat (CS-).

RESULTS

MDD and AnxMDD showed significantly different patterns of activation for CS+ vs CS- in the dorsal anterior insula/inferior frontal gyrus (partial eta squared; ηp2 = 0.02), dorsolateral prefrontal cortex (ηp2 = 0.01) and dorsal anterior/mid cingulate cortex (ηp2 = 0.01). These differences were driven by greater activation to the CS+ in AnxMDD versus MDD.

LIMITATIONS

Limitations include the cross-sectional design, a scream US rather than shock and half the number of MDD as AnxMDD participants.

CONCLUSIONS

AnxMDD showed a pattern of increased activation in regions identified with fear processing. Effects were consistently driven by threat, further suggesting fear signaling as the emergent target process. Differences emerged in regions associated with salience processing, attentional orienting/conflict, self-relevant processing and executive functioning in comorbid anxiety and depression, thereby highlighting potential treatment targets for this prevalent and treatment resistant group.

The relationship between self-reported interoception and anxiety: A systematic review and meta-analysis

Interoception, the processing of internal bodily sensations, is associated with various mental health conditions. In particular, anxiety is often considered to be the prototypical interoceptive disorder. However, empirical evidence is mixed, with meta-analytic work reporting no relationship between anxiety and cardiac interoceptive accuracy. Less explored, however, are the mixed results relating to anxiety and self-reported interoception. This meta-analysis of 71 studies explored the relationship between self-report measures of interoception and anxiety. Across 12 measures (20 subscales), anxiety was associated with increased negative evaluations of, frequency of, and sensitivity to, bodily signals. Anxiety was also associated with greater (negative) attention to bodily signals, and difficulties describing bodily signals and emotions. However, anxiety was not associated with the use of bodily signals to inform emotions (e.g., noticing emotionally induced bodily signals). Results are discussed considering the overlap between anxiety and interoception questionnaires, the lack of specificity of certain measures, and the potential confound of individual differences in questionnaire interpretation. We also discuss limitations of anxiety measures and the clinical relevance of findings.

Sex and sobriety: Human brain structure and function in AUD abstinence

Women are drinking alcohol as much as men for the first time in history. Women experience more health-related consequences from alcohol use disorder (AUD), like increased prevalence of alcohol-related cancers, faster progression of alcohol-related liver disease, and greater risk for relapse compared to men. Thus, sex differences in chronic alcohol use pose a substantial public health problem. Despite these evident sex differences, our understanding of how these differences present during alcohol abstinence is limited. Investigations of brain structure and function are therefore critical for disentangling factors that lead to sex differences in AUD abstinence. This review will discuss current human neuroimaging data on sex differences in alcohol abstinence, focusing on structural and functional brain measures. Current structural imaging literature reveals that abstinent men have smaller gray and white matter volume and weaker structural connectivity compared to control men. Interestingly, abstinent women do not show differences in brain structure when compared to controls; instead, abstinent women show a relation between alcohol use and decreased measures of brain structure. Current functional brain studies reveal that abstinent men exhibit greater brain activation and stronger task-based functional connectivity to aversive stimuli than control men, while abstinent women exhibit lesser brain activation and weaker task-based functional connectivity than control women. Together, the current literature suggests that sex differences persist well into alcohol abstinence and impact brain structure and function differently. Understanding how men and women differ during alcohol abstinence can improve our understanding of sex-specific effects of alcohol, which will be critical to augment treatment methods to better serve women.

Intolerance of uncertainty enhances adolescent fear generalization in both perceptual-based and category-based tasks: fNIRS studies

Fear generalization undergoes marked changes during adolescence, which may relate to the high prevalence of anxiety disorders. While intolerance of uncertainty (IU) is a key factor that amplifies fear generalization, its impact and neural basis in adolescence remain unclear. Here, we investigated the effects of IU on perceptual-based (n = 72) and category-based (n = 68) fear generalization in adolescents aged 12-15 years. Specifically, Experiment 1 utilized two different size rings as conditioned stimuli, with middle-sized rings serving as the generalized stimuli; Experiment 2 employed pictures of sparrows and refrigerators as conditioned stimuli, with other animals categorically related to the sparrow as generalized stimuli. We collected self-reported threat expectancy, response times, and fear ratings in both experiments, and conducted functional near-infrared spectroscopy in Experiment 2. Results showed that high IU adolescents had higher threat expectancy in both experiments compare to low IU. Moreover, in category-based generalization, high IU adolescents had higher fear ratings, shorter response times and reduced engagement of the left dorsolateral prefrontal cortex (DLPFC). Results indicated that IU may enhance fear generalization by deficient left DLPFC recruitment. Together the present findings point to a behavioral and neural mechanism that can render adolescents vulnerable for mental disorders.

The Organization of Anxiety Symptoms Along the Threat Imminence Continuum

Pathological anxiety is highly prevalent, impairing, and often chronic. Yet, despite considerable research, mechanistic understanding of anxiety and its translation to clinical practice remain limited. Here, we first highlight two foundational complications that contribute to this gap: a reliance on a phenomenology-driven definition of pathological anxiety in neurobiological mechanistic research, and a limited understanding of the chronicity of anxiety symptom expression. We then posit that anxiety symptoms may reflect aberrant expression of otherwise normative defensive responses. Accordingly, we propose that threat imminence, an organizing dimension for normative defensive responses observed across species, may be applied to organize and understand anxiety symptoms along a temporal dimension of expression. Empirical evidence linking distinct anxiety symptoms and the aberrant expression of imminence-dependent defensive responses is reviewed, alongside the neural mechanisms which may underpin these cognitive, physiological, and behavioral responses. Drawing from extensive translational and clinical research, we suggest that understanding anxiety symptoms through this neurobiologically-informed framework may begin to overcome the conceptual complications hindering advancement in mechanistic research and clinical interventions for pathological anxiety.

A preliminary study of threat-anticipatory responding in Latina youth: associations with age, anxiety, and cortical thickness

Variation in prefrontal cortex neuroanatomy has been previously associated with elevated physiological responses to anticipated aversive events. The extent to which such associations extend beyond the specific ecology of treatment-seeking youth from upper-middle socioeconomic backgrounds is unknown. The current study tests the replicability of neuroanatomical correlates of anticipatory responding and the moderating roles of age and anxiety severity in a community sample of Latina girls, a historically underrepresented group exhibiting high levels of untreated anxiety. Forty pre-adolescent Latina girls (MAge = 10.01, s.d. = 1.25, range = 8-12 years) completed a structural magnetic resonance imaging scan. Participants also completed a differential threat and safety learning paradigm, during which skin conductance and subjective fear responding were assessed. Anxiety severity was assessed via the Screen for Child Anxiety Related Emotional Disorders. Ventromedial prefrontal cortex thickness was associated with reduced physiological responsivity to anticipated threat. Age- and anxiety-dependent associations emerged between dorsomedial prefrontal cortex thickness and individual differences in subjective fear responding to anticipated threat. This preliminary study extends work on neuroanatomical contributions to physiological threat responsivity to a community sample of Latina youth and highlights potential considerations for early identification efforts in this population when threat neurocircuitry is still developing.