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Luo RH, Su F, Zhao XY, Cao TH, Liao J, Xue YX, Huang GD, Yang JL. Impairment in acquisition of conditioned fear in people with depressive symptoms. Front Psychol 2024; 15:1384053. [PMID: 38863669 PMCID: PMC11166000 DOI: 10.3389/fpsyg.2024.1384053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Background Depression is one of the primary global public health issues, and there has been a dramatic increase in depression levels among young people over the past decade. The neuroplasticity theory of depression postulates that a malfunction in neural plasticity, which is responsible for learning, memory, and adaptive behavior, is the primary source of the disorder's clinical manifestations. Nevertheless, the impact of depression symptoms on associative learning remains underexplored. Methods We used the differential fear conditioning paradigm to investigate the effects of depressive symptoms on fear acquisition and extinction learning. Skin conductance response (SCR) is an objective evaluation indicator, and ratings of nervousness, likeability, and unconditioned stimuli (US) expectancy are subjective evaluation indicators. In addition, we used associability generated by a computational reinforcement learning model to characterize the skin conductance response. Results The findings indicate that individuals with depressive symptoms exhibited significant impairment in fear acquisition learning compared to those without depressive symptoms based on the results of the skin conductance response. Moreover, in the discrimination fear learning task, the skin conductance response was positively correlated with associability, as estimated by the hybrid model in the group without depressive symptoms. Additionally, the likeability rating scores improved post-extinction learning in the group without depressive symptoms, and no such increase was observed in the group with depressive symptoms. Conclusion The study highlights that individuals with pronounced depressive symptoms exhibit impaired fear acquisition and extinction learning, suggesting a possible deficit in associative learning. Employing the hybrid model to analyze the learning process offers a deeper insight into the associative learning processes of humans, thus allowing for improved comprehension and treatment of these mental health problems.
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Affiliation(s)
- Rui-Han Luo
- Tianjin Medical University General Hospital, Tianjin, China
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Feng Su
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Xin-Yue Zhao
- Tianjin Medical University General Hospital, Tianjin, China
| | - Tian-Hui Cao
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jing Liao
- Tianjin Medical University General Hospital, Tianjin, China
| | - Yan-Xue Xue
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Geng-Di Huang
- Department of Addiction Medicine, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Jian-Li Yang
- Tianjin Medical University General Hospital, Tianjin, China
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
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2
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Richardson AL. Hope and anxiety. Curr Opin Psychol 2023; 53:101664. [PMID: 37572550 DOI: 10.1016/j.copsyc.2023.101664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
Anxiety-related disorders continue to be one of the most prevalent and burdensome psychiatric disorders. Research has examined resilience factors, such as hope, that can build resilience toward or mitigate the impact of anxiety disorders. The following review provides a summary of hope as a factor of resilience as well as a mechanism of change in reducing levels of anxiety. First, hope and anxiety are conceptualized as future-oriented traits. Then, hope as a source of resilience against trait anxiety is discussed. The article then discusses the moderate, indirect relationship between hope and general as well as specific forms of anxiety before providing empirical support for hope as a mechanism of change in the reduction of anxiety. Finally, considerations for future study of hope and anxiety are discussed.
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Wang Z, Luo Y, Zhang Y, Chen L, Zou Y, Xiao J, Min W, Yuan C, Ye Y, Li M, Tu M, Hu J, Zou Z. Heart rate variability in generalized anxiety disorder, major depressive disorder and panic disorder: A network meta-analysis and systematic review. J Affect Disord 2023; 330:259-266. [PMID: 36914118 DOI: 10.1016/j.jad.2023.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Heart rate variability (HRV) in patients with emotional disorders and healthy controls (HCs) has been investigated in many studies but the difference between these emotional disorders was unclear. METHODS The PubMed, Embase, Medline and Web of Science databases were systematically searched for studies published in English that compared HCs with generalized anxiety disorder (GAD), major depressive disorder (MDD), panic disorder (PD) patients in HRV. We conducted a network meta-analysis to compare HRV in patients with GAD, MDD, PD and HCs. HRV outcomes, including time domain indices (the standard deviation of NN intervals (SDNN) and the root mean square of the successive differences between normal heartbeats (RMSSD)), and frequency domain indices (High-frequency (HF), Low-frequency (LF) and the ratio of LF to HF (LF/HF)) were obtained. A total of 4008 participants from 42 studies were included. RESULTS The results of pairwise meta-analysis showed that compared with controls, GAD, PD and MDD patients exhibited significantly reduced HRV. Similar findings were also confirmed in network meta-analysis. The most important finding from network meta-analysis was that GAD patients had significantly lower SDNN than PD patients (SMD = -0.60, 95 % CI [-1.09, -0.11]). CONCLUSION Our findings provided a potential objective biological marker to distinguish between GAD and PD. In the future, a large sample of research is needed to directly compare HRV of various mental disorders, which is crucial for finding biomarkers to distinguish them.
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Affiliation(s)
- Zuxing Wang
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yuanyuan Luo
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yuan Zhang
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, PR China
| | - Lili Chen
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yazhu Zou
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Jun Xiao
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Wenjiao Min
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Cui Yuan
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yu Ye
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Mingmei Li
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Mengtian Tu
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Jiangli Hu
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Zhili Zou
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, PR China.
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4
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Kyriakoulis P, Kyrios M. Biological and cognitive theories explaining panic disorder: A narrative review. Front Psychiatry 2023; 14:957515. [PMID: 36793941 PMCID: PMC9924294 DOI: 10.3389/fpsyt.2023.957515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/04/2023] [Indexed: 02/01/2023] Open
Abstract
The current narrative review summarizes and examines several theories of panic disorder (PD) including biological theories, encompassing neurochemical factors, metabolic and genetic theories, respiratory and hyperventilation theories and cognitive theory. Biological theories have informed the development of psychopharmacological treatments; however, they may be limited in their utility given the efficacy of psychological treatments. In particular, behavioral and, more recently, cognitive models have garnered support due to the efficacy of cognitive-behavior therapy (CBT) in treating PD. The role of combination treatments has been found to be superior in the treatment of PD in particular cases, lending support for the need for an integrated approach and model for PD given that the etiology of PD is complex and multifactorial.
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Affiliation(s)
- Peter Kyriakoulis
- Faculty of Arts, Health and Design, Swinburne University, Hawthorn, VIC, Australia
| | - Michael Kyrios
- College of Education, Psychology and Social Work, Órama Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, SA, Australia
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Yarrington JS, Vinograd M, Williams AL, Wolitzky-Taylor KB, Zinbarg RE, Mineka S, Waters AM, Craske MG. Fear-potentiated startle predicts longitudinal change in transdiagnostic symptom dimensions of anxiety and depression. J Affect Disord 2022; 311:399-406. [PMID: 35597470 DOI: 10.1016/j.jad.2022.05.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Elevated defensive responding, through startle reflex (SR) and skin conductance response (SCR), may contribute to onset and maintenance of depression and anxiety. Most work examining SR and SCR has predicted psychiatric diagnoses. There is a paucity of research examining links between SR or SCR and dimensional measures of psychopathology. METHODS We used latent growth curve modeling to predict longitudinal change in three symptom factors (i.e., General Distress, Fears, Anhedonia-Apprehension) from SR and SCR measured during a fear-potentiated startle paradigm among adolescents oversampled for neuroticism (N = 129). RESULTS Elevated SCR in danger phases before and after an unpleasant muscle contraction predicted increasing Fears over time. Elevated SR in safe phases post-contraction also predicted increasing Fears over time. Attenuated SR in safe phases post-contraction predicted elevated General Distress longitudinally. Attenuated SCR pre-contraction in danger phases predicted elevated Anhedonia-Apprehension over time. LIMITATIONS Our non-clinical sample may limit generalizability of results. Additionally, we did not assess change in SR and SCR over time. CONCLUSIONS The present study demonstrates that SR and SCR during a fear-potentiated startle paradigm predict longitudinal change in dimensional anxiety and depression symptom factors and relatedly, that SR and SCR may represent risk factors for the exacerbation of symptomatology.
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Affiliation(s)
- Julia S Yarrington
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Meghan Vinograd
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | | | - Kate B Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Susan Mineka
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Queensland, Australia
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
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6
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Lyu C, Ma R, Hager R, Porter D. The relationship between resilience, anxiety, and depression in Chinese collegiate athletes. Front Psychol 2022; 13:921419. [PMID: 36033035 PMCID: PMC9416885 DOI: 10.3389/fpsyg.2022.921419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022] Open
Abstract
Anxiety disorder is becoming increasingly prevalent across college campuses, particularly among collegiate athletes who face different stressors and challenges than their non-athlete peers. Anxiety and depression are well documented comorbidities. Furthermore, the number of Chinese collegiate athletes suffering from anxiety and depression is increasing. Psychologists have recently begun to take a more prophylactic approach to defend against these disorders through resilience education. Resilience education focuses on developing greater capacity to cope when mental and emotional challenges arise. The purpose of this study was to analyze the relationship between resilience, depression, and anxiety in Chinese collegiate athletes. This study provides additional evidence of the value of incorporating an effective resilience educational module amongst collegiate athletes.
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Affiliation(s)
- Chengjie Lyu
- School of Physical Education, Guangzhou Sport University, Guangzhou, China
| | - Rong Ma
- Athletic Department, Brigham Young University, Provo, UT, United States
- *Correspondence: Rong Ma,
| | - Ronald Hager
- Exercise Science, College of Life Sciences, Brigham Young University, Provo, UT, United States
| | - Dave Porter
- Athletic Department, Brigham Young University, Provo, UT, United States
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7
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Fraunfelter L, Gerdes ABM, Alpers GW. Fear one, fear them all: A systematic review and meta-analysis of fear generalization in pathological anxiety. Neurosci Biobehav Rev 2022; 139:104707. [PMID: 35643120 DOI: 10.1016/j.neubiorev.2022.104707] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
Abstract
It is a defining feature of anxiety disorders that fear is elicited by a circumscribed class of stimuli rather than by only one specific exemplar of that class. Therefore, fear generalization, a mechanism by which associative fear extends from one conditioned stimulus to similar cues, has been central to theories on anxiety. Yet, experimental evidence for the link between generalization and pathological anxiety, as well as its moderators, has not been formally integrated. This systematic review and meta-analysis of empirical findings clarifies the relationship between fear generalization and pathological anxiety. In conclusion, enhanced fear generalization is associated with several anxiety disorders and stress-related disorders, which is supported statistically by a small, but robust effect size of g = 0.44 for risk ratings as an index of fear generalization. However, empirical results are inconsistent across disorders and they rarely allow for conclusions on their causality in the disorders' etiology. Therefore, based on theoretical considerations, we recommend directions for intensified research, especially on the causal relationship between overgeneralization and pathological fear.
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Affiliation(s)
- L Fraunfelter
- University of Mannheim, School of Social Sciences, Department of Psychology, L13, 17, 68131 Mannheim, Germany.
| | - A B M Gerdes
- University of Mannheim, School of Social Sciences, Department of Psychology, L13, 17, 68131 Mannheim, Germany.
| | - G W Alpers
- University of Mannheim, School of Social Sciences, Department of Psychology, L13, 17, 68131 Mannheim, Germany.
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Shabahang R, Aruguete MS, Rezaei S, McCutcheon LE. Psychological Determinants and Consequences of COVID-19 Anxiety: A Web-Based Study in Iran. Health Psychol Res 2021; 9:24841. [PMID: 35106395 PMCID: PMC8801565 DOI: 10.52965/001c.24841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 09/21/2023] Open
Abstract
Pandemic illnesses such as COVID-19 can provoke negative emotions, including anxiety and depression, in addition to compulsive behaviors. Clarifying the psychosocial antecedents and consequences of COVID-19 anxiety can inform successful psychological support and treatment. This study investigated psychological predictors and consequences of COVID-19 anxiety during the outbreak of COVID-19 in Iran. University students (N = 398) completed a web-based survey measuring COVID-19 anxiety, general health anxiety, uncertainty intolerance, interpersonal trust, depression, and COVID-19-related panic shopping. The participants also responded to two additional questions: "Do you personally know of anyone who was suspected of having been infected with COVID-19?" and "Did you get sick in the past year?" Exploratory factor analysis, confirmatory factor analysis, Pearson correlation, multiple regression analysis, multivariate regression analysis, and 2 × 2 factorial ANOVA were used to analyze data. Health anxiety, uncertainty intolerance, and interpersonal trust were significantly associated with COVID-19 anxiety. COVID-19 anxiety was a significant predictor of depression and panic shopping. Participants who knew someone with COVID-19 and those who reported being sick in the past year experienced more COVID-19 anxiety. COVID-19 anxiety appears to be more severe among people with a low tolerance for uncertainty and low interpersonal trust. Understanding these risk factors can inform individualized therapeutic approaches to address the maladaptive outcomes of depression and false safety behaviors, such as panic buying.
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9
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Yin B, Teng T, Tong L, Li X, Fan L, Zhou X, Xie P. Efficacy and acceptability of parent-only group cognitive behavioral intervention for treatment of anxiety disorder in children and adolescents: a meta-analysis of randomized controlled trials. BMC Psychiatry 2021; 21:29. [PMID: 33430817 PMCID: PMC7802251 DOI: 10.1186/s12888-020-03021-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 12/22/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Anxiety disorder is the most prevalent mental disorder among children and adolescents, causing significant psychosocial problems and physical health conditions. Cognitive behavioral therapy (CBT) is an effective treatment for anxiety disorder in children and adolescents. And parent-only CBT is an alternative treatment for childhood anxiety disorder, which includes psychologists and parents rather than children in the treatment. As a new type of CBT, parent-only CBT has some advantages. However, it remains unclear whether parent-only CBT interventions are effective for treating children and adolescents with anxiety disorder. METHODS In this study, we evaluated the efficacy (the mean change scores of the anxiety rating scale from baseline to post-treatment, standardized mean difference SMD) and acceptability (the proportion of patients in the treatment group who withdrew from treatment early for any reason, risk ratios RRs) of parent-only cognitive behavioral therapy (CBT) for children and adolescents with anxiety disorder. We searched electronic databases, including PubMed, Cochrane Library, Embase, Web of Science, ProQuest, and PsycINFO from inception to June 2019. We included randomized controlled trials (RCTs) comparing parent-only CBT either with waitlist (WL), or CBT with parents in children and adolescents with anxiety disorder. RESULTS Finally, six RCTs with 407 participants were included in the meta-analyses. In terms of efficacy, pooled analyses indicated that parent-only CBT was significantly more effective than WL for reducing anxiety symptoms with SMD of - 0.72 (95% CI - 1.41 to - 0.03, p = 0.04), and more remission rate with RR of 4.33 (37.96% vs. 6.85, 95% CI 1.82 to 10.27, p = 0.0009) at post-treatment. And our analyses showed no evidence that parent-only CBT had significantly greater efficacy than CBT with parents with SMD of 0.21 (95% CI - 0.09 to 0.50, p = 0.17). Acceptability in the parent-only CBT group was not significantly different to the WL group with RR of 0.92 (95% CI 0.52 to 1.62, p = 0.77), and was significantly worse than in the CBT with parents group with RR of 1.93 (95% CI 1.05 to 3.57, p = 0.03). CONCLUSIONS Current evidence indicates that parent-only CBT can be an alternative and acceptable intervention for treating children and adolescents with anxiety disorder.
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Affiliation(s)
- Bangmin Yin
- Department of Neurology, People’s Hospital of Deyang City, Deyang, China ,grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016 China
| | - Teng Teng
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016 China
| | - Lyu Tong
- grid.412449.e0000 0000 9678 1884Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Xuemei Li
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016 China
| | - Li Fan
- grid.452206.7Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016 China
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China.
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. .,NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China.
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de Almeida Sampaio TP, Jorge RC, Martins DS, Gandarela LM, Hayes-Skelton S, Bernik MA, Lotufo-Neto F. Efficacy of an acceptance-based group behavioral therapy for generalized anxiety disorder. Depress Anxiety 2020; 37:1179-1193. [PMID: 32333486 DOI: 10.1002/da.23021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) shows the weakest treatment response among anxiety disorders. This study aimed at examining whether an acceptance-based group behavioral therapy (ABBT) for patients in a Brazilian anxiety disorders program, combining mindfulness and exposure strategies, can improve clinical outcome when compared with a standard nondirective supportive group therapy (NDST). METHODS Ninety-two individuals diagnosed with GAD were randomized to receive 10 sessions of either ABBT or NDST. Assessments at pretreatment, midtreatment, posttreatment, and 3-month follow-up comprised the following outcome measures: Hamilton Anxiety Rating Scale (HAM-A), Penn State Worry Questionnaire (PSWQ), Depression Anxiety and Stress Scale (DASS), and the Clinical Global Impressions (CGI). The World Health Organization Quality of Life (WHOQOL) was administered at pretreatment and posttreatment. RESULTS The mixed-effects regression models for DASS-stress, Hamilton Anxiety Interview, and CGI showed a significant effect for Time and the Time × Treatment effect, but not for the Treatment main effect. Similarly, there was a significant Time × Treatment effect for the PSWQ, but not main effects of Time or Treatment. Altogether, these data indicate that symptoms decreased in both conditions across treatment and follow-up, and that the rate of change was more rapid for those participants in the ABBT condition. We found no differences between groups from pretreatment to posttreatment in DASS-anxiety or any secondary outcome measure, but for the physical health domain of WHOQOL, which was faster in ABBT. CONCLUSIONS Both groups showed good clinical outcomes, but in general, participants of the ABBT group improved faster than those in the NDST group.
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Affiliation(s)
- Thiago Pacheco de Almeida Sampaio
- Department of Clinical Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Renê Cabral Jorge
- Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Daniel Santos Martins
- Department of Clinical Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Lucas Marques Gandarela
- Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Sarah Hayes-Skelton
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts
| | - Márcio Antonini Bernik
- Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Francisco Lotufo-Neto
- Department of Clinical Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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11
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Gillie BL, Fazio-Sumrok V, Eagle SR, Kegel N, Trbovich AM, Collins MW, Kontos AP. Clinical predictors of post-injury anxiety in adolescent patients following concussion. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:253-259. [PMID: 32723100 DOI: 10.1080/21622965.2020.1799790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of the current study was to examine predictors (e.g., pre-injury anxiety and sub-types, concussion symptom severity, neurocognitive performance, and vestibular/ocular-motor impairment) of post-injury anxiety scores following concussion among youth aged 10-18 years. This observational cohort study enrolled patients (n = 129) within 30 days of a diagnosed concussion. Patients completed Screening for Child Anxiety Related Disorders-Child Reports (SCARED-C), Generalized Anxiety Disorder-7 (GAD-7), Post-concussion Symptom Scale, neurocognitive testing, and Vestibular-Ocular Motor Screening. Logistic regression analyses were conducted to evaluate the role of risk factors and clinical outcomes as predictors of mild (GAD-7 > 5) and moderate levels (GAD-7 > 10) of post-injury anxiety. Twenty-two percent (n = 28) of patients reported clinical levels of pre-injury anxiety, and 13% (n = 17) reported clinical levels of post-injury anxiety. The logistic regression model predicting mild or greater anxiety was significant (R2 = 31.7%; p < 0.001) and supported pre-injury panic symptoms (OR = 1.38) and total symptom severity (OR = 1.04) as the most robust predictors. The logistic regression model predicting clinical anxiety was significant (R2 = 47.2%; p < 0.001) and supported non-SRC injury type (OR = 9.48), vestibular dysfunction (OR = 1.74) and pre-injury panic symptoms (OR = 1.57) as the most robust predictors. Results suggest that clinicians should employ measures of pre-injury and post-injury emotional functioning when evaluating and treating concussion among adolescents. Moreover, these results highlight the importance of assessing different types of pre-injury and post-injury anxiety in the context of concussion management.
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Affiliation(s)
- Brandon L Gillie
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vanessa Fazio-Sumrok
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn R Eagle
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nathan Kegel
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alicia M Trbovich
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael W Collins
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony P Kontos
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Lamoureux-Tremblay V, Muckle G, Maheu F, Jacobson SW, Jacobson JL, Ayotte P, Bélanger RE, Saint-Amour D. Risk factors associated with developing anxiety in Inuit adolescents from Nunavik. Neurotoxicol Teratol 2020; 81:106903. [PMID: 32512128 DOI: 10.1016/j.ntt.2020.106903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 01/05/2023]
Abstract
This study aimed to examine the relation between anxiety among the at-risk population of Inuit adolescents and diverse developmental risk factors including exposure to environmental chemicals, a subject of concern in Nunavik. Anxiety was assessed in 89 Inuit participants (mean age = 18.4 years; range = 16.2-21.9) with the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the State-Trait Anxiety Inventory (STAI). Potential risk factors for anxiety were documented at birth, 11 years of age and 18 years of age, including blood levels of chemicals (mercury, lead, PCBs) and nutrients, as well as age, sex, estimated IQ, drug and alcohol use, bullying, exposure to domestic violence, food insecurity, crowding and socio-economic status. Results showed that participants scored high on both measures of anxiety, particularly the SCARED, for which the mean score was above the clinical threshold. Multiple regression results show that significant risk predictors obtained from the SCARED scores were female sex (β = 0.32), higher current blood mercury concentration (β = 0.26), food insecurity (β = 0.26) and bullying experiences in the last year (β = 0.21). The significant predictors for the STAI trait anxiety were food insecurity (β = 0.25) and lower estimated IQ (β = -0.31), whereas food insecurity (β = 0.21), lower blood levels of vitamin E (β = -0.25) and higher cord blood mercury concentrations (β = 0.25) were found for STAI situational anxiety. Further regression analyses suggested that the adolescent-related variables were the most important risk factors. Our findings show that Inuit adolescents are at risk for anxiety via multiple contributing factors, particularly current exposure to mercury, food insecurity and female sex.
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Affiliation(s)
| | - Gina Muckle
- École de Psychologie, Université Laval, 2325, rue des Bibliothèques, Québec, Québec G1V 0A6, Canada
| | - Françoise Maheu
- Université de Montréal, 90 Avenue Vincent-D'Indy, Outremont, Montréal, Québec H2V 2S9, Canada
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Drive, Detroit 48201, United States
| | - Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Drive, Detroit 48201, United States
| | - Pierre Ayotte
- Département de Médecine Sociale et Préventive, Faculté de Médecine, 1050, Avenue de la Médecine, Pavillon Ferdinand-Vandry, Université Laval, Québec, Québec G1V 0A6, Canada
| | - Richard E Bélanger
- Département de Pédiatrie, Université Laval, Centre mère-enfant Soleil du CHU de Québec, 2705, Boulevard Laurier, Québec, Québec G1V 4G2, Canada
| | - Dave Saint-Amour
- Université du Québec à Montréal, 320 Sainte-Catherine Est, Pavillon J.A. De Sève, Montréal, Québec H2X 1L7, Canada..
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Conroy K, Curtiss JE, Barthel AL, Lubin R, Wieman S, Bui E, Simon NM, Hofmann SG. Emotion Regulation Flexibility in Generalized Anxiety Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020; 42:93-100. [PMID: 32661451 DOI: 10.1007/s10862-019-09773-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background People differ in their affective styles, which refers to habitual use of emotion regulation (ER) strategies. Previous research has shown that mental health is associated with an individual's adaptive flexibility of emotion regulation strategies rather than any one particular ER strategy. Methods The present study employed a person-centered approach using latent profile analyses to distinguish patients with generalized anxiety disorder based on their responses on an affective styles measure. Results Results of the latent profile analysis supported a three-class solution. Class 1 (26% of participants) identified individuals with the lowest scores of each affective style; class 2 (10%) included individuals with the highest scores of each style; and class 3 (64%) consisted of individuals who scored in the mid-range of each affective style. Greater ER flexibility was associated with better emotional functioning and quality of life. Conclusions Patients with GAD differ in ER flexibility. The vast majority of patients appear to have only moderate or low ER flexibility. Those individuals with high ER flexibility show a greater quality of life and less emotional distress.
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Affiliation(s)
- Kristina Conroy
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Joshua E Curtiss
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Abigail L Barthel
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Rebecca Lubin
- Department of Psychiatry, New York University Langone Health, New York, New York, USA
| | - Sarah Wieman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Naomi M Simon
- Department of Psychiatry, New York University Langone Health, New York, New York, USA
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
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Serotonin 2A receptors are a stress response system: implications for post-traumatic stress disorder. Behav Pharmacol 2020; 30:151-162. [PMID: 30632995 DOI: 10.1097/fbp.0000000000000459] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Serotonin, one of the first neurotransmitters to be identified, is an evolutionarily old molecule that is highly conserved across the animal kingdom, and widely used throughout the brain. Despite this, ascribing a specific set of functions to brain serotonin and its receptors has been difficult and controversial. The 2A subtype of serotonin receptors (5-HT2A receptor) is the major excitatory serotonin receptor in the brain and has been linked to the effects of drugs that produce profound sensory and cognitive changes. Numerous studies have shown that this receptor is upregulated by a broad variety of stressors, and have related 5-HT2A receptor function to associative learning. This review proposes that stress, particularly stress related to danger and existential threats, increases the expression and function of 5-HT2A receptors. It is argued that this is a neurobiological adaptation to promote learning and avoidance of danger in the future. Upregulation of 5-HT2A receptors during stressful events forms associations that tune the brain to environmental cues that signal danger. It is speculated that life-threatening situations may activate this system and contribute to the symptoms associated with post-traumatic stress disorder (PTSD). 3,4-Methylenedioxymethamphetamine, which activates 5-HT2A receptors, has been successful in the treatment of PTSD and has recently achieved status as a breakthrough therapy. An argument is presented that 3,4-methylenedioxymethamphetamine may paradoxically act through these same 5-HT2A receptors to ameliorate the symptoms of PTSD. The central thematic contention is that a key role of serotonin may be to function as a stress detection and response system.
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Temperament clusters associate with anxiety disorder comorbidity in depression. J Affect Disord 2018; 236:252-258. [PMID: 29751240 DOI: 10.1016/j.jad.2018.04.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/24/2018] [Accepted: 04/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Individual temperament is associated with psychiatric morbidity and could explain differences in psychiatric comorbidities. We investigated the association of temperament profile clusters with anxiety disorder comorbidity in patients with depression. METHODS We assessed the temperament of 204 specialized care-treated depressed patients with the Temperament and Character Inventory (TCI-R) and their diagnoses with the Mini International Neuropsychiatric Interview. Two-step cluster analysis was used for defining patients' temperament profiles and logistic regression analysis was used for predicting different anxiety disorders for various temperament profiles. RESULTS Four temperament clusters were found: 1) Novelty seekers with highest Novelty Seeking scores (n = 56),2) Persistent with highest Persistence scores (n = 36), 3) Reserved with lowest Novelty Seeking scores (n = 66) and 4) Wearied with highest Harm avoidance, lowest Reward Dependence and lowest Persistence scores (n = 58). After adjusting for clinical variables, panic disorder and/or agoraphobia were predicted by Novelty seekers' temperament profile with odds ratio [OR] = 3.5 (95% confidence interval [CI] = 1.8 - 6.9, p < 0.001), social anxiety disorder was predicted by Wearied temperament profile with OR = 3.4 (95% CI = 1.6 - 7.5, p = 0.002), and generalized anxiety disorder was predicted by Reserved temperament profile with OR = 2.6 (95% CI = 1.2 - 5.3, p = 0.01). LIMITATIONS The patients' temperament profiles were assessed while displaying depressive symptoms, which may have affected results. CONCLUSIONS Temperament clusters with unique dimensional profiles were specifically associated with different anxiety disorders in this study. These results suggest that TCI-R could offer a valuable dimensional method for predicting the risk of anxiety disorders in diverse depressed patients.
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Fisher AJ, Medaglia JD, Jeronimus BF. Lack of group-to-individual generalizability is a threat to human subjects research. Proc Natl Acad Sci U S A 2018; 115:E6106-E6115. [PMID: 29915059 PMCID: PMC6142277 DOI: 10.1073/pnas.1711978115] [Citation(s) in RCA: 445] [Impact Index Per Article: 74.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Only for ergodic processes will inferences based on group-level data generalize to individual experience or behavior. Because human social and psychological processes typically have an individually variable and time-varying nature, they are unlikely to be ergodic. In this paper, six studies with a repeated-measure design were used for symmetric comparisons of interindividual and intraindividual variation. Our results delineate the potential scope and impact of nonergodic data in human subjects research. Analyses across six samples (with 87-94 participants and an equal number of assessments per participant) showed some degree of agreement in central tendency estimates (mean) between groups and individuals across constructs and data collection paradigms. However, the variance around the expected value was two to four times larger within individuals than within groups. This suggests that literatures in social and medical sciences may overestimate the accuracy of aggregated statistical estimates. This observation could have serious consequences for how we understand the consistency between group and individual correlations, and the generalizability of conclusions between domains. Researchers should explicitly test for equivalence of processes at the individual and group level across the social and medical sciences.
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Affiliation(s)
- Aaron J Fisher
- Department of Psychology, University of California, Berkeley, CA 94720;
| | - John D Medaglia
- Department of Psychology, Drexel University, Philadelphia, PA 19104
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104
| | - Bertus F Jeronimus
- Department of Developmental Psychology, Faculty of Behavioural and Social Sciences, Groningen University, 9712 TS Groningen, The Netherlands
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The renaissance in psychedelic research: What do preclinical models have to offer. PROGRESS IN BRAIN RESEARCH 2018; 242:25-67. [DOI: 10.1016/bs.pbr.2018.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Walker J, Liddle J, Jordan KP, Campbell P. Affective concordance in couples: a cross-sectional analysis of depression and anxiety consultations within a population of 13,507 couples in primary care. BMC Psychiatry 2017; 17:190. [PMID: 28526002 PMCID: PMC5438534 DOI: 10.1186/s12888-017-1354-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/12/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression and anxiety are common and have a significant impact on the individual and wider society. One theory proposed to explain a heightened risk for depression and anxiety is affective concordance in couples (e.g. influence of shared mood states, shared health beliefs). Whilst research has shown concordance for severe psychiatric illnesses and general mood in couples, little attention has been given to concordance for common psychiatric conditions such as depression and anxiety. The aims of this study were to test affective concordance in couples and examine potential influences on concordance. METHODS Study design is a 1-year cross-sectional study of anxiety and depression consultations in primary care. Data were obtained from a validated primary care database of recorded consultations. Outcome was the presence of an anxiety or depression Read Code (GP recorded reason for consultation) in the female (within the couple dyad), and exposure was a recorded Read Code of anxiety or depression in the male. Logistic regression was used to test associations with odds ratios (OR) and 95% confidence intervals (95% CI) reported. Statistical adjustment was carried out on potential influences of concordance; age, environment (deprivation), healthcare behaviour (consultation frequency), and comorbidity. RESULTS A population of 13,507 couples were identified in which 927 people consulted for anxiety and 538 for depression. Logistic regression showed a 3 times increase in odds of an anxiety consultation in females if their male partner had also consulted OR 2.98 (95% CI 2.15 to 4.13). For depression females were over 4 times the odds of consulting if their male partner had also consulted OR 4.45 (95% CI 2.79 to 7.09). Adjustment within a multivariable model showed some reduction in odds; concordant anxiety was reduced to 2.5 times odds OR 2.48 (95%CI 1.76 to 3.50) and depression reduced to OR 3.39 (2.07 to 5.54). CONCLUSION Results show significant associations for affective concordance in couples. Factors influencing concordance are comorbidity and environmental factors, however reasons for deciding to consult (positive or negative) are unknown. This study highlights the patients' social context as a factor in consultations for anxiety and depression and gives support to the consideration of the patient's household as an influence on mental health.
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Affiliation(s)
- J. Walker
- 0000 0004 0415 6205grid.9757.cSchool of Medicine, Faculty of Medicine and Health Sciences, Keele University, Keele, Staffordshire UK
| | - J. Liddle
- 0000 0004 0415 6205grid.9757.cArthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG UK ,0000 0001 0462 7212grid.1006.7Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - K. P. Jordan
- 0000 0004 0415 6205grid.9757.cArthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG UK
| | - P. Campbell
- 0000 0004 0415 6205grid.9757.cArthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG UK
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DiNapoli EA, Pierpaoli CM, Shah A, Yang X, Scogin F. Effects of Home-Delivered Cognitive Behavioral Therapy (CBT) for Depression on Anxiety Symptoms among Rural, Ethnically Diverse Older Adults. Clin Gerontol 2017; 40:181-190. [PMID: 28452665 PMCID: PMC6174534 DOI: 10.1080/07317115.2017.1288670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND We examined the effects of home-delivered cognitive-behavioral therapy (CBT) for depression on anxiety symptoms in an ethnically diverse, low resource, and medically frail sample of rural, older adults. METHOD This was a secondary analysis of a randomized clincial trial with 134 rural-dwelling adults 65 years and older with decreased quality of life and elevated psychological symptomatology. Anxiety symptoms were assessed with the anxiety and phobic anxiety subscales of the Symptom Checklist-90-Revised (SCL-90-R). RESULTS Compared to a minimal support control condition, CBT for depression resulted in significantly greater improvements in symptoms of anxiety and phobic anxiety from pre-treatment to post-treatment. CONCLUSION Home-delivered CBT for depression can be an effective treatment for anxiety in a hard-to-reach older populations. CLINICAL IMPLICATIONS Additional research should explore integrated anxiety and depression protocols and other treatment modalities, including bibliotherapy or telehealth models of CBT, to reduce costs associated with its in home delivery. Flexibility in administration and adaptations to the CBT protocol may be necessary for use with vulnerable, rural older adults.
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Affiliation(s)
- Elizabeth A DiNapoli
- a VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.,b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | | | - Avani Shah
- c University of Alabama , Tuscaloosa , Alabama , USA
| | - Xin Yang
- c University of Alabama , Tuscaloosa , Alabama , USA
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Hantsoo L, Epperson CN. Anxiety Disorders Among Women: A Female Lifespan Approach. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:162-172. [PMID: 28966563 DOI: 10.1176/appi.focus.20160042] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Anxiety symptoms may present differently between women and men, and at different points in the female lifespan. The female lifespan includes distinct epochs of hormonal function, including puberty, the premenstruum, in some women pregnancy or postpartum, and the menopausal transition. These stages give rise to important treatment considerations when treating anxiety in women. When making assessments, the clinician should consider reproductive events and hormonal status, as well as sex differences in anxiety presentation. This review is structured to: 1) Define major epochs of the female lifespan, 2) Provide a brief summary of the major anxiety disorders, with a focus on prevalence and presentation in the context of sex differences and at points in the female lifespan, 3) Describe potential biopsychosocial underpinnings of anxiety disorders among women, 4) Provide guidelines for assessment and differential diagnosis, and 5) Describe treatment options with attention to reproductive events such as pregnancy.
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Affiliation(s)
- Liisa Hantsoo
- Clinical Psychologist & Instructor, Penn Center for Women's Behavioral Wellness, Perelman School of Medicine, University of Pennsylvania
| | - C Neill Epperson
- Professor of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania and Director of the Penn Center for Women's Behavioral Wellness and Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania
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Meuret AE, Kroll J, Ritz T. Panic Disorder Comorbidity with Medical Conditions and Treatment Implications. Annu Rev Clin Psychol 2017; 13:209-240. [PMID: 28375724 DOI: 10.1146/annurev-clinpsy-021815-093044] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Panic disorder (PD) is unique among the anxiety disorders in that panic symptoms are primarily of a physical nature. Consequently, comorbidity with medical illness is significant. This review examines the association between PD and medical illness. We identify shared pathophysiological and psychological correlates and illustrate how physiological activation in panic sufferers underlies their symptom experience in the context of the fight-or-flight response and beyond a situation-specific response pattern. We then review evidence for bodily symptom perception accuracy in PD. Prevalence of comorbidity for PD and medical illness is presented, with a focus on respiratory and cardiovascular illness, irritable bowel syndrome, and diabetes, followed by an outline for potential pathways of a bidirectional association. We conclude by illustrating commonalities in mediating mechanistic pathways and moderating risk factors across medical illnesses, and we discuss implications for diagnosis and treatment of both types of conditions.
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Juliet Kroll
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
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Cook JM, Donovan CL, Garnett MS. A Parent-Mediated, Cognitive Behavioral Therapy Group Treatment for Young Children With High-Functioning Autism Spectrum Disorder and Comorbid Anxiety: Development and Case Illustration of the Fun With Feelings Program. J Cogn Psychother 2017; 31:204-224. [PMID: 32755938 DOI: 10.1891/0889-8391.31.3.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Comorbid anxiety is increasingly being recognized as a significant concern in children with high-functioning autism spectrum disorder (HFASD; Selles & Storch, 2013). Given the significant short and long term impact of anxiety on the functioning of a child with autism spectrum disorder (ASD; e.g., Bellini, 2004; Ben-Sasson et al., 2008), it is imperative that children with HFASD and comorbid anxiety receive intervention as early as is possible. Despite this need, there is a currently a dearth of research examining anxiety management programs for young children with HFASD. This article describes the development of a parent-mediated, cognitive behavioral therapy, group program for anxiety in 4- to 6-year-old children with HFASD. It provides a detailed discussion of the strategies taught to parents and children and highlights some of the challenges involved. A case study is also presented to illustrate progression and outcomes brought about through the program.
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Affiliation(s)
- Julia M Cook
- School of Applied Psychology, Behavioral Basis of Health and Griffith Health Institute, Griffith University, Queensland, Australia
| | - Caroline L Donovan
- School of Applied Psychology, Behavioral Basis of Health and Griffith Health Institute, Griffith University, Queensland, Australia
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Foldes-Busque G, Hamel S, Belleville G, Fleet R, Poitras J, Chauny JM, Vadeboncoeur A, Lavoie KL, Marchand A. Factors associated with pain level in non-cardiac chest pain patients with comorbid panic disorder. Biopsychosoc Med 2016; 10:30. [PMID: 27777612 PMCID: PMC5070074 DOI: 10.1186/s13030-016-0081-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/12/2016] [Indexed: 12/02/2022] Open
Abstract
Background Panic disorder (PD) is highly prevalent in patients with non-cardiac chest pain (NCCP). This study aims to explore the role of psychological factors (PD intensity, anxiety sensitivity, heart-related fear, attention and avoidance) common to NCCP and PD in predicting chest pain levels in patients with both conditions. Methods This association was investigated in emergency department patients with NCCP and PD receiving either evidence-based treatment of PD or treatment as usual. Patients were assessed at baseline and 14 weeks later for post-treatment. Results Only heart-focused fear and attention for cardiac sensations independently explained a significant portion of the variance in baseline pain (n = 66). At 3 months follow-up (n = 53), changes in heart-related fear was the only factor independently associated with changes in chest pain intensity. Even in patients with PD, fear specific to cardiac sensations seems to play a central role in determining NCCP intensity. Conclusion These results suggest that the efficacy of intervention for patients with PD and comorbid NCCP could be improved by targeting heart-related fear and attention. Trial registration NCT00736346
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Affiliation(s)
- Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada ; Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada
| | - Stéphanie Hamel
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada ; Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada
| | - Geneviève Belleville
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada
| | - Richard Fleet
- Research Chair in Emergency Medicine of Laval University, University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada ; Department of Family and Emergency Medicine, Université Laval, 1050 Avenue de la Médecine, Bureau 4617, Québec, G1V 0A6 Canada
| | - Julien Poitras
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada ; Department of Family and Emergency Medicine, Université Laval, 1050 Avenue de la Médecine, Bureau 4617, Québec, G1V 0A6 Canada
| | - Jean-Marc Chauny
- Research Centre, Montreal Sacré-Coeur Hospital, 5400 Boulevard Gouin Ouest, local K-3000, Montréal, Québec H4J 1C5 Canada
| | - Alain Vadeboncoeur
- Research Centre, Montreal Heart Institute, 5000 rue Bélanger, Montréal, Québec H1T 1C8 Canada
| | - Kim L Lavoie
- Research Centre, Montreal Sacré-Coeur Hospital, 5400 Boulevard Gouin Ouest, local K-3000, Montréal, Québec H4J 1C5 Canada ; Research Centre, Montreal Heart Institute, 5000 rue Bélanger, Montréal, Québec H1T 1C8 Canada ; Psychology Department, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Québec H3C 3P8 Canada
| | - André Marchand
- Psychology Department, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Québec H3C 3P8 Canada ; Fernand-Séguin Research Centre, Louis-Hippolyte Lafontaine Hospital, 7331 rue Hochelaga, Montréal, Québec H1N 3V2 Canada
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Bilsky SA, Knapp AA, Bunaciu L, Feldner MT, Leen-Feldner EW. Parental Psychological Control and Adolescent Panic Symptom Frequency. Int J Cogn Ther 2016. [DOI: 10.1521/ijct_2016_09_08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The self-wounds model of anxiety disorders based on the work of Wolfe (2005, 2006) is delineated here. The focal point of this model is the concept of wounded self or early unresolved emotional injuries. According to this view, anxiety disorders represent a chronic struggle with painful experiences. These emotional experiences are driven by two interrelated layers of psychological processes which arise from the wounded self. While the first layer of this process entails conscious awareness of symptoms resulting from cognitive distortions, the second layer comprises implicit or unconscious interpretations of what the symptoms mean to the patient. This article describes the components of the self-wounds model of anxiety disorders, which offers an integrative perspective on the development, onset, maintenance, and treatment of anxiety disorders. This model can be easily adapted to the understanding and treatment of other emotional disorders.
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Mogg K, Salum GA, Bradley BP, Gadelha A, Pan P, Alvarenga P, Rohde LA, Pine DS, Manfro GG. Attention network functioning in children with anxiety disorders, attention-deficit/hyperactivity disorder and non-clinical anxiety. Psychol Med 2015; 45:2633-2646. [PMID: 26234806 PMCID: PMC6309546 DOI: 10.1017/s0033291715000586] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Research with adults suggests that anxiety is associated with poor control of executive attention. However, in children, it is unclear (a) whether anxiety disorders and non-clinical anxiety are associated with deficits in executive attention, (b) whether such deficits are specific to anxiety versus other psychiatric disorders, and (c) whether there is heterogeneity among anxiety disorders (in particular, specific phobia versus other anxiety disorders). METHOD We examined executive attention in 860 children classified into three groups: anxiety disorders (n = 67), attention-deficit/hyperactivity disorder (ADHD; n = 67) and no psychiatric disorder (n = 726). Anxiety disorders were subdivided into: anxiety disorders excluding specific phobia (n = 43) and specific phobia (n = 21). The Attention Network Task was used to assess executive attention, alerting and orienting. RESULTS Findings indicated heterogeneity among anxiety disorders, as children with anxiety disorders (excluding specific phobia) showed impaired executive attention, compared with disorder-free children, whereas children with specific phobia showed no executive attention deficit. Among disorder-free children, executive attention was less efficient in those with high, relative to low, levels of anxiety. There were no anxiety-related deficits in orienting or alerting. Children with ADHD not only had poorer executive attention than disorder-free children, but also higher orienting scores, less accurate responses and more variable response times. CONCLUSIONS Impaired executive attention in children (reflected by difficulty inhibiting processing of task-irrelevant information) was not fully explained by general psychopathology, but instead showed specific associations with anxiety disorders (other than specific phobia) and ADHD, as well as with high levels of anxiety symptoms in disorder-free children.
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Affiliation(s)
- K. Mogg
- Department of Psychology, University of Southampton, Southampton, UK
| | - G. A. Salum
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Porto Alegre, Brazil
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - B. P. Bradley
- Department of Psychology, University of Southampton, Southampton, UK
| | - A. Gadelha
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Porto Alegre, Brazil
- Federal University of São Paulo, São Paulo, Brazil
| | - P. Pan
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Porto Alegre, Brazil
- Federal University of São Paulo, São Paulo, Brazil
| | - P. Alvarenga
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Porto Alegre, Brazil
- University of São Paulo, São Paulo, Brazil
| | - L. A. Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Porto Alegre, Brazil
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- University of São Paulo, São Paulo, Brazil
| | - D. S. Pine
- National Institute of Mental Health Intramural Research Program, Bethesda, MD, USA
| | - G. G. Manfro
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Porto Alegre, Brazil
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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27
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Waters AM, Nazarian M, Mineka S, Zinbarg RE, Griffith JW, Naliboff B, Ornitz EM, Craske MG. Context and explicit threat cue modulation of the startle reflex: preliminary evidence of distinctions between adolescents with principal fear disorders versus distress disorders. Psychiatry Res 2014; 217:93-9. [PMID: 24679992 PMCID: PMC4041703 DOI: 10.1016/j.psychres.2014.01.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/13/2013] [Accepted: 01/30/2014] [Indexed: 02/02/2023]
Abstract
Anxiety and depression are prevalent, impairing disorders. High comorbidity has raised questions about how to define and classify them. Structural models emphasise distinctions between "fear" and "distress" disorders while other initiatives propose they be defined by neurobiological indicators that cut across disorders. This study examined startle reflex (SR) modulation in adolescents with principal fear disorders (specific phobia; social phobia) (n=20), distress disorders (unipolar depressive disorders, dysthymia, generalised anxiety disorder; post-traumatic stress disorder) (n=9), and controls (n=29) during (a) baseline conditions, (b) threat context conditions (presence of contraction pads over the biceps muscle), and (c) an explicit threat cue paradigm involving phases that signalled safety from aversive stimuli (early and late stages of safe phases; early stages of danger phases) and phases that signalled immediate danger of an aversive stimulus (late stages of danger phases). Adolescents with principal fear disorders showed larger SRs than other groups throughout safe phases and early stages of danger phases. SRs did not differ between groups during late danger phases. Adolescents with principal distress disorders showed attenuated SRs during baseline and context conditions compared to other groups. Preliminary findings support initiatives to redefine emotional disorders based on neurobiological functioning.
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Affiliation(s)
- Allison M. Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | | | - Susan Mineka
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Richard E. Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, USA,The Family Institute at Northwestern University, Evanston, IL, USA
| | - James W. Griffith
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Bruce Naliboff
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Edward M. Ornitz
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA,Brain Research Institute, UCLA, Los Angeles, CA, USA
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28
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Waters AM, Peters RM, Forrest KE, Zimmer-Gembeck M. Fear acquisition and extinction in offspring of mothers with anxiety and depressive disorders. Dev Cogn Neurosci 2014; 7:30-42. [PMID: 24275479 PMCID: PMC6987899 DOI: 10.1016/j.dcn.2013.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/27/2013] [Accepted: 10/29/2013] [Indexed: 11/11/2022] Open
Abstract
Maternal anxiety and depression are significant risk factors for the development of these disorders in offspring. The pathways through which risk is conferred remain unclear. This study examined fear acquisition and extinction in 26 children at high risk for emotional disorders by virtue of maternal psychopathology (n=14 with a mother with a principal anxiety disorder and n=12 with a mother with a principal unipolar depressive disorder) and 31 low risk controls using a discriminative Pavlovian conditioning procedure. Participants, aged between 7 and 14 years, completed 16 trials of discriminative conditioning of two geometric figures, with (CS+) and without (CS-) an aversive tone (US), followed by 8 extinction trials (4×CS+, 4×CS-). In the context of comparable discriminative conditioning, children of anxious mothers showed larger skin conductance responses during extinction to the CS+ compared to the CS-, and to both CSs from the first to the second block of extinction trials, in comparison with low risk controls. Compared to low risk controls, children of depressed mothers showed smaller skin conductance responses to the CS+ than the CS- during acquisition. These findings suggest distinct psychophysiological premorbid risk markers in offspring of anxious and depressed mothers.
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Affiliation(s)
| | | | - Kylee E Forrest
- School of Applied Psychology, Griffith University, Australia
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29
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Picardi A, Caroppo E, Fabi E, Proietti S, Di Gennaro G, Meldolesi GN, Martinotti G. Attachment and parenting in adult patients with anxiety disorders. Clin Pract Epidemiol Ment Health 2013; 9:157-63. [PMID: 24155770 PMCID: PMC3804926 DOI: 10.2174/1745017901309010157] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 07/28/2013] [Accepted: 08/07/2013] [Indexed: 11/22/2022]
Abstract
Background: The literature suggests that dysfunctional parenting and insecure attachment may increase risk of anxiety-related psychopathology. This study aimed at testing the association between anxiety disorders, attachment insecurity and dysfunctional parenting while controlling for factors usually not controlled for in previous studies, such as gender, age, and being ill. Methods: A sample of 32 non-psychotic inpatients with SCID-I diagnosis of an anxiety disorder, either alone or in comorbidity, was compared with two age- and sex-matched control groups consisting of 32 non-clinical participants and 32 in-patients with drug-resistant epilepsy. Study measures included the Experience in Close Relationships questionnaire (ECR) and the Parental Bonding Instrument (PBI). Results: The patients with anxiety disorders scored significantly higher on attachment-related anxiety and avoidance than patients with drug-resistant epilepsy and non-clinical participants. These findings were independent of comorbidity for mood disorders. ECR scores did not differ among diagnostic subgroups (generalized anxiety disorder, panic disorder, other anxiety disorders). Patients with anxiety disorders scored significantly lower on PBI mother’s care and borderline significantly lower on PBI father's care than patients with drug-resistant epilepsy. Conclusions: Although limitations such as the relatively small sample size and the cross-sectional nature suggest caution in interpreting these findings, they are consistent with the few previous adult studies performed on this topic and corroborate Bowlby's seminal hypothesis of a link between negative attachment-related experiences, attachment insecurity, and clinical anxiety. Attachment theory provides a useful theoretical framework for integrating research findings from several fields concerning the development of anxiety disorders and for planning therapeutic interventions.
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Affiliation(s)
- Angelo Picardi
- Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
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30
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Pérez-Dueñas C, Acosta A, Lupiáñez J. Reduced habituation to angry faces: increased attentional capture as to override inhibition of return. PSYCHOLOGICAL RESEARCH 2013; 78:196-208. [DOI: 10.1007/s00426-013-0493-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 05/03/2013] [Indexed: 01/09/2023]
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31
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Priest JB. Emotionally Focused Therapy as Treatment for Couples With Generalized Anxiety Disorder and Relationship Distress. JOURNAL OF COUPLE & RELATIONSHIP THERAPY-INNOVATIONS IN CLINICAL AND EDUCATIONAL INTERVENTIONS 2013. [DOI: 10.1080/15332691.2013.749763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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32
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Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California at Los Angeles, California, USA.
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33
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Breinholst S, Esbjørn BH, Reinholdt-Dunne ML, Stallard P. CBT for the treatment of child anxiety disorders: a review of why parental involvement has not enhanced outcomes. J Anxiety Disord 2012; 26:416-24. [PMID: 22306129 DOI: 10.1016/j.janxdis.2011.12.014] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 12/22/2011] [Accepted: 12/25/2011] [Indexed: 11/25/2022]
Abstract
Anxiety affects 10% of all children and disrupts educational, socio-emotional development and overall functioning of the child and family. Research has shown that parenting factors (i.e. intrusiveness, negativity, distorted cognitions) contribute to the development and maintenance of childhood anxiety. Recent studies have therefore investigated if the treatment effect of traditional cognitive behavioural therapy may be enhanced by adding a parental component. However, randomised controlled trials have not shown unequivocal support for this assumption. The results are inconsistent and ambiguous. This article investigates possible reasons for this inconsistency and in particular differences in methodology and the theoretical relevance of the applied parental components are highlighted as possible contributory factors. Another factor is that treatment effect is mainly measured by change in the child's diagnostic status rather than changes in parental or family functioning.
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Affiliation(s)
- Sonja Breinholst
- Dept. of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Copenhagen, Denmark.
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34
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Ashwin C, Holas P, Broadhurst S, Kokoszka A, Georgiou GA, Fox E. Enhanced anger superiority effect in generalized anxiety disorder and panic disorder. J Anxiety Disord 2012; 26:329-36. [PMID: 22196167 PMCID: PMC3277887 DOI: 10.1016/j.janxdis.2011.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 11/14/2011] [Accepted: 11/20/2011] [Indexed: 11/11/2022]
Abstract
People are typically faster and more accurate to detect angry compared to happy faces, which is known as the anger superiority effect. Many cognitive models of anxiety suggest anxiety disorders involve attentional biases towards threat, although the nature of these biases remains unclear. The present study used a Face-in-the-Crowd task to investigate the anger superiority effect in a control group and patients diagnosed with either generalized anxiety disorder (GAD) or panic disorder (PD). The main finding was that both anxiety groups showed an enhanced anger superiority effect compared to controls, which is consistent with key theories of anxiety. Furthermore, both anxiety groups showed a differential pattern of enhanced bias towards threat depending on the crowd in the displays. The different attentional bias patterns between the GAD and PD groups may be related to the diverse symptoms in these disorders. These findings have implications for the diagnosis and treatment of anxiety.
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Affiliation(s)
- Chris Ashwin
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester, UK.
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35
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Waters AM, Donaldson J, Zimmer-Gembeck MJ. Cognitive–Behavioural Therapy Combined With an Interpersonal Skills Component in the Treatment of Generalised Anxiety Disorder in Adolescent Females: A Case Series. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.25.1.35] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe present study describes the outcomes of a manualised treatment for generalised anxiety disorder (GAD) in female adolescents that combined traditional cognitive–behavioural therapy (CBT) with an interpersonal skills (IP) component. The CBT component included psychoeducation, somatic management, cognitive restructuring, exposure therapy and problem-solving. The IP component targeted interpersonal avoidance, passive and aggressive interpersonal styles, and co-rumination. Four female adolescents with a principal diagnosis of GAD participated in 10 weekly 1-hour sessions. Adolescent- and parent-report diagnostic interviews and questionnaires were completed at pre-, mid-, and posttreatment, and at 3-months follow-up. Reductions in GAD and depressive symptoms and improvements in interpersonal functioning for all participants on both adolescent- and parent-report measures suggest that the combination of CBT and IP can benefit adolescent girls with GAD.
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36
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Craske MG, Wolitzky-Taylor KB, Mineka S, Zinbarg R, Waters AM, Vrshek-Schallhorn S, Epstein A, Naliboff B, Ornitz E. Elevated responding to safe conditions as a specific risk factor for anxiety versus depressive disorders: evidence from a longitudinal investigation. JOURNAL OF ABNORMAL PSYCHOLOGY 2011; 121:315-24. [PMID: 21988452 DOI: 10.1037/a0025738] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current study evaluated the degree to which startle reflexes (SRs) in safe conditions versus danger conditions were predictive of the onset of anxiety disorders. Specificity of these effects to anxiety disorders was evaluated in comparison to unipolar depressive disorders and with consideration of level of neuroticism. A startle paradigm was administered at baseline to 132 nondisordered adolescents as part of a longitudinal study examining risk factors for emotional disorders. Participants underwent a repetition of eight safe-danger sequences and were told that delivery of an aversive stimulus leading to a muscle contraction of the arm would occur only in the late part of danger conditions. One aversive stimulus occurred midway in the safe-danger sequences. Participants were assessed for the onset of anxiety and unipolar depressive disorders annually over the next 3 to 4 years. Larger SR magnitude during safe conditions following delivery of the aversive stimulus predicted the subsequent first onset of anxiety disorders. Moreover, prediction of the onset of anxiety disorders remained significant above and beyond the effects of comorbid unipolar depression, neuroticism, and subjective ratings of intensity of the aversive stimulus. In sum, elevated responding to safe conditions following an aversive stimulus appears to be a specific, prospective risk factor for the first onset of anxiety disorders.
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Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California-Los Angeles, Los Angeles, CA 90095-1563, USA.
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37
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Abstract
This review provides an overview of the assays that are used for measuring escape and avoidance behavior in zebrafish, with a specific focus on zebrafish larvae during the first week of development. Zebrafish larvae display a startle response when exposed to tactile, acoustic, or visual stimuli and will avoid dark areas, moving objects, conspecifics, and open spaces. Emotional states such as fear and anxiety might be induced when larvae are exposed to stimuli that they would normally escape from or avoid. Although these emotional states probably differ between species and change during development, much can be learned about human fear and anxiety using zebrafish as a model system. The molecular mechanisms of fear and anxiety are highly conserved in vertebrates and are present during early zebrafish development. Larvae during the first week of development display elevated cortisol levels in response to stress and are sensitive to the same anxiolytics that are used for the management of anxiety in humans. Zebrafish larvae are well suited for high-throughput analyses of behavior, and automated systems have been developed for imaging and analyzing the behavior of zebrafish larvae in multiwell plates. These high-throughput analyses will not only provide a wealth of information on the genes and environmental factors that influence escape and avoidance behaviors and the emotional states that might accompany them but will also facilitate the discovery of novel pharmaceuticals that could be used in the management of anxiety disorders in humans.
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Affiliation(s)
- Ruth M Colwill
- Department of Psychology, Brown University, Providence, RI 02912, USA
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38
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Bum EN, Soudi S, Ayissi ER, Dong C, Lakoulo NH, Maidawa F, Seke PFE, Nanga LD, Taiwe GS, Dimo T, Njikam N, Rakotonirina A, Rakotonirina SV, Kamanyi A. Anxiolytic activity evaluation of four medicinal plants from Cameroon. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2011; 8:130-9. [PMID: 22754066 DOI: 10.4314/ajtcam.v8i5s.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Afrormosia laxiflora (A. laxiflora), Chenopodium ambrosioides (C. ambrosioides), Microglossa pyrifolia (M. pyrifolia) and Mimosa pudica (M. pudica) are plants used in traditional medicine in Cameroon to treat insomnia, epilepsy, anxiety, and agitation. They were evaluated for their anxiolytic like activity in mice. Animal models (elevated plus maze and stress-induced hyperthermia tests) were used. The four plants showed anxiolytic activity. In stress-induced hyperthermia test, A. laxiflora, C. ambrosioides, M. pyrifolia and M. pudica significantly antagonised the increase of temperature. ΔT° decreased from 0.75°C in the control group to 0.36°C at the dose of 110 mg/kg for A. laxiflora; from 1°C in the control group to -1.1°C at the dose of 120 mg/kg for C. ambrosioides; from 1.7°C in the control group to 0.2°C at the dose of 128 mg/kg for M. pyrifolia and from 1.3°C in the control group to 0.5°C at the dose of 180 mg/kg for M. pudica. In the elevated plus maze test, the four plants increased the number of entries into, percentage of entries into, and percentage of time in open arms. A. laxiflora, C. ambrosioides and M. pudica also reduced the percentage of entries and time in closed arms. In addition, C. ambrosioides, M. pyrifolia and M. pudica showed antipyretic activity by reducing the body temperature. The results suggested that C. ambrosioides, M. pyrifolia and M. pudica posses anxiolytic-like and antipyretic activities while A. laxiflora possesses only anxiolytic-like properties. These plants could be helpful in the treatment of anxiety and fever in traditional medicine in Cameroon.
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Affiliation(s)
- E Ngo Bum
- Department of Biological Sciences, Faculty of Sciences, University of Ngaoundéré, PO Box 454 Ngaoundéré, Cameroon.
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Van Bockstaele B, Verschuere B, Koster EHW, Tibboel H, De Houwer J, Crombez G. Effects of attention training on self-reported, implicit, physiological and behavioural measures of spider fear. J Behav Ther Exp Psychiatry 2011; 42:211-8. [PMID: 21315884 DOI: 10.1016/j.jbtep.2010.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 11/04/2010] [Accepted: 12/13/2010] [Indexed: 12/28/2022]
Abstract
Cognitive theories hold that biased attention to threat plays a prominent role in the development and maintenance of anxiety disorders. In support of this view, attention training has been shown to affect emotional reactivity. An important limitation of most attention training studies is that they almost exclusively rely on self-report measures to assess changes in fear. In the present study, we trained attention towards or away from spiders. We assessed not only self-reported spider fear, but also implicit spider associations, physiological, and behavioural measures of spider fear. Although we successfully changed the attentional processing of spiders, attention training had no effect on any of the outcome variables. These results indicate that changes in attentional bias are not necessarily associated with changes in fear, suggesting that attention training may be unsuitable as a clinical intervention for spider fear.
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Affiliation(s)
- Bram Van Bockstaele
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, B-9000 Ghent, Belgium.
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40
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The Threat of Climate Change: Psychological Response, Adaptation, and Impacts. INTERNATIONAL AND CULTURAL PSYCHOLOGY 2011. [DOI: 10.1007/978-1-4419-9742-5_2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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41
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Doberenz S, Roth WT, Wollburg E, Breuninger C, Kim S. Twenty-four hour skin conductance in panic disorder. J Psychiatr Res 2010; 44:1137-47. [PMID: 20537349 PMCID: PMC2937198 DOI: 10.1016/j.jpsychires.2010.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 03/31/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
Abstract
Skin conductance, physical activity, ambient temperature and mood were recorded for 24 h in 22 panic disorder (PD) patients and 29 healthy controls. During the day, subjects performed standardized relaxation tests (ARTs). We hypothesized that tonically elevated anticipatory anxiety in PD during waking and sleeping would appear as elevated skin conductance level (SCL) and greater skin conductance (SC) variability. Mean SCL was higher during both usual waking activities and sleeping in PD, but not during the ARTs. Group SC variability differences did not reach significance, perhaps because of variance unrelated to anxiety. Analyses indicated that in the PD group, antidepressant medication reduced mean SCL whereas state anxiety had the opposite effect during the day. Depressive symptoms reported during the day were related to elevated mean SCL on the night of the recording. The rate and extent of SCL deactivation over the night was equal in the two groups. However, PD patients had more frequent interruptions of deactivation that could have arisen from conditioned arousal in response to threat cues during sleep.
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42
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Neumann DL, Kitlertsirivatana E. Exposure to a novel context after extinction causes a renewal of extinguished conditioned responses: Implications for the treatment of fear. Behav Res Ther 2010; 48:565-70. [DOI: 10.1016/j.brat.2010.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 02/27/2010] [Accepted: 03/02/2010] [Indexed: 11/27/2022]
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Craske MG, Rauch SL, Ursano R, Prenoveau J, Pine DS, Zinbarg RE. What is an anxiety disorder? Depress Anxiety 2010; 26:1066-85. [PMID: 19957279 DOI: 10.1002/da.20633] [Citation(s) in RCA: 279] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Initiated as part of the ongoing deliberation about the nosological structure of DSM, this review aims to evaluate whether the anxiety disorders share features of responding that define them and make them distinct from depressive disorders, and/or that differentiate fear disorders from anxious-misery disorders. The review covers symptom self-report as well as on-line indices of behavioral, physiological, cognitive, and neural responding in the presence of aversive stimuli. The data indicate that the anxiety disorders share self-reported symptoms of anxiety and fear; heightened anxiety and fear responding to cues that signal threat, cues that signal no threat, cues that formerly signaled threat, and contexts associated with threat; elevated stress reactivity to aversive stimuli; attentional biases to threat-relevant stimuli and threat-based appraisals of ambiguous stimuli; and elevated amygdala responses to threat-relevant stimuli. Some differences exist among anxiety disorders, and between anxiety disorders and depressive disorders. However, the differences are not fully consistent with proposed subdivisions of fear disorders vs. anxious misery disorders, and comparative data in large part are lacking. Given the high rates of co-morbidity, advances in our understanding of the features of responding that are shared across vs. unique to anxiety and depressive disorders will require dimensional approaches. In summary, the extant data help to define the features of responding that are shared across anxiety disorders, but are insufficient to justify revisions to the DSM nosology at this time.
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Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California, Los Angeles, California 90095-1563, USA.
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44
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Affiliation(s)
- Norman B. Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida 32306-4301;
| | - Meghan E. Keough
- Department of Psychology, Florida State University, Tallahassee, Florida 32306-4301;
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45
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Grov EK, Fosså SD, Bremnes RM, Dahl O, Klepp O, Wist E, Dahl AA. The personality trait of neuroticism is strongly associated with long-term morbidity in testicular cancer survivors. Acta Oncol 2010; 48:842-9. [PMID: 19412812 DOI: 10.1080/02841860902795232] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neuroticism is a personality trait expressing nervousness and insecurity. Associations between neuroticism and morbidity in long-term cancer survivors have hardly been explored. The aim of this study was to explore associations between neuroticism and somatic and mental morbidity and lifestyle issues in long-term survivors of testicular cancer (TCSs). MATERIAL AND METHODS All Norwegian TCSs treated between 1980 and 1994 (n = 1 814) were invited to this cross-sectional study. Among them 1 428 (79% response rate) delivered valid data. Neuroticism was self-rated on an abridged version of the Eysenck Personality Inventory. Information was collected by mailed questionnaires. The associations of neuroticism and self-reported variables were tested with multivariate logistic regression analyses. RESULTS Neuroticism was significantly associated with presence of somatic complaints, reduced physical function, neurotoxic side-effects (tinnitus, hearing impairment, peripheral neuropathy, and Raynaud's Phenomenon), self-esteem, concerns about not being able to father children, sexual problems, hazardous alcohol use, daily use of medication, use of sedatives and hypnotics, recent visits to a general practitioner, and seeing a psychologist/ psychiatrist after ended cancer treatment. Poor self-rated health, higher number of negative life events, economical problems and problems getting loans granted showed significant associations with neuroticism. DISCUSSION Neuroticism in TCSs at long-term follow-up is significantly associated with somatic and mental morbidities, and several aspects of unhealthy lifestyle. High levels of neuroticism should be considered in TCSs expressing multiple complaints and concerns at follow-up consultations. Assessment of neuroticism may be clinically important in order to offer appropriate interventions to prevent and manage morbidity in TCSs.
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Affiliation(s)
- Ellen Karine Grov
- Department of Clinical Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Sophie D. Fosså
- Department of Clinical Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Faculty Division, The Norwegian Radium Hospital, University of Oslo, Oslo, Norway
| | - Roy M. Bremnes
- Department of Oncology, University Hospital of Northern Norway, University of Tromsø, Tromsø, Norway
| | - Olav Dahl
- Department of Oncology, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Olbjørn Klepp
- Department of Oncology, Ålesund Hospital, Ålesund/Saint Olav's Hospital, National University for Science and Technology, Trondheim, Norway
| | - Erik Wist
- Department of Oncology, Ullevaal, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Alv A. Dahl
- Department of Clinical Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Faculty Division, The Norwegian Radium Hospital, University of Oslo, Oslo, Norway
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Davis M, Walker DL, Miles L, Grillon C. Phasic vs sustained fear in rats and humans: role of the extended amygdala in fear vs anxiety. Neuropsychopharmacology 2010; 35:105-35. [PMID: 19693004 PMCID: PMC2795099 DOI: 10.1038/npp.2009.109] [Citation(s) in RCA: 1020] [Impact Index Per Article: 72.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 06/26/2009] [Accepted: 07/14/2009] [Indexed: 01/11/2023]
Abstract
Data will be reviewed using the acoustic startle reflex in rats and humans based on our attempts to operationally define fear vs anxiety. Although the symptoms of fear and anxiety are very similar, they also differ. Fear is a generally adaptive state of apprehension that begins rapidly and dissipates quickly once the threat is removed (phasic fear). Anxiety is elicited by less specific and less predictable threats, or by those that are physically or psychologically more distant. Thus, anxiety is a more long-lasting state of apprehension (sustained fear). Rodent studies suggest that phasic fear is mediated by the amygdala, which sends outputs to the hypothalamus and brainstem to produce symptoms of fear. Sustained fear is also mediated by the amygdala, which releases corticotropin-releasing factor, a stress hormone that acts on receptors in the bed nucleus of the stria terminalis (BNST), a part of the so-called 'extended amygdala.' The amygdala and BNST send outputs to the same hypothalamic and brainstem targets to produce phasic and sustained fear, respectively. In rats, sustained fear is more sensitive to anxiolytic drugs. In humans, symptoms of clinical anxiety are better detected in sustained rather than phasic fear paradigms.
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Affiliation(s)
- Michael Davis
- Department of Psychiatry, Yerkes National Primate Center, Emory University, and the Center for Behavioral Neuroscience, Atlanta, GA 30329, USA.
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Coelho CM, Purkis H. The Origins of Specific Phobias: Influential Theories and Current Perspectives. REVIEW OF GENERAL PSYCHOLOGY 2009. [DOI: 10.1037/a0017759] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Fears are quick and adaptive responses that permit powerful reply to imminent threats. Less adaptive, phobias are extreme manifestations of fear to objects or situations in the absence of a proportional danger. Although the utility of fear is accepted, the nature of phobias is controversial. Initial theories favored a fear conditioning-based explanation, with vicarious and information learning pathways subsequently included as additional routes to the development of specific phobias. More recently, an important group of investigations strengthened the case for a nonassociative account of fear acquisition proposing that evolutionarily relevant fears can occur without any need of critical learning experiences. In parallel, there is some evidence for a dedicated fear module in the detection of threats, involving the amygdala, which is relatively independent from conscious cognitive control. Nonetheless, cognitive models stress learning and developmental factors and their role in the etiology and maintenance of phobic behavior. This article critically reviews each of these views and theories stressing their recent developments, weaknesses, and controversies with an aim to provide the groundwork for the construction of a more integrated position. Finally, the authors suggest encouraging trends in recent research.
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Affiliation(s)
| | - Helena Purkis
- School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia
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Morrison AS, Amir N, Taylor CT. A Behavioral Index of Imagery Ability in Social Anxiety. COGNITIVE THERAPY AND RESEARCH 2009. [DOI: 10.1007/s10608-009-9274-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Budd R, Hughes I. The Dodo Bird Verdict-controversial, inevitable and important: a commentary on 30 years of meta-analyses. Clin Psychol Psychother 2009; 16:510-22. [DOI: 10.1002/cpp.648] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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The role of the blood-CNS barrier in CNS disorders and their treatment. Neurobiol Dis 2009; 37:3-12. [PMID: 19664711 DOI: 10.1016/j.nbd.2009.07.029] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 07/30/2009] [Accepted: 07/30/2009] [Indexed: 01/16/2023] Open
Abstract
The physical barrier between blood and the CNS (the blood-brain barrier, the blood-spinal cord barrier and the blood-CSF barrier) protects the CNS from both toxic and pathogenic agents in the blood. It is now clear that disruption of the blood-CNS barrier plays a key role in a number of CNS disorders, particularly those associated with neurodegeneration. Such disruption is inevitably accompanied by inflammatory change, as immune cells and immune mediators gain access to the brain or spinal cord. The blood-CNS barrier also presents a major obstacle for potential CNS medicines. Robust methods to assess CNS permeation are therefore essential for CNS drug discovery, particularly when brain pharmacokinetics are taken into account and especially when such measures are linked to neurochemical, physiological, behavioural or neuroimaging readouts of drug action. Drug candidates can be successfully designed to cross the blood-CNS barrier, but for those that can't there is the possibility of entry with a delivery system that facilitates the movement of drug candidate across the blood-CNS barrier.
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