Relationship between face recognition ability and anxiety tendencies in healthy young individuals: A prosopagnosia index and state-trait anxiety inventory study

Developmental prosopagnosia (DP) is a condition that indicates the inability to recognize individuals by their faces from birth, without any history of brain damage. The assessment of face recognition ability and diagnosis of DP involve the use of face tests such as the Cambridge Face Memory Test (CFMT) and the Cambridge Face Perception Test, along with self-reported measures like the 20-Item Prosopagnosia Index (PI20). Face recognition accuracy is affected by anxiety. However, previous studies on the relationship between face recognition ability and anxiety have not used the PI20 measure. This study aimed to investigate the relationship between self-reported measures of face recognition ability and anxiety tendencies among healthy young individuals for DP diagnosis and its implications. We used a face recognition test, involving the PI20, CFMT, Visual Perception Test for Agnosia-Famous Face Test (VPTA-FFT), and State-Trait Anxiety Inventory (STAI). We assessed the performance of 116 Japanese young adults (75 females, median age of 20.7 years, with a standard deviation of 1.2). Subsequently, we conducted a statistical analysis to examine the relationship between the outcomes of the face recognition tests and STAI scores using Pearson correlation analysis and single correlation coefficients. The results showed a positive correlation between state anxiety and PI20 (r = 0.308, p = 0.007), and a weak positive correlation was also observed between trait anxiety and PI20 (r = 0.268, p = 0.04). In contrast, there was no correlation between CFMT and VPTA-FFT with respect to STAI. The results of the hierarchical multiple regression analysis also suggested that the correlation between the performance on the PI20 (self-report) and objective measures of face recognition performance (the CFMT and the VPTA-FFT) are driven by differences in anxiety. This study is the first to explore the relationship between face recognition abilities and anxiety using the PI20 self-report measure. There are implications for future research on the diagnosis of DP and the relationship between anxiety and face recognition.

Intersubject representational similarity analysis uncovers the impact of state anxiety on brain activation patterns in the human extrastriate cortex

The current study used functional magnetic resonance imaging (fMRI) and showed that state anxiety modulated extrastriate cortex activity in response to emotionally-charged visual images. State anxiety and neuroimaging data from 53 individuals were subjected to an intersubject representational similarity analysis (ISRSA), wherein the geometries between neural and behavioral data were compared. This analysis identified the extrastriate cortex (fusiform gyrus and area MT) to be the sole regions whose activity patterns covaried with state anxiety. Importantly, we show that this brain-behavior association is revealed when treating state anxiety data as a multidimensional response pattern, rather than a single composite score. This suggests that ISRSA using multivariate distances may be more sensitive in identifying the shared geometries between self-report questionnaires and brain imaging data. Overall, our findings demonstrate that a transient state of anxiety may influence how visual information - especially those relevant to the valence dimension - is processed in the extrastriate cortex.

Effects of arginine vasopressin on human anxiety and associations with sex, dose, and V1a-receptor genotype

RATIONALE

Arginine vasopressin (AVP) has dose- and sex-specific effects on social behavior, and variation in social responses is related to variation in the V1a receptor gene in animals. Whether such complexity also characterizes AVP effects on anxiety in humans, or whether V1a genotype is related to anxiety and/or AVP's ability to affect it, remains to be determined.

OBJECTIVE

To test if AVP has dose-dependent effects on anxiety in men and/or women and if a particular allele within the RS3 promoter region of the V1a receptor gene is associated with anxiety and/or AVP effects on anxiety.

METHOD

Men and women self-administered 20 IU or 40 IU intranasal arginine vasopressin (AVP) and placebo in a double-blind, within-subjects design, and State (SA) and Trait (TA) anxiety were measured 60 min later. PCR was used to identify allelic variation within the RS3 region of the V1a receptor gene.

RESULTS

AVP decreased SA in men across both doses, whereas only the lower dose had the same effect, across sexes, in individuals who carry at least one copy of a previously identified "risk" allele in the RS3 promoter of the V1a receptor gene. Additionally, after placebo, women who carried a copy of the allele displayed lower TA than women who did not, and AVP acutely increased TA scores in those women.

CONCLUSIONS

Exogenous AVP has modest sex- and dose-dependent effects on anxiety/affect in humans. Further, allelic variation in the V1a promoter appears associated with responsiveness to AVP's effects and, at least in women, to stable levels of anxiety/affect.

How state anxious individuals estimate time retrospectively: The mediating effect of memory bias

The purpose of the present study is to explore how anxious individuals estimate time retrospectively, which may fill in a research gap of time estimation literature. Two experiments were conducted to investigate the mediating effect of memory bias on the relationship between state anxiety and retrospective time estimation. In Experiment 1, state anxiety (high and low) was manipulated by a standardized induction procedure, and retrospective time estimation was tested by the verbal estimation task. In Experiment 2, memory bias was measured by the free-recall task for the data analysis of the mediating role of memory bias in the relationship of state anxiety and retrospective time estimation. In a Supplementary Experiment, different methods were used to verify the robustness of the results in Experiment 2. The results suggest that (1) high state anxious individuals estimate a retrospective duration to be longer than low state anxious individuals, and (2) memory bias mediates the influence of state anxiety on retrospective time estimation. Our findings contribute to a deep understanding of the time distortion consequence of anxiety from a new perspective and offers important insight into the mechanism underlying the effect anxiety has on retrospective time estimation.

Pre-scan state anxiety is associated with greater right amygdala-hippocampal response to fearful versus happy faces among trait-anxious Latina girls

BACKGROUND

Unfamiliarity with academic research may contribute to higher levels of anticipatory state anxiety about affective neuroimaging tasks. Children with high trait anxiety display differences in brain response to fearful facial affect compared to non-anxious youth, but little is known about the influence of state anxiety on this association. Because reduced engagement in scientific research and greater mistrust among minoritized groups may lead to systematic differences in pre-scan state anxiety, it is crucial to understand the neural correlates of state anxiety during emotion processing so as to disambiguate sources of individual differences.

METHODS

The present study probed the interactive effects of pre-scan state anxiety, trait anxiety, and emotional valence (fearful vs. happy faces) on neural activation during implicit emotion processing in a community sample of 46 preadolescent Latina girls (8-13 years).

RESULTS

Among girls with mean and high levels of trait anxiety, pre-scan state anxiety was associated with greater right amygdala-hippocampal and left inferior parietal lobe response to fearful faces relative to happy faces.

CONCLUSIONS

Anticipatory state anxiety in the scanning context may cause children with moderate and high trait anxiety to be hypervigilant to threats, further compounding the effects of trait anxiety. Neuroimaging researchers should control for state anxiety so that systematic differences in brain activation resulting from MRI apprehension are not misleadingly attributed to demographic or environmental characteristics.

The association between mechanical temporal summation, state anxiety at baseline, and persistent low back pain: a 12-month prospective cohort study

BACKGROUND

Persons with acute low back pain (LBP) have a good prognosis for regaining function, while pain often persists. Neurobiological and psychosocial factors are recognized to amplify pain responses, as reported for central sensitization. This study investigated the combination of mechanical temporal summation (TS) chosen to characterize central sensitization and state anxiety representing a psychological factor and their association with persistent pain.

METHODS

A longitudinal prospective cohort study including 176 participants aged between 18 and 65 with acute LBP was performed. The following independent variables were analyzed at baseline: The mechanical TS at the lower back, of whom the Wind-up ratio (WUR) was calculated, and the state anxiety level measured with the State and Trait Anxiety Inventory (STAI-S). The outcome pain intensity was assessed at baseline and 2,3,6 and 12 months after the onset of acute LBP with the Numeric Rating Scale 0-10 (NRS). Linear mixed models (LMM) were used to analyze the association of the independent variables with pain intensity over time.

RESULTS

The mean baseline WUR was 1.3 (SD 0.6) for the right and 1.5 (SD 1.0) for the left side. STAI-S revealed a mean score of 43.1 (SD 5.2). Pain intensity was, on average, 5.4 points (SD 1.6) on the NRS and decreased over one year to a mean of 2.2 (SD 2.4). After one year, 56% of the participants still experienced pain. The LMM revealed a considerable variation, as seen in large confidence intervals. Therefore, associations of the independent variables (WUR and STAI-S) with the course of the outcome pain intensity over one year were not established.

CONCLUSION

This investigation did not reveal an association of mechanical TS and state anxiety at baseline with pain intensity during the one-year measurement period. Pain persistence, mediated by central sensitization, is a complex mechanism that single mechanical TS and state anxiety cannot capture.

Relationship between types of anxiety and the ability to recognize facial expressions

This study examined whether three subtypes of anxiety (trait anxiety, state anxiety, and social anxiety) have different effects on recognition of facial expressions. One hundred and thirty-eight participants matched facial expressions of three intensity levels (20 %, 40 %, 100 %) with one of the six emotion labels ("happy", "sad", "fear", "angry", "disgust", and "surprise"). While using a conventional method of analysis we were able to replicate some significant correlations between each anxiety type and recognition performance found in the literature. However, when we used partial correlation to isolate the effect of each anxiety type, most of these correlations were no longer significant, apart from the negative correlations between Beck Anxiety Inventory and reaction time to fearful faces displayed at 40 % intensity level, and the correlations between anxiety and categorisation errors. Specifically, social anxiety was positively correlated with misidentifying a happy face as a disgust face at 40 % intensity level, and state anxiety negatively correlated with misidentifying a happy face as a sad face at 20 % intensity level. However, these partial correlation analyses became non-significant after p value adjustment for multiple comparisons. Our eye tracking data also showed that state anxiety may be associated with reduced fixations on the eye regions of low-intensity sad or fearful faces. These analyses cast doubts on some effects reported in the previous studies because they are likely to reflect a mixture of influences from highly correlated anxiety subtypes.

The effect of positive and negative evaluation on state anxiety and repetitive negative thinking in social evaluative situations: An experimental study

The Bivalent Fear of Evaluation (BFOE) Model suggests that fears of negative and positive evaluation are core cognitive vulnerability and maintenance factors for social anxiety disorder The aim of this study was to experimentally assess cognitive and emotional effects of positive and negative feedback in social anxiety. False positive or negative feedback (vs no feedback) was provided following a speech task to high and low socially anxious individuals to investigate impacts on state anxiety and repetitive negative thinking (N = 152, Mage = 22.13, 69 % female). Measures were completed prior to the speech and after the false feedback but prior to an anticipated discussion with the group about participants' feedback and performance. High socially anxious participants reporting higher state anxiety and repetitive negative thinking than low socially anxious participants. There were no feedback type by group interactions, indicating that high socially anxious individuals experienced heightened social anxiety and repetitive negative thinking regardless of feedback type (or the absence of feedback). Exploratory analyses revealed that state fear of negative evaluation but not state fear of positive evaluation uniquely predicted both outcomes. Implications for theory and clinical practice are discussed.

Vulnerability to anxiety differently predicts cortisol reactivity and state anxiety during a laboratory stressor in healthy girls and boys

BACKGROUND

Children diagnosed with anxiety disorders show altered cortisol and state anxiety reactivity to stressful situations. To date, it remains unclear whether these dysregulations emerge after the pathology or whether they are also detectable in healthy children. If the latter is true, this may provide insight into children's vulnerability to develop clinical anxiety. Various personality factors (anxiety sensitivity, intolerance of uncertainty, perseverative cognitions) increase youth's vulnerability to develop anxiety disorders. This study aimed to examine whether vulnerability to anxiety was associated with cortisol reactivity and state anxiety in healthy youth.

METHODS

114 children (8-12 y/o) were exposed to the Trier Social Stress Test for Children (TSST-C), where saliva samples were collected for cortisol quantification. State anxiety was assessed 20 min before and 10 min after the TSST-C using the state form of the State-Trait Anxiety Inventory for Children. Vulnerability to anxiety was assessed using a composite score of the Childhood Anxiety Sensitivity Index, Intolerance of Uncertainty Scale for Children, and Perseverative Thinking Questionnaire.

RESULTS

Higher vulnerability to anxiety was associated with enhanced cortisol reactivity in boys. Irrespective of vulnerability level, girls reported greater changes in state anxiety in response to the TSST.

LIMITATIONS

Given the correlational nature of this study, the directionality of the results remains to be elucidated.

CONCLUSIONS

These results indicate that endocrine patterns characterizing anxiety disorders are detectable in healthy boys who exhibit a high level of self-reported vulnerability to anxiety. These results could aid in the early identification of children at risk of developing anxiety disorders.

The Effect of Intolerance of Uncertainty on State Anxiety in the Regular Epidemic Prevention and Control Phase in the Context of Informatization: A Moderated Chain Mediation Model

The COVID-19 pandemic has led to a generally high level of state anxiety resulting from the high contagiousness of the disease and strict prevention and control policies. The present study mainly focused on the relationship between the individual intolerance of uncertainty and state anxiety in the regular epidemic prevention and control phase in China, and aimed to investigate the mediating role of information overload and rumination, as well as the moderating role of self-compassion. A total of 992 Chinese residents from 31 provinces participated in this study, and completed questionnaires regarding intolerance of uncertainty, information overload, self-compassion, rumination, and state anxiety. Descriptive statistics and correlation analyses, as well as tests for mediating effects and moderated chain mediating effects, were performed on the data using SPSS 26.0 and Process 3.5 macro program. The findings indicated that intolerance of uncertainty significantly predicted individual state anxiety. Information overload mediates the effects of intolerance of uncertainty and state anxiety. Rumination also mediates the effect of uncertainty intolerance on state anxiety. Information overload and rumination have a chain mediation effect on the link between intolerance of uncertainty and state anxiety. Self-compassion mediates the effect of information overload on rumination. The results illuminate theoretical and practical implications in the regular epidemic prevention and control phases and reveal the protective role of self-compassion.

Gender stereotypes and motor performance: How explicit and implicit stereotypes influence girls standing long jump and anxiety

OBJECTIVES

Inducing a negative stereotype toward women usually leads to a decrease in women's motor performance. Given that most studies have focused on explicit stereotype induction among adults, the main aim of this study was to investigate the effects of explicit and implicit gender stereotypes on standing long jump performance in children. The second aim was to investigate the effects of these same manipulations on children's state anxiety.

DESIGN

A mixed model design with within-between-subject was used with standing long jump performance and state anxiety as dependent variables.

METHOD

Two hundred and four children (Mage = 10.95 years, SDage = 0.85) participated in this study and were randomly assigned, after baseline measurement, into four different groups (i.e., explicit/implicit vs. explicit vs. implicit vs. control). Specifically, participants performed 8 trials of standing long jump (4 trials during the baseline phase and 4 trials during the experimental phase). Children also completed the competitive state Anxiety Inventory at baseline as well as immediately after the trials.

RESULTS

For motor performance, children in the explicit/implicit group and in the implicit group were negatively affected by the stereotype manipulation during all trials whereas participants in the explicit group were only negatively impacted during the last two trials. However, regarding state anxiety, children were negatively affected after both explicit only and implicit only manipulations and more significantly after explicit/implicit manipulation.

CONCLUSIONS

The present research showed that the explicit and implicit manipulations influenced motor performance differently, but that these two manipulations increased state anxiety in the same way. Moreover, the combination of the explicit and implicit inductions leads to a greater significant negative influence on state anxiety but not motor performance.

Better Understand to Better Predict Subjective Well-Being Among Older Greeks in COVID-19 Era: Depression, Anxiety, Attitudes Towards eHealth, Religiousness, Spiritual Experience, and Cognition

Despite similarities with previous pandemics, the potential physical and psychosocial impact of COVID-19 on older adults is still little investigated in Greece. This study examines the intercorrelations between subjective well-being/life satisfaction, depression, state anxiety, global cognitive function, attitudes towards eHealth, religiousness and spiritual experience in older adults during COVID-19. Results revealed that statistically significant negative correlations exist between subjective life satisfaction and depressive symptomatology as well as with religiousness, a finding that can be explained by the COVID-19 externally imposed religious practice restrictions. Subjective life satisfaction was positively correlated with overall cognition as measured by Mini-Mental State Examination (MMSE). MMSE was also negatively correlated with state anxiety, depression, and attitudes towards eHealth use. The best predictors of subjective well-being is global cognition (as measured by MMSE) and depressive symptomatology (measured by GDS). The conclusions of this study underscore the need to examine in more detail psychological variables during COVID-19 and quality of life in older adults.

Patient-Physician Concordance for Quantitative Formats and Treatment Options and the Relationship with State Anxiety

Patient-physician concordance about topics discussed in a clinic visit is essential for effective communication but may be difficult to achieve in cancer care. We conducted a multicenter, observational study at two Midwestern oncology clinics. A sample of 48 English-speaking or Spanish-speaking women with newly diagnosed stage 0-3 breast cancer completed surveys before and after a visit with an oncologist. Patient-physician dyads were coded as concordant if both patient and physician follow-up self-reports agreed whether (or not) specific treatments were discussed (i.e., treatment option concordance; mastectomy, lumpectomy, hormone therapy, neoadjuvant, and adjuvant chemotherapy) and whether risk was described using certain quantitative formats (i.e., quantitative format concordance; percentages, proportions out of 100 and 1000, graphs, pictures, evidence from clinical studies, cancer stage). Agreement was determined using percent agreement and prevalence-adjusted bias-adjusted kappa (PABAK). Pearson's correlations were used to determine relationships between anxiety and each measure concordance. Percent concordance was higher for treatment concordance (73.3%) compared to quantitative format concordance (64.5%), and PABAK scores tended to be higher for treatment options (PABAK = .21-.78). Both treatment and quantitative format concordance were negatively associated with pre-visit state anxiety, but only treatment concordance was statistically significant (treatment: r =  - .504, p = .001; quantitative format: r =  - .096, p = .523). Our study indicates moderate patient-physician concordance in early breast cancer care communication and that patient anxiety may impact the ability for patients and physicians to agree on the content communicated in a clinic visit.

The moderating role of resilience in the relationship between state and trait anxiety and post-traumatic growth of medical freshmen

BACKGROUND

Psychological distress such as anxiety of medical students especially during the first-year has been widely acknowledged. However, many students could exhibit post-traumatic growth when experiencing anxiety. Previous study demonstrated that anxiety might have impacts on post-traumatic growth, but how anxiety affects post-traumatic growth is still undefined. This study sought to examine whether resilience has a moderating role between state and trait anxiety and post-traumatic growth when medical freshmen are experiencing stressful events.

METHODS

A total of 295 medical freshmen were administered the Post Traumatic Growth Inventory, the State-Trait Anxiety Inventory and the Connor-Davidson Resilience Scale.

RESULTS

Post-traumatic growth was negatively correlated with state anxiety and trait anxiety, with a correlation coefficient of -0.474 and -0.462 (p < 0.01), and positively correlated with resilience, with a correlation coefficient of 0.635 (p < 0.01). Resilience acted as a moderator for the indirect effect of state and trait anxiety on post-traumatic growth.

CONCLUSIONS

These findings demonstrated resilience could be of extreme importance for developing post-traumatic growth, and therapeutic interventions tailored to the medical freshmen to promote their resilience to adapt to life in college.

Longitudinal PTSD symptom trajectories: Relative contributions of state anxiety, depression, and emotion dysregulation

BACKGROUND

Prospective research on the development and trajectory of PTSD symptoms after a traumatic event is crucial for assessment and early intervention. Further, examining predictors of PTSD pathology provides a better conceptualization of the temporal course of PTSD in trauma victims.

METHODS

The present study examined PTSD symptom severity in individuals presenting to the emergency department (ED) following a traumatic event. Participants (N = 147) were assessed at four timepoints: 2-weeks, 3-months, between 6 and 9 months, and 12-months after ED admission. Growth curve modeling was conducted to examine changes in PTSD symptom severity over time. Age, sex, state anxiety, trait anxiety, emotion dysregulation, depression, and trauma type (motor vehicle accident [MVA] and assault), and PTSD diagnosis were included as covariates in the model.

RESULTS

Results demonstrated that baseline PTSD symptom severity was positively associated with severity of depression and state (but not trait) anxiety, emotion dysregulation, and PTSD diagnosis. Results also revealed significant associations with PTSD symptom changes over time; greater state anxiety and depression symptoms at baseline were associated with steeper declines in PTSD symptoms over time.

LIMITATIONS

Data were collected at only four timepoints over the course of 12-months. Results may be different with more measurement points over longer periods and inclusion of pre-, peri- and post-trauma risk factors.

CONCLUSIONS

Results illustrate the relevance of assessing state anxiety, depression, and emotion dysregulation in following trauma victims for trauma-related psychopathology over the course of time to alleviate the negative impact of the same.

Differences in college students' occupational dysfunction and mental health considering trait and state anxiety during the COVID-19 pandemic

Background

Due to the COVID-19 pandemic, university education has shifted from face-to-face classes to online and distance learning. Effects of exposure may manifest in terms of psychological, cognitive, or musculoskeletal impairments that affect an individual's daily functioning and quality of life. There is a dearth of studies exploring anxiety states, occupational dysfunction, and mental health associated with the new standard of increased telecommunication. Accordingly, the present study aimed to identify the differences in occupational dysfunction, health literacy, positive and negative emotions, and stress response considering the anxiety states of college students during the COVID-19 pandemic. Another purpose is to identify relationships among the parameters such as occupational dysfunction and mental health.

Methods

This cross-sectional study included 358 students (average age: 18.5 years, age range: 18-29 years). Five tools were used: the State-Trait Anxiety Inventory (STAI), Classification and Assessment of Occupational Dysfunction (CAOD), European Health Literacy Survey Questionnaire (HLS-EU-Q47), Profile of Mood States 2nd Edition (POMS-2), and Stress Response Scale-18 (SRS-18). Based on the cutoff value of state and trait anxiety of the STAI, the participants were classified into four groups and compared using one-way analysis of variance and multiple comparison tests. The relationship between all parameters was analyzed using Pearson's correlation coefficient.

Results

The group with high trait anxiety and high state anxiety had the highest CAOD total score, Total Mood Disturbance score on the POMS-2, SRS-18 score, and scores on many sub-items of the three parameters. The prevalence of occupational dysfunction was 47% for university students, and there was a variation of from 19 to 61% in each group. The correlation coefficients of the state and trait anxiety scores of the STAI, Total Mood Disturbance score, and SRS-18 ranged from .64 to .75. Additionally, the correlation coefficient between the CAOD total score and these parameters ranged from .44 to .48.

Conclusion

The prevalence of occupational dysfunction was highest in the group with high trait anxiety and high state anxiety, and occupational dysfunction, negative emotions, and stress responses were strongest in this group. Our findings point to potential areas for targeted support and interventions.

Cognitive complaints mediate the influence of sleep disturbance and state anxiety on subjective well-being and ill-being in adult community volunteers: a cross sectional study

Background

Sleep disturbance, state anxiety, and cognitive complaints (CCs) have been recognized as important issues in public health. Although the mediating role of CCs has been proposed, their role in the relationships between sleep disturbance, state anxiety, and subjective well-being (SWB) and subjective ill-being (SIB) are not yet fully understood. This study used path analyses to investigate whether CCs mediate these relationships.

Methods

The study recruited 523 Japanese adult volunteers using convenience sampling. Participants completed the Pittsburgh Sleep Quality Index, State–Trait Anxiety Inventory (Form Y), Cognitive Complaints in Bipolar Disorder Rating Assessment, and Subjective Well-Being Inventory to evaluate sleep disturbance, state anxiety, CCs, and SWB and SIB, respectively. Path analyses were conducted to assess the mediating effects of CCs.

Results

The path analyses showed significant indirect associations of sleep disturbance and state anxiety with SWB (p = 0.024 and p = 0.012) and SIB (p < 0.001 and p < 0.001), respectively, mediated by CCs. Furthermore, there were significant indirect associations of sleep disturbance with CCs (p < 0.001), SWB (p < 0.001), and SIB (p < 0.001), via state anxiety, respectively.

Conclusions

This study suggests that CCs mediate the associations of sleep disturbance and state anxiety with SWB and SIB, respectively, in adult community volunteers. To address SWB and SIB associated with sleep disturbance and state anxiety, evaluating CCs may be useful in public mental health. Our findings will encourage health care workers to assess CCs more systematically. Future studies may need to target CCs to develop interventions for SWB and SIB.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12936-0.

Anxiety, resilience and local conditions: A cross-cultural investigation in the time of Covid-19

The spread of Covid‐19 is a worldwide phenomenon, unprecedented in modern times. Differences among countries in such matters are of interest as they provide a unique window to understand human behaviour and culture. The aim of this study is to examine cross‐cultural differences in state anxiety, and any moderating role of resilience and social contact. Participants from three countries were recruited: Ireland (n = 449), Italy (n = 324) and Spain (n = 471). While these countries share many characteristics, it was anticipated that their experiences might differ because of pronounced differences in governmental measures and the local severity and history of the pandemic at the time of data collection. Results indicated that: (a) Resilience was negatively related to state anxiety both bivariately and multivariately; (b) number of hours outside per week did not predict state anxiety but was negatively correlated with fear of contagious diseases in the essential workers from the Irish sample; (c) national measures had a moderating role in the relationship between resilience and state anxiety; and (d) social contact, in terms of numbers of written, audio or visual interactions, was not a statistically significant predictor of state anxiety. These results may help to understand the adverse impact on mental health.

Transcranial direct current stimulation of bilateral dorsolateral prefrontal cortex eliminates creativity impairment induced by acute stress

The creativity impairment under acute stress may be closely related to the down-regulation of the prefrontal cortex function caused by stress-related neurotransmitters and hormones. In the current study, we explored whether transcranial direct current stimulation (tDCS) over bilateral dorsolateral prefrontal cortex (DLPFC) eliminated stress-induced creativity impairment and the potential mechanism from the perspective of stress response recovery. Seventy participants were randomly allocated to a group undergoing the activation of right DLPFC and the deactivation of left DLPFC (R+L-; N = 35), and a group of sham stimulation (sham; N = 35). Participants received tDCS after the stress induction, and then completed the Alternative Uses Task (AUT) and the Remote Association Task (RAT) during the stimulation. The stress response was indicated using heart rate, cortisol, and emotion changes. Results showed that R+L- stimulation facilitated the recovery of anxious state compared to sham stimulation. We also found that the decreased value of AUT scores after stress in the R+L- group was significantly lower than that in the sham group. Moreover, further analysis revealed state anxiety mediated the effect of tDCS on the flexibility component of the AUT. We concluded that bilateral tDCS over the DLPFC is efficient in alleviating stress-induced creativity impairment, which may correlate with greater recovery of state anxiety. Our findings provide causal evidence for the neurophysiological mechanisms by which stress affects creativity, as well as clinical suggestions for stress-related psychiatric disorders prevention and intervention.

High-gamma oscillations as neurocorrelates of ADHD: A MEG crossover placebo-controlled study

Attention Deficit Hyperactive Disorder (ADHD) is a common neurobehavioral disorder with a significant and pervasive impact on patients' lives. Identifying neurophysiological correlates of ADHD is important for understanding its underlying mechanisms, as well as for improving clinical accuracy beyond cognitive and emotional factors. The present study focuses on finding a diagnostic stable neural correlate based on evaluating MEG resting state frequency bands. Twenty-two ADHD patients and 23 controls adults were blindly randomized to two methylphenidate/placebo evaluation days. On each evaluation day state anxiety was assessed, a 2N-back executive function task was performed, and resting state MEG brain activity was recorded at three timepoints. A frequency-based cluster analysis yielded higher high-gamma power for ADHD over posterior sensors and lower high-gamma power for ADHD over frontal-central sensors. These results were shown to be stable over three measurements, unaffected by methylphenidate treatment, and linked to cognitive accuracy and state anxiety. Furthermore, the differential high-gamma activity evidenced substantial ADHD diagnostic efficacy, comparable to the cognitive and emotional factors. These results indicate that resting state high-gamma activity is a promising, stable, valid and diagnostically-relevant neurocorrelate of ADHD. Due to the evolving understanding both in the cellular and network level of high-gamma oscillations, focusing future studies on this frequency band bears the potential for a better understanding of ADHD, thus advancing the specificity of the evaluation of the disorder and developing new tools for therapy.

Is the choice of anesthesia during gastrointestinal endoscopic procedures a result of anxiety?

BACKGROUND AND STUDY AIMS

Esophagogastroduodenoscopy (EGD) and colonoscopy (CS) are vital endoscopic procedures in the diagnosis and follow-up of gastrointestinal tract diseases. Endoscopic procedures can be performed with or without anesthesia as per patient preferences. These procedures can cause some anxiety in almost all patients, and the degree of anxiety differs for each individual. Thus, we aimed to evaluate the trait and state anxiety levels of the patients and assess the relationship between the preference of anesthesia and anxiety levels.

PATIENTS AND METHODS

To investigate this issue, 723 patients who underwent elective endoscopy (EGD and/or CS) were enrolled. The researchers collected sociodemographic data and medical history records as reported by the patients. State and trait anxiety levels of the patients were evaluated using the State and Trait Anxiety Inventory (STAI).

RESULTS

The patients were divided into two groups as with anesthesia and without anesthesia. Of the respondents, 43.4% requested anesthesia during endoscopic procedure. Sociodemographic data, except sex, showed similar characteristics. The STAI trait scores of the two groups were similar; however, there was a significant difference in the STAI state scores of the groups (p = 0.018). A significant difference was observed in the anesthesia preference and the type of endoscopic procedure (EGD, CS, or both) (p < 0.001). Type of endoscopic procedure, STAI state scores, and sex were determined as the predictors of the anesthesia choice.

CONCLUSION

Endoscopic procedures are known to cause anxiety among many patients. Our findings suggest that the anesthesia preferences of patients are an important factor in preventing these situational concerns. However, this study found that being a woman and undergoing a CS procedure are important factors related to anesthesia preferences. Thus, more detailed assessments on this subject are required.

High-caloric or isocaloric maternal high-fat diets differently affect young-adult offspring behavior in anxiety-related tests and offspring sensitivity to acute fluoxetine

OBJECTIVE

to evaluate the influence of two maternal high-fat diets with different caloric contents on anxiety-like behavior in young-adult offspring and their sensitivity to acute fluoxetine.

METHODS

females Wistar rats were used and divided according to diet received during gestation and lactation: Control (CTR), high-fat/isocaloric (HI) and high-fat/high-caloric (HH). Offspring were subsequently divided into three subgroups according to acute administration of vehicle or fluoxetine (1 or 10 mg/kg). To assess animals' anxiety-like behaviors, three tests were used: open field (OF), elevated plus-maze (EPM) and free-exploratory paradigm (FEP).

RESULTS

In OF, HI and HH showed increased hyperactivity- and anxiety-related behaviors, HI being more hyperactive than HH. In response to fluoxetine, HI offspring decreased number of quadrants entered, decreased number of central entries and spent less time in rearing in peripheral areas, while HH offspring showed less time spent in rearing in the OF peripheral area. In EPM test, HI pups spent more time in closed arms than the HH pups. Fluoxetine decreased number of open arms entries for HI offspring and increased percentage of time spent in central area for HH animals. Maternal diet did not influence FEP test, neither HI nor HH presented a response after fluoxetine acute administration.

CONCLUSION

Maternal high-fat diets influence offspring anxiety-like behavior in state-anxiety tests but not in trait-anxiety test. Responsiveness to acute fluoxetine depended on maternal diet, dose and which behavioral tests were being evaluated.

Self-focused attention vs. negative attentional bias during public speech task in socially anxious individuals

Enhanced self-focused attention (SFA) and negative attentional bias (NAB) towards social cues are characteristic hallmarks of social anxiety. It is essential to investigate these two attentional phenomena under socially relevant situations using comparable stimuli. In the present study, individuals with high social anxiety (HSA, n = 32) and low social anxiety (LSA, n = 29) were compared according to their attention toward self-related stimuli and toward positive, neutral, and negative feedback related stimuli. Video stimuli of moving indicators of self-anxiety-status and positive, neutral, and negative feedback from an audience were presented during an impromptu speech task (high anxiety condition) and a re-watching phase (low anxiety condition). Eye movements in response to the different stimuli served as readouts for attentional preference. An interaction effect suggested that the HSA group directed more attention to self-related stimuli relative to other stimuli and the LSA group only during the high anxiety condition. The LSA group exhibited a general attentional preference toward positive feedback, especially during the low anxiety condition. Meanwhile, only the total duration of fixation on positive feedback negatively correlated with subjective anxiety rating. Our results point to increased SFA rather than NAB in HSA individuals under social threats.

Upward social comparison and state anxiety as mediators between passive social network site usage and online compulsive buying among women

Although Social Network Site (SNS) usage has been shown to be related to online compulsive buying among women, little is known about the mediating mechanisms underlying this association. Based on the Interaction of Person-Affect-Cognition-Execution model (I-PACE) for addictive behaviors and social comparison theory, the present study examined the mediating roles of upward social comparison and state anxiety in the link between passive SNS usage and online compulsive buying among female undergraduate students. A sample of 799 Chinese female undergraduate students (mean age = 19.86 years, SD = 1.63) were recruited to complete questionnaires measuring passive SNS usage, upward social comparison on SNS, state anxiety, and online compulsive buying. After controlling for online shopping experience, the results showed that passive SNS usage was positively associated with online compulsive buying; upward social comparison and state anxiety partially mediated this link, which contained three mediating pathways - the separate mediating effect of upward social comparison and state anxiety, and the sequential mediating effect of upward social comparison and state anxiety. These findings can advance our understanding of how passive SNS usage is related to online compulsive buying among female undergraduate students. Limitations and implications of this study are discussed.

The psychological burden of routine prenatal ultrasound on women's state anxiety across the three trimesters of pregnancy

OBJECTIVE

Although obstetric ultrasound examination has recognizable clinical and psychological benefits, it also involves some psychological burdens, mainly in terms of the woman's state anxiety, the level of which can change during pregnancy. This research aimed to study the influence of routine ultrasound examination on the woman's state anxiety and its relation with her personality background in the three trimesters of pregnancy.

STUDY DESIGN

This work was a prospective interventional study. Women who underwent routine-screening ultrasound examinations in the first, second, or third trimester of pregnancy were recruited. The state anxiety level was assessed using the State-Trait Anxiety Inventory - subscale S (S-Anxiety), administered immediately before and after the exams. More stable personality characteristics were evaluated before ultrasound, assessing trait anxiety by State-Trait Anxiety Inventory - subscale T (T-Anxiety) and psychological coping by Coping Orientations to Problem Experienced (COPE). The S-Anxiety scores, collected immediately before and after the exams, were compared by two-tailed paired t-test. Moreover, S-Anxiety scores collected in each one of the three-trimester groups immediately before and after the exams were compared by one-way between groups ANOVA. Relations among S-Anxiety scores with more stable aspects of personality (T-Anxiety and COPE scores) were also studied, by correlation analysis.

RESULTS

A total of 285 women were recruited. In all trimesters, S-Anxiety scores decreased significantly after the exam (P < 0.001), with a more relevant reduction in women with higher T-Anxiety scores (P < 0.001). A gradual decrease in S-Anxiety scores before the examination was seen across the three trimesters, with significantly higher scores in the first trimester (P = 0.016). Before ultrasound, S-Anxiety score resulted positively correlated with avoidance coping strategies (P < 0.001), while it was inversely related to active coping style (P < 0.001) and positive aptitude (P < 0.001).

CONCLUSIONS

The psychological burden of prenatal ultrasound in the different trimesters of pregnancy was studied. Clinicians should be sensitive to women's state anxiety during prenatal routine-screening ultrasound examination, using a personalized approach. Particular attention should be paid to the psychological burden associated with ultrasound evaluation of the first trimester, when the level of the anxiety state is higher.

State anxiety and alcohol choice: Evidence from experimental and online observational studies

BACKGROUND

Experimental studies have investigated the effects of physical, psychological and pharmacological stressors (that induce state anxiety) on alcohol outcomes. However, no study has investigated the effects of state anxiety on alcohol outcomes, and the moderating role of drinking to cope (DTC) motives, using the 7.5% carbon dioxide (CO2) challenge.

AIMS

We aimed to investigate the relationships between state anxiety and alcohol-related outcomes (primarily alcohol choice). We also explored whether DTC motives moderated these relationships.

METHODS

We conducted two experiments using the 7.5% CO2 challenge (Studies 1 and 2) and an observational study (Study 3) (ns = 42, 60 and 219, respectively), to triangulate findings.

RESULTS

In Study 1, experimentally induced state anxiety increased alcohol choice (p < .001, ηp2 = .29). This finding was replicated in Study 2, but the effect was weaker (p = .076, ηp2 = .06). Furthermore, DTC moderated the effect (p = .013, ηp2= .11). However, in Study 3 there was no clear evidence of an association between naturally occurring state anxiety and alcohol choice (b = 0.05, p = .655), or a moderating role of DTC (b = 0.01, p = .852).

CONCLUSIONS

Experimentally induced, but not naturally occurring, state anxiety increases alcohol choice, although state anxiety levels were lower in the non-manipulated sample.

Relation of attention deficit hyperactivity disorder (ADHD) to basic number skills and arithmetic fact retrieval in children

Although research has provided evidence for a clear association of core executive function (CEF) to math performance, fewer studies have been carried out on arithmetic fact retrieval in relation to the symptoms of attention deficit hyperactivity disorder (ADHD). The present study assessed mathematical achievement on a basic number skill test and on an arithmetic fact retrieval task. Besides math achievement, self-ratings of ADHD symptoms (attention deficits, hyperactivity, impulsivity), core executive functions (inhibition, cognitive flexibility, working memory capacity, global index) and state anxiety in 646 fourth and fifth grade students (48.1 % girls) were measured. CEF was evaluated by means of a tablet-based test. Regression analysis showed different predictors for both math abilities. While all CEF measures, inattention and impulsivity self-ratings predicted basic number skills, only inhibition, WMC and inattention self-rating were predictors of arithmetic fact retrieval. On the basis of a cluster analysis of ADHD self-ratings and CEF performance, three different groups were identified: 1: low ADHD, average CEF; 2: high ADHD, low CEF; 3: moderate ADHD, high CEF. Cluster 2 showed scores below the mean in both math scores, whereas cluster 3 exhibited performances above the mean in both math scores. No math differences were found between cluster 1 and 3. The data yield evidence that the association between CEF and math achievement depends on the specific math skill and test type. The results underline the importance of differentiating between CEF components and specific math abilities. Implications for future research on the associations between mathematics, ADHD and CEF are discussed.

Correlation between crowdedness in emergency departments and anxiety in Chinese patients

BACKGROUND

Emergency department (ED) overcrowding is a severe health care concern, while anxiety and depression rates among ED patients have been reported to be substantially higher compared to the general population. We hypothesized that anxiety due to over crowdedness may lead to adverse events in EDs.

AIM

To investigate correlations between crowdedness in EDs and anxiety of patients and nurses, and to identify factors affecting their anxiety.

METHODS

In this prospective observational study, a total 43 nurses and 389 emergency patients from two tier III hospitals located in Beijing were included from January 2016 to August 2017. Patients were grouped into inpatients when they were hospitalized after diagnoses, or into outpatients when they were discharged after treatments. The State Trait Anxiety Inventory (STAI Form Y) questionnaire was used to investigate patient and nurse anxieties, while crowdedness of EDs was evaluated with the National Emergency Department Over Crowding Score.

RESULTS

The present results revealed that state anxiety scores (49.50 ± 6.00 vs 50.80 ± 2.80, P = 0.005) and trait anxiety scores (45.40 ± 5.70 vs 46.80 ± 2.70, P = 0.002) between inpatients (n = 173) and outpatients (n = 216) were significantly different, while the state anxiety of nurses (44.70 ± 5.80) was different from those of both patient groups. Generalized linear regression analysis demonstrated that multiple factors, including crowdedness in the ED, were associated with state and trait anxieties for both inpatients and outpatients. In addition, there was an interaction between state anxiety and trait anxieties. However, multivariable regression analysis showed that while overcrowding in the ED did not directly correlate with patients’ and nurses’ anxiety levels, the factors that did correlate with state and trait anxieties of inpatients were related to crowdedness. These factors included waiting time in the ED, the number of patients treated, and the number of nurses in the ED, whereas for nurses, only state and trait anxieties correlated significantly with each other.

CONCLUSION

Waiting time, the number of patients treated, and the number of nurses present in the ED correlate with patient anxiety in EDs, but crowdedness has no effect on nurse or patient anxiety.

High consequence infectious diseases training using interprofessional simulation and TeamSTEPPS

BACKGROUND

The comfort level of health care workers to respond to an infectious disease outbreak or epidemic is likely directly related to the amount of education, training, and experience they have in responding to these events.

METHODS

A quasi-experimental study evaluated health care workers' state anxiety, self-efficacy, and interprofessional teamwork when working with patients simulated to have a potentially high consequence infectious disease.

RESULTS

Pretest-posttest 1 scores revealed a significant decrease in state anxiety (P < .0001) and an increase in self-efficacy (P < .0001). Overall state anxiety preintervention (pretest) to postintervention (posttest 3) significantly decreased (P = .0265). Overall TeamSTEPPS knowledge significantly increased (P < .0001) from baseline.

CONCLUSIONS

Simulation exercises are an effective strategy to increase self-efficacy and decrease state anxiety for health care workers. Positive teamwork scores indicate that the subjects value interprofessional teamwork.

Metacognitive beliefs mediate the relationship between anxiety sensitivity and traits of obsessive-compulsive symptoms

BACKGROUND

Metacognition has been shown as a key contributor to Obsessive Compulsive Disorder as well as other anxiety-related disorders, yet its role in the development and maintenance of these disorders remains unclear. This study aims to investigate whether anxiety sensitivity traits are related to obsessive-compulsive symptoms in the general population and whether the relationship between anxiety sensitivity and obsessive-compulsive symptoms is mediated by metacognition.

METHODS

Non-clinical volunteers (N = 156, mean age: 23.97, 121 females) completed measures related to state/trait anxiety, anxiety sensitivity, obsessive compulsive symptoms and metacognition.

RESULTS

A direct relationship between anxiety sensitivity and obsessive-compulsive symptoms was established. Further analysis revealed that metacognition was the strongest mediator of this relationship, even when accounting for state and trait anxiety.

CONCLUSIONS

Results suggest that the relationships between traits of anxiety sensitivity and obsessive-compulsive symptoms are partially attributable to the role of metacognition.

To step or to spring: the influence of state anxiety on perceptual judgements and executed action

Emotional state, in particular anxiety, has been shown to constrain perceptual judgement of action capabilities. However, whether anxiety also constrains actual behaviour is unknown. The current study, therefore, aimed to determine whether state anxiety constrained firstly perceptual judgements of action capabilities and secondly actual behaviour. To do this, we asked participants to make perceptual judgements and perform action behaviours in relation to crossing ground-based apertures representing puddles. State anxiety was measured in 30 participants using the State-Trait Anxiety Inventory. The critical ratio of aperture size relative to leg length at which participants' behaviour choice would switch between a step and a spring was calculated. In a perceptual judgement task, participants judged the ratio at which they would choose to switch. In a subsequent executed action task, the ratio at which they actually switched was measured. Perceptual critical ratio could be predicted via state anxiety and age, while action critical ratio was not predicted by either. Therefore, this study has demonstrated that state anxiety and age both constrain perceptual judgement of action capabilities, as shown in previous studies. However, this does not seem to result in a change in emergent behaviour. This highlights the importance of measuring emergent behaviour rather than inferring it from perceptual judgements even when they are couched in terms of action.

Avoidance of all feedback? Attention allocation during and after public speech in social anxiety

BACKGROUND AND OBJECTIVES

Attention avoidance of feedback-related stimuli is proposed to be associated with and maintain social anxiety. However, previous research has mainly focused on comparing the attention bias between two types of stimuli, while little is known about attention distribution patterns among positive, neutral, and negative feedback and non-feedback stimuli in individuals with high trait social anxiety (HSA) or low trait social anxiety (LSA).

METHODS

The current study assessed eye movement pattern of participants with HSA or LSA during a speech task (high anxiety condition) or while solely watching audience feedback of the speech (low anxiety condition). A pre-recorded audience who displayed approving, neutral, or disapproving gestures was presented as feedback stimuli, while neutral facial photos were used as non-feedback stimuli.

RESULTS

Only in the high anxiety condition, participants with HSA exhibited longer total fixation on non-feedback stimuli compared to those with LSA; whereas in the low anxiety condition, both groups paid more attention to emotional feedback stimuli.

LIMITATIONS

The final sample size was modest due to a high suspicion rate of the reality of the audience.

CONCLUSIONS

These findings suggest that only in highly anxious social situations, socially anxious individuals lack the attentional preference toward positive feedback that individuals with low anxious have.

Do state-trait anxiety and previous unpleasant dental experiences predict the need for sedation in women having third molar surgery?

The aim of this study was to examine the need for sedation in women who had or had not had a previous unpleasant dental experience, and to assess possible contributory factors. The sample size required was estimated at 312 subjects. Healthy women listed for the surgical removal of third molars were asked to complete a questionnaire regarding their health, clinical and personal experience, past dental experience, result of the Indicator of Sedation Need (IOSN) scale, and of the Spielberger's State-Trait Anxiety Inventory. The participants were categorised before analysis by the nature of their previous dental experience. The number of participants who required sedation, their mean IOSN score, and the mean degree of state anxiety were significantly higher in the unpleasant experience group. The younger the patient at the time of the experience, the worse the state-anxiety (r=-0.25). The odds that sedation would be needed were 2.24 times higher in the same group. The final model correctly predicted the need for sedation in 75.3% of the cases. Healthy women having third molar surgery who had had a previous upsetting dental experience were more likely to need sedation and had worse state-anxiety than those who had not.

Quantifying implicit uncertainty in primary care consultations: A systematic comparison of communication about medically explained versus unexplained symptoms

OBJECTIVE

General practitioners (GPs) disclose more uncertainty (e.g. "I don't know") in consultations with patients presenting medically unexplained symptoms (MUS) versus medically explained symptoms (MES), which could negatively affect patient outcomes. This study assessed if this pattern also holds for more subtle, implicit uncertainty expressions (e.g. "maybe", "might") during different consultation phases, and assessed their relation to patient pre-post consultation anxiety.

METHODS

We quantified implicit markers of uncertainty of 18 GPs in 82 consultations about MUS or MES during different consultation phases. Relative frequencies of implicit uncertainty per consultation were regressed on differences in momentary anxiety pre and post consultation.

RESULTS

We coded 2590  GP utterances. Uncertainty expressions were more frequent in MUS versus MES consultations (OR = 1.54, p = .004), especially during diagnosis and treatment recommendations compared to physical examinations (OR =0 .45, p = .001). Implicit uncertainty was not related to patients' changes in anxiety (b = -0.11, p = .817).

CONCLUSIONS

GPs express more uncertainty during MUS (versus MES) consultations, especially during the diagnostic phase and treatment recommendations. This does not necessarily affect patient anxiety.

PRACTICE IMPLICATIONS

Implicit uncertainty expressions reflect the mere complexity of communicating a medically unexplained diagnosis, which does not affect patient anxiety.

Peripersonal space is diversely sensitive to a temporary vs permanent state of anxiety

Peripersonal Space (PPS) is the multisensory space immediately surrounding our body. Visual and tactile stimuli here are promptly processed, since their interaction gradually strengthens as the distance between visual stimulus and the body decreases. Recently, a modified version of the Temporal Order Judgment (TOJ) task was proposed to assess PPS based on the spatial congruence between somatosensory and visual stimuli. Here, we used this paradigm to explore how a temporary vs a permanent state of anxiety can alter PPS. Indeed, previous research showed that PPS boundaries are not fixed, but they can be enlarged by contingent factors (i.e. emotional features). Participants performed the TOJ paradigm twice, just before and after completing an anxiety-inducing task (experimental breathing condition) or a neutral one (control breathing condition), while their trait and state anxiety levels were repeatedly measured. We found that the pattern of visuo-tactile integration in PPS changes in the very opposite way following the two breathing tasks for participants with high levels of temporary anxiety, by strengthening and weakening its power after the experimental and control conditions, respectively. On the contrary, both the breathing tasks are capable of reducing the cross-modal interplay as compared to baseline for high trait-anxious participants, who show an overall stronger visuo-tactile integration inside the PPS than low trait anxious individuals. These results are discussed in the light of the double dissociation between orienting and alerting attentional network over-functioning, reported in state anxiety participants, and impoverished prefrontal attentional control shown by trait anxiety individuals.

The spontaneous activity and functional network of the occipital cortex is correlated with state anxiety in healthy adults

The occipital lobe has been implicated in anxiety disorder, however, its contributions to anxiety in healthy adults remain less clear. We conducted a resting-state functional magnetic resonance imaging study to explore the relationship between the amplitude of low-frequency fluctuation (ALFF), functional connectivity (FC), and state anxiety level in the healthy population. First, the results showed that the ALFF of the left inferior occipital gyrus (IOG) was negatively correlated with state anxiety. Furthermore, state anxiety was positively correlated with the FC between the left IOG and the right medial superior frontal gyrus and right cerebellum 8 area and negatively correlated with the FC between the left IOG and the left superior parietal gyrus. These results indicate that the occipital lobe of healthy individuals is involved in processing of anxiety in part through a frontal-parietal network.

The impact of yoga on teachers' self-rated emotions

Objectives

To assess (i) if teachers’ age or gender could predict their baseline levels of mental well-being and anxiety and any change after yoga. (ii) Whether mental well-being or anxiety changed following 15 days of yoga in primary school teachers. Primary school teachers took part in this single group longitudinal trial (n = 302, group mean age ± SD; 41.8 ± 5.90 years). They received 240 min of yoga practice and 120 min of yoga theory each day. At baseline and after 15 days of yoga the assessments were (i) mental well-being (Warwick-Edinburgh scale) and (ii) state anxiety (Spielberger’s State Trait Anxiety Inventory).

Results

Gender acted as a significant predictor for mental well-being scores (P = 0.001) and state anxiety (P = 0.005) in the group at baseline. Females showed higher anxiety scores and lower mental well-being scores. Following yoga the teachers showed a significant increase in mental well-being by 5.84% and a decrease in state anxiety by 4.48%.

Trial registration The trial was registered retrospectively (August 15, 2019; Trial Registration Number: ISRCTN90253431).

State anxiety in pregnancies affected by obstetric complications: A systematic review

BACKGROUND

Maternal mental health status remains an important area of study due to its influence on maternal health outcomes. Past reviews on anxiety in pregnancy have included multiple mental health diagnoses and pre-existing conditions. A systematic review was performed to understand maternal state anxiety during pregnancies affected by obstetrical complications.

METHODS

A systematic search of electronic databases was performed including quantitative, primary studies in the English language. The population of interest was women whose pregnancies were affected by maternal and/or fetal obstetric (not pre-existing) complications with state anxiety as the outcome. Twenty-six studies met the inclusion and methodological criteria and were included in the review.

RESULTS

The review revealed that 20% to 100% of women experiencing pregnancies affected by obstetric complications had high levels of state anxiety, and these rates are negatively influenced by complication type and severity, demographic characteristics, and maternal perceptions and expectations. Overall, antenatal state anxiety was shown to improve over the course of the pregnancy, though levels remained above clinical thresholds.

LIMITATIONS

This review was based only on English peer-reviewed articles, many of which used convenience sampling with homogenous samples, limiting generalizability. Additional limitations include how anxiety prevalence was aggregated due to differences in measurement across studies.

CONCLUSIONS

Anxiety is prevalent among women experiencing pregnancies affected by obstetric complications. Based on this review, we recommend that all women treated for obstetric complications are screened for anxiety; facilitating detection, referral, and treatment, ultimately contributing to optimal maternal outcomes.

What are constructive anxiety levels in wilderness therapy? An exploratory pilot study

BACKGROUND AND PURPOSE

Participant state anxiety in outdoor therapeutic practices continues to raise many questions. To help inform this important topic we present and discuss the results of an exploratory pilot study on participant day-to-day state anxiety throughout a Norwegian wilderness therapy intervention.

MATERIALS AND METHODS

Thirty-three adolescents from six groups completed a total of 251 state sections of the State-Trait Anxiety Inventory.

RESULTS

On average, there was a slight decrease in state anxiety as the program progressed and a significant reduction in anxiety between the first and final days. The between-subject range was large, and boys reported significantly lower anxiety than did girls.

CONCLUSION

In light of the results, we discuss general understandings of day-to-day state anxiety, gender differences, group differences, the perception of risk, and the relationship between perceived autonomy and state anxiety. The paper concludes with implications for the outdoor therapy field at large.

Comparing Parent and Child Self-report Measures of the State-Trait Anxiety Inventory in Children and Adolescents with a Chronic Health Condition

Anxiety symptoms in children and adolescents with a chronic health condition have been estimated as high as 40% lifetime prevalence. Clinicians often rely on parent/caregiver information to supplement or substitute child self-report related to pediatric physical and mental health. We developed a caregiver proxy version (STAI-P) for the State-Trait Anxiety Inventory (STAI) State Anxiety Scale that was compared with a child self-report version in 201 parent-child dyads to evaluate its utility in measuring state anxiety in chronically ill youth. For patients aged 7-12, self-reports of state anxiety were moderately associated with parent distress and health provider-reported functional status, but negatively associated with parent STAI-P scores. For patients aged 13-17, self-reports of state anxiety were significantly associated with STAI-P scores, parent distress, and health provider-reported functional status. The STAI-P parent version may be a useful tool in identifying and addressing anxiety symptoms in youth living with a chronic health condition.

Interactive effects of trait and state anxieties on time perception

Although some previous studies have investigated the time distortion of anxious patients, it remains open about the interactive effects of trait and state anxieties on time perception. In the present study, participants in high and low trait anxieties perceived 24 negative and 24 neutral words for 2 s in induced anxious and calm mood states, and their time perceptions were recorded by the time reproduction task. The results showed that high trait anxious individuals underestimated the 2-second duration while low trait anxious individuals overestimated the 2-second duration in the anxious state compared with those in the calm state. Meanwhile, in the anxious state, the timing error was absolute for high trait anxious individuals, whereas it was relative for low trait anxious individuals. The results show the interactive effects of trait and state anxieties on time perception. We suggest that the temporal distortion of the high trait anxious individuals in the anxious state might be due to an attentional dysfunction, whereas the temporal distortion of the low trait anxious individuals in the anxious state might be due to a mood congruency.

Effects of a rat model of gestational hypothyroidism on forebrain dopaminergic, GABAergic, and serotonergic systems and related behaviors

We investigated the effects of maternal hypothyroidism on forebrain dopaminergic, GABAergic, and serotonergic systems and related behavior in adult rat offspring. Experimental gestational hypothyroidism (EGH) was induced by administering 0.02% methimazole (MMI) to pregnant rats from gestational day 9 to delivery. Neurotransmitter-related protein and gene expression were evaluated in offspring forebrain at postnatal day (P) 120. Exploratory behavior, contextual fear conditioning, locomotion, and 30-day reserpine Parkinson induction were assessed from P75-P120. Protein and gene expression assessments of medial prefrontal cortex showed group differences in dopaminergic, GABAergic, and serotonergic receptors, catabolic enzymes, and transporters. Striatum of MMI offspring showed an isolated decrease in the dopaminergic enzyme, tyrosine hydroxylase. MMI exposure increased GABA and dopamine receptor expression in amygdala. MMI offspring also had decreased state anxiety and poor contextual fear conditioning. We found that baseline locomotion was not changed, but reserpine treatment significantly reduced locomotion only in MMI offspring. Our results indicated that restriction of maternal thyroid hormones reduced dopaminergic, GABAergic, and serotoninergic forebrain components in offspring. Tyrosine hydroxylase deficiency in the striatum may underlie enhanced reserpine induction of Parkinson-like movement in these same offspring. Deficits across different neurotransmitter systems in medial prefrontal cortex and amygdala may underlie decreased state anxiety-like behavior and reduced fear conditioning in offspring, but no changes in trait anxiety-like behavior occurred with maternal MMI exposure. These findings strongly support the hypothesis that adequate delivery of maternal thyroid hormones to the fetus is crucial to the development of the central nervous system critical for emotion and motor regulation.

Examining a training effect on the state anxiety response to an acute bout of exercise in low and high anxious individuals

BACKGROUND

An acute bout of exercise temporarily reduces state anxiety. The current study examined whether these benefits are greater for those with higher levels of anxiety, and whether these benefits are augmented with exercise training.

METHODS

Young adults were randomized to either a nine-week moderate-intensity exercise group or an inactive control group. We assessed changes in state anxiety in response to an acute bout of exercise each week.

RESULTS

State anxiety reductions following acute exercise increased in the exercise subgroup with high anxiety at baseline as training progressed (p = .029). No training effects were observed for the exercise subgroup with low baseline anxiety (p = .27).

LIMITATIONS

A predominantly female sample, a single state anxiety measure post exercise and a non-exercise control group should be addressed in future research.

CONCLUSIONS

The results support the use of regular physical activity as a method for managing state anxiety in young adults. In particular, regular physical activity may be especially beneficial for those experiencing higher levels of anxiety.

Efficacy of virtual reality exposure therapy for the treatment of dental phobia in adults: A randomized controlled trial

BACKGROUND

Although Virtual Reality Exposure Therapy (VRET) has proven to be effective in the treatment of various subtypes of specific phobia, there is limited evidence of its role in the treatment of dental phobia.

METHOD

A single-blind RCT was conducted among 30 randomized patients with dental phobia to either VRET or informational pamphlet (IP) condition. Primary outcome anxiety measures (VAS-A, MDAS and DFS) were evaluated at baseline, pre- and post-intervention, 1-week, 3-months and 6-months follow-up. Secondary outcome measures assessed were pre-post behavioral avoidance, temporal variations of heart rate and VR-experience during and post-VRET, and dental treatment acceptance in both conditions at 6-month follow-up.

RESULTS

Intention to treat analysis, using a repeated measures MANOVA, revealed a multivariate interaction effect between time and condition (p = 0.015) for all primary outcome measures (all ps < 0.001). Only patients of the VRET condition showed a significant reduction in anxiety scores (mean reduction [s.d.]: VAS-A 44.4 [36.1]; MDAS 7.1 [5.4]; DFS 21.2 [13.1]) whereas the patients in the IP group did not (mean reduction [s.d.]: VAS-A -0.33 [7.7]; MDAS -0.33 [1.3]; DFS -1.9 [3.8]), F (15, 14) = 3.3, p = 0.015.

CONCLUSIONS

VRET was found to be efficacious in the treatment of dental phobia.

Banning pre-event rumination in social anxiety: A preliminary randomized trial

BACKGROUND AND OBJECTIVES

Pre-event rumination has a clear role in maintaining social anxiety according to cognitive models. However, it is unclear what specific strategies can address pre-event rumination for individuals diagnosed with SAD. The current study aimed to determine the effectiveness of a brief intervention on multiple aspects of pre-event rumination, state anxiety and performance and threat appraisals. Additionally, the trajectory of pre-event rumination was investigated over four days.

METHODS

Participants with SAD were informed they would be required to complete a speech task in four days' time and were randomised to an intervention (n = 27) or a non-active control group (n = 25). The intervention group were instructed to "ban" pre-event rumination using a metacognitive therapy technique known as detached mindfulness. All participants completed daily measures of pre-evet rumination that assessed frequency, uncontrollability, engagement and distress associated with pre-event rumination. On the day of the speech task, participants also completed state and cognitive measures before delivering the speech task.

RESULTS

The intervention group reported reduced frequency, uncontrollability and distress associated with pre-event rumination, compared to the control group. There was no difference between groups for performance and threat appraisals as well as state anxiety. Rumination is a stable and robust process, with an increase in frequency and associated distress 24 hours before a feared social situation.

LIMITATIONS

The lack of an active control group precludes comparisons to more traditional cognitive-behavioural therapy strategies for pre-event rumination.

CONCLUSIONS

Pre-event rumination is a durable process but banning pre-event rumination using metacognitive therapy techniques shows promise for specifically addressing this maladaptive process.

Anxious and alert? Hypervigilance in social anxiety disorder

The vast majority of research on attentional biases to threat focusses on selective attention, even though several cognitive-behavioral models furthermore assume hypervigilance to be important in this regard. Thus, the current study examined hypervigilance in trait and state social anxiety. We analyzed visual scanpath lengths and fixation counts of participants with Social Anxiety Disorder (SAD) (n = 61) and healthy controls (n = 60) in a combined visual search and eye tracking paradigm, including photographs of facial expressions. Half of all participants were randomly assigned to a state anxiety induction. Interaction effects revealed opposed attentional patterns of participants with SAD as compared to healthy controls considering overall visual scanpath lengths (F(1,117) = 5.32, p = 0.023, η²_partial = 0.043) and fixation counts (F(1,117) = 5.10, p = 0.026, η²_partial = 0.042). Accordingly, participants with SAD showed signs of hypervigilance in the anxiety induction condition. In contrast, there was no main effect of diagnostic group, indicating that individuals with SAD shift their attentional focus to broad scanning behavior only under conditions of threat. Our results add to the small number of existing studies on hypervigilance in SAD and suggest the topic to be promising for future research.

Altered temporal variance and functional connectivity of BOLD signal is associated with state anxiety during acute systemic inflammation

Systemic inflammation is accompanied by complex behavioral changes and disturbed emotion regulation that have been related to the pathophysiology of mood disorders including depression and anxiety. However, the causal role of systemic inflammation on mood disorders is still unclear. We herein investigated neural resting state patterns of temporal variance of the amygdala and functional connectivity within the salience network underlying changes in state anxiety during experimentally-induced systemic inflammation. In this randomized, double-blind study, N = 43 healthy men received an intravenous injection of either low-dose lipopolysaccharide (LPS, 0.4 ng/kg body weight) or saline. Resting state functional magnetic resonance imaging was assessed before and 3.5 h after injection. State anxiety, assessed with a standardized questionnaire, and plasma cytokine concentrations were repeatedly measured. LPS administration induced a transient systemic inflammatory response reflected in increases in plasma Interleukin (IL)-6 and Tumor Necrosis Factor (TNF)-α concentration. Compared to placebo, state anxiety and temporal variance in the amygdala significantly increased while functional connectivity in the salience network decreased during LPS-induced systemic inflammation. Together, these data indicate that acute systemic inflammation alters temporal variance of the BOLD signal as well as functional connectivity in brain regions and networks implicated in emotion processing and regulation. These results are of translational importance to encourage further research on the role of inflammatory pathways in the pathophysiology of neuropsychiatric conditions including anxiety disorders.

Quantifying positive communication: Doctor's language and patient anxiety in primary care consultations

OBJECTIVE

Positive communication is advocated for physicians during consultations with patients presenting medically unexplained symptoms (MUS), but studies generally focus on what is said rather than how it is said. This study quantified language use differences of general practitioners (GPs), and assessed their relation to patient anxiety.

METHODS

Language use of 18 Dutch GPs during 82 consultations was compared for patients with MUS versus medically explained symptoms (MES). Message content (positive or negative) was differentiated from its directness (direct or indirect), and related to changes in patient's state anxiety (abbreviated State Trait Anxiety Inventory; STAI).

RESULTS

In total, 2590 clauses were identified. GPs approached patients with MES with relatively more direct (vs. indirect) positive and indirect (vs. direct) negative messages (OR 1.91, 95% CI 1.42-2.59). Anxiety of both patient groups increased when GPs used more direct (vs. indirect) negative messages (b = 0.67, 95% CI 0.07-1.27) CONCLUSIONS: GPs use different language depending on the content of messages for patients with MES, but not MUS. Direct negative messages relate to an increase in patient anxiety.

PRACTICE IMPLICATIONS

GPs could manage patient's state anxiety by expressing negative messages in an indirect rather than direct manner.

Excitotoxic lesion of the medial prefrontal cortex in Wistar rats: Effects on trait and state anxiety

The neural substrate of anxiety response (state anxiety) to a threatening situation is well defined. However, a lot less is known about brain structures implicated in the individual's predisposition to anxiety (trait anxiety). Scientific evidences lead us to suppose that the medial prefrontal cortex (mPFC) is involved in both trait and state anxiety. Thus, the aim of this study was to investigate the involvement of mPFC in trait anxiety and to further evaluate its participation in state anxiety. Sixty six adult, Wistar, male rats were first tested in the free-exploratory paradigm (FEP) and were categorized according to their levels of trait anxiety (high, medium and low). Three to six days after this exposure, all animals were submitted to stereotaxic brain surgery. Half the animals from each anxiety category was allocated to the mPFC-lesioned group and the other half to the Sham-lesioned group. After seven to nine days, all animals were again tested in FEP. Eight to 10 days later, the animals were tested in the Hole Board test, a model of state anxiety. The mPFC lesion decreased levels of trait anxiety of highly anxious rats, whereas it reduced the state anxiety of all animals, regardless the level of trait anxiety. These data extend evidence of the participation of the mPFC in state anxiety and it demonstrate the involvement of this brain structure in trait anxiety, a personality trait supposed to be a predisposing factor for anxiety disorders.

The effects of alcohol on heartbeat perception: Implications for anxiety

INTRODUCTION

It is well established that some individuals self-medicate their anxiety with alcohol. Though much evidence exists that alcohol consumption can be negatively reinforcing, there remains uncertainty regarding what mediates the relationship between alcohol and anxiety. An unexplored possibility is that, for some, alcohol impairs interoceptive sensitivity (the ability to accurately perceive one's physiological state), thereby decreasing state anxiety. Consistent with this, highly accurate heartbeat perception is a risk factor both for elevated trait anxiety and anxiety disorders. However, the direct impact of alcohol on cardioceptive accuracy has not to our knowledge been previously examined.

METHODS

Sixty-one social drinkers came to the lab in groups of 4-6 on two days spaced a week apart. Each participant was randomly assigned to receive alcoholic drinks targeting a BAC of 0.05% on one testing day and placebo drinks on the other, with the order counter-balanced. On both testing days, participants engaged in a Schandry heartbeat perception task on three occasions: at baseline, after an alcohol absorption period, and after physiological arousal was raised via exercise.

RESULTS

For men only, alcohol significantly impaired cardioceptive accuracy relative to a placebo at both low and high levels of arousal, with medium to large effect sizes.

CONCLUSIONS

Though preliminary, this finding is consistent with the proposed hypothesis linking alcohol consumption and anxiety, at least for men. Future studies should directly examine whether, among individuals with anxiety disorders, cardioceptive sensitivity mediates the relationship between alcohol consumption and state anxiety.