Transient state-dependent fluctuations in anxiety measured using STAI, POMS, PANAS or VAS: a comparative review

Effects of Behaviorally Supported Exercise and Exercise-Induced Mood Changes on Elevated Blood Pressure and Hypertension in African American Adults with Severe Obesity

African Americans with obesity have high rates of hypertension. Exercise has been shown to significantly reduce high blood pressure; however, effects through associated reductions in anxiety and depression are unclear. African American adults with either class 2 or 3 obesity (n = 86; M_age = 43.4 years) and either elevated blood pressure (n = 16) or stage 1 (n = 33) or stage 2 (n = 37) hypertension participated in a theoretically driven community-based weight-management program. There were significant increases in exercise outputs; while systolic and diastolic blood pressure, anxiety, and depression significantly decreased from baseline-month 6. Increased exercise significantly predicted reduced anxiety, depression, and diastolic blood pressure. Change in anxiety significantly mediated the relationship between exercise and both systolic and diastolic blood pressure changes. Increasing exercise from the equivalent of 1.5 to 4.5 moderate bouts/week reduced elevated blood pressure/hypertension in African American adults with severe obesity largely through their exercise-associated improvement in anxiety.

The Mood-Improving Effect of Viewing Images of Nature and Its Neural Substrate

It has been recently suggested that contact with nature improves mood via reducing the activity of the prefrontal cortex. However, the specific regions within the prefrontal cortex that underlie this effect remain unclear. In this study, we aimed to identify the specific regions involved in the mood-improving effect of viewing images of nature using a 52-channel functional near-infrared spectroscopy (fNIRS). Specifically, we focused on the orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex (dlPFC), two regions associated with affective processing and control. In a randomized controlled crossover experiment, we assigned thirty young adults to view images of nature and built environments for three minutes each in a counterbalanced order. During image viewing, participants wore a fNIRS probe cap and had their oxyhemoglobin (oxy-Hb) measured. Immediately following each image viewing, participants indicated their mood in terms of comfortableness, relaxation, and vigor. Results showed that viewing images of nature significantly increased comfortableness and relaxation but not vigor compared to viewing images of built environments, with a large effect size. Meanwhile, the concentration of oxy-Hb in only the right OFC and none of the other regions significantly decreased while viewing the images of nature compared to built environments, with a medium effect size. We speculate that viewing images of nature improves mood by reducing the activity of or calming the OFC. Since the OFC is hyperactive in patients with depression and anxiety at rest, contact with nature might have therapeutic effects for them.

Validation of the Bath CRPS Body Perception Disturbance Scale

The Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale ("B-CRPS-BPDS") measures alterations in body perception. We assessed its internal consistency, known group validity, construct validity, and associations with demographic and clinical characteristics. We also evaluated changes in, and baseline predictors of B-CRPS-BPDS scores at follow-up. We included people with CRPS (N = 114) and pain-free controls (N = 69). People with CRPS obtained higher scores than pain-free controls on all B-CRPS-BPDS items, except the item on attention. Because this item also had an insufficient corrected item-total correlation, we propose a revised B-CRPS-BPDS (r-B-CRPS-BPDS) excluding this item. The internal consistency of the r-B-CRPS-BPDS was good. The r-B-CRPS-BPDS showed a large positive relationship with "motor neglect-like symptoms", indicating good construct validity. The r-B-CRPS-BPDS showed positive relationships with pain intensity, fear of movement, depression, and upper limb disability. There were no independent relationships with handedness, affected side, affected limb, disease duration, CRPS severity score, tension, anger, fatigue, confusion, and vigour. Finally, r-B-CRPS-BPDS scores did not consistently change over time. Our results demonstrate the utility of the r-B-CRPS-BPDS for measuring body perception disturbances in CRPS. PERSPECTIVE: This article evaluates the validity of the Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale ("B-CRPS-BPDS") in CRPS, and assesses relationships with demographic and clinical variables. The proposed revised B-CRPS-BPDS appears to be a valid measure of body perception disturbances in CRPS.

Efficacy of anodal suboccipital direct current stimulation for endogenous pain modulation and tonic thermal pain control in healthy participants: a randomised controlled clinical trial

OBJECTIVE

The aim of this study was to assess whether anodal DCS applied to the suboccipital (SO) target area could potentiate antinociception assessed primarily with conditioned pain modulation of tonic thermal test stimuli.

DESIGN

Randomised double-blinded control trial.

SETTING

Rehabilitation hospital.

SUBJECTS

Healthy participants.

METHODS

Forty healthy participants were randomized to receive either SO-DCS or M1-DCS. The 20-minute 1.5mA anodal or sham DCS intervention were applied to each participant in randomised order during two test sessions. The primary outcome measure included heterotopic cold-pressor conditioned pain modulation (CPM) of tonic heat pain. Secondary measures included pressure pain threshold and tonic thermal pain intensity.

RESULTS

Heterotopic CPM of tonic heat pain intensity was unaffected by either SO-DCS or active M1, including the secondary measures of pressure pain threshold and tonic thermal pain intensity. Although low-power non-significant interactions were identified for DCS intervention (active versus sham) and time (before and after), a significant within-group inhibition of tonic cold pain was identified following SO-DCS (p = 0.011, mean [SD]: -0.76±0.88 points) and M1-DCS (p < 0.002: -0.84±0.82 points), without a significant change following sham DCS.

CONCLUSIONS

Although heterotopic CPM was not facilitated with either SO-DCS or M1-DCS, a general significant inhibition of tonic cold pain intensity was demonstrated following both interventions. The general effects of active DCS compared to sham on tonic cold pain-irrespective of the M1 or SO target-need to be confirmed using standard quantitative sensory testing.

Do fear and catastrophizing about mental activities relate to fear-avoidance behavior in a community sample? An experimental study

Introduction: Healthy people often experience headache, cognitive failures, or mental fatigue. Some people even experience these symptoms on a level comparable to patients with mild spectrum brain injuries. In these individuals, the fear-avoidance model explains symptoms as a consequence of catastrophizing and fear-avoidance toward mental activities. This experimental study investigated in healthy adults whether fear-avoidance and catastrophizing about mental activities are related to fear-avoidance behavior (i.e., behavioral avoidance of mental activities) according to the fear-avoidance model.Method: A randomized crossover within-subject design was used with two measurements and 80 participants. Participants were exposed to three demanding cognitive tasks and their simplified counterparts. Post-concussion symptoms, catastrophizing, fear-avoidance, behavioral avoidance (time spent working on cognitive tasks), exposure to mental activity, depression, heart rate, and state-trait anxiety were assessed.Results: Significant correlations between the variables of the fear-avoidance model were found. Furthermore, catastrophizers spent less time on difficult tasks compared to easy tasks. Both catastrophizing and female sex predicted time spent on difficult tasks, whereas only female sex predicted time spent on easy tasks.Conclusions: This study found that, according to the fear-avoidance model, catastrophizing is related to behavioral avoidance of cognitively challenging tasks in a community sample.

Move and Be Moved: The Effect of Moving Specific Movement Elements on the Experience of Happiness

Dynamic body feedback is used in dance movement therapy (DMT), with the aim to facilitate emotional expression and a change of emotional state through movement and dance for individuals with psychosocial or psychiatric complaints. It has been demonstrated that moving in a specific way can evoke and regulate related emotions. The current study aimed to investigate the effects of executing a unique set of kinetic movement elements on an individual mover's experience of happiness. A specific sequence consisting of movement elements that recent studies have related to the feeling of happiness was created and used in a series of conditions. To achieve a more realistic reflection of DMT practice, the study incorporated the interpersonal dimension between the dance movement therapist (DMTh) and the client, and the impact of this interbodily feedback on the emotional state of the client. This quantitative study was conducted in a within-subject design. Five male and 20 female participants (mean age = 20.72) participated in three conditions: a solo executed movement sequence, a movement sequence executed with a DMTh who attuned and mirrored the movements, and a solo executed movement sequence not associated with feelings of happiness. Participants were only informed about the movements and not the feelings that may be provoked by these movements. The effects on individuals were measured using the Positive and Negative Affect Schedule and visual analog scales. Results showed that a specific movement sequence based on movement elements associated with happiness executed with a DMTh can significantly enhance the corresponding affective state. An additional finding of this study indicated that facilitating expressed emotion through movement elements that are not associated with happiness can enhance feelings such as empowerment, pride, and determination, which are experienced as part of positive affect. The results show the impact of specific full-body movement elements on the emotional state and the support outcome of DMT on emotion regulation.

Negative Mood States Are Related to the Characteristics of Facial Expression Drawing: A Cross-Sectional Study

An assessment of mood or emotion is important in developing mental health measures, and facial expressions are strongly related to mood or emotion. This study thus aimed to examine the relationship between levels of negative mood and characteristics of mouth parts when moods are drawn as facial expressions on a common platform. A cross-sectional study of Japanese college freshmen was conducted, and 1,068 valid responses were analyzed. The questionnaire survey consisted of participants’ characteristics, the Profile of Mood States (POMS), and a sheet of facial expression drawing (FACED), and the sheet was digitized and analyzed using an image-analysis software. Based on the total POMS score as an index of negative mood, the participants were divided into four groups: low (L), normal (N), high (H), and very high (VH). Lengths of drawn lines and between both mouth corners were significantly longer, and circularity and roundness were significantly higher in the L group. With increasing levels of negative mood, significant decreasing trends were observed in these lengths. Convex downward and enclosed figures were significantly predominant in the L group, while convex upward figures were significantly predominant and a tendency toward predominance of no drawn mouths or line figures was found in the H and VH groups. Our results suggest that mood states can be significantly related to the size and figure characteristics of drawn mouths of FACED on a non-verbal common platform. That is, these findings mean that subjects with low negative mood may draw a greater and rounder mouth and figures that may be enclosed and downward convex, while subjects with a high negative mood may not draw the line, or if any, may draw the line shorter and upward convex.

Can acupuncture therapy reduce preoperative anxiety? A systematic review and meta-analysis

BACKGROUND

Acupuncture therapy has shown promise for effectively relieving preoperative anxiety. Nevertheless, previous findings from randomized controlled trials (RCTs) are inconsistent and must be examined in detail.

OBJECTIVE

This study systematically evaluates the efficacy and safety of acupuncture therapy for preoperative anxiety as well as the quality of evidence supporting this application.

SEARCH STRATEGY

The China National Knowledge Infrastructure Database, Wanfang Data Journal Database, Chinese Biomedical Literature Database, Chongqing VIP, Embase, PubMed and Cochrane Library Databases were queried from their inception to 19, February 2020, using keywords such as "acupuncture therapy," "preoperative" and "anxioty." Manual searches expanded the search breadth and included conference abstracts and other reference lists.

INCLUSION CRITERIA

RCTs were included in the current study if they contained a comparison between a group of anxiety patients that received acupuncture therapy and a control group that received sham acupuncture.

DATA EXTRACTION AND ANALYSIS

Literature was reviewed, and various articles were selected using the NoteExpress 3.2.0 software. Two researchers independently screened and extracted data and evaluated the risk of bias in the included studies. The RevMan 5.3 software was used for data aggregation and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) assessment was used to evaluate the quality of the study outcomes.

RESULTS

Twelve studies were included in the review, containing a total of 916 patients. Meta-analysis showed that, compared with the control group, patients who received acupuncture therapy had reduced State-Trait Anxiety Inventory Scale (STAI-S) score (mean difference [MD] = -9.07, 95% confidence interval [CI] [-13.19 to -4.96], P < 0.0001) and Visual Analogue Scale (VAS) score (MD = -1.37, 95% CI [-2.29 to -0.45], P = 0.003). However, for the Hamilton Anxiety Scale (HAMA) score, there was no difference between the two groups (MD = -3.98, 95% CI [-12.89 to 4.92], P = 0.38). Further, the GRADE assessment demonstrated that the STAI-S was of moderate quality, the VAS of low quality and the HAMA of very low quality.

CONCLUSION

Acupuncture therapy may be able to decrease anxiety in preoperative patients, but the results need to be further verified due to the small sample sizes and the low quality of evidence to date.

Emotion Network Analysis During COVID-19 Quarantine - A Longitudinal Study

Introduction: The coronavirus disease 2019 (COVID-19) emergency has imposed important challenges in the lives of individuals, particularly since the restriction of free movement. In Spain, this mandatory home confinement started on March 14, 2020. In this scenario, some calls have been made to better understand the exact impact of the quarantine on the emotional status of individuals across time. Materials and Methods: On the first day that the Spanish government imposed the quarantine, our team launched an online longitudinal study to monitor emotional responses to the COVID-19 emergency over time. For 2 weeks, 187 people have responded to a daily diary on emotion functioning. An emotion network analysis was performed to study the network structure of 30 mood states and its changes during the first 2 weeks of the quarantine. Results: The emotional network showed critical changes in the interactions of emotions over time. An analysis of mean emotional levels did not show statistically significant changes in mood over time. Interestingly, two different network patterns were found when the sample was divided between those with favorable responses and those with unfavorable responses. Discussion: This new approach to the study of longitudinal changes of the mood state network of the population reveals different adaptation strategies reflected on the sample's emotional network. This network approach can help identify most fragile individuals (more vulnerable to external stressors) before they develop clear and identifiable psychopathology and also help identify anti-fragile individuals (those who improve their functioning in the face of external stressors). This is one of the first studies to apply an emotional network approach to study the psychological effects of pandemics and might offer some clues to psychologists and health administrators to help people cope with and adjust to this critical situation.

Severity of negative mood and anxiety symptoms occurring during acute abstinence from tobacco: A systematic review and meta-analysis

This review was conducted with the following goals: To quantify the severity of mood and anxiety symptoms emerging during acute abstinence from tobacco (1). To explore sex differences related to the experience of specific symptoms (2). To investigate the early time course of symptoms (3). A meta-analysis was performed from 28 studies assessing mood and anxiety symptoms during the earliest phases of tobacco abstinence (up to 24 hrs post-quit) conducted from 1999 to 2019. Results revealed a significant (p < 0.0001) increase in 'anxiety', 'anger/irritability', 'depressed mood /sadness', and composite negative affect ('NA') in the 24 hours following smoking cessation. The largest effect size was detected for 'anxiety' (0.63). A qualitative analysis was performed to investigate sex differences and the time course of the specific symptoms. Results indicated that female smokers may experience worse mood symptoms compared to male smokers and that these symptoms may emerge within 3 hrs post-quit. Smoking cessation programs should implement sex-tailored interventions in order to improve their effectiveness, while future research should focus on alternative methods of nicotine administration.

Virtual Reality Games and the Role of Body Involvement in Enhancing Positive Emotions and Decreasing Anxiety: Within-Subjects Pilot Study

Background

In the last few years, the introduction of immersive technologies, especially virtual reality, into the gaming market has dramatically altered the traditional concept of video games. Given the unique features of virtual reality in terms of interaction and its ability to completely immerse the individual into the game, this technology should increase the propensity for video games to effectively elicit positive emotions and decrease negative emotions and anxiety in the players. However, to date, few studies have investigated the ability of virtual reality games to induce positive emotions, and the possible effect of this new type of video game in diminishing negative emotions and anxiety has not yet been tested. Furthermore, given the critical role of body movement in individuals’ well-being and in emotional responses to video games, it seems critical to investigate how body involvement can be exploited to modulate the psychological benefits of virtual reality games in terms of enhancing players’ positive emotions and decreasing negative emotions and anxiety.

Objective

This within-subjects study aimed to explore the ability of commercial virtual reality games to induce positive emotions and diminish negative emotions and state anxiety of the players, investigating the effects of the level of body involvement requested by the game (ie, high vs low).

Methods

A total of 36 young adults played a low body-involvement (ie, Fruit Ninja VR) and a high body-involvement (ie, Audioshield) video game in virtual reality. The Visual Analogue Scale (VAS) and the State-Trait Anxiety Inventory, Form-Y1 (STAI-Y1) were used to assess positive and negative emotions and state anxiety.

Results

Results of the generalized linear model (GLM) for repeated-measures multivariate analysis of variance (MANOVA) revealed a statistically significant increase in the intensity of happiness (P<.001) and surprise (P=.003) and, in parallel, a significant decrease in fear (P=.01) and sadness (P<.001) reported by the users. Regarding the ability to improve anxiety in the players, the results showed a significant decrease in perceived state anxiety after game play, assessed with both the STAI-Y1 (P=.003) and the VAS-anxiety (P=.002). Finally, the results of the GLM MANOVA showed a greater efficacy of the high body-involvement game (ie, Audioshield) compared to the low body-involvement game (ie, Fruit Ninja VR), both for eliciting positive emotions (happiness, P<.001; and surprise, P=.01) and in reducing negative emotions (fear, P=.05; and sadness, P=.05) and state anxiety, as measured by the STAI-Y1 (P=.05).

Conclusions

The two main principal findings of this study are as follows: (1) virtual reality video games appear to be effective tools to elicit positive emotions and to decrease negative emotions and state anxiety in individuals and (2) the level of body involvement of the virtual video game has an important effect in determining the ability of the game to improve positive emotions and decrease negative emotions and state anxiety of the players.

Immunological and Neurometabolite Changes Associated With Switch From Efavirenz to an Integrase Inhibitor

BACKGROUND

The biological mechanisms by which efavirenz (EFV) causes central nervous system (CNS) effects are unclear. The objective of this pilot study was to elucidate the mechanisms underlying these CNS effects by correlating well-described neuropsychological (NP) changes with neurometabolites and immunologic markers following switch off EFV.

SETTING

Two single-arm parallel switch studies among HIV-infected adults in Boston, USA, from 2015 to 2017.

METHODS

Twenty asymptomatic HIV-infected adults on EFV-containing regimens were switched to an integrase strand transfer inhibitor-based regimen for 8 weeks. NP assessments were conducted before and after switch and correlated with neurometabolite changes measured using magnetic resonance spectroscopy and immunological markers. All pre-EFV and post-EFV measures were evaluated using matched-paired analyses.

RESULTS

NP testing demonstrated improvement in the domains of mood, cognition, and sleep off EFV. Magnetic resonance spectroscopy revealed decreases in the neurometabolite glutathione level (P = 0.03), a marker of oxidative stress after switch. Inhibitory neuronal activity as reflected by gamma-amino butyric acid levels increased (P = 0.03), whereas excitatory neurotransmitters glutamine + glutamate (Glx) and aspartate decreased (P = 0.04, 0.001). Switching off EFV was also associated with changes in inflammatory markers; plasma markers sCD14 (P = 0.008) decreased, whereas I-FABP and TNFRI levels increased (P = 0.05, 0.03). Cellular markers CD4 and CD8 HLA-DR-/CD38 subsets both increased (P = 0.05, 0.02).

CONCLUSIONS

Even asymptomatic participants showed improvements in NP parameters when switched off EFV. These improvements were associated with decreased CNS oxidative stress and excitatory neuronal activity. Changes in immune activation biomarkers suggested overall decreased inflammation. EFV may exert CNS effects through oxidative and inflammatory pathways, providing insight into possible mechanisms of EFV neurotoxicity.

Can Machine Learning Predict Stress Reduction Based on Wearable Sensors’ Data Following Relaxation at Workplace? A Pilot Study

Nowadays, psychological stress represents a burdensome condition affecting an increasing number of subjects, in turn putting into practice several strategies to cope with this issue, including the administration of relaxation protocols, often performed in non-structured environments, like workplaces, and constrained within short times. Here, we performed a quick relaxation protocol based on a short audio and video, and analyzed physiological signals related to the autonomic nervous system (ANS) activity, including electrocardiogram (ECG) and galvanic skin response (GSR). Based on the features extracted, machine learning was applied to discriminate between subjects benefitting from the protocol and those with negative or no effects. Twenty-four healthy volunteers were enrolled for the protocol, equally and randomly divided into Group A, performing an audio-video + video-only relaxation, and Group B, performing an audio-video + audio-only protocol. From the ANS point of view, Group A subjects displayed a significant difference in the heart rate variability-related parameter SDNN across the test phases, whereas both groups displayed a different GSR response, albeit at different levels, with Group A displaying greater differences across phases with respect to Group B. Overall, the majority of the volunteers enrolled self-reported an improvement of their well-being status, according to structured questionnaires. The use of neural networks helped in discriminating those with a positive effect of the relaxation protocol from those with a negative/neutral impact based on basal autonomic features with a 79.2% accuracy. The results obtained demonstrated a significant heterogeneity in autonomic effects of the relaxation, highlighting the importance of maintaining a structured, well-defined protocol to produce significant benefits at the ANS level. Machine learning approaches can be useful to predict the outcome of such protocols, therefore providing subjects less prone to positive responses with personalized advice that could improve the effect of such protocols on self-relaxation perception.

Time flies faster when you're feeling blue: sad mood induction accelerates the perception of time in a temporal judgment task

Investigating the interaction of mood and time perception has provided key information in the mechanisms that underlie cognition and emotion. However, much of the literature that has investigated the role of emotions in time perception has focused on the valence of stimuli, or correlational studies of self-reported mood. In the present study, 31 healthy undergraduates completed a temporal judgment task before and after an autobiographical sad mood induction procedure. In the temporal judgment task, participants identified whether a presented neutral stimulus was onscreen for the same duration as a target (2 s). Along with target trials, very short (1.25 s), short (1.6 s), long (2.25 s), and very long (3.125 s) trials were presented in random order and in equal proportion. Following mood induction, ratings of sadness and fear increased, but returned to baseline at the end of the study. After the mood induction, participants significantly increased temporal overestimation as participants were more likely to affirm short than long-duration trials as matching the target. These results indicate that transient changes in mood in otherwise healthy adults can accelerate the subjective experience of time. Sadness may increase physiological components of time perception that are related approach motivation.

Mood instability during pregnancy and postpartum: a systematic review

Perinatal mood instability (MI) is a common clinical observation in perinatal women, and existing research indicates that MI is strongly associated with a variety of mental disorders. The purpose of this study is to review the evidence of perinatal MI systematically, with a focus on perinatal MI, its relation to perinatal depression, and its effects on children. A systematic search of the literature using PRISMA guidelines was conducted on seven academic health databases to identify any peer-reviewed articles published in English from 1985 to July 2017. Studies were screened, data were extracted, and quality of the selected studies was assessed. A total of 1927 abstracts were returned from the search, with 1063 remaining for abstract screening after duplicate removal, and 4 quantitative studies were selected for final analysis. The selected studies addressed perinatal MI (n = 2), the relation of perinatal MI to perinatal depression (n = 1), and the effects of perinatal MI on children (n = 1). The selected studies identified that perinatal women experienced a significantly higher level of MI than non-perinatal women, MI is a prominent feature in perinatal women with and without depression, mood lability during the early postpartum predicts psychopathology up to 14 months postpartum, and maternal emotion dysregulation, rather than maternal psychopathology, increases the risk of heightened facial affect synchrony in mother-infant interaction. The study reveals a significant gap in the literature of perinatal MI.

Effectiveness of music therapy for alleviating pain during haemodialysis access cannulation for patients undergoing haemodialysis: a multi-facility, single-blind, randomised controlled trial

Background

Repeated pain during haemodialysis access cannulations is a serious problem for haemodialysis patients even when prescribed oral or topical analgesics. Although some studies have observed the efficacy of music therapy for improving pain and anxiety, its effectiveness during haemodialysis access cannulations during dialysis is uncertain. The purpose of this study is to investigate the effects of music therapy for pain when cannulating haemodialysis access for haemodialysis patients.

Methods

A prospective, multi-facility, single-blind, crossover, randomised controlled trial will be implemented. The intervention includes listening to Mozart, along with a white noise control condition. One hundred twenty haemodialysis patients will be enrolled across five facilities. Patients will be randomly allocated to either an Early-sequence group or a Later-sequence group. The Early-sequence group will receive cannulation while listening to Mozart’s Sonata for two pianos in D major (K.448) during the second week (Music period) and white noise during the fourth week (White noise period). The Later-sequence group will receive cannulation along with white noise first, followed by Mozart. All patients will also undergo cannulation during a no-sound period (wearing only headphones) during the first and third week (No-sound period). The music or no-music protocol will begin 8 min prior to the cannulating procedure, and participants will finish listening after starting haemodialysis during each period. The primary outcomes that will be assessed include the Visual Analogue Scale (VAS) score for pain during cannulation, and secondary outcomes are blood pressure, heart rate, VAS anxiety score, State-Trait Anxiety Inventory score, and salivary amylase activity. The operators who are in charge of haemodialysis access cannulation will be blind to the listening condition and VAS report.

Discussion

The proposed study has several methodological benefits. First, using white noise is a suitable control condition for addressing the role of sound in pain management. Additionally, using a crossover design with repeated measurements can help control individual differences between participants, which should better distinguish between- and within-participant variability. Overall, music therapy is a safe and inexpensive intervention that does not have the problematic side effects typically associated with pharmacological treatment. If effective, music therapy can be easily implemented for reducing pain and anxiety during cannulation.

Trial registration

This trial was prospectively registered to UMIN Clinical Trials Registry on 1 July 2018 (UMIN 000032850).

Didgeridoo Health Promotion Method Improves Mood, Mental Stress, and Stability of Autonomic Nervous System

A potential method of health promotion using the traditional wooden brass instrument the didgeridoo was examined, especially in terms of mood, stress, and autonomic nerve stabilization. Twenty Japanese healthy subjects undertook 10 lessons of the Didgeridoo Health Promotion Method (DHPM) and a moods questionnaire, blood pressure, salivary amylase (sAmy) as a stress marker, pulse rate and autonomic balance expressed by Ln[low frequency (LF)/High frequency (HF) were examined twice before the entire lessons and once before and after each lesson. The subjects had improved total mood disturbance (TMD: overall mood disorder degree) as measured by the Japanese version of the Profile of Mood States 2nd Edition (POMS2) as a result of taking the lessons. The pulse of the subjects decreased after the lessons, which correlated with a reduction in sAmy. Additionally, it was found that sAmy decreased after the lessons with increasing age of the subject, subjects with higher TMD before the lessons, or subjects with higher sAmy values before the lessons. With autonomic balance measured by Ln[LF/HF], subjects who had parasympathetic dominance as a result of the lesson were significantly more frequent. Additionally, it has been shown that Ln[LF/HF] decreased over 10 weeks, and it is also clear that the effect is sustained. Health promotion is an important concern for societies as a whole. In this study, it became clear that the DHPM affected mood, stress, and autonomic stability. Future studies should focus on monitoring the effects of continuing the lessons for a longer period of time. Additionally, physical effects such as strength of respiratory muscles should be examined. DHPM may be employed in the work place to promote the mental health of workers as well as in regional neighborhood associations/communities.

State and Trait Anxiety and Diabetes Outcomes in Youth With Type 1 Diabetes

PURPOSE

The purpose of this exploratory pilot study was to examine the associations of state and trait anxiety with glycemic control, self-management, and diabetes-specific quality of life (QOL) in youth 10 to 16 years of age with type 1 diabetes (T1D).

METHODS

Bivariate Pearson correlations and multiple linear regression modeling were conducted to examine the relationship among anxiety symptoms, hemoglobin A1C (A1C), self-management, QOL, and covariates.

RESULTS

A sample of 67 adolescents was 50.7% female, and 87.1% were non-Hispanic white, with a mean ± SD age of 13.4 ± 1.85 years and an A1C of 8.3% ± 1.2% (67 mmol/mol). Higher state anxiety was correlated with older age. Better self-management was correlated with lower trait anxiety and lower state anxiety. Higher state and trait anxiety were associated with poorer self-management. Higher state anxiety was associated with higher A1C. Higher trait anxiety was associated with poorer diabetes-specific QOL.

CONCLUSIONS

State and trait anxiety may differentially affect diabetes outcomes. State anxiety may be a modifiable target for physiologic (A1C) and psychosocial (QOL) outcomes in youth with T1D, while trait anxiety may be a modifiable target for psychosocial outcomes (QOL). Anxiety symptoms should be assessed at regular clinic visits. Interventions to improve anxiety symptoms may in turn improve physiologic and psychosocial outcomes.

Subjective unpleasantness of malodors induces a stress response

Unpleasant odors impair our mood and may affect physical health, even when the odorants are not toxic. A possible cause for such negative effects is stress induced by odors; however, whether the unpleasantness itself elicited stress or not has not been clear. Thus, we examined whether unpleasantness of odors induced the stress responses of emotion, the hypothalamic-pituitary-adrenal (HPA) axis, and the sympathetic nervous system (SNS). Six experiments were conducted, where salivary cortisol or salivary alpha amylase (sAA), markers for activities of the HPA and the SNS, respectively, were measured, along with subjective ratings of odors and emotion. First, the responses to three malodors listed in the Offensive Odor Control Law in Japan were examined. While these odors were rated as unpleasant, and exposure to them increased anxiety, no response of the HPA was observed (experiment 1, n = 69). In contrast, an increase of the SNS activity was observed after exposure to two of the three malodors, while the SNS did not respond to pleasant odors (experiments 2-4, n = 35, 34 and 30). To examine the effect of unpleasantness further, the SNS response was examined while subjective unpleasantness of odors was manipulated by adding negative verbal information (experiment 5, n = 92), or by mixing in a pleasant odor (experiment 6, n = 35). The SNS responses upon inhalation of the same odorous substances were found to be dependent on whether they were perceived as unpleasant. Finally, a correlation analysis on the pooled data from experiments 2-6 showed that the odor-elicited SNS activity and anxiety were strongly correlated with perceived unpleasantness of odors. These results suggest that subjective unpleasantness of odors per se can induce the stress response of emotion and the SNS.

Evaluation of a Mental Care System for Patients Recuperating in a Sterile Room after Hematopoietic Cell Transplantation

We developed a mental healthcare system using 360° interactive video for hematopoietic cell transplant patients whose treatment is obligatory in a sterile room. This system uses projection mapping for video presentation. By using it, our aim was to allow patients to feel the spread of virtual space in aseptic rooms and to reduce anxiety and anger and to relieve stress. To assess the effectiveness of the developed system for mental care, especially in the presentation method, we executed an experiment comparing projection mapping and a monitor as a presentation tool. Twelve patients participated in the experiments. The changes in the state of patients before and after using the system were investigated. Physiological indices obtained from electrocardiography, respiration, skin conductance, scores of questionnaires, and answers in interviews were used for evaluation. Significant changes were observed between pre and post trials in the scores of STAI-Y1 and the anxiety score of VAS; however, there were no significant differences between the two presentation methods. The results of interview showed the advantage of projection mapping in the feeling of space spreading, presence, and preference to use.

Psychometric properties of the St. Elizabeth Youngstown hospital wellbeing inventory and non-burnout inventory for physicians and nurses

BACKGROUND

Physicians and nurses have substantial problems with wellbeing and burnout. We examined the reliability and construct validity of a wellbeing inventory (WBI) administered to some physicians and nurses working in St. Elizabeth Youngstown Hospital (SEYH).

METHODS

The SEYH-WBI, consisting of 4 positive affect (PA) items and 7 negative affect (NA) items developed from 5 validated surveys, was administered (n = 419). A non-burnout inventory (SEYH-NBI) consisting of 2 PA items and 3 NA items was derived from the SEYH-WBI. The Positive and Negative Affect Schedule (PANAS), a validated survey consisting of 10 PA items and 10 NA items, was conducted (n = 191). The Maslach Burnout Inventory (MBI), a validated survey consisting of 3 domains (3 items each), was completed (n = 150).

RESULTS

For the SEYH-WBI, Cronbach coefficients were 0.76 for PA items and 0.83 for NA items. The NA item loading on factor 1 was 0.55-0.84 and the PA item loading on factor 2 was 0.47-0.89. Confirmatory indices were as follows: root mean square residual, 0.07 and Bentler Comparative Fit Index, 0.92. For the SEYH-NBI, Cronbach coefficients were 0.76 for PA items and 0.79 for NA items. The NA item loading on factor 1 was 0.80-0.87 and the PA item loading on factor 2 was 0.89-0.90. Confirmatory indices were as follows: root mean square residual, 0.02; and Bentler Comparative Fit Index, 0.99. PANAS correlations were as follows: SEYH-WBI PA and PANAS PA scores, r = 0.9; p <  0.0001; SEYH-WBI NA and PANAS NA scores, r = 0.9; p <  0.0001; SEYH-NBI PA and PANAS PA scores, r = 0.8; p <  0.0001; and SEYH-NBI NA and PANAS NA scores, r = 0.7; p <  0.0001. Correlations for SEYH-NBI and MBI were as follows: total NBI and total MBI, r = - 0.6, p <  0.0001; NA and emotional exhaustion, r = 0.6, p <  0.0001; PA and personal accomplishment, r = 0.3, p = 0.0003; and NA and depersonalization, r = 0.3, p = 0.0008.

CONCLUSIONS

Validation assessments indicate that the SEYH-WBI and SEYH-NBI have acceptable psychometric performance. Similar findings in a larger cohort would be more compelling.

Effect of Methylphenidate on State Anxiety in Children With ADHD-A Single Dose, Placebo Controlled, Crossover Study

Introduction: Non-adherence to efficacious pharmacotherapy is a major obstacle in the treatment of children suffering from attention deficit hyperactive disorder (ADHD). Some hold the position that pharmacotherapy induces anxiety, and that this is one of the reasons for this non-adherence. Previous studies have pointed to the opposite, a moderating effect of methylphenidate (MPH) on state anxiety in patients with ADHD. This has been shown in continuous treatment in children, but not on a single dose. We hypothesized that a single dose might have a different effect.

Method: Twenty children with ADHD were given single doses of MPH in a randomized, controlled, crossover, double blind study. State anxiety using The Spielberger State-Trait Anxiety Inventory (STAI) and a continuous performance test were assessed.

Results: As a group, no change was detected in state anxiety with MPH or placebo. However, children who were given MPH during the first session as opposed to those who received placebo first, demonstrated deterioration in baseline state anxiety in the second session [t_(2.485), p < 0.05].

Conclusion: Our findings show a possible delayed anxiety-provoking effect of a single dose of MPH. This may be relevant to the understanding of difficulties in adherence with MPH treatment in children with ADHD.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT01798459

Stress and neurocognitive efficiency in managerial contexts

Purpose

The purpose of this paper is to test the potential of an innovative technology-mediated mental training protocol for the empowerment of stress management and neurocognitive efficiency in highly stressful professional contexts, with people who occupy top management positions. The innovative protocol specifically combines mindfulness practice and a wearable neurofeedback system managed via smartphone.

Design/methodology/approach

The longitudinal research included pre- and post-training assessment steps in order to test training effects with respect to subjective level and physiological markers of stress, anxiety and mood profiles, cognitive abilities and markers of neurocognitive efficiency.

Findings

Results showed decreased stress, anxiety, anger and mental fatigue; increased participants’ information-processing efficiency; increased electrophysiological markers concerning the balance and reactivity of the mind-brain system; and improved physiological markers of vagal tone.

Research limitations/implications

Though further investigation and replication with larger samples would strengthen present findings, the authors suggest that observed outcomes, together with the limited duration of the overall protocol and of daily practices, make the training a potentially valuable tool especially for people whose professional position imposes time limitations and elevated job duties, thus increasing the risk of drop-out from traditional stress management programs.

Originality/value

The combination of mindfulness-based mental training with the advantages offered by a novel brain-sensing wearable technology allows for overcoming the weak points of traditional approaches (e.g. notable time expense) and optimizing training opportunities and outcomes. Furthermore, this is, to the authors’ best knowledge, the first systematic report of the application of such methodology in an organization and with top management professionals.

The Effect of Symptom Clusters on Quality of Life Among Patients With Type 2 Diabetes

Purpose

The purpose of this study was to examine the collective effect of a symptom cluster (depression, anxiety, fatigue, and impaired sleep quality) at baseline on the quality of life (QOL) of patients with type 2 diabetes (T2DM) over time.

Methods

This was a secondary data analysis of 302 patients with T2DM who presented with both hypertension and hyperlipidemia. All of the participants were enrolled in a randomized controlled intervention study testing strategies to improve medication adherence. The psychological symptoms and QOL were assessed at baseline, 6 months, and 12 months. Cluster analysis was used to identify subgroups of patients based on the severity of symptoms at baseline.

Results

Hierarchical cluster analysis identified 4 patient subgroups: all low severity, mild, moderate, and all high severity. There were significant differences in patients’ QOL overall among the 4 subgroups. Compared with the all-low-severity subgroup, subgroups with higher severity of the 4 symptoms had poorer QOL across all 3 time points. QOL was most impacted by trait anxiety across the 3 time points.

Conclusion

QOL was significantly impacted by psychological symptom clusters among patients with T2DM. Healthcare providers should not neglect psychological symptoms that patients experience. It is important to assess and manage these symptoms to improve QOL among patients with diabetes.

Effects of technology-mediated mindfulness practice on stress: psychophysiological and self-report measures

Repeated exposure to stressors, even if mild, may alter the efficiency of optimal stress responses and hinder emotion regulation skills. Mindfulness meditation, by strengthening self-regulation and awareness, may optimize the efficiency of physiological, cognitive, and behavioral reactions to stressful events but typically requires notable commitment to practice, which often leads to disengagement. Recent research suggested that such practices may be made more accessible and that the potential for self-enhancement and stress management of meditation might be improved by supporting mental training with wearable neurofeedback devices able to inform the practicer on ongoing modulation of bodily and brain activity. This study aimed at testing the effect of such novel training approach based on the integration of mental training with brain-sensing wearable devices on physiological (heart rate and variability) and subjective markers of stress (perceived stress, anxiety, and mood states). Participants (N = 55) have been randomly divided into an active control (CONTg) and an experimental group (EXPg). Both groups completed a four-week training constituted by brief daily activities based on mindfulness practices. Experimental participants practiced with the support of dedicated brain-sensing devices. By analyzing pre- and post-training assessments, we observed relevantly decreased stress and anxiety measures in EXPg, as well as relevantly decreased mental fatigue and increased vigor. EXPg also showed improved physiological markers of vagal tone both at rest and during exposure to a cognitive stressor. Reported findings add to the limited available literature on potential effects of technology-supported mental training protocols for promoting subjective well-being and enhancing self-regulation skills.

The impact of their role on telephone crisis support workers' psychological wellbeing and functioning: Quantitative findings from a mixed methods investigation

Research suggests that frequent empathic engagement with others in distress places helpers in registered professional roles (e.g. medical practitioners, psychologists) at risk of functional impairment related to symptoms of psychological distress, including the delivery of sub-optimal care to patients. Preliminary research suggests that telephone crisis support workers may also be impacted in a similar way. This repeated measures study is the first known research to examine telephone crisis support workers’ functional impairment related to symptoms of psychological distress before and after speaking with callers in crisis. A representative sample of telephone crisis support workers from Lifeline Australia participated by completing three surveys: 1) directly before; 2) directly after; and 3) one week after completing a shift on the national crisis line. Surveys included standardised measures of functional impairment, psychological distress, lived experience of mental health issues and suicide, motivations for volunteering, coping strategies and help-seeking. Categorical items were used to assess personal and shift-related factors. Repeated measures analyses of variance were used to identify changes in symptoms of psychological distress and impairment across time points. Structural equation modelling was used to test relationships within a hypothesised model of impairment. A significant proportion of participants reported functional impairment related to symptoms of psychological distress. Significant differences in functional impairment and symptoms of psychological distress were detected, and were associated with different mechanisms, across time points. An important outcome of this study is empirically-supported models which explain how telephone crisis support workers come to experience functional impairment in relation to their TCS role, as well as other work/study, home/family and social/leisure activities. Results warrant the deliberate development and/or modification of existing service strategies to optimise telephone crisis support workers’ psychological wellbeing and functioning, including by structuring the work environment and emphasising certain messages during training and supervision.

Anxiety Associated with Colonoscopy and Flexible Sigmoidoscopy: A Systematic Review

OBJECTIVES

Addressing procedure-related anxiety should improve adherence to colorectal cancer screening programs and diagnostic colonoscopy. We performed a systematic review to assess anxiety among individuals undergoing colonoscopy or flexible sigmoidoscopy (FS).

METHODS

We searched multiple electronic databases for studies evaluating anxiety associated with colonoscopy or FS published from 2005 to 2017. Two reviewers independently identified studies, extracted data, and assessed study quality. The main outcomes were the magnitude of pre-procedure anxiety, types of concerns, predictors of anxiety, and effectiveness of anxiety-lowering interventions in individuals undergoing lower endoscopy. The protocol was prospectively registered in PROSPERO.

RESULTS

Fifty-eight studies (24,490 patients) met the inclusion criteria. Patients undergoing colonoscopy had a higher mean level of anxiety than that previously reported in the general population, with some studies reporting more than 50% of patients having moderate-to-severe anxiety. Areas of anxiety-related concern included bowel preparation, difficulties with the procedure (embarrassment, pain, possible complications, and sedation), and concerns about diagnosis; including fear of being diagnosed with cancer. Female gender, higher baseline anxiety, functional abdominal pain, lower education, and lower income were associated with greater anxiety prior to colonoscopy. Providing higher-quality information before colonoscopy, particularly with a video, shows promise as a way of reducing pre-procedure anxiety but the studies to date are of low quality.

CONCLUSIONS

A large proportion of patients undergoing colonoscopy report anxiety before the procedure. Improvement in pre-procedure information delivery and evaluation of approaches to reduce anxiety is required, especially for those with predictors of pre-procedure anxiety.

Premedication to reduce anxiety in patients undergoing coronary angiography and percutaneous coronary intervention

Aims

In this study, we examined the effects of the routinely administration of benzodiazepines on reducing periprocedural anxiety versus no premedication.

Methods

In this open label study, we enrolled 1683 patients undergoing diagnostic coronary angiograms (CAG) or percutaneous coronary interventions (PCI). Randomisation was simulated by systematically allocating patients in monthly rotational periods to lorazepam 1  mg/sl, oxazepam 10  mg/po, diazepam 5  mg/po, midazolam 7.5  mg/po or no premedication. Anxiety was measured at four different time points using the one-item Visual Analogue Scale for Anxiety (VAS score) ranging from 0 to 10. The primary outcome was the difference in anxiety reduction (ΔVAS, preprocedure to postprocedure), between the different premedication strategies versus no premedication.

Results

Anxiety reduction was larger in patients premedicated with lorazepam (ΔVAS=−2.0, SE=1.6, P=0.007) or diazepam (ΔVAS=−2.0, SE=1.5, p=0.003) compared with patients without any premedication (ΔVAS=−1.4, SE=1.2). The use of midazolam or oxazepam did not lead to a significant reduction in anxiety compared with patients who did not receive premedication. Additionally, a high number of patients treated with midazolam (N=39, 19.8%) developed side effects.

Conclusions

In this study, the use of lorazepam or diazepam was associated with a significant, but modest anxiety reduction in patients undergoing CAG or PCI. This study does not support the standard use of oxazepam or midazolam as premedication to reduce anxiety.

Exploring the occurrence of sudden gains among anxious youth receiving evidence-based cognitive-behavioral therapy

BACKGROUND

There is limited information on the occurrence of 'sudden gains' - recognized improvements of substantial magnitude occurring between individual sessions of treatment. This study explores changes in anxiety across sessions of CBT for youth anxiety disorders to determine whether evidence exists for sudden gains in this population.

METHOD

A total of 133 anxious youth (M_age  = 10.16 years; 55.6% male) were randomly assigned to receive 16 sessions of individual cognitive-behavioral therapy (ICBT), family-based CBT (FCBT), or a family-based educational support and attention control (FESA). At each treatment session, youth completed a measure of anxiety. Sudden gains were calculated from weekly state anxiety scores using methods consistent with previous research (i.e., Tang & DeRubeis, 1999).

RESULTS

Three participants experienced a sudden gain at any point during treatment; all experienced a reversal of the sudden gain, although one experienced a regain of the improvement that occurred during the sudden gain.

CONCLUSIONS

While sudden gains have been demonstrated in some studies, in a relatively new topic to the literature such as this, it should also be considered that many evidence-based treatments are actually intended to produce more steady/gradual gains - which may be particularly true for youth who are not as cognitively advanced as adults and who have much to learn about how psychopathology - and for this analysis, anxiety - operates.

Mapping movement, mood, motivation and mentation in the subthalamic nucleus

The anatomical connections of the subthalamic nucleus (STN) have driven hypotheses about its functional anatomy, including the hypothesis that the precise anatomical location of STN deep brain stimulation (DBS) contributes to the variability of motor and non-motor responses across patients with Parkinson's disease (PD). We previously tested the hypothesis using a three-dimensional (3D) statistical method to interpret the acute effects of unilateral DBS at each patient's clinically optimized DBS settings and active contact. Here, we report a similar analysis from a new study in which DBS parameters were standardized and DBS locations were chosen blind to clinical response. In 74 individuals with PD and STN DBS, STN contacts were selected near the dorsal and ventral borders of the STN contralateral to the more affected side of the body. Participants were tested off PD medications in each of three unilateral DBS conditions (ventral STN DBS, dorsal STN DBS and DBS off) for acute effects on mood, apathy, working memory, response inhibition and motor function. Voltage, frequency and pulse width were standardized, and participants and raters were blind to condition. In a categorical analysis, both dorsal and ventral STN DBS improved mean motor function without affecting cognitive measures. Ventral STN DBS induced greater improvement in rigidity and anxiety than dorsal STN DBS. In the 3D analysis, contact location was significant for body hypokinesia, rigidity and resting tremor, with the greatest improvement occurring with DBS in dorsal STN and zona incerta. The 3D results provide new, direct functional evidence for the anatomically derived model of STN, in which motor function is best represented in dorsal STN. However, our data suggest that functional segregation between motor and non-motor areas of the STN is limited, because locations that induced improvements in motor function and mood overlapped substantially.

Impact of video on the understanding and satisfaction of patients receiving informed consent before elective inpatient coronary angiography: A randomized trial

BACKGROUND

Appropriate information about the benefits and risks of invasive procedures is crucial, but limited data is available in this field. The aim of this study was to evaluate the incremental value of a short video about coronary angiography compared with standard information, in terms of patient understanding, satisfaction and anxiety.

METHODS

This prospective multicenter study included patients admitted for scheduled coronary angiography, who were randomized to receive either standard information or video information by watching a three-dimensional educational video. After information was delivered, patients were asked to complete a dedicated 16-point information questionnaire, as well as satisfaction and anxiety scales.

RESULTS

From 21 September to 4 October 2015, 821 consecutive patients were randomized to receive either standard information (n=415) or standard information with an added educational video (n=406). The information score was higher in the video information group than in the standard group (11.8±2.8 vs 9.5±3.1; P<.001). This result was consistent across age and education level subgroups. Self-reported satisfaction was also higher in the video information group (8.4±1.9 vs. 7.7±2.3; P<.001), while anxiety level did not differ between groups. The variables associated with a higher information score were the use of the educational video, younger age, higher level of education, previous follow-up by a cardiologist, prior information about coronary angiography and previous coronary angiography.

CONCLUSIONS

In comparison with standard information, viewing a dedicated educational video improved patients' understanding and satisfaction before scheduled coronary angiography. These results are in favor of widespread use of this incremental information tool.

The provision of written information and its effect on levels of pain and anxiety during electrodiagnostic studies: A randomised controlled trial

Objective

The provision of written information is a low-cost and readily available intervention that has been found to reduce pain and anxiety in a variety of clinical settings. The current study was undertaken to determine if information provision may improve patients’ experience during conventional electrodiagnostic studies.

Methods

128 participants were recruited from a tertiary teaching hospital who were referred for electrodiagnostic studies. They were randomized into 2 groups where the intervention group was provided with written information about the electrodiagnostic testing. Patients were invited to complete a questionnaire that included pain and anxiety using a visual analogue scale (VAS) following the testing. All participants underwent nerve conduction studies (NCS) whilst a subset also underwent subsequent needle electromyography (EMG).

Results

Those who received information had a statistically significant lower perception of anxiety during NCS, whilst only females who received information had a statistically significant lower perception of pain to both NCS and EMG.

Conclusions

The provision of written information can reduce the degree of pain and anxiety experienced during electrodiagnostic testing.

Significance

Improving patient comfort and tolerability during electrodiagnostic testing may have practical implications towards more reliable and accurate results obtained from such investigations that may in turn improve patient diagnosis and management.

Disruptions in Emotion Regulation as a Mechanism Linking Community Violence Exposure to Adolescent Internalizing Problems

Although community violence is an established risk factor for youth aggression, less research has examined its relation with internalizing psychopathology. This study examined associations of community violence exposure with internalizing symptoms, and state and trait emotion dysregulation as mechanisms underlying these associations, in 287 adolescents aged 16-17 (45.6% male; 40.8% White). Community violence exposure was associated with internalizing symptoms, negative affect during peer evaluation, trait emotional reactivity, and infrequent problem solving. Multiple emotion dysregulation indices were also associated with internalizing symptoms. In simultaneous multiple mediator models, indirect effects of community violence on internalizing problems were significantly explained by state and trait emotion dysregulation. Findings implicate emotion dysregulation as one mechanism linking community violence exposure to adolescent internalizing symptoms.

Children's experiences and responses towards an intervention for psychological preparation for radiotherapy

BACKGROUND

Children can experience distress when undergoing radiotherapy as a reaction to being scared of and unfamiliar with the procedure. The aim was to evaluate children's experiences and responses towards an intervention for psychological preparation for radiotherapy.

METHODS

A case control design with qualitative content analysis of semi-structured interviews and statistical analysis of anxiety ratings were used for evaluating a strategy for psychological preparation and distraction. Fifty-seven children aged 2 to 18 years and their parents participated - 30 children in the baseline group and 27 in the intervention group. Child interviews were performed and the child and their parents rated the child's anxiety.

RESULTS

The intervention was most appropriate for the younger children, who enjoyed the digital story, the stuffed animal and training with their parents. There were some technical problems and the digital story was not detailed enough to fit exactly with various cancer diagnoses. Children described suggestions for improvement of the intervention. The ratings of the child's anxiety during radiation treatment showed no differences between the baseline group and the intervention group.

CONCLUSIONS

The children of all the age groups experienced their interventions as positive. The strength of the intervention was that it encouraged interaction within the family and provided an opportunity for siblings and peers to take part in what the child was going through. Future research on children's experiences to interventions should be encouraged. The intervention and the technical solutions could improve by further development.

TRIAL REGISTRATION

The study design was structured as an un-matched case-control study, baseline group vs. intervention group.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02993978 , Protocol Record 2012-113-31 M. Retrospectively registered - 21 November 2016.

Anticipatory Effects on Perceived Pain: Associations With Development and Anxiety

OBJECTIVE

Naturalistic studies suggest that expectation of adverse experiences such as pain exerts particularly strong effects on anxious youth. In healthy adults, expectation influences the experience of pain. The current study uses experimental methods to compare the effects of expectation on pain among adults, healthy youth, and youth with an anxiety disorder.

METHODS

Twenty-three healthy adults, 20 healthy youth, and 20 youth with an anxiety disorder underwent procedures in which auditory cues were paired with noxious thermal stimulation. Through instructed conditioning, one cue predicted low-pain stimulation and the other predicted high-pain stimulation. At test, each cue was additionally followed by a single temperature calibrated to elicit medium pain ratings. We compared cue-based expectancy effects on pain across the three groups, based on cue effects on pain elicited on medium heat trials.

RESULTS

Across all groups, as expected, participants reported greater pain with increasing heat intensity (β = 2.29, t(41) = 29.94, p < .001). Across all groups, the critical medium temperature trials were rated as more painful in the high- relative to low-expectancy condition (β = 1.72, t(41) = 10.48, p < .001). However, no evidence of between-group differences or continuous associations with age or anxiety was observed.

CONCLUSIONS

All participants showed strong effects of expectancy on pain. No influences of development or anxiety arose. Complex factors may influence associations among anxiety, development, and pain reports in naturalistic studies. Such factors may be identified using experiments that employ more complex, yet controlled manipulations of expectancy or assess neural correlates of expectancy.

Parents' Experiences and Responses to an Intervention for Psychological Preparation of Children and Families During the Child's Radiotherapy

The aim of this study was to evaluate parents' experiences and responses to a systematic intervention for psychological preparation of children and families during the child's radiotherapy (RT) treatment. In this case-control study at 3 pediatric RT centers, an intervention with a preparatory kit, including age-adjusted information on tablets, gift of a stuffed toy or a pair of headphones, a parent booklet, and toy models of the computed tomography and RT machines was implemented. For evaluation, a mixed methods data collection was conducted. A total of 113 parents of children undergoing RT were included-n = 59 in the baseline group and n = 54 in the intervention group. Health-related quality of life was rated low, but parents in the intervention group expressed less anxiety after the RT compared with the baseline group. They found information suitable for their young children, siblings, and friends were involved and the toy models were used for play. Parents expressed positive feelings due to close interaction with staff and each other within the family. The solutions developed within a human-centered design approach and shaped as a systematic family-centered strategy contributed to parents understanding and coping with the child's RT.

The effect of fear of falling on vestibular feedback control of balance

Vestibular sensation contributes to cervical‐head stabilization and fall prevention. To what extent fear of falling influences the associated vestibular feedback processes is currently undetermined. We used galanic vestibular stimulation (GVS) to induce vestibular reflexes while participants stood at ground level and on a narrow walkway at 3.85 m height to induce fear of falling. Fear was confirmed by questionnaires and elevated skin conductance. Full‐body kinematics was measured to differentiate the whole‐body centre of mass response (CoM) into component parts (cervical, axial trunk, appendicular short latency, and medium latency). We studied the effect of fear of falling on each component to discern their underlying mechanisms. Statistical parametric mapping analysis provided sensitive discrimination of early GVS and height effects. Kinematic analysis revealed responses at 1 mA stimulation previously believed marginal through EMG and force plate analysis. The GVS response comprised a rapid, anode‐directed cervical‐head acceleration, a short‐latency cathode‐directed acceleration (cathodal buckling) of lower extremities and pelvis, an anode‐directed upper thorax acceleration, and subsequently a medium‐latency anode‐directed acceleration of all body parts. At height, head and upper thorax early acceleration were unaltered, however, short‐latency lower extremity acceleration was increased. The effect of height on balance was a decreased duration and increased rate of change in the CoM acceleration pattern. These results demonstrate that fear modifies vestibular control of balance, whereas cervical‐head stabilization is governed by different mechanisms unaffected by fear of falling. The mechanical pattern of cathodal buckling and its modulation by fear of falling both support the hypothesis that short‐latency responses contribute to regulate balance.

Trait vs. state anxiety in different threatening situations

OBJECTIVE

Anxiety as a uni- or multidimensional construct has been under discussion. The unidimensional approach assumes that there is a general trait anxiety, which predisposes the individuals to increases in state anxiety in various threatening situations. In this case, there should be a correlation between state and trait anxiety in any situation of threat. Therefore, the aim of this study was to investigate the correlation between trait and state anxiety in participants exposed to two different anxiogenic situations: interpersonal threat (Video-Monitored Stroop Test - VMST) and physical threat (third molar extraction - TME).

METHODS

Participants with various levels of trait anxiety (general trait: State-Trait Anxiety Inventory - STAI, Hospital Anxiety and Depression Scale; specific trait: Social Phobia Inventory, Dental Anxiety Scale) had their anxious state evaluated (STAI, self-evaluation of tension level, heart rate, electromyogram activity) before, during and after the VMST or the TME.

RESULTS

In VMST, trait anxiety correlated to state anxiety (psychological parameters) in all test phases. However, in TME, the only trait measurement that correlated to state anxiety (psychological parameters) was the Dental Anxiety Scale.

CONCLUSION

Trait anxiety correlates positively to state anxiety in situations of interpersonal threat, but not of physical threat.

Gene by cognition interaction on stress-induced attention bias for food: Effects of 5-HTTLPR and ruminative thinking

INTRODUCTION

Stress is often found to increase the preference and intake of high caloric foods. This effect is known as emotional eating and is influenced by cognitive as well as biological stress vulnerabilities. An S-allele of the 5-HTTLPR gene has been linked to decreased (brain) serotonin efficiency, leading to decreased stress resilience and increased risks for negative affect and eating related disturbances. Recently it has been proposed that a cognitive ruminative thinking style can further exacerbate the effect of this gene by prolonging the already increased stress response, thereby potentially increasing the risk of compensating by overeating high palatable foods.

OBJECTIVE

This study was aimed at investigating whether there is an increased risk for emotional eating in high ruminative S/S-allele carriers reflected by an increased attention bias for high caloric foods during stress.

METHODS

From a large (N=827) DNA database, participants (N=100) were selected based on genotype (S/S or L/L) and ruminative thinking style and performed an eye-tracking visual food-picture probe task before and after acute stress exposure. A significant Genotype x Rumination x Stress-interaction was found on attention bias for savory food; indicating that a stress-induced attention bias for specifically high-caloric foods is moderated by a gene x cognitive risk factor.

CONCLUSION

Both a genetic (5-HTTLPR) and cognitive (ruminative thinking) stress vulnerability may mutually increase the risk for stress-related abnormal eating patterns.

Light and smell stimulus protocol reduced negative frontal EEG asymmetry and improved mood

Light and smell have both been shown to induce beneficial changes to human psychophysiology. Bright light therapy has been shown to have a positive impact on anxiety and depression and smell has also been shown to have positive effects on mood, stress, anxiety and depression. We developed a method for the delivery of integrated light and smell stimulation to try to optimise positive psychophysiological benefit. We tested its effectiveness on a physiological measure, EEG frontal alpha asymmetry (FA) and a psychological paradigm, the POMS test, both of which have been used as a measure of emotional state and mood. Light, pleasant smell, combined light+smell and a no stimulus control were delivered for 90s while the frontal alpha asymmetry (FA) was monitored. Smell and light+smell caused significant reductions in negative FA during stimulation. Exposure to a longer 15 min nonadaptive light+smell stimulus protocol reduced negative FA and decreased negative affect (POMS). The effects were greater in the negative FA group. Both the physiological (EEG) and psychometric (POMS) data indicate that integrated light and smell stimulation can reduce negative affect and reduce a marker for anxiety/ depression. This light+smell sensory stimulation protocol could offer a safe treatment for depression/anxiety.

Comparative study of pencil-and-paper and electronic formats of GHQ-12, WHO-5 and PHQ-9 questionnaires

INTRODUCTION

The increase in telemedicine in the mental health field has led to psychometric instruments changing from paper-and-pencil administration to an electronic format. A study is performed to determine if both formats are equivalent for well-known questionnaires such as GHQ-12, WHO-5, and PHQ-9.

MATERIAL AND METHODS

Forty-seven volunteers completed GHQ-12, WHO-5 and PHQ-9 questionnaires in paper-and-pencil format, and in the following 24h they completed their electronic versions via the web site www.memind.net. An electronic-Likert format was used by 24 participants, and 23 used an electronic-slider format. Internal consistency was measured by α-Cronbach index and omega coefficient, and test-retest was measured by the intraclass correlation coefficient (ICC). Agreement between individual items was compared using Weighted Kappa coefficients, and dimensional structure between formats using the Comparative Fit Index (CFI).

RESULTS

Internal consistency was higher than 0.8 for GHQ-12 and WHO-5. The ICC ranged between 0.655 for PHQ-9 paper-and-pencil/electronic-slider and 0.901 for GHQ-12 paper-and-pencil/electronic- slider. Agreement for individual items in paper-and-pencil and electronic-Likert versions was variable, ranging from low agreement in PHQ-1 (weighted κ=0.143; P=.384) to high agreement in PHQ-5 (weighted κ=0.769; P=.000). The CFI results showed an adequate equivalence between formats.

CONCLUSIONS

Except for the PHQ-9 electronic-Likert, questionnaires keep their structure in electronic formats. Discrepancies were found in items agreement. This study supports previous works indicating that the change from paper-and-pencil to electronic formats is not an immediate process, and needs a proper adaptation.

Obsessions and compulsions in the lab: A meta-analysis of procedures to induce symptoms of obsessive-compulsive disorder

Efficacious induction procedures of symptoms of obsessive-compulsive disorder (OCD) are necessary in order to test central tenets of theories on OCD. However, the efficacy of the current range of induction procedures remains unclear. Therefore, this meta-analysis set out to examine the efficacy of induction procedures in participants with and without OCD symptoms. Moreover, we explored whether the efficacy varied across different moderators (i.e., induction categories, symptom dimensions of OCD, modalities of presentation, and level of individual tailoring). In total we included 4900 participants across 90 studies. The analyses showed that there was no difference in studies using subclinical and clinical participants, confirming the utility of analogue samples. Induction procedures evoked more symptoms in (sub)clinical OCD than in healthy participants, which was most evident in the contamination symptom dimension of OCD. Analysis within (sub)clinical OCD showed a large effect size of induction procedures, especially for the threat and responsibility category and when stimuli were tailored to individuals. Analysis within healthy participants showed a medium effect size of induction procedures. The magnitude of the effect in healthy individuals was stronger for mental contamination, thought-action fusion and threat inductions.

Anxiety levels of patients undergoing coronary procedures in the catheterization laboratory

BACKGROUND

High levels of anxiety are associated with worse outcomes in coronary artery disease patients. Little is known about anxiety levels in patients undergoing coronary procedures. Our objective is to examine the levels of anxiety in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) during the different phases of hospital stay and to evaluate which patient characteristics are associated with increased anxiety.

METHODS

Patients undergoing CAG or PCI between April 2009 and April 2010 were included in this prospective cohort study. Anxiety levels were measured using the self reported Visual Analogue Scale (VAS) of Anxiety, ranging from 0 to 100. VAS anxiety scores were obtained at hospital intake, pre- and post-procedure, and at hospital discharge. Multivariate linear regression analyses were performed to assess correlations between baseline characteristics and anxiety levels at the different time points.

RESULTS

In total 2604 patients were included, with 70.4% male participants with a mean age of 65±12years. VAS anxiety scores were highest pre-procedure (44.2±27.0mm). Female patients reported a significantly higher pre procedure VAS anxiety score (50.4±26.5) compared to males (41.5±26.8, p=0.02). Other factors associated with higher levels of anxiety at different time points were age<65years, low level of education and an acute primary PCI.

CONCLUSION

In the largest cohort to date, we examined anxiety among patients undergoing PCI or CAG was highest immediately around the procedure, particularly in patients aged <65years, of female gender, undergoing primary PCI, or with a lower level of education. Better pre-procedural information or pharmacological strategies may reduce anxiety in these patients.