Anticipatory Distress Research Articles

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

Temporal dynamics play a central role in models of emotion: "fear" is widely conceptualized as a phasic response to certain-and-imminent danger, whereas "anxiety" is a sustained response to uncertain-or-distal harm. Yet the underlying human neurobiology remains contentious. Leveraging an ethnoracially diverse sample, translationally relevant paradigm, and theory-driven modeling approach, we demonstrate that certain and uncertain threat recruit a shared threat-anticipation circuit. This circuit exhibits persistently elevated activation when anticipating uncertain threat encounters and a transient burst of activation in the moments before certain encounters. For many scientists and clinicians, feelings are the defining feature of human fear and anxiety. Here we used an independently validated brain signature to covertly decode the momentary dynamics of anticipatory distress for the first time. Results mirrored the dynamics of neural activation. These observations provide fresh insights into the neurobiology of threat-elicited emotions and set the stage for more ambitious clinical and mechanistic research.

Using a transdiagnostic approach to examine the associations among internalizing symptoms, emotion regulation, and distress tolerance

Difficulty tolerating distress (e.g., distress tolerance [DT]) and regulating emotions (e.g., emotion regulation [ER]) are implicated as transdiagnostic risk factors for various internalizing disorders. The present study investigated the relationships among six internalizing disorder symptoms, baseline ER, and DT in college students ( N = 137) to identify which internalizing disorders were most closely associated with DT. We expected ER and internalizing symptoms to be associated with DT and that ER would moderate relationships among internalizing symptoms and both trait DT and state distress. Results indicated that ER, Post-traumatic Stress Disorder (PTSD), and social anxiety symptoms influenced trait DT. ER moderated the associations between depression, anxiety, and panic disorder (PD) symptoms, and trait DT at the .05 level. Similarly, ER moderated the association between PD symptoms and anticipatory distress at the .05 level. However, these analyses did not withstand the Bonferroni adjustment ( p = .008) for multiple comparisons. Findings suggest that, when considering transdiagnostic symptoms, certain internalizing symptoms (i.e., social anxiety, PTSD) may have a stronger influence on trait DT. Further, strong ER abilities may buffer the adverse effects of internalizing symptoms on one’s perceived ability to handle distress. These patterns may not translate to individuals’ behavioral capacity to handle distress.

An Investigation of Patients’ and Doctors’ Autonomic Nervous System Responses Throughout News-Focused Medical Consultations

ABSTRACT Although it is clear that people experience physiological arousal in anticipation of news-focused medical consultations, our knowledge of people’s experiences during and throughout these consultations is scarce. We examine interbeat interval responses (IBI) of patients and doctors during real-life medical consultations to understand how the experiences of both parties change throughout these encounters and whether they differ from each other. We also examine how the type of news delivered affects responses. We measured the IBI responses of patients and their oncologists throughout 102 consultations in which providers delivered news (classified as good, bad, or status quo) to patients about a recent computerized tomography scan. We observed two distinct phases of consultations: an initial “news” delivery phase and a subsequent “information” phase. During the news phase, on average, patients’ IBI responses rapidly increased–indicating less autonomic arousal over time – whereas doctors’ responses did not change over time. In contrast, throughout the information phase, on average, both patients’ and doctors’ responses remained steady. During the information phase, responses differed based on news type: on average, status quo consultations involved an increase in autonomic arousal, whereas good and bad news consultations involved no changes. Lastly, we observed significant variability in patients’ responses during both phases. In sum, on average, patients (but not doctors) experience decreases in autonomic arousal while news is being delivered, suggesting that anticipatory distress regarding these consultations wanes quickly. However, our results also indicate that patients’ experiences vary from one another, and future research should focus on factors explaining this variability.

Distress Scores During Radiotherapy for Lung Cancer: Course and Prognostic Factors.

Cancer treatment can lead to significant distress. We investigated the course of distress during radiotherapy (RT) for lung cancer. Data of 159 patients receiving RT for lung cancer were investigated for change of distress scores during RT. Five characteristics were analyzed including age, sex, Karnofsky performance score, intent of RT, and receipt of previous RT. Additional analyses were performed in patients with pre-RT scores ≤5 points. Mean pre-RT and post-RT distress scores were 5.5 (±2.6) and 4.7 (±2.6), respectively. No characteristic was significantly associated with mean change or increase of distress. In patients with pre-RT scores ≤5 points, non-significantly higher rates of increased distress were found for age ≤64 years, female sex, and Karnofsky performance score 90-100. Distress is reduced during a course of RT for lung cancer. This may reflect a reduction in anticipatory distress after first-hand experience.

Lower socioeconomic status is related to poorer emotional well-being prior to academic exams

ABSTRACT Background: People of lower social status tend to have greater emotional responses to stress. The present study assessed whether lower social status was related to greater emotional responses in anticipation of a naturalistic stressor: academic exams among college students. Methods: College students in an introductory statistics class (N = 252; 75.81% female; 18.41% Latino, 25.10% White, 43.93% Asian, 12.56% different racial backgrounds) completed two course exams as part of this naturalistic prepost-experimental design. They provided four reports of positive, depressive, and anxious emotion – one the day before and one immediately after each exam. Results: As hypothesized, multilevel models (ratings nested within participants) predicting emotion indicated that students with lower mother’s education had less positive emotion, more depressive emotion, and more anxious emotion the day prior to academic exams than students with higher mother’s education (proportional reductions in variance [PRV] = .013–.020). Specifically, lower mother’s education was associated with poorer well-being before but not after the exam. Exploratory models revealed that differences in emotion by mother’s education were strongest for students with lower exam scores (PRV = .030–.040). Conclusions: Socioeconomic status may influence college students’ anticipatory distress prior to academic exams, which may impact health and academic performance.

Haitian and Haitian American experiences of racism and socioethnic discrimination in Miami-Dade county: At-risk and court-involved youth.

We examine how juvenile justice-involved youth of Haitian descent in Miami-Dade County cope with structural racism and its impact on their mental health. Drawing on longitudinal ethnography, psychosocial assessment data, and a family-based clinical intervention funded by the National Institute on Drug Abuse, this article explores youth narratives of discrimination prior to and during the COVID-19 pandemic. We use critical race theory and theory of practice to understand youths' perceptions as racialized bodies and stigmatized selves, highlighting the experiences and perspectives of a particular black immigrant group, ethnic beings caught up in the everyday practices of racialization, sociocultural marginalization, and racism. We frame these experiences as a variation of the complex continuum of structural racism and racial domination in the US. These experiences have caused anger, fear, anxiety, chronic anticipatory distress, and hopelessness among youth of Haitian descent. We conclude with some recommendations for therapeutic support that encourages youth to process their experiences, promotes their development of a positive self-concept, and provides them with mind-body techniques to attenuate the physical impacts of discriminatory events. The clinical trial registration number for this study intervention is NCT03876171.

48.5 THE OBSERVATION OF FEEDING IN THE DIAGNOSIS AND TREATMENT OF AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER (ARFID) SUBTYPE: FEAR OF AVERSIVE CONSEQUENCES (POSTTRAUMATIC FEEDING DISORDER)

The operational criteria for avoidant/restrictive food intake disorder (ARFID) subtype, fear of aversive consequences (posttraumatic feeding disorder), will be explained. The child demonstrates food refusal after a traumatic event or repeated traumatic events to the oropharynx or esophagus (eg, choking, severe gagging, vomiting, reflux); the event triggers intense distress in the child; after the event, the child experiences distress when anticipating feeding (ie, when positioned for feeding); the child refuses to eat and becomes increasingly distressed when force-fed. The child’s irritability and emotional dependency increase (ie, co-sleeping in parent’s bed, separation anxiety); the child shows diminished interest in daily activities and routines, including play and social interactions. The Feeding Resistance Scale was developed by Chatoor (2001) as a complement of the Parent-Child Feeding Scale for observation of the child’s anticipatory anxiety and resistance to feeding. Clinical vignettes and videotapes of children with this ARFID subtype will be shown to demonstrate the characteristic feeding behavior of these children. The observation of these children during a meal show that they have a high level of anticipatory distress and defense strategies of resistance to feeding following past traumatic experiences of the oropharynx. Moreover, emotional dysregulation of these children shows an increase in negative affect, such as angry moods and aggression. The mothers of these children show high levels of distress and anxiety, which can compromise their capacity to compensate or moderate the impact of the child’s traumatic experience. Considering the child’s anticipatory anxiety and emotional dysregulation as a reaction to the past negative experience of the oropharynx, the therapeutic approach should be based on desensitization of the child’s fear of eating by gradual exposure to food of increasing texture and consistency, psychological support for the parents, and parent guidance on how to help their child.

609 Combined Physical, Occupational, and Psychotherapies in the Holistic Care of the Burn

Abstract Introduction Burn patients often experience pain and fear of the recovery process, negatively impacting their engagement in necessary treatments for maximal functional outcomes. Patients routinely exhibit aversions toward physical and occupational therapies (PT and OT). As a result, therapists have been tasked with managing the patient’s psychological reactions while simultaneously providing rehabilitation. We developed a program for our psychologist to co-treat patients with burn physical and occupational therapists to directly address the painful or feared aspects of burn recovery. These multidisciplinary visits offer in-vivo interventions for managing patient distress and allows therapists the ability to focus solely on their specialized interventions. Methods This program has been active for 12 months and was created during therapy to aid a patient with high distress during PT and OT. Therapists now work with psychology to co-treat improving patient engagement in rehabilitative interventions. During co-treatment, the patients are able to engage in PT and OT more effectively and achieve short-term goals. The burn center psychologist and therapists have developed an interventional method to explore potential generalization of co-treatment effectiveness. Patients are identified based on high need for psychological support during therapy sessions. Each patient case is reviewed and discussed to develop individualized treatment plans and establish goals. Through qualitative review of each co-treatment visit, common barriers have been identified as well as strategies to improve engagement and compliance. Results The common barriers encountered had a high association with a history of traumatic experiences and avoidant coping/low distress tolerance. The most effective co-treatment interventions included: collaboratively setting patient goals with PT, OT and psychology; scheduling patient therapy with burn psychology in advance; teaching distress tolerance skills to manage anticipatory and in-vivo distress related to rehabilitation. Conclusions Treating the emotional aspects of burn recovery during moments of acute distress is integral for holistic patient care. This multidisciplinary approach offers patients increased involvement through collaboratively tailored treatment planning and improved ability to tolerate distressing aspects of recovery. Additionally, therapists were taught various approaches to improve patient engagement and adherence.

Parent-Child Reminiscing about Past Pain as a Preparatory Technique in the Context of Children's Pain: A Narrative Review and Call for Future Research.

Pain permeates childhood and remains inadequately and/or inconsistently managed. Existing research and clinical practice guidelines have largely focused on factors influencing the immediate experience of pain. The need for and benefits of preparing children for future pain (e.g., painful procedures) has been well established. Despite being a robust predictor of future pain and distress, memories of past painful experiences remain overlooked in pediatric pain management. Just as autobiographical memories prepare us for the future, children’s memories for past pain can be harnessed to prepare children for future painful experiences. Children’s pain memories are malleable and can be reframed to be less distressing, thus reducing anticipatory distress and promoting self-efficacy. Parents are powerful agents of change in the context of pediatric pain and valuable historians of children’s past painful experiences. They can alter children’s pain memories to be less distressing simply by talking, or reminiscing, about past pain. This narrative review summarizes existing research on parent–child reminiscing in the context of acute and chronic pediatric pain and argues for incorporation of parent–child reminiscing elements into preparatory interventions for painful procedures.

(245) - Parent emotional availability is associated with reduced preoperative anxiety in children undergoing a tonsillectomy procedure

Child preoperative anxiety is associated with greater pain following surgery, and greater parent anxiety increases child anxiety during induction of anesthesia. Anxious parents are often less sensitive in their interactions with their child. Parent emotional availability (EA), is an observational measure of parent support and genuinity. Parent EA is the strongest predictor of child anticipatory distress for future painful procedures; however, it has not been explored within a surgical context. Therefore, we examined whether parent EA was associated with child anxiety during anesthesia induction Included were 84 children between 4–7 years old, undergoing an elective tonsillectomy. The parents' and child's surgical history was collected. On the day of surgery, parents reported their current state of anxiety using the State-Trait Anxiety Inventory. Child pre-operative anxiety was determined using the modified-Yale Preoperative Anxiety Scale. Two weeks following surgery, parent-child dyads returned to the hospital and reminisced about the surgery using a structured elicitation task. Parent EA (i.e. Structuring, Sensitivity, Non-intrusiveness, and Non-hostility) was assessed during this reminiscing task using the EA Scale. Linear regression was used to examine whether greater EA is associated with less child preoperative anxiety, after accounting for child age, gender, SES, prior surgeries (parent and child) and parent anxiety. If EA was significant, linear regressions for the individual parent EA subscales were explored. We found that greater parental EA was associated with less child preoperative anxiety (B = −.256, P = .026, R2 =.16). Analysis of the EA subscales revealed that greater parent structuring was important for lowering child anxiety during anesthesia induction (B = −.349, P = .006, R2 = .26). Altogether, parent behavior may be more influential on child anxiety during anesthesia induction than the parent's state of anxiety. Parent structuring (support and guidance) appears particularly important for reducing anxiety during induction. Results of the study support developing a parent-led intervention to reduce child preoperative anxiety.

Characterizing spouse/partner depression and alcohol problems over the course of military deployment.

Spouse/partners of military personnel demonstrate elevated levels of distress during military deployments, yet there is insufficient information about courses of adjustment over time. The current study identified trajectories of depression and alcohol use problems and predictors of those trajectories across the deployment cycle. National Guard soldiers (N = 1973) and spouses/intimate partners (N = 1020) completed assessments of risk/protective factors and baseline measures of mental health functioning 2 to 5 months prior to soldiers' 1-year deployments (Time 1) to Kuwait/Iraq in support of Operation New Dawn or Afghanistan in support of Operation Enduring Freedom. Partners' mental health was reassessed at 4 months (Time 2) and 8 months (Time 3) after soldiers deployed, and both spouses/partners and soldiers were reassessed 2-3 months postdeployment (Time 4). Latent class growth modeling of partner depression symptoms over time revealed 4 groups: Resilience (79.9%), Deployment Distress (8.9%), Anticipatory Distress (8.4%), and Post-Deployment Distress (2.7%). Three alcohol misuse trajectories were identified: Resilience (91.3%), Deployment Onset (5.4%), and Deployment Desistance (3.3%). Predeployment predictors of partners' depression symptom trajectories varied by group and included soldier reports of stressors and social support and partner levels of neuroticism, introversion, disconstraint, and reported stressors. Predeployment predictors of alcohol misuse trajectories varied by group, and included soldier levels of alcohol misuse as well as partner neuroticism, disconstraint, and family readiness. Delineating and predicting trajectories of partner adjustment can allow for better targeted interventions toward those most at risk for heightened distress or alcohol problems over the deployment cycle. (PsycINFO Database Record

Anger and guilt in treatment for chronic posttraumatic stress disorder

Background and objectivesFeelings of anger and guilt are important to consider when treating PTSD as they are related to higher PTSD severity and may be related to avoidance during treatment. Avoidance may impede emotional engagement, the process of connecting with distressing, fear-related emotions during imaginal exposure, which is considered an important mechanism for successful PTSD treatment in prolonged exposure (PE). Yet, little research has examined possible complications in achieving emotional engagement, such as anger and guilt. MethodsThe present study utilized data from 116 individuals with PTSD who received PE to investigate whether anger and guilt were associated with poorer emotional engagement, as captured by pre, peak, post, and mean subjective units of distress (SUDs), during the initial imaginal exposure, and whether anger and guilt predicted worse treatment outcome generally and as a result of lessened emotional engagement. ResultsNeither initial anger nor guilt hindered engagement nor predicted worse outcome. Contrary to hypotheses, higher guilt was predictive of greater anticipatory distress and slightly better PTSD outcome. The relationship between pre-treatment guilt cognitions and post-treatment PTSD severity was not mediated by engagement. LimitationsThis study used a trauma-specific measure of guilt and general measure for anger, however both are commonly used. In addition, this study examined emotional engagement during imaginal exposure to the exclusion of engagement with other therapy components, such as in vivo exposure. ConclusionsThese findings help dispel concerns that those with higher anger and guilt will avoid emotionally engaging during the initial imaginal exposure due to feeling distressed by intense negative emotionality.

Predicting preschool pain-related anticipatory distress: the relative contribution of longitudinal and concurrent factors.

Anticipatory distress prior to a painful medical procedure can lead to negative sequelae including heightened pain experiences, avoidance of future medical procedures, and potential noncompliance with preventative health care, such as vaccinations. Few studies have examined the longitudinal and concurrent predictors of pain-related anticipatory distress. This article consists of 2 companion studies to examine both the longitudinal factors from infancy as well as concurrent factors from preschool that predict pain-related anticipatory distress at the preschool age. Study 1 examined how well preschool pain-related anticipatory distress was predicted by infant pain response at 2, 4, 6, and 12 months of age. In study 2, using a developmental psychopathology framework, longitudinal analyses examined the predisposing, precipitating, perpetuating, and present factors that led to the development of anticipatory distress during routine preschool vaccinations. A sample of 202 caregiver-child dyads was observed during their infant and preschool vaccinations (the Opportunities to Understand Childhood Hurt cohort) and was used for both studies. In study 1, pain response during infancy was not found to significantly predict pain-related anticipatory distress at preschool. In study 2, a strong explanatory model was created whereby 40% of the variance in preschool anticipatory distress was explained. Parental behaviours from infancy and preschool were the strongest predictors of child anticipatory distress at preschool. Child age positively predicted child anticipatory distress. This strongly suggests that the involvement of parents in pain management interventions during immunization is one of the most critical factors in predicting anticipatory distress to the preschool vaccination.

Systematic Review: Predisposing, Precipitating, Perpetuating, and Present Factors Predicting Anticipatory Distress to Painful Medical Procedures in Children.

To conduct a systematic review of the factors predicting anticipatory distress to painful medical procedures in children. A systematic search was conducted to identify studies with factors related to anticipatory distress to painful medical procedures in children aged 0-18 years. The search retrieved 7,088 articles to review against inclusion criteria. A total of 77 studies were included in the review. 31 factors were found to predict anticipatory distress to painful medical procedures in children. A narrative synthesis of the evidence was conducted, and a summary figure is presented. Many factors were elucidated that contribute to the occurrence of anticipatory distress to painful medical procedures. The factors that appear to increase anticipatory distress are child psychopathology, difficult child temperament, parent distress promoting behaviors, parent situational distress, previous pain events, parent anticipation of distress, and parent anxious predisposition. Longitudinal and experimental research is needed to further elucidate these factors.

Medical Hypnosis as a Tool to Acclimatize Children to Noninvasive Positive Pressure Ventilation

Background Patient cooperation is crucial for the success of noninvasive positive pressure ventilation (NPPV). This study evaluated the efficacy of medical hypnosis to reduce anticipatory anxiety and acclimatization time in children who are candidates for long-term NPPV. Methods Medical hypnosis was performed by a trained nurse. The acclimatization time and long-term compliance with NPPV were evaluated. Results Hypnosis was performed in nine children aged 2 to 15 years. Seven children had a high level of anticipatory anxiety because of a tracheotomy since birth (n = 2), a history of maxillofacial surgery (n = 2), severe dyspnea because of lung disease (n = 2), and morbid obesity and depression (n = 1), and two children with obstructive sleep apnea failed standard NPPV initiation. The hypnosis techniques were based on distraction in the youngest patient and indirect or direct hypnotic suggestions in the older children to obtain a progressive psychocorporal relaxation. All patients accepted the interface and the NPPV after the first hypnosis session. A median of three sessions was needed for overnight (> 6 h) NPPV acceptance. The 6-month compliance with NPPV was excellent, with a median use of 7.5 h per night. Conclusion Medical hypnosis is an effective, safe, noninvasive, and inexpensive tool for reducing the anticipatory distress and acclimatization time for NPPV. This therapy is particularly useful in children with traumatic experiences, such as a tracheotomy or facial surgical procedures. Patient cooperation is crucial for the success of noninvasive positive pressure ventilation (NPPV). This study evaluated the efficacy of medical hypnosis to reduce anticipatory anxiety and acclimatization time in children who are candidates for long-term NPPV. Medical hypnosis was performed by a trained nurse. The acclimatization time and long-term compliance with NPPV were evaluated. Hypnosis was performed in nine children aged 2 to 15 years. Seven children had a high level of anticipatory anxiety because of a tracheotomy since birth (n = 2), a history of maxillofacial surgery (n = 2), severe dyspnea because of lung disease (n = 2), and morbid obesity and depression (n = 1), and two children with obstructive sleep apnea failed standard NPPV initiation. The hypnosis techniques were based on distraction in the youngest patient and indirect or direct hypnotic suggestions in the older children to obtain a progressive psychocorporal relaxation. All patients accepted the interface and the NPPV after the first hypnosis session. A median of three sessions was needed for overnight (> 6 h) NPPV acceptance. The 6-month compliance with NPPV was excellent, with a median use of 7.5 h per night. Medical hypnosis is an effective, safe, noninvasive, and inexpensive tool for reducing the anticipatory distress and acclimatization time for NPPV. This therapy is particularly useful in children with traumatic experiences, such as a tracheotomy or facial surgical procedures.

Force-on-Force Handgun Practice

The aim of this study was to explore human factors aspects of reality-based "force-on-force" (FoF) handgun practice through a within-subjects field experiment that assessed subjective stress measurements, biomarker regulation, performance outcomes, and behavioral adaptations. FoF handgun practice is a recent training asset for armed officers whereby dynamic opponents may act, react, and even retaliate with specially designed marker ammunition. Predesigned scenarios enable trainees to practice in a simulated real-life environment. A sample of experienced military personnel (N = 20) ran a handgun workshop in two conditions: FoF practice and traditional cardboard-target practice. Intra-individual assessments included anticipated distress, subjective stress, salivary alpha-amylase (sAA), shooting accuracy, and directly observable training seriousness. Compared with the standard cardboard practice condition, FoF exposure caused significant increases in anticipatory distress, subjective stress, and sAA secretion. Furthermore, participants' first encounter with FoF practice (vs. cardboard practice) substantially degraded their shooting performance and had a significant positive impact on the earnestness with which they approached their mission during the workshop. FoF practice is an effective training tool for armed officers because it simulates a realistic work environment by increasing task-specific stress such that it affects important outcomes of professional performance and leads to desirable behavioral changes during training. Potential applications of this research include the introduction of biomarker assessments in human factors research and the design, based on reality-based practice, of effective training procedures for high-reliability professionals.

Pre-Biopsy Psychological Factors Predict Patient Biopsy Experience

Excisional/surgical breast biopsy has been related to anticipatory emotional distress, and anticipatory distress has been associated with worse biopsy-related outcomes (e.g., pain, physical discomfort). The present study was designed to investigate (a) whether anticipatory distress before an image-guided breast biopsy would correlate with biopsy-related outcomes (pain and physical discomfort during the biopsy) and (b) whether type of distress (i.e., general anxiety, worry about the procedure, worry about biopsy results) would differentially relate to biopsy-related outcomes. Fifty image-guided breast biopsy patients (mean age = 44.4 years) were administered questionnaires pre- and post-biopsy. Pre-biopsy, patients completed the Profile of Mood States-tension/anxiety subscale and two visual analog scale items (worry about the biopsy procedure, worry about the biopsy results). Post-biopsy, patients completed two visual analog scale items (pain and physical discomfort at their worst during the procedure). The following results were gathered: (1) Pre-biopsy worry about the procedure was significantly related to both pain (r = 0.38, p = 0.006) and physical discomfort (r = 0.31, p = 0.026); (2) pre-biopsy general anxiety was significantly related to pain (r = 0.36, p = 0.009), but not to physical discomfort; and (3) Pre-biopsy worry about the biopsy results did not significantly relate to pain or physical discomfort. Worry about the procedure was the only variable found to be significantly correlated with both biopsy-related outcomes (pain and physical discomfort). From a clinical perspective, this item could be used as a brief screening tool to identify patients who might be at risk for poorer biopsy experiences and who might benefit from brief interventions to reduce pre-biopsy worry.

The risk of being shot at: Stress, cortisol secretion, and their impact on memory and perceived learning during reality-based practice for armed officers.

A field experiment was organized during a handgun shooting workshop for armed officers (N 36). In-depth stress analyses involved anticipatory distress, subjective stress, and salivary cortisol reactivity triggered by reality-based handgun shooting practice and, more specifically, by being in an uncontrollable situation with the risk of being shot at. Subsequently, the study examined to what extent exposure to reality-based stress affected working memory performances and self-perceived active learning. As expected, the risk of being shot at caused more anticipatory distress, subjective stress, and increasingly triggered cortisol secretion. Further results showed that, although stress endurance deteriorated working memory performance, participants in the high-realism group simultaneously self-perceivably learned more (i.e., acquired task-relevant

Behavioral Analysis of Children’s Response to Induction of Anesthesia

It is documented that children experience distress at anesthesia induction, but little is known about the prevalence of specific behaviors exhibited by children. Digital audiovisual recordings of 293 children undergoing outpatient elective surgery were coded using Observer XT software and the validated Revised Perioperative Child-Adult Medical Procedure Interaction Scale. Multiple pass second-by-second data recording was used to capture children's behaviors across phases of anesthesia induction. More than 40% of children aged 2-10 yr displayed some distress behavior during induction with 17% of these children displaying significant distress and more than 30% of children resisting anesthesiologists during induction. Children's distress and nondistress behaviors displayed four profiles over the course of anesthesia induction: Acute Distress, Anticipatory Distress, Early Regulating Behaviors, and Engagement with Procedure. Older children had higher scores on early regulating and engagement profiles whereas younger children had higher scores on Acute Distress. There were no differences across age in children's Anticipatory Distress. Construct validity of behavior profiles was supported via correlations of profile score (overall and on the walk to the operating room) with a validated assessment of children's anxiety at induction. Children undergoing anesthesia display a range of distress and nondistress behaviors. A group of behaviors was identified that, when displayed on the walk to the operating room, is associated with less distress at anesthesia induction. These data provide the first examination of potentially regulating behaviors of children, but more detailed sequential analysis is required to validate specific functions of these behaviors.

Anticipatory psychological distress in women scheduled for diagnostic and curative breast cancer surgery

Psychological distress is a central experience for women facing diagnostic and curative breast cancer surgery. The present study was designed to predict anticipatory distress in 187 women scheduled to undergo excisional breast biopsy or lumpectomy. Participants completed questionnaires assessing emotional distress and predictors of this distress (surgery type, worry about the surgical procedure, and worry about what the surgeon will find). The study found that lumpectomy patients experienced greater anticipatory distress than excisional breast biopsy patients on three of the four distress measures (all ps < 0.05) and that worry about what the surgeon might find partially mediated these effects. The results suggest that although women awaiting lumpectomy are more distressed than women awaiting biopsy, both groups report substantial distress, and, consequently, psychosocial interventions are recommended for both groups.