Improvement In Anxiety Symptoms Research Articles

Clinical Significance of Stress, Depression, Anxiety, and Worry Symptom Improvement Following Mindfulness-based Stress Reduction

Mindfulness-based stress reduction (MBSR) teaches mindfulness meditation to reduce stress, anxiety, depression, and related forms of distress among a variety of patients. Much research has documented statistically significant reductions across a variety of self-report measures following MBSR, but researchers rarely assessed and reported the clinical significance of MBSR symptom reduction in accordance with specific criteria famously established by Jacobson and Truax [1]. Patients reporting symptoms of anxiety, depression, and/or other stress-related concerns received MBSR in an outpatient mental health clinic. In order to assess the clinical significance of reported symptom reduction, specific criteria to determine reliable clinical improvement and recovery were applied to the data from each patient across the main symptom outcome measures. This secondary clinical significance analysis was conducted with all 23 patients who completed MBSR and completed assessment measures both before and after the intervention in the original open trial. A reliable change index and a cutoff point for outcome measures of worry, depression, anxiety, and stress were obtained so that reliable clinical improvement and recovery on each measure could be assessed for each patient. The proportion of patients who were elevated in the clinical range above the cutoff before the intervention was determined, as well as the proportion of those reporting symptom reduction, the proportion showing reliable improvement, and the proportion recovered at the final MBSR session. Clinical significance analyses revealed that over half of the patient sample scored in the clinical range on each measure before MBSR. At the end of the intervention, the vast majority of these patients reported symptom reduction, and depending on the measure, 45-69% of patients who were clinically elevated initially and reported symptom reduction following MBSR exhibited reliable clinical improvement. Furthermore, 29-50% of those patients showing reliable clinical improvement also met criteria as recovered at the conclusion of the MBSR program. These results suggest that the symptom reduction observed following MBSR is substantial and clinically meaningful for many patients – an outcome that cannot be determined with statistical tests of significance alone. Clinical significance criteria, such as those applied in this study, could be implemented in randomized controlled trial protocols to supplement conventional tests of statistical significance and shed light on how clinically meaningful obtained changes on outcome measures are for patients.

Component analysis of a synchronous and asynchronous blended care CBT intervention for symptoms of depression and anxiety: Pragmatic retrospective study

BackgroundDepression and anxiety are leading causes of disability worldwide. Though effective treatments exist, depression and anxiety remain undertreated. Blended care psychotherapy, combining the scalability of online interventions with the personalization and engagement of a live therapist, is a promising approach for increasing access to evidence-based care. ObjectivesTo evaluate the effectiveness and individual contribution of two components - i) digital tools and ii) video-based therapist-led sessions - in a blended care CBT-based intervention under real world conditions. MethodsA retrospective cohort design was used to analyze N = 1372 US-based individuals who enrolled in blended care psychotherapy. Of these, at baseline, 761 participants had depression symptoms in the clinical range (based on PHQ-9), and 1254 had anxiety symptoms in the clinical range (based on GAD-7). Participants had access to the program as a mental health benefit offered by their employer. The CBT-based blended care psychotherapy program consisted of regular video sessions with therapists, complemented by digital lessons and digital exercises assigned by the clinician and completed in between sessions. Depression and anxiety levels and clients' treatment engagement were tracked throughout treatment. A 3-level individual growth curve model incorporating time-varying covariates was utilized to examine symptom trajectories of PHQ-9 scores (for those with clinical range of depression at baseline) and GAD-7 scores (for those with clinical range of anxiety at baseline). ResultsOn average, individuals exhibited a significant decline in depression and anxiety symptoms during the initial weeks of treatment (P < .001), and a continued decline over subsequent weeks at a slower rate (P < .001). Engaging in a therapy session in a week was associated with lower GAD-7 (b = −0.81) and PHQ-9 (b = −1.01) scores in the same week, as well as lower GAD-7 (b = −0.58) and PHQ-9 (b = −0.58) scores the following week (all P < .01). Similarly, engaging with digital lessons was independently associated with lower GAD-7 (b = −0.19) and PHQ-9 (b = −0.18) scores during the same week, and lower GAD-7 (b = −0.25) and PHQ-9 (b = −0.27) the following week (all P < .01). ConclusionsTherapist-led video sessions and digital lessons had separate contributions to improvements in symptoms of depression and anxiety over the course of treatment. Future research should investigate whether clients' characteristics are related to differential effects of therapist-led and digital components of care.

Heart-Focused Anxiety, General Anxiety, Depression and Health-Related Quality of Life in Patients with Atrial Fibrillation Undergoing Pulmonary Vein Isolation.

(1) Background: Atrial fibrillation (AF) is associated with anxiety, depression, and chronic stress, and vice versa. The purpose of this study was to evaluate potential effects of pulmonary vein isolation (PVI) on psychological factors. (2) Methods: Psychological assessment was performed before PVI as well as after six months. (3) Results: A total of 118 patients [age 64 ± 9 years, 69% male, left ventricular ejection fraction 57 ± 8%, 56% paroxysmal AF] undergoing PVI were included. After PVI, significant improvements were observed in the mean total heart-focused anxiety (HFA) score, as well as in the Cardiac Anxiety Questionnaire (CAQ) sub-scores: HFA attention, HFA fear, and HFA avoidance scores. Subgroup analyses showed an association of improvement with freedom of documented AF recurrence. Mean scores of general anxiety and depression evaluated by the Hospital Anxiety and Depression Scale (HADS) decreased significantly after PVI in all subgroups regardless of AF recurrence. Further, both physical and mental composite scores of the Short Form Health Survey (SF-12) increased significantly from baseline. (4) Conclusions: PVI results in a significant reduction in HFA. Improvements in general anxiety and depressive symptoms did not seem to be related only to rhythm control per se. Therefore, CAQ may represent a more specific evaluation tool as HADS in patients with AF.

Sudden gains and treatment outcomes among depressed individuals in a partial hospitalization programme

Sudden gains commonly occur among patients receiving psychotherapy for depression and have been found to consistently predict better treatment outcomes. However, the majority of prior research has examined sudden gains primarily in weekly or biweekly treatment settings. Individuals were divided into two groups: those who experienced at least one sudden gain and those who did not. Rates of sudden gain occurrence, pretreatment factors and posttreatment outcomes were examined between the two groups. Over 60% of this sample experienced at least one sudden gain, the majority of which occurred during the first 3 days of treatment. Sudden gains were associated with significantly lower baseline depression and anxiety severity. Patients who experienced sudden gains reported significantly greater improvement in depressive and anxiety symptoms, coping skills, functioning, positive mental health and well-being at treatment termination. This study was conducted in a single location with a relatively homogeneous sample. Due to a lack of follow-up data, we were unable to determine if treatment outcomes were sustained after treatment termination. The assessment timeline of the depressive symptoms differs between baseline and daily scales, which may have affected the number of observed sudden gains after the initial treatment day. The proportion of sudden gains in this study is higher than those found in outpatient settings, demonstrating that this phenomenon may commonly occur among depressed patients in acute treatment. These results suggest that the mechanisms by which sudden gains occur may be reinforced by daily, intensive treatment.

Effect of Medical Marijuana Card Ownership on Pain, Insomnia, and Affective Disorder Symptoms in Adults

Despite the legalization and widespread use of cannabis products for a variety of medical concerns in the US, there is not yet a strong clinical literature to support such use. The risks and benefits of obtaining a medical marijuana card for common clinical outcomes are largely unknown. To evaluate the effect of obtaining a medical marijuana card on target clinical and cannabis use disorder (CUD) symptoms in adults with a chief concern of chronic pain, insomnia, or anxiety or depressive symptoms. This pragmatic, single-site, single-blind randomized clinical trial was conducted in the Greater Boston area from July 1, 2017, to July 31, 2020. Participants were adults aged 18 to 65 years with a chief concern of pain, insomnia, or anxiety or depressive symptoms. Participants were randomized 2:1 to either the immediate card acquisition group (n = 105) or the delayed card acquisition group (n = 81). Randomization was stratified by chief concern, age, and sex. The statistical analysis followed an evaluable population approach. The immediate card acquisition group was allowed to obtain a medical marijuana card immediately after randomization. The delayed card acquisition group was asked to wait 12 weeks before obtaining a medical marijuana card. All participants could choose cannabis products from a dispensary, the dose, and the frequency of use. Participants could continue their usual medical or psychiatric care. Primary outcomes were changes in CUD symptoms, anxiety and depressive symptoms, pain severity, and insomnia symptoms during the trial. A logistic regression model was used to estimate the odds ratio (OR) for CUD diagnosis, and linear models were used for continuous outcomes to estimate the mean difference (MD) in symptom scores. A total of 186 participants (mean [SD] age 37.2 [14.4] years; 122 women [65.6%]) were randomized and included in the analyses. Compared with the delayed card acquisition group, the immediate card acquisition group had more CUD symptoms (MD, 0.28; 95% CI, 0.15-0.40; P < .001); fewer self-rated insomnia symptoms (MD, -2.90; 95% CI, -4.31 to -1.51; P < .001); and reported no significant changes in pain severity or anxiety or depressive symptoms. Participants in the immediate card acquisition group also had a higher incidence of CUD during the intervention (17.1% [n = 18] in the immediate card acquisition group vs 8.6% [n = 7] in the delayed card acquisition group; adjusted odds ratio, 2.88; 95% CI, 1.17-7.07; P = .02), particularly those with a chief concern of anxiety or depressive symptoms. This randomized clinical trial found that immediate acquisition of a medical marijuana card led to a higher incidence and severity of CUD; resulted in no significant improvement in pain, anxiety, or depressive symptoms; and improved self-rating of insomnia symptoms. Further investigation of the benefits of medical marijuana card ownership for insomnia and the risk of CUD are needed, particularly for individuals with anxiety or depressive symptoms. ClinicalTrials.gov Identifier: NCT03224468.

Mindfulness-based Cognitive Therapy for People with Parkinson's Disease during the COVID-19 Pandemic

IntroductionAnxiety and depression are among the most common non-motor PD symptoms. People with PD have experienced additional stress and social isolation during the COVID-19 pandemic. Caregivers of people with PD may experience significant caregiver burden. MBCT can prevent the relapse of depression and improve anxiety symptoms. Few studies have explored its benefits for people with PD; none have included caregivers. This study aimed to investigate the feasibility and effectiveness of a mindfulness-based cognitive therapy (MBCT) intervention in reducing anxiety and/or depression in people with Parkinson's disease (PD) and their caregivers. The study was registered on ClinicalTrials.gov (NCT04469049) and it was conducted entirely online.MethodsPeoplewith PD or parkinsonism and mild-to-moderate anxiety and/or depressive symptoms and caregivers of people with PD were recruited from neurology clinics, support groups, and online. 3 MBCT groups were conducted in Zoom from November 2020 to June 2021, using a previously adapted MBCT protocol, further modified for online delivery during the pandemic. Caregivers could also enter MBCT groups or complete pre- and post- surveys without joining groups. Data collected included demographic and clinical variables, pre- and post-MBCT behavioral measures (GAD-7, PHQ-9, Five Facet Mindfulness Questionnaire: FFMQ-15), home practice time, and satisfaction surveys. Descriptive statistics were used to summarize participant characteristics, home practice time, and satisfaction survey responses. Pre- and post-MBCT behavioral measure scores were compared using mixed-effect models.ResultsSee attached tables. All 27 participants who entered MBCT groups completed the intervention, except for one man with PD (n = 22 people with PD/parkinsonism, n = 4 caregivers). Attendance and participant satisfaction were high. MBCT completers had significant anxiety (GAD-7) and depression (PHQ-9) score reductions and FFMQ-15 total and Observing and Non-reactivity subscale score increases (all p’s < 0.05). Completers with PD/parkinsonism and anxiety (n = 14) had a significant GAD-7 score reduction; those with PD/parkinsonism and depression (n = 13) had a significant PHQ-9 score reduction (both p’s < 0.05). Completers with PD/parkinsonism also had a significant FFMQ-15 Observing subscale score increase (p < 0.05). The caregiver sample was too small to be analyzed.ConclusionsOnline MBCT is feasible and may be effective in reducing anxiety and/or depression in people with PD. Results should be replicated in studies with larger samples and control groups.Please note, this study built on the previous pilot trial presented in poster #1101 at the 2021 AAGP Virtual Annual Meeting. This was a different study and it also included caregivers.This research was funded byThis study was supported by the Mount Zion Health Fund.

Comprehensive physical rehabilitation of patients with heart failure: impact on clinical and functional status and analysis of problems related to the enrollment

Aim. To evaluate functional, clinical and psychological status of patients with class II-III heart failure, who underwent comprehensive cardiac rehabilitation program.Material and methods. Patients of both sexes with class II-III heart failure who met the inclusion criteria, did not have the exclusion criteria, and signed informed consent were included. The training process consisted of a 4-week respiratory muscle (RM) training using the THRESHOLD® IMT breathing trainer followed by a 12-week moderate intensity aerobic exercise (AE). AE were conducted under the supervision of an instructor 3 times a week for 40 minutes. RM training was carried out by patients at home on their own 5-7 times a week. Minnesota Living With Heart Failure Questionnaire (MLwHFQ.23) was used to assess quality of life. In addition, we applied Hospital Anxiety and Depression Scale (HADS). The evaluation was performed before the start of the study (visit 1), after 4 weeks of respiratory training (visit 2) and at the end of 16 weeks of AE (visit 3). The baseline characteristics of patients who were screened and not enrolled in the study were compared with those who participated in training.Results. A total of 102 patients were included in the study (passed the first visit). Subsequently, for various reasons, including due to the pandemic, 82 patients refused to participate in the study. Only 20 patients participated in RM training for 4 weeks followed by a 12-week cycle of moderate-intensity AR (median age, 67,0 (58,7-74,3) years; men, 70%; Δ peak oxygen uptake (VO2peak) (1-2) =1,1, p=0,3863; ΔVO2 peak (1-3) =2,3 ml/kg/min, p=0,139. During 16-week training, we revealed an increase in expiratory muscle strength (EMS) (ΔEMS =10 cmH2O (p=0,037), six-minute walk test (6MWT) (Δ6MTX=60 meters, p=0,005), and SHOKS score (p=0,0117), as well as improvement in anxiety and depression symptoms (ΔHADS =-2 points, p=0,0346). Patients who refused to be included in the study were older, had lower blood pressure, and had a worse quality of life. The groups did not differ significantly in other clinical, functional and laboratory parameters.Conclusion. Patients’ motivation to exercise was associated with younger age and better subjective health perception and did not depend on objective status. In patients undergoing a comprehensive rehabilitation program, there was a significant change in RM strength, as well as an increase in 6MWT distance, clinical and psychological status already at the stage of respiratory training. This trend continued at the AE stage as well.

Real-World Evaluation of a Large-Scale Blended Care-Cognitive Behavioral Therapy Program for Symptoms of Anxiety and Depression.

Introduction:Prior studies have supported the effectiveness of blended interventions for anxiety and depression; however, outcomes research of large-scale blended interventions for these conditions is limited.Objective: To investigate the outcomes of scaled-up blended care (BC) cognitive behavioral therapy (CBT), a program that combined video-based psychotherapy with internet CBT, for symptoms of anxiety and depression.Materials and Methods: Participants were 6,738 U.S.-based adults with elevated symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) at baseline who received BC-CBT as an employer-offered mental health benefit. The primary outcomes, anxiety (GAD-7) and depression (PHQ-9) symptoms, were routinely measured in the program. Recovery and reliable improvement in outcomes were calculated, and growth curve models evaluated change in outcomes during treatment and the effects of engaging in psychotherapy sessions on outcomes.Results: On average, participants received treatment for 7.6 (standard deviation = 6.2) weeks. By the end of care, 5,491 (81.5%) participants had reliable improvement in either anxiety or depression symptoms; in addition, 5,535 (82.1%) fell below the clinical threshold for either anxiety or depression symptoms (i.e., recovered). Declines in anxiety and depression symptoms were statistically significant over the course of BC-CBT (both p's < 0.01), with the rate of decline significantly decreasing for each outcome as treatment progressed (both p's < 0.01). Each psychotherapy session completed was significantly associated with lower anxiety and depression symptoms during the week of the session and the subsequent week (all p's < 0.01).Conclusions: This real-world study provides evidence that scaled-up BC-CBT can be effective in the treatment of symptoms of anxiety and depression.

Changes of brain-derived neurotrophic factors in rats with generalized anxiety disorder before and after treatment.

The aim of the current study was to investigate the association between brain-derived neurotrophic factor (BDNF) and generalized anxiety disorder (GAD). A total of sixty male adult Wistar rats with similar body weight and age were randomly divided into 3 groups the blank control group (CON, n=20), the saline control group (SAL, n=20), and the combined medication group (Deanxit +fluoxetine, DF, n=20), then rats in group SAL and group DF were prepared for model of anxiety disorder for 14 days. The body weight, center-retention time (CRT) and square-crossover number per unit time (SCN) were compared during modeling to define the anxiety of rats on day 1, day 7 and day 14; the BDNF mRNA in brain were detected by RT-PCR and the protein of BDNF in brain were detected by immunohistochemistry before and after intervention. The body weight, CRT and SCN in group SAL and DF after modeling were decreased with time compared with CON (p<0.05). The rats were taken euthanasia after 14 days, the BDNF mRNA showed significant decrease in SAL group (0.58±0.07) compared with group CON (2.87±0.23), while in DF group (1.76±0.21), the BDNF mRNA were higher than SAL group but lower than CON (p<0.05); the BDNF positive cells in group CON was highest (90%), then was group DF (75%) and group SAL was the lowest (35%). The changes in the indexes of the rats among different groups before and after modeling showed that after modeling, the body weights of the rats in group SAL and group DF were lower than group CON, the CRT decreased, and the SCN increased. The differences were statistically significant (p < 0.05), indicating that the combined medication (Qilixin + fluoxetine) can improve anxiety symptoms (body weight, CRT, and SCN). Anti-anxiety drugs (Deanxit+fluoxetine) can improve anxiety symptoms of rats and increase the expressions of BDNF mRNA and protein in rat brain cells. Anxiolytic drugs (Deanxit+fluoxetine) may achieve the treatment of anxiety disorders through improving the 5-HT nervous system and the expressions of BDNF mRNA and protein. BDNF can be used as a biochemical indicator for the diagnosis and efficacy evaluation of GAD.

Effects of an low carbohydrate/healthy fat/ketogenic diet on biomarkers of health and symptoms, anxiety and depression in Parkinson's disease: a pilot study.

Aim: To evaluate a low carbohydrate/healthy fat/ketogenic diet (LCHF/KD) on symptoms, depression, anxiety and biomarkers in adults with Parkinson's disease (PD). Patients & methods: 16adults ages 36-80 with PDparticipated in the intervention for 12weeks. The study provided pre-post-study comparisons of biomarkers, weight, waist measurement, united Parkinson's Disease Rating Scale (UPDRS), Parkinson's Anxiety Scale (PAS) and Center for Epidemiologic Studies Depression Scale Revised-20 (CESD-R-20) Depression Scale. Results: Although LCHF/KD improves blood glucose in diabetes and seizure control in epilepsy, research gaps exist in this dietary intervention in PD. Statistically, significant improvements occurred in several measurements, PAS scores and Part I of the UPDRS. Conclusion: The LCHF/KD shows positive trends with improvements in biomarkers and anxiety symptoms. Further research is needed to evaluate dietary interventions for PD.

Measurement of Post-Treatment Changes in Brain Metabolites in Patients with Generalized Anxiety Disorder using Magnetic Resonance Spectroscopy.

Background: From previous studies, we know the correlations of some brain metabolites with a generalized anxiety disorder (GAD) and its symptoms. The response of GAD patients to various treatments is not the same and finding the best treatment option for each patient takes a long period of time.Objective: In this study, we try to examine if there is any relationship between a special treatment option and GAD patients’ response and brain metabolite correlation with anxiety level change.Material and Methods: This study is a clinical trial type of studies. We have used proton MRS (1H-MRS) with field strength of 3 Tesla to assess whether a different treatment option makes different responses based on metabolite changes. We chose 16 patients based on Hamilton’s anxiety rate and a psychiatrist diagnosis. Patients were divided into two groups randomly. Each group took different treatments. Before treatment started, patients underwent MRS imaging and 8 weeks after treatment as well. Our study lacked a control group, and the results were analyzed by comparing the measured values of metabolites and clinical scores before and after treatment. Results: The NAA and Cho concentration increased after treatments and Cr concentration remained constant in both groups. Both groups showed improvements in their symptoms of anxiety and also in their clinical score rates. Sertraline group showed a more increase in NAA concentration than CBT and also a more decrease in HAMA and HAMD-17 scores.Conclusion: A simultaneously increase in NAA and Cho in both groups and a decrease in clinical anxiety levels demonstrate that NAA and Cho concentration are associated negatively with anxiety levels. In addition, both CBT and sertraline are effective in the improvement of anxiety symptoms.

Patient-Reported Outcome Measures in Adult Patients Diagnosed with Epilepsy Being Treated with Perampanel.

BackgroundEpilepsy is a complex disorder that can affect patients’ medical, psychological, and social well-being. The purpose of this study was to evaluate the patient-reported outcome (PRO) measures of health-related quality of life (HRQoL), satisfaction, and adherence in adult patients diagnosed with epilepsy treated with perampanel in the United States (US).MethodsA US-based, multicenter, observational cross-sectional survey was completed by 61 patients taking perampanel with or without other antiseizure medications (ASMs). Respondents were ≥18 years old, had a physician-confirmed diagnosis of epilepsy, used perampanel for ≥4 months, and provided informed consent. Patients responded to questions concerning their demographic characteristics, treatment history, experiences before perampanel, experiences while taking perampanel, HRQoL, treatment satisfaction, and medication adherence.ResultsPatients (N=61) were 42.8 years old on average; majority were female (63.9%) and white (75.4%). Mean time on perampanel was 2.5 years, with sodium channel blockers often (55.7%) used concomitantly with perampanel. Patients reported, on average, 5.5 (standard deviation [SD]=13.2) seizures/month after initiating perampanel, whereas these same patients reported experiencing 20.4 (SD=60.0) seizures/month prior to perampanel. When comparing their experience on perampanel with their experience with previous ASMs, more patients “strongly agreed” that perampanel allowed them to live a more normal life (36.1% vs 27.5%) and worked as intended if they missed taking a dose (16.4% vs 7.8%). Average satisfaction scores were high, with ratings of 71.8 for effectiveness, 84.0 for convenience, and 71.9 for global satisfaction (0–100 scores). Perampanel use was associated with improvements in HRQoL and fewer symptoms of depression and anxiety. The majority of patients were adherent (62.3%) to perampanel.DiscussionPerampanel use was associated with reductions in number of seizures, better HRQoL, and high adherence rates. These results provide initial evidence that perampanel can be an effective, tolerable, and valid option for patients with epilepsy in the real world.

The Role of Resilience in Psychological Health Among Bariatric Surgery Patients.

Many individuals who undergo bariatric surgery have experienced repeated unsuccessful diet attempts and negative messages from healthcare providers, family, and others about their weight. Research pre- and post-operatively has taken a pathological or risk-based approach, investigating psychiatric problems and disordered eating. In contrast, the current study explores resilience in this population. Participants were 148 bariatric surgery patients. Participants completed measures pre-operatively and 1.5-3years post-operatively, including the Binge Eating Scale, Eating Disorder Examination Questionnaire, Patient Health Questionnaire, Generalized Anxiety Questionnaire, Impact of Weight on Quality of Life, Coping Responses Inventory, and Duke Social Support and Stress Scales. The Connor-Davidson Resilience Scale was measured post-operatively. Correlations demonstrated a significant association between post-operative resilience and lower symptoms of binge eating, disordered eating, depression, anxiety, and impact of weight on quality of life. Resilience was also associated with greater social support and less social stress, and greater use of approach coping strategies. Resilience was significantly associated with improvements in symptoms of binge eating, disordered eating, depression, anxiety, and impact of weight on quality of life from pre- to post-operative assessments. In regression models, associations remained significant after controlling for psychosocial variables at baseline (e.g., binge eating symptoms pre-operatively) and demographic covariates. Psychological resilience has been under-studied in the literature on obesity and bariatric surgery, with a primary focus on risk factors for poor outcomes. This study was among the first to investigate associations between resilience and post-operative psychological outcomes. Results suggest the field would benefit from consideration of patient resilience in psychological assessments and interventions.

A Text Messaging-Enhanced Intervention for African American Patients With Heart Failure, Depression, and Anxiety (TXT COPE-HF): Protocol for a Pilot Feasibility Study.

BackgroundAfrican Americans have a higher incidence rate of heart failure (HF) and an earlier age of HF onset compared to those of other racial and ethnic groups. Scientific literature suggests that by 2030, African Americans will have a 30% increased prevalence rate of HF coupled with depression. In addition to depression, anxiety is a predictor of worsening functional capacity, decreased quality of life, and increased hospital readmission rates. There is no consensus on the best way to treat patients with HF, depression, and anxiety. One promising type of treatment—cognitive behavioral therapy (CBT)—has been shown to significantly improve patients’ quality of life and treatment compliance, but CBT has not been used with SMS text messaging reminders to enhance the effect of reducing symptoms of depression and anxiety in racial and ethnic minority patients with HF.ObjectiveThe objectives of our study are to (1) adapt and modify the Creating Opportunities for Personal Empowerment (COPE) curriculum for delivery to patients with HF by using an SMS text messaging component to improve depression and anxiety symptoms, (2) administer the adapted intervention to 10 patients to examine the feasibility and acceptability of the approach and modify it as needed, and (3) examine trends in depression and anxiety symptoms postintervention. We hypothesize that patients will show an improvement in depression scores and anxiety symptoms postintervention.MethodsThe study will comprise a mixed methods approach. We will use the eight steps of the ADAPT-ITT (assessment, decision, administration, production, topical expert, integration, training, and testing) model to adapt the intervention. The first step in this feasibility study will involve assembling individuals from the target population (n=10) to discuss questions on a specific topic. In phase 2, we will examine the feasibility and acceptability of the enhanced SMS text messaging intervention (TXT COPE-HF [Texting With COPE for Patients With HF]) and its preliminary effects with 10 participants. The Beck Depression Inventory will be used to assess depression, the State-Trait Anxiety Inventory will be used to assess anxiety, and the Healthy Beliefs and Lifestyle Behavior surveys will be used to assess participants’ lifestyle beliefs and behavior changes. Changes will be compared from baseline to end point by using paired 2-tailed t tests. An exit focus group (n=10) will be held to examine facilitators and barriers to the SMS text messaging protocol.ResultsThe pilot feasibility study was funded by the Academy for Clinical Research and Scholarship. Institutional review board approval was obtained in April 2021. Data collection and analysis are expected to conclude by November 2021 and April 2022, respectively.ConclusionsThe study results will add to the literature on the effectiveness of an SMS text messaging CBT-enhanced intervention in reducing depression and anxiety among African American patients with HF.International Registered Report Identifier (IRRID)PRR1-10.2196/32550

A campus-based spiritual-mind-body prevention intervention against symptoms of depression and trauma; an open trial of Awakened Awareness

Increasing prevalence and severity of undergraduate psychopathology alongside evidence linking spiritual well-being to the prevention of psychopathology has led to the development of campus-supported spiritual-mind-body (SMB) wellness interventions, which have yet to be formally tested in either open or controlled clinical trials. The primary aim of this open trial was to evaluate the feasibility and acceptability of an eight-session SMB wellness intervention, Awakened Awareness for Adolescents (AA-A), to support the developmental task of spiritual development and individuation. Undergraduates aged 18–24 (N = 77) from two sister universities participated in an open trial study. Clinical and spiritual well-being variables were assessed before and after delivery of the AA-A intervention. Paired samples t-tests were conducted to examine pre-to-post-intervention differences. Multiple regression models were conducted to estimate if post-intervention psychopathology symptoms were predicted by a change in spiritual well-being across the intervention. Analyses of student self-reported psychopathology indicated significant improvements in depression, anxiety, and post-traumatic stress (PTS) symptoms as well as spiritual well-being variables from pre-to-post-intervention. Furthermore, improvements in spiritual well-being predicted improvements in depression, anxiety, and PTS. AA-A appears feasible and acceptable within a culturally, racially, and religiously diverse sample of college students in a secular university. Additionally, this study suggests that AA-A may initiate recovery from moderate forms of psychological distress by addressing pre-existing spiritual distress. SMB interventions may offer novel targeted prevention approaches by providing support for the developmental tasks of identity development and spiritual individuation within the college environment.

Absence of early mood improvement as a robust predictor of rTMS nonresponse in major depressive disorder.

Symptoms of major depressive disorder (MDD) are reported to change early in treatment with repetitive transcranial magnetic stimulation (rTMS). We evaluated early changes in sleep, anxiety, and mood as predictors of nonresponse to rTMS treatment. Three hundred twenty-nine subjects with nonpsychotic MDD completed a 6-week course of rTMS treatment. Subjects were stratified by the severity of their baseline depression, and had their overall depressive symptoms recorded every week of treatment. We evaluated lack of improvement in sleep, anxiety, and mood symptoms after 1 and 2 weeks as potential predictors of eventual nonresponse, defined as <50% improvement in compositive depressive symptoms after 6 weeks. This was measured as negative predictive value (NPV; the likelihood that lack of early symptom improvement accurately predicted eventual treatment nonresponse). Subjects with severe or very severe baseline depression achieving <20% improvement in mood at 1 week were correctly predicted as nonresponders with NPVs largely >90%. At 2 weeks, subjects with very severe baseline depression who failed to demonstrate any improvement in mood were all nonresponders. Lack of improvement in sleep at 2 weeks was also a significant predictor. Identifying a lack of early mood improvement is a practical and robust method to predict rTMS nonresponse. This suggests a treatment protocol change may be indicated in patients with more severe baseline depression showing minimal early mood improvement.

Impacts of mindfulness-based interventions in people undergoing hemodialysis: a systematic review.

Introduction:Chronic kidney disease (CKD) is a serious public health problem worldwide, leading to a series of physical and psychological comorbidities, in addition to costly treatments, lifestyle and dietary restrictions. There is evidence that mindfulness-based interventions (MBIs) offer complementary treatment for people with chronic illnesses, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. This review aims to investigate the MBIs impact on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to support future studies.Methods:We ran searches in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. The papers were selected and evaluated by two reviewers independently, using predefined criteria, including the Cochrane Group's risk of bias tool and its recommendations (CRD42020192936).Results:Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and ranged from 2014 to 2019. There were significant improvements in symptoms of anxiety, depression, self-efficacy, sleep quality, and quality of life (n=3) in the groups submitted to the intervention, in addition to physical measures such as blood pressure, heart rate and respiratory rate (n=1).Conclusions:MBIs can offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on quality of life and physical aspects of the disease.

Boosting exposure and response prevention with imagery-based techniques: a case study tackling sexual obsessions in an adolescent

Abstract Sexual obsessions are common in adolescents with obsessive compulsive disorder (OCD), but how to address these obsessions in a developmentally sensitive manner remains under-explored. This report presents the case of an adolescent who experienced unwanted sexual imagery, undergoing conventional exposure and response prevention, which was subsequently augmented with imagery-based techniques. This approach was associated with remission in symptoms of OCD and marked improvements in symptoms of anxiety and depression. The imagery-based approach was well received and valued as key to treatment success by the adolescent. This raises the tantalising possibility that working directly with images can fuel treatment innovation in tackling sexual (and non-sexual) obsessions in youth OCD. Key learning aims (1) Sexual obsessions are common in adolescent obsessive compulsive disorder (OCD). (2) Little guidance is available on how to conduct exposure and response prevention sensitively for sexual obsessions in adolescent OCD. (3) Imagery-based techniques can be used effectively for reducing sexual obsessions. (4) Imagery-based techniques delivered by videoconferencing can be acceptable for young people.

Cannabis Use among Patients with Alopecia Areata: A Cross-Sectional Survey Study.

Importance:Little is known about cannabis use among patients with alopecia areata (AA). These patients often experience significant psychosocial burden and may seek alternative therapies beyond that of traditional medical treatments, such as cannabis.Objective:To characterize cannabis use among patients with AA.Design:This was a cross-sectional study conducted from March 9, 2021, to March 22, 2021, using a web-based survey distributed to adult patients with AA using the National AA Foundation's email listserv and social media platforms.Results:1,087 participants completed the survey (completion rate: 88.1%). Most participants were female (n = 870, 83.3%) and Caucasian (n = 771, 73.8%), with a mean age of 47.6 ± 15.5 years. 65.9% (n = 689) of participants with AA had a history of cannabis use and among those, 51.8% (n = 357) were current cannabis users. The most common reason for cannabis use among current users was for AA-related symptoms (n = 199, 55.7%), with the greatest perceived improvement in symptoms of stress (n = 261, 73.1%) and anxiety, sadness, and depression (n = 234, 65.6%). 80.4% (n = 287) indicated that cannabis had no impact on their hair loss.Conclusion:Cannabis use is common among patients with AA and is often used to alleviate the psychosocial symptoms related to AA, despite the lack of perceived improvement in hair regrowth.

Sympathetic Neural Control in Humans with Anxiety-Related Disorders.

Numerous conceptual models are used to describe the dynamic responsiveness of physiological systems to environmental pressures, originating with Claude Bernard's milieu intérieur and extending to more recent models such as allostasis. The impact of stress and anxiety upon these regulatory processes has both basic science and clinical relevance, extending from the pioneering work of Hans Selye who advanced the concept that stress can significantly impact physiological health and function. Of particular interest within the current article, anxiety is independently associated with cardiovascular risk, yet mechanisms underlying these associations remain equivocal. This link between anxiety and cardiovascular risk is relevant given the high prevalence of anxiety in the general population, as well as its early age of onset. Chronically anxious populations, such as those with anxiety disorders (i.e., generalized anxiety disorder, panic disorder, specific phobias, etc.) offer a human model that interrogates the deleterious effects that chronic stress and allostatic load can have on the nervous system and cardiovascular function. Further, while many of these disorders do not appear to exhibit baseline alterations in sympathetic neural activity, reactivity to mental stress offers insights into applicable, real-world scenarios in which heightened sympathetic reactivity may predispose those individuals to elevated cardiovascular risk. This article also assesses behavioral and lifestyle modifications that have been shown to concurrently improve anxiety symptoms, as well as sympathetic control. Lastly, future directions of research will be discussed, with a focus on better integration of psychological factors within physiological studies examining anxiety and neural cardiovascular health. © 2022 American Physiological Society. Compr Physiol 12:1-33, 2022.