Distress Behavior Research Articles

Caregiver Ratings of Toddler Pain: The Role of Caregiver Psychological Predictors.

Young children's limited ability to self-report pain necessitates an understanding of the factors that influence pain ratings. The current paper examines the relative prediction of caregiver psychological factors and toddler pain behaviors on caregiver pain ratings post-vaccination. One hundred fifty-six parent-toddler dyads were video recorded during pediatric vaccinations. Child pain behaviors were coded before, during, and after the needle using the Face, Legs, Activity, Cry, Consolability Scale and the Neonatal Facial Coding System). Caregivers rated their child's pain after the needle, reported pre- and post-needle worry during the visit, and completed rating scales assessing other areas of psychological functioning within 2 weeks after the appointment. Regression models were estimated to examine the relative contribution of child and caregiver factors to the prediction of caregiver pain ratings. The regression model predicting caregiver pain ratings from the toddlers' pain-related distress (facial activity immediately after the needle, overall pain-related behavior immediately after, 1-min and 2-min post-needle) and caregiver worry were significant (adjusted R-square = 0.21), with caregiver pre- and post-needle worry being the only significant predictors of caregiver pain ratings. This study outlines that although child distress behavior remains a significant influence on pain ratings during toddlerhood, when caregiver worry (pre- and post-needle) was entered into the model, they were the only significant predictors of caregiver pain ratings.

Effect of Benson's relaxation technique versus music intervention on physiological parameters and stress of children with thalassemia during blood transfusions: A randomized controlled trial

BackgroundChildren with thalassemia are generally dependent on blood transfusions and face a lot of stress and alteration in their physiological parameters through the procedure. AimThis study aimed to investigate the effect of Benson's relaxation technique versus music intervention on physiological parameters and stress of children with thalassemia during blood transfusions. DesignA randomized, controlled trial with three parallel groups. MethodsOne hundred and twenty preschool-age children with thalassemia who underwent blood transfusions were randomly assigned to three groups. Children of the control group received only routine hospital care through blood transfusions. Music intervention group children listened to recorded Mozart's music and children of Benson's relaxation group received relaxation intervention before and during the blood transfusions. Outcome measures were physiological parameters and behavioral distress levels. SettingHematology outpatient clinic of the Children's University Hospital at El-Shatby in Alexandria from October 2022 to February 2023. ResultsThe mean total score of children's behavioral responses to stress before the blood transfusions procedure was 19.32 ± 4.08, 14.20 ± 0.93, and 16.92 ± 4.74 in the control, music, and Benson groups, respectively. Beyond that, there was a decline in their physiological parameters and behavioral stress response during and after procedure among groups of study (P = 0.005 & <0.001, respectively). ConclusionMusic and Benson's relaxation interventions had a helpful effect on stabilizing the physiological parameters and reducing behavioral distress levels in children with thalassemia undergoing blood transfusions. Practice implicationsThis study directs paediatric nurses to apply Benson's relaxation and music interventions for children with thalassemia to enhance their responses.

Psychological distress in a sample of predominately white female college students: the role of mindfulness and physical activity

Objective: Framed in Reinforcement Sensitivity Theory, this study examined the moderating effects of mindfulness and moderate-to-vigorous physical activity (MVPA) on the relationship between behavioral inhibition system (BIS) sensitivity and psychological distress in college students. Participants: Undergraduate students (n = 183) at a large public university in the United States were included in the study. Methods: Self-reported BIS sensitivity, mindfulness, MVPA, and psychological distress were examined in November 2021. Results: Findings revealed a positive relationship between BIS sensitivity and psychological distress, however, this relationship was conditional on levels of mindfulness and MVPA. Specifically, increased reports of mindfulness and MVPA related to lower psychological distress for participants with higher than average BIS sensitivity. Conclusions: Mindfulness and MVPA are buffers for university students prone to psychological distress. Identifying diverse strategies that effectively lower psychological vulnerabilities in college students can be used to develop targeted interventions that reduce psychopathology and promote mental health.

Preliminary efficacy of an acceptance-based diabetes education (ACT-DE) programme for people with type 2 diabetes on diabetes distress and self-care behaviours: A pilot randomised controlled trial

BackgroundDiabetes distress is often characterised by aversive feelings about diabetes and avoidance of diabetes self-care, leading to suboptimal blood glucose control, diabetes complications and depression. Evidence from a recent review has indicated the potential efficacy of acceptance-based diabetic self-management programmes for improving blood glucose levels and mental health outcomes by fostering psychological flexibility. MethodsWe conducted a two-arm and assessor-blinded pilot randomised controlled trial (RCT) with 48 participants aged 18–64 with type 2 diabetes and moderate distress levels, in which we compared a 6-week acceptance and commitment therapy and diabetes education (ACT-DE) programme intervention with diabetes education. Diabetes distress (the primary outcome), self-care behaviour, self-efficacy in diabetes management, and psychological inflexibility were measured at baseline and post-intervention. Focus group interviews were conducted to explore the intervention group's perceptions of the benefits and limitations of the intervention. ResultsResults of ANCOVA test showed that the intervention group exhibited significantly greater decrease in diabetes distress (effect size [Cohen's d] = 0.65), and increase in exercise frequency (d = 1.16), and foot-care frequency (d = 0.59) than the diabetes education group. The qualitative feedback of the intervention group revealed that the learnt ACT skills can be effectively applied in self-care and highlighted the utility of some of the intervention's therapeutic components, primarily mindfulness practices, metaphors, and interactive diabetes education. The intervention was well-accepted, with an 87.5% completion rate, but caution is needed due to a low recruitment rate (28.1%) during COVID-19 pandemic peak. ConclusionThis pilot study confirmed that ACT-DE programme is an acceptable intervention for people with type 2 diabetes. It demonstrated preliminary efficacy with medium-to-large effect sizes in alleviating the participants’ diabetes distress and improving their self-care. Recruitment strategies can be improved to enhance the feasibility. Moreover, a full-scale RCT with longer-term follow-up is warranted to examine the intervention effects on diabetes distress, blood glucose control and other health outcomes.

146 Reducing distressed behaviour in cognitively vulnerable patients during hospitalisation: the role of a Health and Wellbeing Health Care Assistant (HWB-HCA)

Abstract Background Over 40% of older people admitted to acute care experience physical and/or cognitive hospital-associated decline (HAD). People with cognitive vulnerabilities (dementia, delirium) are at particular risk of HAD due to longer hospital stays, use of psychotic medication, boredom, and separation from family. We aimed to implement and evaluate a new ‘Health and Wellbeing Health Care Assistant (HWB-HCA) role as part of a multidisciplinary older adult ward team to provide positive stimulation for cognitively vulnerable patients. Methods The HWB-HCA role was funded by the South/South-West Hospital Group. It combines elements of the standard HCA role (personal care, nutrition, mobilisation etc.) with protected time (four hours per day) for cognitive distraction activities tailored to the individual patient. Interactions start with the HWB-HCA, family and patient completing the Sunflower tool to identify personal interests, dislikes, and triggers for distressed behaviour. Individual activities at the bedside are planned and driven by the patient’s interest. The multiple methods evaluation includes audit of psychotic prescribing, observation, patient and family feedback, and staff interviews. Results To date, the HWB-HCA has delivered 130 structured sessions (72 hours) to 14 patients (median hospital stay 22 days). Activities include chatting, reading, prayers, painting, creative writing, exercise, hand massage. Patients’ reactions are overwhelmingly positive (smiling, laughing, engaged, more relaxed). The role is positively viewed by families, one testimony- ‘she is amazing, so patient, I don’t know how she does it’. Monthly point prevalence audit of PRN psychotic indicates a reduction (mean 5.5% vs 9% in the previous six-month). Lack of social space and staff shortages remain the biggest challenge to operationalising the role. Conclusion The HWB-HCA has been a positive innovation enabling a wider range of non-pharmacological activities to reduce incidents of distressed behaviour managed by psychotic prescribing.

Ethical Work Climate, Moral Distress and Organizational Citizenship Behavior of Nurses: The Mediating Effect of Moral Courage

Ethical Work Climate, Moral Distress and Organizational Citizenship Behavior of Nurses: The Mediating Effect of Moral Courage

Relationships between diversity demographics, psychological distress, and suicidal thinking in the veterinary profession: a nationwide cross-sectional study during COVID-19.

This study aimed to determine the relationship between demographic diversity and veterinary professionals regarding their psychological distress and suicidal experiences. This study also aimed to determine what demographic factors were associated with psychological distress and suicidal experiences for veterinary professionals. This study used a cross-sectional web-based questionnaire to assess the prevalence of diversity, psychological distress, and suicidality in individuals over 18 working in the veterinary field within the United States. The study received 2,482 responses resulting in 2,208 responses that were included in the analysis. Descriptive statistics were performed to identify the categories with the highest rates of psychological distress, suicidal thoughts, and suicidal behaviors. Binomial logistic regressions were conducted to identify the strongest statistical predictors of psychological distress (Kessler-6-K6), suicidal thinking and suicide behaviors. Of the 2,208 respondents included in the analysis, 888 (41%) were experiencing serious psychological distress and 381 (17.3%) had considered suicide in the past 12 months. Results of the binomial regressions indicate gender, social class, age, and disability status were the strongest predictors of psychological distress. When controlling for psychological distress, the strongest predictors of suicidal thinking were sexual orientation, marital status, and professional role. Limited research has been done to explore the relationship between demographic diversity of veterinary professionals and psychological distress, suicidal thoughts, and suicidal behaviors specifically. These results shed light on multiple demographic factors that promote and attenuate mental health, as well as the importance of asking respondents their demographic identities in veterinary medicine research. This research attempts to identify these mental health factors without collapsing categories with small sample sizes, which does cause a limitation in statistical power, yet also demonstrates how to increase inclusivity in research.

Effectiveness of distraction intervention to overcome pain and associated distress during painful procedures in children

If procedures like injections and vaccinations are made free from pain, overall opinion about hospitalization will change. Nonpharmacological techniques like distraction allows focus of client to be diverted away from pain. This part of preliminary study aimed to evaluate the effectiveness of distraction in preventing or minimizing pain and behavioural distress among children while undergoing invasive intravenous procedures. Purpose: To assess and evaluate the intensity of pain and behavioural distress among children during invasive intravenous procedures with and without distraction technique and to determine the association between the intensity of pain, behavioural distress in children undergoing invasive intravenous procedures and selected variables. Method: An experimental approach with post test only control group design was used for the study. The sample for the study comprised of 24 children with age group of 3 - 12 years; 12 children for each experimental group and control group selected by purposive sampling with random assignment. Pain and behavioural distress were assessed using Revised Faces Pain Scale and Behavioural Distress Scale respectively. Findings: The results of this preliminary study showed that using distraction technique during invasive intravenous procedures reduces pain and pain associated behavioural distress among children caused due to invasive intravenous procedures.

Toxic sensation seeking? Psychological distress, cyberbullying, and the moderating effect of online disinhibition among adults.

Cyberbullying among adults is barely studied, though its consequences may be as severe as in children and adolescents. The present study investigated the links between psychological distress, cyber-perpetration, and passive cyber-bystander behavior. We also explored the moderating role of toxic disinhibition in this regard. Our sample comprised 385 adults aged 19-66 (M = 28.35, SD = 11.22, 76.62% females). The results suggested that psychological distress was significantly associated with cyberbullying perpetration and passive bystander behavior. Also, higher psychological distress significantly predicted toxic disinhibition. Further moderation analyses suggested that at high and medium levels of toxic disinhibition, psychological distress significantly predicted cyberbullying perpetration but not passive cyber-bystander behavior. Finally, we discuss our results regarding their theoretical and practical implication for cyberbullying prevention among adults.

Comparison of prevalence of mental distress, help-seeking behaviour of undergraduates in public and private Universities in Osun State, Nigeria

Objective: Mental distress is prevalent and increasing in tertiary institutions. This study compared the prevalence of mental distress and help-seeking behaviour among undergraduates in public and private universities in Osun State, Nigeria.&#x0D; Methods: A comparative cross-sectional design was used to collect data from 910 respondents in one public and one private university of Osun State, using a multistage sampling technique. Data was collected with pre-tested, semi-structured, self-administered questionnaires. Data were analysed using IBM SPSS version 22. Univariate and bivariate analyses were conducted with a level of statistical significance set at p &lt; 0.05. Ethical clearance was obtained from the Institute of Public Health Obafemi Awolowo University. &#x0D; Results: The mean age and standard deviation for public university students was 20.74 ± 2.19 years and 19.02 ± 2.27 years for private university students (p&lt;0.001). The prevalence of mental distress was 40.4% in the public university and 43.6% in the private university (p=0.324). All respondents with mental distress in both universities sought help in the preceding 12 months. Respondents in both institutions commonly sought informal sources of help from parents and friends. A significantly higher proportion of respondents in the private university (62.9%) sought help from formal sources in the 12 months prior to the study compared with respondents in the public university (37.1%) (p=0.012).&#x0D; Conclusion: The prevalence of mental distress is high in both universities with informal sources of help- seeking frequently reported. There is a need for university authorities to promote professional help-seeking in these universities.

Investigation of Ukrainian refugees' eating behavior, food intake, and psychological distress: Study protocol and baseline data.

Since the start of the war in Ukraine, almost 8 million people left the country; more than 1 million of them relocated to Germany. It is to be expected that the war puts considerable strain on refugees, which will impact the public health system in host countries. This paper presents baseline data and protocol of longitudinal online experimental study of 619 Ukrainian refugees in Germany started in autumn 2022, focusing on participants' self-reports of appetite, food intake, and levels of stress, anxiety, and depressive symptoms to examine their associations. Results indicate that levels of stress, anxiety, and depressive symptoms in refugees significantly exceed the indicators of relevant parameters as reported by independent large-scale surveys conducted in Ukraine before the war as well as strong correlations between these deviations (.59 ≤ r ≤ .69, p = .005). Changes in appetite were related to more severe psycho-emotional deviations (.15 ≤ r ≤ .19, p = .003) and somewhat unhealthier food intake (r = -.08, p < .001). The study underlines the need of psychological care for refugees to improve their mental health and counteract potential negative consequences for physical health via changes in food intake, for which suitable interventions need to be developed.

Novel five-phase model for understanding the nature of misophonia, a conditioned aversive reflex disorder

Background: Misophonia is a recently identified condition in which a person perceives a subtle stimulus (e.g., eating sounds, hair twirling) and has an intense, negative emotional response. Misophonia cannot be classified with established nosological systems. Methods: We present a novel five-phase model of misophonia from a cognitive-behavioral framework. This model identifies a learned reflex of the autonomic nervous system as the primary etiology and maintenance of misophonia. Phase one is anticipatory anxiety and avoidance. Phase two is a conditioned physical reflex (for example, the tensing of calf muscles) that develops through stimulus-response Pavlovian conditioning. Phase three includes intense negative emotional responses and accompanying physiological distress, thoughts, urges, and emotion-driven behavior. Phase four is the individual’s coping responses to emotional distress, and phase five is the environmental response and resulting internal and external consequences of the coping behaviors. Each phase helps explain the maintenance of the response and the individual’s impairment. Results: Anticipatory anxiety and avoidance of phase one contributes to an increased arousal and awareness of triggers, resulting in increased severity of the trigger experience. Both the Pavlovian-conditioned physical reflex of phase two and the emotion-driven behavior caused by the conditioned emotional response of phase three increase with in vivo exposure to triggers. Phase four includes internal and external coping behaviors to the intense emotions and distress, and phase 5 includes the consequences of those behaviors. Internal consequences include beliefs and new emotions based on environmental responses to anger and panic. For example, the development of emotions such as shame and guilt, and beliefs regarding how ‘intolerable’ the trigger is. Conclusions: We assert misophonia is a multi-sensory condition and includes anticipatory anxiety, conditioned physical reflexes, intense emotional and physical distress, subsequent internal and external responses, and environmental consequences.

Linking sedentary behavior and mental distress in higher education: a cross-sectional study.

Sedentary behavior among university students could negatively affect their mental health. The aim of this study was to examine the relationship of mental health (anxiety and depression) and sedentary behavior between gender in Health Degrees at the University of Zaragoza. Cross-sectional descriptive study. Sample of 257 University students who completed an online questionnaire. Sedentary behavior was assessed with the SBQ questionnaire. Anxiety and depression were assessed with the GADS questionnaire. The Mann-Whitney U test and multiple linear regression models were used. In comparison to men, female students with symptoms of anxiety spend more time in total engaged in sedentary behaviors (10.56 ± 4.83) vs. (7.8 ± 3.28; p < 0.001) and mentally-passive sedentary activities [2.24 (1.57) vs. 1.15 (0.90; p < 0.005)]. Female students at risk of depression also spend more hours engaged in mentally-passive sedentary behaviors in comparison to men (8.28 ± 50.70 vs. 1.27 ± 1.02; p = 0.009). Female students at risk of anxiety and/or depression spend more time engaged in sedentary activities in comparison to male students. The risk of anxiety and depression is associated with the total number of hours a day spent engaged in sedentary behaviors and with mentally passive behaviors, but not mentally active behaviors.

Virtual reality environment for exposure therapy in obsessive–compulsive disorder: a validation study

IntroductionObsessive–compulsive disorder (OCD) is characterised by recurrent, repetitive, and unwanted thoughts or impulses triggering significant anxiety. Exposure and response prevention is currently the first-line therapy for OCD. The goal of this validation study was to confirm the potential of the VR house environment that incorporates OCD-specific items that cluster around major symptom dimensions: ‘contamination’, ‘symmetry’, ‘checking’ and ‘hoarding’ to induce anxiety and compulsive behaviour in patients with OCD.MethodWe assessed a sample of OCD patients (n = 44) that was compared to a group of healthy controls (n = 31). The severity of OCD symptoms was assessed in all subjects. During a single session, participants were asked to approach a set of 10 stimuli (covering four OCD dimensions) and rate their current intensity of distress/anxiety and compulsive tendencies (scales 0–5) provoked by observing each stimulus. Before and after the VR exposure, participants completed questionnaires assessing subjective levels of anxiety (before/after VR exposure), their sense of presence in VR and experienced simulator sickness.ResultsThe results show that the OCD group reports elevated levels of distress and compulsive behaviour when confronted with VR exposure stimuli compared to the control group, but no increase in anxiety levels has been observed after the VR exposure. The subjective ratings of provoked distress and compulsive behaviour are not associated with severity of OCD symptoms, perceived sense of presence, association with cybersickness symptoms is weak.ConclusionOur data suggest that the VR house environment is a suitable tool for VR exposure therapy in OCD patients as it demonstrates OCD symptom provocation relevant for individual patients.

The association between communication behavior and psychological distress among couples coping with cancer: Actor-partner effects of disclosure and concealment

ObjectiveThis study applies the Actor-Partner Interdependence Model (APIM) to explore the associations between disclosure and concealment with depression and anxiety among patients with cancer and their partners. Method90 patient-spouse dyads completed the Self-Disclosure Index (SDI), the Self-Concealment Scale (SCS), the Couples Illness Self-Concealment (CISC) questionnaire, and anxiety and depression via the Patient-Reported Outcomes Measurement Information System (PROMIS) and the Hospital Anxiety and Depression Scale (HADS). ResultsSignificant actor effects were found for most variables, showing disclosure is negatively and concealment is positively associated with depression and anxiety (β between |0.29| to |0.65|, p ≤ .029). Partner's effect showed a negative association between patients' self-disclosure and their spouses' depression (β = −0.35, p = .043). Patients' anxiety was negatively associated with similarity in all communication variables (β between −0.21 to −0.22, p = .042). ConclusionsDyadic communication is an important correlate of distress among couples coping with cancer. Specifically, concealment behaviors have a positive association with distress, whereas disclosure is related to lower levels of anxiety and depression among both partners. In addition, whereas patients are affected more strongly than their spouses by the dyadic similarity, spouses seem to be more attuned to their partners' behaviors and therefore potentially more related to patients' propensity for sharing.

Machine learning approaches for predicting suicidal behaviors among university students in Bangladesh during the COVID-19 pandemic: A cross-sectional study.

Psychological and behavioral stress has increased enormously during Coronavirus Disease 2019 (COVID-19) pandemic. However, early prediction and intervention to address psychological distress and suicidal behaviors are crucial to prevent suicide-related deaths. This study aimed to develop a machine algorithm to predict suicidal behaviors and identify essential predictors of suicidal behaviors among university students in Bangladesh during the COVID-19 pandemic. An anonymous online survey was conducted among university students in Bangladesh from June 1 to June 30, 2022. A total of 2391 university students completed and submitted the questionnaires. Five different Machine Learning models (MLMs) were applied to develop a suitable algorithm for predicting suicidal behaviors among university students. In predicting suicidal behaviors, the most crucial background and demographic features were relationship status, friendly environment in the family, family income, family type, and sex. In addition, features related to the impact of the COVID-19 pandemic were identified as job loss, economic loss, and loss of family/relatives due to COVID-19. Moreover, factors related to mental health include depression, anxiety, stress, and insomnia. The performance evaluation and comparison of the MLM showed that all models behaved consistently and were comparable in predicting suicidal risk. However, the Support Vector Machine was the best and most consistent performing model among all MLMs in terms of accuracy (79%), Kappa (0.59), receiver operating characteristic (0.89), sensitivity (0.81), and specificity (0.81). Support Vector Machine is the best-performing model for predicting suicidal risks among university students in Bangladesh and can help in designing appropriate and timely suicide prevention interventions.

Caring for critically ill patients with a mental illness: A discursive paper providing an overview and case exploration of the delivery of intensive care to people with psychiatric comorbidity.

To address the need for additional education in the management of mental illness in the critical care setting by providing a broad overview of the interrelationship between critical illness and mental illness. The paper also offers practical advice to support critical care staff in managing patients with mental illness in critical care by discussing two hypothetical case scenarios involving aggressive and disorganised behaviour. People living with mental illness are over-represented among critically unwell patients and experience worse outcomes, contributing to a life expectancy up to 30 years shorter than their peers. Strategic documents call for these inequitable outcomes to be addressed. Staff working in intensive care units (ICUs) possess advanced knowledge and specialist skills in managing critical illness but have reported limited confidence in managing patients with comorbid mental illness. A discursive paper, drawing on clinical experience and research of the authors and current literature. Like all people, patients with mental illnesses draw on their cognitive, behavioural, social and spiritual resources to cope with their experiences during critical illness. However, they may have fewer resources available due to co-morbid mental illness, a history of trauma and social disadvantage. By identifying and sensitively addressing patients' underlying needs in a trauma-informed way, demonstrating respect and maximising patient autonomy, staff can reduce distress and disruptive behaviours and promote recovery. Caring for patients who are distressed and/or display challenging behaviours can evoke strong and unpleasant emotional responses. Self-care is fundamental to maintaining a compassionate approach and effective clinical judgement. Staff should be enabled to accept and acknowledge emotional responses and access support-informally with peers and/or through formal mechanisms as needed. Organisational leadership and endorsement of the principles of equitable care are critical to creation of the environment needed to improve outcomes for staff and patients. ICU nurses hold an important role in the care of patients with critical illnesses and are ideally placed to empower, advocate for and comfort those patients also living with mental illness. To perform these tasks optimally and sustainably, health services have a responsibility to provide nursing staff with adequate education and training in the management of mental illnesses, and sufficient formal and informal support to maintain their own well-being while providing this care. This paper is grounded in accounts of patients with mental illness and clinicians providing care to patients with mental illness in critical care settings but there was no direct patient or public contribution.

Psychological distress and physical activity behaviors among parents and caregivers during different COVID‐19 restriction periods: Secondary analysis of the Active Kids voucher program evaluation

AbstractParents and caregivers who participate in regular physical activity have improved physical and mental health and can influence the physical activity behaviors of children in their care. This study aimed to assess the association between psychological distress and physical activity levels of parents/caregivers in New South Wales, Australia during different COVID‐19 restriction periods. A repeat‐cross‐sectional design was adopted. Parents/caregivers involved in a government‐led children's sport and recreation voucher program were recruited to participate in an online survey as part of the program's evaluation. In response to COVID‐19, parents and caregivers' psychological distress and physical activity levels were assessed using validated items. Binary logistic regression models were used to examine the relationship between physical activity and probable mental illness, and differences across different COVID‐19 restriction periods in 2020 and 2021. In 2020, 10,990 parents/caregivers responded to survey questions and in 2021, 17,106 parents/caregivers responded. Parents/caregivers who were physically active on 7 days per week had lower odds of reporting high psychological distress (odds ratio [OR]: 0.40, 95% confidence interval [CIs]: 0.33, 0.49) than parents/caregivers physically active on fewer days per week. In 2020 9.8% of parents/caregivers (n = 1076) reported high psychological distress, which decreased to 8% in 2021 (n = 1366). In 2021, parents/caregivers had lower odds of reporting high psychological distress (OR: 0.79, 95% CIs: 0.72, 0.86). Socioeconomic disadvantage negatively impacted psychological distress and physical activity levels. Australian parents and caregivers who reported high psychological distress, during and after COVID‐19 restrictions, were participating in low levels of physical activity. Greater collaboration between the mental health, and sport and recreation sectors is recommended to harness the co‐benefits of physical activity throughout parenthood, particularly in low socioeconomic areas.

Novel five-phase model for understanding the nature of misophonia, a conditioned aversive reflex disorder

Background: Misophonia is a recently identified condition in which a person perceives a subtle stimulus (e.g., eating sounds, hair twirling) and has an intense, negative emotional response. Misophonia cannot be classified with established nosological systems. Methods: We present a novel five-phase model of misophonia from a cognitive-behavioral framework. This model identifies a learned reflex of the autonomic nervous system as the primary etiology and maintenance of misophonia. Phase one is anticipatory anxiety and avoidance. Phase two is a conditioned physical reflex (for example, the tensing of calf muscles) that develops through stimulus-response Pavlovian conditioning. Phase three includes intense negative emotional responses and accompanying physiological distress, thoughts, urges, and emotion-driven behavior. Phase four is the individual’s coping responses to emotional distress, and phase five is the environmental response and resulting internal and external consequences of the coping behaviors. Each phase helps explain the maintenance of the response and the individual’s impairment. Results: Anticipatory anxiety and avoidance of phase one contributes to an increased arousal and awareness of triggers, resulting in increased severity of the trigger experience. Both the Pavlovian-conditioned physical reflex of phase two and the emotion-driven behavior caused by the conditioned emotional response of phase three increase with in vivo exposure to triggers. Phase four includes internal and external coping behaviors to the intense emotions and distress, and phase 5 includes the consequences of those behaviors. Internal consequences include beliefs and new emotions based on environmental responses to anger and panic. For example, the development of emotions such as shame and guilt, and beliefs regarding how ‘intolerable’ the trigger is. Conclusions: We assert misophonia is a multi-sensory condition and includes anticipatory anxiety, conditioned physical reflexes, intense emotional and physical distress, subsequent internal and external responses, and environmental consequences.

Fellowship of the fin: Fish empathy and oxytocin.

Zebrafish exhibit fear contagion, a basic form of empathy, and when observing social fellows that have been exposed to predation cues, will themselves exhibit similar distress behaviours. As in mammals, the nonapeptide hormone oxytocin is essential for this empathic response, and homologous areas of the brain are involved, suggesting that the mechanistic basis of empathy may be conserved among vertebrates.