Fear Reduction Research Articles

Treating specific phobia in youth: A randomized controlled microtrial comparing gradual exposure in large steps to exposure in small steps

IntroductionExposure may be especially effective when within exercises, there is a strong violation of threat expectancies and much opportunity for fear reduction. Outcomes of exposure may therefore improve when exposure is conducted in large steps (LargeSE) relative to small steps (SmallSE). MethodsChildren and young people with a specific phobia (SP) (N = 50, age 8–17, 64 % girls) participated in a preregistered single-blind, randomized controlled microtrial comparing LargeSE and SmallSE in a four-week baseline-treatment design. Clinical interviews, behavioral avoidance tests, and self-report measures were assessed at pre-treatment, post-treatment, and at one-month follow-up. ResultsWithin exercises, LargeSE resulted in higher initial fear levels and more within-session expectancy violation. Nevertheless, SmallSE resulted in a larger decline of SP severity from baseline to post-treatment and follow-up, and a larger decline of anxiety and avoidance towards one’s individual goal from baseline to follow-up. There were no differences between LargeSE and SmallSE regarding changes in general self-efficacy or behavioral avoidance. Although session duration was standardized and similar for both conditions, participants in SmallSE received more (shorter) exercises. DiscussionSmallSE might be more effective in reducing SP severity because children in SmallSE were exposed to a larger number and variety of exercises than children in LargeSE.

Exploring Fear of Oral Presentation: A Look at The Origin and Strategies for Reduction

In a language learning course, there are four skills that students must master, and communication is one of the essential skills. Lately, with the adaption of alternative assessment, an oral presentation has been a favourite assessment tool for educators to evaluate students. The main reason for students’ inability to succeed in this assessment is the fear or anxiety faced in the evaluation. Educators should educate students on ways or methods to overcome these negative feelings, as oral presentation is an essential skill that students should acquire before entering the working world. The research aims to investigate whether 1) The origins of fear influence students’ oral presentation. 2) Fear reduction strategies influents learners’ oral presentation. 3) The relationship between origins of oral presentation and fear reduction strategies. The quantitative study was contacted in several faculties in a Malaysian public university. One hundred seventy-six respondents were involved in answering a five-Likert scale survey of three sections designed to facilitate the research findings. The findings show that students’ oral presentations do influent by internal and external factors of fear. Students do implement strategies to overcome their fear of oral presentation. However, the relationship between the origins of oral presentation and fear reduction strategies was weak. The reduction strategies applied by the students did not overcome the fear of oral presentation. This study found that other issues might be the course of the fear of oral presentation.

Do oral contraceptives modulate the effects of stress induction on one-session exposure efficacy and generalization in women?

RationaleThe administration of glucocorticoids (GC) as an adjunct to exposure represents a promising strategy to improve one-session exposure outcome in anxiety disorders. It remains to be determined whether similar effects can be induced with the use of acute stress. Furthermore, the possible modulation of exposure effects by hormonal factors (e.g., use of oral contraceptives (OCs)) was not explored so far.ObjectivesWe investigated whether acute stress prior to one-session exposure for spider fear affects its efficacy in women using oral contraceptives (OC) relative to free-cycling (FC) women. In addition, effects of stress on generalization of exposure therapy effects towards untreated stimuli were examined.MethodsWomen with fears of spiders and cockroaches were randomly assigned to a Stress (n = 24) or No-Stress (n = 24) condition prior to one-session exposure. Of these 48 participants, 19 women used OC (n = 9 in the Stress, and n = 10 in the No-Stress group). All FC women had a regular menstrual cycle and were tested only in the follicular phase of their menstrual cycle. Pre-exposure stress induction was realized with the socially evaluated cold-pressor test. Exposure-induced changes towards treated and untreated fear stimuli were tested with behavioral approach tests for spiders and cockroaches and subjective fear and self-report measures.ResultsAcute stress did not influence exposure-induced reduction in fear and avoidance of the treated stimuli (spiders). Similarly, stress had no effect on the generalization of exposure-therapy effects towards untreated stimuli (cockroaches). Exposure-induced reduction in subjective fear and self-report measures for treated stimuli was less evident in women using OC specifically after pre-exposure stress. Women using OC had higher levels of subjective fear and scored higher in self-report measures at post-treatment (24 h after exposure) and follow-up (4 weeks after exposure).ConclusionsOC intake may represent an important confounding factor in augmentation studies using stress or GC.

The fear-increasing and fear-decreasing effects of a pilot policy to reduce fear of crime.

Fear of crime has been rising persistently in Chile, even in periods where actual crime rates have decreased, making the perception of crime an important policy issue. This paper presents the results of the impact evaluation of a pilot public policy designed to reduce fear of crime around a shopping centre in Santiago, Chile. The pilot policy consisted of installing a team including police officers and local government officials that handed out information leaflets and talked to passers-by about crime prevention. Pre-intervention and post-intervention surveys were conducted in the shopping centre where the programme was implemented and in a control shopping centre nearby to identify the causal effects of the policy using a difference-in-differences empirical strategy. The results indicate that the programme was effective in reducing fear of crime around the shopping centre, especially at night among its workers, and that it reduced actual crime. However, a deeper analysis suggests that the programme might have actually increased fear of crime among the individuals who directly interacted with the programme. The reduction in crime might have indirectly resulted in an overall reduction in fear among workers, who are likely to be up to date on criminal occurrences in the area, explaining how an increase in fear in those directly contacted is consistent with an overall reduction in fear across workers.

Impact of stocking density on the welfare and productivity of broiler chickens reared to 34 d of age

Re-evaluating management practices to highlight opportunities for improving bird welfare is a necessary response to changing genetics, evolving standards, and increasing consumer interest in how poultry is raised. The aim of this study was to evaluate the impact of stocking density (SD) on the welfare and productivity of broilers. The SD treatments were 31, 34.5, 38, and 41.5 kg/m2. Litter moisture decreased and footpad dermatitis improved as SD was reduced, indicating an improvement in welfare. Results from the novel object test suggest birds reared at lower SD were less fearful. Heterophil/lymphocyte ratios were highest in the 31 and 41.5kg/m2 treatments, indicating these birds experienced more chronic stress. At 20 d as SD was decreased, birds spent more time at the drinker and less time resting. When older (31 d), birds preened more in the 31 and 41.5kg/m2 treatments. Stretching behaviour decreased while ruffling increased at lower SD. Final body weights were heaviest in the 31 and 34.5 kg/m2 treatments. Overall, body weight gain increased as SD was reduced, and feed intake was greatest in the 34.5kg/m2 treatment. From 21-24 d, infectious mortality was reduced in the low SD treatments. The impacts of SD are dependent on environmental management; however, even under research conditions, differences between treatments were observed. The results of this study suggest that reducing SD for broilers results in improved welfare and performance as evidenced by reductions in litter moisture, footpad dermatitis, fear, stress, and infectious mortality as well as greater market body weights and feed consumption.

Compassionate mind training for ex-service personnel with PTSD and their partners.

Posttraumatic stress disorder (PTSD) is a significant issue for a substantial proportion of Australian ex-service personnel. In addition to the functional impact on individuals, PTSD can have a significant impact on intimate partner relationships. Research has demonstrated that practicing compassion and self-compassion may be an important component of psychological therapy for survivors of trauma, while also demonstrating benefits to intimate relationships. This pilot study aimed to investigate the utility of a Compassionate Mind Training intervention for ex-service personnel with PTSD and their partners. An uncontrolled, within-subjects, longitudinal design was utilized with assessment at pre-intervention, post-intervention and 3-month follow-up. Twenty-four participants attended 12 biweekly group sessions. Self-report measures of compassion, quality of life and psychological symptoms were administered at each time point. Findings demonstrated a significant reduction in fears of compassion and PTSD symptoms for ex-service personnel at 3-month follow-up and a reduction in depressive symptoms and increase in quality-of-life and social safeness at post-intervention. Additionally, significant reductions in anxiety, stress, external shame and self-criticism at 3-month follow-up were found, and couples reported significant increases in relationship satisfaction. Findings from this pilot study demonstrate promising outcomes, warranting further investigation in a larger randomized controlled trial of Compassionate Mind Training for ex-service personnel and their partners.

Improvements in Compassion and Fears of Compassion throughout the COVID-19 Pandemic: A Multinational Study.

During large-scale disasters, social support, caring behaviours, and compassion are shown to protect against poor mental health outcomes. This multi-national study aimed to assess the fluctuations in compassion over time during the COVID-19 pandemic. Respondents (Time 1 n = 4156, Time 2 n = 980, Time 3 n = 825) from 23 countries completed online self-report questionnaires measuring the flows of compassion (i.e., Compassionate Engagement and Action Scales) and fears of compassion toward self and others and from others (i.e., Fears of Compassion Scales) and mental health at three time-points during a 10-month period. The results for the flows of compassion showed that self-compassion increased at Time 3. Compassion for others increased at Time 2 and 3 for the general population, but in contrast, it decreased in health professionals, possibly linked to burnout. Compassion from others did not change in Time 2, but it did increase significantly in Time 3. For fears of compassion, fears of self-compassion reduced over time, fears of compassion for others showed more variation, reducing for the general public but increasing for health professionals, whilst fears of compassion from others did not change over time. Health professionals, those with compassion training, older adults, and women showed greater flows of compassion and lower fears of compassion compared with the general population, those without compassion training, younger adults, and men. These findings highlight that, in a period of shared suffering, people from multiple countries and nationalities show a cumulative improvement in compassion and reduction in fears of compassion, suggesting that, when there is intense suffering, people become more compassionate to self and others and less afraid of, and resistant to, compassion.

Psychological support and strategies for raising motivation in fresh students.

The goal of this study was to investigate the of fear of starting university training, determine its general characteristics, and test how providing psychological and motivational support for university enrollees may influence the elimination of this type of fear. The study used a random sample of 536 individuals, 268 participants each from one university in the Russian Federation and one from China, who were also randomly selected. Approximately equivalent experimental and control groups (134 people) were formed. The main experiment was conducted simultaneously for Chinese and Russian groups of participants under the same conditions. The modified Kessler psychological distress scale (K10) was used to measure fear of starting training 10 days before training and 2 days after. The experimental group received a special 7-step training to overcome fear and prepare for learning; results between groups and results before and after the start of training were compared using Student's t-test. Test scores for each participant were tested using Pearson's correlation to establish an association with the intervention for the majority of participants. In sum, the results of the carried out testing demonstrate a marked reduction in fear and stress after the start of training for both groups of both universities. Those students who have already experienced support show lower levels of fear of starting a course than those who have not received any help. The results of this study can be used to prepare university applicants for their future studies.

BENEFITS AND CHALLENGES WHEN USING THE TECHNIQUE OF ROLE-PLAYING IN SPEAKING EXERCISES IN TEACHING ENGLISH AS A FOREIGN LANGUAGE

The aim of this paper is to show the complete experiences, both benefits and challenges that A2 level students have when using role-plays in learning English as a foreign language. The respondents included in the survey consist of two groups of students: teenagers aged 12 to 15 (36 of them) and first-year students (38 of them) at the Department of Applied and Fine Arts of the University of Kragujevac (aged 18 up to 20 years). The teenage students attended an English language course at a private school in Kragujevac and were preparing for the international A2 knowledge test of the University of Cambridge, Cambridge A2 test also known as KEY (KET) in its pre-2020 version. In part 3 (conversation), task 2, the knowledge of those taking the test is assessed by means of a kind of a role play. Role-play is organized in pairs where both members of the pair have an equal chance to ask questions and provide information in predetermined situations that are partially structured. The task of the students was to play a role, to understand the situation and to express themselves in an adequate way both linguistically and in accordance with communicative competences. It was noticed that the students did not or to a lesser extent met with such activities, that their motivation for learning was higher than usu- al during and after the activities. There was also a gradual reduction of stage fright and fear of public speaking. On the other hand, the challenges that the examinees faced were the inability to form sentences grammatically correctly, especially questions, that they lack everyday vocabu- lary, as well as that they often sound unnatural and not polite enough. Some respondents could not avoid using their native language for more than a few seconds or not make long pauses in communication using postman’s sticks. Pedagogical implications of this research are the need for English teachers to systematically, and for a longer period, devote at least part of the lesson to such activities with the aim of relieving students of nervousness, activating knowledge and preparing for the challenges of the 21st century and the international circumstances of the use of the English language. We hope that this is one of a series of further investigations on similar topics that will give us better insight into how to improve learners’ communicative competence of English as a foreign language.

Comparison Between Clonazepam and Bromazepam as Premedication Drugs to Reduce Anxiety in Patients Undergoing Elective Surgery Under General Anaesthesia

Background: The majority of patients admitted in hospital for elective surgery experience anxiety preoperatively which can adversely influence the surgical procedure as well as the patient’s recovery. Reduction of anxiety and fear during preoperative period in patients of elective surgery is an essential surgical preparation. Benzodiazepines are the most commonly used drugs for this purpose. Materials and Methods: The study was carried out in a series of 60 consecutive, randomly selected patients, aged 18-60 years, admitted for elective surgery under General Anaesthesia, in Combined Military Hospital, Chattogram during the period September 2021 to February 2022. Patients who received Clonazepam or Bromazepam as preoperative medication were included in the study. Anxiety was scored using VAS (Visual Analogue Scale), sedation was scored by using Ramsay Sedation Scale and anterograde amnesia by asking preoperative events after 24 hours of premedication. Results: While evaluating mean anxiety reduction, mean reduction is not significantly different between the two groups (P value 0.856). Sedation level was more achieved with Clonazepam but that was not statistically significant (mean 2.13 vs mean 2.0, P value 0.557). In the Clonazepam group, greater percentage of patients could not recall preoperative events but that was not statistically significant (average 51.10% vs 39.99%, P value>0.05). Incidence of adverse effects was more in the Bromazepam group (16.66% vs 6.66%). Conclusion: The standard administration of Clonazepam and Bromazepam before operation provides patients with a moderate reduction of periprocedural anxiety. Clonazepam produces more amnesia, sedation and less adverse effects.. Therefore, this study favors routine use of Clonazepam as premedication to reduce anxiety before surgery. KYAMC Journal Vol. 13, No. 03, October 2022: 139-144

Examining Personal and Altruistic Fear of Ransomware

ABSTRACT Despite the growth in literature examining fear of cybercrime, few studies have examined altruistic fear online. Additionally, few studies have examined ransomware fear, potentially limiting the effectiveness of fear reduction policies. Using randomly assigned vignettes administered to online samples (n = 428; 432), findings indicate that perceptions of disorder were associated with increased personal fear, yet were not associated with altruistic ransomware fear. Social cohesion was associated with altruistic fear, yet was not associated with personal fear. Findings demonstrate the need for fear reduction policies to acknowledge the multifaceted nature of fear and adapt explanatory models to online contexts.

Does fear reduction predict treatment response to exposure for social anxiety disorder?

Background and objectivesFear activation and reduction have traditionally been considered important mechanisms of exposure therapy. Evidence to date is mixed and impeded by inadequate methodology. This study examined the extent to which fear activation and reduction within and across exposures predicted treatment outcomes for social anxiety disorder within a paradigm suitable for their measurement. MethodsSixty-eight adults with social anxiety disorder and fear of public speaking completed seven exposure sessions, each consisting of seven speeches conducted in virtual reality. Exposures were identical in duration, task requirements, and virtual public speaking situation. Fear was measured with skin conductance and subjective distress ratings. At baseline and post-treatment, participants completed a public speaking behavioral approach test with a panel of confederate judges; subjective fear was measured. A standardized questionnaire of anxiety symptoms was administered at baseline, post-treatment, and one-month follow-up. ResultsNo indices of within- or between-session fear reduction, measured by subjective distress and skin conductance response, predicted treatment outcome. One measure of fear activation was associated with outcomes such that less activation predicted greater symptom reduction; remaining indices did not predict outcomes. LimitationsData were collected in the context of a randomized controlled trial of scopolamine; drug group was included in analytic models to account for drug influence. VR exposures elicited mild levels of distress that may underestimate levels of distress in clinical settings. ConclusionsFindings failed to support fear activation or reduction within or across exposure sessions as significant predictors of treatment outcome for social anxiety. Treatment implications are discussed.

Reduction in pain-related fear is not associated with improvement in spinal biomechanics but with decrease in movement-evoked pain in patients with chronic low back pain.

While a causal relationship between pain-related fear and spinal movement avoidance in patients with chronic low back pain (CLBP) has frequently been postulated, evidence supporting this relationship is limited. This study aimed to test if decreases in pain-related fear or catastrophizing were associated with improvements in spinal biomechanics, accounting for possible changes in movement-evoked pain. Sixty-two patients with CLBP were assessed before and after an interdisciplinary rehabilitation program (IRP). Pain-related fear was assessed with general and task-specific measures. Lower and upper lumbar angular amplitude and velocity as well as paraspinal muscle activity were recorded during five daily-life tasks to evaluate spinal biomechanics. Relationships were tested with multivariable linear regression analyses. The large decreases in pain-related fear and catastrophizing following the IRP were scarcely and inconsistently associated with changes in spinal biomechanics (< 3% of the models reported a statistically significant association). Results remained comparable for activities inducing more or less fear, for specific or general measures of pain-related fear, and for analyses performed on the entire population or limited to subgroups of patients with higher levels of task-specific fear. In contrast, reductions in task-specific pain-related fear were significantly associated with decreases in movement-evoked pain in all tasks (r=0.26-0.62, p ≤ 0.02). This study does not support an association between pain-related fear and spinal movement avoidance. However, it provides evidence supporting a direct relationship between decreased pain-related fear and decreased movement-evoked pain, possibly explaining some mechanisms of the rehabilitation programs.

A Guideline-Implementation Intervention to Improve the Management of Low Back Pain in Primary Care: A Difference-in-Difference-in-Differences Analysis.

Real-world adherence to clinical practice guidelines is often poor, resulting in sub-standard patient care and unnecessary healthcare costs. This study evaluates the effect of a guideline-implementation intervention for the management of low back pain (LBP) in general practice-the Fear Reduction Exercised Early (FREE) approach-on LBP-related injury insurance claims, healthcare utilisation, and costs of treatment. Data were extracted from comprehensive nationwide New Zealand injury insurance claims records. Data were analysed using a 'triple-difference' (difference-in-difference-in-differences) method to isolate the causal effect of FREE training on LBP claims activity, comparing the difference in general practitioner (GP) LBP claims and associated activity before and after training with their non-musculoskeletal injury claims for the same periods (assumed to be unaffected by training), relative to the same comparisons for GPs not trained in the FREE approach. Training GPs in the FREE approach resulted in significant reductions in the number of LBP injury claims lodged (- 19%, 95% CI -34 to -5), the use of physiotherapy (-30%, 95% CI - 42 to - 18) and imaging (- 27%, 95% CI - 46 to - 8%), and the healthcare costs (- 21%, 95% CI - 41 to - 1) of LBP injury. Changes in claims for earnings' compensation (- 10%, 95% CI - 34 to 13) were not significant. A brief guideline-implementation intervention following best-practice LBP management and guideline-implementation strategies achieved significant reductions, persisting over at least 6 to18 months, in healthcare utilisation consistent with improved delivery of guideline-concordant care.

‘Thinking about pain in a different way’: Patient perspectives of a neuroscience-informed physiotherapy programme for rotator cuff-related shoulder pain

BackgroundRotator cuff-related shoulder pain (RCRSP) is a common musculoskeletal problem. The multi-factorial contributors to persistent pain are often overlooked during treatment. Pain neuroscience education (PNE) contributes to a holistic approach for patients with persistent pain but has not yet been researched for patients with RCRSP. ObjectiveTo explore the perspectives and experiences of participants with RCRSP who had completed a programme of PNE-informed pragmatic physiotherapy. DesignA qualitative study using semi-structured interviews. MethodsWe included a sub-group of five males and five females, aged 46–75 years, with persistent RCRSP of at least three months. They had undertaken a three-month pragmatic physiotherapy integrated with PNE. Individual semi-structured interviews were recorded, transcribed verbatim, and analysed using the General Inductive Approach. ResultsFour themes emanated from the interviews. The first two themes were named ‘Patient Beliefs’ and overall ‘Rapport and Relationship’. Another theme, ‘Perspective and Understanding of the Resources’, indicated diverse uptake of the resource information. The participants reported developing self-management skills, active coping strategies and a reduction in fear of pain described by the theme: ‘Empowerment: My Shoulder into the Future’. ConclusionsParticipants experienced a change in their beliefs, which were enhanced by an individualised delivery and a strong therapeutic relationship through the course of the physiotherapy care. The participants appeared to value when the physiotherapist listened to and understood their beliefs. This required a shift in the patient-therapist relationship from the physiotherapist being the ‘expert’ to facilitating the patient's ability to take control of their shoulder health.

No differences in return of pain-related fear after extinction and counterconditioning.

Extinction-based protocols such as exposure-in-vivo successfully reduce pain-related fear in chronic pain conditions, but return of fear and clinical relapse often occur. Counterconditioning is assumed to attenuate return of fear, likely through changing the negative affective valence of the conditioned stimulus (CS). We hypothesized that counterconditioning would outperform extinction in mitigating return of pain-related fear and decrease CS negative affective valence. Healthy participants performed a conditioning task, in which 2 joystick movements (CSs+) were paired with a painful electrocutaneous stimulus (unconditioned stimulus; pain-US), whereas 2 other movements (CSs-) were not. Subsequently, in the extinction group, 1 CS+ was extinguished (pain-US omission) and the other not, whereas in the counterconditioning group, 1 CS+ was presented with a US of opposite valence (reward-US) and the other was paired with both USs. We tested reinstatement of pain-related fear after 2 unsignalled pain-US presentations. Results showed no group differences in fear reduction and no differences in CS affective valence changes between the extinguished and counterconditioned CS. Remarkably, none of the groups showed reinstatement. Overall, counterconditioning did not appear to be more effective than extinction in reducing pain-related fear and its return. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Strategies for managing dental care for refugee patients.

To outline key factors that contribute to oral health issues of refugees and asylum seekers and provide management strategies for dental providers to teach desensitization and fear reduction for this special population. We researched published literature in the PubMed database and incorporated lessons gained from treating refugee and asylee patients at a Vulnerable Populations Clinic (VPC) at an urban academic dental school. Refugees and asylees are at high risk for oral conditions due to a tendency to not seek routine dental treatment, psychological stressors, and various systemic factors. Oral healthproviders can teach patients desensitization and fear reduction by working to gain patients' trust by having effective communication and prioritizing comfort in the dental operatory. Providers should also utilize translation, psychological, and/or multicultural support services during their management of care. By having a stronger understanding of the key causes of oral health issues among refugees and asylees in the United States, dental providers can better approach managing care for this vulnerable patient population. The concepts of teaching desensitization and fear reduction utilized for this special population can be applied to managing care for the wider special needs patient community.

Self-compassion training for individuals with social anxiety disorder: a preliminary randomized controlled trial

ABSTRACT Self-compassion is the ability to offer oneself kindness and compassion in response to failure, suffering, or insecurity. Learning how to be self-compassionate through self-compassion training appears effective for improving psychological well-being in community samples and promising for clinical populations. The current randomized controlled trial was designed to (a) examine the effectiveness of a self-guided self-compassion training program; and (b) determine whether self-compassion training can help mitigate social anxiety disorder (SAD) symptoms. Adults with SAD (n = 63; Mage = 34.3, SD = 11.4; 67.8% female; 84.7% Caucasian) were randomized to a waitlist control condition, a self-guided self-compassion training condition, or a self-guided applied relaxation training condition for six weeks. Outcome measures of SAD symptoms and self-compassion were completed pre-, mid-, and post-treatment, as well as at 3-months follow-up. Multilevel linear modelling results suggested the self-compassion training program was statistically superior at improving outcome measures relative to the waitlist control condition (ps < .05; η 2 ps = .12–.33), but not relative to the applied relaxation training condition (ps > .05; η 2 ps = .01–.05). Self-compassion training produced greater clinically significant gains in self-compassion and reductions in fear of self-compassion compared to both the waitlist condition and applied relaxation training. The current trial provides preliminary evidence for the effectiveness of a self-help self-compassion training program and provides evidence that self-compassion training may be beneficial for managing clinically significant SAD symptoms.

Fear of cancer recurrence and coping attitudes of breast cancer survivors

This study aimed to determine the fear of cancer recurrence levels and coping orientation of breast cancer survivors. This descriptive exploratory study was conducted using a web-based online survey. This article is written using the STROBE checklist. The study was completed with 204 women participants. Data were collected using the 'Demographic and Clinical Information Form', 'Fear of Cancer Recurrence Inventory (FCRI)' and 'Coping Orientation to Problems Experienced Inventory-Revised (COPE-R)'. FCRI total score average within the scope of the study was calculated as 42.00 ± 18.88. Women's COPE-R total score average is 80.62 ± 13.20. There was a positive correlation between FCRI total score and COPE-R (r = 0.183, p = 0.009). According to the results of multiple linear regression analysis, age, education level, CAM usage, getting psychological support and COPE-R subscales (accommodation, avoidance, self-punishment) were associated with FCRI total score. The fear of cancer recurrence experienced by breast cancer survivors was associated with their coping orientation. Determining the fear of cancer recurrence level and coping orientation of breast cancer survivors by healthcare professionals will guide the reduction of women's fear of cancer recurrence and further the development of adaptive coping orientation.

Comparison between Bromazepam and Lorazepam as premedicant to reduce anxiety in patients undergoing elective surgery under General Anaesthesia

Background: The majority of patients admitted to the hospital for elective surgery experience anxiety preoperatively which can adversely influence the surgical procedure as well as the patient’s recovery. Reduction of anxiety and fear at the preoperative period in patients of elective surgery is essential for surgical preparation. Benzodiazepines are the most commonly used drugs for this purpose. Materials and Methods: The study was carried out on a series of 60 consecutivepatients, aged 18-60 years, admitted for elective surgery under General Anaesthesia, in Combined Military Hospital, Chattogram during the period September 2021 to February 2022. Patients receiving bromazepam or lorazepam as preoperative medication were selected. Anxiety was scored using VAS (Visual Analogue Scale), sedation was scored by using the Ramsay Sedation scale and anterograde amnesia by asking about preoperative events after 24 hours of premedication. Results: While evaluating mean anxiety reduction only, mean reduction is greater in the lorazepam group compared to that of bromazepam. Sedation level was less achieved with bromazepam. In the lorazepam group, a greater number of patients could not recall preoperative events but incidence of adverse effects was significantly more in this group. Conclusion: The standard administration of bromazepam before the procedure provides patients with a moderate reduction of periprocedural anxiety. Premedication of lorazepam is associated with a high incidence of adverse effects. Therefore, this study does not support the routine use of lorazepam as premedication to reduce anxiety before surgery. Bangladesh Crit Care J September 2022; 10(2): 110-115