Greater Reductions In Anxiety Research Articles

Exercise interventions to reduce anxiety in mid-life and late-life anxiety disorders and subthreshold anxiety disorder: a systematic review.

Background:Anxiety disorders are highly prevalent and cause significant distress, disability, and cost. Medication adverse effects and interactions increase in mid-life and late-life, highlighting the need for effective non-pharmacological interventions.Objectives:We aimed to evaluate the extent of evidence supporting exercise interventions for anxiety and subthreshold anxiety disorders in mid-life and late-life.Design:Systematic review.Data Sources and Methods:We searched MEDLINE, PsycINFO, Embase, Emcare, Ovid Nursing, CINAHL Plus, Cochrane Library, Health Collection, Humanities & Social Sciences Collection, and https://clinicaltrials.gov databases for trials published January 1994–May 2019. Randomised controlled trials of exercise interventions involving aerobic exercise or resistance training for adults aged 40 years and above with anxiety or subthreshold anxiety disorders in residential or health settings were identified. The primary outcome was change in anxiety. We excluded trials including participants aged below 40 years, participants with diagnosis of separation anxiety, selective mutism, obsessive-compulsive disorder, acute stress disorder and post-traumatic stress disorder, and head-to-head comparisons of interventions. Trial quality was assessed using the Cochrane Risk of Bias Tool and evidence synthesised in narrative form.Results:Four trials totalling 132 participants met inclusion criteria, although some had methodological limitations. Interventions included a home-based resistance training intervention, supervised group-based aerobic intervention, Tai Chi intervention, and supervised group-based aerobic and strength intervention. Three trials included late-life participants and the fourth mid-life. Three trials demonstrated greater reductions in anxiety in the intervention group compared with control. The fourth trial showed pre–post reductions in anxiety in both groups, with between-group difference not reaching statistical significance.Conclusion:There is limited supportive evidence suggesting that exercise interventions have potential to be effective, feasible and safe non-pharmacological interventions for anxiety and subthreshold anxiety disorders in mid-life and late-life. The heterogeneity, limited number and high risk of bias of some trials meant that we were not able to conduct a meta-analysis. Tailoring of interventions may improve uptake and reduce dropout. The paucity of research in this area with only four included trials demonstrates the urgent need for future and larger trials to provide proof of concept, data about effective types and doses of exercise interventions, and guidance to community, clinical, and public health services.

Clinical Delivery and Effectiveness of Music Therapy in Hematology and Oncology: An EMMPIRE Retrospective Study.

Music therapy (MT) has been shown to improve outcomes for patients with sickle cell disease (SCD) and patients with hematologic and/or oncologic conditions excluding SCD (HemOnc) in prior randomized trials. While few studies have described the clinical delivery (ie, volume, clinical settings, patient characteristics, referrals, and session characteristics) of MT and examined its real-world effectiveness, no studies have compared responses between hematology/oncology populations. The purpose of this study was to examine the clinical delivery and effectiveness of MT at a freestanding academic cancer center and compare the effectiveness of MT on pain, anxiety, and fatigue between adult patients in the HemOnc and SCD groups. A retrospective review was conducted of all MT sessions provided at a freestanding academic cancer center between January 2017 and July 2020. The unadjusted single-session effects of MT on pain, anxiety, and fatigue were assessed among patients reporting symptoms ≥1 out of 10 on a 0 to 10 scale. Adjustments were made for multiple sessions on the same patient using a mixed model to compare pre-session and change scores between the HemOnc and SCD groups. Patients' comments were analyzed using conventional qualitative content analysis. Music therapists provided 4002 sessions to 1152 patients including 1012 in the HemOnc group and 140 in the SCD group. In the combined sample, statistically significant reductions in pain (1.48 units), anxiety (2.58 units), and fatigue (0.84 units) were observed, with changes in pain and anxiety exceeding clinically significant thresholds. After adjustment, the SCD group reported significantly greater pre-session pain (7.22 vs 5.81) and anxiety (6.11 vs 5.17) as well as greater anxiety reduction (2.89 vs 2.23) than the HemOnc group. Patients' comments contained themes including enjoyment, gratitude, and improvements in mood, pain, and anxiety. This study supports the delivery and clinical effectiveness of MT for addressing the needs of patients throughout their course of treatment at an academic cancer center and justifies the inclusion of individuals with SCD within integrative oncology services.

Effects of an eight-week, online mindfulness program on anxiety and depression in university students during COVID-19: A randomized controlled trial

The COVID-19 pandemic has had adverse mental health effects for many groups in British society, especially young adults and university students. The present study reports secondary outcomes (i.e., symptoms of anxiety and depression) from a randomized waitlist controlled trial, with a one-month post-intervention follow-up, on the effects of a guided, eight-week mindfulness program delivered online during the COVID-19 pandemic among students at the University of Oxford. Longitudinal multilevel models showed greater reductions in anxiety but not depression symptoms for participants in the mindfulness condition relative to participants in the waitlist control condition (time X group B=-0.36, p=.025).

Momentary affective response to bouts of moderate-to-vigorous physical activity predicts changes in physical activity and sedentary behavior during behavioral weight loss

BackgroundAffective responses are posited to be key predictors of the uptake and maintenance of health behaviors. However, few studies have examined how individuals’ affective response to physical activity, as well as the degree to which their affect response changes, may predict changes in physical activity and sedentary time during behavioral weight loss treatment. PurposeThe current study examined how baseline momentary affective response (i.e., stress and anxiety) to moderate-to-vigorous physical activity (MVPA) and the degree of pre--post intervention change in this response predicted change in daily sedentary, light, and MVPA time during a three-month internet-based weight loss program. MethodsWomen with overweight/obesity (final N = 37) completed 14-day ecological momentary assessment (EMA) protocols with objective measurement of physical activity (i.e., bout-related MVPA time) before and after the intervention. ResultsWomen who had more reinforcing responses to MVPA (i.e., greater reductions in anxiety and stress response following MVPA bouts) at baseline had greater increases in overall MVPA at the end of the intervention. Those who had greater anxiety reductions after MVPA bouts at baseline also evidenced less sedentary time at the end of the intervention. Changes in affective responses across the intervention were not related to changes in physical activity levels. ConclusionsFindings suggest initial levels of affective reinforcement from MVPA bouts predict future change in MVPA and sedentary time during behavioral weight loss. Future work is needed to examine the utility of more precisely targeting affective responses to physical activity to optimize intervention approaches.

Lesional psychiatric neurosurgery: meta-analysis of clinical outcomes using a transdiagnostic approach

BackgroundFour ablative neurosurgical procedures are used in the treatment of refractory psychiatric illness. The long-term effects of these procedures on psychiatric symptoms across disorders has never been synthesised and meta-analysed.MethodsA...

Aromatherapy Plus Music Therapy Improve Pain Intensity and Anxiety Scores in Patients With Breast Cancer During Perioperative Periods: A Randomized Controlled Trial

IntroductionTo investigate the effect of perioperative aromatherapy (AT) or/plus music therapy (MT) on pain and anxiety level, and the potential mechanism in women experiencing breast cancer surgery. MethodsA total of 160 patients with breast cancer were randomly assigned in a 1:1:1:1 ratio to receive usual care (UC), AT, MT, or combination therapy (CT) during perioperative periods. Pain intensity and anxiety scores were measured by visual analog scale. Interleukin (IL)-6 and high mobility group box 1 (HMGB-1) were measured by enzyme-linked immunosorbent assay. ResultsThere was a significant group effect on pain, anxiety, and IL-6 and HMGB-1 levels, with the greatest improvement occurring in the CT group (P < .001). Compared with the UC group, the AT and MT groups had lower mean changes of pain intensity and IL-6 and HMGB-1 levels, and greater anxiety reduction (P < .001). However, the differences between the AT and MT groups did not reach significance (P > .05). ConclusionIn patients with breast cancer, perioperative CT achieves greater pain improvement and anxiety reduction and less marked increase in IL-6 and HMGB-1 levels. These results suggest that CT is an acceptable complementary and alternative medicine for breast cancer patients.

Managing Anxiety from Cancer (MAC): A pilot randomized controlled trial of an anxiety intervention for older adults with cancer and their caregivers.

Anxiety is common in older adults with cancer (OACs) and their caregivers and is associated with poor outcomes including worse physical symptoms, poor treatment adherence and response, and longer hospitalizations. This study examined the feasibility, acceptability, adherence, and preliminary efficacy of a cognitive-behavioral therapy (CBT) intervention for OACs and their caregivers. Patients with active cancer age 65 years and older and their caregivers were randomized to Managing Anxiety from Cancer (MAC), a seven-session CBT-based psychotherapy intervention delivered over the telephone or usual care. Patients and caregivers completed the intervention separately with licensed social workers. Self-report measures of anxiety, depression, and quality of life were administered after randomization and following intervention completion. Analyses were conducted separately for patients and caregivers and at the dyad level. Hierarchical Linear Modeling accounted for the within-dyad intraclass correlation coefficients (ICCs) by random intercepts associated with the dyads. Twenty-nine dyads were randomized; 28 (96.6%) patients and 26 (89.7%) caregivers completed all study procedures. Of dyads randomized to MAC, 85.7% (n = 12) of patients and caregivers completed all seven sessions. Most patients (≥50%) and over 80% of caregivers rated the overall intervention and intervention components as "moderately" to "very" helpful. MAC was associated with a greater reduction in anxiety among dyads than usual care, the effect of MAC was greater in caregivers than in patients, and improvement in patient anxiety was associated with the reduction in caregiver anxiety. However, these results did not reach statistical significance. This pilot study demonstrates the feasibility of MAC and suggests strategies for improving acceptability, with a focus on adherence. Furthermore, these results indicate that MAC is promising for the reduction of anxiety in OAC-caregiver dyads and may be particularly beneficial for OAC caregivers. Larger randomized controlled trials are needed to evaluate the efficacy of MAC.

Aerobic exercise reduces anxiety and fear ratings to threat and increases circulating endocannabinoids in women with and without PTSD

Reductions in state anxiety have been reported following an acute bout of aerobic exercise. However, less is known regarding anxiety and fear ratings to specific threatening stimuli following an acute bout of aerobic exercise in women with PTSD. Moreover, the mechanisms responsible for the anxiolytic effects of exercise are not fully understood, although recent studies suggest a role for the endocannabinoid (eCB) system. Thus, this study utilized a randomized, counterbalanced approach to examine anxiety and fear ratings to predictable or unpredictable electric shock administration and circulating concentrations of eCBs and mood states immediately following moderate-intensity aerobic exercise (30 min on treadmill at 70–75% maximum heart rate) and a quiet rest control condition in women with and without a history of trauma, and in women with PTSD (N = 42). Results revealed that anxiety and fear ratings to unpredictable and predictable threats were significantly (p < .05) lower following exercise compared to quiet rest, with correlational analyses indicating those with greater increases in circulating eCBs had greater reductions in anxiety and fear ratings to unpredictable and predictable threats following exercise. Also, there were significant (p < .05) reductions in fatigue, confusion, total mood disturbance, and increases in positive affect following exercise for the entire sample. Non-trauma controls and PTSD groups reported significant (p < .05) increases in vigor, with additional mood improvements following exercise for the PTSD group (i.e., decreases in state anxiety, negative affect, tension, anger, and depression). Results from this study suggest that aerobic exercise exerts psychological benefits in women with PTSD, potentially due to exercise-induced increases in circulating concentrations of eCBs.

Self-efficacy moderates the relationship between avoidance intentions and anxiety.

Future-directed intentions elicit emotional changes that may affect behavioral performance. We have previously shown that avoidance intentions can elicit a reduction in anxiety (Ng & Lovibond, 2017). In the present experiment, we manipulated within-participant self-efficacy for an avoidance behavior to determine whether self-efficacy moderates the relationship between avoidance intentions and anxiety. Anxiety was indexed through skin conductance response and self-report. Participants learned that certain stimuli signaled an aversive electric shock, which they could avoid by performing an easy task or a hard task. Participants had relatively high self-efficacy for the easy task and low self-efficacy for the hard task. Results indicated that on trials when participants intended to avoid the shock, they experienced significantly greater reductions in anxiety when they had to perform the easy task compared with the hard task. We conclude that self-efficacy for avoidance behavior moderates the relationship between avoidance intentions and anxiety. In situations in which avoiding a harmful outcome is an adaptive response, it may be important to increase self-efficacy for avoidance behaviors from the intention-formation stage itself. If that occurs, the reinforcing reductions in anxiety may reaffirm the intention and increase its temporal stability, thereby increasing the likelihood of behavioral performance. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A blended cognitive behavioral intervention for patients with adjustment disorder with anxiety: A randomized controlled trial

Adjustment disorder with anxiety (ADA) is a common psychiatric pathology worldwide, but it is often undertreated. Cognitive behavioral therapy (CBT) is the first-line treatment, but very few studies have been carried out for the treatment of ADA. Internet-delivered CBT (iCBT) appears to be an effective treatment option, with the potential to reach a larger proportion of individuals suffering from ADA. Guidance is a beneficial feature of iCBT, provided in most studies by email or telephone (traditional guided iCBT). Blended CBT, which combines an online intervention and therapeutic guidance provided in person (face-to-face), could be a way to benefit from both the advantages of face-to-face CBT regarding human interactional quality and the advantages of internet-based CBT in terms of improved access to treatment.In this randomized controlled trial, the effectiveness of two forms of administration of Seren@ctif, a 5-week CBT program for patients with ADA according the DSM-5, was examined: one delivered through face-to-face sessions (face-to-face CBT) and the other delivered online and guided with face-to-face contact with a nurse (blended CBT); these formats were compared with a wait-list control group (WLC). A total of 120 patients were included and randomized to one of these three conditions. Measures were administered before treatment, after treatment and 6 months after inclusion in the study. Both treatment conditions displayed significant decreases in anxiety, depression, worry and perceived stress at posttreatment when compared to the WLC group. The decrease in symptoms was mostly maintained 6 months after inclusion for the two experimental groups. Blended CBT showed significantly greater reductions in anxiety and depression than did face-to-face CBT on some secondary outcome measures.We conclude that both face-to-face CBT and blended CBT are effective treatments for patients with ADA, and we suggest that blended CBT may be slightly more effective than classical face-to-face CBT.Trial Registration: Clinicaltrials.gov NCT02621775;https://clinicaltrials.gov/ct2/show/NCT02621775(Archived by WebCite at http://www.webcitation.org/6tQrkPs1u).

Music during image-guided breast biopsy reduces patient anxiety levels

PurposeInterventions to decrease anxiety associated with image-guided breast biopsy are needed. Music intervention has been shown to be helpful in other outpatient procedural settings but data are limited regarding its effectiveness in the setting of breast biopsy. The purpose of this study was to determine whether listening to self-selected music during image-guided breast biopsy lowers anxiety. Materials and methodsThis randomized controlled trial was approved by the institutional review board and was HIPAA-compliant. 157 women between 18 and 75 (mean, 49.7 years) years of age, undergoing stereotactic or ultrasound-guided core biopsy, were enrolled in the study and were prospectively randomized to music or usual care. Patients in the music group listened to music of their choice during the biopsy. All patients completed the State Trait Anxiety Inventory (STAI) before and after the biopsy. Differences in pre-biopsy and post-biopsy anxiety levels were compared between the two groups using the Mann–Whitney U test. ResultsBaseline trait anxiety scores in the two groups were similar (34.0 music, 31.5 control, p = .11). Patients in both groups showed lower state anxiety levels after the biopsy (45.6 to 34.3 music, 41.0 to 33.8 control, p < .001 for both). Patients who listened to music showed a greater reduction in anxiety (mean decrease 11.2 music, 7.3 control, p = .03). Post-biopsy anxiety levels were similar to normative values for working women in the same age group. ConclusionListening to self-selected music reduces anxiety in patients undergoing breast biopsy.

Seizure detection devices and health-related quality of life: A patient- and caregiver-centered evaluation

IntroductionThe unpredictability of epilepsy has a severe impact on health-related quality of life (HR-QOL) for people with epilepsy. Seizure detection devices have the potential to improve HR-QOL by improving seizure safety, reducing caregiver hypervigilance, and reducing seizure anxiety. Emerging data have led to an improved understanding of characteristics that promote acceptability of detection devices for people with epilepsy and caregivers. However, whether usage of seizure detection devices is associated with clinically meaningful improvement in anxiety and HR-QOL remains poorly understood. MethodsWe analyzed cross-sectional survey data collected first-hand from 371 people with epilepsy and caregivers on seizure detection device and HR-QOL using an enriched population of electronic seizure diary users. Metrics related to quality of life and anxiety reduction were compared between users and nonusers of seizure detection devices. ResultsCompared with nonusers of seizure detection devices, device users were significantly more likely to have been impacted by epilepsy in multiple HR-QOL domains, including anxiety, mood, emotional regulation/aggression, speech/language, sleep quality, social life, activities of daily living, independence, and education/academic potential. The majority (80.2%) of people using seizure detection devices experienced moderate or greater anxiety reduction from seizure detection device usage, while 11.1% reported that detection devices did not help at all with anxiety. Despite potential benefit, seizure detection devices were used only by a minority (21.8%) of people with epilepsy surveyed, and usage tended to be skewed toward younger patient age, higher income, and caregivers. There was no significant difference in overall HR-QOL between users and nonusers. ConclusionsSeizure detection devices provide moderate or greater anxiety reduction among the majority of people with epilepsy and their caregivers, but current translatability into improvements in overall HR-QOL may be limited. Affordability and technological support are potential barriers to maximizing benefit equally among the epilepsy community. These considerations may be useful to help guide future device development and inform patient–clinician discussions on device usage and HR-QOL.

Effectiveness of the doula program in Northern Taiwan.

Objective:The cesarean section rate in Taiwan is 32%–34%, exceeding the rate that the World Health Organization considers reasonable. A doula is a trained woman who provides physical, emotional, and informational support to pregnant women before, during, and after delivery. This study investigated the effectiveness of a new doula program in Northern Taiwan.Materials and Methods:A quasi-experimental research design was employed. Two hundred and twenty women, divided into an experimental group with doula services and a no-doula control group receiving routine hospital care, participated in the present study. Participants' basic information was collected; the study tools were the State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale, labor pain visual analog scale, a labor timetable, and Mother's Level of Childbirth Satisfaction Rating Scale, which were distributed to participants during the postpartum hospitalization period.Results:The highest level of satisfaction was with the spouse in the control group and the doula in the experimental group. The results indicated that the childbirth process involved considerable anxiety in both groups. After delivery, the doula group exhibited a greater reduction in anxiety than the control group, but the reduction was not significant; however, a statistically significant difference was identified in the cesarean section (C/S) rate (13.0% vs. 43.2%) and normal spontaneous delivery (NSD) rate (87.0% vs. 56.8%) between the doula and control groups after controlling for the factor of primara.Conclusion:Providing continuous doula program to pregnant women requiring labor support may reduce the C/S rate and increase the NSD rate. The regression model showed that the factors including high prenatal anxiety, total time needed for doula accompaniment, and epidural and analgesics use were associated with labor women receiving C/S. The factors of continuous doula support and oxytocin use were associated with receiving NSD.

No strings attached: Using 2D paper dolls and 3D toy puppets to promote young children’s positive responses towards immigrants

Previous research indicates that imagining contact with someone who is an immigrant can reduce prejudice and promote positive friendship intentions. Much less is known about the optimal ways of effecting imagined contact. The reported research used an experimental design, where the status of a target-child toy puppet (immigrant versus refugee versus control) and the type of imagined contact (2D or 3D figures) was changed. Children aged 4–10 years, were tested for their responses towards immigrants and refugees, before and after a three-minute interactive play session with 2D or 3D toy puppet figures. Children were asked to show in the session how they would ‘have a really good time’ with the target-child toy puppet. Measures of children’s direct contact with immigrants were also taken. The results suggest that 3D figures have a similar positive impact as 2-D figures on friendship intentions following imagined play. It was in the 2D experimental conditions only that children’s friendship intentions were more positive with greater anxiety reduction.

Augmenting the unified protocol for transdiagnostic treatment of emotional disorders with transcranial direct current stimulation in individuals with generalized anxiety disorder and comorbid depression: A randomized controlled trial

BackgroundThe aim of the current study was to compare the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) with and without transcranial direct current stimulation (tDCS) in individuals suffering from generalized anxiety disorder (GAD) and comorbid depression. MethodsA total of 43 individuals diagnosed with GAD and comorbid depression enrolled in a randomized controlled trial (IRCT20140929019334N1). Participants were randomly assigned to three groups including UP with tDCS (UP+tDCS; n = 15), UP alone (UP; n = 13) or wait-list control (n = 15). GAD and depression symptoms, worry severity, anxiety sensitivity, and intolerance of uncertainty were assessed at baseline, post-treatment and 3-month follow-up. ResultsTreatment with both UP+tDCS and UP alone resulted in significant lower ratings across all measures relative to wait-list controls at post-treatment and 3-month follow-up (all p-values <0.001). UP+tDCS showed significantly greater reductions in anxiety (p = 0.001 post-treatment; p = 0.003 follow-up), worry (p = 0.001 post-treatment; p = 0.002 follow-up), and anxiety sensitivity (p = 0.003 post-treatment; p = 0.002 follow-up) relative to UP alone. LimitationsThe present study had some limitations. First, the sample size was low. Another limitation was the use of a short-term follow-up. ConclusionsThese results suggest augmenting UP treatment with tDCS may be an efficacious strategy to improve treatment outcomes in GAD with comorbid depression.Trial registration reference is IRCT20140929019334N1 (see https://irct.ir/trial/27988).

Yogic Breathing and Mindfulness as Stress Coping Mediate Positive Health Outcomes of Yoga

ObjectivesDespite accumulating research on yoga and its positive impact on both physiological and psychological health, it is still unclear how yoga improves health. Two central components of yoga, yogic breathing and mindfulness, may be important mechanisms by which individuals learn to cope with their daily stressors, and thereby reduce their risk of developing stress-related illness. In this study, we experimentally tested whether yogic breathing as a stress coping mechanism and increased mindfulness mediates the psychological health benefits of a yoga interventionMethodsSeventy-one middle-aged adults (78% women; Mage 53.5 ± 6.9) who self-rated as moderately stressed were randomly assigned to either a control group or a 5-week yoga intervention called the Yoga and Mindfulness Intervention (YOMI) program. The YOMI combines 60 min of yin yoga practice with 30 min of psychoeducation, administered twice weekly; participants also completed a 5-min breathing exercise as homework daily.ResultsThe YOMI group showed greater reductions in anxiety, depression, and sleep problems compared with controls (R2 varied between .09 to .23), and these reductions were statistically mediated by increased use of yogic breathing and a related increase in participants’ overall mindfulness.ConclusionsThese mediation results provide new insights into how yoga improves psychological health and suggests promising implications for policymakers aimed at improving public health.

Use of the Chatbot "Vivibot" to Deliver Positive Psychology Skills and Promote Well-Being Among Young People After Cancer Treatment: Randomized Controlled Feasibility Trial.

BackgroundPositive psychology interventions show promise for reducing psychosocial distress associated with health adversity and have the potential to be widely disseminated to young adults through technology.ObjectiveThis pilot randomized controlled trial examined the feasibility of delivering positive psychology skills via the Vivibot chatbot and its effects on key psychosocial well-being outcomes in young adults treated for cancer.MethodsYoung adults (age 18-29 years) were recruited within 5 years of completing active cancer treatment by using the Vivibot chatbot on Facebook messenger. Participants were randomized to either immediate access to Vivibot content (experimental group) or access to only daily emotion ratings and access to full chatbot content after 4 weeks (control). Created using a human-centered design process with young adults treated for cancer, Vivibot content includes 4 weeks of positive psychology skills, daily emotion ratings, video, and other material produced by survivors, and periodic feedback check-ins. All participants were assessed for psychosocial well-being via online surveys at baseline and weeks 2, 4, and 8. Analyses examined chatbot engagement and open-ended feedback on likability and perceived helpfulness and compared experimental and control groups with regard to anxiety and depression symptoms and positive and negative emotion changes between baseline and 4 weeks. To verify the main effects, follow-up analyses compared changes in the main outcomes between 4 and 8 weeks in the control group once participants had access to all chatbot content.ResultsData from 45 young adults (36 women; mean age: 25 [SD 2.9]; experimental group: n=25; control group: n=20) were analyzed. Participants in the experimental group spent an average of 74 minutes across an average of 12 active sessions chatting with Vivibot and rated their experience as helpful (mean 2.0/3, SD 0.72) and would recommend it to a friend (mean 6.9/10; SD 2.6). Open-ended feedback noted its nonjudgmental nature as a particular benefit of the chatbot. After 4 weeks, participants in the experimental group reported an average reduction in anxiety of 2.58 standardized t-score units, while the control group reported an increase in anxiety of 0.7 units. A mixed-effects models revealed a trend-level (P=.09) interaction between group and time, with an effect size of 0.41. Those in the experimental group also experienced greater reductions in anxiety when they engaged in more sessions (z=–1.9, P=.06). There were no significant (or trend level) effects by group on changes in depression, positive emotion, or negative emotion.ConclusionsThe chatbot format provides a useful and acceptable way of delivering positive psychology skills to young adults who have undergone cancer treatment and supports anxiety reduction. Further analysis with a larger sample size is required to confirm this pattern.

A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa.

Outpatient interventions for adult anorexia nervosa typically have a modest impact on weight and eating disorder symptomatology. This study examined whether adding a brief online intervention focused on enhancing motivation to change and the development of a recovery identity (RecoveryMANTRA) would improve outcomes in adults with anorexia nervosa. Participants with anorexia nervosa (n = 187) were recruited from 22 eating disorder outpatient services throughout the UK. They were randomised to receiving RecoveryMANTRA in addition to treatment as usual (TAU) (n = 99; experimental group) or TAU only (n = 88; control group). Outcomes were measured at end-of-intervention (6 weeks), 6 and 12 months. Adherence rates to RecoveryMANTRA were 83% for the online guidance sessions and 77% for the use of self-help materials (workbook and/or short video clips). Group differences in body mass index at 6 weeks (primary outcome) were not significant. Group differences in eating disorder symptoms, psychological wellbeing and work and social adjustment (at 6 weeks and at follow-up) were not significant, except for a trend-level greater reduction in anxiety at 6 weeks in the RecoveryMANTRA group (p = 0.06). However, the RecoveryMANTRA group had significantly higher levels of confidence in own ability to change (p = 0.02) and alliance with the therapist at the outpatient service (p = 0.005) compared to the control group at 6 weeks. Augmenting outpatient treatment for adult anorexia nervosa with a focus on recovery and motivation produced short-term reductions in anxiety and increased confidence to change and therapeutic alliance.

Association of Pediatric Obesity Treatment, Including a Dietary Component, With Change in Depression and Anxiety

Children and adolescents with obesity are at higher risk of developing depression and anxiety, and adolescent dieting is a risk factor for the development of depression. Therefore, determining the psychological effect of obesity treatment interventions is important to consider. To investigate the association between obesity treatment interventions, with a dietary component, and the change in symptoms of depression and anxiety in children and adolescents with overweight/obesity. Searches of MEDLINE, Embase, Cochrane Library, and PsychINFO were conducted from inception to August 2018. Hand searching of references was conducted to identify missing studies. Obesity treatment interventions, with a dietary component, conducted in children and adolescents (age <18 years) with overweight/obesity, and validated assessment of depression and/or anxiety were included. Data were independently extracted by 1 reviewer and checked for accuracy. Meta-analysis, using a random-effects model, was used to combine outcome data and moderator analysis conducted to identify intervention characteristics that may influence change in depression and anxiety. The meta-analyses were finalized in May 2019. Change in symptoms of depression and anxiety postintervention and at the latest follow-up. Of 3078 articles screened, 44 studies met inclusion criteria with a combined sample of 3702 participants (age range, 5.6 to 16.6 years) and intervention duration of 2 weeks to 15 months. Studies reported either no change or a statistically significant reduction in symptoms of depression or anxiety. Meta-analyses of 36 studies found a reduction in depressive symptoms postintervention (standardized mean difference [SE], -0.31 [0.04]; P < .001), maintained at follow-up in 11 studies at 6 to 16 months from baseline (standardized mean difference [SE], -0.25 [0.07]; P < .001). Anxiety was reduced postintervention (10 studies; standardized mean difference [SE], -0.38 [0.10]; P < .001) and at follow-up (4 studies; standardized mean difference [SE], -0.32 [0.15]; P = .03). Longer intervention duration was associated with a greater reduction in anxiety (R2 = 0.82; P < .001). Higher body mass index z score at baseline was associated with a greater reduction in depression (R2 = 0.19; P = .03). Structured, professionally run pediatric obesity treatment is not associated with an increased risk of depression or anxiety and may result in a mild reduction in symptoms. Treatment of weight concerns should be considered within the treatment plan for young people with depression and obesity.

Levels of perceived control and treatment response in a brief partial hospital setting

BackgroundPerceived internal and external control have long been theorized to relate to development and maintenance of anxiety (Barlow, 2002) and depression (Seligman, 1975). Experimental research studies investigating perceived control have largely focused on anxiety within cross-sectional samples and have shown that low levels of perceived internal and external control are associated with higher levels of anxiety (Gallagher et al., 2014) and depression (Brown & Siegel, 1988; Wardle et al., 2004). The majority of previous research has looked at the combined effects of perceived internal and external control and has not investigated these constructs as potential treatment targets in intensive, short-term clinical settings. MethodsThe current study examined the associations of perceived internal and external control as they relate to anxiety and depression symptom change in a partial hospital sample. ResultsBoth perceived internal and external control increased significantly over brief, intensive treatment. Further, greater gains in internal perceived control were related to greater reductions in anxiety and depression symptoms. DiscussionOur study was limited in that it did not include a control group or follow-up data. This study provides evidence that perceived internal control is related to change in symptoms in a diagnostically diverse and severe population, after very brief intensive treatment. Future studies should investigate if perceived internal control is a mechanism of change in treatment and explore how to maximize the development of perceived internal control in treatment, to maximize reduction in symptoms.