Measures Of Anxiety Research Articles

Camouflaging in neurodivergent and neurotypical girls at the transition to adolescence and its relationship to mental health: A participatory methods research study

AbstractBackgroundAdolescent girls with diagnoses of autism, ADHD and/or developmental coordination disorder (DCD) are at higher risk for mental health problems than boys with the same diagnoses and neurotypical girls. These girls are called neurodivergent here, though neurodivergence includes a broader range of diagnoses. One possible reason for this mental health disparity could be camouflaging, a coping strategy used more by girls. Camouflaging is when the individual pretends to be neurotypical, often involving substantial effort. This study aims to understand: (a) if the use of camouflaging has started by early adolescence, (b) how components of camouflaging (assimilation, masking, and compensation) present at this age, (c) if age predicts camouflaging and (d) what is the relationship with mental health.MethodsParticipatory methods: A co‐production team of 15 adult neurodivergent women co‐produced the project and ranked camouflaging as their most important research theme.Main Study: Participants were 119 girls (70 neurodivergent, 49 neurotypical) aged 11–14 years. A transdiagnostic approach was adopted and the neurodivergent group had a diagnosis of autism, ADHD and/or DCD. Girls completed self‐report measures of camouflaging, anxiety, and depression in an online meeting with a researcher.ResultsNeurodivergent and neurotypical girls presented similarly on two components of camouflaging namely masking and compensation, components related to presenting in a socially acceptable way and mimicry. Groups differed on the assimilation component, which is related to trying to fit in and involves the feelings of pretending/acting. Age had a medium effect on camouflaging with higher levels of camouflaging observed in older girls. Camouflaging scores strongly predicted anxiety and depression scores in both groups.ConclusionsThe use of camouflaging, specifically assimilation, is evident in a transdiagnostic sample of 11–14 year old neurodivergent girls. Importantly, the strong relationship between camouflaging and poor mental health is present at this early age, substantiating the co‐production team's insights.

Within- and between therapist variability in movement and physiological synchrony and its effects on symptom change.

The predictive power of movement and electrodermal activity (EDA) synchrony has been demonstrated in various studies. Although most studies have examined each synchrony modality separately, a growing interest in the simultaneous investigation of multiple modalities has emerged. Previous research has demonstrated the importance of disentangling within and between-dyad effects, however within and between-therapist effects have yet to be investigated. The aim of the present study was to test whether movement and EDA synchrony (measured both within and between therapists) predict across-session symptom change in two types of interventions (emotion-focused vs. cognitive). The results are based on 990 session segments of 90 clients with test anxiety who were treated with a six-session treatment program by 22 therapists, treating 3-15 clients each. Movement synchrony (on the basis of motion energy analysis (MEA) values) and EDA synchrony were quantified using cross-correlations. Symptom severity was assessed before each session using the state test anxiety measure. Movement and EDA synchrony correlated negatively (-0.19, p < .001). Moreover, higher movement synchrony as well as an interaction between movement and EDA synchrony was significantly associated with symptom improvement within, but not between therapists. In addition, an interaction between EDA synchrony and cognitive (versus emotion-focused) interventions was significantly associated with symptom improvement. These results provide initial evidence that therapists' average levels of synchrony may matter less than how synchronous they are with a specific client.

Psychedelics as an intervention for psychological, existential distress in terminally ill patients: A systematic review and network meta-analysis.

The interest in psychedelics as a therapeutic intervention for existential distress of people with terminal illness grounds on their mechanism of action and effect on the spiritual/existential aspects accompanying end-of-life experiences. This systematic review and network meta-analysis aimed at examining the efficacy and safety of psychedelic compounds for existential distress in terminally ill people. PubMed, CINAHL, PsycINFO, EMBASE, and clinicaltrials.gov were searched for randomized controlled trials (RCTs) administering psychedelics for existential distress in people with terminal illnesses. Meta-analysis estimated the standardized mean difference (SMD) and odds ratio (OR), with corresponding 95% confidence intervals (95% CI), between treated and control groups in pairwise and network comparisons, using random-effects models. Post-treatment measures of depression and anxiety, as proxies of existential distress, and tolerability were the primary outcomes. Nine studies, involving 606 participants (362 treated with psychedelics: psilocybin, ketamine, 3,4-methylenedioxymethamphetamine, and lysergic acid diethylamide (LSD)) were included. The meta-analysis supported the efficacy of psychedelics on depression (SMD: -0.80 (95% CI: -0.98, -0.63)) and anxiety (SMD: -0.84 (95% CI: -1.20, -0.48)). Network meta-analysis identified psilocybin as the most effective compound for depression, and LSD for anxiety. However, head-to-head comparison between psychedelics did not reach statistical significance. The rates of treatment discontinuation and adverse events between psychedelics and controls were comparable. Psychedelics, especially psilocybins and LSD, showed promising effects on depression and anxiety in people with terminal illnesses. Limitations include the small number of RCTs, methodological issues related to blinding, and the lack of direct comparisons between psychedelic compounds. Larger studies and comparative research are needed to consolidate these findings.

Brief Video-Delivered Intervention to Reduce Anxiety and Improve Functioning in Older Veterans: Pilot Randomized Controlled Trial.

Older veterans with anxiety disorders encounter multiple barriers to receiving mental health services, including transportation difficulties, physical limitations, and limited access to providers trained to work with older persons. To address both accessibility and the shortage of available providers, evidence-based treatments that can be delivered via guided self-management modalities are a potential solution. This study aims to determine the feasibility and acceptability of a randomized controlled trial of 2 guided self-management interventions. This study compared the treatment effects of these 2 interventions (relaxation and health psychoeducation) on anxiety symptom severity and functioning in older veterans with anxiety disorders. Our exploratory aims examined factors related to home practices and treatment engagement and perceptions of the practices. Participants were randomized to one of two video-delivered interventions: (1) Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment (BREATHE)-breathing and progressive relaxation or (2) Healthy Living for Reduced Anxiety-psychoeducation about lifestyle changes. Telephone coaching calls were conducted weekly. Measures of anxiety, depression, and functioning were obtained at baseline, week 4 (end of treatment), week 8, and week 12. Participants completed a semistructured interview at week 12. Analyses included descriptive statistics to summarize measures of intervention engagement; mixed-effects models to characterize symptom change, and qualitative analyses. Overall, 56 participants (n=48, 86% men; n=23, 41% from ethnic or racial minority groups; mean age 71.36, SD 6.19 y) were randomized. No difference in retention between study arms was found. The Healthy Living group (29/56, 52%) completed significantly more lessons (mean 3.68, SD 0.86) than the BREATHE group (27/56, 48%; mean 2.85, SD 1.43; t53=2.60; P=.01) but did not differ in completion of coaching calls. In the BREATHE group, greater baseline anxiety scores (r=-0.41; P=.03) and greater severity of medical comorbidity (r=-0.50; P=.009) were associated with fewer completed practices. There was no effect of intervention on change in total anxiety scores or functioning. For specific anxiety subtypes, Healthy Living produced a greater decline in somatic anxiety compared with BREATHE. Qualitative analyses found barriers to practicing, including difficulty setting time aside to practice, forgetting, or having other activities that interfered with BREATHE practices. Some participants described adapting their practice routine to fit their daily lives; some also used relaxation skills in everyday situations. These findings suggest that a larger randomized controlled trial of guided self-management approaches to treating late-life anxiety is feasible; however, BREATHE was not effective in reducing anxiety compared with Healthy Living. Possible contributing factors may have been the reliance on a single technique. Progressive relaxation was reported to be enjoyable for most participants, but maintaining home practices was challenging. Those with milder anxiety severity and fewer health problems were better able to adhere to practices. ClinicalTrials.gov NCT02400723; https://clinicaltrials.gov/study/NCT02400723.

Association of home and neighbourhood conditions with anxiety and depression symptoms during the COVID-19 lockdown: Findings from the ALSPAC cohort

Background The first COVID-19 lockdown in the UK entailed widespread social restrictions, including instructions to stay at home at all times. This created a natural quasi-experiment, during which time home and neighbourhood conditions may have been especially important to mental health. However, evidence on this topic is scarce. Methods Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based cohort, we examined associations of home and neighbourhood conditions with anxiety and depression symptoms during the first UK lockdown in 2020, when participants were approximately 28 years of age. Questionnaires were completed at two timepoints (T1: April; T2: May/June) and included validated measures of anxiety (GAD-7) and depression (SMFQ); as well as questions about current home conditions and behaviours. Neighbourhood conditions were obtained via linkage, and included population density, neighbourhood deprivation, social fragmentation, and greenspace. Main associations were examined using linear regression. Potential confounders were identified using a directed acyclic graph and included ethnicity, family psychiatric history, maternal social class, financial difficulties and unemployment before lockdown, and anxiety and depression at ages 18 and 24. Results At T1 after considering confounders, reduced access to nature (B=0.48, 95% CI=0.26-0.70, p&lt;0.001) and neighbourhood deprivation (B=0.25, 95% CI=0.04-0.47, p=0.024) were associated with anxiety. Furthermore, reduced access to nature (B=0.43, 95% CI=0.20-0.66, p=0.001), no garden access (B=0.22, 95% CI=0.01-0.43, p=0.043), living alone (B=0.33, 95% CI=0.13-0.53, p=0.002), and neighbourhood deprivation (B=0.22, 95% CI=0.00-0.44, p=0.048) were associated with depression. There were fewer associations at T2. Conclusion Disadvantaged home and neighbourhood conditions were associated with more anxiety and depression symptoms during the first UK lockdown. The findings underscore the importance of home and neighbourhood conditions for mental health and highlight potential interventions such as improved urban design to increase access to nature and reduce isolation. However, the causality of the findings is uncertain.

A challenge to identity: Identity processing style and moral injury.

Moral injury is a potentially deleterious mental health outcome that can result from exposure to morally challenging events. Treatment of moral injury is currently hindered by incomplete understanding of its underlying mechanisms. Theories of adaptation posit that maintaining a coherent sense of self while realigning one's sense of self with reality aids in adaptation following a disruptive life event. Differences in identity processing style are thought to impact the extent to which an individual engages with the challenges of maintaining a coherent sense of self following identity-related challenges. However, little is known about how identity processing style relates to moral injury event-related distress. This study sought to investigate a hypothesized relationship between identity processing style and event-related distress as well as alternative outcomes including traumatic stress, depression and anxiety. Adults (N = 167) who had been exposed to a potentially morally injurious event were recruited online and completed validated measures of event-related distress, traumatic stress, depression, anxiety and identity processing style. There were significant positive associations between diffuse-avoidant processing and all mental health outcomes, no significant associations between informational processing and any mental health outcomes, and significant negative associations between normative processing and event-related distress and depression.

Six Month Follow up of the one of the First Patients to Complete MDMA-Assisted Therapy for PTSD Outside of Clinical Trials in Australia: Implications for Translating Clinical Research to Clinical Practice

Purpose: The goal of this case report is to illustrate the implementation of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for posttraumatic stress disorder (PTSD) and learning points for health professionals in the translation of psychedelic assisted therapy research into clinical practice. We present our key learnings and 6-month follow up data from one of the first patients to complete MDMA-assisted therapy for PTSD outside of clinical trials, in an Australian outpatient clinic setting. Methodology: The patient described in this case report had chronic PTSD, depression and anxiety due to experiencing domestic violence, including sexual, physical, and psychological abuse in her adolescence. Treatment was informed by the Multidisciplinary Association of Psychedelic Studies (MAPS) MDMA-assisted therapy manual. After completing treatment, she enrolled in our weekly integration peer support group, including meditation workshops and family support sessions. Data was gathered using the Australian National University (ANU) Psychedelic-assisted therapy Australian national outcome database (https://medicine-psychology.anu.edu.au/research/research-projects/australian-interventional-pharmacotherapy-psychedelic-assisted-psychotherapy), which collates de-identified questionnaire data and outcomes from MDMA, psilocybin and ketamine assisted psychotherapy. Outcome data was gathered at baseline, the beginning of preparation, in the week after each dosing session, at the end of the program. Follow up data is collected at 3-, 6-, 9- and 12-months post-treatment. At the time of writing, she had completed 3 and 6 month follow up. Tables and figures are used to present the outcome data. Findings: Our patient no longer met DSM-V criteria for PTSD or major depressive disorder at the end of treatment, and at 6-month follow up. Her Impact of Events Scale – Revised (IES-R) score was 61 at intake, reduced to 0 after the second dosing session and remained 0 at 3 and 6-months follow up. There were no adverse events, with the only side effect reported being loss of appetite in the first 24 hours after each dosing session. All scores on depression and anxiety measures reduced to the normal ranges after the second dosing session and remained in the normal ranges at her six month follow up. After the second dosing session reported having greater self-compassion and being less troubled by the trauma memories. After the third dosing session, she began to feel comfortable leaving her children with their father or trusted family member to run errands for the first time, and an increased sense of connectedness with herself and with others. All these gains were maintained at three- and six-months post-treatment, illustrating a case of safe and effective implementation of MDMA-assisted therapy for PTSD in an outpatient mental health service. Unique Contribution to Theory, Practice and Policy: Our case study offers one model of clinical practice, contributing to Australian practitioner’s implementation of safe and effective MDMA-assisted therapy in mental health services. We reflect on learning points for practitioners such as whether MDMA or psilocybin would be the most effective treatment, for a patient with both PTSD and treatment resistant depression. Recommendations for practitioners include the importance of working in a dyad, accessing ongoing supervision in the early stages of implementation, and the benefits of the having had legal experience with psychedelic medicines as part of therapist training.

Disentangling developmental trajectories of childhood anxiety and depression symptoms in the prediction of adolescent substance use.

Adolescent substance use is comorbid with internalizing problems (e.g., anxious and depressive symptoms) and externalizing problems (EPs). Developmental researchers have linked early anxious and depressive symptoms to later substance use behaviours via an "internalizing pathway". Support for this pathway exists among young adults; however, evidence from prospective studies of adolescents has been inconsistent. Given the paucity of prospective studies in this area, the current study used a developmental framework to examine childhood anxiety and depression symptom trajectories as predictors of adolescent substance use and whether these relationships depend on sex and EPs. Children with and without EPs participated annually in an ongoing longitudinal study (N = 744; Time 1 age = 6.3-10.6). Youth completed self-report measures of anxiety and depression symptoms (Times 3-6) and substance use (Times 7-8). Parents and teachers completed measures of children's EPs (Time 0). Parallel process growth models showed that changes over time in childhood depression symptoms were significantly positively associated with adolescent alcohol/cannabis use, substance-related consequences, and total score of problematic substance use. Changes over time in childhood anxiety symptoms were significantly negatively associated with adolescent alcohol/cannabis use. These results were invariant by EPs and sex. Research implications of this study emphasize the importance of isolating the respective pathways of anxious and depressive symptoms to later substance use outcomes, while clinical implications focus on targets for early identification and prevention of problematic substance use in adolescence.

Perceiving precedence: Order of operations errors are predicted by perception of equivalent expressions

Students often perform arithmetic using rigid problem-solving strategies that involve left-to-right-calculations. However, as students progress from arithmetic to algebra, entrenchment in rigid problem-solving strategies can negatively impact performance as students experience varied problem representations that sometimes conflict with the order of precedence (the order of operations). Research has shown that the syntactic structure of problems, and students’ perceptual processes, are involved in mathematics performance and developing fluency with precedence. We examined 837 U.S. middle schoolers’ propensity for precedence errors on six problems in an online mathematics game. We included an algebra knowledge assessment, math anxiety measure, and a perceptual math equivalence task measuring quick detection of equivalent expressions as predictors of students’ precedence errors. We found that students made more precedence errors when the leftmost operation was invalid (addition followed by multiplication). Individual difference analyses revealed that students varied in propensity for precedence errors, which was better predicted by students’ performance on the perceptual math equivalence task than by their algebra knowledge or math anxiety. Students’ performance on the perceptual task and interactive game provide rich insights into their real-time understanding of precedence and the role of perceptual processes in equation solving.

Assessing the efficacy and safety of STOP (successful treatment for paranoia)—an app-based cognitive bias modification therapy for paranoia: a randomised clinical trial protocol

BackgroundParanoia, the belief that you are at risk of significant physical or emotional harm from others, is a common difficulty, which causes significant distress and impairment to daily functioning, including in psychosis-spectrum disorders. According to cognitive models of psychosis, paranoia may be partly maintained by cognitive processes, including interpretation biases. Cognitive bias modification for paranoia (CBM-pa) is an intervention targeting the bias towards interpreting ambiguous social scenarios in a way that is personally threatening. This study aims to test the efficacy and safety of a mobile app version of CBM-pa, called STOP (successful treatment of paranoia).MethodsThe STOP study is a double-blind, superiority, three-arm randomised controlled trial (RCT). People are eligible for the trial if they experience persistent, distressing paranoia, as assessed by the Positive and Negative Syndrome Scales, and show evidence of an interpretation bias towards threat on standardised assessments. Participants are randomised to either STOP (two groups: 6- or 12-session dose) or text-reading control (12 sessions). Treatment as usual will continue for all participants. Sessions are completed weekly and last around 40 min. STOP is completely self-administered with no therapist assistance. STOP involves reading ambiguous social scenarios, all of which could be interpreted in a paranoid way. In each scenario, participants are prompted to consider more helpful alternatives by completing a word and answering a question. Participants are assessed at baseline, after each session, and at 6, 12, 18 and 24 weeks post-randomisation. The primary outcome is the self-reported severity of paranoid symptoms at 24 weeks, measured using the Paranoia Scale. The target sample size is 273 which is powered to detect a 15% symptom reduction on the primary outcome. The secondary outcomes are standardized measures of depression, anxiety and recovery and measures of interpretation bias. Safety is a primary outcome and measured by the Negative Effects Questionnaire and a checklist of adverse events completed fortnightly with researchers. The trial is conducted with the help of a Lived Experience Advisory Panel.DiscussionThis study will assess STOP’s efficacy and safety. STOP has the potential to be an accessible intervention to complement other treatments for any conditions that involve significant paranoia.Trial registrationISRCTN registry, ISRCTN17754650. Registered on 03/08/2021. https://doi.org/10.1186/ISRCTN17754650.

Examining the role of post-event processing in test anxiety—Pilot testing in three student samples

This work investigates the occurrence of post-event processing (PEP) in the context of test anxiety; PEP involves rumination and self-critical thinking following an event and commonly observed in social anxiety. Three short-term longitudinal studies in student samples examined whether PEP occurs after exams and how it is associated with test anxiety. University students (N = 35 in Study 1, N = 146 in Study 2, and N = 37 in Study 3) completed measures of trait and state test anxiety before an actual exam; PEP related to the exam was assessed at various time points afterward. Results revealed that PEP occurred to a meaningful extent after exam situations. Overall, it was positively associated with trait and state test anxiety, although some variations in the relations were found across the three studies. These findings underscore the relevance of PEP in the context of test anxiety, as PEP might contribute to maintaining test anxiety in the long term. Implications for future studies are discussed.

The Sleep Course: An inclusive trial examining the feasibility, acceptability, and preliminary efficacy of a digital sleep intervention for adults with self-reported sleep difficulties

Cognitive Behavioural Therapy for Insomnia (CBTi) is a well-established first-line treatment for insomnia and sleep difficulties, yet numerous barriers hinder its widespread adoption. One potential criticism of the existing evidence base for CBTi is that many trials exclude participants that would commonly be seen in in primary care, such as those aged over 65, with comorbid health conditions, or prescribed sleep medication. The current pilot study therefore aimed to assess the acceptability and efficacy of a brief, digitally delivered sleep intervention, the Sleep Course using a broad range of participants. Participants (n = 74) completed the 6-week, 4-lesson intervention alongside measures of sleep disturbance, sleep-related impairment, depression, anxiety and sleep-wake patterns (via sleep diary). Generalized estimating equations analysis modelled change in participants' outcomes from pre- to post-treatment and 3-month follow-up, and subgroup analyses explored the role of possible moderators (e.g., age over 65, co-morbidities, and concurrent prescription medication use). The intervention was associated with good rates of satisfaction (79 %) and lesson completion (70 %). Results showed significant and large reductions in insomnia, sleep disturbance and associated symptoms (e.g., d = 1.06–1.37 change in insomnia symptoms). Evidence of high acceptability and clinical improvement was found irrespective of age, physical comorbidity, and sleep medication use. However, there was evidence of less improvement among those taking medications or having tried psychological treatment in the past. These results provide strong preliminary evidence for the intervention as an acceptable, efficacious and scalable treatment for a broad range of participants with sleep difficulties. Larger randomised controlled trials are needed.

Sexual Aversion, Disgust, and Fear of Intimacy: A Comprehensive Case History Using a Multimodal Therapeutic Approach.

This single-case study examines the psychotherapeutic journey of a 23-year-old woman experiencing a persistent and long-standing fear of emotional intimacy and aversion to physical intimacy, which led to the active avoidance of sexual encounters, psychological distress, and interpersonal difficulties. Over 26 one-hour sessions, an integrative therapeutic approach was employed, combining elements from psychodynamic, acceptance and commitment, cognitive-behavioral, and exposure therapies, with psychoeducation and sex education playing pivotal roles. The treatment resulted in significant improvements, as evidenced by both quantitative and qualitative assessments. Quantitative measures of emotional distress-specifically anxiety, depression, and fear of intimacy-initially increased during intentional exposure but showed significant improvements at 6-month and 1-year follow-ups. Qualitative data revealed enhancements in self-concept, increased self-compassion, and improved social functioning aligned with the individual's life aspirations. This case study highlights effective therapeutic strategies for addressing sexual aversion in young adults and demonstrates the potential for alleviating symptoms and enriching quality of life through an integrative approach.

Validity of Cognitive Disengagement Syndrome with Mother and Father Ratings of Brazilian Children: Replication of Northern Hemisphere Findings in South America.

Although the Child and Adolescent Behavior Inventory (CABI) cognitive disengagement syndrome (CDS) scale has demonstrated validity relative to the CABI attention-deficit/hyperactivity disorder-inattention (ADHD-IN) scale with parent ratings of youth from North America, Europe, East Asia, and Central Asia, no study has evaluated the validity of the 15 symptom CDS scale with children from South America. Our purpose was to examine for the first time the validity of the CABI CDS scale with Brazilian children. Latent variable modeling procedures were used to examine the validity of CDS scores. Mothers and fathers completed measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), anxiety, depression, and academic impairment on 366 Brazilian children (Mage = 8.64, SDage = 1.39, 53.3% females). First, the CDS symptoms showed strong internal validity with the ADHD-IN symptoms. Second, within and across sources, ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-HI, whereas CDS, especially across sources, showed stronger first-order and unique associations than ADHD-IN with anxiety and depression. CDS and ADHD-IN were similarly associated with academic impairment. This study is the first to support the validity of CABI CDS scores with Brazilian children, thus replicating the findings in North America, Europe, East Asia, and the Central Asia in South America.

Evaluation of a Reiki Volunteer Program within Two Cancer Infusion Centers

Reiki is a biofield therapy from Japan currently used in many US hospitals. Evidence supports Reiki's effectiveness for addressing cancer and treatment-related symptoms such as pain and anxiety. However, no study to date has assessed changes in nausea following Reiki received during infusion treatments or assessed patients from multiple healthcare locations. To evaluate a Reiki program for outpatients with cancer and other chronic illnesses receiving infusion treatments (e.g., chemotherapy) at two University Hospitals infusion centers. Participants in the outpatient infusion clinics completed Edmonton Symptom Assessment System measures of pain, fatigue, anxiety, nausea, and well-being before and after receiving a 15-20-minute Reiki session during their infusion. Data analysis included means and 95% confidence intervals (CI) of single-session effects on measures where the pre-session score was ≥1 and analysis of post-session comments. Between March 2022 and February 2024, 392 Reiki sessions were provided to 268 unique patients (mean age 63.3 ± 13.9, 57.5% female, 71.6% White, 26.5% Black/African American). Participants reported clinically significant mean [95% CI] improvements (≥1 unit) in pain (-1.78 [-2.38, -1.18]), fatigue (-1.33 [-1.85, -0.82]), anxiety (-2.09 [-2.68, -1.50]), nausea (-2.30 [-2.95. -1.62), and wellbeing (1.37 [0.95, 1.79]). Participants also commented that the Reiki session was a positive experience helpful for promoting relaxation and symptom reduction. Outpatients receiving Reiki during infusion reported clinically significant improvements in all symptoms, high levels of satisfaction, and a qualitatively positive healing experience. More research is needed to assess long term changes following Reiki, including with an expanded program at additional healthcare locations.

Deprescribing anticholinergics to preserve brain health: reducing the risk of dementia through deprescribing (R2D2): study protocol for a randomized clinical trial

BackgroundOlder adults commonly experience chronic medical conditions and are at risk of cognitive impairment as a result of age, chronic comorbidity, and medications prescribed to manage multiple chronic conditions. Anticholinergic medications are common treatments for chronic conditions and have been repeatedly associated with poor cognitive outcomes, including delirium and dementia, in epidemiologic studies. However, no study has definitively evaluated the causal relationship between anticholinergics and cognition in a randomized controlled trial design. Utilizing our prior experience in deprescribing anticholinergic medications in various clinical environments, we designed an outpatient deprescribing intervention to prospectively test the potential causal relationship between anticholinergics and cognition in primary care older adults.MethodsThis cluster randomized clinical trial will be conducted to evaluate the impact of an anticholinergic deprescribing intervention compared to usual care on outcomes of cognition and safety in primary care older adults. Participants will include those aged 65 years and over, receiving primary care in the greater Indianapolis area, using a strong anticholinergic within the last 2 weeks or with evidence of high-risk exposure in the past year. Those excluded will have a diagnosis of Alzheimer’s disease or related dementia, or serious mental illness. The trial plans to enroll 344 participants who will be cluster-randomized at the level of primary care physician to avoid contamination. Participants will complete outcome assessments every 6 months up to 2 years by blinded outcome assessors. The primary outcome of the study is a composite measure of cognition that includes domains assessing executive cognitive function, language, and memory. Secondary outcomes include patient-reported measures of pain intensity, depression, anxiety, sleep disturbance, and health-related quality of life.DiscussionThe R2D2 trial will be the largest and longest prospective randomized trial testing the impact of an anticholinergic-specific deprescribing intervention on cognition in primary care older adults. Results could influence deprescribing methodology and provide new insight on the relationship between anticholinergics and cognition.Trial registrationClinicalTrials.gov NCT04270474. Registered on February 17, 2020.

Effectiveness of Mindfulness-Based Stress Reduction on Anxiety Disorder: A Systematic Review

Anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder, and specific phobias, are significant public health concerns that affect millions worldwide and lead to substantial impairments in daily functioning and quality of life. Traditional treatments may not suit everyone, highlighting the need for alternatives like Mindfulness-Based Stress Reduction (MBSR), which emphasizes mindfulness meditation. This systematic review evaluates the effectiveness of MBSR in reducing anxiety symptoms across various anxiety disorders by synthesizing research findings from studies published between January 2013 and April 2024. A comprehensive search was conducted in electronic databases, including PubMed, Semantic Scholar, ScienceDirect, PsycINFO, and Web of Science, using keywords such as “Mindfulness-Based Stress Reduction,” “MBSR,” “anxiety disorder,” and “effectiveness.” Peer-reviewed studies assessing the efficacy of MBSR on anxiety disorders were included, with data extraction and quality assessment performed following PRISMA 2022 guidelines. The search identified 1095 articles, with 13 studies meeting the inclusion criteria for the final analysis, encompassing a total sample size of 751 participants. The studies varied in design, sample size, participant demographics, and targeted anxiety disorders. Findings consistently showed significant reductions in anxiety symptoms among participants receiving MBSR compared to control groups. For GAD, studies reported improvements in anxiety and stress measures such as the Beck Anxiety Inventory (BAI) and Hamilton Anxiety Rating Scale (HAM-A). For SAD, reductions in social anxiety symptoms were observed, with some studies showing comparable effectiveness to CBT. This review presents compelling evidence supporting the efficacy of MBSR in reducing symptoms associated with anxiety disorders. Future research should focus on the long-term effects, impact on diverse demographic groups, and specific mechanisms to improve its clinical applicability.

Effectiveness and cost-effectiveness of guided self-help for depression for autistic adults: the Autism Depression Trial (ADEPT-2) – protocol for a multicentre, randomised controlled trial of a remotely delivered low-intensity intervention

IntroductionDepression is three to four times more prevalent in autistic people and is related to reduced quality of life. There is a need for empirically supported psychological interventions for depression...

CarersCanADAPT: Study protocol of a stepped care pathway and hybrid type 1 effectiveness-implementation trial of an online cognitive behavioural therapy (iCBT) program for cancer carers with anxiety and depression

BackgroundFamily or friend carers of people with cancer report high levels of depression, anxiety, caregiving strain, and unmet needs. Limited strategies for identification and management of distress have been established among cancer carers. This paper describes the protocol of two linked studies: Study 1a, a distress screening and stepped care pathway feasibility study and Study 1b, a hybrid implementation-effectiveness Randomised Controlled Trial (RCT) to assess the benefit of a comprehensive, carer-centred online Cognitive Behavioural Therapy (iCBT) program for carers with anxiety and depression. MethodsFor Study 1a, 300 cancer carers will be screened for distress. Carers with low distress will be referred to publicly available carer resources. Carers scoring 4 and higher on the distress thermometer will complete depression and anxiety measures. Carers with high anxiety/depression will be recommended psychological therapy. Carers with mild/moderate anxiety and/or depression will be allocated to the Carers iCBT Program, evaluated via a RCT with waitlist control group (Study 1b). For Study 1b, intervention group carers will receive access to a 6-lesson self-directed online iCBT program. Waitlist-controls will access the intervention at 14 weeks. Intervention and control groups will complete baseline, 6 week, and 14 week self-report measures; controls will complete additional measures at 20 and 28 weeks. A sample size of n = 166 carers in the iCBT RCT is needed. ConclusionsIf acceptable, feasible and effective, this pathway and iCBT intervention could offer a sustainable, scalable and low-cost approach to identifying and managing distress in carers, and potentially improving patient and carer outcomes.Trial Registration: Australian and New Zealand Clinical Trial Registry number: ACTRN12623001341617p.

Socioeconomic deprivation and perinatal anxiety: an observational cohort study

BackgroundWomen from areas of social deprivation and minority ethnic groups are more likely to experience poor physical health and have higher rates of mental health problems relative to women from less socially disadvantaged groups. However, very little research has examined this in relation to perinatal anxiety. The current study aims to determine prevalence, risk factors and desire for treatment for perinatal anxiety in three regions of the UK with diverse regional characteristics.MethodsWomen completed measures of anxiety in early, mid-, late-pregnancy and postpartum. Participants were included from three regions of the UK: Region 1 = North East England & North Cumbria n = 512; Region 2 = London North Thames n = 665; Region 3 = West Midlands n = 705.ResultsPrevalence of perinatal anxiety was lower in Region 1 (OR 0.63 95% CI 0.45 to 0.89) and Region 2 (OR 0.72 95% CI 0.52 to 0.98) relative to Region 3. Analysis showed the effect of neighbourhood socioeconomic deprivation on perinatal anxiety differed by region. In more affluent regions, living in a deprived neighbourhood had a greater impact on perinatal anxiety than living in a deprived neighbourhood in a deprived region. Other factors associated with risk of anxiety in the perinatal period included physical health problems and identifying as being from ‘mixed or multiple’ ethnic groups.ConclusionsNeighbourhood deprivation relative to regional deprivation is a better predictor of perinatal anxiety than either regional deprivation or neighbourhood deprivation alone. Women of mixed ethnic backgrounds and women with physical health problems may warrant more attention in terms of screening and support for perinatal anxiety. Self-reported desire for treatment was found to be low.