Panic Symptoms Research Articles

A longitudinal examination of the relation between academic stress and anxiety symptoms among adolescents in India: The role of physiological hyperarousal and social acceptance.

Academic stress is a critical aspect of adolescent experience around the world, but particularly in countries with dense populations that lead to highly competitive college admissions. With a population of over one billion people, the competition for higher education in India is significantly high. Although research has shown that academic pressures are associated with anxiety in adolescents, this work is primarily cross-sectional. The current study examined academic stress and anxiety symptoms over time and assessed physiological hyperarousal as a mediator and social acceptance as a moderator of this relation in a sample of adolescents from India (N= 282, 13-18 years, 84% female). Adolescents completed measures of academic stress, physiological hyperarousal, social acceptance and anxiety symptoms at two-time points, 5 months apart. Findings demonstrate direct effects of academic stress on changes in symptoms of generalised anxiety and panic, as well as indirect effects through physiological hyperarousal. Social acceptance did not moderate the relation, although it uniquely predicted changes in panic disorder symptoms over time. The findings of this study contribute to the scientific understanding of a potential mechanism through which academic stress leads to anxiety among adolescents in India.

Comparing symptom networks of daytime and nocturnal panic attacks in a community-based sample

Nocturnal panic refers to waking in a state of panic without obvious triggers, experiencing the same symptoms as panic attacks that occur while awake. Interrelationships between daytime and nocturnal panic symptoms have not been examined despite theories suggesting panic symptoms perpetuate one another in a forward feedback loop. The current study compared associations between symptoms in daytime and nocturnal panic using network analysis. Network theory conceptualizes symptoms as causing one another, rather than originating from a latent variable (i.e., a disorder). Given that nocturnal panic originates from sleep stages without cognitive activity, cognitive symptoms were expected to be more central in daytime panic networks than nocturnal panic networks. Prior literature indicates similar nocturnal and daytime panic severity; thus, we expected that panic groups would report equivalent panic symptom severity. An online community sample (N = 215) provided panic symptom history. Panic network structures did not differ, although the daytime panic network produced stronger and more numerous connections between physical and cognitive symptoms. The nocturnal panic group, however, reported more severe cognitive symptoms than the daytime panic group. These results challenge biologically-focused nocturnal panic theories and suggest a more significant role of cognitive symptoms in perpetuating nocturnal panic attacks once the individual awakens.

Comparison of the Effectiveness of Cognitive Behavioral Therapy and Training of Diaphragmatic Respiratory Exercises on Panic Symptoms in Women with Asthma

Comparison of the Effectiveness of Cognitive Behavioral Therapy and Training of Diaphragmatic Respiratory Exercises on Panic Symptoms in Women with Asthma

The Implications of the Diving Response in Reducing Panic Symptoms.

Increased CO2 sensitivity is common in panic disorder (PD) patients. Free divers who are known for their exceptional breathing control have lower CO2 sensitivity due to training effects. This study aimed to investigate the immediate effects of cold facial immersion (CFI), breath holding and CO2 challenges on panic symptoms. Healthy participants and patients with PD were subjected to four experimental conditions in a randomly assigned order. The four conditions were (a) breath-holding (BH), (b) CFI for 30 s, (c) CO2 challenge, and (d) CO2 challenge followed by CFI. Participants completed a battery of psychological measures, and physiological data (heart rate and respiration rate) were collected following each experimental condition. Participants with PD were unable to hold their breath for as long as normal controls; however, this finding was not significant, potentially due to a small sample size. Significant reductions in both physiological and cognitive symptoms of panic were noted in the clinical group following the CFI task. As hypothesized, the CFI task exerted demonstrable anxiolytic effects in the clinical group in this study by reducing heart rate significantly and lessening self-reported symptoms of anxiety and panic. This outcome demonstrates the promise of the CFI task for clinical applications.

Generalised anxiety and panic symptoms in the German National Cohort (NAKO)

Objectives Anxiety disorders (AD) are common in the general population, leading to high emotional distress and disability. The German National Cohort (NAKO) is a population-based mega-cohort study, examining participants in 16 German regions. The present study includes data of the first 101,667 participants and investigates the frequency and severity of generalised anxiety symptoms and panic attacks (PA). Methods The Generalised Anxiety Disorder Symptoms Scale (GAD-7) and the first part of the Patient Health Questionnaire Panic Disorder (PHQ-PD) were filled out by NAKO participants (93,002). We examined the correlation of GAD-7 and PHQ-PD with demographic variables, stress (PHQ-Stress), depression (PHQ-9) and childhood trauma (CTS). Results The total proportion of prior lifetime diagnoses of AD in the NAKO cohort reached 7.8%. Panic attacks were reported by 6.0% and possible/probable current GAD symptoms in 5.2% of the examined participants. Higher anxiety severity was associated with female sex, lower education level, German as a foreign language and younger age as well as high perceived stress and depression. Conclusions Clinically relevant GAD symptoms as well as panic attacks are frequent in the NAKO and are associated with sociodemographic factors, and high anxiety symptoms are accompanied by pronounced stress and depression levels.

Defensive Mobilization During Anticipation of Symptom Provocation: Association With Panic Pathology

BackgroundAnxious apprehension about feared body symptoms is thought to play a crucial role in the development, chronicity, and treatment of panic disorder (PD). In this study, we therefore aimed to elucidate the role of defensive reactivity to anticipated unpleasant symptoms in PD that can contribute to a better understanding of pathomechanisms of PD as well as identification of potential targets in PD-focused interventions. By measuring amygdala-dependent potentiation of the startle reflex, we aimed to investigate whether 1) patients with PD exhibit a specifically increased defensive reactivity to anticipated unpleasant body symptoms and 2) whether clinical severity of panic symptomatology varies with magnitude of defensive activation. MethodsDefensive mobilization to anticipated threat was investigated in 73 patients with a primary diagnosis of PD with agoraphobia (PDA) and 52 healthy control subjects. Threat of symptom provocation was established by a standardized hyperventilation task and contrasted to threat of shock to the forearm of the participant. ResultsPatients with PDA and healthy control subjects did not differ in their defensive responses during anticipation of shock. In contrast, patients with severe PDA as compared with healthy control subjects exhibited increased defensive response mobilization and reported more anxiety and panic symptoms during anticipation of feared body symptoms. Moreover, startle potentiation during anticipation of hyperventilation covaried with the severity of panic symptomatology. ConclusionsThe present findings suggest that increased defensive mobilization during anticipation of body symptoms is a neurobiological correlate of severe PDA that should be specifically targeted in PD interventions and might be used to monitor treatment success.

Effectiveness of Self-Guided Virtual Reality-Based Cognitive Behavioral Therapy for Panic Disorder: Randomized Controlled Trial.

BackgroundVirtual reality (VR) is as effective a technique as traditional cognitive behavioral therapy (CBT) and a promising tool for treating panic disorder symptoms because VR exposure can be safer and has better acceptability than in vivo exposure and is more immersive than exposure through imagination. CBT techniques can be delivered more effectively using VR as well. So far, VR has required high-quality devices, but the development of mobile VR technology has improved user availability. At the same time, a well-structured form of VR can be reproduced and used anywhere. This means that VR can be used to provide a self-guided form of treatment and address the high treatment costs of evidence-based therapy and the lack of professional therapists. This study aimed to investigate the potential of self-guided VR as an alternative to high-cost treatment.ObjectiveThe main goal of this study was to offer data about the efficacy of a mobile app-based self-led VR CBT in the treatment of panic disorder.MethodsA total of 54 subjects with panic disorder were enrolled in this study and randomly assigned to either the VR treatment group or waitlist group. The VR treatment was designed to be total 12 sessions for 4 weeks. The VR treatment consists of 4 steps in which patients are gradually exposed to phobic stimuli while learning to cope with panic symptoms in each stage. The effectiveness of treatment was assessed through the Panic Disorder Severity Scale, Hamilton Rating Scale for Depression, Body Sensations Questionnaire, Albany Panic and Phobia Questionnaire, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, Korean Inventory of Social Avoidance and Distress Scale, Korean Inventory of Depressive Symptomatology, and Perceived Stress Scale. In addition, physiological changes using heart rate variability were evaluated.ResultsIn within-group analyses, the VR treatment group exhibited improvements in panic disorder symptoms, anxiety, and depression after 4 weeks, while the waitlist group did not show any significant improvement. Compared to the waitlist group, the VR treatment group showed significantly greater improvements in the Panic Disorder Severity Scale in both completer analysis and intention-to-treat analysis. Heart rate variability in the VR treatment group showed improvement in normalized high frequency from baseline to postassessment with no significant differences in any outcome measure between groups.ConclusionsThe self-guided, mobile app-based VR intervention was effective in the treatment of panic symptoms and restoring the autonomic nervous system demonstrating the validity of the use of VR for self-guided treatment. VR treatment can be a cost-effective therapeutic approach.Trial RegistrationClinicalTrials.gov NCT04985019; https://clinicaltrials.gov/ct2/show/NCT04985019

Adolescents’ Concerns About School Violence or Shootings and Association With Depressive, Anxiety, and Panic Symptoms

The prevalence of internalizing problems among US adolescents has risen in the past decade. The extent to which concerns about school violence or shootings are associated with risk of internalizing problems is unknown. To examine the prospective association of concern, worry, and stress related to school violence or shootings with internalizing problems and to examine sex and racial and ethnic differences in the magnitude of the associations. This longitudinal cohort study involved 3 surveys administered 6 months apart (fall of grade 11 [prebaseline]; spring of grade 11 [baseline]; and fall of grade 12 [follow-up]) from 2015 to 2016. Participants included 2263 students from 10 high schools in Los Angeles, California. Analyses were performed from April 29, 2020, to April 8, 2021. Baseline self-reported level of concern, worry, and stress about shootings or violence at the student's school or other schools, each rated on 5-point scales (ranging from not at all [0] to extremely [4]) with a mean score calculated as a 3-item composite index rescaled into z-score standard deviation units. Surpassing clinically significant or borderline significant thresholds for major depressive disorder, generalized anxiety disorder, or panic disorder based on symptom ratings on the Revised Children's Anxiety and Depression Scale at 6-month follow-up. Of the 2263 students included in the analyses (1250 [55.2%] girls; mean [SD] age, 16.5 [0.4] years), appreciable proportions reported being very or extremely concerned (850 0f 2226 [38.2%]), worried (703 of 2209 [31.8%]), or stressed (332 of 2183 [15.2%]) about shootings or violence at their school or other schools. After adjusting for prebaseline covariates, concerns about school violence or shootings were associated with clinically significant generalized anxiety symptoms (odds ratio [OR], 1.31; 95% CI, 1.15-1.50) and panic symptoms (OR, 1.18; 95% CI, 1.05-1.32), but not depressive symptoms (OR, 1.13; 95% CI, 0.99-1.30) at the 6-month follow-up. There was a significant association between concern with school violence or shootings and depressive symptoms for Black youth (OR, 3.15; 95% CI, 1.38-7.19) and non-Hispanic/Latinx White youth (OR, 1.62 [95% CI, 1.25-2.09]) but not for youth of other races and ethnicities (OR for Asian, 1.26 [95% CI, 0.86-1.85]; OR for Hispanic/Latinx, 0.94 [95% CI, 0.76-1.16]; OR for other, 0.93 [95% CI, 0.54-1.61]). Sex did not moderate these associations. The findings of this study suggest that concern, worry, and stress related to school violence or shootings may be risk factors for internalizing problems among adolescents, with variation in the strength of the association by race/ethnicity.

Effect of a Biofeedback Intervention on Heart Rate Variability in Individuals With Panic Disorder: A Randomized Controlled Trial.

Some individuals with panic disorder (PD) display reduced heart rate variability (HRV), which may result in an increased risk of cardiovascular mortality. Heart rate variability-biofeedback (HRV-BF) training has been shown to improve the modulation of the autonomic activity. Therefore, this randomized controlled trial was conducted to investigate the effect of a 4-week HRV-BF intervention in individuals with PD. HRV-BF training improved the modulation of the autonomic activity. Therefore, with this randomized controlled trial, we aimed to investigate the effect of a 4-week HRV-BF intervention in people with PD. Thirty-six women and 16 men with PD (mean age = 35.85 [15.60] years) were randomly allocated either to HRV-BF with 0.1-Hz breathing as intervention group or to HRV-Sham-BF as active control group. HRV-BF was performed for 4 weeks, whereas HRV was measured both during a short-term resting condition and during a paced breathing condition before and after intervention. HRV-BF with 0.1-Hz breathing increased HRV and reduced panic symptoms in individuals with PD. HRV-BF with 0.1-Hz breathing demonstrated an increase in the time and frequency domain parameters of HRV during the short-term resting condition (ΔPost-Pre root mean square successive differences: 5.87 [14.03] milliseconds; ΔPost-Pre standard deviation of all NN intervals: 11.63 [17.06] milliseconds; ΔPost-Pre total power: 464.88 [1825.47] milliseconds2; ΔPost-Pre power in low-frequency range 0.04-0.15 Hz: 312.73 [592.71] milliseconds2), a decrease in the heart rate during the paced breathing condition (ΔPost-Pre: -5.87 [9.14] beats/min), and a decrease in the Panic and Agoraphobia Scale (ΔPost-Pre: -3.64 [6.30]). There was no intervention effect in the HRV-Sham-BF group. HRV-BF as a noninvasive and nonpharmacological treatment seems to be an important intervention option to improve reduced HRV and decrease panic symptoms in individuals with PD. Future studies are needed to establish whether these effects translate to reductions in the risk of cardiovascular disease in PD.

Altering Dynamics of Autonomic Processing Therapy (ADAPT) trial: a novel, targeted treatment for reducing anxiety in joint hypermobility

BackgroundHypermobility is a poorly recognised and understood musculoskeletal disorder thought to affect around 20% of the population. Hypermobility is associated with reduced physiological and psychological functioning and quality of life and is a known risk factor for the development of an anxiety disorder. To date, no evidence-based, targeted treatment for anxiety in the context of hypermobility exists. The present intervention (ADAPT—Altering Dynamics of Autonomic Processing Therapy) is a novel therapy combining bio-behavioural training with cognitive approaches from clinical health psychology targeting the catastrophisation of internal sensations, with aim to improve autonomic trait prediction error.MethodEighty individuals with diagnosed hypermobility will be recruited and the efficacy of ADAPT to treat anxiety will be compared to an Emotion-Focused Supportive Therapy (EFST) comparator therapy in a randomised controlled trial. The primary treatment target will be post therapy score on the Beck Anxiety Inventory, and secondary outcomes will also be considered in relation to interoception, depression, alexithymia, social and work adjustment, panic symptoms and dissociation. Due to COVID restrictions, the intervention will be moved to online delivery and qualitative assessment of treatment tolerance to online therapy will also be assessed.DiscussionOnline delivery of an intervention targeting anxiety would improve the quality of life for those experiencing anxiety disorder and help to reduce the £11.7 billion that anxiety disorders cost the UK economy annually.Trial registrationWorld Health Organization ISRCTN17018615. Registered on 20th February 2019; trial protocol version 2

The association of obsessive-compulsive disorder, anxiety disorders, and posttraumatic stress disorder with impairment related to eating pathology

Prior work has shown a number of similarities between obsessive-compulsive disorder (OCD) and eating disorders such as perfectionism and depressive symptoms. However, distress and impairment due to eating pathology are also highly comorbid with other disorders, which brings into question whether the relationship with eating pathology is unique to OCD. The aims of the current study were 1) to test perfectionism and depression as mediators of the relationship between OCD and eating pathology, and 2) to determine whether OCD is related to greater distress/impairment regarding eating habits, exercising, or feelings about eating, shape, or weight above and beyond other disorders. Symptoms were assessed in 329 treatment-seeking patients in a secondary analysis of a clinical battery. The results showed that depressive symptoms and perfectionism were found to mediate the relationship between OCD and eating pathology. Additionally, a regression analysis showed that OCD, social anxiety disorder, and panic disorder symptoms were associated with eating pathology to a greater extent than other disorders. These results suggest that distress and impairment related to eating habits, exercising, or feelings about eating, shape, or weight are not unique to OCD and that depression and perfectionism may, in part, explain the association between OCD and eating pathology.

A fog assisted intelligent framework based on cyber physical system for safe evacuation in panic situations

In the current scenario of the COVID-19 pandemic and worldwide health emergency, one of the major challenges is to identify and predict the panic health of persons. The management of panic health and on-time evacuation prevents COVID-19 infection incidences in educational institutions and public places. Therefore, a system is required to predict the infection and suggests a safe evacuation path to people that control panic scenarios with mortality. In this paper, a fog-assisted cyber physical system is introduced to control panic attacks and COVID-19 infection risk in public places. The proposed model uses the concept of physical and cyber space. The physical space helps in real time data collection and transmission of the alert generation to the stakeholders. Cyberspace consists of two spaces, fog space, and cloud-space. The fog-space facilitates panic health and COVID-19 symptoms determination with alert generation for risk-affected areas. Cloud space monitors and predicts the person’s panic health and symptoms using the SARIMA model. Furthermore, it also identifies risk-prone regions in the affected place using Geographical Population Analysis. The performance evaluation acknowledges the efficiency related to panic health determination and prediction based on the SARIMA with risks mapping accuracy. The proposed system provides an efficient on time evacuation with priority from risk-affected places that protect people from attacks due to panic and infection caused by COVID-19.

Effectiveness of selected nursing interventions on Fatigue and Quality of life among Chronic Renal Failure patients undergoing Hemodialysis in a selected hospital at Madurai

Title: Effectiveness of selected nursing interventions on fatigue and quality of life among Chronic Renal Failure Patients undergoing Hemodialysis in a selected hospital at Madurai. Background: Non communicable diseases are increasing day by day. Health is wealth is an old saying, which is realised by people who has CKD today. As their wealth is reduced by treating the disease throughout their life time, the restrictions in food and fluid impose lot of stress, affects their Quality of life. Nearly 10% of the populations were affected by CKD and millions of them die each year because they could not afford the treatment. Hemodialysis has been proved to be the effective treatment modality. It results in a marked change in the QOL, due to number of modifications and restrictions, which affect patient’s psychological and physiological wellbeing. Dialytic nurses can play a crucial role in enhancing quality of life and reducing fatigue level through exercises and teaching. Aim: The aim of the study was to evaluate the effectiveness of selected nursing interventions on fatigue and quality of life (QOL) among chronic renal failure patients undergoing hemodialysis in a selected hospital at, Madurai. Methodology: Quasi experimental non-equivalent pretest and post-test control group design was used for the study. The study was conducted in patients undergoing hemodialysis in selected hospital at Madurai. A total of 100 patients were selected using convenient sampling technique. Tools used were Piper Fatigue Scale (PFS) and SF 36 World Health Organisation BREF QOL (SF36 WHO BREF QOL) interview scale. The therapeutic nursing intervention which includes planned teaching about care of patient with haemodialysis, demonstration of dialytic exercises, dietary management, adherence to medication, follow up, teaching on sexual relationship were administered over 4 days in a week for 4 consecutive weeks. Data was analysed using descriptive and inferential statistics. Results: The therapeutic nursing interventions were effective in improving quality of life and reducing fatigue level. Pre-test with 15th day post-test fatigue scores comparison [t =23.05, P(< 0.001)] , Comparison of pre-test with 30th day post-test fatigue scores [t =41.19, P(< 0.001)], Comparison between 15th and 30th day post-test fatigue scores [t= 25.58, P(<0.001)], Comparison of pre-test with 15th day post-test level of quality of life score [t =16.32, P(<0.001)], Comparison of pre-test with 30th day post-test level of quality of life score [t=23.76; P(<0.001)], Comparison between 15th and 30th day post-test quality of life score [t = -15.19, P(<0.001)]. The problems reported by the people were, physiological problems such as anaemia, muscle cramping, difficulty sleeping, itching, fatigue, neurological disturbances, cognitive impairment, Sexual dysfunction and psychological problems such as depression, feeling of loneliness, sadness, problems with adjustment, lack of love and affection, suicidal behaviour, delirium, anxiety and panic symptoms. The post tests in experimental group, the correlation between fatigue and quality of life in post-test-1 (15th day) was r = - 0.372 and it was significant at p = 0.008. Similarly, the correlation between fatigue and quality of life in post-test - 2 (30th day) was r = -0.370 and it was significant at p=0.008. Conclusion: The problems of the people vary from person to person, study findings concluded that, selected nursing interventions are effective intervention to improved Quality of life and reduced fatigue level. There is a real need for nurses to provide physical, mental and social support to treat the health problems and to heighten their spirit.

Error-related negativity predicts increases in anxiety in a sample of clinically anxious female children and adolescents over 2 years.

Background:An increased neural response to making errors has emerged as a biomarker of anxiety. Error negativity (Ne) or error-related negativity (ERN) is an event-related potential generated when people commit errors; the Ne/ERN is greater among people with anxiety and predicts increases in anxiety. However, no previous study has examined whether the Ne/ERN can be used as a prognostic indicator among people with current anxiety. The present study addressed this gap by examining whether the Ne/ERN prospectively predicts increases in anxiety symptoms in clinically anxious children and adolescents.Methods:The sample included 34 female participants between the ages of 8 and 14 years who met the criteria for a clinical anxiety disorder based on clinical interview. The Ne/ERN was measured using a flanker task.Results:Increased Ne/ERN at baseline predicted increases in total anxiety symptoms 2 years later, even when accounting for baseline symptoms. The Ne/ERN predicted increases in the symptom domains of generalized anxiety, social anxiety and harm avoidance/perfectionism, but not panic, separation anxiety, school avoidance or physical symptoms.Limitations:The sample size was small, which may have inflated the false discovery rate. To mitigate this possibility, we used multiple self-report measures, and the results for the 2 measures (as well as their symptom domains) converged.Conclusion:These data suggest that the Ne/ERN can delineate specific risk trajectories, even among those who already meet the criteria for a clinical anxiety disorder. Considering the need for prognostic markers among people with clinical anxiety, the current findings are an important and novel extension of previous work.

Virtual reality exposure therapy in panic disorder: a pilot study

AimsTo ascertain if virtual reality exposure therapy (VRET) is an effective add-on tool in the treatment of Panic Disorder (PD).BackgroundThe exposure to virtual stimuli has been studied as a useful treatment for PD. However, the studies with PD are still scarce and use dissimilar protocols, with effectiveness varying according to the protocol applied.MethodEight PD patients received VRET as an add-on treatment to pharmacotherapy. The treatment protocol consisted of eight sessions. The first session is for the patient to understand the treatment and to answer the questionnaires. The second and third sessions were to prepare the patients for exposures with breathing training using diaphragmatic breathing and others breathing techniques to manage anxiety. From the fourth to eighth sessions, the patients followed a hierarchy of tasks during virtual reality exposure. Clinicians rated the Clinical Global Impression Scale (CGI) and the Panic Disorder Severity Scale (PDSS). The patients rated the Diagnostic Symptom Questionnaire (DSQ); the Mobility Inventory (MI), the Anxiety Sensibility Index (ASI-R), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the WHOQOL-BREF before and after the protocol. After all exposures, the Igroup Presence Questionnaire (IPQ) was applied to measure the sense of presence experienced in the virtual environment. The virtual environment simulated the subway of Rio de Janeiro.ResultThere were no statistically significant improvements in the CGI-S, PDSS, BAI, MI or WHOQOL. There was a significant improvement in the BDI scores (P = 0.033). There was a trend towards improvement of anxiety measured by the ASI-R (P = 0.084) and of panic symptoms measured by the DSQ (P = 0.081) scores. There was also a significant improvement of sense of presence (IPQ – general presence) through the exposure sessions.ConclusionOur study demonstrated that VRET as an add-on to pharmacological therapy could benefit PD patients. Despite the lack of significant differences in the means, the dispersion of PDSS and BAI scores were smaller after treatment compared to before treatment, suggesting that patients with more severe anxiety, panic and agoraphobia symptoms benefited more of the VRET protocol so, at the end of the treatment, differences were found in important measures of panic. Randomized controlled clinical trials are warranted to confirm the efficacy of VRET.This study was funded by the Brazilian National Council for Scientific Development (Cnpq). The authors report no conflicts of interest.

Symposium Abstracts

Background: The countermeasures used to mitigate the COVID-19 pandemic might have impacted the mental health of populations around the world. Methods: We used data from the Brazilian Longitudinal Study of Health (ELSA-Brasil), a prospective cohort, to characterize the mental health of participants between 2018 (wave-3) and 2020 (wave-COVID). The Clinical Interview Scheduled-Revised (CIS-R), a validated questionnaire, was used to assess the prevalence of common mental disorders (CMDs). The electronic survey was applied online in May-July 2020, during a severe quarantine phase in Satild;o Paulo. Results: Out of 4191 participants from wave-3, 2117 responded the questionnaire. Most were women, white, had a university degree and presented a mean age of 60 years-old. 517 (24.4%) presented at least one CMD, the most common being anxiety disorders (15.1%), mixed anxiety and depressive disorder (8.5%) and depressive disorders (2.8%). Such prevalence were not significantly different than at wave-3. Moreover, we observed a statistically significant increase in depressive ideas (9.7% to 12.3%, p = 0.001), sleep disturbances (31.8% to 35.1% p = 0.005), and phobic symptoms (9.8% to 12.7%, p = 0.001), and a decrease of fatigue and obsessive symptoms. No significant changes in somatic complaints, worries about physical health, worries, anxiety, panic symptoms, concentration, depression, irritability, and compulsion symptoms were observed. Conclusions: No changes in the prevalence of CMDs was observed in participants from Satild;o Paulo during a strict lockdown phase, although the pattern of mental symptoms presented subtle changes. A longer observational period might be necessary to detect a putative increase in the prevalence of psychiatric disorders.

Ethical Challenges in the Treatment of Anxiety.

Ethical Challenges in the Treatment of Anxiety.

Testing Invariance of Measures of Internalizing Symptoms Before and After a Major Life Stressor: The Impact of COVID-19 in an Adolescent and Young Adult Sample.

There are reports of increases in levels of internalizing psychopathology during the COVID-19 pandemic. However, these studies presume that measurement properties of these constructs remained unchanged from before the pandemic. In this study, we examined longitudinal measurement invariance of assessments of depression, anxiety, and intolerance of uncertainty (IU) in adolescents and young adults from ongoing longitudinal studies. We found consistent support for configural and metric invariance across all constructs, but scalar invariance was unsupported for depression and IU. Thus, it is necessary to interpret pandemic-associated mean-level changes in depression and IU cautiously. In contrast, mean-level comparisons of panic, generalized, and social anxiety symptoms were not compromised. These findings are limited to the specific measures examined and the developmental period of the sample. We acknowledge that there is tremendous distress accompanying disruptions due to the COVID-19 outbreak. However, for some instruments, comparisons of symptom levels before and during the pandemic may be limited.

Calling out the COVID blues- how much of a psychological impact does the COVID-19 pandemic have on health care professionals in India

Background: COVID-19 pandemic is one of the rarest health crises the world has ever encountered. As mental health professionals; we need to consider the psychological impact of the pandemic. There are certain groups of people that are largely more vulnerable to pernicious effects on mental health including frontline healthcare workers. Hence, the current study was undertaken look into the minds of our covid warriors.
 Aims and Objectives: This study aims to assess psychological impact of COVID-19 pandemic among health care professionals, with the primary objectives being to study: 1. Perceived stress regarding COVID-19 pandemic among health care professionals. 2. Stigma associated with the pandemic, faced by health care professionals in their surroundings as well as in the society. 3. Obsessive-Compulsive symptoms among the health care professionals. The secondary objective of the study is to compare between High and Low exposure groups on the basis of different variables.
 Materials and Methods: This study is an observational, cross-sectional study wherein the sample size is 410, taken by consequent sampling. Data was collected from health care professionals all over India, by manual or digital interview. Health care professionals of a tertiary care hospital were taken up for the study including doctors, nurses and other hospital staff.
 Results: On K10 scale, 369 (90%) of the subjects had scores below 25, meaning they reported to have no or mild perceived stress, whereas 41 of them (10%) had scores 25 or above, meaning to have moderate or severe perceived stress. Forty (9.8%) subjects reported to be experiencing panic symptoms at the time of the interview. One hundred twenty-eight (31.2%) admitted to have faced stigma from the society in at least one of the facets of the questionnaire based on SARI stigma scale. 39 people (9.5%) reported to be experiencing OC symptoms at the time of interview.
 Conclusion: With this research we conclude that owing to the ongoing COVID-19 pandemic, the health care professionals are under a lot of stress, many of them have also experienced panic like symptoms. Large scale screenings should be carried out at regular intervals at hospitals to keep a check on the mental health of health care workers. Mental health should be given a priority by the government officials and sufficient awareness campaigns should be rolled out.

Cognitive processes associated with emotional disorders: implications for efficient psychological treatments

Background Emotional disorders (EDs) are the most prevalent worldwide. Despite psychotherapies are their treatment of choice, there are difficulties to apply them properly in mental health services. Since literature shows that cognitive processes are associated with anxiety and depressive symptoms, more information is needed in order to improve psychological treatments. Aims To determine the relation between cognitive factors with specific and non-specific ED symptoms in order to promote the development of accurate psychological treatments. Methods We analyzed the relation between rumination, worry, and metacognition with generalized anxiety, panic, and depression disorder symptoms from a clinical sample of 116 individuals through correlation and linear regression analyses. Results Although each specific disorder had a closer link with a particular cognitive process, all general ED symptoms were associated with the three cognitive factors studied. Conclusions For “pure” disorders, targeting a concrete cognitive process might be an optimal therapeutic option. However, due to the high comorbidity among EDs, we support the dissemination of the transdiagnostic treatment approach in which all cognitive factors are taken into account.