Phobic Symptoms Research Articles

Pattern of anxiety, insecurity, fear, panic and/or phobia observed by quantitative electroencephalography (QEEG).

Stress is a response in which an individual wants to have more control over a situation. A constant state of stress is called anxiety. Some patients deny symptoms. An instrument can help arrive at a diagnosis.Objective:Using TQ-7 QEEG, this study aimed to evaluate the association of symptoms of anxiety, insecurity, fear, panic and phobia with hot temporals defined as Beta (15-23 Hz) >17% and High-Beta waves (23-38 Hz) >10% at T3 and T4.Methods:Five hundred and forty-three patients of both genders with ages ranging from 16-59 years were evaluated, divided into two groups: Control (without hot temporals: n=274) and Case Group (with hot temporals: n=269). The Chi-square test was used (p-values ≤0.05).Results:There was a significant association (p-value <0.001) between the symptoms related to amygdala activation, expressed in the temporals (Beta >17% and High-Beta >10%). (Anxiety, T3=89.6% - T4=88.8%; T3=92.6% - T4=93.3%), (Fear, T3=80.7% - T4=84.4%; T3=82.9% - T4=95.9%), (Insecurity, T3=82.2% - T4=81.4%; T3=69.5% - T4=97.8%), (Panic, T3=52.4 - T4=72.5%; T3=90.3% - T4=74.0%), (Phobia, T3=17.5% - T4=22.7%; T3=19.7% - T4=27.1%), when compared to the respective controls (Beta control, T3=8.4%, 10.2%, 21.2%, 1.1%, 0.4% and T4=11.3%, 4.4%, 23.0%, 2.6%, 1.1%) (High-Beta control, T3=4.0%, 6.9%, 6.2%, 0.4%, 0.0% and T4=17.5%, 6.2%, 3.3%, 4.0%, 0.7%).Conclusion:Anxiety, insecurity, fear, panic and phobia are observed by QEEG when the levels of total Beta >17% and High-Beta waves >10% at T3 and T4.

Association between attention bias to threat and anxiety symptoms in children and adolescents.

Considerable research links threat-related attention biases to anxiety symptoms in adults, whereas extant findings on threat biases in youth are limited and mixed. Inconsistent findings may arise due to substantial methodological variability and limited sample sizes, emphasizing the need for systematic research on large samples. The aim of this report is to examine the association between threat bias and pediatric anxiety symptoms using standardized measures in a large, international, multi-site youth sample. A total of 1,291 children and adolescents from seven research sites worldwide completed standardized attention bias assessment task (dot-probe task) and child anxiety symptoms measure (Screen for Child Anxiety Related Emotional Disorders). Using a dimensional approach to symptomatology, we conducted regression analyses predicting overall, and disorder-specific, anxiety symptoms severity, based on threat bias scores. Threat bias correlated positively with overall anxiety symptoms severity (ß=0.078, P=.004). Furthermore, threat bias was positively associated specifically with social anxiety (ß=0.072, P=.008) and school phobia (ß=0.076, P=.006) symptoms severity, but not with panic, generalized anxiety, or separation anxiety symptoms. These associations were not moderated by age or gender. These findings indicate associations between threat bias and pediatric anxiety symptoms, and suggest that vigilance to external threats manifests more prominently in symptoms of social anxiety and school phobia, regardless of age and gender. These findings point to the role of attention bias to threat in anxiety, with implications for translational clinical research. The significance of applying standardized methods in multi-site collaborations for overcoming challenges inherent to clinical research is discussed.

Effects of Relaxation Therapy on Anxiety Disorders: A Systematic Review and Meta-analysis

To explore the effect of relaxation therapy applied to people with anxiety disorders. Systematic review with meta-analysis. Sixteen Randomized Control Trials (RCTs) were included for meta-analysis to determine the effect of relaxation therapy. The overall effect of relaxation therapy on symptom of anxiety was significant with Hedges' g=0.62 (95% CI: 0.42-0.81), which indicates a medium-high effect; heterogeneity was statistically significant with I2=48.84. Subgroup analysis exploring the possible causes of heterogeneity found that types of comparison of TAU and CBT was significant (Q=4.20, p=0.04). The effect of relaxation therapy on symptoms of depression, phobia, and worry was significant; Hedges' g=0.44 (95% CI: 0.30-0.59), 0.40 (95% CI: 0.06-0.75), 0.54 (95% CI: 0.28-0.79), respectively. The results of this study provide evidence for the effectiveness of relaxation therapy for people with anxiety disorders. Therefore, relaxation therapy can be selected as a useful intervention for reducing negative emotions in people with anxiety disorders.

Prevalence of Social Phobia among Medical Students in Saudi Arabia

Background: Social phobia is the second most common type of anxiety disorders. It is A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating. The symptoms of social phobia including nausea, slurred speech and palpitations. It can negatively affect the activity of the person. Persons with social phobia have a negative effect on social relationships and impairments in work performance. Social phobia prevalence varies between different countries and cultures. Aim:To estimate the prevalence of social phobia among medical students in Saudi Arabia. Methods:This study was conducted by using SPIN structured questionnaire and it included 1447 of medical students from different educational years. The questionnaire involved 17 questions, the total score referred to the different severity of the disease that ranged from no disease to very severe. Results: The female percent was 61.7% and male percent was 38.3%. Students from the 7th medical year represented the large majority of participants 25.4%. The mean score of social phobia was 37.95 ±14.17. The prevalence of mild grade of social phobia was 29%, moderate represented 24.3%, sever grade represented 19.1% and very severe represented 19.8%, higher percent of females 20.3% suffered very sever social phobia than males (19%). There was a significant difference regarding different social phobia grades and the medical years of students (P-value=0.004). Conclusion:There was a mild prevalence of social phobia between medical students with no significant difference between males and females regarding different grades of social phobia.

Uric acid in major depressive and anxiety disorders

BackgroundUric acid has neuroprotective effects, owing to its antioxidant properties. Lowered antioxidant capacity, causing increased oxidative stress, may be involved in affective disorders and might be altered by antidepressants. This study investigated the association of plasma uric acid, the greatest contributor to blood antioxidant capacity, with major depressive disorder (MDD) and anxiety disorders. MethodsData were from the Netherlands Study of Depression and Anxiety including patients with current (N = 1648), remitted (N = 609) MDD and/or anxiety disorders (of which N = 710 antidepressant users) and 618 controls. Diagnoses were established with the Composite International Diagnostic Interview. Symptom severity was assessed with the Inventory of Depressive Symptoms-Self Report, Beck Anxiety Inventory and Fear Questionnaire. Uric acid was measured in plasma. Analyses were adjusted for sociodemographic, health and lifestyle variables. ResultsPlasma uric acid adjusted mean levels were lower in current MDD and/or anxiety disorder(s) (289μmol/l) compared to remitted disorders (298μmol/l, p < .001) and controls (299μmol/l, p < .001; Cohen's d .10). This finding was independent of antidepressant use. Depressive (β-.05, p = .0012), anxiety (β-.04, p = .009) and phobic (β-.03, p = .036) symptom severity, and symptom duration (β-.04, p = .009) were negatively associated with uric acid. LimitationsLimitations include the lack of data on dietary intake which could be a potential confounding factor. From these cross-sectional findings, the association between uric acid and psychopathology cannot be inferred to be causal. ConclusionThis large scale study finds plasma uric acid levels are lower in current, but not remitted, MDD and/or anxiety disorders, according to a dose-response gradient. This suggests the involvement of decreased antioxidant status in affective disorders, and points to their potential as an avenue for treatment.

Ketamine for Social Anxiety Disorder: A Randomized, Placebo-Controlled Crossover Trial.

Many patients with social anxiety disorder (SAD) experience inadequate symptom relief from available treatments. Ketamine is a potent N-methyl-D-aspartate receptor antagonist with a potentially novel mechanism of action for the treatment of anxiety disorders. Therefore, we conducted a double-blind, randomized, placebo-controlled crossover trial in 18 adults with DSM-5 SAD and compared the effects between intravenous ketamine (0.5 mg/kg over 40 min) and placebo (normal saline) on social phobia symptoms. Ketamine and placebo infusions were administered in a random order with a 28-day washout period between infusions. Ratings of anxiety were assessed 3-h post-infusion and followed for 14 days. We used linear mixed models to assess the impact of ketamine and placebo on anxiety symptoms. Outcomes were blinded ratings on the Liebowitz Social Anxiety Scale (LSAS) and self-reported anxiety on a visual analog scale (VAS-Anxiety). We also used the Wilcoxon signed-rank test to compare the proportion of treatment responders. Based on prior studies, we defined response as a greater than 35% LSAS reduction and 50% VAS-Anxiety reduction. We found ketamine resulted in a significantly greater reduction in anxiety relative to placebo on the LSAS (Time × Treatment: F9,115=2.6, p=0.01) but not the VAS-Anxiety (Time × Treatment: F10,141=0.4, p=0.95). Participants were significantly more likely to exhibit a treatment response after ketamine infusion relative to placebo in the first 2 weeks following infusion measured on the LSAS (33.33% response ketamine vs 0% response placebo, Wilcoxon signed-rank test z=2.24, p=0.025) and VAS (88.89% response ketamine vs 52.94% response placebo, Wilcoxon signed-rank test z=2.12, p=0.034). In conclusion, this proof-of-concept trial provides initial evidence that ketamine may be effective in reducing anxiety.

PREVALENCE OF SOCIAL ANXIETY IN STUDENTS OF COLLEGE OF EDUCATION – UNIVERSITY OF GARMIAN

INTRODUCTION:We are social beings and always in emotional need for social communication, but this connection is not easily possible for all. Such factors as lack of self-confidence, fear of rejection, criticism, etc. cause people feel anxious in social situations. The anxiety, in severe cases, becomes a disorder called social phobia or social anxiety disorder (American Psychiatry Association, 2013).This is one of the prevalent disorders which shows comorbidity with other psychiatric disorders. Social anxiety disorder imposes negative effects on different aspects of patient's life, including educational, social, family and interpersonal relationships dimensions (Taylor and et al., 2016). The disorder causes a persistent fear of social situations in which person may be embarrassed when exposed to unfamiliar people or under observation of others (Ghaedi and et al., 2010). Therefore, people with social phobia may avoid such situations or experience a lot of tension at work.Due to undesirable process and prognosis of the disorder, psychologists and psychiatrists have recently concentrated on this disorder (Morrison and et al., 2016). The epidemiological studies showed that the prevalence of social anxiety disorder in lifetime is 13.3 %. After major depression disorder and alcohol dependence, this disorder is the third most common disorder in the general population and it is also the most prevalent anxiety disorder (Menezes and et al., 2011).One of the most common symptoms of social phobia is fear of speaking in front of people. Studies show that 89.4% of people with social anxiety are afraid of speaking to others which is the most common fear factor in these people (Faravelli and et al., 2000). In college, this is normally more important since s/he is required to speak against others and to participate in social activities more than before. In fact, college years are the last years of adolescence, consequently, the other people's opinions are more important for them. That is why people with high self-expectations experience increased anxiety if their expectations are not met.In recent decades, many studies have addressed the prevalence and factors associated with students' social anxiety; e.g. Momeni and et al. (2015). Relatively high prevalence of social phobia has been reported in Iranian college students. Bani Mustafa and et al. (2014), in a study of Jordanian students, reported similar results. Bella and et al. (2009), in a similar study in Nigeria, investigated the prevalence of social phobia and factors associated with it. They reported Lifetime and 12-month prevalence of this disorder in students respectively as 9.4 and 8.5. Salina and et al. (2008) studied medical students in Malaysia. They found that most students experience significant social anxiety symptoms. The prevalence of social anxiety in this study was reportedly 2.11%.In another study in Sweden, Tillfors and et al. (2007) showed that there were mild to severe forms of the disorder among the students, and reported its prevalence as 16.1% in students compared to 15.6% in the general population. In a research carried out in Turkey, Izgic and et al. (2004) reported 9.6% for the lifetime prevalence of disorders, and 7.9% for the recent years among college students.Most of previous studies have shown that anxiety experienced during the college, can cause problems in later life (Tyssen and et al., 2001). Developing social anxiety and fear of talking among others can make a negative impact on academic performance in two ways: firstly, development of the disorder may cause avoidance in situations that require talking to others which is one on of the essentials of educational systems; and secondly, if a person is forced to talk in such situations, s/he will try to use avoidance behaviors (fast-talking and avoiding eye contact). This problem, in both cases, has a negative effect on performance in situations such as lectures and oral exam. …

The Youth Anxiety Measure for DSM-5 (YAM-5): Correlations with anxiety, fear, and depression scales in non-clinical children

The Youth Anxiety Measure for DSM-5 (YAM-5) is a newly developed rating scale for assessing anxiety disorder symptoms of children and adolescents in terms of the contemporary classification system. In the present study, 187 children aged 8–12 years completed the new measure as well as the trait version of the State-Trait Anxiety Inventory for Children (STAIC), the Short Form of the Fear Survey Schedule for Children-Revised (FSSC-R-SF), the Spence Children’s Anxiety Scale (SCAS), the Selective Mutism Questionnaire (SMQ), and the Children’s Depression Inventory (CDI). Results indicated that part one of the YAM-5, which measures symptoms of the major anxiety disorders, was most substantially linked with the trait anxiety scale of the STAIC, whereas part two, which measures phobic symptoms, was most clearly associated with the FSSC-R-SF. The correlation between the YAM-5 and the SCAS was also robust, and particularly strong correlations were found between subscales of both questionnaires that assessed similar symptoms. Further, the selective mutism subscale of the YAM-5 was most clearly linked to the SMQ. Finally, the YAM-5 was also significantly correlated with depression symptoms as indexed by the CDI. These findings provide further support for the concurrent validity of the YAM-5.

060 Psychological and Sexual Correlates of Sexual Abuse in Women with Sexual Dysfunction

Approximately 20% of women experience sexual abuse (SA) worldwide. SA survivors are prone to experiencing psychiatric symptoms and sexual dysfunction (SD). This study aimed to evaluate the prevalence and correlates of reported SA at different ages in a sexual medicine setting. We retrospectively studied 200 heterosexual women attending our clinic for SD. All patients completed the Middlesex Hospital Questionnaire (MHQ), Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS) and Body Uneasiness Test (BUT). Forty-seven women (23.5%) reported SA, which occurred in childhood, adolescence and adulthood in 9% (n=18), 7.5% (n=15) and 7% (n=14) of cases, respectively. SA women showed significantly higher MHQ total score (p=0.023), free-floating anxiety (MHQ-A: p<0.0001) and phobic anxiety symptoms (p=0.043) when compared with non-SA women. SA women also showed significantly lower FSFI Orgasm domain (p=0.001), Satisfaction domain (p=0.004) and Total scores (p=0.027), and a higher FSDS total score (p=0.003). After adjusting for age and the use of psychotropic drugs, only the difference in MHQ-A (F=9.824, p=0.002), FSFI Orgasm (F=7.395, p=0.007) and FSDS total scores (F=7.208, p=0.008) retained statistical significance. When considering BUT, SA patients showed significantly higher Global Severity Index (p=0.021), Weight Phobia (p=0.025), Body Image Concerns (p=0.025), Avoidance (p=0.042), Depersonalization (p=0.032), Positive Symptom Total (p=0.045) and Positive Symptom Distress Index (PSDI) scores (p=0.022) than non-SA patients. All the differences retained statistical significance after adjusting for age, psychotropic drugs and body mass index. Significantly lower FSFI Orgasm (p=0.009) and Satisfaction domain scores (p=0.012) were found in patients reporting SA in adolescence when compared with SA in childhood, even after adjusting for confounders (F=8.577, p=0.007 and F=7.102, p=0,013 for Orgasm and Satisfaction, respectively).

Clinical and neurobiological effects of aerobic exercise in dental phobia: A randomized controlled trial.

Physical activity has shown to be effective in anxiety disorders. For specific phobia, no studies are available that systematically examined the effects of an aerobic exercise intervention on phobic fear within a randomized-controlled design. Therefore, we investigated the acute effect of a standardized aerobic training on clinical symptoms of dental phobia as well as on stress-related neurobiological markers. Within a crossover design, 30 patients with dental phobia (mean age: 34.1 years; mean score of the Dental Anxiety Scale: 18.8) underwent two minor dental interventions separated by 7 days. Dental treatment was performed after 30 min of physical activity at either 20% VO2 max (control) or 70% VO2 max (intervention), respectively. To control for habituation, patients were randomly assigned to one of the two conditions prior to the first intervention. Moreover, saliva samples were collected at five times in order to determine changes in salivary cortisol (sC) and alpha-amylase (sAA) due to treatment. In comparison to baseline, aerobic exercise within 70% VO2 max significantly reduced clinical anxiety and sC concentrations before, during, and after the dental treatment. In contrast, the control condition led to decreased sAA levels at different time points of measurement. Habituation occurred at the second study day, independent of the order. Our study provides evidence for an effect of moderate-intense exercise on clinical symptoms and sC in patients with dental phobia. Therefore, acute aerobic exercise might be a simple and low-cost intervention to reduce disorder-specific phobic fear.

Linking Anxiety and Insistence on Sameness in Autistic Children: The Role of Sensory Hypersensitivity.

Sensory hypersensitivity and insistence on sameness (I/S) are common, co-occurring features of autism, yet the relationship between them is poorly understood. This study assessed the impact of sensory hypersensitivity on the clinical symptoms of specific phobia, separation anxiety, social anxiety and I/S for autistic and typically developing (TD) children. Parents of 79 children completed questionnaires on their child's difficulties related to sensory processing, I/S, and anxiety. Results demonstrated that sensory hypersensitivity mediated 67% of the relationship between symptoms of specific phobia and I/S and 57% of the relationship between separation anxiety and I/S. No relationship was observed between sensory hypersensitivity and social anxiety. These mediation effects of sensory hypersensitivity were found only in autistic children, not in TD children.

Do Symptoms of Irritable Bowel Syndrome Improve when Patients Receive Cognitive Behavioural Therapy for Co-morbid Anxiety Disorders in a Primary Care Psychological Therapy (IAPT) Service?

Irritable bowel syndrome (IBS) is a common co-morbid condition with anxiety disorders, and patients often report a fear of incontinence in public places. This type of bowel control anxiety (BCA) can be conceptualized as a phobic syndrome. Yet little evidence exists on the prevalence or outcomes of these co-morbidities in routine primary care psychological therapy (Improving Access to Psychological Therapies, IAPT) services. To examine the prevalence and outcomes of IBS and BCA patients treated with cognitive behavioural therapy (CBT) for anxiety disorders within a routine IAPT service. An observational cohort study screened 2322 referrals to an IAPT service over 12 months for the presence of IBS. Patients with co-morbid anxiety disorders and IBS were grouped into those with, and without BCA. Patients completed the IBS symptom severity scale and the IAPT minimum data set. Diagnoses and outcomes were examined for all groups up to 6 months follow-up. A greater proportion of BCA patients had a primary diagnosis of phobic disorder. After receiving CBT, patients made clinically significant improvement in both anxiety and IBS symptoms at 6 months follow-up. Patients with BCA made greater improvement in phobia scales and IBS symptoms than non-BCA patients. Anxiety disorders with co-morbid IBS improved significantly in a routine IAPT service. A significant proportion of co-morbid IBS sufferers had a fear of incontinence in public places (BCA). Directly addressing and modifying these fears with CBT appeared to enhance improvement in both phobic anxiety and IBS symptoms.

Somatogenic depression on cardiovascular disease patients

In research, based on the systematic approach of evaluating results of complex clinical-psychopathological, psychodiagnostical investigation myocardial infarction and cerebral stroke patients the clinical structure features, regularities in the formation, development and course of somatogenic depression and associated disorders on these patients was determined. At patients with cardiac infarction in acute period the pain syndrome is the main one, leads to severe psycho-emotional disorders. Against the background of cognitive function preservation phobic, anxiety and depressive symptoms prevail, their intensity depends on the severity of pain. Subsequently, the primary psycho-emotional constituent element disappeared and anxiety-depressive disorders developed along with hypo and anozognostical type of personal condition perception. At cerebral stroke, patient's disorders of level of consciousness were primary with cognitive and asthenic disturbances with subsequent formation of psycho-emotional disorders, anxiety and depressive disorders with hypohondrical elements on the basis of persistent cognitive impairments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sleep disturbances and mental strain in university students: results from an online survey in Luxembourg and Germany

ObjectivesThis study examined the prevalence of sleep disturbances and mental strain in students from two European countries, Luxembourg and Germany.MethodsA total of 2831 students took part in an online survey, with 2777 students from Germany and 184 students from Luxembourg. Sleep disturbances were assessed with the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, and aspects of mental strain using the Patient Health Questionnaire, the Social-Interactive-Anxiety Scale, the self-efficacy questionnaire and the test anxiety questionnaire. In addition, we also assessed students’ chronotypes.ResultsAcross the whole sample mean scores on the sleep questionnaires were above the cut-off for clinically relevant sleep problems, indicating an increased prevalence of sleep disturbances in students from both countries. Sleep quality was impaired in 42.8%, and 17.9% showed clinically relevant scores. Overall 25.5% reported elevated depression and 13.3% social phobia symptoms, while 45% indicated elevated stress levels. Sleep quality, daytime sleepiness, chronotype, depression scores, stress levels, test anxiety, and self-efficacy differed significantly between men and women, but there were no differences between countries.ConclusionsSleep disturbances and mental strain in students are common, with the current results replicating previous findings. Students from Luxembourg and Germany are affected equally.

Ultra-brief behavioral skills trainings for blood injection injury phobia

Blood injection injury (BII) phobia is common, with debilitating consequences to the health and well being of many of its sufferers. BII phobia presents with a unique fear response that can involve drops in blood pressure and ultimately fainting. The aim of this study was to provide proof of concept for a line of brief, easy to implement, video-based interventions for reducing phobic avoidance and fears in BII sufferers. One of the interventions was a novel Hypoventilation Respiratory Training (HRT) aimed at reducing the exaggerated ventilation response (hyperventilation) seen in BII phobia. The response has been linked to cerebral vasoconstriction and fainting symptoms. Sixty BII patients were randomly assigned to one of three 12-min video-guided trainings: Symptom-Associated Tension (SAT) training, Relaxation Skills Training (RST), or HRT. Experiential and cardiorespiratory activity to phobic stimuli was assessed before and after training. Both SAT and HRT resulted in overall greater reductions of phobic fears and symptoms than RST. SAT significantly increased heart rate during exposure, and HRT led to significantly reduced ventilation, increases in PCO2 , and elevated blood pressure throughout exposure and recovery. Treatment expectancy was rated equally high across conditions, whereas credibility ratings were highest for HRT. Brief, video-based instructions in muscle tension and normocapnic breathing are effective in reducing BII symptom severity and require minimal time and expertise. HRT may be particularly helpful in reducing fainting caused by cerebral vasoconstriction.

Prenatal exposure to anxiolytic and hypnotic medication in relation to behavioral problems in childhood: A population-based cohort study

Benzodiazepines and benzodiazepine-related medications (BBRMs) are anxiolytics and hypnotics acting on γ-amino butyric acid (GABA)A receptors. BBRMs are assumed to have a low potential for major congenital malformations, but research on more subtle and protracted developing symptoms of these medications is lacking. Therefore, we prospectively investigated the association between BBRM use in pregnancy and long-term effects on child behavior in a large population-based cohort study. The study population consisted of 104 children prenatally exposed to BBRM, 527 children exposed to maternal prenatal anxiety or phobic anxiety symptoms (without exposure to BBRM), and 5609 control children. At child age, 6years, Oppositional Defiant Disorder (ODD), Aggressive Behavior and Anxiety Problems were assessed by the Child Behavior Checklist (CBCL) reported by the mother and the Teacher Report Form (TRF). Children prenatally exposed to BBRM had higher scores of ODD and aggressive behavior, but not of anxiety. However, these associations were explained by maternal anxiety symptoms during pregnancy. Moreover, prenatal exposure to anxiety (without exposure to BBRM) was associated with increased scores of child ODD, aggressive behavior, and anxiety. In conclusion, the current study demonstrates that prenatal BBRM exposure was not independently associated with ODD and aggressive behavior in childhood when prenatal anxiety symptoms were taken into account.

Symptoms of swallowing anxiety in panic disorder patients and associated psychopathologic factors.

The aim of this study was to investigate symptoms of swallowing difficulty in Panic Disorder (PD) patients and the factors associated with these symptoms. In the pre-phase of the study, 22 PD patients who were treated in psychiatry outpatient clinics and who were found to have swallowing difficulty were evaluated. PD patients were asked to write about their thoughts, feelings and behaviors associated with swallowing difficulty. Later, these texts were examined and 41 expressions were identified in which patients described their swallowing difficulty. These expressions were evaluated by mental health workers in the field and twelve different swallowing difficulty items were defined. In the main phase of the study, 119 PD outpatients were evaluated using twelve different swallowing difficulty items and psychometric tests [Panic and Agoraphobia Scale (PAS), Separation Anxiety Symptom Inventory (SASI), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI-1/STAI-2)]. As a result of the validity and reliability analysis, a valid one-factor instrument with ten items was obtained. Cronbach's alpha value for this measurement tool was 0.89 and it was termed the "Swallowing Anxiety Scale (SAS)". It was found that SAS items "always" accompany PD patients at rates of 5-20.2%. According to hierarchical regression analysis, 35% of SAS scores were explained by PAS, SASI, STAI-2 and BDI scores. Swallowing difficulty items in PD patients involved anxious, phobic and somatic symptoms associated with swallowing. In addition, swallowing difficulty symptoms in PD patients can be confounded with eating disorder symptoms.

Major depressive disorder and generalized anxiety disorder show different autonomic dysregulations revealed by heart-rate variability analysis in first-onset drug-naïve patients without comorbidity.

The aim of the present study was to examine whether depression and anxiety disorder manifest different autonomic dysregulations using heart-rate variability (HRV) and heart rate (HR) measurements. HRV and HR were recorded both at rest and during task execution (random-number generation) in first-onset drug-naïve patients with major depressive disorder (MDD, n = 14) and generalized anxiety disorder (GAD, n = 11) as well as in healthy controls (n = 41). The patients showed no comorbidity of depression and anxiety disorder. GAD patients did not exhibit panic or phobic symptoms at the time of measurement. Following power spectrum analysis of HR trend, the high- (HF) and low-frequency (LF) components, the sum (LF + HF), and the LF/HF ratio were compared among the groups. In the MDD patients, as previously reported, HF was low and the LF/HF ratio was high during the initial-rest condition, and HF was less reactive to the task. In contrast, GAD patients showed significantly high HF, although autonomic reactivity was not impaired. The results indicate that baseline autonomic activity and its reactivity to behavioral changes are different between MDD and GAD in the early stage of illness. High parasympathetic tone in GAD may reflect responses of the parasympathetic system to anxiety. MDD is accompanied by an autonomic shift toward sympathetic activation and a reduced reactivity to task.

Efficacy of Emotion Regulation Skills and Meta-cognitive Beliefs in Reducing Social Phobia Among Students- A Casual-Comparative Study

The purpose of this study was to compare the efficacy of emotion regulation skills and meta-cognitive beliefs in reducing social phobia among students. The study method was experimental type. The statistical society of this study was consisted of 60 high school girls in Tehran, who were selected randomly as case group and were divided evenly into three groups (each group 20 individuals). Emotion regulation and meta-cognition training were considered for both groups for 8 sessions and one group was selected as control. Data were collected using the Social Phobia Inventory (SPIN). Obtained information was analyzed via MANCOVA and the SPSS software. The results were demonstrative of reduced symptoms in social phobia and panic symptoms, avoidance and physiological symptoms in the case group (p < 0.001) after receiving emotion regulation skills and meta-cognitive training. Tukey test showed effectiveness of two methods (Emotion regulation and meta-cognition). It appears plausible that emotion regulation and meta-cognitive interventions can be used to improve the symptoms of social phobia.

A psychological content of social phobia syndrome

To perform a psychological analysis of social phobia syndrome. The subject area of research is the structure of mental activity and behavior in social activity. The study included 32 patients with symptoms of social phobia (ICD-10 F40.1) and 29 healthy people (controls). A complex of psychological methods (questionnaires; pathopsychological experiment) was used. Early maladaptive schemes and a tendency to mental rigidity can be a premorbid basis of the syndrome. Primary violation is in organizational target component by type of distortion of goal-setting regulation. The mechanism is a reduction in the mediation of emotions and behavior (an influence of emotions on the process of activity, excess metacognitive anxiety control leading to multi-task and exhaustion of resources of voluntary activity). Fear of negative evaluation leads to the fact that a wide class of situations is interpreted as threatening. Secondary are changes in the system of goals and motives of activity (technically performing components of social behavior act as a focus of attention, along with the target, the target replaces the suprasituational meaning). Along with a strong motivation to succeed, the motive of avoiding failure is formed, which leads to a decrease in social activity. Tertiary symptoms of syndrome dynamics (ways to cope with maladaptation) are destructive forms of decompensation (substance abuse, learned helplessness and hopelessness, suicidal behavior, etc.), repeatedly reinforcing the primary and secondary disturbances.