Fear Reduction Research Articles

Pediatric Phagophobia: A Systematic Review and a Case Report of Pharmacological Interventions

Background: Phagophobia is characterized by conditioned excessive fear of swallowing or choking that is usually triggered by an incident. It usually leads to avoidance of certain types of food or, in severe forms, a complete refusal to eat solid food and/or liquids. The condition is commonly associated with physical and psychological symptoms impacting the health condition of the individual due to deprivation of essential nutrients. Case Presentation: A 12-year-old boy developed acute onset fear of swallowing (Phagophobia) following a dream he had of someone choking. This was exacerbated by watching an online video of a person choking. This has led to an avoidance of solid food and dependence on soft food and liquids. Fear of swallowing along with food avoidance has led to malnutrition, weight loss, and several physical complaints for which the patient was admitted under pediatric care. A course of Cognitive Behavioral Therapy (CBT) resulted in limited response and was augmented with fluoxetine. Full remission was achieved within six weeks. Methods: A systematic review of all peer-reviewed English literature was performed for articles related to the pharmacological treatment of pediatric phagophobia (0-18 years) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results: A total of 17 case reports were identified describing 17 children with phagophobia (females = 70 %). The mean age was 9.3 and the average was between 2 and 15 years who were diagnosed with choking phobia/ phagophobia or different but equivalent diagnoses like Avoidant/Restrictive Food Intake Disorder or Post Traumatic Feeding Disorder. Different classes of medications were used in variable doses for different durations which were associated with significant improvement in eating patterns and reduction in fear and anxiety associated with eating. Conclusion: Phagophobia is a serious and potentially life-threatening illness that can cause physical complications and functional impairment in the psychosocial aspect. Pharmacological treatment can be a beneficial and safe option either alone or in combination with therapeutic interventions for children presenting with phagophobia.

Fear of crime and the willingness to report crime to police: A case study of model policing in Meta-Mercado, Coatepeque, Guatemala

ABSTRACT Community-oriented policing has been a mainstay of policing over the past quarter century. In March 2019, the municipality of Coatepeque in Guatemala, with the assistance of Research Triangle Institute (RTI) International, implemented a new community policing plan called Vivir y Prosperar in the Meta Mercado. Vivir y Prosperar was designed to improve security, reduce crime, and promote economic prosperity. This study utilises the pre-test, baseline and 6-months post-test, endline survey data of market vendors in the Meta Mercado to assess whether Vivir y Prosperar reduced fear of crime and increased someone’s willingness to report crime to police as tenets of community policing would anticipate. Results show that Vivir and Prosperar did not directly contribute to a decrease in fear of crime or improve one’s willingness to report crimes to the police. However, improving personal victimisation experiences, bribery payments, and other factors may indirectly promote a reduction in fear of crime and increase the willingness to report a crime among market vendors.

Effects of Exercise Testing and Cardiac Rehabilitation in Patients with Coronary Heart Disease on Fear and Self-Efficacy of Exercise: A Pilot Study.

Exercise fear and low exercise self-efficacy are common in patients attending cardiac rehabilitation (CR). This study tested whether exercise prescription methods influence exercise fear and exercise self-efficacy. We hypothesized that the use of graded exercise testing (GXT) with a target heart rate range exercise prescription, relative to standard exercise prescription using rating of perceived exertion (RPE), would produce greater reductions in exercise fear and increase self-efficacy during CR. Patients in CR (N = 32) were randomized to an exercise prescription using either RPE or a target heart rate range. Exercise fear and self-efficacy were assessed with questionnaires at three time points: baseline; after the GXT in target heart rate range group; and at session 6 for the RPE group and CR completion. Items were scored on a five-point Likert-type scale with higher mean scores reflecting higher fear of exercise and higher self-efficacy. To analyze mean differences, a mixed effects analysis was run. There were no significant changes in exercise self-efficacy between baseline and discharge from CR; these were not statistically significant (mean differences baseline - 0.63; end - 0.27 (p = 0.13)). Similarly, there was no change in fear between groups (baseline 0.30; end 0.51 (p = 0.37)). Patients in the RPE and target heart rate groups had non-significant changes in exercise self-efficacy over the course of CR. Contrary to our hypothesis, the use of GXT and target heart rate range did not reduce fear, and we noted sustained or increases in fear of exercise among patients with elevated baseline fear. A more targeted psychological intervention seems warranted to reduce exercise fear and self-efficacy in CR.

Flight to Lottery Ahead of FOMC Announcements: Institutional Investors or Retail Investors?

AbstractThis paper studies the pre‐Federal Open Market Committee (FOMC) announcement drift at the stock level. We hypothesize that investors have a higher propensity to speculate before the monetary policy announcements by the FOMC, due to the resolution of uncertainty and associated reduction in investors' fear. Indeed, we find evidence that there exists a drift of lottery‐like stocks in the pre‐FOMC window, when investors' fear gauge is lower, together with higher demand for lottery‐like stocks and higher realized skewness. Moreover, we show that the demand for lottery‐like stocks ahead of FOMC announcements is more prominent among institutional investors than retail investors. Our findings also identify the key role of transient and quasi‐index institutional investors in our documented flight‐to‐lottery effect. Our findings advance the ongoing debates about the role of firms' investor heterogeneity in determining how monetary policy affects corporate managers' decisions. Our paper has important implications for central banks and managers by showing that investors' preference for lottery‐like stocks increases before FOMC announcements.

Comparison of anxiolytic effects of mammalian and bony fish kisspeptins in <dfn>Danio rerio</dfn>

In our previous work, we suggested that analogs of mammalian kisspeptin Kiss1 reduce anxiety and phobic reactions novel in Danio rerio. The most effective dose for the action of the studied analogs of kisspeptin corresponded to 0.1 mg per 1000 mL of water. In this study, other analogs of mammalian Kiss1 at a dose of 0.1 mg per 1000 mL of water also reduced the anxious behavior of Danio fish. The effect of Kiss1 and Kiss2 kisspeptins on the behavior of Danio rerio was also evaluated. In the novel test, the number of freezing decreased by two times with the introduction of kisspeptin 10 and by three times after the introduction of the kisspeptin analog. An analog of mammalian kisspeptin reduced the freezing time by two times. The length of the trajectory decreased by two times under the influence of the mammalian Kiss1 kisspeptin analog. With the action of kisspeptin 10, the number of transitions to the upper part of the tank increased by two times. After the introduction of the kisspeptin analog, the number of transitions to the upper part of the aquarium increased by three times. In the predator test, the number and time of freezing decreased by 1.5 times with the action of mammalian kisspeptins. The length of the trajectory after the introduction of kisspeptin bony fish and kisspeptin 10 mammals increased. The length of the trajectory after the introduction of Kiss1 increased by 1.5 times. The length of the trajectory after the introduction of Kiss2 increased by three times. After the introduction of kisspeptin 10, the trajectory increased by two times, and the time spent in the lower part of the tank decreased by two times. Kisspeptins of bony fish also reduced the anxiety and phobic reactions in fish, but to a lesser extent. Thus, kisspeptin 10 and an analog of mammalian kisspeptin in response to the presentation of a predator had more significant effects on anxiety in Danio rerio compared with the action of kisspeptin bony fish Kiss1 and Kiss2. Thus, bony fish kisspeptins and mammalian kisspeptins can reduce anxiety and phobic reactions in Danio rerio; however, mammalian kisspeptins are the most effective. Bony fish kisspeptin Kiss1 has an anxiolytic effect in contrast to Kiss2, which suggests that it affects fear reduction, and Kiss2 appears to be responsible for social and sexual behavior. The results support the hypothesis that kisspeptins may be involved in the regulation of anxiety and phobic states, apparently to maintain the emotional aspects of reproductive behavior, such as sexual motivation and arousal.

1794-PUB: Potential for Improving CGM Systems? Anticipated Benefits from Increasing the Glucose Prediction of Current CGM Algorithms

Current CGM algorithms allow a glucose prediction up to 30 minutes. To elaborate on the potential to improve current CGM systems, we investigated if a possible increase in this prediction window to up to 2 hours would be perceived as a significant benefit. People with type 1 and type 2 diabetes currently using a CGM system were invited to participate. Participants were presented with a scenario depicting the potential of a hypothetical CGM algorithm to predict the course of glucose for up to 2 hours. They were instructed to imagine how such a long-term prediction would affect their diabetes management. They were asked to complete the T1-Diabetes Distress Scale (T1-DDS) and the Hypoglycemia Fear Survey (HFS-II) and rate each item regarding the perceived potential change from using such a long-term prediction (scale: -2 strong deterioration, -1 deterioration, 0 no change, 1 improvement, 2 strong improvement). 206 people participated (29.1% type 2 diabetes). Participants expected moderate improvements in hypoglycemia and management distress (Box plots shown in Figure 1 for T1-DDS). Similar improvements in HFS-II scores (0.57±0,49) were seen with no differences between diabetes types. Increasing the glucose prediction to up to 2 hours would be seen as a potential improvement regarding reductions in hypoglycemia distress and fear of hypoglycemia by both people with type 1 and type 2 diabetes. Disclosure D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Glatzer: Employee; Roche Diabetes Care, Berlin-Chemie AG. L.Priesterroth: Speaker's Bureau; Ypsomed AG. B.Olesen: Advisory Panel; AstraZeneca, Evivamed, Berlin-Chemie AG, Speaker's Bureau; Medtronic, Medtrixx. B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG. Funding Roche Diabetes Care

Is It Safe Now? Intolerance of Uncertainty as a Pre-treatment Predictor of Exposure Outcome

Safety learning is considered to be a key aspect in attaining symptom reduction for patients with anxiety disorders. While treatment based on safety learning principles is highly effective in general, individual differences exist in the speed and retention of fear reduction. An individual difference variable that has been demonstrated to be associated with difficulties in safety learning in laboratory paradigms is intolerance of uncertainty, or the incapacity to endure the absence of key information and the corresponding perception of uncertainty. In this study, we sought to determine if intolerance of uncertainty is associated with the course and outcome of an exposure intervention. Intolerance of uncertainty was assessed in 104 subclinical spider-fearful participants, prior to a 30-minute exposure session in virtual reality. While the exposure session was found to be successful in modifying spider fear and avoidance, we failed to find significant correlations between intolerance of uncertainty and any of the outcome measures. Exploratory analyses assessed if intolerance of uncertainty was associated with reductions in physiological arousal during the exposure session itself. No significant correlations were found between intolerance of uncertainty and arousal reduction within the exposure exercises or throughout the session. In conclusion, deviating from some of the findings in extinction research, we failed to find evidence for associations between intolerance of uncertainty and the outcome and course of exposure. Still, additional research is needed to assess the replicability of these findings.

An online contextual schema therapy workshop for social anxiety symptoms – A randomized controlled trial

Given the high prevalence of social anxiety, developing accessible psychological interventions for this condition becomes a priority. Self-criticism and experiential avoidance have been established as two transdiagnostic mechanisms involved in social anxiety. Contextual Schema Therapy (Cst; roediger, stevens, & brockman, 2018) is a novel psychological treatment addressing these two mechanisms by conceptualizing them as two distinct patterns of schema activation (modes). We therefore aimed to test the efficacy of a brief (single session) CST intervention, delivered in an online group format, for individuals with social anxiety symptoms. We also examined experiential avoidance as a potential mechanism of change. 112 participants with social anxiety symptoms above cut-off were randomized to either the CST group intervention or a waitlist control group. The Brief Fear of Negative Evaluation Scale – Second Version (BFNE-II) and the Acceptance and Action Questionnaire – Second Version (AAQ-2) were filled in by participants at baseline, immediately after the intervention and at a two-week follow-up. The CST intervention comprised psychoeducation, a conceptualization of social anxiety in schema and mode terms, reflection exercises, chairwork and imagery techniques. At follow-up, significant reductions in fear of negative evaluation and experiential avoidance were found in the CST group. Experiential avoidance was a marginally significant mediator of the changes in fear of negative evaluation from pre-test to follow-up. The results support the potential large-scale usefulness of brief online CST interventions with socially anxious individuals.

142-LB: Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (rt-CGM) vs. Intermittent-Scanning Continuous Glucose Monitoring (is-CGM) in Patients with Type 2 Diabetes on Multiple Daily Injections of Insulin (T2D MDI) in Canada

Rt-CGM systems provide real-time glucose values, hypo- and hyperglycemia alerts, and predictive “urgent low soon” alerts that have been shown to improve glycemic outcomes and reduce severe hypoglycemic events (SHEs) in patients with T2D, without the need for periodic scanning. The economic value of rt-CGM vs is-CGM is unknown for patients with T2D MDI in Canada. We conducted a cost-effectiveness analysis comparing the two systems for this patient population using the INESSS Canadian payer perspective. ­ A 30-year analysis was performed using the validated ECHO-T2DM. Patient characteristics were sourced from Karter (2021). Efficacy and safety were derived from the DIAMOND T2D and REPLACE RCTs. The HbA1c difference of -0.33 (favoring rt-CGM) was derived using Bucher's adjusted indirect comparison, SHE rates were 0.014 and 0 Per Person-Year (PPY) for is-CGM and rt-CGM, respectively, and severe hyperglycemia/DKA rates were proxied by the difference in time above range (0.0313 and 0 PPY, respectively). Costs and disutility weights were sourced from published Canadian literature and discounted at 1.5% annually. A reduction in fear of hypoglycemia (FOH) utility was sourced from the ALERTT1 RCT. Sensitivity analyses were performed. Rt-CGM was associated with quality-adjusted life year gains of 0.346 and incremental costs of CAD 5,737, with an incremental cost-effectiveness ratio (ICER) of CAD 16,598. No DKA events for is-CGM and a 50% reduction in FOH utility increased the ICERs to CAD 30,987 and CAD 29,116, respectively. ICER was CAD 2,278 when both CGM costs were reduced by 50% and rt-CGM became cost-saving (dominant) at a 65% reduction. These results suggest rt-CGM is cost-effective vs is-CGM in patients with T2D MDI in Canada. These findings can inform government and commercial healthcare decision-makers when considering reimbursement of CGM systems. Disclosure H. Alshannaq: Employee; Dexcom, Inc., Other Relationship; Vertex Pharmaceuticals Incorporated. G. J. Norman: Employee; Dexcom, Inc. M. Willis: None. A. Nilsson: None. Funding Dexcom, Inc.

Emotional empowerment through information research and communication to reduce fear of COVID-19 among nursing students: a randomised controlled trial

BackgroundDespite an existing body of literature on anxiety reduction using multi-component methods, little is known about the effect of active student participation in research and communication of scientific information on anxiety and fear reduction. The aim of this study is to evaluate the impact of quality scientific information research and the production of informative videos on the preventive aspects of COVID-19 on fear and anxiety reduction.MethodsA randomised controlled trial was conducted with 220 undergraduate nursing students in the first year of the nursing degree. The participating students were randomised into two groups. The experimental group carried out an intervention based on a database search for information on preventing COVID-19 and production of a video giving scientific reasons why prevention measures should be followed. In the control group, students created posters and videos about theoretical aspects of one module of the nursing degree. Both groups were surveyed before and after the intervention, measuring their state of resilience, preventive behaviours, level of anxiety, and fear of COVID-19.ResultsThe intervention group showed a greater decrease in fear levels after the intervention than those in the control group. There were no differences between the groups in terms of resilience, preventive behaviours, or anxiety. In the experimental group, there was a significant decrease in anxiety levels and fear levels after the intervention compared to the baseline levels.ConclusionsAn intervention based on active participation in searches for high-quality scientific information and production of information videos on COVID-19 prevention reduced fear and anxiety caused by COVID-19 among nursing students.Trial registrationWe have retrospectively registered the trial in Open Science Framework and the identification number is https://doi.org/10.17605/OSF.IO/6QU5S.

Hippocampal Involvement in Safety Signal Learning Varies With Anxiety Among Healthy Adults

BackgroundSafety signal learning (SSL), based on conditioned inhibition of fear in the presence of learned safety, can effectively attenuate threat responses in animal models and humans. Difficulty regulating threat responses is a core feature of anxiety disorders, suggesting that SSL may provide a novel mechanism for fear reduction. Cross-species evidence suggests that SSL involves functional connectivity between the anterior hippocampus and the dorsal anterior cingulate cortex. However, the neural mechanisms supporting SSL have not been examined in relation to trait anxiety or while controlling for the effect of novelty. MethodsHere, we investigated the neural mechanisms involved in SSL and associations with trait anxiety in a sample of 64 healthy (non-clinically anxious) adults (ages 18–30 years; 43 female, 21 male) using physiological, behavioral, and neuroimaging (functional magnetic resonance imaging) data collected during an SSL task. ResultsDuring SSL, compared with individuals with lower trait anxiety, individuals with higher trait anxiety showed less fear reduction as well as altered hippocampal activation and hippocampal–dorsal anterior cingulate cortex functional connectivity, and lower inferior frontal gyrus and ventrolateral prefrontal cortex activation. Importantly, the findings show that SSL reduces threat responding, across learning and over and above the effect of novelty, and involves hippocampal activation. ConclusionsThese findings provide new insights into the nature of SSL and suggest that there may be meaningful variation in SSL and related neural correlates as a function of trait anxiety, with implications for better understanding fear reduction and optimizing interventions for individuals with anxiety disorders.

Follow Friends One Hour a Day: Limiting Time on Social Media and Muting Strangers Improves Well-Being

Introduction: Social media use is ubiquitous among young adults, and empirical research is increasingly suggesting that how it is used and how much time is spent using it have significant implications for psychological well-being and mental health. Most recent studies find that limiting but not eliminating social media has beneficial effects. Correlational findings suggest that following actual friends is beneficial, while following strangers can be harmful. Method: This study sought to test the impact of limiting time spent on social media as well as “muting” strangers on Instagram and eliminating TikTok use in an experimental paradigm. Results: Replicating prior studies, we found that limiting social media use to 60 minutes per day (versus unlimited use) led to reductions in depression, F(1,96) = 5.84, p = .018, for the most depressed participants. Moreover, limiting stranger content (by muting strangers on Instagram and eliminating TikTok use), in addition to limiting time, led to significant reductions in fear of missing out, F(2,138) = 4.806, p = .01, for the most depressed participants and to significant reductions in social comparison, F(2,138) = 4.367, p = .015. Discussion: In conclusion, it is not just how much time one spends on social media that matters to well-being, but how one uses that time and who one is interacting with.

Patterns of maladaptive exercise behavior from ages 14-24 in a longitudinal cohort.

Exercise for weight loss and maladaptive exercise (exercise that results in negative consequences or interference with daily life) are common behaviors among youth and are associated with increased risk of disordered eating symptoms. The current study clarifies processes that influence exercise-related risk in adolescence and young adulthood, including the frequency with which young people transition between engaging in exercise for weight loss and experiencing negative consequences of this behavior. Participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) reported on eating disorder cognitions at age 14, and exercise behavior at ages 14, 16, 18, and 24 years old. Analyses examined rates of transition between the categories of 'No Exercise for Weight Loss', 'Exercise for Weight Loss', and 'Maladaptive Exercise' over time, identified overall trends in endorsement of exercise for weight loss and maladaptive exercise, and clarified predictors of these behaviors. Endorsement of exercise for weight loss and maladaptive exercise increased over time in both males and females. Those in the 'Exercise for Weight Loss' category were more likely than those in the 'No Exercise for Weight Loss Category' to transition to 'Maladaptive Exercise' over time. Body mass index (Age 13) and fear of weight gain (Age 14) were consistent predictors of maladaptive exercise across sex. Results support re-framing motivations for exercise in youth away from weight loss at a population level and targeting reductions in fear of weight gain for high-risk individuals.

The impact of training on stockpersons’ behaviour and cows’ fear response

In tropical developing regions, such as Brazil, animal welfare (AW) has been gaining increasing attention, while stockperson job satisfaction, which is intimately related to AW, is often neglected. This research evaluated the effects of AW training on stockpersons’ attitudes and behaviour towards dairy cows and the impact on cows' fear of humans. Ten dairy farms with pasture-based systems where animal handlers are farm owners or employees were selected from three regions of Sao Paulo, Brazil. The experiment consisted of four stages: 1) Selection of pasture-based dairy farms; 2) First assessment of attitudes, human behaviour, and cows’ flight distance (day one – D1); 3) Pre-assessment of owners' and employees’ AW knowledge, and training (day two – D2); and 4) Final assessment of attitudes, human behaviour, cows’ flight distance, and owners' and employees’ AW knowledge (day three – D3), focusing on the training’s effects on human attitudes and behaviour, and cows’ fear of humans. Among owners and employees, positive attitudes were more often expressed, and negative attitudes were less frequent on day three (D3) after training. Nevertheless, the expression of positive attitudes by farm owners was less common compared to employees. Stockpersons manifested positive behaviour more frequently at D3 than on day one (D1), before training, in contrast to negative behaviour at D1. Taking all cow handling observations together, including those before and after training, the greatest percentage of negative behaviour was at the time of moving the cows from the holding area to the milking stalls (18% of all observed human behaviour), followed by moving cows out of the milking parlour (17%), positioning cows for milking (15%) and placing/removing the milking suction devices (1%). Positive human behaviour usually occurred when moving cows from the holding area to the milking stalls (21%) and during the positioning of cows for milking (19%). After training, cows’ flight distances decreased. In conclusion, the training may have promoted positive human behaviour and reduced the number of fearful cows. Therefore, AW training may positively influence human behaviour, technical expertise, the reduction of fear in cows, and stockpersons' attitudes.

Effects of tailored interventions for anxiety management in choking-susceptible performing artists: a mixed-methods collective case study.

Not being able to manage performance anxiety and subsequently experiencing a decline in performance have been called "choking under pressure". High trait anxiety and fear of negative evaluation, as well as low self-efficacy or self-confidence, can put performers especially at risk of experiencing choking. This study, therefore, examined the effects of psychological choking interventions tailored to "choking-susceptible" performing artists individually in a coaching setting. We conducted a mixed-methods (QUANT + QUAL) collective case study with nine performing artists, who each received five individual coaching sessions. The tailored choking interventions comprised acclimatization training, goal setting, and pre-performance routines, including elements such as imagery, self-talk, and relaxation techniques. Before and after the 10-week intervention phase, they filled in questionnaires on trait performance anxiety, fear of negative evaluation, and self-efficacy, performed in front of a jury, and were interviewed about their experiences. Transcripts of interviews and coaching sessions were analyzed using thematic analysis. Heart rate measurements, weekly performance videos, and expert evaluations were also part of our comprehensive data. Quantitative data showed reductions in performance anxiety and fear of negative evaluation, and increases in self-efficacy and performance quality, from before to after the intervention phase. Most participants also had a lower heart rate when performing for the jury. Themes from qualitative analysis comprised managing nervousness and feeling more relaxed, becoming more self-confident, satisfaction with artistic and mental performance, feeling good and enjoying performing, and general positive effects. Tailoring psychological interventions may provide several benefits for choking-susceptible performing artists.

The role of illustration in pediatric hospitalization.

Health services, in particular pediatric units in a hospital, are increasingly committed to human well-being, on the one hand by researching more effective treatments, on the other hand by promoting emotional well-being for their patients, caregivers and professionals. The investment in making hospital environments and services more humane is evident in several studies and projects disseminated around the world. Even so, and despite these efforts, most people continue to have a negative feeling when they think of a hospital. For an institution whose main objective is to preserve and restore health, a negative impression or a feeling of discomfort can be seen as a factor of stress that does not contribute to the patients’ quick recovery. Although fear or stress reduction values are difficult to quantify, empirical evidence shows that there are intangible factors crucial for the patients’ recovery and well-being 1.This is an issue of increasing importance, therefore this paper will analyze how illustration can play a decisive role in the child’s perception and overall experience in hospital. It will also evaluate how illustrators and storytellers' commitment in creating a positive, playful and comfortable environment for patients and caregivers has been recognised by the whole community. The process of adapting an illustrated children’s picture book to a specific hospital area, its effectiveness and how it can reach other audiences, will be widely analyzed.

A Survey of Virtual Reality Interventions for Autistic Spectrum Disorder Therapy: A Neuroscience Perspective (P1-12.006)

<h3>Objective:</h3> This review evaluates the clinical efficacy of virtual reality as a behavioral modification tool to teach and support the social-communication needs of ASD children. <h3>Background:</h3> Autistic spectrum disorder (ASD) characterizes a taxonomy of disorders affecting social communication and interactive behaviors. Researchers in affective computing have begun to use virtual reality as a therapy tool for autistic individuals. This technology has demonstrated significant potential as our understanding of the social-communication deficits in autism increases. We conducted a literature review investigating the efficacy of virtual <i>reality</i> as an intervention for autism. <h3>Design/Methods:</h3> A search was conducted using Google Scholar, PubMed, IEEE Xplore, CDC, and the National Autism Center databases. The search keywords were: “Affective computing Autism” OR “Affective computing ASD”. <h3>Results:</h3> Five articles were included in our analysis. <h3>Emotional facial expression recognition tasks:</h3> ASD Children demonstrated significant increases in paired t-tests comparisons of pre and post-training performance in NEPSYII Affect recognition t(24)= −3.40, p=0.001 and Attention and executive function “Fluid reasoning” t(17)= −2.33, p=0.016. Significant increases were noted on the pre-training assessment for social attribution Triangles intentionality t(23) =−2.28, p=0.016. 88% of participants accurately identified the emotional expressions portrayed by a virtual avatar. <h3>Emotional regulation tasks:</h3> VRE therapy yielded results that persisted 12 to 16 months after treatment. 89% of children were able to diminish phobia-induced anxiety and four children overcame their phobias. <h3>Virtual reality receptivity in ASD:</h3> Virtual embodied agents effectively elicited continued affective and social conversational behaviors in ASD children for approximately 60 minutes. ASD children also reported <i>significantly</i> higher ratings of enjoyability t(38)= 2.26; P= 0.03)) while using virtual technology compared to experimental controls. <h3>Conclusions:</h3> Use of virtual reality as a tool for behavioral modification revealed positive application with enduring results, by demonstrating: (1) conversational spontaneity, (2) social appraisal, (3) emotional recognition, (4) anxiety and fear reduction, and (5) social-skill acquisition in autistic children. <b>Disclosure:</b> Ms. Allison has nothing to disclose. Dr. Prelock has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Publishing. The institution of Dr. Prelock has received research support from PCORI. The institution of Dr. Prelock has received research support from HRSA. Dr. Prelock has received publishing royalties from a publication relating to health care. Dr. Prelock has received publishing royalties from a publication relating to health care. Dr. Prelock has received publishing royalties from a publication relating to health care.

“I don't have chronic back pain anymore”: Patient Experiences in Pain Reprocessing Therapy for Chronic Back Pain

In a recently published randomized controlled trial, two-thirds of the patients receiving a novel psychological treatment, pain reprocessing therapy (PRT), reported elimination or near-elimination of chronic back pain. The mechanisms of PRT and related treatments remain poorly understood but are hypothesized to center on pain reappraisal, fear reduction, and exposure-potentiated extinction. Here, we investigated treatment mechanisms from the participants' perspective. A sample of 32 adults with chronic back pain who received PRT completed semi-structured posttreatment interviews about their treatment experiences. The interviews were analyzed with multiphase thematic analysis. The analyses identified 3 major themes reflecting participants’ understanding of how PRT led to pain relief: 1) reappraisal to reduce fear of pain, which included guiding participants to relate to pain as a helpful indicator, overcoming pain-related fear and avoidance, and reconceptualizing pain as a “sensation;” 2) the link between pain, emotions, and, stress, which included gaining insight into these connections and resolving difficult emotions; and 3) social connections, which included patient-provider alliance, therapist belief in the treatment model, and peer models of recovery from chronic pain. Our findings support the hypothesized mechanisms of PRT centered on pain reappraisal and fear reduction, but also highlight additional processes from the participants' perspective, including a focus on emotions and relationships. This study underscores the value of qualitative research methods in illuminating the mechanisms of novel pain therapies. PerspectiveThis article presents participants' perspectives on their experience engaging in a novel psychotherapy for chronic pain, PRT. Through pain reappraisal, linking pain, emotions, and stress, and connecting with their therapist and peers, many participants reported an elimination or near-elimination of their chronic back pain with therapy.

Distraction versus focusing during VR exposure therapy for acrophobia: A randomized controlled trial

Background and ObjectivesThe therapeutic mechanisms of exposure therapy are not well understood. Research suggests that focusing on the most feared aspect might not be necessary, and that distraction with a low cognitive load (e.g., conversation) might enhance exposure. We aimed at systematically testing the efficacy of exposure therapy with focusing vs. conversational distraction, hypothesizing that distracted exposure would yield superior effects. MethodsThirty-eight patients with acrophobia (specific phobia of heights; clinician-determined) (free from relevant somatic or other mental disorders) were randomly assigned (1:1) to one virtual reality (VR) session of either focused (n = 20) or distracted exposure (n = 18). This monocentric trial took place at a psychiatric university hospital. ResultsBoth conditions resulted in a significant reduction of acrophobic fear and avoidance, and a significant increase of self-efficacy (primary outcome variables). However, condition did not have a significant effect on any of these variables. Effects were stable at four-week follow-up. Heart rate and skin conductance level indicated significant arousal, but did not differ between conditions. LimitationsEye-tracking was unavailable, nor did we assess emotions other than fear. Power was limited due to sample size. ConclusionsA balanced exposure protocol combining attention to fear cues with conversational distraction, while not being superior, might be as effective as focused exposure for acrophobia, at least during the initial stages of exposure therapy. These results support previous findings. This study demonstrates how VR can be exploited for therapy process research, as VR supports dismantling designs and the incorporation of online process measures.

Perceived psychological reactions to second wave of pandemic COVID-19 Among Working Adult Indonesians: An online survey study

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: The Corona Virus Disease (Covid-19) pandemic caused serious health consequences including mental health issues. Thus, gaining insight into the emergence of mental health problems including fear, anxiety and stress in society during the second wave Covid-19 pandemic is imperative. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Objectives&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: This study aimed to identify the psychological reactions of working Indonesians living in five metropolitan cities in Java Island and its association with personal characteristics during the second wave Covid-19 pandemic.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Methods:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; This cross-sectional study included a total of 916 respondents from five metropolitan cities in the Island of Java that was voluntarily completing the anonymous online survey. The data were administered by using the Indonesian version of Perceived Stress Scale (PSS), Covid-19 Anxiety Scale (CAS), and Fear of Covid-19 Scale (FCS). Bivariate and multivariate analysis were performed using non-parametric methods due to non-normal distribution data. Significance for hypothesis testing was set with p-value 0.05 on 95% Confidence Interval. Data was analyzed using software STATA14 of StataCorp.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; A total of 916 respondents were included, with the median of age being 28 years old. Perceived fear and anxiety to Covid-19 among working individuals was low (35.92% and 40.94%), yet they were on moderate and high-levels of stress (31.88% and 45.52%) respectively. After adjusted all predictors, age was a significant predictor to the level of fear (p&amp;lt; 0.001), anxiety (p= 0.05), and stress (p&amp;lt; 0.001). The first dose of vaccination significantly predicted a reduction in the fear of Covid-19 (p= 0.045).&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusions&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: Increasing a year of age predicted the reduction of fear, anxiety, and perceived of stress to Covid-19. First dose vaccination significantly reduced the fear to Covid-19. &lt;/em&gt;&lt;/p&gt;