Reduction In Self-reported Anxiety Research Articles

Prefrontal engagement predicts the effect of museum visit on psychological well-being: an fNIRS exploration.

Recent research suggests that museum visits can benefit psychological well-being by reducing symptoms of stress and anxiety. However, these reported relaxing effects remain inconsistent between studies. Shedding light on the underlying cerebral mechanisms of museum visits might support a better understanding of how it affects psychological well-being. This study aimed to investigate the prefrontal engagement evoked by artwork analysis during a museum visit and to determine if these prefrontal substrates are associated with the museum's effect on psychological well-being in older adults. Nineteen adults aged between 65 and 79, toured a Baroque-style exhibit at the Montreal Museum of Fine Arts for approximately 20 minutes while equipped with a near-infrared spectroscopy system measuring the prefrontal cortex's hemodynamic activity. For each painting, participants received the instruction to either (1): analyze the painting and produce a personal interpretation of its signification (analytic condition) or (2) visualize the painting without any specific thoughts (visualization condition). Questionnaires measuring stress, anxiety, and well-being were administered before and after the visit. Sixteen older women (71.5 ± 4 years) were included in the analyses. Results showed that, at the group level, the analytic condition was associated with an increased activation pattern in the left ventrolateral prefrontal region, typically related to attentional processes (not observed in the visualization condition). The activation associated with the analytic condition predicted pre-/post-visit reductions in self-reported anxiety and stress in the sample of older women. These observations suggest that the level of engagement of attentional processes during artwork analysis may play a major role in the effect of a museum's visit on self-reported symptoms of anxiety.

AGING-IN-PLACE TECHNOLOGY: PROGRAMMING TO ADDRESS SOCIAL CONNECTEDNESS AND MENTAL HEALTH

Abstract According to the National Academies of Sciences, Engineering, and Medicine, the drastic increase of older adult social isolation from the pandemic has contributed to premature death, dementia, anxiety, and suicide. Jewish Family Service of Central New Jersey (JFSCNJ) clients corroborated this phenomenon with 65% meeting the diagnostic criteria for moderate to severe older adult depression or anxiety in 2020. In 2022, JFSCNJ established the Fig Tree Virtual Senior Center, a dynamic program that focused on older adults as they readjust to a post-pandemic world. By addressing social isolation through a Person-Centered Trauma Informed and biopsychosocial approaches, various wellness programs were provided in-home via the use of virtual video programming. Sixteen older adults (age range 68-95 years-old) were assessed on anxiety and depressive symptoms and social connectedness both prior to and six months following the start of the video programming intervention. Paired samples t-testing found a significant reduction in self-reported anxiety (p=.01) and depressive (p=.05) symptoms after video programming engagement at six-months follow-up. Path analysis using bootstrapping with bias corrected confidence intervals found amount of video programming with a positive and significant indirect effect on both increased social connectedness and improved well-being. Implications for homebound older adult social engagement and well-being programming will be discussed.

Acute Relaxation Response Induced by Tibetan Singing Bowl Sounds: A Randomized Controlled Trial.

The prevalence of anxiety has increased dramatically due to COVID-19, so effective preventive interventions are welcome. The main objective of our study was to compare the acute relaxation response (RR) induced by Tibetan singing bowl (TSB) sound-based treatment against progressive muscle relaxation (PMR) and a control waiting list group (CWL) in a single treatment session in an adult nonclinical anxious population. In this cross-sectional randomized control trial, 50 participants selected based on high state anxiety were randomly assigned to one of the experimental groups. Pre/post self-reported anxiety, electroencephalographic activity (EEG), and heart rate variability (HRV) were recorded at baseline (T1), minute 15 (T2), minute 30 (T3), and minute 45 (T4). The TSB group showed significant reductions in alpha power (from T2 to T4) and increased HRV (from T3 to T4) compared with the PMR and CWL groups. Moreover, TSB and PMR both showed significant reductions in self-reported anxiety compared with CWL, with this effect being more evident in the TSB group. We concluded that a single session of TSB treatment was able to induce a more evident psychological/physiological relaxation response compared with PMR and CWL. TSB could be a relevant acute intervention in stressful situations or crisis intervention and while waiting for conventional interventions.

Exploring the efficacy of a low intensity psychological intervention for family members and carers of individuals with a first episode of psychosis in early intervention services.

The study aimed to evaluate the efficacy, and explore carers' experience, of a brief carer focussed intervention in an Early Intervention in Psychosis (EIP) service using a mixed methods approach. Carers within EIP services were invited to have the intervention, comprising a psychoeducation and wellbeing component, and 153 carers completed routine outcome measures including the Brief Experience of Caregiving Inventory (BECI), The Warwick-Edinburgh Mental Well-being Scale (WEMWEBS) and the Hospital Anxiety and Depression Scale (HADS) at baseline and after the completion of the intervention. Separately, nine carers took part in semi-structured interviews about their experience of the intervention. The intervention resulted in improvement of overall well-being, a reduction in self-reported anxiety and caregiving experience relating to difficult behaviours and stigma/effects on the family. Overall, the carers' subjective experiences of the intervention were positive. Thematic analysis indicated epistemic trust indexed by the connection carers achieved with the service, an experience of being valued and of experiencing change through the intervention. A short, 8 weeks intervention delivered by assistant psychologists, may offer an effective method for facilitating understanding of the illness and acclimatizing to new challenges. Exploring the effectiveness of psychoeducation and capturing this with specific measures may allow the service to make meaningful adaptations to their intervention.

Preoperative and perioperative music to reduce anxiety during first-time phacoemulsification cataract surgery in the high-volume setting: randomized controlled trial.

To determine whether preoperative and perioperative music exposure reduced patient self-rated anxiety and physiologic indicators of stress during first-time phacoemulsification cataract surgery in the high-volume setting. Aravind Eye Care System, Pondicherry, India. Prospective single-masked randomized controlled trial. Patients were provided music before and during first-time phacoemulsification in 1 group and patients underwent surgery without music in another group. Measurements of blood pressure (BP), heart rate, respiration rate, and a Likert scale anxiety rating were collected at preoperative, perioperative, and postoperative timepoints. One hundred sixty-five patients (aged 53-65 years) were provided music using a portable MP3 player before and during first-time phacoemulsification, and 165 patients underwent surgery without music. Systolic and diastolic BPs were statistically significantly lower in the music intervention group at the postoperative timepoint, with similar physiologic measures between groups during the perioperative timepoints. In the preoperative period, before music exposure, 62 patients (38%) in the music group reported being very or extremely anxious. After 10 minutes of music exposure, only 7 patients (4%) reported this anxiety level. In the perioperative period, 80 patients (48%) in the intervention group reported feeling not at all or a little anxious, compared with 50 patients (30%) of the control group. In the postoperative period, 139 (84%) music group patients felt not at all or a little anxious postoperatively compared with 92 patients (56%) in the control group. Marked reductions in self-reported anxiety preoperatively, intraoperatively, and postoperatively when exposed to music and a statistically significant decrease in postoperative BP showed that music can be an inexpensive and effective solution to improve the patient experience of cataract surgery in the high-volume setting.

Peer Actors and Theater Techniques Play Pivotal Roles in Improving Social Play and Anxiety for Children With Autism.

Children with autism spectrum disorder (ASD) have significant difficulty in social functioning to include engaging in natural play with peers. Many children with ASD exhibit significantly less interactive play and more physiological stress during benign social encounters with same-age peers on a playground. Theatrical role-playing and performance with expert role models may provide a unique opportunity for children with ASD to learn to engage with other children in a safe, supportive environment. SENSE Theatre® is a peer-mediated, theater-based program aimed at improving social competence in youth with ASD. Previous studies have shown significant improvements in social and communication skills following SENSE Theatre® intervention. The current project examined play with novel peers and self-reported anxiety before and after participation in SENSE Theatre®. Participants included 77 children between 8 and 16 years with high-functioning (IQ ≥ 70) ASD. The combined sample of three cohorts was randomized to the experimental (EXP, N = 44) or waitlist control (WLC, N = 33) group. Participants in the EXP group received 40 h (10, 4-h sessions) of SENSE Theatre®. The Peer Interaction Paradigm (PIP), an ecologically valid measure of natural play, was administered before and after the intervention. Group Play and Self Play on the playground equipment during solicited (T4) and unsolicited (T1) play were used in the current study. The State Trait Anxiety Scale for Children (STAIC; Spielberger et al., 1983) was used to measure self-reported current and persistent anxiety, respectively. Following treatment, children in the EXP group engaged in significantly more Group Play with novel peers [F(2,73) = 7.78, p = 0.007] and much less Self Play [F(2,73) = 6.70, p = 0.01] during solicited play compared to the WLC group. Regression analysis revealed that pretreatment play and group status were significant predictors of solicited Group Play. Children in the EXP group reported significantly less Trait anxiety following intervention [F(2,71) = 6.87, p = 0.01]; however, State anxiety was comparable. Results corroborate previous findings of significant changes in social and play behavior in children with ASD following the peer-mediated, theater-based intervention. Acting and theatrical performance with supportive role models facilitates social engagement in everyday settings with novel peers and reductions in self-reported anxiety.

Analysis of Usage Data from a Self-Guided App-Based Virtual Reality Cognitive Behavior Therapy for Acrophobia: A Randomized Controlled Trial.

This study examined user engagement with ZeroPhobia, a self-guided app-based virtual reality (VR) Cognitive Behavior Therapy for acrophobia symptoms using cardboard VR viewers. Dutch acrophobic adults (n = 96) completed assessments at baseline and immediately following treatment. Primary outcome measures were the Acrophobia Questionnaire (AQ) and the Igroup Presence Questionnaire (IPQ). Usage data consisted of number of VR sessions practiced, practice time, and fear ratings directly after practicing. Results show that of the 66 participants who played at least one level, the majority continued to finish all levels, spending on average 24.4 min in VR. Self-reported fear consistently decreased between the start and finish of levels. Post-test AQ scores depended quadratically on time spent in VR. Higher pre-test AQ scores were significantly associated with subjective anxiety after the first level and a reduction of post-test AQ scores, but not with number of sessions, suggesting it might be more beneficial to play one level for a longer time period instead of practicing many VR levels. Results also show an optimum exposure level at which increasing practice time does not result in increased benefit. Self-guided VR acrophobia treatment is effective and leads to consistent reductions in self-reported anxiety both between levels and after treatment. Most participants progressed effectively to the highest self-exposure level, despite the absence of a therapist.

What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study

Abstract Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group (n = 44) and individual (n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative. Key learning aims (1) To explore whether gCBT and individual CBT yield significant symptom reduction in self-reported anxiety and depression in GAD patients from a routine IAPT service. (2) To explore gCBT and individual CBT clinical recovery rates in non-optimum routine conditions. (3) To explore whether gCBT for GAD produces unacceptable attrition rates and if this differs from attrition rates in individual CBT for GAD in a routine IAPT service.

Depressive Suppression: Effects of Emotion Suppression on Multiple Emotions for Depressed Versus Nondepressed Individuals

Clinical theory from multiple psychological perspectives, including cognitive therapies, have long suggested that the maladaptive use of strategies to regulate emotion play a central role in the development and maintenance of psychopathology. This consideration may be particularly salient for depressive symptoms, given the prevalence of multiple negative emotions in the context of depression and the recently established tendency for depressed individuals to suppress emotions. We experimentally tested whether emotional and physiological effects of emotion suppression in response to separate sadness and anxiety inductions are moderated by depressive symptoms. Results indicated no effect of suppression on self-reported sadness compared to control condition for depressed or nondepressed participants (total N = 113). However, suppressing anxiety led to a reduction in self-reported anxiety compared to control condition for nondepressed participants, but there was no effect of suppression on anxiety among depressed participants. A similar pattern emerged for cardiac responding during both inductions. Results suggest that the effects of suppression depend on the emotion suppressed and on one’s level of depressive symptoms. Depressed participants’ difficulty mitigating state anxiety also suggests that depressed individuals have difficulty regulating certain emotions, but not others. Further implications for theoretical understanding, assessment of psychopathology, and clinical practice are discussed.

Interaction and Engagement with an Anxiety Management App: Analysis Using Large-Scale Behavioral Data.

BackgroundSAM (Self-help for Anxiety Management) is a mobile phone app that provides self-help for anxiety management. Launched in 2013, the app has achieved over one million downloads on the iOS and Android platform app stores. Key features of the app are anxiety monitoring, self-help techniques, and social support via a mobile forum (“the Social Cloud”). This paper presents unique insights into eMental health app usage patterns and explores user behaviors and usage of self-help techniques.ObjectiveThe objective of our study was to investigate behavioral engagement and to establish discernible usage patterns of the app linked to the features of anxiety monitoring, ratings of self-help techniques, and social participation.MethodsWe use data mining techniques on aggregate data obtained from 105,380 registered users of the app’s cloud services.ResultsEngagement generally conformed to common mobile participation patterns with an inverted pyramid or “funnel” of engagement of increasing intensity. We further identified 4 distinct groups of behavioral engagement differentiated by levels of activity in anxiety monitoring and social feature usage. Anxiety levels among all monitoring users were markedly reduced in the first few days of usage with some bounce back effect thereafter. A small group of users demonstrated long-term anxiety reduction (using a robust measure), typically monitored for 12-110 days, with 10-30 discrete updates and showed low levels of social participation.ConclusionsThe data supported our expectation of different usage patterns, given flexible user journeys, and varying commitment in an unstructured mobile phone usage setting. We nevertheless show an aggregate trend of reduction in self-reported anxiety across all minimally-engaged users, while noting that due to the anonymized dataset, we did not have information on users also enrolled in therapy or other intervention while using the app. We find several commonalities between these app-based behavioral patterns and traditional therapy engagement.

145 Tractography-defined Subregions of Human Nucleus Accumbens Predict Acute Anxiolytic Response to Selective Stimulation

Abstract INTRODUCTION The nucleus accumbens (NAc) serves as a key node in reward processing underlying motivated behavior, and its dysfunction is implicated in a host of psychiatric disorders that are amenable to deep brain stimulation (DBS). On the basis of histochemical and structural connectivity data most thoroughly conducted in animals, the NAc is divided into two primary subregions, core (dorsolateral) and shell (ventromedial), which have dissociable afferent and efferent connections and functions. To characterize NAc subregions, the current study used high-resolution diffusion tractography to delineate core and shell and assessed the immediate clinical implications. METHODS Multimodal MRI data from 245 healthy, unrelated subjects was obtained from the Human Connectome Project database. Freesurfer-generated brain regions were used to perform probabilistic tractography using every NAc voxel as seed and every other Freesurfer region as target. NAc voxels with similar connectivity fingerprints were grouped using k-means clustering. This procedure was also performed retrospectively on two other datasets of lesser quality, including that of one patient with obsessive-compulsive disorder who underwent bilateral DBS lead placement targeting the NAc. The final position of the DBS leads relative to tractography-defined subregions was determined, and the effect of monopolar stimulation on self-reported anxiety utilizing subregion-specific contacts was assessed utilizing a Likert scale. RESULTS >Tractography-based segmentation of the NAc produced ventromedial and dorsolateral subregions across subjects and datasets, consistent with prior histochemical evidence from humans. At electrical currents as low as 1.6 mA, monopolar stimulation of dorsolateral but not ventromedial subregions produced an acute reduction in self-reported anxiety. CONCLUSION NAc subregions that resemble histologically defined core and shell with dissociable acute clinical effects can be produced with tractography-based segmentation. These results have implications for DBS targeting of the NAc, and may help to explain variances in clinical outcome among patients receiving NAc DBS to date.

A Randomized Controlled Trial Provides Evidence to Support Aromatherapy to Minimize Anxiety in Women Undergoing Breast Biopsy.

Aromatherapy has been used to reduce anxiety in a variety of settings, but usefulness associated with breast biopsies has not been documented. This study was conducted in women undergoing image-guided breast biopsy. We explored the use of two different aromatherapy scents, compared to placebo, aimed at reducing anxiety with the intent of generating new knowledge. This was a randomized, placebo-controlled study of two different types of external aromatherapy tabs (lavender-sandalwood and orange-peppermint) compared with a matched placebo-control delivery system. Anxiety was self-reported before and after undergoing a breast biopsy using the Spielberger State Anxiety Inventory Scale. Eighty-seven women participated in this study. There was a statistically significant reduction in self-reported anxiety with the use of the lavender-sandalwood aromatherapy tab compared with the placebo group (p = .032). Aromatherapy tabs reduced anxiety during image-guided breast biopsy. The completion of the biopsy provided some relief from anxiety in all groups. The use of aromatherapy tabs offers an evidence-based nursing intervention to improve adaptation and reduce anxiety for women undergoing breast biopsy. Lavender-sandalwood aromatherapy reduced anxiety and promoted adaptation more than orange-peppermint aromatherapy or placebo.

The Electronic CardioMetabolic Program (eCMP) for Patients With Cardiometabolic Risk: A Randomized Controlled Trial.

BackgroundEffective lifestyle interventions targeting high-risk adults that are both practical for use in ambulatory care settings and scalable at a population management level are needed.ObjectiveOur aim was to examine the potential effectiveness, feasibility, and acceptability of delivering an evidence-based Electronic Cardio-Metabolic Program (eCMP) for improving health-related quality of life, improving health behaviors, and reducing cardiometabolic risk factors in ambulatory care high-risk adults.MethodsWe conducted a randomized, wait-list controlled trial with 74 adults aged ≥18 years recruited from a large multispecialty health care organization. Inclusion criteria were (1) BMI ≥35 kg/m2 and prediabetes, previous gestational diabetes and/or metabolic syndrome, or (2) BMI ≥30 kg/m2 and type 2 diabetes and/or cardiovascular disease. Participants had a mean age of 59.7 years (SD 11.2), BMI 37.1 kg/m2 (SD 5.4) and were 59.5% female, 82.4% white. Participants were randomized to participate in eCMP immediately (n=37) or 3 months later (n=37). eCMP is a 6-month program utilizing video conferencing, online tools, and pre-recorded didactic videos to deliver evidence-based curricula. Blinded outcome assessments were conducted at 3 and 6 months postbaseline. Data were collected and analyzed between 2014 and 2015. The primary outcome was health-related quality of life. Secondary outcomes included biometric cardiometabolic risk factors (eg, body weight), self-reported diet and physical activity, mental health status, retention, session attendance, and participant satisfaction.ResultsChange in quality of life was not significant in both immediate and delayed participants. Both groups significantly lost weight and reduced waist circumference at 6 months, with some cardiometabolic factors trending accordingly. Significant reduction in self-reported anxiety and perceived stress was seen in the immediate intervention group at 6 months. Retention rate was 93% at 3 months and 86% at 6 months post-baseline. Overall eCMP attendance was high with 59.5-83.8% of immediate and delayed intervention participants attending 50% of the virtual stress management and behavioral lifestyle sessions and 37.8-62.2% attending at least 4 out of 7 in-person physical activity sessions. The intervention received high ratings for satisfaction.ConclusionsThe technology-assisted eCMP is a feasible and well-accepted intervention and may significantly decrease cardiometabolic risk among high-risk individuals.Trial RegistrationClinicaltrials.gov NCT02246400; https://clinicaltrials.gov/ct2/show/NCT02246400 (Archived by WebCite at http://www.webcitation.org/6h6mWWokP)

Anxiety reduction in patients undergoing cardiac catheterization following massage and guided imagery

ObjectiveThis study aimed to evaluate the effectiveness of massage with or without guided imagery in reducing anxiety prior to cardiac catheterization. MethodA total of 55 inpatients and outpatients received massage, guided imagery, or massage with guided imagery prior to cardiac catheterization. Self-reported anxiety levels and blood pressure (BP) and heart rate (HR) were evaluated in participants and a matched comparison group. ResultsMassage with and without guided imagery resulted in significant reductions in self-reported anxiety (p < 0.0001). Patients receiving intervention had lower diastolic BP and HR vs. the comparison group (p < 0.0001 and p < 0.05). ConclusionsMassage with or without guided imagery immediately reduced self-reported anxiety. This pilot study has certain limitations: a non-randomized, convenience sample and a matched control group that was created retrospectively. However, the study indicates a benefit to providing massage or massage with guided imagery prior to anxiety-inducing medical procedures such as cardiac catheterization.

Matter Over Mind: A Randomised-Controlled Trial of Single-Session Biofeedback Training on Performance Anxiety and Heart Rate Variability in Musicians

BackgroundMusical performance is a skilled activity performed under intense pressure, thus is often a profound source of anxiety. In other contexts, anxiety and its concomitant symptoms of sympathetic nervous system arousal have been successfully ameliorated with HRV biofeedback (HRV BF), a technique involving slow breathing which augments autonomic and emotional regulatory capacity. Objective: This randomised-controlled study explored the impact of a single 30-minute session of HRV BF on anxiety in response to a highly stressful music performance.MethodsA total of 46 trained musicians participated in this study and were randomly allocated to a slow breathing with or without biofeedback or no-treatment control group. A 3 Group×2 Time mixed experimental design was employed to compare the effect of group before and after intervention on performance anxiety (STAI-S) and frequency domain measures of HRV.ResultsSlow breathing groups (n = 30) showed significantly greater improvements in high frequency (HF) and LF/HF ratio measures of HRV relative to control (n = 15) during 5 minute recordings of performance anticipation following the intervention (effect size: η2 = 0.122 and η2 = 0.116, respectively). The addition of biofeedback to a slow breathing protocol did not produce differential results. While intervention groups did not exhibit an overall reduction in self-reported anxiety, participants with high baseline anxiety who received the intervention (n = 15) displayed greater reductions in self-reported state anxiety relative to those in the control condition (n = 7) (r = 0.379).ConclusionsThese findings indicate that a single session of slow breathing, regardless of biofeedback, is sufficient for controlling physiological arousal in anticipation of psychosocial stress associated with music performance and that slow breathing is particularly helpful for musicians with high levels of anxiety. Future research is needed to further examine the effects of HRV BF as a low-cost, non-pharmacological treatment for music performance anxiety.

Mental skills for musicians: Managing music performance anxiety and enhancing performance.

The aim of the present study was to examine the effects of a short-term mental skills intervention on reducing music performance anxiety and enhancing performance. Thirty-three musicians, including students, amateurs, and professionals, volunteered to participate (ages 19 to 66 years, mean = 42.09, standard deviation = 15.18). Participants were randomly assigned to a treatment group (cognitive restructuring; N = 15) or a wait-list control group (N = 18). A provisionally registered psychologist taught participants mental skills strategies in three 1-hr, psychoeducational workshops. Self-report, behavioral, and physiological indicators of anxiety and performance quality were collected pretest and posttest. Self-report measures were also taken for the treatment group at a 1-month follow-up. We hypothesized anxiety reduction and performance enhancement in the treatment group from pre- to posttest, and that the benefits of treatment would be maintained or strengthened at the 1-month follow-up. Results revealed a significant reduction in self-reported anxiety, a significant increase in performance quality in the treatment group, and a significant decrease in performance quality in the wait-list control group. The follow-up assessment revealed a significant decrease in self-reported anxiety. No other significant differences were observed.

Can Public Versus Private Disclosure Cause Greater Psychological Symptom Reduction?

Three studies examined the effects of disclosure in a social context. In 2 longitudinal experiments (N = 65 and N = 48), undergraduates wrote nonanonymous personal life stories and then were told that their stories either would or would not be read by their classmates. Both experiments revealed that participants in the public, as compared to private, disclosure condition experienced significantly greater self-reported psychological symptom reduction in the weeks following the writing. The second experiment showed that this effect was completely mediated by a reduction in self-reported anxiety and negative emotions surrounding the written disclosure. A third study (N = 354) showed that disclosing personal topics more publicly was significantly correlated with fewer psychological symptoms. Taken together, these findings demonstrate that the benefits of written disclosure can be magnified if the disclosure is public, as opposed to private, because of the accompanying reduction in negative affect surrounding the public disclosure.

Effects of safety behaviors on fear reduction during exposure

The use of safety behaviors has been considered one of the primary maintaining mechanisms of anxiety disorders; however, evidence suggests that they are not always detrimental to treatment success ( Milosevic & Radomsky, 2008). This study examined the effects of safety behaviors on behavioral, cognitive, and subjective indicators of fear during exposure for fear of spiders. A two-stage design was used to examine fear reduction and approach distance during an in vivo exposure task for participants ( N = 43) assigned to either a safety behavior use (SBU) or no safety behavior use (NSB) condition. Overall, both groups reported significant and comparable reductions in self-reported anxiety and negative beliefs about spiders at posttest and 1-week follow-up. Participants in the SBU group approached the spider more quickly than did participants in the NSB condition; however, participants in the SBU condition showed a small but significant decrease in approach distance at follow-up. These results call for a reconceptualization of the impact of safety behaviors on in vivo exposure.

Pilot Study Evaluating the Effect of Massage Therapy on Stress, Anxiety and Aggression in a Young Adult Psychiatric Inpatient Unit

The aim of the present pilot study was to examine the effectiveness of a relaxation massage therapy programme in reducing stress, anxiety and aggression on a young adult psychiatric inpatient unit. This was a prospective, non-randomized intervention study comparing treatment as usual (TAU) with TAU plus massage therapy intervention (MT) over consecutive 7 week blocks (May-August 2006). MT consisted of a 20 min massage therapy session offered daily to patients during their period of hospitalization. The Kennedy Nurses' Observational Scale for Inpatient Evaluation (NOSIE), the Symptom Checklist-90-Revised (SCL-90-R), the State-Trait Anxiety Inventory (STAI) and stress hormone (saliva cortisol) levels were used to measure patient outcomes at admission and discharge from the unit. The Staff Observation Aggression Scale-Revised (SOAS-R) was used to monitor the frequency and severity of aggressive incidents on the unit. There was a significant reduction in self-reported anxiety (p < 0.001), resting heart rate (p < 0.05) and cortisol levels (p < 0.05) immediately following the initial and final massage therapy sessions. Significant improvements in hostility (p = 0.007) and depression scores (p < 0.001) on the SCL-90-R were observed in both treatment groups. There was no group x time interaction on any of the measures. Poor reliability of staff-reported incidents on the SOAS-R limited the validity of results in this domain. Massage therapy had immediate beneficial effects on anxiety-related measures and may be a useful de-escalating tool for reducing stress and anxiety in acutely hospitalized psychiatric patients. Study limitations preclude any definite conclusions on the effect of massage therapy on aggressive incidents in an acute psychiatric setting. Randomized controlled trials are warranted.

The Efficacy of Habituation in Decreasing Subjective Distress Among High Anxiety-Sensitive College Students

While there is mounting evidence that the concept of anxiety sensitivity (AS) is linked to the expression of anxiety (specifically, panic), there has been little research comparing the efficacy of interoceptive exposure alone with interoceptive exposure coupled with cognitive restructuring among high AS participants. The present investigation addressed this issue in a sample of high anxiety-sensitive college students (scores above 29 on the Anxiety Sensitivity Index). Participants were randomly assigned to receive either five consecutive trials of voluntary hyperventilation or five consecutive trials of hyperventilation with cognitive restructuring instructions. It was expected that while repeated hyperventilation would be associated with a significant reduction in self-reported anxiety, catastrophic cognitions, and somatic sensations across trials, the greatest reduction in symptoms would occur with the addition of cognitive restructuring. These predictions were partially supported. As expected, high AS participants evidenced significant decreases in anxiety symptoms when habituation was accompanied by cognitive restructuring. Contrary to predictions, however, interoceptive exposure alone was not effective in reducing anxious symptoms. These results suggest that brief habituation alone may not be an effective strategy for high AS participants and are discussed as providing further support for a cognitive model of anxiety.