Fear Reduction Research Articles

Evaluation of Physical Security of Indonesian Formed Police Units' Garuda Camp in the Perspective of Crime Prevention Through Environmental Design

Indonesia is one of the Police Contributing Countries (PCC) in the United Nations Peacekeeping Operations. Since 1989, Indonesia has deployed their police officers into various peacekeeping missions, either individually or in the units called Formed Police Units (FPU). In deploying the FPU, Indonesia as the PCC is not only responsible for preparing the personnel, but also equipping the FPU in logistics and infrastructure, which includes appropriate camps in the mission area. These camps have an important role as the operational and administrative base of the FPU, personnels accommodation, assets storage facility, and notably as the symbol of Indonesia’s commitment to its contribution to world peace. Garuda Camp Indonesian FPU in MINUSCA, Central African Republic, was built in 2018 by the International Relations Division of The National Police with total assets more than 500 billion rupiahs. During the 2 years of placing the Indonesian FPU in MINUSCA, several security threats have occurred in this camp, such as theft and burglary.
 In this case, the camp security is an important element to ensure the Unit's success in performing its mission mandate. Therefore, the author sees the need for an evaluation using the perception of Crime Prevention Through Environmental Design (CPTED) to increase the level of security at Garuda Camp. This is based on CPTED which has a basic idea that proper and effective design in the use of the built environment can lead to a reduction in crime and fear of crime, as well as an improvement in the quality of life in an environment. The author explores threats and use qualitative methods to identify the compliance of physical security requirements in the camp. The result of the study shows that Garuda Camp is included in the medium level threat category. Thus, a threat prevention strategy is needed.

Masking our risky behavior: how licensing and fear reduction reduce social distancing behavior

ABSTRACT Licensing and fear reduction can explain why people only partially adopt health precautions while still believing that they are remaining compliant with recommendations during the COVID-19 pandemic. We assessed individuals’ attitudes regarding social distancing and personal protective practices, as well as concern about COVID-19 and behaviors in April of 2020. Concern about COVID-19 had dual, competing effects on social distancing behavior. Concern predicted increased social distancing behavior via more positive social distance policy attitudes. However, concern also predicted decreased social distancing behavior via more positive attitudes toward personal protective practices, such as mask wearing. Licensing and/or fear reduction allows individuals to view personal protective practices as substitutable rather than additive measures of safety that should complement social distancing, and this effect is not explained by partisanship or working from home. Policy makers should be cautious when advocating for multiple health precautions of varying effectiveness that are intended to be additive.

Mind’s eye: The impact of spider presence and cognitive therapy on size estimation biases in spider phobia

The present study assessed the circumstances under which size estimation biases in spider phobia occur, and whether such biases are modifiable by treatment. Women with (n = 67) and without (n = 33) spider phobia approached a spider during a behavioral approach test (BAT). They provided size estimates of the spider both during and shortly after the BAT (with the spider in view, or not in view, respectively). Phobic women then received cognitive therapy or a placebo treatment and one week later they underwent a second BAT and provided size estimates of the same spider during and after the BAT. Phobic women reported larger size estimates than non-phobic women after, but not during, the BAT. Size estimates after, but not during, the BAT correlated with self-reported fear but not avoidance. Size estimates after, but not during, the BAT reduced from the first to second BAT in phobic women; an effect evident in both the cognitive therapy and placebo treatment conditions. Changes in size estimates were not associated with treatment-induced reductions in fear or avoidance. These results suggest that estimation biases in spider phobia are likely driven by non-perceptual processes. The clinical utility of size estimation measures is discussed.

Factors Moderating the Impact of After Death Communications on Beliefs and Spirituality.

After death communications(ADCs) are defined as perceived spontaneous contacts with living individuals by the deceased. This research presents on a subset of data from a recent large international survey of individuals who experienced ADCs and provided systematic information regarding these experiences. In our research we explore the impact of having an ADC on reported spirituality, religiosity, beliefs and attitudes about death and dying and also explore the moderating factors of this impact. We found that having an ADC was perceived as a positive life experience and that it was associated with a reduction in fear of death, belief in life after death and that the deceased could communicate with the living, and increased reported spirituality. Moderating factors include aspects of having or desiring physical contact with the deceased as well as perceiving some emotional reaction to the ADCs. Future directions for research exploration are also provided based on our findings.

Interventions for fear of childbirth including tocophobia.

Many women experience fear of childbirth (FOC). While fears about childbirth may be normal during pregnancy, some women experience high tosevereFOC. At the extreme end of the fear spectrum is tocophobia, which is considereda specific condition that may cause distress,affect well-being during pregnancy and impede the transition to parenthood.Various interventions have been trialled, which support women to reduce and manage high to severeFOC, including tocophobia. To investigate the effectiveness of non-pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia. In July 2020, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We contacted researchers of trials which were registered and appeared to be ongoing. We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. Two review authors independently screened and selected titles and abstracts for inclusion. We excluded quasi-randomised and cross-over trials. We used standard methodological approaches as recommended by Cochrane. Two review authors independently extracted data and assessed the studies for risk of bias. A third review author checked the data analysis for accuracy. We used GRADE to assess the certainty of the evidence. The primary outcome was a reduction in FOC. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use. We included seven trials with a total of 1357participants. The interventions included psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. We judged four studies as high or unclear risk of bias in terms of allocation concealment; we judged three studies as high risk in terms of incomplete outcome data; and in all studies, there was a high risk of bias due to lack of blinding. We downgraded thecertainty of the evidence due to concerns about risk of bias, imprecision and inconsistency. None of the studies reported data about women's anxiety. Participating in non-pharmacological interventions may reduce levels of fear of childbirth, as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful (mean difference (MD) -7.08, 95% confidence interval (CI) -12.19 to -1.97; 7 studies, 828 women; low-certainty evidence). The W-DEQ tool is scored from 0 to 165 (higher score = greater fear). Non-pharmacological interventions probably reduce the number of women having a caesarean section(RR 0.70, 95% CI 0.55 to0.89; 5 studies, 557 women; moderate-certainty evidence). There may be little to no difference between non-pharmacological interventions and usual care in depression scores measured with the Edinburgh Postnatal Depression Scale (EPDS) (MD 0.09, 95% CI -1.23to 1.40;2 studies, 399 women;low-certainty evidence). The EPDS tool is scored from 0 to 30 (higher score = greater depression). Non-pharmacological interventions probably leadto fewer women preferring a caesarean section (RR0.37, 95% CI 0.15 to 0.89; 3 studies, 276 women; moderate-certainty evidence). Non-pharmacological interventions may increase epidural use compared with usual care, but the 95% CI includes the possibility of a slight reduction in epidural use (RR 1.21, 95% CI 0.98 to 1.48;2 studies, 380 women; low-certainty evidence). The effect of non-pharmacological interventionsfor women with high to severe fear of childbirth in terms of reducing fear is uncertain.Fear of childbirth, as measured by W-DEQ, may be reduced but it is not certain if this represents a meaningful clinical reduction of fear. There may be little or no difference in depression, but there may be a reduction in caesarean section delivery. Future trials should recruit adequate numbers of women and measure birth satisfaction and anxiety.

A Complex Impact of Systemically Administered 5-HT2A Receptor Ligands on Conditioned Fear.

BackgroundThough drugs binding to serotonergic 5-HT2A receptors have long been claimed to influence human anxiety, it remains unclear if this receptor subtype is best described as anxiety promoting or anxiety dampening. Whereas conditioned fear expressed as freezing in rats is modified by application of 5-HT2A–acting drugs locally into different brain regions, reports on the effect of systemic administration of 5-HT2A receptor agonists and 5-HT2A antagonists or inverse agonists on this behavior remain sparse.MethodsWe assessed the possible impact of systemic administration of 5-HT2A receptor agonists, 5-HT2A receptor inverse agonists, and a selective serotonin reuptake inhibitor (SSRI)—per se or in combination—on the freezing displayed by male rats when re-exposed to a conditioning chamber in which they received foot shocks 7 days earlier.ResultsThe 5-HT2A receptor agonists psilocybin and 25CN-NBOH induced a reduction in conditioned fear that was countered by pretreatment with 5-HT2A receptor inverse agonist MDL 100907. While both MDL 100907 and another 5-HT2A receptor inverse agonist, pimavanserin, failed to impact freezing per se, both compounds unmasked a robust fear-reducing effect of an SSRI, escitalopram, which by itself exerted no such effect.ConclusionsThe results indicate that 5-HT2A receptor activation is not a prerequisite for normal conditioned freezing in rats but that this receptor subtype, when selectively over-activated prior to expression, exerts a marked fear-reducing influence. However, in the presence of an SSRI, the 5-HT2A receptor, on the contrary, appears to counter an anti-freezing effect of the enhanced extracellular serotonin levels following reuptake inhibition.

The Impact of Virtual Reality Exposure on Stress Level and Sense of Competence in Ambulance Workers.

Virtual reality (VR) exposure is used in clinical psychology to treat anxiety disorders. It is also used to enhance resilience in soldiers by allowing them to confront virtual combat environments to help fortify them against the negative consequences of trauma exposure. Most VR studies have focused on military and emergency medical staff; however, thus far, none have investigated VR in ambulance workers (AWs), who are confronted with traumatic situations daily. The current study aimed to assess the impact of a single VR exposure session on self-perceived competence and stress level in a sample of AWs. Participants (N = 40) were randomly assigned to either a VR immersion (i.e., experimental group, n = 20) or an audio immersion (i.e., control group, n = 20) of a shooting attack situation. We hypothesized that compared to controls, VR participants would report decreased anxiety, as measured using visual analog scales, as well as an increased sense of competence. The results showed a significant reduction in fear in both groups, d = 0.33, and an increased sense of competence in VR participants, d = 0.35. Although our hypotheses were only partially confirmed, the observed beneficial effects of VR and the audio immersion on stress levels in AWs suggest that VR exposure could be a useful way to increase resilience in AWs.

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

Students' Attitudes to and Knowledge of Brown Bears (Ursus arctos L.): Can More Knowledge Reduce Fear and Assist in Conservation Efforts?

Simple SummaryLarge carnivores distributed throughout Europe have interactions with people because their habitats often collide with human settlements. Since human behavior can significantly influence the conservation of these species, knowledge of certain behaviors and factors of influence are crucial. The present study included 534 students from lower and upper secondary schools. In this article, students’ attitudes to and knowledge of brown bears and the indirect effect of teaching are examined. Factors such as gender and seeing a bear in nature were found to influence the students’ attitudes and knowledge significantly, implying that they should be considered in any future educational actions. Other factors like residence, owning a dog, having a hunter in the family, breeding livestock and visiting a zoo had a smaller effect on the students’ attitudes and knowledge in general. The results thus indicate that greater knowledge was correlated with proconservation attitudes and reduced fear among the students.The expansion of large carnivores across Europe is posing a challenge to their conservation. Since success with conservation may depend significantly on human behavior, knowledge of certain behaviors’ emergence and all the factors that affect them are crucial. The present study included 534 students who were divided into a comparison group (n = 317) and a treatment group (n = 217) consisting of 309 lower secondary (LS, MAge = 12.2, SD = 0.94) and 225 upper secondary (US, n = 225, MAge = 16.5, SD = 0.99) school students. We assessed their attitudes to and knowledge of brown bears. An indirect effect of the workshops (instructions) is also described. Sociodemographic factors, such as gender and seeing a bear in nature, significantly influenced the students’ attitudes and knowledge. Residence, owning a dog, having a hunter in the family, breeding livestock and visiting a zoo had a smaller effect on the students’ attitudes and knowledge. The results thus show that greater knowledge is correlated with proconservation attitudes, and partly with reduction of fear. Therefore, future conservation and management should employ strong communication, especially education activities based on direct experiences and carefully designed information regarding species and socio-scientific issues.

Use of Virtual Reality Distraction to Reduce Child Pain and Fear during Painful Medical Procedures in Children with Physical Disabilities in Uganda: A Feasibility Study.

This study explored the acceptability and feasibility of the use of low-cost virtual reality (VR) glasses, and the Wong-Baker Faces Pain Scale and Children's Fear Scale scales, for pain and fear reduction in children admitted at the septic ward of CoRSU Rehabilitation Hospital in Uganda. In total, 79 children aged 4-17 years of age were offered to watch cartoons using VR glasses while undergoing painful dressing procedures. Before and after the procedure, children were asked to index current pain; children and their caregivers were asked to rate anticipated fear. Focus group discussions with 13 children, 10 caregivers and 9 nurses explored acceptability and feasibility. Quantitative data were analyzed using STATA15, NVIVO12 was used for qualitative data analysis. The VR glasses were accepted by 76 (96%) of the children. Children, caregivers, and nurses mentioned the glasses were helpful in distracting children from the medical procedure and felt the use of the glasses helped reduce child fear and pain. Nurses felt it made their work easier. The Wong-Baker Faces Pain Scale was an acceptable and feasible method to measure pain, while the Children's Fear Scale was more difficult to interpret for our study population as they felt the faces on the scale were hard to read and identify with. The use of VR glasses may offer an acceptable and effective pain and fear reduction method in resource-constrained settings and should be further explored in a randomized controlled trial.

Impact of continuous glucose monitoring on improving emotional well‑being among adults with type 1 diabetes mellitus: a systematic review and meta‑analysis.

Real-time continuous glucose monitoring (CGM) has changed the way people with type 1 diabetes mellitus (T1DM) and health care providers perceive diabetes management and glucose control. The purpose of this meta-analysis was to compare the emotional well-being of adults with T1DM who used CGM and those using conventional self-monitoring of blood glucose (SMBG). The MEDLINE/PubMed, Cochrane Library / Embase, CINAHL, Scopus, Web of Science, and ProQuest databases were searched for relevant publications. Primary outcome measures were health-related quality of life, glycemic control, and fear of hypoglycemia. Randomized controlled trials and survey studies focused on the quality of life and fear of hypoglycemia among adult patients using CGM and SMBG were included in the analysis. The meta-analysis included 11 studies involving a total of 1228 patients with T1DM. Analysis of the Worry subscale of the Hypoglycemia Fear Survey indicated a reduction of hypoglycemia fear in CGM users compared with SMBG users (Cohen d = –0.24; 95% CI, –0.41 to –0.07; mean difference, –3.15; 95% CI, –5.48 to –0.82). Outcome analysis of studies including the Diabetes Treatment Satisfaction Questionnaire showed Cohen d of 0.23 (95% CI, –0.18 to 0.63). The overall value of Cohen d equaled –0.24 (95% CI, –0.57 to 0.09), indicating a lack of effect of CGM use on improving HbA1c levels; however, after one of the studies was excluded from calculations, the reduction of HbA1c levels was significantly higher in CGM users (Cohen d = –0.33; 95% CI, –0.66 to 0.00; P = 0.047). This is the first quantitative meta-analysis of studies involving adult patients exclusively with T1DM, providing further evidence for the ability of CGM systems to reduce fear of hypoglycemia and improve quality of life. Continuous glucose monitoring systems have advantage over SMBG in adults with T1DM and improve HbA1c levels.

Fear From Afar, Not So Risky After All: Distancing Moderates the Relationship Between Fear and Risk Taking.

A growing line of research has shown that individuals can regulate emotional biases in risky judgment and decision-making processes through cognitive reappraisal. In the present study, we focus on a specific tactic of reappraisal known as distancing. Drawing on appraisal theories of emotion and the emotion regulation literature, we examine how distancing moderates the relationship between fear and risk taking and anger and risk taking. In three pre-registered studies (Ntotal = 1,483), participants completed various risky judgment and decision-making tasks. Replicating previous results, Study 1 revealed a negative relationship between fear and risk taking and a positive relationship between anger and risk taking at low levels of distancing. Study 2 replicated the interaction between fear and distancing but found no interaction between anger and distancing. Interestingly, at high levels of distancing, we observed a reversal of the relationship between fear and risk taking in both Study 1 and 2. Study 3 manipulated emotion and distancing by asking participants to reflect on current fear-related and anger-related stressors from an immersed or distanced perspective. Study 3 found no main effect of emotion nor any evidence of a moderating role of distancing. However, exploratory analysis revealed a main effect of distancing on optimistic risk estimation, which was mediated by a reduction in self-reported fear. Overall, the findings suggest that distancing can help regulate the influence of incidental fear on risk taking and risk estimation. We discuss implications and suggestions for future research.

Taxonomy and nature of fear-related expectancies.

People who expect harmful outcomes from encounters with feared events may adapt their behavior dramatically. Such behavioral change, on the one hand, most likely produces positive short-term effects (i.e., reduction of fear). On the other hand, there can also arise important negative side effects that are expressed in unintended unfavorable long-term consequences. For instance, socially anxious students may tend to avoid giving presentations because of fear of negative feedback from teachers and classmates. When such avoidance is possible, the immediate response will be relief. Yet, after some time has passed, these individuals often experience disappointment with themselves because they have not been able to master the situation. Such self-directed disappointment, in turn, will further reduce their already cracked self-esteem. Moreover, the avoidance behavior substantially conflicts with the students’ desire to successfully complete their studies and subsequently prosper in their jobs. Hence, fear of social failure yields a situation in which expectancies shape the future according to self-fulfilling prophecies, thereby substantially decreasing quality of life. This example thus shows that critical unfavorable expectancies need to be identified and targeted in the clinical context. With their review on the influence of expectancies on experienced fear, Hilleke et al. (2021) make an overdue contribution to the field of research on anxiety disorders. The authors rightfully point out that the sophisticated or differentiated nature of expectancies has long been ignored, a point that I would like to further develop in this commentary. Another important aspect that I will address relates to the fact that expectancies do not exist in isolation but can plausibly be assumed to interact with other information processing domains such as attention, interpretation, and memory. Finally, I will outline how advancements in expectancy categorizations and an in-depth investigation of the interplay of expectancies with other cognitive processes may inform therapeutic approaches.

Can a pure motivational interviewing intervention be manualized and still efficacious? A test of feasibility and initial efficacy.

The importance of attending to the therapeutic process despite the challenges in manualizing it is demonstrated in the empirical evolution of motivational interviewing (MI). Whereas manuals exist for adaptations of MI, no manual has been developed and tested for MI in its pure form (pure MI). This study evaluated the feasibility and initial efficacy of a pure MI intervention manual - MI for risky social drinking (MI-RSD) - designed to target risky social drinking behaviors in college students with social anxiety. A pilot sample of 42 college students completed measures of alcohol use and mental health symptoms and the MI-RSD intervention. We developed a manual for the 2-session MI-RSD intervention, trained 4 clinical doctoral students, and used observer-, therapist- and participant-completed measures to evaluate fidelity. Therapists met beginner proficiency in MI fidelity and participant gave high ratings of therapist adherence to MI and working alliance, demonstrating intervention feasibility. Also, participants reported significant reductions in hazardous drinking and evaluation fears, but not in social interaction anxiety. We offer preliminary evidence that pure MI can be manualized and effective. Specifically, MI-RSD represents an alternative to MI adaptations in mitigating alcohol-related harm for young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A thalamo-amygdalar circuit underlying the extinction of remote fear memories.

Fear and trauma generate some of the longest-lived memories. Despite the corresponding need to understand how such memories can be attenuated, the underlying brain circuits remain unknown. Here, combining viral tracing, neuronal activity mapping, fiber photometry, chemogenetic and closed-loop optogenetic manipulations in mice, we show that the extinction of remote (30-day-old) fear memories depends on thalamic nucleus reuniens (NRe) inputs to the basolateral amygdala (BLA). We found that remote, but not recent (1-day-old), fear extinction activates NRe-to-BLA inputs, which become potentiated upon fear reduction. Furthermore, both monosynaptic NRe-to-BLA and total NRe activity increase shortly before freezing cessation, suggesting that the NRe registers and transmits safety signals to the BLA. Accordingly, pan-NRe and pathway-specific NRe-to-BLA inhibition impairs, whereas their activation facilitates, remote fear extinction. These findings identify the NRe as a crucial BLA regulator for extinction and provide the first functional description of the circuits underlying the attenuation of consolidated fear memories.

Is Continued Improvement After Automated Virtual Reality Exposure Therapy for Spider Phobia Explained by Subsequent in-vivo Exposure? A First Test of the Lowered Threshold Hypothesis.

Consumer Virtual Reality (VR) technology offers a powerful, immersive medium for scalable dissemination of mental health interventions. Decades of research has shown VR exposure therapy to be efficacious in the treatment of anxiety disorders and that the fear reduction generalizes to real-world stimuli. Many studies also report continued improvement over time, after discontinuing VR use. The lowered threshold hypothesis states that this continued improvement is moderated by lowering the threshold to conduct subsequent in-vivo exposure. The current study is the first to formally test this hypothesis, using data from a recent trial on automated VR exposure therapy for spider phobia, in which participants (n = 49) were followed for 1 year, completing assessments 1 week, 3 and 12 months post-treatment. The assessment included validated self-report of phobia symptoms, a standardized behavioral approach test featuring a real spider, and a questionnaire for self-reporting frequency of in-vivo exposures since last assessment. Number of in-vivo exposures was found to be independently associated with greater symptom decrease in longitudinal outcome models. In sequential structural equation models, immediate post-treatment symptom reduction was associated with subsequent in-vivo exposures, which in turn was associated with continued symptom reduction. However, this applied only to self-reported phobia symptoms (not behavioral avoidance) and no associations were found past 3 months. Our findings offer preliminary, partial support for the lowered threshold hypothesis, suggesting that VR exposure interventions may benefit from including explicit in-virtuo to in-vivo transitioning components.

Neural adaptation of cingulate and insular activity during delayed fear extinction: A replicable pattern across assessment sites and repeated measurements

Adapting threat-related memories towards changing environments is a fundamental ability of organisms. One central process of fear reduction is suggested to be extinction learning, experimentally modeled by extinction training that is repeated exposure to a previously conditioned stimulus (CS) without providing the expected negative consequence (unconditioned stimulus, US). Although extinction training is well investigated, evidence regarding process-related changes in neural activation over time is still missing. Using optimized delayed extinction training in a multicentric trial we tested whether: 1) extinction training elicited decreasing CS-specific neural activation and subjective ratings, 2) extinguished conditioned fear would return after presentation of the US (reinstatement), and 3) results are comparable across different assessment sites and repeated measures. We included 100 healthy subjects (measured twice, 13-week-interval) from six sites. 24 h after fear acquisition training, extinction training, including a reinstatement test, was applied during fMRI. Alongside, participants had to rate subjective US-expectancy, arousal and valence. In the course of the extinction training, we found decreasing neural activation in the insula and cingulate cortex as well as decreasing US-expectancy, arousal and negative valence towards CS+. Re-exposure to the US after extinction training was associated with a temporary increase in neural activation in the anterior cingulate cortex (exploratory analysis) and changes in US-expectancy and arousal ratings. While ICCs-values were low, findings from small groups suggest highly consistent effects across time-points and sites. Therefore, this delayed extinction fMRI-paradigm provides a solid basis for the investigation of differences in neural fear-related mechanisms as a function of anxiety-pathology and exposure-based treatment.

Transfer of exposure therapy effects to a threat context not considered during treatment in patients with panic disorder and agoraphobia: Implications for potential mechanisms of change

Further developments of exposure-based therapy (EBT) require more knowledge about transfer of treatment to non-trained everyday contexts. However, little is known about transfer effects of EBT.Using a standardized EBT protocol in 275 patients with panic disorder and agoraphobia we investigated the transfer of EBT to a highly standardized context during a Behavioral Avoidance Test (BAT; being entrapped in a small and dark test chamber) and not part of the exposure sessions. Patients of a treatment group underwent the BATs before treatment (t1), after a preparatory treatment phase (t2), and after an agoraphobic exposure phase (t3) and were compared with wait-list control patients, who repeated BAT assessments across the same time period.We found stronger reductions in avoidance behavior, reported fear, and autonomic arousal during the BAT from t1 to t3 in the treatment group patients who were anxious during t1 relative to the anxious but untreated patients. Fear reduction was related to treatment outcome indicating the contribution of transfer effects to successful EBT. Interestingly, reduction varied for different fear response systems suggesting different processes to may be involved in transfer effects. Importantly, final BAT assessment still evoked residual fear in the treatment group as compared to BAT non-anxious control patients, suggesting limited transfer effects – one possible reason for the return of symptoms in new situations.

Genes in treatment: Polygenic risk scores for different psychopathologies, neuroticism, educational attainment and IQ and the outcome of two different exposure-based fear treatments

Objectives Evidence for a genetic influence on psychological treatment outcome so far has been inconsistent, likely due to the focus on candidate genes and the heterogeneity of the disorders treated. Using polygenic risk scores (PRS) in homogenous patient samples may increase the chance of detecting genetic influences. Methods A sample of 342 phobic patients treated either for clinically relevant dental fear (n = 189) or other (mixed) phobic fears (n = 153) underwent highly standardised exposure-based CBT. A brief five-session format was used to treat dental fear, whereas longer multi-session treatments were used with the mixed-fear cohort. PRS were calculated based on large genetic studies of Neuroticism, Educational Attainment (EA), Intelligence, and four psychopathology domains. We compared PRS of post-treatment and follow-up remitters and non-remitters and regressed PRS on fear reduction percentages. Results In the dental fear cohort, EA PRS were associated with treatment outcomes, i.e. drop-out, short- and long-term remission state, fear reduction, and attendance of subsequent dental appointments. In the mixed fear treatment cohort, no gene effects were observable. Conclusions Results indicate the importance of EA-related traits for outcomes following brief, but not long, standardised exposure-based CBT. Such use of PRS may help inform selection and tailoring of treatments.

Identifying the active ingredients of cardiac rehabilitation: A behaviour change technique and qualitative analysis.

Despite evidence that cardiac rehabilitation (CR) can be effective, the active ingredients or behaviour change techniques (BCTs) constituting effective CR remain unclear. There is also a lack of research surrounding patient and facilitator perceptions of active ingredients. This study sought to identify the active ingredients of a community-based CR programme and explore patient and facilitator perceptions of the active ingredients. A multimethod design conducted in two stages, a BCT coding stage and a qualitative stage. The BCT coding stage involved the observation and audio recording of ten sessions from a community-based CR programme and the collection of programme materials. Data were coded using the BCT Taxonomy version 1 (Ann Behav Med, 46, 2013, 81). During the qualitative stage, six focus groups were carried out separately with patients (n=16) and facilitators (n=4). Qualitative data were analysed using an inductive thematic analysis. The BCT coding phase identified 34 BCTs, many of which were highlighted by patients and facilitators. Patients and facilitators felt the group effort, motivation provided by facilitators, individualized care, knowledge gained, acceptance, and fear reduction enabled change. The majority of BCTs identified in the qualitative stage were also identified in the BCT coding stage, excluding a component related to self-acceptance. Facilitators felt the programme was limited by duration and inadequate psychological support. The study provides a comprehensive overview of objectively coded BCTs and perceived active ingredients of CR. The findings can be used to inform future refinement and improvement of CR.