Subjective Anxiety Levels Research Articles

Use of virtual reality in bipolar disorder: a systematic review.

Virtual reality (VR) is a technology that allows to interact with recreated digital environments and situations with enhanced realism. VR has shown good acceptability and promise in different mental health conditions. No systematic review has evaluated the use of VR in Bipolar Disorder (BD). This PRISMA-compliant systematic review searched PubMed and Web of Science databases (PROSPERO: CRD42023467737) to identify studies conducted in individuals with BD in which VR was used. Results were systematically synthesized around four categories (cognitive and functional evaluation, clinical assessment, response to VR and safety/acceptability). Eleven studies were included (267 individuals, mean age = 36.6 years, 60.7% females). Six studies using VR to carry out a cognitive evaluation detected impairments in neuropsychological performance and delayed reaction times. VR was used to assess emotional regulation. No differences in well-being between VR-based and physical calm rooms were found. A VR-based stress management program reduced subjective stress, depression, and anxiety levels. VR-based cognitive remediation improved cognition, depressive symptoms, and emotional awareness. 48.7% of the individuals with BD considered VR-based cognitive remediation 'excellent', whereas 28.2% considered it 'great'. 87.2% of individuals did not report any side effects. 81.8% of studies received a global quality rating of moderate. Emerging data point towards a promising use of VR in BD as an acceptable assessment/intervention tool. However, multiple unstudied domains as comorbidity, relapse and prodromal symptoms should be investigated. Research on children and adolescents is also recommended. Further research and replication of findings are required to disentangle which VR-interventions for which populations and outcomes are effective.

Effect of Music Listening on Neurocognition, Stress, and Performance in Neurosurgeons During Microsurgery

BackgroundStress in surgeons is well-known for its negative impact on neurocognition and surgical performance. Surgeons commonly use music for stress reduction, but its specific effects on neurosurgeons remain unclear. This study aims to investigate how listening to music during microsurgery affects neurocognitive functions, subjective anxiety, and stress levels in neurosurgeons. MethodConducted in two phases, the pilot phase involved 23 neurosurgeons completing a survey and rating compositions based on ragas of North Indian/Hindustani classical music for suitability during surgery. Five excerpts were selected for the main phase, which involved three neurosurgeons performing 16 surgeries, eight with and eight without music. Data collection included pre-surgery assessments of sleep, caffeine intake, subjective stress levels, perceived complexity of the surgery that was to be performed, and neurocognitive tasks. Post-surgery subjective stress levels, actual complexity, and surgeon experiences with music were recorded. ResultsWhile there was a trend toward reduced stress and perceived complexity with music, statistical significance was not reached. Neurocognitive tasks showed non-significant improvement with music, with a significant (at p < 0.001) speed-accuracy trade-off noted in response inhibition. ConclusionMusic appears to reduce subjective stress and task complexity, influencing neurocognition, particularly through speed-accuracy trade-offs. Further research is needed to understand its mechanisms and appropriate contexts for use before widespread recommendation.

Evaluation of Virtual Reality in the Reduction of Pain During Dressing Changes in Patients with Burn Wounds: A pilot study.

Burn injuries are among the most common life-threatening injuries for which medical attention is sought, and are accompanied by intense, severe pain, particularly during treatment. Burn therapy pain management with opioid and non-opioid analgesics is often insufficient when administered alone. Virtual reality (VR) interfaces provide an immersive experience that has demonstrable therapeutic benefits, including distraction from, and reduction of, pain. In this interventional pilot study, we assessed the correlation between VR and passive distraction and pain tolerance during burn wound treatment. This pilot study assessed patients undergoing burn wound dressing changes while receiving both pharmacological and VR intervention at [Removed for masked review]. Questionnaires and evaluation forms were subjectively completed by both patients and medical staff before and after treatment, and clinical metrics were recorded throughout the treatment. Forty-one patients ≥18 years old and 76.9% male that had primarily undergone ≥4 dressing changes before the study were included. Correlations were found between VR engagement during treatment and a decrease in subjective levels of nausea, anxiety, and pain sensation. Furthermore, high levels of VR engagement were correlated with high levels of VR enjoyment. These results suggest that highly engaging and enjoyable VR interfaces may reduce sensations of anxiety and pain in burn patients during dressing changes. Furthermore, these data suggest that VR technology may be applied as an adjunct therapy to pharmacological treatment in the standardization of burn wound care management. Further studies with control groups and larger sample populations are needed for better quantification of these benefits.

Virtual reality environment for exposure therapy in obsessive–compulsive disorder: a validation study

IntroductionObsessive–compulsive disorder (OCD) is characterised by recurrent, repetitive, and unwanted thoughts or impulses triggering significant anxiety. Exposure and response prevention is currently the first-line therapy for OCD. The goal of this validation study was to confirm the potential of the VR house environment that incorporates OCD-specific items that cluster around major symptom dimensions: ‘contamination’, ‘symmetry’, ‘checking’ and ‘hoarding’ to induce anxiety and compulsive behaviour in patients with OCD.MethodWe assessed a sample of OCD patients (n = 44) that was compared to a group of healthy controls (n = 31). The severity of OCD symptoms was assessed in all subjects. During a single session, participants were asked to approach a set of 10 stimuli (covering four OCD dimensions) and rate their current intensity of distress/anxiety and compulsive tendencies (scales 0–5) provoked by observing each stimulus. Before and after the VR exposure, participants completed questionnaires assessing subjective levels of anxiety (before/after VR exposure), their sense of presence in VR and experienced simulator sickness.ResultsThe results show that the OCD group reports elevated levels of distress and compulsive behaviour when confronted with VR exposure stimuli compared to the control group, but no increase in anxiety levels has been observed after the VR exposure. The subjective ratings of provoked distress and compulsive behaviour are not associated with severity of OCD symptoms, perceived sense of presence, association with cybersickness symptoms is weak.ConclusionOur data suggest that the VR house environment is a suitable tool for VR exposure therapy in OCD patients as it demonstrates OCD symptom provocation relevant for individual patients.

Self-Efficacy and the Digit Ratio in a Group of Sports University Students.

Self-efficacy is one's awareness of being able to cope optimally with different situations. Perceived self-efficacy is a belief that closely involves emotional and personological functioning. In fact, when one perceives oneself as capable, the likelihood of success increases significantly. The aim of this research was to verify a possible correlation between self-efficacy and the Digit Ratio (2D:4D), referred to as prenatal androgen levels, and whether these correlate with some psychological variables, considering possible gender differences. This study involved 56 sports university students, whose 2D:4D ratio was calculated. Moreover, self-assessment questionnaires: the Self-efficacy Scale (SES), the Big Five Questionnaire-2 (BFQ-2), the Profile of Mood State (POMS), the State-Trait Anxiety Inventory Form Y (STAI-Y) and the Emotional Regulation Questionnaire (ERQ) were administered. The data show that the perceived levels of self-efficacy seem to be influenced by an innate predisposition linked to prenatal androgen values to which the subjects were exposed during uterine life (2D:4D). This negative correlation indicates that the higher the value of the digit ratio, the more likely it is that the level of perceived self-efficacy will be lower. Finally, the degree of perceived self-efficacy also seems to depend on the levels of subjective anxiety, understood both as a personological disposition and a contingent condition, and the latter also seems to be influenced by prenatal androgen levels, particularly in women.

Divulging the Impetus of Yoga on Cardiorespiratory Fitness and Its Persona in Alleviating Anxiety Experienced by Youth: A Cohort Interventional Study.

Globalization endangers youngsters worldwide with new standards and possibilities. Hereat of being exposed to greater demands and expectations, when it comes to performance review, their life may become more distressed. Yoga with revolutionary methods may assistyoungsters in bettering their physical health regardingtheir maximal oxygen uptake, and also help manage their anxiety. This study ascertains the effect of yoga on youth's anxiety levels and cardio-respiratory fitness. It was a longitudinal interventional study recruiting 99 medical students wherein VO2max (maximal oxygen uptake) on thetreadmill/ergometer exercise and anxiety scores throughSpielberger's anxiety scale was assessed at baseline and evaluated after 6 months of a regular yogic regime.The VO2max wasrecorded by the metabolic module of Labchart software (Bella Vista,New South Wales, Australia). The VO2max evaluated by incremental exercise to volitional fatigue was found to be 2.64 ± 0.49 L/min in males and 1.51 ± 0.44 L/min in females pre-yoga and 2.81 ± 0.52 L/min in males and 1.69 ± 0.47 L/min in females post yoga. The difference in the endline and baseline VO2max values of yoga-performing males (t=6.595, p<0.001) and females (t = 2.478, p = 0.017) was found to be significantly higher than non-yoga performers. The METS value obtained in males was 11.96 and in females was 7.68 before yoga. Post-yoga values were 13.44 and 8.37, respectively. The difference in total anxiety scores post-intervention was 34.6 which was statistically significant (t= 4.959, p <0.001). From the viewpoint of a physiologist, higher VO2max in young adults links to better physical fitness which is the potential outcome of regular yogic practice. As a result ofregular yogic practice, initial soaring anxiety levels of subjects culminated in a drastic observable reduction in anxiety, which helped inculcate a judicious acumen in youngsters.

Improving Ambulatory Surgery Environments: The Effects on Patient Preoperative Anxiety, Perception, and Noise.

The study aimed to comparatively evaluate three types of preoperative care environment in terms of patient experience outcomes including patient preoperative anxiety, perceived environmental qualities, and noise level. Preoperative anxiety is a major healthcare problem causing delays, complications, dissatisfaction, and rising healthcare costs. The design of preoperative spaces may play an important role in reducing preoperative anxiety and improving outcomes. Anonymous questionnaire surveys were conducted with 228 patients in the three types of preoperative bays that varied in terms of bay size and the amount of hard-wall partitions between bays to compare patient self-reported anxiety and perceived environmental qualities. Sound level measurements were conducted throughout the three preoperative care units. Female patients in the preoperative unit with largest bays and full hard-wall partitions between bays reported significantly lower levels of subjective anxiety (p's = .002, <.001) and higher levels of perceived environmental qualities on privacy, cleanliness, noise, and pleasantness (p's from <.001 to .017) than patients in the units with smaller bays and no or partial hard-wall partitions. Similar but less clear pattern was found among male patients. The lowest average noise levels were recorded in the unit with largest bays and full hard-wall partitions between bays (2.3-6.1 decibels lower than the other units). The design of preoperative care environment may contribute to the better management of preoperative anxiety. Further efforts in research and design are needed to maximize the benefits in clinical, experiential, and financial outcomes.

Associations Between Emotion Regulation Strategies and Anxiety in Lithuanian Medical Students

Background. Appropriate emotion regulation is crucial for medical students to properly prepare for the practical part of their career. Emotion dysregulation, however, is associated with maladaptive emotion regulation strategies, which in turn often causes higher levels of anxiety. This could lead to difficulties concerning the studying process and preparation for the future career. This research is conducted due to the lack of previous studies.&#x0D; Methods. Medical students of Lithuanian University of Health Sciences participated in an online survey. There were a total of 98 female and 18 male students, mean participant age M = 21,6 (SD = 2,21). The survey consisted of 3 questionnaires – Cognitive Emotion Regulation Questionnaire – Short Form (CERQ-SF), GAD-7 and sociodemographic questions. Scales were used to assess emotion regulation strategies and subjective anxiety levels.&#x0D; Results. Female students experience higher levels of anxiety compared to their male counterparts. High levels of anxiety are associated with year 2–6 students; 1st year students are the only ones experiencing low levels of anxiety. However, it is worth mentioning that no statistical significance groups was found in those groups. Results suggest a weak negative correlation between adaptive ER strategies and anxiety, with a moderate positive correlation between maladaptive ER strategies and anxiety. No statistical significance was found between genders, years of study or age concerning the use of ER strategies.&#x0D; Conclusion. Our findings suggest weak negative correlation between adaptive ER strategies and anxiety; moderate positive correlation between maladaptive ER strategies and anxiety was also found.&#x0D; Keywords: medical students, emotion regulation, anxiety.

Reliability of repeated exposure to the human elevated plus-maze in virtual reality: Behavioral, emotional, and autonomic responses

Approach–avoidance conflicts are a hallmark of anxiety-related behaviors. A gold standard for assessing anxiety-related behaviors in rodents is the elevated plus-maze (EPM), which was recently translated to humans using immersive virtual reality. Repeated behavioral testing is particularly interesting for clinical and pharmacological research in humans but could be limited by habituation effects. Here, we tested whether comparable strategies that are used in rodents (different environments and inter-trial interval of 28 days) are sufficient to avoid habituation or sensitization effects on the EPM, making it possible to perform repeated measurement of anxiety-related behavior in humans. Moreover, we developed two novel virtual environments for repeated testing to explore whether a scenario resembling the real world is superior to a video game-like EPM in terms of lifelike physiological, emotional, and behavioral responses. On a behavioral level, no significant differences but a high correlation between first and repeated exposure to the human EPM independent of EPM version were found. On a psychophysiological level, salivary alpha-amylase, skin-conductance, and respiratory frequency increased at first and second exposure independent of EPM version. However, at repeated exposure, skin-conductance and heart rate showed indicators for anticipatory anxiety and a small sensitization effect, while no effect of real-world resemblance on these physiological measures was found. This was also reflected in slightly higher subjective anxiety levels at second exposure, although subjective anxiety still correlated strongly between first and second exposure. In conclusion, the human EPM can be used for longitudinal assessments of human anxiety-related behavior when strategies to avoid habituation and sensitization are considered.

Reducing Anxiety in HIV/AIDS Patients Through Cognitive Therapy

This study aims to determine the effect of giving cognitive therapy in reducing anxiety in people with HIV/AIDS. The research subjects were 8 women with HIV/AIDS. Data collection was carried out using an anxiety scale, interviews and observations. The research design used was the Pretest-Posttest Control Group Design. The research analysis used is quantitative and qualitative analysis. Quantitative analysis by testing the hypothesis using the Mann-Whitney test analysis to determine whether there is an effect of cognitive therapy in reducing anxiety in HIV/AIDS sufferers in the study group before being given training and after being given training. Qualitative analysis was carried out based on the results of observations, interviews, worksheets. The results of the study, namely the pre-test and post-test anxiety showed that there were differences in anxiety after being given training with a value of Z = -2.309, p = 0.021, p &lt;0.05. In the post-test and follow-up study groups there was a difference in anxiety with a value of Z = -2.323, p = 0.020, p &lt;0.05. The conclusion of this study is that there are differences in the level of anxiety in the study subjects after follow-up.

The effect of distraction versus post-event processing on cortisol recovery in individuals with elevated social anxiety

There are preliminary findings that repetitive thinking on social situations (post-event processing; PEP) is associated with impaired cortisol recovery after experiencing social evaluative stressors. However, no studies have examined the effect of experimental manipulation of PEP on cortisol recovery among socially anxious individuals. The aim of the present study was to examine the effect of distraction on cortisol recovery following a social-evaluative stressor in individuals with subclinical social anxiety symptoms. A total of 40 participants, who scored >30 on the Liebowitz Social Anxiety Scale, completed a standardized stress test (the Trier Social Stress Test; TSST). They were then randomized to complete either a 10-min distraction or PEP induction task. Subjective anxiety and salivary cortisol levels were assessed at −20, −10, 0, +10, +20, +30, +40, and +50 min, with respect to the TSST offset. Contrary to the hypothesis, no difference in cortisol recovery was observed between distraction induction and PEP induction. These findings suggest that short-term distraction induction may not be sufficient to promote cortisol recovery in individuals with elevated social anxiety.

Assessment of patient’s anxiety before, during, and after dental scaling procedure

Background: Dental anxiety and fear describe the stress a subject experiences in a dental setting and is an important factor that prevents the subjects from seeking dental care leading to poor oral hygiene status among the population.Aim: In this study, we aimed to assess the anxiety level of subjects before, during, and after the scaling procedure.Materials and method: One hundred subjects visiting the outpatient Department of Periodontology, KIDS, Bhubaneswar, and indicated for ultrasonic scaling procedure, participated in the study. Anxiety levels before, during, and after the scaling procedure was assessed with a Modified Dental Anxiety Scale (MDAS) and an Anxiety Questionnaire consisting of fifteen questions. Statistical analysis: Statistical analysis of the study was done using SPSS software. Results: It was observed that only 2% and 3% of patients are extremely anxious about deciding to visit a dental clinic and about experiencing pain or bleeding during the procedure Conclusion: Assessing the subjects’ level of anxiety using a questionnaire before the procedure can lead to modification of the patient counseling, treatment plan as needed as well as the modifications in the ambiance of the dental clinic or hospital.

Changes in health-related quality of life, motivation for physical activity, and the levels of anxiety and depression after individualized aerobic training in subjects with metabolic syndrome

ObjectiveNumerous studies associate metabolic syndrome (MetS) with poor life quality, depression, and anxiety. Aerobic exercise training has proven its value in promoting health among subjects with MetS. We aimed to evaluate the changes in health-related quality of life (HRQOL), motivation for physical activity, and the levels of anxiety and depression in subjects with MetS after individualized aerobic training. MethodsA total of 140 subjects with MetS (53.2 ± 6.8 years, 55% female) were analyzed after the random assignment to the intervention (n = 84) or the control group (n = 56). Only the intervention group participated in the 8-week HR targeted aerobic training program, which consisted of exercises on a cycle ergometer for 30‑40 min/day, 5 days/week. In all study participants HRQOL, motivation for physical activity, anxiety and depression levels were evaluated by the Medical Outcomes Study 36-Item Short-Form Health Survey, the Exercise Motivations Inventory-2, and the Hospital Anxiety and Depression scale before and after 8 weeks. ResultsAfter 8 weeks, self-reported physical functioning significantly increased only in the intervention group (p = 0.01). The scores of mental health-summary and role limitations due to emotional problems also improved in subjects with MetS, who participated in the aerobic training program (p < 0.001, p = 0.009, respectively). The scores for social engagement motive, enjoyment and revitalization motive, and fitness motive to exercise increased (p = 0.003, p < 0.001, p = 0.023, respectively), whereas the level of depression reduced only in the intervention group (p = 0.021). ConclusionsThe 8-week individualized aerobic training had a positive effect on HRQOL, motivation for physical activity, and the level of depression in subjects with MetS.

Neurofeedback Training and Cognitive Behavior Therapy for Treatment of Generalized Anxiety Disorder in Children and Adolescents: A Comparative Study

Introduction. The present study aimed to evaluate the effectiveness of neurofeedback (NF) and cognitive-behavioral therapy (CBT) on the reduction of anxiety symptoms in children and adolescents with generalized anxiety disorder. Methods. The current pseudo-experimental study with a pre–posttest design was conducted on a population of patients with a generalized anxiety disorder (GAD) referring to the child psychiatry clinic in Alexandria’s University Hospital, Egypt. The sample size comprised of 30 children and adolescents selected by random sampling method and assigned to groups of NF and CBT. Data elicited from the State-Trait Anxiety Inventory (STAI), which is a self-report scale for measuring two distinct anxiety concepts. Data were analyzed with SPSS. Student t-test was performed on CBT and NF groups. Results. The current study showed that both CBT and NF are effective in reducing the level of anxiety in the study subjects with no significant differences between the two groups. The obtained results also showed that NF therapy is an effective method with more improvement on state anxiety score, while CBT showed more improvement in trait anxiety score. Conclusion. Both treatments were significantly effective, and therefore neurofeedback training can be effectively used as a treatment approach for children and adolescents with GAD.

Dysfunctional coronavirus anxiety in nonpsychotic psychiatric outpatients during the COVID-19 pandemic: A network analysis.

BackgroundThe 2019 coronavirus disease (COVID‐19) pandemic has had a profound impact on the mental health of people worldwide. This study examined dysfunctional coronavirus anxiety in nonpsychotic psychiatric outpatients during the pandemic using the coronavirus anxiety scale (CAS) and examined the relationship between coronavirus anxiety and clinical symptoms using network analysis.MethodsIn this cross‐sectional study, 192 patients who first visited the psychiatric outpatient clinic of Severance Hospital during the COVID‐19 pandemic with chief complaints of depressed mood, anxiety, somatic symptoms, or insomnia were included. We compared the clinical characteristics of patients with and without dysfunctional coronavirus anxiety. Network analysis was conducted to estimate the network of coronavirus anxiety and depressive, anxious, and hypochondriacal psychopathology.ResultsThe results showed that 7.8% of patients exhibited dysfunctional coronavirus anxiety (CAS ≥ 5). Patients with dysfunctional coronavirus anxiety showed higher levels of health worry, somatic preoccupation, and subjective anxiety compared to patients without dysfunctional coronavirus anxiety. In the network analysis, the health worry node (Item 6 of the WI) showed the greatest number of connections with coronavirus anxiety nodes.ConclusionsThese findings suggest that health worry may be an important bridge symptom that connects coronavirus anxiety and other clinical psychopathology. Patients with elevated health worries should be carefully monitored during the COVID‐19 pandemic for exacerbation of previous symptoms and COVID‐19‐related psychopathology. Understanding the psychological factors in the face of the pandemic and their relationships with clinical psychiatric symptoms would help people prevent and overcome mental health problems during the pandemic.

Associations of Vitamin D, chronic obstructive pulmonary disease and acute exacerbations of COPD with anxiety and depression: a nested case control study

Background: Lower vitamin D levels have not only been associated with chronic obstructive pulmonary disease (COPD), exacerbations and lower lung functions, but also with anxiety and depression. We examined the associations of severity of anxiety and depression using HAM-A (Hamilton Anxiety Rating Scale) and HAM-D (Hamilton Depression Rating Scale) scores with COPD and vitamin D levels. Methods: Observational nested case control study was conducted in MUDHRA cohort. One hundred COPD subjects and 100 age- gender- matched non-COPD subjects (controls) underwent evaluation of socioeconomic status, respiratory symptoms, spirometry, severity of anxiety and depression, six minute walk test and estimation of serum vitamin D levels. Independent association of low vitamin D levels with severity of anxiety and depression was assessed by logistic regression. Results: COPD group had higher mean±SD anxiety and depression scores (HAM-A 8.0±3.5, HAM-D 8.72±4) compared to control group (HAM-A 4.51±2.2, HAM-D 4.3±2). The COPD group had 53 subjects with mild/moderate anxiety/depression whereas control group had 16 subjects with mild/moderate anxiety/depression. In COPD group, subjects with mild/moderate anxiety/depression had lower vitamin D levels compared to subjects with no/minimal anxiety/depression, while the difference in control group was not significant. In logistic regression, anxiety and depression levels had independent association with vitamin D levels, lung function variables, six-minute walk distance and presence of COPD. In COPD subgroup, anxiety and depression levels had independent association with breathlessness, GOLD FEV1 staging, CAT score, SGRQ-C Symptom score and exacerbation of COPD. Conclusions: Greater proportion of COPD subjects suffer from anxiety and depression as compared to subjects without COPD. Severity of anxiety and depression was greater in COPD subjects. Poorer lung functions, higher respiratory symptoms and lower vitamin D levels are associated with higher levels of anxiety and depression in COPD subjects. There is an urgent need to recognise anxiety and depression in COPD patients.

Effects of circulating estradiol on physiological, behavioural, and subjective correlates of anxiety: A double-blind, randomized, placebo-controlled trial

Anxiety-related behaviours as well as the prevalence of anxiety disorders show a large sex difference in humans. Clinical studies in humans as well as behavioural studies in rodents suggest that estradiol may have anxiolytic properties. In line with this, anxiety symptoms fluctuate with estradiol levels along the menstrual cycle. However, the influence of estradiol on subjective, behavioural, as well as physiological correlates of anxiety has never been systematically addressed in humans.We ran a double-blind, randomized, placebo-controlled study (N = 126) to investigate the effects of estradiol on anxiety in men and women. In healthy volunteers, circulating estradiol levels were elevated through estradiol administration over two consecutive days to simulate the rise in estradiol levels around ovulation. Subjective, behavioral, as well as, physiological correlates of anxiety were assessed using a virtual reality elevated plus-maze (EPM).Estradiol treatment reduced the physiological stress response with blunted heart rate response and lower cortisol levels compared to placebo treatment in both sexes. In contrast, respiration frequency was only reduced in women after estradiol treatment. Behavioural measures of anxiety as well as subjective anxiety on the EPM were not affected by estradiol treatment. In general, women showed more avoidance and less approach behavior and reported higher subjective anxiety levels on the EPM than men.These results highlight the limited anxiolytic properties of circulating levels of estradiol in humans, which influence physiological markers of anxiety but not approach and avoidance behaviour or subjective anxiety levels.

Paradoxical somatic information processing for interoception and anxiety in alexithymia.

The concept of alexithymia has garnered much attention in an attempt to understand the psychological mechanisms underlying the experience of feeling an emotion. In this study, we aimed to understand how the interoceptive processing in an emotional context relates to problems of alexithymia in recognizing self‐emotions. Therefore, we prepared experimental conditions to induce emotional awareness based on interoceptive information. As such, we asked participants to be aware of interoception under an anxiety‐generating situation anticipating pain, having them evaluate their subjective anxiety levels in this context. High alexithymia participants showed attenuated functional connectivity within their ‘interoception network’, particularly between the insula and the somatosensory areas when they focused on interoception. In contrast, they had enhanced functional connectivity between these regions when they focused on their anxiety about pain. Although access to somatic information is supposed to be more strongly activated while attending to interoception in the context of primary sensory processing, high alexithymia individuals were biased as this process was activated when they felt emotions, suggesting they recognize primitive and unprocessed bodily sensations as emotions. The paradoxical somatic information processing may reflect their brain function pathology for feeling emotions and their difficulty with context‐dependent emotional control.

Changes in Brain Activation through Cognitive-Behavioral Therapy with Exposure to Virtual Reality: A Neuroimaging Study of Specific Phobia.

Background: Cognitive-behavioral therapy (CBT) with exposure is the treatment of choice for specific phobia. Virtual reality exposure therapy (VRET) has shown benefits for the treatment and prevention of the return of fear in specific phobias by addressing the therapeutic limitations of exposure to real images. Method: Thirty-one participants with specific phobias to small animals were included: 14 were treated with CBT + VRET (intervention group), and 17 were treated with CBT + exposure to real images (active control group). Participants’ scores in anxiety and phobia levels were measured at baseline, post-treatment, and 3-month follow-up, and brain activation was measured through functional magnetic resonance imaging (fMRI) baseline and post-treatment. Results: Both groups showed a significant decrease in anxiety and phobia scores after the therapy and were maintained until follow-up. There were no significant differences between both groups. Overall, fMRI tests showed a significant decrease in brain activity after treatment in some structures (e.g., prefrontal and frontal cortex) and other structures (e.g., precuneus) showed an increasing activity after therapy. However, structures such as the amygdala remained active in both groups. Conclusions: The efficacy of CBT + VRET was observed in the significant decrease in anxiety responses. However, the results of brain activity observed suggest that there was still a fear response in the brain, despite the significant decrease in subjective anxiety levels.

VIRTUAL REALITY BERBASIS COGNITIVE BEHAVIOR THERAPY UNTUK MENURUNKAN KECEMASAN BERBICARA DI DEPAN UMUM

Most students carry out formal communication such as presenting assignments or expressing opinions in formal forums and there is anxiety about public speaking in their implementation. Virtual reality based on cognitive behavior therapy (VR-CBT) is one of the psychological interventions that can be applied in this study with the aim of reducing the level of anxiety in public speaking. The public speaking anxiety scale, TMAS, and psychological tests were used as measures to determine the subject's anxiety level. Collecting data using observation and interviews with subjects and related parties. This research design uses descriptive qualitative with a case study approach (case study). This study consisted of one subject who was a 20 year old sixth semester student. The VR CBT consisted of 10 sessions (+60 minutes / session). The data analysis technique used qualitative data analysis. The results showed that the subject's public speaking anxiety level decreased. That is, VR CBT is effective in reducing the level of public speaking anxiety.