Subjective Units Of Distress Scale Research Articles

Formation of resilience of student youth by physical therapy methods

The article examines the negative impact of chronic stress caused by military aggression on the state of mental health of students, which directly affects their desire and ability to study effectively. The purpose of the work: to systematize the negative effects of chronic stress on the health of young people and to outline approaches to the formation of students' resilience using physical therapy methods. Scientific novelty: the main factor in preserving the health of students is an effectively organized pedagogical process and the correct use of pedagogical technologies. Methods of combating stress consist in removing emotional tension and changing a person's psychological mood. Students need to be taught how to manage stress and recover from exhaustion. The Kessler Psychological Distress Scale (K10), a "stress thermometer", and the subjective units of distress scale (SUDS) are used to monitor the impact of stress on the psycho-emotional state. Physical stress management methods include: regular physical activity, deep breathing, massage, reflexology, progressive muscle relaxation, healthy eating, sleep and rest.
 Conclusions: 1. The priority of higher education institutions of Ukraine should be the formation of resilience of all participants in the educational process. 2. Since during the war it is impossible to eliminate the source of stress, it is necessary to know its signs and manage it with stress management methods (regular physical activity, healthy diet, relaxation techniques, time planning, making positive changes in life). 3. Prevention of the negative impact of chronic stress on students, the search for resources to restore their physical and mental health, with the help of stress management and physical therapy methods, is a promising direction of scientific research.

Heart rate variability and perception of mental stress among medical students and residents at an emergency department

BackgroundWhen Medical Residents (MR) and Medical Students (MS) are assigned to the demanding environment of an Emergency they inevitably encounter stress. The aims of this study are to measure short-term heart rate variability (HRV) before and after shifts, estimate perceived stress levels, and assess the recovery patterns after their shifts. MethodsWe assessed HRV parameters in MS and MR using the wristband physiological monitor Polar® Verify Sense before and after day (DS) and night shifts (NS). Perceived stress levels were evaluated using the simplified State Trait Anxiety Inventory (STAI-S6) and the Subjective Units of Distress Scale. ResultsThis study included 60 participants of which 55% were female with a mean age of 26 years. MS presented significant reduction in sympathetic nervous system index after DS [0.68 (0.01–2.42) vs −0.22 (−0.75–1.13), p < 0.01] and NS [0.87 (−0.28–1.45) vs 0.06 (−0.70–1.04), p < 0.01], while MR maintained the same levels of sympathetic activity [DS: 1.17 (0.04 –2.88) vs 0.93 (0.50–1.41), p = 0.14; NS: 1.37 (0.76–2.21) vs 1.29 (0.35–2.18), p = 0.40]. Psychological data from STAI-S6 showed statistically significant differences when comparing before and after DS in both groups, with more perceived stress after than before DS (MS: 12 ± 4 vs 14 ± 4, p = 0.04; MR: 14 ± 4 vs 16 ± 4, p = 0.04), which was not observed at NS (MS: 12 ± 3 vs 12 ± 3, p = 0.84; MR: 15 ± 3 vs 15 ± 4, p = 0.40). ConclusionsShort-term HRV recordings before and after day or night shifts among MR and MS revealed heightened sympathetic activity preceding each shift, with a more sustained increase observed in the MR population and more perceived stress after day shifts in both groups.

Effectiveness of High-dose Clonazepam Versus Low-Dose Clonazepam With Cognitive Behavioral Therapy in Older Adults With Moderately Severe Insomnia: A Prospective Cohort Study

To evaluate the effectiveness of high-dose clonazepam (1 mg) versus low-dose clonazepam (0.5 mg) with cognitive behavioral therapy for insomnia (CBT-i) in older adults with moderately severe insomnia. A prospective cohort study was conducted in patients who did not respond to low-dose clonazepam for insomnia secondary to chronic medical conditions. After starting with 0.25 mg of clonazepam, their dose was increased to 0.5 mg, then to 1 mg (Group A), or to the same dose with additional CBT-i (Group B). They were followed for 24 weeks, and scores of the insomnia severity index (ISI) and subjective units of distress scale (SUDS) were recorded. Patient adverse drug reactions (ADRs) were documented and assessed for their causality. ISI and SUDS scores were considered primary outcome measures. Between-group analysis revealed a significant decline in the mean score of ISI at week 16 (P < 0.05) and for SUDS at week 20 (P < 0.05) in group B compared to group A. Similarly, within-group analysis also revealed a statistically significant reduction of the mean score in ISI and SUDS scores at week 4 and 8 (P < 0.05) in both groups. ADRs occurred more frequently in group A (14%) than in group B (5%). Assessments of causality showed that the majority of cases were possible. For individuals who were resistant to 0.5 mg of clonazepam, adding CBT-i with low-dose clonazepam is a viable alternative to increasing the dose to 1 mg.

STRESS MANAGEMENT INTERVENTION IN CAREGIVERS OF PEOPLE WITH SCHIZOPHRENIA AT PUSKESMAS X YOGYAKARTA

Being a caregiver for patients with schizophrenia is not easy. Physically, caregivers certainly experience fatigue and sometimes get sick or drop. Psychologically, caregivers experience stress, anxiety, fear and others. As for the behavior shown such as anger, aggression, apathy and others. In the social aspect, of course the caregiver feels embarrassed, cornered, threatened and many other impacts. The results of the assessment using the Subjective units of Distress Scale (1-10) conducted on 6 caregivers who visited X health center, showed stress scores that were in the medium and high categories. This was reinforced by an interview with one of the caregivers and health workers at the health center. One of the efforts to reduce the stress condition of caregivers can be through psychological intervention, namely stress management. This study aims to see the effect of stress management intervention on caregivers of people with schizophrenia. This study used a quasi-experimental approach with a one group pretest postest design. The sampling technique used purposive sampling. The results showed that there was a change in stress conditions after being given the intervention with an average decrease of 3 points.

Virtual reality gaze exposure treatment reduces state anxiety during public speaking in individuals with public speaking anxiety: A randomized controlled trial

BackgroundPublic speaking anxiety (PSA) is a prevalent social anxiety affecting up to 30% of the population. Individuals with PSA often express fear of being evaluated by others and avoid eye contact. Despite this behavioral characteristic, the potential of gaze avoidance reduction as a therapeutic intervention to alleviate PSA-related anxiety remains unexplored. MethodsWe designed a standalone virtual reality (VR) gaze exposure treatment focused on enhancing eye contact in public speaking contexts and evaluated its effectiveness in reducing state anxiety during public speaking. In a single-blind, randomized controlled trial, 89 participants with subclinical PSA were assigned to either a gaze exposure treatment or a control group. Assessments occurred at baseline, following a one-hour intervention, and after nine additional 20-minute home interventions. The primary outcome was state anxiety, assessed using the Subjective Units of Distress Scale during a real-life public speaking test. ResultsRepeated, but not acute VR gaze exposure reduced state anxiety during public speaking compared to the control group (treatment: baseline 48.95 [SD 19.52], post-intervention 2: 26.60 [SD 19.23]; control: baseline 48.92 [SD 18.43], post-intervention 2: 56.34 [SD 28.15]; adjusted mean group difference: -29.82, 95% CI: -41.77 to -17.87; Cohen's d = -1.07, p < 0.0001). LimitationsOur study design does not allow conclusions regarding the effective component (i.e., gaze exposure vs. social context) of the intervention. ConclusionsOur findings indicate that repeated VR gaze exposure treatment in public speaking contexts can effectively reduce state anxiety during public speaking among individuals with subclinical PSA. These promising results call for further investigations in clinical populations.

Veterans who focus on sexual assault trauma show slower between-session habituation and symptom reduction during prolonged exposure treatment for posttraumatic stress disorder.

Prolonged exposure (PE) is an effective treatment for posttraumatic stress disorder (PTSD), but veterans with sexual assault (SA) trauma often discontinue it prematurely. Elevated dropout rates may be due to SA triggering more intense and complex emotions that are more difficult to habituate during imaginal exposures; SA during PE has yet to be examined as a moderator of distress habituation or symptom reduction. Participants were N = 65 veterans (n = 12 SA treatment focus; n = 10 SA history but not treatment focus; n = 43 no SA history) enrolled in a clinical trial of a preparatory sleep intervention followed by PE. The sample was representative of the veteran population. Growth curve modeling was used to examine differences in peak subjective units of distress scale (SUDS) ratings across imaginal exposures and changes in biweekly PTSD symptom assessments between veterans who did versus did not focus on SA during PE and between veterans who did versus did not endorse a history of SA. Peak SUDS ratings and PTSD symptoms declined slower among veterans who focused on an SA trauma relative to those who did not. In contrast, participants who endorsed SA history showed similar declines in distress and PTSD symptoms relative to veterans with no SA history. Veterans who focus on SA during PE may take longer to habituate to trauma content and experience resolution of PTSD symptoms. Awareness of this pattern could allow clinicians to deliver PE more effectively to veterans focusing on an SA trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Constant installation of present orientation and safety (CIPOS) - subjective and physiological effects of an ultrashort-term intervention combining both stabilizing and confrontational elements.

Constant Installation of Present Orientation and Safety (CIPOS) is a Eye Movements Desensitization and Reprocessing (EMDR)-derived technique, which is often used to prepare for the treatment of post-traumatic stress disorder (PTSD). It differs from the latter by involving cyclically recurring exercises in reorientation to the present, interspersed between brief periods of exposure to the traumatic material.While EMDR is well established as a therapeutic method, the efficacy and mechanisms of action of CIPOS have not been investigated so far. In this pilot study, an experimental setting was used to record the subjective and physiological effects of the CIPOS intervention compared to a control condition with pure mental exposition. The study was performed on 30 healthy volunteers aged from 20 to 30 years. Distress was induced using audio files of subjectively stressful situations. Subjective distress was measured via the Subjective Units of Distress Scale (SUD), while physiological indicators (noise-induced startle reflex, skin conductance level) were used as measures for objective stress. For each condition, pre- and post-intervention comparisons were calculated. In both groups, startle reflex potentiation and mean skin conductance level significantly decreased. In the group with CIPOS intervention, but not in the control group, a significant decrease in the SUD value was found. The results show that the CIPOS technique is as effective as pure mental exposition in reducing physiological stress. In addition, a superiority in reducing subjective distress (indicating a simplified reassessment of the stressful material) was found compared to pure mental exposition. Possible explanations of these effects are discussed.

Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers

Health care workers (HCWs) have been experiencing substantial stress and burnout, and evidence-based mitigation strategies are needed. Transcendental Meditation (TM) is a mantra meditation practice with potential efficacy in reducing stress. To assess the efficacy of TM practice in reducing stress among HCWs over a 3-month period. This single-center open-label randomized clinical trial was conducted among HCWs at an academic medical center from November 19, 2020, to August 31, 2021. Inclusion criteria comprised a score of 6 points or greater on the Subjective Units of Distress Scale and an increase of 5% or greater in baseline heart rate or an increase of 33% or greater in galvanic skin response after exposure to a stressful script. Exclusion criteria included the use of antipsychotic or β blocker medications, current suicidal ideation, or previous TM training. Of 213 HCWs who participated in prescreening, 95 attended in-person visits, resulting in 80 eligible participants who were randomized to receive a TM intervention (TM group) or usual treatment (control group). The TM group practiced TM for 20 minutes twice daily over a 3-month period. The control group received usual treatment, which consisted of access to wellness resources. The primary outcome was change in acute psychological distress measured by the Global Severity Index. Secondary outcomes included changes in burnout (measured by the Maslach Burnout Inventory), insomnia (measured by the Insomnia Severity Index), and anxiety (measured by the Generalized Anxiety Disorder-7 scale). Among 80 participants, 66 (82.5%) were women, with a mean (SD) age of 40 (11) years. One participant (1.3%) was American Indian or Alaska Native, 5 (6.3%) were Asian, 12 (15.0%) were Black, 59 (73.8%) were White, and 3 (3.8%) were of unknown or unreported race; 4 participants (5.0%) were Hispanic, and 76 (95.0%) were non-Hispanic. A total of 41 participants were randomized to the TM group, and 39 were randomized to the control group. Participants in the TM group did not show a statistically significant decrease in psychological distress on the Global Severity Index compared with those in the control group (-5.6 points vs -3.8 points; between-group difference, -1.8 points; 95% CI, -4.2 to 0.6 points; P = .13). Compared with the control group, the TM group had significantly greater reductions in the secondary end points of emotional exhaustion (Maslach Burnout Inventory subscore: -8.0 points vs -2.6 points; between-group difference, -5.4 points; 95% CI, -9.2 to -1.6 points; P = .006), insomnia (Insomnia Severity Scale score: -4.1 points vs -1.9 points; between-group difference, -2.2 points; 95% CI, -4.4 to 0 points; P = .05), and anxiety (Generalized Anxiety Disorder-7 score: -3.1 points vs -0.9 points; between-group difference, -2.2 points; 95% CI, -3.8 to -0.5; P = .01) at 3 months. A total of 38 participants (92.7%) in the TM group adhered to home practice. In this randomized clinical trial, TM practice among HCWs over a 3-month period did not result in a statistically significant reduction in the primary outcome of acute psychological distress compared with usual treatment but significantly improved the secondary outcomes of burnout, anxiety, and insomnia. These findings suggest that TM may be a safe and effective strategy to alleviate chronic stress among HCWs. ClinicalTrials.gov identifier: NCT04632368.

Transcutaneous cervical vagus nerve stimulation reduces behavioral and physiological manifestations of withdrawal in patients with opioid use disorder: A double-blind, randomized, sham-controlled pilot study

BackgroundOpioid Use Disorder (OUD) is a serious public health problem, and the behavioral and physiological effects of opioid withdrawal can be a major impediment to recovery. Medication for OUD is currently the mainstay of treatment; however, it has limitations and alternative approaches are needed. ObjectiveThe purpose of this study was to assess the effects of transcutaneous cervical vagus nerve stimulation (tcVNS) on behavioral and physiological manifestations of acute opioid withdrawal. MethodsPatients with OUD undergoing acute opioid withdrawal were randomly assigned to receive double blind active tcVNS (N = 10) or sham stimulation (N = 11) while watching neutral and opioid cue videos. Subjective opioid withdrawal, opioid craving, and anxiety were measured using a Visual Analogue Scale (VAS). Distress was measured using the Subjective Units of Distress Scale (SUDS), and pain was measured using the Numerical Rating Scale (NRS) for pain. Electrocardiogram signals were measured to compute heart rate. The primary outcomes of this initial phase of the clinical trial (ClinicalTrials.gov NCT04556552) were heart rate and craving. ResultstcVNS compared to sham resulted in statistically significant reductions in subjective opioid withdrawal (p = .047), pain (p = .045), and distress (p = .004). In addition, tcVNS was associated with lower heart rate compared to sham (p = .026). Craving did not significantly differ between groups (p = .11). ConclusionstcVNS reduces behavioral and physiological manifestations of opioid withdrawal, and should be evaluated in future studies as a possible non-pharmacologic, easily implemented approach for adjunctive OUD treatment.

Effect of distinct psychological interventions on changes in self-reported distress, depression and loneliness among older adults during COVID-19.

BACKGROUNDOlder adults have been considered a primary at-risk population during the coronavirus disease 2019 (COVID-19) pandemic, and many efforts have been and still are directed toward supporting them and enhancing their capacity to cope with the pandemic. Evidence shows that by enhancing proactive coping abilities through psychological interventions, in which cognitive-behavioral and mindfulness techniques are taught and practiced effectively, these interventions have supported older adults throughout the pandemic. However, the underlying mechanisms by which specific intervention components affect various mental states such as distress, depression and loneliness among older adults remain unclear and warrant investigation. AIMTo determine the effect of an intervention using cognitive-behavioral and mindfulness techniques on changes in distress, depression and loneliness.METHODSWe performed a secondary analysis on data from a previous study in which community-dwelling older adults attended a short-term, internet-based intervention during the first COVID-19 wave in Israel. The intervention included seven sessions during which various cognitive-behavioral and mindfulness techniques were learned and practiced. In-session changes in psychological distress were measured using the Subjective Units of Distress Scale (SUDS), which participants rated at the beginning and end of each session. Participants also filled out questionnaires that evaluated levels of depression [Patient Health Ques-tionnaire (PHQ-9)] and loneliness (UCLA loneliness Scale) prior to and after the entire intervention process. The effect of in-session changes in the SUDS on changes in post-intervention depression and loneliness levels were assessed, as a proxy for distinct technique effectiveness.RESULTSThe findings indicated in-session differences in terms of a decrease in psychological distress (SUDS). Sessions that included relaxation exercises and guided imagery, as well as sessions that included cognitive restructuring and mindfulness meditation, demonstrated the largest decreases in in-session psychological distress (≥ 35%). Two multivariate regression models, one for levels of post-intervention depression (PHQ-9 score) and the other for levels of post-intervention loneliness (UCLA loneliness score), were fitted. The results revealed two statistically significant explanatory variables for depression: The SUDS difference for sessions in which cognitive restructuring and mindfulness meditation were practiced, beta = -0.25, 95%CI: -1.23 to -0.1, and the pre-intervention level of depression, beta = 0.62, 95%CI: 0.37-0.75. The second model for loneliness revealed only one significant explanatory variable: The SUDS difference for sessions in which relaxation and guided imagery were practiced, beta = 0.41, 95%CI: 0.14-0.65.CONCLUSIONDifferent psychological techniques seem to have different effects on distress, loneliness and depression. Understanding the pathways by which distinct techniques affect negative mental symptoms has implications for future intervention design.

Targeted Memory Reactivation During REM Sleep in Patients With Social Anxiety Disorder.

BackgroundSocial anxiety disorder (SAD) is characterized by a significant amount of fear when confronted to social situations. Exposure therapy, which is based on fear extinction, does not often lead to full remission. Here, based on evidence showing that rapid eye movement (REM) sleep promotes the consolidation of extinction memory, we used targeted memory reactivation (TMR) during REM sleep to enhance extinction learning in SAD.MethodsForty-eight subjects with SAD were randomly assigned to two groups: control or TMR group. All patients had two successive exposure therapy sessions in a virtual reality (VR) environment, where they were asked to give a public talk in front of a virtual jury. At the end of each session, and only in the TMR group (N = 24), a sound was paired to the positive feedback phase of therapy (i.e., approval of their performance), which represented the memory to be strengthened during REM sleep. All participants slept at home with a wearable headband device which automatically identified sleep stages and administered the sound during REM sleep. Participants' anxiety level was assessed using measures of parasympathetic (root mean square of successive differences between normal heartbeats, RMSSD) and sympathetic (non-specific skin conductance responses, ns-SCRs) activity, and subjective measures (Subjective Units of Distress Scale, SUDS), during the preparation phase of their talks before (T1) and after (T2) one full-night's sleep and after 1 week at home (T3). Participants also filled in a dream diary.ResultsWe observed an effect of time on subjective measures of anxiety (SUDS). We did not find any difference in the anxiety levels of the two groups after 1 week of TMR at home. Importantly, the longer the total duration of REM sleep and the more stimulations the TMR group had at home, the less anxious (increased RMSSD) these participants were. Finally, fear in dreams correlated positively with ns-SCRs and SUDS at T3 in the TMR group.ConclusionTMR during REM sleep did not significantly modulate the beneficial effect of therapy on subjective anxiety. Yet, our results support that REM sleep can contribute to extinction processes and substantiate strong links between emotions in dreams and waking stress levels in these patients.

The efficacy of eye movement desensitization and reprocessing in reducing anxiety among female university students with primary dysmenorrhea

BackgroundUnpleasant experiences of dysmenorrhea can lead to increased anxiety. The anxiety associated with dysmenorrhea is a pain-related anxiety which might reduce the efficacy of medication as well as enhance the perception of pain. The present study evaluated the efficacy of eye movement desensitization and reprocessing (EMDR) in reducing anxiety among female university students with primary dysmenorrhea.MethodsIn this randomized controlled trial, 88 female university students were recruited from April 2019 to February 2020. Eligible participants were selected by convenience sampling and were allocated into study groups (44 individuals in the intervention group and comparison group) using balanced block randomization. The final sample comprised 78 participants who completed the study (39 individuals in each group). Data were collected using the Spielberger State-Trait Anxiety Inventory, Subjective Units of Distress Scale, and Validity of Cognition Scale before the intervention and at the time of the first menstrual period after completion of the intervention. The intervention group received EMDR in two individual interventional sessions which lasted approximately one hour. Data analysis was performed using analysis of variance with control of covariance method at a significance level of 0.05.ResultsThe results of the study showed that EMDR did not have a statistically significant effect on State-Trait Anxiety of patients with dysmenorrhea (p > 0.05). Based on the Cohen’s d effect size of 0.06 for state-anxiety, -0.01 for trait-anxiety, and partial eta square less than 0.059 for both uncorrected and corrected models, the intervention was within a trivial effect.ConclusionEMDR intervention did not have a statistically and clinically significant effect on State-Trait Anxiety of patients with dysmenorrhea. Therefore, the efficacy of EMDR in treating dysmenorrhea-related anxiety remains inconclusive.Trial registration IRCT20180823040851N2 on 2019-02-09.

Pilot study of a brief hypnotic induction: Effects on blood pressure, heart rate, and subjective distress in patients diagnosed with hypertension

ABSTRACT The feasibility of hypnotherapy interventions for lowering blood pressure and psychological stress in hypertensive patients was investigated in a pilot study. The research objective was to determine the effect of audio hypnotherapy on blood pressure, stress levels, and heart rate in primary hypertension patients. The study randomized 64 hypertensive patients to the intervention or usual care. The intervention group received hypnotherapy through audio recordings for 15 minutes, while the control group took a rest for about 15 minutes. Blood pressure and heart rate were measured with digital tensimeter and stress levels with the Subjective Units of Distress Scale. Data analysis used Kruskal Wallis Test. The results showed a significant difference between the intervention and control groups with p value < .001 for decreasing in systolic blood pressure and p value < .001 for decreasing in stress levels. This pilot study suggests that a hypnotherapy intervention may be feasible and of benefit in a clinical population of hypertensive patients, however further study is needed.

Efficacy of video-based psychotherapy in reducing psychological distress of COVID-19 patients treated in isolation ward

BACKGROUND Hospitalized patients with COVID-19 experience isolation during treatment, which may cause psychological distress. Thus, alternative ways to deliver psychological support are needed when face-to-face therapy is not possible. This study aimed to investigate the efficacy of video-based psychotherapy in reducing distress in COVID-19 patients treated in an isolation ward.&#x0D; METHODS This quasi-experimental trial without a control group included 42 COVID-19 patients aged 20–59 years. Participants were recruited conveniently in the COVID-19 isolation ward in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. They watched three brief psychotherapy videos including relaxation, managing thoughts and emotions, and mindfulness for approximately 30 min. The videos were created by the Department of Psychiatry, Faculty of Medicine, Universitas Indonesia. Subjective units of distress scale (SUDS) was measured before and after watching all videos. Data were analyzed using the Wilcoxon-signed rank test.&#x0D; RESULTS All 42 subjects finished watching the videos. 31 subjects experienced a significant median decrease in SUDS score after the intervention. The effect size of the psychotherapy videos for the SUDS score was 0.485 (95% CI 0.302 to 0.634).&#x0D; CONCLUSIONS Watching psychotherapy videos is effective in reducing the SUDS score for COVID-19 patients in an isolation ward. Our brief video-based psychotherapy intervention has reduced psychological distress in hospitalized COVID-19 patients with limited access to face-to-face consultations due to the risk of disease transmission.

Psychological Distress Among the First Quarantined Community in the United States: Initial Observations From the Early Days of the COVID-19 Crisis.

This study assesses distress and anxiety symptoms associated with quarantine due to COVID-19 exposure among the first quarantined community in the United States and identifies potential areas of intervention. All participants were directly or peripherally related to "patient 1,"-the first confirmed community-acquired case of COVID-19 in the New York Area. As such, this is a historically significant sample whose experiences highlight a transitional moment from a pre-pandemic to a pandemic period in the United States. In March 2020, an anonymous survey was distributed to 1,250 members of a NYC area community that was under community-wide quarantine orders due to the COVID-19 outbreak. Distress was measured using the Subjective Units of Distress Scale (SUDS) and symptoms of anxiety were measured using the Beck Anxiety Inventory (BAI). A variety of psychosocial predictors relevant to the current crisis were explored. Three hundred and three individuals responded within forty-eight hours of survey distribution. Mean levels of distress in the sample were heightened and sustained, with 69% reporting moderate to severe distress on the SUDS and 53% of the sample reported mild, moderate, or severe anxiety symptoms on the BAI. The greatest percentage of variance of distress and anxiety symptoms was accounted for by modifiable factors amenable to behavioral and psychological interventions.

Effectiveness of a smartphone-based, augmented reality exposure app to reduce fear of spiders in real-life: A randomized controlled trial

Although in vivo exposure therapy is highly effective in the treatment of specific phobias, only a minority of patients seeks therapy. Exposure to virtual objects has been shown to be better tolerated, equally efficacious, but the technology has not been made widely accessible yet.We developed an augmented reality (AR) application (app) to reduce fear of spiders and performed a randomized controlled trial comparing the effects of our app (six 30-min sessions at home over a two-week period) with no intervention. Primary outcome was subjective fear, measured by a Subjective Units of Distress Scale (SUDS) in a Behavioural Approach Test (BAT) in a real-life spider situation at six weeks follow-up.Between Oct 7, 2019, and Dec 6, 2019, 66 individuals were enrolled and randomized. The intervention led to significantly lower subjective fear in the BAT compared to the control group (intervention group, baseline: 7.12 [SD 2.03] follow-up: 5.03 [SD 2.19] vs. control group, baseline: 7.06 [SD 2.34], follow-up 6.24 [SD 2.21]; adjusted group difference -1.24, 95 % CI -2.17 to -0.31; Cohen’s d = 0.57, p = 0.010).The repeated use of the AR app reduces subjective fear in a real-life spider situation, providing a low-threshold and low-cost treatment for fear of spiders.

Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality.

ObjectivesVirtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures.Study DesignRandomized controlled trial.SettingTertiary care center.MethodsAdult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected.ResultsEight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively (P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively (P = .770). Average pain scores were 3.53 and 2.64, respectively (P = .434).ConclusionThis pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia.Level of Evidence1

Challenges in Obtaining and Assessing Salivary Cortisol and α-Amylase in an Over 60 Population Undergoing Psychotherapeutic Treatment for Complicated Grief: Lessons Learned.

Biomarkers may serve as objective measures in complicated grief (CG) potentially capturing responses to stress reduction treatment. This paper reports challenges in obtaining and assessing salivary cortisol and α-amylase (sAA) for a recent randomized clinical trial. Within-session changes in salivary cortisol and sAA for 54 older adults with CG who received Accelerated Resolution Therapy were compared with perceived stress measured by Subjective Units of Distress Scale. Bivariate correlations and multiple regressions examined changes in biomarkers. Protocols, study logs, and audit reports identified challenges. Challenges included obtaining unstimulated passive drool salivary samples and their analyses. Our sample of older females on multiple medications may have resulted in a perfect storm of moderating and intervening variables which affected the stress response. This paper contributes to the discussion on designing clinical trials for older adults which must account for physiologic changes, multimorbidity, and polypharmacy common in this population and makes recommendations moving forward.

Abstract 12683: Genome-wide Mrna Expression Analysis of Acute Psychological Stress Responses

Introduction: Previous studies have examined effects of acute psychological stress in humans on selected panels of genes. This exploratory study aimed to investigate genome-wide transcriptional activity changes in responses to acute psychological stress. Methods: The sample included 40 healthy women who participated in a previous study (22 who had a stress induced experience (experimental group) and 18 who did not (control group)). The psychological stress was induced by the Trier Social Stress Test (TSST). Psychological stress levels (measured by the Subjective Units of Distress Scale (SUDS) and the state anxiety subscale of the Spielberger State-Trait Anxiety Inventory) and hemodynamic changes (measured by blood pressure (BP) and heart rate (HR)) were assessed before and after the TSST. The peripheral blood samples obtained before and after the TSST were processed for mRNA-sequencing. Results: The mean age of the participants was 31 years (SD 11.6). The psychological and hemodynamic stress parameters indicated that the TSST successfully induced moderate but statistically significant levels of acute psychological stress in the participants of the experimental group. Compared with the participants in the control group, six genes ( BCL2L14, FAM3B, HCG26, HLA-F-AS1, LOC101928710 , and SLC22A16 ) were up-regulated and 9 genes ( ATP2C2, CA1, CRYBG3, FBXO9, HBD, SLC39A9, SNCA, STRADB , and TRMT12 ) were down-regulated among those who experienced stress induction. The IPA analysis identified one network of cell-to-cell signaling and interaction, cellular function and maintenance, and hematological system development and function. Thirteen genes out of 15 were found in this network. Conclusions: The identified genes including FAM3B, BCL2L14, SLC22A16 , and SNCA , have been proposed as the therapeutic targets of diabetes-related CVDs, certain cancers, and Parkinson’s disease, but have not previously been reported to be associated with psychological stress. Future studies are suggested to examine the pathological mechanisms by which the identified genes may mediate the association between psychological stress and adverse health outcome.

App-Based Delivery of Clinical Emotional Freedom Techniques: Cross-Sectional Study of App User Self-Ratings.

BackgroundThe burgeoning area of mobile health (mHealth) has experienced rapid growth in mobile apps designed to address mental health issues. Although abundant apps offer strategies for managing symptoms of anxiety and stress, information regarding their efficacy is scarce.ObjectiveThis study aimed to assess the effect of an mHealth app on user self-ratings of psychological distress in a sample of 270,461 app users. The Tapping Solution App guides users through the therapeutic protocols of Clinical Emotional Freedom Techniques (EFT), an evidence-based psychophysiological intervention that combines acupressure with elements of cognitive and exposure therapies.MethodsApp users provided self-ratings of emotional intensity before and after app sessions (termed “tapping meditations”) using an 11-point Subjective Units of Distress scale. App user data for 23 tapping meditations, which addressed psychological symptoms of anxiety and stress, were gathered between October 2018 and October 2019, totaling 380,034 completed app sessions.ResultsAcross 12 anxiety-tapping meditations, the difference in emotional intensity ratings from presession (mean 6.66, SD 0.25) to postsession (mean 3.75, SD 0.30) was statistically significant (P<.001; 95% CI −2.92 to −2.91). Across 11 stress-tapping meditations, a statistically significant difference was also found from presession (mean 6.91, SD 0.48) to postsession (mean 3.83, SD 0.54; P<.001; 95% CI −3.08 to −3.07). The results are consistent with the literature on the efficacy of Clinical EFT for anxiety and stress when offered in conventional therapeutic formats.ConclusionsThe findings provide preliminary support for the effectiveness of the mHealth app in the immediate reduction of self-rated psychological distress. As an adjunct to professional mental health care, the app promises accessible and convenient therapeutic benefits.