Treatment Of Anxiety Disorders Research Articles

Resting state functional connectivity differences following working memory training with massed exposure in individuals with public speaking anxiety

Exposure-based cognitive behavioral therapy (CBT) is a gold standard treatment for Social Anxiety Disorder (SAD), but many patients do not gain complete symptom relief. Since fear extinction is central to the effectiveness of exposure within CBT, adjunctive treatments that target neurocognitive systems underlying fear extinction could increase the effectiveness of CBT. Successful fear extinction and cognitive tasks like working memory share neurocognitive substrates. The present study evaluates the neural impact of working memory training (WMT) as an adjunctive CBT treatment by exploring changes in intrinsic network connectivity associated with combining WMT with exposure exercises. The sample included twenty-four adults (Mean Age = 27.42(9.75), 62.5% female) with elevated social anxiety symptoms. Participants completed either a WMT or sham training (ST) condition, followed by a speech-based massed exposure session (WMT+Exp versus ST+Exp). Compared to ST+Exp, WMT+Exp participants exhibited lower connectivity between the default and visual networks and visual and dorsal networks. Lower connectivity between these networks was associated with lower subjective distress at the end of the massed exposure across the whole sample. WMT+Exp completers exhibited unique functional connectivity between the frontoparietal and dorsal attention networks. WM+Exp was associated with a neural connectivity profile involving networks critical to working memory, fear learning, and emotion regulation, as well as emotional and sensory processing functions. Data provisionally point to combined working memory training and exposure facilitating improvement in neural connections useful for benefitting from CBT for SAD.

Intervention Treatment for Anxiety and Depression-Induced Emotional Disorders in College Students: Mindfulness-Based Stress Reduction

Abstract The objective of this study was to investigate the effects of mindfulness-based stress reduction (MBSR) on relieving symptoms of emotional disorders caused by anxiety and depression in college students. Fifty college students with generalized anxiety disorder 7-item (GAD-7) scale scores >7 and self-rating depression scale (SDS) scores ≥50 were randomly divided into a blank group and an MBSR group. The MBSR group completed an eight-week training program, which included activities such as breath awareness and body scanning. The GAD-7 scale, SDS, Pittsburgh sleep quality index (PSQI), and five-facet mindfulness questionnaire (FFMQ) scores were compared between the two groups before and after the experiment. After the experiment, the MBSR group showed a significant improvement in mindfulness levels as it had a FFMQ score of 124.64±10.72 (p < 0.05 compared to the pre-experiment and blank group). The GAD-7 scale score was 5.46±2.98, and the SDS score was 45.32 ± 6.01, indicating that both anxiety and depression symptoms were relieved. The sleep quality improved as the PSQI score decreased to 5.26 ± 1.88 (p < 0.05 compared to the pre-experiment and blank group). MBSR is beneficial in reducing anxiety and depression among college students, improving sleep quality, and has a certain effect on symptoms of emotional disorders. It can be promoted and applied in practice.

Cognitive behavioural therapy for social anxiety disorder in people with bipolar disorder: a case series

BackgroundSocial anxiety disorder increases the likelihood of unfavourable outcomes in people with bipolar disorder. Cognitive behavioural therapy (CBT) is the first-line treatment for social anxiety disorder. However, people with bipolar disorder have been excluded from the studies that this recommendation is based on. MethodWe completed a case series to obtain initial data on whether CBT is an acceptable, safe, and effective treatment for social anxiety disorder in people with bipolar disorder.ResultsEleven euthymic participants with bipolar disorder attended up to sixteen treatment and three follow-up sessions of CBT for social anxiety disorder. Participants attended on average 95% of the offered CBT sessions. No adverse events were reported. Participants’ mean score on the Social Phobia Inventory decreased from 46.5 (SD 6.6) before the treatment to 19.8 (SD 11.9) at the end of the sixteen-session intervention and further to 15.8 (SD 10.3) by the end of the 3-month follow-up. This degree of improvement is equivalent to the effect observed in studies of CBT for social anxiety disorder in people without severe mental illness.ConclusionsThis case series provides preliminary evidence that CBT is acceptable, safe, and effective for treating social anxiety disorder in people with bipolar disorder during euthymia. A randomized controlled trial is needed to confirm these findings, and to establish whether treatment for social anxiety disorder improves the course of bipolar disorder.

Examination of the Use of VR Combined with Internet Technology to Enhance the Experience of Sound Art in the Treatment of Anxiety Disorders

《Due to the rapid development of interactive technology, sound interaction, as one of the core forms of interactive art, plays an important role in sound art. Its interactivity is one of the main factors affecting audiences’ perception. As far as the interaction of sound art is concerned, it can neither be extended as sound art nor give full play to its function, which is the key difficulty in the current development. Therefore, only by making full use of the existing advantages of virtual reality and the innovation of digital processing technology that the value of art therapy can be better reflected. However, in sound art therapy, the most critical thing is to establish the correct understanding of it and followed by the selection of the most appropriate treatment method to achieve the best outcomes. On this basis, this study reviews the progress and trend of virtual reality and related technologies. The results show that virtual reality can be used as an effective means to assist sound art therapy. Also, this paper explores how to use existing Internet technology to enhance the experience of virtual reality combined with sound art to improve the feasibility and effectiveness of treating anxiety disorders. After a systematic discussion through MFSC extraction algorithm, the results indicated that the extraction rate of MFSC changed several times and the index decreased significantly before and after the LF/HF experiment, which proved that this approach is more effective than the traditional one. In addition, VR can combine existing Internet technologies, such as high-speed Internet, cloud computing, Internet of Things technology, artificial intelligence, real-time performance, etc. Through these combined methods, the practice of the use of sound art in treating anxiety disorders will be enhanced by the interaction of virtual reality and high-speed Internet technology, which will deepen patients’ experience and improve the treatment effect.《

Anticipatory anxiety of seizures: What is the best treatment?

Anxiety disorders affect roughly 25% of people with epilepsy (PWE), and are associated with a strong impairment of quality of life and a poorer stabilization of epilepsy. Anticipatory anxiety of seizure (AAS), defined by the persistent worry or fear to have another seizure, is highly frequent and associated with avoidant behavior. Unfortunately, AAS is often overlooked and untreated. Here, we present the case of a 35-year-old patient suffering from AAS secondary to focal epilepsy. We aimed to provide practical guidelines and tools for the screening and treatment of anxiety disorders in PWE. Regarding psychotropic medication, Sertraline or Citalopram might be good options for first-line treatment of AAS, since they are efficient against anxiety and well-tolerated in epilepsy.

The potential of Chinese herbal medicines in treating anxiety disorders

The potential of Chinese herbal medicines in treating anxiety disorders

Uncovering Hemispheric Asymmetry and Directed Oscillatory Brain-Heart Interplay in Anxiety Processing: An fMRI Study.

Brain-heart interactions (BHI) are critical for generating and processing emotions, including anxiety. Understanding specific neural correlates would be instrumental for greater comprehension and potential therapeutic interventions of anxiety disorders. While prior work has implicated the pontine structure as a central processor in cardiac regulation in anxiety, the distributed nature of anxiety processing across the cortex remains elusive. To address this, we performed a whole-brain-heart analysis using the full frequency directed transfer function to study resting-state spectral differences in BHI between high and low anxiety groups undergoing fMRI scans. Our findings revealed a hemispheric asymmetry in low-frequency interplay (0.05 Hz - 0.15 Hz) characterized by ascending BHI to the left insula and descending BHI from the right insula. Furthermore, we provide evidence supporting the "pacemaker hypothesis", highlighting the pons' function in regulating cardiac activity. Higher frequency interplay (0.2 Hz - 0.4Hz) demonstrate a preference for ascending interactions, particularly towards ventral prefrontal cortical activity in high anxiety groups, suggesting the heart's role in triggering a cognitive response to regulate anxiety. These findings highlight the impact of anxiety on BHI, contributing to a better understanding of its effect on the resting-state fMRI signal, with further implications for potential therapeutic interventions in treating anxiety disorders.

Cannabidiol in anxiety disorders: Current and future perspectives.

Anxiety disorders are highly prevalent psychiatric disorders, characterized by a chronic course and often accompanied by comorbid symptoms that impair functionality and decrease quality of life. Despite advances in basic and clinical research in our understanding of these disorders, currently available pharmacological options are associated with limited clinical benefits and side effects that frequently lead to treatment discontinuation. Importantly, a significant number of patients do not achieve remission and live with lifelong residual symptoms that limit daily functioning. Since the 1970s, basic and clinical research on cannabidiol (CBD), a non-psychotomimetic compound found in the Cannabis sativa plant, has indicated relevant anxiolytic effects, garnering attention for its therapeutic potential as an option in anxiety disorder treatment. This chapter aims to review the history of these studies on the anxiolytic effects of CBD within the current understanding of anxiety disorders. It highlights the most compelling current evidence supporting its anxiolytic effects and explores future perspectives for its clinical use in anxiety disorders.

Long-term benzodiazepine use and risk of labor market marginalization in Finland: A cohort study with 5-year follow-up.

Benzodiazepines and related drugs (BZDRs) are widely used in the treatment of anxiety and sleep disorders, but cognitive adverse effects have been reported in long-term use, and these may increase the risk of labor market marginalization (LMM). The aim of this study was to investigate whether the risk of LMM is associated with new long-term BZDR use compared to short-term use. This register-based nationwide cohort study from Finland included 37,703 incident BZDR users aged 18-60years who initiated BZDR use in 2006. During the first year of use, BZDR users were categorized as long-term users (≥180days) versus short-term users based on PRE2DUP method. The main outcome was LMM, defined as receipt of disability pension, long-term sickness absence (>90days), or long-term unemployment (>180days). The risk of outcomes was analyzed with Cox regression models, adjusted with sociodemographic background, somatic and psychiatric morbidity, other types of medication and previous sickness absence. During 5 years of follow-up, long-term use (34.4%, N=12,962) was associated with 27% (adjusted Hazard Ratio, aHR 1.27, 95% CI 1.23-1.31) increased risk of LMM compared with short-term use. Long-term use was associated with 42% (aHR 1.42, 95% CI 1.34-1.50) increased risk of disability pension and 26% increased risk of both long-term unemployment and long-term sickness absence. These results indicate that long-term use of BZDRs is associated with increased risk of dropping out from labor market. This may be partly explained by cognitive adverse effects of prolonged BZDR use, which should be taken into account when prescribing BZDRs.

Baseline symptom severity and efficacy of Silexan in patients with anxiety disorders: A symptom-based, patient-level analysis of randomized, placebo-controlled trials.

The influence of baseline severity on the efficacy of Silexan, a proprietary essential oil from Lavandula angustifolia, in anxiety disorders has not been investigated in a pooled dataset. We report on an individual patient data analysis of all five double-blind, randomized, placebo-controlled trials with Silexan in anxiety disorders. Eligible participants received Silexan 80mg/d or placebo for 10 weeks. Analyses were based on the Hamilton Anxiety Rating Scale (HAMA), its psychic and somatic anxiety subscores, and the Clinical Global Impressions (CGI) scale. To correlate baseline severity with outcome, patients were segregated into mild, moderate, and severe cases. Altogether 1,172 patients (Silexan, n=587; placebo, n=585) were analyzed. For the HAMA total score, we found a significant association between the score at baseline and the treatment effect of Silexan versus placebo at week 10 (p<0.001). HAMA items from the somatic domain scored lower at baseline and showed less improvement than items from the psychic domain, particularly in patients with mild or moderate baseline symptoms. For CGI item 2 (global improvement), significant efficacy favoring Silexan were observed in mild, moderate, and severe baseline symptom severity. Although significant improvements were found for all subsets, the more severe the initial symptoms, the greater the treatment effects documented by the HAMA. Overall this analysis confirms that Silexan is an effective treatment option in early or mild stages of anxiety disorder. Given its favorable safety profile, Silexan can thus fill a therapeutic gap in the treatment of (subsyndromal) anxiety disorders.

An animal model of trait anxiety: Carioca high freezing rats as a model of generalized anxiety disorder.

Despite being one of the main components of anxiety and playing a pivotal role in how an individual perceives and copes with anxiogenic situations or responds to a given treatment, trait anxiety is paradoxically omitted in most animal models of anxiety. This is problematic and particularly more concerning in models that are used to screen drugs and other treatments for specific anxiety disorders and to investigate their neurobiological mechanisms. Our group has been engaged in the search for specific anxiety-related traits in animal models of anxiety. We developed two new lines of rats with strong phenotypic divergence for high (Carioca High-conditioned Freezing [CHF]) and low (Carioca Low-conditioned Freezing [CLF]) trait anxiety as expressed in the contextual fear conditioning paradigm. Here, we summarize key behavioral, pharmacological, physiological, and neurobiological differences in one these lines, the CHF rat line, relative to randomized-cross controls and discuss how far they represent a valid and reliable animal model of generalized anxiety disorder and so high trait anxiety.

Prescriptions of antidepressants and anxiolytics in France 2012–2022 and changes with the COVID-19 pandemic: interrupted time series analysis

BackgroundDepression and anxiety have increased in prevalence since the start of the COVID-19 pandemic.ObjectiveTo evaluate the consumption of antidepressants and anxiolytics from 2012 to 2022 and the pandemic’s potential impact...

Brazilian Psychiatric Association guidelines for the treatment of Social Anxiety Disorder.

Social anxiety disorder (SAD) is one of the most prevalent anxiety disorders, often not well recognized. In most of the cases, SAD follows an unremitted and chronic course, affecting several areas of the individual functioning (i.e.: relationship, academic, work). Due to its relevance, there is a need for guideline-based treatments for SAD treatment adapted to the Brazilian social and economic reality. A systematic review was produced by our group assessing several treatment modalities for SAD. The Medical Subject Headings term used was Social Anxiety Disorder or Social Phobia. PubMed, Cochrane, Scielo, ClinicalTrials.gov were searched resulting in 438 articles screened, of which 20 were selected. Selective serotonin reuptake inhibitors are considered first line choices for the treatment of SAD, with great effects and a large database of evidence. Monoamine oxidase inhibitors (MAOIs), benzodiazepines and the anticonvulsants pregabalin and gabapentin are also effective. The serotonin noradrenaline reuptake inhibitor (SNRI) venlafaxine shows divergent results. With regards to psychological interventions, robust data offered evidence for cognitive behavioral therapy (CBT) as a first line option (individual, group and internet delivered). Psychodynamic psychotherapy, exposure and social skills therapy, self-help (with and without support) therapies, cognitive bias modification, virtual reality exposure therapy and mindfulness-based therapy are also effective techniques. Compared to pharmacological agents, psychological interventions are better tolerated and show evidence of long-term benefits. Patient's access to treatments (considering the Brazilian socioeconomic context), adherence, response rates (short and long-term treatment) and side effects must be considered when choosing the best strategy for the treatment of SAD.

Pathogenetic basis of modern approaches to the therapy of sleep disorders in the clinic of depression

Epidemiological studies indicate that about 35% of the world's population periodically suffer from insomnia. Many authors in their studies note sleep disturbances in the clinic of both somatic and mental disorders, often considering sleep disturbances as one of the predictors of these diseases. In psychiatric practice, sleep disorders are most often described in the clinic of depression, which is determined by the general pathophysiological mechanisms of their development due to disruption of the activity of the main neurotransmitter systems of the brain. The results of clinical studies show that the drug of choice in the treatment of sleep disorders in the depression clinic is the antidepressant Mirtazapine, which has a unique profile of pharmacological activity. According to international recommendations, Mirtazapine is a first-line drug in the treatment of anxiety and depressive disorders with sleep disorders and sexual dysfunction caused by taking other antidepressants.

Study on the mechanism of SND in the treatment of anxiety disorders based on network pharmacology, molecular docking and experiment validation

Study on the mechanism of SND in the treatment of anxiety disorders based on network pharmacology, molecular docking and experiment validation

Role of 5-hydroxytryptamine type 3 receptors in the regulation of anxiety reactions.

5-Hydroxytryptamine (5-HT) type 3 receptor (5-HT3R) is the only type of ligand-gated ion channel in the 5-HT receptor family. Through the high permeability of Na+, K+, and Ca2+ and activation of subsequent voltage-gated calcium channels (VGCCs), 5-HT3R induces a rapid increase of neuronal excitability or the release of neurotransmitters from axon terminals in the central nervous system (CNS). 5-HT3Rs are widely expressed in the medial prefrontal cortex (mPFC), amygdala (AMYG), hippocampus (HIP), periaqueductal gray (PAG), and other brain regions closely associated with anxiety reactions. They have a bidirectional regulatory effect on anxiety reactions by acting on different types of cells in different brain regions. 5-HT3Rs mediate the activation of the cholecystokinin (CCK) system in the AMYG, and the γ‍-aminobutyric acid (GABA) "disinhibition" mechanism in the prelimbic area of the mPFC promotes anxiety by the activation of GABAergic intermediate inhibitory neurons (IINs). In contrast, a 5-HT3R-induced GABA "disinhibition" mechanism in the infralimbic area of the mPFC and the ventral HIP produces anxiolytic effects. 5-HT2R-mediated regulation of anxiety reactions are also activated by 5-HT3R-activated 5-HT release in the HIP and PAG. This provides a theoretical basis for the treatment of anxiety disorders or the production of anxiolytic drugs by targeting 5-HT3Rs. However, given the circuit specific modulation of 5-HT3Rs on emotion, systemic use of 5-HT3R agonism or antagonism alone seems unlikely to remedy anxiety, which deeply hinders the current clinical application of 5-HT3R drugs. Therefore, the exploitation of circuit targeting methods or a combined drug strategy might be a useful developmental approach in the future.

Comparison of Escitalopram Alone versus in Combination with Jacobson’s Progressive Muscle Relaxation in Patients with Neurotic, Stress Related and Somatoform Disorders: A Randomised Clinical Study

Introduction: Anxiety disorders have a prevalence rate of 2.57% and significantly impact well-being and productivity. The course of anxiety disorders is characterised by fluctuating symptom severity, a high relapse rate, and chronicity. Patients with anxiety disorders are typically prescribed antidepressants or anti-anxiety medications, but these treatments often have limited long-term efficacy. Combining pharmacotherapy with non-pharmacological techniques, such as Progressive Muscle Relaxation (PMR), may enhance the effectiveness of treatment for anxiety disorders. Aim: To assess and compare the Hamilton Anxiety Rating Scale (HAM-A) scores at six-month between Group-E (who received Escitalopram exclusively) and Group-E+PMR (who received Escitalopram in addition to PMR). Materials and Methods: A randomised clinical study was conducted in the Department of Psychiatry at Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar, Punjab, India, from March 2020 to March 2021. The study was carried out following approval from the Institutional Ethics Committee (IEC). Participants were individuals aged 18 to 45 years who visited the Psychiatry Department's Outpatient Department (OPD) and met the ICD-10 criteria for Neurotic, stress-related, and somatoform disorders (F40-F48). One hundred and seventeen participants were randomly allocated to the two groups using a simple randomization method. Group-E received a daily dose of 10 mg Escitalopram for six months, while Group-E+PMR received the same dosage of Escitalopram along with Jacobson’s PMR exercises lasting 20 minutes, twice daily, at their place of residence. The HAM-A scale was employed to assess anxiety levels in both groups. Paired t-tests were conducted to compare pre- and post-treatment HAM-A scores within each group, while independent t-tests were used to compare scores between the groups. Statistical analysis was carried out using SPSS version 24.0 and a significance level of p&lt;0.05 was adopted for the statistical assessments. Results: Both groups were comparable in terms of sociodemographic variables, mean age, and baseline HAM-A scores. The majority of participants, 70 (70%), were females. Significant improvements were noted in the HAM-A scores at six-month mark compared to baseline for both, Group-E and Group-E+PMR (p&lt;0.001). Furthermore, Group-E+PMR exhibited a significant decrease in the HAM-A score at six months compared to Group-E (p&lt;0.001), indicating more substantial improvements. Conclusion: Escitalopram and Escitalopram combined with PMR treatment effectively lowered anxiety. However, the incorporation of PMR Exercises alongside Escitalopram demonstrated more favourable outcomes in individuals with anxiety disorders.

The Effect of Oral Chamomile on Anxiety: A Systematic Review of Clinical Trials.

Anxiety disorder is a prevalent psychiatric issue that affects 4.05% of the global population. As complementary and alternative medicine gains popularity, many individuals with anxiety symptoms seek herbal remedies. This systematic review aims to explore the sedative efficacy of chamomile as an herbal medicine for anxiety treatment. Our search was conducted in PubMed, Google Scholar, and Scopus databases until August 2023. Among 389 papers found, after removing duplicates and irrelevant papers, 10 clinical trials investigating the effect of oral consumption of chamomile on anxiety were included. Two researchers independently completed all steps, including the screening process and data extraction. Out of the 10 articles selected, 9 studies have concluded that chamomile is effective in reducing anxiety. Even though, the exact mechanism of chamomile's anxiolytic action is not well understood, evidence suggests that its active compounds, including apigenin, may modulate the function of the hypothalamic-pituitary-adrenocortical axis by affecting neurotransmitter pathways. This systematic review showed that chamomile potentially has an anxiolytic effect. In addition, due to the side effects of drugs used to treat anxiety disorders, the use of chamomile seems to be effective and less dangerous.

Brazilian Psychiatric Association treatment guidelines for generalized anxiety disorder: perspectives on pharmacological and psychotherapeutic approaches.

Generalized anxiety disorder is a highly prevalent mental disorder. Previous data indicate that more than 18 million Brazilians suffer from this condition. Traditionally, generalized anxiety disorder has been considered a mild mental health disorder, despite its links to lower life expectancy, cardiovascular disease, and suicide. The aim of this article is to combine elements of systematic and critical reviews to produce a synthesis of the best evidence about generalized anxiety disorder treatment. Systematic reviews, meta-analyses, and randomized controlled trials were included. The descriptor used in the search was "generalized anxiety disorder," which resulted in 4,860 articles and seven other studies, of which 59 were selected. Antidepressants and benzodiazepines were indicated, as was pregabalin, and atypical antipsychotics, such as quetiapine, have been studied. Individual cognitive behavior therapy (third wave) has proven effective. There is extensive literature on many effective treatments for generalized anxiety disorder. The present review summarizes the therapeutic possibilities, emphasizing those available in Brazil. Further studies are needed to compare other available medications, assess psychotherapies and new treatments in greater depth, as well as to assess the ideal duration of therapy.

Posttraumatic stress disorder clinical guidelines and treatment standards: focus on the symptoms of the psychophysiological arousal

The article describes the main diagnostic criteria and principles of posttraumatic stress disorder (PTSD) diagnostic with the consideration of risk factors and specific clinical features. The main biomarkers search trends and existing limitations are considered. The role of the psychophysiological arousal symptoms claster is highlighted in the clinical picture of PTSD as well as in connection with the main cluster of re-experiencing symptoms activation and slowing of sanogenesis process. The necessity of PTSD detection in somatic medicine is thoroughly described. The article presents therapeutic algorithms of the latest international and Russian PTSD treatment clinical guidelines based on the individual combination of psychotherapy and psychopharmacotherapy treatment choice. Additionally the accumulated during the last decades national clinical experience of the anxiety disorders treatment, including the symptoms of psychophysiological arousal is highlighted that determined the list of the recommended drugs indicating the evidence level, in the PTSD treatment standards and guidelines. The treatment choices possibilities with the consideration of different PTSD symptoms cluster expression and comorbid states and individual case distress level specific are presented. Main evidence based psychotherapeutic methods are described.