"All we have to fear is fear itself": Paradigms for reducing fear by preventing awareness of it.

Research on unconscious fear responses has recently been translated into experimental paradigms for reducing fear that bypass conscious awareness of the phobic stimulus and thus do not induce distress. These paradigms stand in contrast to exposure therapies for anxiety disorders, which require direct confrontation of feared situations and thus are distressing. We systematically review these unconscious exposure paradigms. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-based search yielded 39 controlled experiments based on 10 paradigms that tested whether exposure without awareness can reduce fear-related responses. In randomized controlled trials of phobic participants, unconscious exposure interventions: (a) reduced behavioral avoidance (weighted mean d = 0.77, N = 469) and self-reported fear (d = 0.78, N = 329) during in vivo exposure to feared situations; (b) reduced neurobiological indicators of fear and enhanced such indicators of fear regulation (d = 0.81, N = 205); (c) had significantly stronger effects on reducing symptomatic behaviors and enhancing neurobiological indicators of fear regulation than did conscious exposure (d = 0.78, N = 342); and (d) produced these effects without inducing subjective fear. In fear-conditioned participants, unconscious exposureinduced extinction learning (d = 0.80, N = 420), even during sleep, and yielded somewhat stronger extinction learning than conscious exposure did (d = 0.44, N = 438). We organize these findings within a neuroscientific framework and evaluate alternative mechanisms for unconscious exposure. The use of incommensurate outcome measures across exposure paradigms and nonreporting of relevant statistics limited meta-analyses. Despite steps taken to address publication bias, 25.6% of included studies came from a single laboratory. We propose potential clinical applications of these findings. Future research should clarify underlying mechanisms, use common outcome measures, and explore effects on other anxiety disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effect of meditation music and comedy movie interventions on postoperative kinesiophobia and pain in patients undergoing total knee arthroplasty.

BACKGROUND: This study aimed to investigate the effects of music and comedy movie interventions on postoperative pain and kinesiophobia in patients who underwent total knee arthroplasty. METHODS: This randomized-controlled study was carried out with the participation of patients who underwent total knee arthroplasty. The patients were divided into three groups. To reduce surgical pain and kinesiophobia, the patients in group 1 watched a comedy movie, those in group 2 listened to music, and those in group 3 did not participate in any intervention other than the routine practices of the clinic. RESULTS: The personal and medical characteristics of the patients in all groups were similar. The patients in all three groups were kinesiophobic, and their surgical pain levels were moderate despite pharmaceutical interventions. Groups 1 and 2 had a statistically significant decrease in kinesiophobia and pain scores after the interventions. The effects of having patients watch a comedy movie and having them listen to meditation music were not significantly different. CONCLUSIONS: The results of the study showed that listening to meditation music or watching comedy movie scenes had significant positive effects in alleviating postoperative pain and kinesiophobia after TKA. Based on the results of this study, it is recommended that patients watch comedy movies and listen to meditation music to alleviate their postoperative pain and kinesiophobia. TRIAL REGISTRATION: NCT, NCT05471778. The study was registered at ClinicalTrials.gov.

Preventing and reducing fear using positive modelling: A systematic review of experimental research with children.

Fear of specific stimuli is thought to develop through associative learning mechanisms and research indicates that a form of observational (vicarious) learning known as positive modelling can counter these effects. This systematic review examined and synthesised the experimental positive modelling literature to establish its efficacy for reducing fear. Psych Info, Medline and the Psychology and Behavioural Science Collection databases were systematically searched until August 2021. Of the 1,677 papers identified, 18 experiments across 14 articles met the inclusion criteria. In the majority of these, positive modelling was found to lower fear levels in one or more of three procedures: fear prevention, fear reduction and fear reversal. Procedures inform prevention and treatment initiatives for specific phobias in several ways. The overall efficacy of positive modelling techniques and the ease in which they can be implemented highlight the importance of further research to evaluate their inclusion in prevention and treatment interventions. More research is required to establish the longevity and transferability of positive modelling.

Steroid Phobia: A Review of Prevalence, Risk Factors, and Interventions.

Topical corticosteroid phobia may lead to poor adherence, resulting in persistent disease and escalation to systemic agents. The aim of this paper was to review current literature to assess topical steroid phobia prevalence, populations most at risk, reasons behind steroid phobia, and interventions to reduce it. A systematic search of PubMed, Ovid (Journals@Ovid, MEDLINE), ScienceDirect, and Web of Science was performed. Studies ranged from May 2000 to February 2021. In total, 37 articles met the inclusion criteria. There was inter-study variation in the way steroid phobia is defined, from concern to irrational fear. The worldwide prevalence of topical steroid phobia ranges from 31 to 95.7% and does not differ with patient race/ethnicity or dermatological condition. Female patients and caregivers, and those who have experienced side effects of topical corticosteroids are most likely to express steroid phobia. Reasons for steroid phobia include lack of education, fear of side effects, polypharmacy, misinformation, negative experience with topical steroids, and frequently changing of clinics. Successful interventions to address steroid phobia include patient education in the form of educational videos followed by individualized oral education based on concerns, and demonstrations of application of topical steroids. Multiple interventions address topical corticosteroid phobia and improve adherence of topical corticosteroids in the management of dermatological conditions. Providers should screen patients for steroid phobia, especially in populations particularly at risk. Interventions using patient education should be individualized based on concerns expressed during screening. Further research should investigate if reducing steroid phobia can in fact improve long-term adherence.

The Nature of Islamophobia: A Test of a Tripartite View in Five Countries.

This article provides an examination of the structure of Islamophobia across cultures. Our novel measure-the Tripartite Islamophobia Scale (TIS)-embeds three theoretically and statistically grounded subcomponents of Islamophobia: anti-Muslim prejudice, anti-Islamic sentiment, and conspiracy beliefs. Across six samples (i.e., India, Poland, Germany, France, and the United States), preregistered analyses corroborated that these three subcomponents are statistically distinct. Measurement invariance analyses indicated full scalar invariance, suggesting that the tripartite understanding of Islamophobia is generalizable across cultural contexts. Furthermore, the subcomponents were partially dissociated in terms of the intergroup emotions they are predicted by as well as the intergroup outcomes they predict (e.g., dehumanization, ethnic persecution). For example, intergroup anger and disgust underpin Islamophobic attitudes, over and above the impact of fear. Finally, our results show that social dominance orientation (SDO) and ingroup identification moderate intergroup emotions and Islamophobia. We address both theoretical implications for the nature of Islamophobia and practical interventions to reduce it.

Emergency Imaging in Pregnancy and Lactation [Formula: see text].

The use of diagnostic imaging studies in the emergency setting has increased dramatically over the past couple of decades. The emergency imaging of pregnant and lactating patients poses unique challenges and calls upon the crucial role of radiologists as consultants to the referring physician to guide appropriate use of imaging tests, minimize risk, ensure timely management, and occasionally alleviate unwarranted trepidation. A clear understanding of the risks and benefits involved with various imaging tests in this patient population is vital to achieve this. This review discusses the different safety and appropriateness issues that could arise with the use of ionizing radiation, iodinated-, and gadolinium-based contrast media and radiopharmaceuticals in pregnant and lactating patients. Special considerations such as trauma imaging, safety concerns with magnetic resonance imaging and ultrasound, management of claustrophobia, contrast extravasation, and allergic reactions are also reviewed. The consent process for these examinations has also been described.

Role of medial hypothalamic orexin system in panic, phobia and hypertension.

Orexin has been implicated in a number of physiological functions, including arousal, regulation of sleep, energy metabolism, appetitive behaviors, stress, anxiety, fear, panic, and cardiovascular control. In this review, we will highlight research focused on orexin system in the medial hypothalamic regions of perifornical (PeF) and dorsomedial hypothalamus (DMH), and describe the role of this hypothalamic neuropeptide in the behavioral expression of panic and consequent fear and avoidance responses, as well as sympathetic regulation and possible development of chronic hypertension. We will also outline recent data highlighting the clinical potential of single and dual orexin receptor antagonists for neuropsychiatric conditions including panic, phobia, and cardiovascular conditions, such as in hypertension.

Effect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis.

PURPOSE: Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall efficacy of available psychological interventions on FCR remains unknown. We therefore evaluated this in the present systematic review and meta-analysis. METHODS: We searched key electronic databases to identify trials that evaluated the effect of psychological interventions on FCR among patients with and survivors of cancer. Controlled trials were subjected to meta-analysis, and the moderating influence of study characteristics on the effect were examined. Overall quality of evidence was evaluated using the GRADE system. Open trials were narratively reviewed to explore ongoing developments in the field (PROSPERO registration no.: CRD42017076514). RESULTS: A total of 23 controlled trials (21 randomized controlled trials) and nine open trials were included. Small effects (Hedges's g) were found both at postintervention (g = 0.33; 95% CI, 0.20 to 0.46; P < .001) and at follow-up (g = 0.28; 95% CI, 0.17 to 0.40; P < .001). Effects at postintervention of contemporary cognitive behavioral therapies (CBTs; g = 0.42) were larger than those of traditional CBTs (g = 0.24; ß = .22; 95% CI, .04 to .41; P = .018). At follow-up, larger effects were associated with shorter time to follow-up (ß = -.01; 95% CI, -.01 to -.00; P = .027) and group-based formats (ß = .18; 95% CI, .01 to .36; P = .041). A GRADE evaluation indicated evidence of moderate strength for effects of psychological intervention for FCR. CONCLUSION: Psychological interventions for FCR revealed a small but robust effect at postintervention, which was largely maintained at follow-up. Larger postintervention effects were found for contemporary CBTs that were focused on processes of cognition-for example, worry, rumination, and attentional bias-rather than the content, and aimed to change the way in which the individual relates to his or her inner experiences. Future trials could investigate how to further optimize and tailor interventions to individual patients' FCR presentation.

Reducing avoidance in adults with high spider fear using perceptual discrimination training.

BACKGROUND: Fear overgeneralization is a central feature of anxiety disorders and can lead to excessive avoidance. As perceptual discrimination is a key component of fear overgeneralization, a perceptual discrimination training task was created aimed at improving perceptual discrimination and reducing fear overgeneralization. METHODS: Participants with high spider fear were randomized into training or placebo conditions. After completing their assigned task, perceptual discrimination was tested. Thereafter, participants completed a behavioral avoidance test, consisting of five stimuli ranging from a paper spider to a live tarantula. Last, participants completed a threat/safety discrimination task using schematic morphs ranging from a flower to a spider, while self-report and skin conductance responses were collected. RESULTS: The training group showed better perceptual discrimination during the test than did the placebo group. Furthermore, as stimuli became increasingly similar to a live spider, participants in the training group exhibited decreased avoidance behavior. Finally, participants in the training group indicated that schematic morphs were less similar to a spider and showed less physiological arousal than did the placebo group. CONCLUSIONS: Together, these results attest to the possible clinical relevance of the perceptual discrimination training.

Video Teaching Leads to Improved Attitudes Towards Obesity-a Randomized Study with 949 Participants.

BACKGROUND: Obesity is a rising social and economic burden. Patients with obesity often suffer from stigmatization and discrimination. Underrecognition of obesity as a disease could be a contributing factor. The present study aimed to compare attitudes towards obesity with other chronic diseases and to evaluate the recognition of need of professional treatment. METHODS: Nine hundred and forty-nine participants (subgroups: general population, patients with obesity, nurses in training, nurses, medical students, physicians) were randomized to video teaching on obesity and control. Questionnaires on the burden and influence of obesity on daily life compared to other chronic diseases and the fat phobia scale (FPS) were answered. RESULTS: Burden of obesity was rated low (4.2 ± 1.3; rank 9 of 11) compared to other diseases. Bowel cancer (5.5 ± 0.9) had the highest and caries the lowest (2.7 ± 1.4) estimated impact. Females (p = 0.011) and older people (p < 0.001) rated burden of obesity high whereas general population (p < 0.001) and control (p < 0.001) rated it low. Females (p = 0.001) and people with higher BMI (p = 0.004) rated the influence of obesity on daily life high; the general population (p < 0.001; reference physicians) and the control group (p < 0.001) rated it low. FPS was lowest in patients with obesity (3.2 ± 0.7) and highest in the general population (3.6 ± 0.4) and medical students (3.6 ± 0.5; p < 0.001; compared to physicians). CONCLUSIONS: Obesity is underestimated as a disease compared to other chronic diseases and attitudes towards obesity are rather negative in comparison. Video teaching showed positive effects so a focus in medical education and public campaigns should aim to improve prevention and treatment of obesity.

Fostering Student's Engagement and Active Learning in Neuroscience Education.

Neurophobia is a term coined to describe university students' fear of neuroscience, which negatively affect learning. The implementation of new technologies in higher education, such as new response systems, provide an opportunity to improve neurosciences learning and teaching by engaging students. However, most response systems rely on student devices such as clickers. The aim of this study is to illustrate the application of a new digital application for collection of real-time formative assessment data in higher education. Results of this study support the utility paper-based response cards to foster engagement and active learning in higher education, even with complex neuroscience topics, providing real-time formative assessment data without the need for student devices.

A psychological intervention (ConquerFear) for treating fear of cancer recurrence: Views of study therapists regarding sustainability.

OBJECTIVE: ConquerFear is a metacognitive intervention for fear of cancer recurrence (FCR) with proven efficacy immmediately and 6 months post-treatment. This qualitative study documented barriers and facilitators to the sustainability of ConquerFear from the perspective of study therapists. METHODS: Fourteen therapists who had delivered ConquerFear in a randomised controlled trial completed a semi-structured phone interview, reaching theoretical saturation. Themes from thematic analysis were mapped to the Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework. RESULTS: Participants were 13 males and one female with, on average, 14 years psycho-oncology experience. Nine over-arching themes were identified, falling into three domains, which when present, were facilitators, and if absent, were barriers: evidence (intervention credibility, experienced efficacy, perceived need for intervention); context (positive attitude to and capacity for survivorship/FCR care, favourable therapist orientation and flexibility, strong referral pathways); and facilitation of implementation (intervention/service fit, intervention/patient fit, and training, support, and provided resources). CONCLUSIONS: ConquerFear is a sustainable intervention in routine clinical practise. Facilitators included a sound evidence base; a receptive context; good fit between the intervention, therapist orientation, and patient need; and flexibility of delivery. Where absent, these factors served as barriers. These results have implications for enhancing uptake of psycho-oncology interventions in routine care.

Revision of the fear of cancer recurrence cognitive and emotional model by Lee-Jones et al with women with breast cancer.

BACKGROUND: Fear of cancer recurrence (FCR) is among the top unmet concerns reported by breast cancer survivors. Despite the sizable literature on FCR, few theoretical models have been empirically tested. One of the most cited is the FCR model. AIM: This study seeks to understand the nature of women's cognitive and emotional issues from FCR using specific guidance from the model by Lee-Jones and to provide suggestions for modifications to the model based on empirical results from the reported experiences of women living with breast cancer. METHODS AND RESULTS: A qualitative descriptive study using semi-structured interviews was conducted at an urban hospital. Recruited by convenience sampling, 12 breast cancer survivors concerned with FCR and who had recently completed active treatment participated in the study. Seven thematic categories emerged from the women's descriptions of their cognitive and emotional experiences with FCR: (a) FCR is always there; (b) beliefs about risk of recurrence; (c) beliefs about eradication of cancer; (d) preferences not to seek information about recurrence; (e) derailment of normal life; (f) worries related to recurrence; and (g) need for support. Adjustments to the model by Lee-Jones et al1 specifically to women living with breast cancer include the addition of new variables-the fear is always present, a preference not to seek information, and the need for support beyond treatment-and the merging of two variables, anxiety and worry, as participants viewed these concepts as interchangeable and experienced in similar ways. Lastly, participants did not report any remorse related to not opting for more aggressive treatments. CONCLUSION: The refinement of a more comprehensive FCR theoretical model, such as through the modifications derived from this study, provides a deeper understanding of breast cancer survivors' experiences with FCR and can more effectively guide health care professionals to develop appropriately tailored interventions aimed at decreasing FCR levels.

Sakarya University students' fat phobia levels and attitudes towards obese individuals and their correlation with healthy lifestyle behaviours: Knowledge, attitude and practice (KAP) study.

OBJECTIVE: To evaluate fat phobia levels and attitudes towards obese person among university students to determine their correlation with healthy lifestyle behaviour. METHODS: The knowledge, attitude and practice study was conducted at Sakarya University, Turkey, between May and December 2015, and comprised students of either gender. Data was collected by using the socio-demographic form, fat phobia scale, attitudes toward obese persons scale, and health-promoting lifestyle profile II scale. SPSS 16 was used for data analysis. RESULTS: Of the 2100 students, 1056(50.3%) were male and 2067(98.4%) were in the 17-26 years age group. The mean fat phobia scale score was 3.72±0.63and mean attitudes toward obese persons scale score was 59.95±0.63. Relationship between fat phobia scale, attitudes toward obese persons scale, and health-promoting lifestyle profile II scale scores was significant (p<0.05). CONCLUSIONS: Fatphobia moderately existed among the students.

Effects of respiratory and applied muscle tensing interventions on responses to a simulated blood draw among individuals with high needle fear.

Fear of blood and needles increases risk for presyncopal symptoms. Applied muscle tension can prevent or attenuate presyncopal symptoms; however, it is not universally effective. This study examined the effects of applied muscle tension, a respiratory intervention, and a no treatment control condition, on presyncopal symptoms and cerebral oxygenation, during a simulated blood draw with individuals highly fearful of needles. Participants (n = 95) completed questionnaires, physiological monitoring, and two trials of a simulated blood draw with recovery. Presyncopal symptoms decreased across trials; however, no group differences emerged. Applied muscle tension was associated with greater cerebral oxygenation during trial two, and greater end-tidal carbon dioxide during both trials. The respiratory intervention did not differ from the no treatment control. Applied muscle tension is an intervention that can increase cerebral oxygenation and end-tidal carbon dioxide. While the respiratory intervention is promising within therapeutic settings, it was not efficacious after a brief audio training.

[Effectiveness of therapeutic education against "nicotinophobia" in smokers hospitalized for cardiovascular and pulmonary rehabilitation]. / Efficacité de l'éducation thérapeutique contre la « nicotinophobie ¼ de patients fumeurs hospitalisés en soins de suite et réadaptation cardiovasculaire et pulmonaire.

INTRODUCTION: Nicotine replacement therapies remain the main validated treatment to stop smoking. Nevertheless, treatment acceptance deals with patients negative representations. This "nicotinophobia" could be the main barrier to treatment acceptance and as a consequence would be at the origin of numerous failures of smoking cessation. MATERIALS AND METHODS: We estimated the efficiency of an educational collective workshop to fight against nicotinophobia in patients smokers hospitalized for cardiovascular and pulmonary rehabilitation. RESULTS: Smoking cessation was significantly improved in patients who participated at the workshop (81 vs. 48 %), associated with a significant decrease of anxiety-depression scores, and without significant weight gain (average loss of 2.8kg). CONCLUSION: Educational approaches seem to help a majority of patient smokers to stop smoking, without anxiety and without weight gain. These results encourage the creation of a real therapeutic educational program dedicated to smoking cessation.

Preoperative Pain Neuroscience Education Combined With Knee Joint Mobilization for Knee Osteoarthritis: A Randomized Controlled Trial.

OBJECTIVES: This study aimed to first compare the effects of a preoperative treatment combining pain neuroscience education (PNE) with knee joint mobilization versus biomedical education with knee joint mobilization on central sensitization (CS) in patients with knee osteoarthritis, both before and after surgery. Second, we wanted to compare the effects of both interventions on knee pain, disability, and psychosocial variables. MATERIALS AND METHODS: Forty-four patients with knee osteoarthritis were allocated to receive 4 sessions of either PNE combined with knee joint mobilization or biomedical education with knee joint mobilization before surgery. All participants completed self-administered questionnaires and quantitative sensory testing was performed at baseline, after treatment and at a 1 month follow-up (all before surgery), and at 3 months after surgery. RESULTS: Significant and clinically relevant differences before and after surgery were found after treatments for both knee pain and disability, and some measures of CS (ie, widespread hyperalgesia, CS inventory), with no significant between-group differences. Other indicators of CS (ie, conditioned pain modulation, temporal summation) did not change over time following either treatment, and in some occasions the observed changes were not in the expected direction. Patients receiving PNE with knee joint mobilization achieved greater improvements in psychosocial variables (pain catastrophizing, kinesiophobia) both before and after surgery. DISCUSSION: Preoperative PNE combined with knee joint mobilization did not produce any additional benefits over time for knee pain and disability, and CS measures compared with biomedical education with knee joint mobilization. Superior effects in the PNE with knee joint mobilization group were only observed for psychosocial variables related to pain catastrophizing and kinesiophobia.