A model for occupational stress amongst paediatric and adult critical care staff during COVID-19 pandemic.

PURPOSE: The coronavirus 2019 pandemic has placed all intensive care unit (ICU) staff at increased risk of psychological distress. To date, measurement of this distress has largely been by means of validated assessment tools. We believe that qualitative data may provide a richer view of staff experiences during this pandemic. METHODS: We conducted a cross-sectional, observational study using online and written questionnaires to all ICU staff which consisted of validated tools to measure psychological distress (quantitative findings) and open-ended questions with free-text boxes (qualitative findings). Here, we report our qualitative findings. We asked four questions to explore causes of stress, need for supports and barriers to accessing supports. A conventional content analysis was undertaken. RESULTS: In total, 269 of the 408 respondents (65.9%) gave at least one response to a free-text question. Seven overarching themes were found, which contribute to our proposed model for occupational stress amongst critical care staff. The work environment played an important role in influencing the perceived psychological impact on healthcare workers. Extra-organisational factors, which we termed the "home-work interface" and uncertainty about the future, manifested as anticipatory anxiety, had a proportionally larger influence on worker well-being than would be expected in non-pandemic conditions. CONCLUSION: Our findings have important implications for appropriate allocation of resources and ensuring well-being of the ICU multidisciplinary team for this and future pandemics.

Qualitative investigation of the factors that generate ambivalent feelings in women who give birth after receiving negative results from non-invasive prenatal testing.

BACKGROUND: Women who receive negative results from non-invasive prenatal genetic testing (NIPT) may find that they later have mixed or ambivalent feelings, for example, feelings of accepting NIPT and regretting undergoing the test. This study aimed to investigate the factors generating ambivalent feelings among women who gave birth after having received negative results from NIPT. METHODS: A questionnaire was sent to women who received a negative NIPT result, and a contents analysis was conducted focusing on ambivalent expressions for those 1562 women who responded the questionnaire. The qualitative data gathered from the questionnaire were analyzed using the N-Vivo software package. RESULTS: Environmental factors, genetic counseling-related factors, and increased anticipatory anxiety, affected the feeling of ambivalence among pregnant women. Furthermore, pregnant women desired more information regarding the detailed prognosis for individuals with Down syndrome and living with them and/or termination, assuming the possibility that they were positive. CONCLUSIONS: Three major interrelated factors affected the feeling of ambivalence in women. Highlighting and discussing such factors during genetic counseling may resolve some of these ambivalences, thereby enhancing the quality of decisions made by pregnant women.

Behavioral and neural sensitivity to uncertain threat in individuals with alcohol use disorder: Associations with drinking behaviors and motives.

A developing theory is that individuals with alcohol use disorder (AUD) display exaggerated reactivity to threats that are uncertain (U-threat), which facilitates excessive drinking as a means of avoidance-based coping. There is a promising initial behavioral evidence supporting this theory; however, the neural bases of reactivity to U-threat in individuals with AUD have not been examined. The extent to which biomarkers of U-threat reactivity map onto drinking behaviors and coping motives for alcohol use is also unknown. The current study therefore examined group differences in behavioral and neural reactivity to U-threat in adults with and without AUD. The study also tested whether behavior and brain responses to U-threat correlate with problematic drinking and coping motivated drinking. Volunteers (n = 65) with and without a history of AUD (38 AUD, 27 controls) were included and completed a well-validated threat-of-shock task to probe responses to U-threat and predictable threat (P-threat) while startle eyeblink potentiation was collected. Individuals also completed a newly designed, analogous version of the task during functional magnetic resonance imaging (fMRI). Results indicated that individuals with AUD displayed greater startle magnitude during U-threat, but not P-threat, and greater right insula and dorsal anterior cingulate cortex (dACC) activation during both forms of threat compared with controls. Startle magnitude and insula activation during U-threat positively correlated with self-reported problem drinking and coping motives for alcohol use. Findings demonstrate that individuals with AUD display exaggerated sensitivity to U-threat at the behavioral and neural level and that these multimethod biomarkers tap into negative reinforcement processes of alcohol abuse.

Perpetuating factors of social anxiety: a serial mediation model.

BACKGROUND: There is evidence that individuals with high levels of social anxiety utilize more safety behaviours and experience more post-event processing than those with lower levels of social anxiety. There are also data to suggest that the relationship between safety behaviour use and social anxiety symptoms is mediated by perceived control of one's anxiety. Furthermore, it has been suggested that post-event processing influences anticipatory anxiety for a future social situation. AIM: A direct link between the perpetuating factors of social anxiety described above has not been established in the literature. The aim of the current study was to test a model examining the relationship between these constructs. METHOD: Participants first completed a battery of questionnaires. They then participated in an impromptu, 3-minute speech and were informed they would be videotaped. Following the speech, participants completed measures of anxiety and were instructed to return the following week. During the second session, they were informed they would deliver an additional speech and provided ratings of their anxiety in anticipation of delivering the second speech. RESULTS: The results of a serial mediation support that greater levels of social anxiety lead to less perceived control over one's anxiety, leading to increased safety behaviour use. The increase in safety behaviours led to an increase of post-event processing which resulted in greater anticipatory anxiety for a future speech task. CONCLUSIONS: This study provides novel evidence for the importance of perceived control in the genesis of social anxiety, which has implications for treatment.

Letting go of yesterday: Effect of distraction on post-event processing and anticipatory anxiety in a socially anxious sample.

According to cognitive models, post-event processing (PEP) is a key factor in the maintenance of social anxiety. Given that decreasing PEP can be challenging for socially anxious individuals, it is important to identify potentially useful strategies. Although distraction may help to decrease PEP, the findings have been equivocal. The primary purpose of this study was to examine whether a brief distraction period immediately following a speech would lead to less PEP the next day. The secondary aim was to examine the effect of distraction following an initial speech on anticipatory anxiety for a second speech, via reductions in PEP. Participants (N = 77 undergraduates with elevated social anxiety; 67.53% female) delivered a speech and were randomly assigned to a distraction, rumination, or control condition. The following day, participants reported levels of PEP in relation to the first speech, as well as anxiety regarding a second, upcoming speech. As expected, those in the distraction condition reported less PEP than those in the rumination and control conditions. Additionally, distraction following the first speech was indirectly related to anticipatory anxiety for the second speech, via PEP. Distraction may represent a potentially useful strategy for reducing PEP and other maladaptive processes that may maintain social anxiety.

Experiences and insomnia-associated factors in Chinese breast cancer survivors: a qualitative study.

AIMS AND OBJECTIVES: This study aimed to explore the experiences and factors associated with insomnia in Chinese breast cancer survivors. BACKGROUND: Insomnia is a common and significant symptom in breast cancer survivors. Quantitative studies are unable to describe the experience of insomnia and the sleep-associated factors from a personal point of view. A profound understanding of the experience of insomnia in breast cancer survivors can provide information for health workers and caregivers to allow them to provide more effective support. DESIGN: A descriptive qualitative research was adopted. METHODS: In-depth interviews were conducted with 22 insomniac breast cancer survivors. A qualitative content analysis was used to analyse the data. RESULTS: Three themes emerged concerning the experiences of insomnia, including sleep neglect, insomnia perception and insomnia anxiety. Participants reported their own opinions on three insomnia-associated factors, including factors associated with hospitalisation, factors associated with breast cancer and the therapies and too much attention placed on sleep. CONCLUSIONS: Survivors would neglect their sleep problems in the early stage after diagnosis. When they became aware of their sleep problems, they were inclined to worry too much and sought help from traditional Chinese medicine. Anticipatory sleep anxiety, excessive negative cognitive activities and insomnia became a vicious circle for insomniac breast cancer survivors. RELEVANCE TO CLINICAL PRACTICE: The findings provide detailed information to help nurses understand the experiences of breast cancer survivors with insomnia. Nurses could provide proper care to help prevent insomnia or improve sleep.

SPIDER OR NO SPIDER? NEURAL CORRELATES OF SUSTAINED AND PHASIC FEAR IN SPIDER PHOBIA.

BACKGROUND: Processes of phasic fear responses to threatening stimuli are thought to be distinct from sustained, anticipatory anxiety toward an unpredicted, potential threat. There is evidence for dissociable neural correlates of phasic fear and sustained anxiety. Whereas increased amygdala activity has been associated with phasic fear, sustained anxiety has been linked with activation of the bed nucleus of stria terminalis (BNST), anterior cingulate cortex (ACC), and the insula. So far, only a few studies have focused on the dissociation of neural processes related to both phasic and sustained fear in specific phobia. We suggested that first, conditions of phasic and sustained fear would involve different neural networks and, second, that overall neural activity would be enhanced in a sample of phobic compared to nonphobic participants. METHODS: Pictures of spiders and neutral stimuli under conditions of either predicted (phasic) or unpredicted (sustained) fear were presented to 28 subjects with spider phobia and 28 nonphobic control subjects during functional magnetic resonance imaging (fMRI) scanning. RESULTS: Phobic patients revealed significantly higher amygdala activation than controls under conditions of phasic fear. Sustained fear processing was significantly related to activation in the insula and ACC, and phobic patients showed a stronger activation than controls of the BNST and the right ACC under conditions of sustained fear. Functional connectivity analysis revealed enhanced connectivity of the BNST and the amygdala in phobic subjects. CONCLUSIONS: Our findings support the idea of distinct neural correlates of phasic and sustained fear processes. Increased neural activity and functional connectivity in these networks might be crucial for the development and maintenance of anxiety disorders.

Emotion regulation difficulties in social anxiety disorder and their specific contributions to anxious responding.

OBJECTIVE: Recent theories emphasize the contribution of emotion regulation (ER) difficulties to psychopathology. The present study sought to identify patterns of ER difficulties in social anxiety disorder (SAD) and to test the predictive value of these difficulties for actual anxious responding during the anticipation of a social evaluative task. METHOD: Participants diagnosed with SAD (n = 67) and healthy controls (n = 59) completed self-ratings of ER difficulties (DERS) and depressive symptoms. This was followed by the announcement of an impromptu speech. During the anticipation period, subjective ratings of anxiety and arousal were assessed. RESULTS: Compared to healthy controls, SAD participants reported significantly higher levels of ER difficulties. With the exception of "lack of emotional awareness," these differences remained significant when controlling for depression. ER difficulties also contributed to anxious responding during the stress test; but this held true only for nonclinical participants. CONCLUSION: SAD is characterized by a wide range of ER deficits. However, the associations between ER difficulties and symptoms of anxiety remain poorly understood.

To avoid or not to avoid: impact of self-compassion on safety behaviors in social situations.

BACKGROUND/OBJECTIVES: Safety behaviors are commonly used to decrease anxiety in social settings but maintain anxiety. Self-compassion has been shown to reduce anxiety and rumination, but the impact on safety behaviors has not been examined. For the present studies, it was hypothesized that inducing self-compassion would lead to lower safety behaviors compared to controls. METHODS: In Study 1 (N = 390), participants with elevated social anxiety recalled a distressing social situation, were randomly assigned to a self-compassionate (n = 186) or control (n = 204) writing exercise, and then reported predicted self-compassion and safety behaviors for a future situation. In Study 2 (N = 114), the impact of self-compassionate (n = 56) or control writing (n = 58) on safety behaviors was investigated during a Zoom interaction. RESULTS/CONCLUSIONS: In Study 1, as hypothesized, the self-compassion condition reported fewer expected avoidance behaviors compared to controls. In Study 2, state self-compassion and safety behaviors did not differ between conditions. In both studies, distress significantly mediated the relationship between condition and safety behaviors, such that the self-compassion condition reported significantly lower distress, which was associated with lower safety behaviors. Future research can examine whether reduced distress and safety behaviors allow for greater social connection.

Altered neural processing of threat in alcohol-dependent men.

BACKGROUND: Stress-response biological systems are altered in alcohol-dependent individuals and are reported to predict future relapse. This study was designed to assess neural disruptions in alcohol-dependent participants when exposed to a conditioned stimulus (CS) warning of the impending onset of a universal, nonpersonalized stressor. METHODS: Fifteen alcohol-dependent men abstinent for 3 to 5 weeks and 15 age- and race-similar healthy controls were studied. Anticipatory anxiety was induced by a CS paired with an uncertain, physically painful unconditioned stressor. Neural response was assessed using functional magnetic resonance imaging. RESULTS: Both groups experienced significant, similar levels of anticipatory anxiety in response to the high-threat relative to the low-threat CS. Whereas control participants markedly increased the blood oxygen level-dependent (BOLD) amplitude in cortical-limbic-striatal regions during the high-threat, relative to low-threat, stimulus, alcohol-dependent participants decreased BOLD amplitude in the pregenual anterior cingulate cortex (pgACC), medial prefrontal cortex (mPFC), medial orbitofrontal cortex, posterior cingulate cortex (PCC), bilateral parietal/occipital cortex, and right hippocampus. Alcohol-dependent participants significantly deactivated pgACC/mPFC and PCC clusters, relative to controls, during the high- versus low-threat stimulus. This difference was due to a decrease in %BOLD amplitude during the high-threat stimulus in the alcohol-dependent, but not the control, participants. CONCLUSIONS: Alcohol-dependent men show cortical-limbic-striatal deactivation during anticipatory anxiety, particularly in regions associated with emotional regulation. These findings suggest a lack of engagement of affective regulatory mechanisms during high-stress situations in alcohol-dependent men.

Higher anxiety rating does not mean poor speech performance: dissociation of the neural mechanisms of anticipation and delivery of public speaking.

Public speaking anxiety refers to feelings of nervousness when anticipating or delivering a speech. However, the relationship between anxiety in the anticipation phase and speech delivery phase is unclear. In this study, we used functional near-infrared spectroscopy to record participants' brain activities when they were anticipating or performing public speaking tasks in an immersive virtual reality environment. Neuroimaging results showed that participants' subjective ratings of public anxiety in the anticipation phase but not the delivery phase were correlated with activities in the dorsolateral prefrontal cortex, the inferior frontal gyrus, and the precentral and postcentral gyrus. In contrast, their speaking performance could be predicted by activities in the temporal gyrus and the right postcentral gyrus in the delivery phase. This suggests a dissociation in the neural mechanisms between anxiety in preparation and execution of a speech. The conventional anxiety questionnaire is a good predictor of anticipatory anxiety, but cannot predict speaking performance. Using virtual reality to establish a situational test could be a better approach to assess in vivo public speaking performance.

Anticipatory anxiety of epileptic seizures: An overlooked dimension linked to trauma history.

OBJECTIVE: Fear of having a seizure called anticipatory anxiety of epileptic seizure (AAS), constitutes a daily life burden but has been rarely studied. Our aim was to assess the prevalence and the determining factors of AAS in patients with drug-resistant focal epilepsy, a dimension that has not been thoroughly investigated before. METHODS: We conducted an observational, prospective study enrolling patients with drug-resistant focal epilepsy. The psychiatric assessment aimed to evaluate psychiatric comorbidities, trauma history, and quality of life using hetero-evaluation and self-assessment tools. Dimensions of anxiety specifically related to epilepsy (peri-and-inter-ictal) were explored as exhaustively as possible. RESULTS: AAS was found in 53 % of the 87 patients. We compared the two groups of patients: with or without AAS. Patients with AAS had a significantly shorter duration of epilepsy (p = 0.04). There was no difference between groups with respect to psychiatric disorders, except for cannabis dependence, more frequent in patients with AAS (p = 0.02). Compared to patients without AAS, those with AAS presented more subjective ictal anxiety (p = 0.0003) and postictal anxiety (p = 0.02), were more likely to avoid outdoor social situations due to seizure fear (p = 0.001), and had a poorer quality of life (QOLIE emotional well-being; p = 0.03). Additionally, they had experienced more traumatic events in their lifetime (p = 0.005) and reported more frequently a feeling of being unsafe during their seizures (p = 0.00002). SIGNIFICANCE: AAS is a specific dimension of anxiety, possibly linked to trauma history. AAS is strongly linked to subjective ictal anxiety but not to the objective severity of seizures or frequency.

Associations among exaggerated threat perceptions, suicidal thoughts, and suicidal behaviors in U.S. firearm owners.

Firearm availability has traditionally been conceptualized as an environmental risk factor for suicide mortality. Firearm acquisition for the primary purpose of self-protection (i.e., protective gun ownership) is often motivated by exaggerated threat expectancies-a central component of anticipatory anxiety-but firearm acquisition may paradoxically reinforce or exacerbate threat expectancies and contribute to behavioral disinhibition. Firearm ownership may therefore confer increased risk for suicide mortality through biobehavioral mechanisms. The present study conducted an initial test of this hypothesis by examining associations among firearm ownership, intentions to acquire additional firearms, threat expectancies, and past-month suicidal thoughts and behaviors using data collected from a national sample of 6200 U.S. adults. Results indicated threat expectancies and rates of suicide-related behaviors were significantly elevated among protective gun owners and participants who intended to acquire a firearm within the next year as compared to non-gun owners and non-protective gun owners. Threat expectancies were associated with significantly increased risk for past-month suicide-related behavior. Results suggest that threat expectancies in particular, and anticipatory anxiety more generally, may be biobehavioral processes associated with the correlation of firearm ownership and increased suicide risk.

Brain activation and subjective anxiety during an anticipatory anxiety task is related to clinical outcome during prazosin treatment for alcohol use disorder.

BACKGROUND: Higher levels of anxiety, negative affect, and impaired emotion regulation are associated with alcohol use disorder (AUD) and contribute to relapse and worse treatment outcomes. Prazosin, while typically used to treat post-traumatic stress disorder (PTSD) and other anxiety disorders, has shown promise for treating AUD. In order to better understand these underlying neural processes in individuals with AUD, our aims in this study were to measure brain activation during an anticipatory anxiety task before treatment to determine whether observed patterns supported previous work. We then aimed to measure the effects of prazosin on patients with AUD and explore whether greater baseline anticipatory anxiety (as measured by subjective and neural measures) predicts better treatment outcomes. METHODS: Thirty-four individuals seeking treatment for AUD participated in a six-week placebo-controlled study of prazosin and underwent an anticipatory anxiety task during fMRI scans at baseline and three weeks. Alcohol use over six weeks was measured. RESULTS: Greater levels of subjective anxiety and deactivation in posterior cingulate cortex (PCC) and ventromedial prefrontal cortex (vmPFC) were observed during high-threat stimuli compared to low-threat stimuli. Compared to placebo, prazosin reduced subjective anxiety to high-threat stimuli but there were no observed significant effects of prazosin on brain activation during the task. However, AUD patients with greater vmPFC deactivation during high threat relative to low threat and patients with low baseline anticipatory anxiety during the task had worse clinical outcomes on prazosin. CONCLUSIONS: Deactivation in PCC and vmPFC to high-threat stimuli replicated previous work and shows promise for further study as a marker for AUD. Although prazosin did not affect brain activation in the regions of interest during the anticipatory anxiety task, subjective levels of anxiety and brain activation in vmPFC predicted treatment outcomes in individuals with AUD undergoing treatment with prazosin, highlighting individuals more likely to benefit from prazosin than others.

Context-specific drinking and social anxiety: The roles of anticipatory anxiety and post-event processing.

Individuals with clinically elevated social anxiety are especially vulnerable to alcohol-related problems, despite not drinking more than those with less anxiety. It is therefore important to identify contexts in which socially anxious persons drink more to inform intervention efforts. This study tested whether social anxiety was related to greater drinking before, during, or after a social event and whether such drinking was related to the psychosocial factors anticipatory anxiety or post-event processing (PEP; review of the social event). Among past-month drinkers, those with clinically elevated or higher social anxiety (HSA; n = 212) reported more anticipatory anxiety, more pre-event drinking to manage anxiety, and PEP than those with normative or lower social anxiety (LSA; n = 365). There was a significant indirect effect of social anxiety on pre-drinking via anticipatory anxiety. Social anxiety was related to more drinking during the event indirectly via the serial effects of anticipatory anxiety and pre-drinking. Unexpectedly, PEP did not mediate or moderate the relation between social anxiety and post-event drinking. In sum, anticipatory anxiety was related to more drinking before, during, and after a social event and HSA drinkers were especially vulnerable to drinking more to manage this anxiety, which increased drinking before and during the event. This effect was specific to anticipatory anxiety and not evident for another social anxiety-specific risk factor, PEP. Thus, anticipatory anxiety may be an important therapeutic target for drinkers generally and may be especially important among HSA drinkers.

The endogenous opioid system modulates defensive behavior evoked by Crotalus durissus terrificus: Panicolytic-like effect of intracollicular non-selective opioid receptors blockade.

BACKGROUND: There is a controversy regarding the key role played by opioid peptide neurotransmission in the modulation of panic-attack-related responses. AIMS: Using a prey versus rattlesnakes paradigm, the present work investigated the involvement of the endogenous opioid peptide-mediated system of the inferior colliculus in the modulation of panic attack-related responses. METHODS: Wistar rats were pretreated with intracollicular administration of either physiological saline or naloxone at different concentrations and confronted with rattlesnakes ( Crotalus durissus terrificus). The prey versus rattlesnake confrontations were performed in a polygonal arena for snakes. The defensive behaviors displayed by prey (defensive attention, defensive immobility, escape response, flat back approach and startle) were recorded twice: firstly, over a period of 15 min the presence of the predator and a re-exposure was performed 24 h after the confrontation, when animals were exposed to the experimental enclosure without the rattlesnake. RESULTS: The intramesencephalic non-specific blockade of opioid receptors with microinjections of naloxone at higher doses decreased both anxiety- (defensive attention and flat back approach) and panic attack-like (defensive immobility and escape) behaviors, evoked in the presence of rattlesnakes and increased non-defensive responses. During the exposure to the experimental context, there was a decrease in duration of defensive attention. CONCLUSIONS: These findings suggest a panicolytic-like effect of endogenous opioid receptors antagonism in the inferior colliculus on innate (panic attack) and conditioned (anticipatory anxiety) fear in rats threatened by rattlesnakes.

The role of pre-sleep cognitions in adolescent sleep-onset problems.

STUDY OBJECTIVES: To examine the relationship between pre-sleep cognitions and sleep-onset difficulties in an adolescent sample. METHODS: Participants comprised 385 students (59% male) from grades 9 to 11, aged between 13 and 18 years (M = 15.6, SD = 1.0), from eight co-educational high schools of varied socio-economic status in metropolitan Adelaide, South Australia. The cross-sectional study used a questionnaire battery including the Sleep Anticipatory Anxiety Questionnaire -Adolescent Version (SAAQ-A), completed during school time, followed by eight days of sleep diary completion and wearing wrist actigraphy to obtain subjective and objective sleep onset latency (SOL). RESULTS: Significant relationships were found between somatic arousal (SAAQ-A subscale) and objective SOL and also between sleep-related cognitions (SAAQ-A subscale) and subjective SOL and SOL overestimation (sleep misperception). No relationships were found between subjective SOL and somatic or rehearsal and planning cognitions. Objective SOL was not related to rehearsal and planning and to sleep-related cognition scores, and sleep misperception had no relationship with somatic as well as rehearsal and planning cognition scores. CONCLUSIONS: These findings are not only similar to those in clinical adult populations but also notably different, for example, the lack of association between negative sleep-related pre-sleep cognitions and objective sleep difficulty. The results of this study provide a basis for a more detailed causal study on the existing relationships between negative pre-sleep cognitions and subjective and objective sleep difficulties in this population.

Nonpharmacologic Intervention on the Prevention of Pain and Anxiety During Pediatric Dental Care: A Systematic Review.

BACKGROUND: Nonpharmacologic interventions may be used to reduce fear and anxiety during dental treatment. OBJECTIVES: To systematically review trials on the effect of nonpharmacologic interventions in behavior, anxiety, and pain perception in children undergoing dental treatment. DATA SOURCES: Medline, Scopus, Web of Science and CINAHL, Google Scholar, and studies' reference lists. PARTICIPANTS AND INTERVENTIONS: Studies performed with children and adolescents that evaluated the effect of interventions on children's behavior, anxiety, and pain perception during dental treatment were included. STUDY APPRAISAL METHODS: Independent quality assessment of the studies was carried out following the classification categories present on the Cochrane Handbook for Development of Systematic Reviews of Intervention. RESULTS: Twenty-two articles, reporting 21 studies, were selected. Most studies tested distraction techniques. Eight studies presented bias and results were not considered. The remaining 13 studies had control groups with inactive controls, and 4 also included a variation of the intervention. Of the 4 studies assessing behavior, 3 found difference between intervention and control. Anxiety was evaluated by 10 studies: 4 found differences between intervention and control and 2 found differences between interventions. Five studies investigated pain perception: 3 found difference comparing active versus inactive interventions. In 1 of the 3, variations in the intervention decreased pain perception. CONCLUSIONS: More research is needed to know whether the techniques are effective for improving behavior and reducing children's pain and distress during dental treatment. However, the majority of the techniques improved child's behavior, anxiety, and pain perception.

The Effect of Massage on Anticipatory Anxiety and Procedural Pain in Patients with Burn Injury.

BACKGROUND: Pain related to burn injuries is one of the most troublesome pain intensity. This study aimed to investigate the effect of massage on anticipatory anxiety, procedural pain intensity, vital signs and relaxation level of patients with burn injury. METHODS: In this quasi-experimental study, through convenience sampling, 60 hospitalized adult burn patients were selected from a specialized burn and reconstructive hospital. Subjects were assigned to massage and control groups through simple randomization. Massage was offered by using non aromatic oil about 10-15 minutes before wound care on intact part of the body once a day for 20 minutes on patients' bedside for 3 consecutive days. In the 3 days, the control group did not received any massage and were asked to stay at bed. Demographic and clinical characteristics and vital signs, Visual Analogue Scale and the Persian version of Burn Specific Pain Anxiety Scale were used to determine baseline and procedural pain, anxiety and relaxation levels and anticipatory anxiety. RESULTS: No significant difference was noted between mean score of pain intensity, anxiety and relaxation level, and vital signs in massage and control groups after intervention following wound care. In massage and control groups, there was no significant differences between mean scores of anticipatory anxiety before and after intervention. There was no significant difference between the mean scores of anticipatory anxiety in massage and control groups after intervention prior wound care. CONCLUSION: Massage was shown not to have any effect on anticipatory anxiety and procedural pain.

Impact of Panic on Psychophysiological and Neural Reactivity to Unpredictable Threat in Depression and Anxiety.

Exaggerated anxious responding to unpredictable threat (U-threat) is a core feature of panic disorder (PD). However, it is unknown whether this abnormality is specific to the diagnosis of PD or would manifest along a continuum of panic symptomatology (PS). Additionally, little is known about the neural processes underlying this abnormality among those high in PS. Finally, no studies have tested whether startle potentiation and limbic neural reactivity - commonly used indices of U-threat responsivity - are associated and therefore reflect common abnormalities. These questions were investigated in 42 adults with a range of PS. U-threat responding was measured twice during threat-of-shock - once with startle and once with functional magnetic resonance imaging (fMRI). As hypothesized, PS positively predicted startle potentiation and dACC reactivity to U-threat. Startle potentiation and dACC activation to U-threat were positively associated. These results suggest a biobehavioral profile of aberrant responding to U-threat associated with PS.