Psychophysiological Models to Identify and Monitor Elderly with a Cardiovascular Condition: The Added Value of Psychosocial Parameters to Routinely Applied Physiological Assessments.

The steadily growing elderly population calls for efficient, reliable and preferably ambulant health supervision. Since cardiovascular risk factors interact with psychosocial strain (e.g., depression), we investigated the potential contribution of psychosocial factors in discriminating generally healthy elderly from those with a cardiovascular condition, on and above routinely applied physiological assessments. Fifteen elderly (aged 60 to 88) with a cardiovascular diagnosis were compared to fifteen age and gender matched healthy peers. Six sequential standardized lab assessments were conducted (one every two weeks), including an autonomic test battery, a 6-min step test and questionnaires covering perceived psychological state and experiences over the previous two weeks. Specific combinations of physiological and psychological factors (most prominently symptoms of depression) effectively predicted (clinical) cardiovascular markers. Additionally, a highly significant prognostic model was found, including depressive symptoms, recently experienced negative events and social isolation. It appeared slightly superior in identifying elderly with or without a cardiovascular condition compared to a model that only included physiological parameters. Adding psychosocial parameters to cardiovascular assessments in elderly may consequently provide protocols that are significantly more efficient, relatively comfortable and technologically feasible in ambulant settings, without necessarily compromising prognostic accuracy.

Prehabilitation before major intra-abdominal cancer surgery: A systematic review of randomised controlled trials.

BACKGROUND: Although prehabilitation programmes for patients undergoing major intra-abdominal cancer surgery have been shown to improve pre-operative physical fitness, the conclusions regarding any postoperative benefits are inconsistent. OBJECTIVES: The aim of this study was to evaluate the content of and the outcome measures used in studies of prehabilitation programmes for these patients. It was hypothesised that the content of prehabilitation programmes is often therapeutically invalid, and that the postoperative outcomes assessed are inadequate to evaluate the impact of complications. DESIGN: A systematic review of randomised controlled trials. DATA SOURCES: Studies published between January 2009 and January 2019 were retrieved from PubMed, Embase and PEDro. ELIGIBILITY CRITERIA: Studies were included when they investigated the effects of prehabilitation in patients undergoing intra-abdominal surgery for cancer, reported pre-operative and/or postoperative outcome measures and were conducted as a randomised controlled trial. Studies for which the full text was not available were excluded, as were studies of patients undergoing nonabdominal cancer surgery. RESULTS: Eight studies (565 patients) were included. Therapeutic validity was low in five studies. Most studies included low-risk surgical patients and considerable variation was observed between prehabilitation programmes in terms of supervision, training context, frequency, intensity, duration and training type. Objective monitoring of training progression was typically not performed, and most trials did not include nutritional or psychological support. Postoperative complications were reported in seven studies, but no study reported the impact of postoperative complications, nor on long-term postoperative outcomes. CONCLUSION: The content of prehabilitation programmes was heterogeneous. Studies with a high therapeutic validity found unequivocal evidence that prehabilitation had beneficial effects on postoperative outcomes. Future research should focus on adequate selection and inclusion of high-risk surgical patients and provide personalised and probably multimodal (partly) supervised prehabilitation, with objective monitoring of progress. Measuring the incidence and impact of postoperative complications may contribute to demonstrating the clinical value of prehabilitation.

Explicit and Implicit Responses to Tasting Drinks Associated with Different Tasting Experiences.

Probing food experience or liking through verbal ratings has its shortcomings. We compare explicit ratings to a range of (neuro)physiological and behavioral measures with respect to their performance in distinguishing drinks associated with different emotional experience. Seventy participants tasted and rated the valence and arousal of eight regular drinks and a "ground truth" high-arousal, low-valence vinegar solution. The discriminative power for distinguishing between the vinegar solution and the regular drinks was highest for sip size, followed by valence ratings, arousal ratings, heart rate, skin conductance level, facial expression of "disgust," pupil diameter, and Electroencephalogram (EEG) frontal alpha asymmetry. Within the regular drinks, a positive correlation was found between rated arousal and heart rate, and a negative correlation between rated arousal and Heart Rate Variability (HRV). Most physiological measures showed consistent temporal patterns over time following the announcement of the drink and taking a sip. This was consistent over all nine drinks, but the peaks were substantially higher for the vinegar solution than for the regular drinks, likely caused by emotion. Our results indicate that implicit variables have the potential to differentiate between drinks associated with different emotional experiences. In addition, this study gives us insight into the physiological temporal response patterns associated with taking a sip.

Associations between Autonomic and Endocrine Reactivity to Stress in Adolescence: Related to the Development of Anxiety?

Internalizing disorders in adolescence have been associated with disturbances in autonomic and endocrine functioning. Because the prefrontal cortex and the limbic system play a central role in regulating both the autonomic and the endocrine systems, their joint functioning is hypothesized to provide information about the potential development of internalizing symptoms throughout adolescence, notably in the preclinical stage. This hypothesis was tested in a sample of 198 adolescents from the general population. Heart rate variability (HRV) and skin conductance levels (SCLs) were measured before, during, and after a public speaking task. These autonomic parameters were associated with cortisol response to the task in the complete sample as well as in low- and high-anxiety adolescents separately. Self-reported social anxiety, low HRV, and high SCL recovery values were predictive of cortisol response. Importantly, in low-anxiety adolescents, only HRV during the task predicted the cortisol response, whereas, in their highly anxious peers, both HRV and SCL were strongly associated with this response. In the latter finding, age was a prominent factor. Additional analyses supported the idea that the interaction of autonomic and endocrine reactivity is subject to natural development. These findings provide evidence that adolescence might be a period of highly interactive emotional-neurobiological development, particularly with respect to the development of stress management skills.

The effect of individual characteristics on susceptibility to aggressive and/or intimidating approaches: quantifying probability pathways by creating a victimization model.

Background: A significant body of literature has identified multiple factors that contribute to established victimization by aggressive and/or intimidating behaviours. These studies primarily originate from the fields of intimate partner violence (IPV), bullying, sexual abuse, and/or commercial sexual exploitation (CSE), and generally focus on female victims. It appears, however, complicated to quantify the cumulative contribution of these factors on susceptibility to intimidating and/or hostile engagements on an individual level.Objective: To develop a comprehensive risk model to quantify, on an individual level, the cumulative effects of previously reported characteristics on susceptibility to aggressive/intimidating approaches, leading to victimization (e.g. in the context of IPV/sexual abuse).Methods: A Bayesian belief network was developed using data from previous studies, capturing the multivariate contribution of previously reported characteristics on the likelihood of becoming victimized by aggressive and/or intimidating approaches (e.g. in the IPV/CSE context) in female victims aged 12-24 years.Results: The model showed that specific combinations of characteristics may contribute to an increased likelihood of victimization (e.g. in the context of IPV/bullying/sexual abuse or CSE). This likelihood could be quantified and categorized into specific clusters of factors differentiating between victimization by physically violent, non-physical, and/or sexual aggressive/intimidating approaches.Conclusion: The present model appears to be the first to successfully quantify the cumulative contribution of individual characteristics on the likelihood of becoming victimized by aggressive and/or intimidating approaches, typically leading to victimization. Moreover, the present scientific effort and resulting model suggest that there may be a latent variable mediating between the implemented factors and overall outcome, i.e. the susceptibility to aggressive and/or intimidating approaches. From that perspective, the model may also be considered as an initial outline to effectively indicate susceptibility to such approaches.

This study constructed a Bayesian belief network of published statistics to quantify the cumulative effects of individual characteristics on victimization (e.g. in the context of IPV/sexual abuse/bullying/CSE).The model showed that the likelihood of victimization following aggressive and/or intimidating approaches could be quantified and categorized into three different features: the likelihood of becoming victimized by physically violent, non-physical, and/or sexual aggressive/intimidating approaches. The likelihood of becoming victimized by physically violent and non-physical aggressive/intimidating approaches seems to be predominantly characterized by risk factors such as depressive symptoms and elevated neuroticism. The likelihood of victimization by sexual intimidating approaches seems to be primarily associated with externalizing risk factors (e.g. impulsivity), strengthened by factors related to previous (negative) sexual experiences and early-onset puberty.This model could be considered as an initial outline to effectively indicate susceptibility to aggressive/intimidating approaches. The model may therefore be considered an applicable framework for future research to further unravel the complicated aggressive and/or intimidating victim­perpetrator interactions related to victimization.

The Physical Activity and Nutritional INfluences in Ageing (PANINI) Toolkit: A Standardized Approach towards Physical Activity and Nutritional Assessment of Older Adults.

Assessing multiple domains of health in older adults requires multidimensional and large datasets. Consensus on definitions, measurement protocols and outcome measures is a prerequisite. The Physical Activity and Nutritional INfluences In Ageing (PANINI) Toolkit aims to provide a standardized toolkit of best-practice measures for assessing health domains of older adults with an emphasis on nutrition and physical activity. The toolkit was drafted by consensus of multidisciplinary and pan-European experts on ageing to standardize research initiatives in diverse populations within the PANINI consortium. Domains within the PANINI Toolkit include socio-demographics, general health, nutrition, physical activity and physical performance and psychological and cognitive health. Implementation across various countries, settings and ageing populations has proven the feasibility of its use in research. This multidimensional and standardized approach supports interoperability and re-use of data, which is needed to optimize the coordination of research efforts, increase generalizability of findings and ultimately address the challenges of ageing.

Knowledge of Nutrition and Physical Activity Guidelines is Not Associated with Physical Function in Dutch Older Adults Attending a Healthy Ageing Public Engagement Event.

Purpose: Evidence-based guidelines on nutrition and physical activity are used to increase knowledge in order to promote a healthy lifestyle. However, actual knowledge of guidelines is limited and whether it is associated with health outcomes is unclear. Participants and Methods: This inception cohort study aimed to investigate the association of knowledge of nutrition and physical activity guidelines with objective measures of physical function and physical activity in community-dwelling older adults attending a public engagement event in Amsterdam, The Netherlands. Knowledge of nutrition and physical activity according to Dutch guidelines was assessed using customized questionnaires. Gait speed and handgrip strength were proxies of physical function and the Minnesota Leisure Time Physical Activity Questionnaire was used to assess physical activity in minutes/week. Linear regression analysis, stratified by gender and adjusted for age, was used to study the association between continuous and categorical knowledge scores with outcomes. Results: In 106 older adults (mean age=70.1 SD=6.6, years) who were highly educated, well-functioning, and generally healthy, there were distinct knowledge gaps in nutrition and physical activity which did not correlate with one another (R2=0.013, p=0.245). Knowledge of nutrition or physical activity guidelines was not associated with physical function or physical activity. However, before age-adjustment nutrition knowledge was positively associated with HGS in males (B= 0.64 (95% CI: 0.05, 1.22)) and having knowledge above the median was associated with faster gait speed in females (B=0.10 (95% CI: 0.01, 0.19)). Conclusion: Our findings may represent a ceiling effect of the impact knowledge has on physical function and activity in the this high performing and educated population and that there may be other determinants of behavior leading to health status such as attitude and perception to consider in future studies.

Aging and Allostasis: Using Bayesian Network Analytics to Explore and Evaluate Allostatic Markers in the Context of Aging.

Allostatic load reflects the cumulative strain on organic functions that may gradually evolve into overt disease. Our aim was to evaluate the allostatic parameters in the context of aging, and identify the parameters that may be suitable for an allostatic load index for elderly people (>60 years). From previously published studies, 11 allostatic (bio)markers could be identified that sustain sufficient variability with aging to capture meaningful changes in health status. Based on reported statistics (prevalence of a biomarker and its associated outcome, and/or an odds/risk ratio relating these two), seven of these could be adopted in a Bayesian Belief Network (BBN), providing the probability of "disturbed" allostasis in any given elder. Additional statistical analyses showed that changes in IL-6 and BMI contributed the most to a "disturbed" allostasis, indicating their prognostic potential in relation to deteriorating health in otherwise generally healthy elderly. In this way, and despite the natural decline in variance that irrevocably alters the prognostic relevance of most allostatic (bio)markers with aging, it appeared possible to outline an allostatic load index specifically for the elderly. The allostatic parameters here identified might consequently be considered a useful basis for future quantitative modelling in the context of (healthy) aging.

Neutralizing a Springboard for Inflammation: Physical Activity to Control the Immune Network.

The severe consequences of the present Corona Virus Disease 2019 COVID-19 pandemic seem to be closely related to an already ongoing ('first') pandemic, directly associated with a sedentary lifestyle. It seems evident that the prognosis after infection is substantially worse for individuals suffering from, for example, (visceral) obesity, cardiovascular disease, and diabetes type 2. Consequently, it may be considered highly relevant to gain insight into the potential beneficial effects of exercise interventions to strengthen the immune system, particularly in high-risk populations. For this reason, the exercise protocols that are suggested to strengthen the immune system, which can be executed by all ages and almost all physical conditions, were reviewed and evaluated. Previously published protocols range from interrupting prolonged sitting, to regular low-to-moderate exercise activities, to high intensity, typically interval, sports formats. Reported positive effects on immune functioning appear to be induced either directly or via beneficial metabolic and/or psychological effects and become measurable after 3 weeks to 3 months. Based in these findings, it appeared possible to design an optimal exercise protocol to maximize effects on immune functioning that should be executable for all, even under restricted ('lockdown') circumstances.

Emotional State During Tasting Affects Emotional Experience Differently and Robustly for Novel and Familiar Foods.

Emotional state during food consumption is expected to affect food pleasantness. We hypothesize that a negative emotional state reduces food pleasantness and more so for novel foods than for familiar foods because novel foods have not yet been associated with previous emotions. Furthermore, we expect this effect to be stronger when judging the food again from memory without tasting. We induced a positive emotional state in 34 participants by telling them that they earned a monetary bonus and induced a negative emotional state in 35 other participants by subjecting them to a social stress test. After this emotion induction, both groups tasted and rated a (for them) novel soup (sumashi soup) and a familiar soup (vegetable soup). Several explicit and implicit measures of food pleasantness (rated valence, EsSense25, willingness-to-take-home and sip size) indicated that while the negative emotion group did not experience the soups as less pleasant than the positive emotion group, there was an interaction between food familiarity and emotional group. The positive emotion group experienced novel and familiar soups as equally pleasant, whereas the negative emotion group experienced the novel soup as relatively unpleasant and the familiar soup as pleasant. The latter result is consistent with a comforting effect of a familiar taste in a stressful situation. This effect remained in the ratings given 1 week later based on memory and even after retasting. Our results show that emotional state affects food pleasantness differently for novel and familiar foods and that such an effect can be robust.

EmojiGrid: A 2D pictorial scale for cross-cultural emotion assessment of negatively and positively valenced food.

Because of the globalization of world food markets there is a growing need for valid and language independent self-assessment tools to measure food-related emotions. We recently introduced the EmojiGrid as a language-independent, graphical affective self-report tool. The EmojiGrid is a Cartesian grid that is labeled with facial icons (emoji) expressing different degrees of valence and arousal. Users can report their subjective ratings of valence and arousal by marking the location on the area of the grid that corresponds to the emoji that best represent their affective state when perceiving a given food or beverage. In a previous study we found that the EmojiGrid is robust, self-explaining and intuitive: valence and arousal ratings were independent of framing and verbal instructions. This suggests that the EmojiGrid may be a valuable tool for cross-cultural studies. To test this hypothesis, we performed an online experiment in which respondents from Germany (GE), Japan (JP), the Netherlands (NL) and the United Kingdom (UK) rated valence and arousal for 60 different food images (covering a large part of the affective space) using the EmojiGrid. The results show that the nomothetic relation between valence and arousal has the well-known U-shape for all groups. The European groups (GE, NL and UK) closely agree in their overall rating behavior. Compared to the European groups, the Japanese group systematically gave lower mean arousal ratings to low valenced images and lower mean valence ratings to high valenced images. These results agree with known cultural response characteristics. We conclude that the EmojiGrid is potentially a valid and language-independent affective self-report tool for cross-cultural research on food-related emotions. It reliably reproduces the familiar nomothetic U-shaped relation between valence and arousal across cultures, with shape variations reflecting established cultural characteristics.

CROCUFID: A Cross-Cultural Food Image Database for Research on Food Elicited Affective Responses.

We present CROCUFID: a CROss-CUltural Food Image Database that currently contains 840 images, including 479 food images with detailed metadata and 165 images of non-food items. The database includes images of sweet, savory, natural, and processed food from Western and Asian cuisines. To create sufficient variability in valence and arousal we included images of food with different degrees of appetitiveness (fresh, unfamiliar, molded or rotten, spoiled, and partly consumed). We used a standardized photographing protocol, resulting in high resolution images depicting all food items on a standard background (a white plate), seen from a fixed viewing (45°) angle. CROCUFID is freely available under the CC-By Attribution 4.0 International license and hosted on the OSF repository. The advantages of the CROCUFID database over other databases are its (1) free availability, (2) full coverage of the valence - arousal space, (3) use of standardized recording methods, (4) inclusion of multiple cuisines and unfamiliar foods, (5) availability of normative and demographic data, (6) high image quality and (7) capability to support future (e.g., virtual and augmented reality) applications. Individuals from the United Kingdom (N = 266), North-America (N = 275), and Japan (N = 264) provided normative ratings of valence, arousal, perceived healthiness, and desire-to-eat using visual analog scales (VAS). In addition, for each image we computed 17 characteristics that are known to influence affective observer responses (e.g., texture, regularity, complexity, and colorfulness). Significant differences between groups and significant correlations between image characteristics and normative ratings were in accordance with previous research, indicating the validity of CROCUFID. We expect that CROCUFID will facilitate comparability across studies and advance experimental research on the determinants of food-elicited emotions. We plan to extend CROCUFID in the future with images of food from a wide range of different cuisines and with non-food images (for applications in for instance neuro-physiological studies). We invite researchers from all parts of the world to contribute to this effort by creating similar image sets that can be linked to this collection, so that CROCUFID will grow into a truly multicultural food database.

Methods for Evaluating Emotions Evoked by Food Experiences: A Literature Review.

Besides sensory characteristics of food, food-evoked emotion is a crucial factor in predicting consumer's food preference and therefore in developing new products. Many measures have been developed to assess food-evoked emotions. The aim of this literature review is (i) to give an exhaustive overview of measures used in current research and (ii) to categorize these methods along measurement level (physiological, behavioral, and cognitive) and emotional processing level (unconscious sensory, perceptual/early cognitive, and conscious/decision making) level. This 3 × 3 categorization may help researchers to compile a set of complementary measures ("toolbox") for their studies. We included 101 peer-reviewed articles that evaluate consumer's emotions and were published between 1997 and 2016, providing us with 59 different measures. More than 60% of these measures are based on self-reported, subjective ratings and questionnaires (cognitive measurement level) and assess the conscious/decision-making level of emotional processing. This multitude of measures and their overrepresentation in a single category hinders the comparison of results across studies and building a complete multi-faceted picture of food-evoked emotions. We recommend (1) to use widely applied, validated measures only, (2) to refrain from using (highly correlated) measures from the same category but use measures from different categories instead, preferably covering all three emotional processing levels, and (3) to acquire and share simultaneously collected physiological, behavioral, and cognitive datasets to improve the predictive power of food choice and other models.

EmojiGrid: A 2D Pictorial Scale for the Assessment of Food Elicited Emotions.

Research on food experience is typically challenged by the way questions are worded. We therefore developed the EmojiGrid: a graphical (language-independent) intuitive self-report tool to measure food-related valence and arousal. In a first experiment participants rated the valence and the arousing quality of 60 food images, using either the EmojiGrid or two independent visual analog scales (VAS). The valence ratings obtained with both tools strongly agree. However, the arousal ratings only agree for pleasant food items, but not for unpleasant ones. Furthermore, the results obtained with the EmojiGrid show the typical universal U-shaped relation between the mean valence and arousal that is commonly observed for a wide range of (visual, auditory, tactile, olfactory) affective stimuli, while the VAS tool yields a positive linear association between valence and arousal. We hypothesized that this disagreement reflects a lack of proper understanding of the arousal concept in the VAS condition. In a second experiment we attempted to clarify the arousal concept by asking participants to rate the valence and intensity of the taste associated with the perceived food items. After this adjustment the VAS and EmojiGrid yielded similar valence and arousal ratings (both showing the universal U-shaped relation between the valence and arousal). A comparison with the results from the first experiment showed that VAS arousal ratings strongly depended on the actual wording used, while EmojiGrid ratings were not affected by the framing of the associated question. This suggests that the EmojiGrid is largely self-explaining and intuitive. To test this hypothesis, we performed a third experiment in which participants rated food images using the EmojiGrid without an associated question, and we compared the results to those of the first two experiments. The EmojiGrid ratings obtained in all three experiments closely agree. We conclude that the EmojiGrid appears to be a valid and intuitive affective self-report tool that does not rely on written instructions and that can efficiently be used to measure food-related emotions.

Capturing effort and recovery: reactive and recuperative cortisol responses to competition in well-trained rowers.

BACKGROUND/AIM: It is well known that physical strain is associated with increased cortisol production. And although mental stress elevates cortisol concentrations as well, little is known of the independent and/or combined effects of both on the secretion of cortisol. Aim of the study was to investigate the day-to-day cortisol dynamics associated with training, performance and recuperation and the immediate responses to mental stress and physical endurance under competitive conditions. METHODS: Sixteen freshmen competitive male rowers were prospectively followed from Thursday to Tuesday with an intermediate competition on Saturday and Sunday. On all days, three saliva samples were collected within 30 min after awakening to assess the cortisol awakening rise (CAR). Additionally, five saliva samples were collected previously to and immediately after all races during the regatta weekend. RESULTS: CAR values peaked during competition days and recovered during the 2 days after. Cortisol concentrations significantly increased during and after all races. Furthermore, although response patterns did not differ, the morning races showed significantly higher cortisol levels compared with the levels measured during the afternoon races. This likely reflects the normal diurnal rhythm of corticosteroids. CONCLUSIONS: These results indicate that cortisol levels of athletes might be sensitive for both immediate responses to competition and, in case of CAR, (midterm) recovery phasing. Consequently, monitoring cortisol responses during training and competition may provide valuable information regarding how athletes cope with competition-induced stress and their recovery status during the days following. This insight might help to plan future training loads and recovery.

The biphasic effects of moderate alcohol consumption with a meal on ambiance-induced mood and autonomic nervous system balance: a randomized crossover trial.

BACKGROUND: The pre-drinking mood state has been indicated to be an important factor in the mood effects of alcohol. However, for moderate alcohol consumption there are no controlled studies showing this association. Also, the mood effects of consuming alcohol combined with food are largely unknown. The aim of this study was to investigate the effects of moderate alcohol combined with a meal on ambiance-induced mood states. Furthermore effects on autonomic nervous system activity were measured to explore physiological mechanisms that may be involved in changes of mood state. METHODS: In a crossover design 28 women (age 18-45 y, BMI 18.5-27 kg/m2) were randomly allocated to 4 conditions in which they received 3 glasses of sparkling white wine (30 g alcohol) or alcohol-free sparkling white wine while having dinner in a room with either a pleasant or unpleasant created ambiance. Subjects filled out questionnaires (B-BAES, POMS and postprandial wellness questionnaire) at different times. Skin conductance and heart rate variability were measured continuously. RESULTS: Moderate alcohol consumption increased happiness scores in the unpleasant, but not in the pleasant ambiance. Alcohol consumption increased happiness and stimulation feelings within 1 hour and increased sedative feelings and sleepiness for 2.5 hour. Skin conductance was increased after alcohol within 1 hour and was related to happiness and stimulation scores. Heart rate variability was decreased after alcohol for 2 hours and was related to mental alertness. CONCLUSION: Mood inductions and autonomic nervous system parameters may be useful to evaluate mood changes by nutritional interventions. Moderate alcohol consumption elevates happiness scores in an unpleasant ambiance. However, drinking alcohol during a pleasant mood results in an equally positive mood state. TRIAL REGISTRATION: Clinicaltrials.gov NCT01426022.

A systematic review on heart-rate recovery to monitor changes in training status in athletes.

Heart-rate recovery (HRR) has been proposed as a marker of autonomic function and training status in athletes. The authors performed a systematic review of studies that examined HRR after training. Five cross-sectional studies and 8 studies investigating changes over time (longitudinal) met our criteria. Three out of 5 cross-sectional studies observed a faster HRR in trained compared with untrained subjects, while 2 articles showed no change as a result of training. Most longitudinal studies observed a corresponding increase in HRR and power output (training status). Although confounding factors such as age, ambient temperature, and the intensity and duration of the exercise period preceding HRR make it difficult to compare these studies, the available studies indicated that HRR was related to training status. Therefore, the authors conclude that HRR has the potential to become a valuable tool to monitor changes in training status in athletes and less well-trained subjects, but more studies and better standardization are required to match this potential.

Threat-related selective attention predicts treatment success in childhood anxiety disorders.

OBJECTIVE: The present study examined whether threat-related selective attention was predictive of treatment success in children with anxiety disorders and whether age moderated this association. Specific components of selective attention were examined in treatment responders and nonresponders. METHOD: Participants consisted of 131 children with anxiety disorders (aged 8-16 years), who received standardized cognitive-behavioral therapy. At pretreatment, a pictorial dot-probe task was administered to assess selective attention. Both at pretreatment and posttreatment, diagnostic status of the children was evaluated with a semistructured clinical interview (the Anxiety Disorders Interview Schedule for Children). RESULTS: Selective attention for severely threatening pictures at pretreatment assessment was predictive of treatment success. Examination of the specific components of selective attention revealed that nonresponders showed difficulties to disengage their attention away from severe threat. Treatment responders showed a tendency not to engage their attention toward severe threat. Age was not associated with selective attention and treatment success. CONCLUSIONS: Threat-related selective attention is a significant predictor of treatment success in children with anxiety disorders. Clinically anxious children with difficulties disengaging their attention away from severe threat profit less from cognitive-behavioral therapy. For these children, additional training focused on learning to disengage attention away from anxiety-arousing stimuli may be beneficial.

A prepared speech in front of a pre-recorded audience: subjective, physiological, and neuroendocrine responses to the Leiden Public Speaking Task.

This study describes a new public speaking protocol for youth. The main question asked whether a speech prepared at home and given in front of a pre-recorded audience creates a condition of social-evaluative threat. Findings showed that, on average, this task elicits a moderate stress response in a community sample of 83 12- to 15-year-old adolescents. During the speech, participants reported feeling more nervous and having higher heart rate and sweatiness of the hands than at baseline or recovery. Likewise, physiological (heart rate and skin conductance) and neuroendocrine (cortisol) activity were higher during the speech than at baseline or recovery. Additionally, an anticipation effect was observed: baseline levels were higher than recovery levels for most variables. Taking the anticipation and speech response together, a substantial cortisol response was observed for 55% of participants. The findings indicate that the Leiden Public Speaking Task might be particularly suited to investigate individual differences in sensitivity to social-evaluative situations.