Longitudinal SARS-CoV-2 Nucleocapsid Antibody Kinetics, Seroreversion, and Implications for Seroepidemiologic Studies.

Given widespread use of spike antibody in generating coronavirus disease vaccines, SARS-CoV-2 nucleocapsid antibodies are increasingly used to indicate previous infection in serologic surveys. However, longitudinal kinetics and seroreversion are poorly defined. We found substantial seroreversion of nucleocapsid total immunoglobulin, underscoring the need to account for seroreversion in seroepidemiologic studies.

Dissociative Symptoms In Posttraumatic Stress Disorder: A Systematic Review.

Objectives: Research on dissociative symptomatology in the context of Posttraumatic Stress Disorder (PTSD) has been gaining traction, with dissociation being studied as a set of complex symptoms following trauma exposure and as a specific subtype of PTSD. The aims of this review are to summarize the literature as it stands, examine the efficacy of existing interventions in treating dissociative symptomatology within the context of PTSD, and offer potential suggestions for future research. Methods: A systematic approach was taken to locate empirical studies on PTSD that included dissociation as an outcome in the PubMed, Scopus, and PsycINFO databases. Recent experimental designs with adult subjects (18+ years) in the English language were included, yielding 103 potentially eligible studies. Thirty-three full-text articles were screened with 17 articles meeting criteria for inclusion in the systematic review. Results: Designs, populations, treatments, and inventories were extremely diverse. Most therapies did not target dissociation specifically, although the results of this review suggest that PTSD patients who experience dissociative symptoms could benefit from trauma-focused treatments, which often significantly reduced dissociative and trauma-related symptoms. Conclusion: Future work should consider the evaluation of dissociation as a unique outcome to gain understanding about the nature of traumatic stress and to develop treatment options for its many presentations. The current literature displays limited generalizability to the treatment of individuals with high dissociation, which is a line of inquiry that should be explored. More RCTs are needed.

Classroom-Based Mindfulness Training Reduces Anxiety in Adolescents: Acceptability and Effectiveness of a Cluster-Randomized Pilot Study.

OBJECTIVE: Many high school students experience a high degree of anxiety and perceived stress. This study examined whether a classroom-based mindfulness program or a wellness program were acceptable and effective as anxiety and stress reduction interventions based on students' self-reports. DESIGN SETTING AND PARTICIPANTS: Thirteen health education classes (n=285 students, aged 14-16 years) were randomized by classroom to one of three conditions: mindfulness, wellness, or usual health class only (passive control/ waitlist), for 8 weeks. OUTCOMES: Pre- and post-intervention scores compared self-reported measures of depression, anxiety and stress. RESULTS: Complete data were available from nine classes (n=202 students). Post-intervention anxiety scores were reduced in students who received the mindfulness intervention compared to those who received only their usual health class (ß=-0.07, SE=0.03, P≤0.001; 95% CI=-0.12, -0.02). No significant between group differences were found for depression or stress (P>0.4). Students' satisfaction with the mindfulness intervention they received withstood baseline credibility and expectancy effects: r=0.21, n=67, P=0.17 for credibility; r=-0.001, n=67, P=0.99 for expectancy. However, students' satisfaction with the wellness intervention they received was positively correlated with their pre-intervention expectations, r=0.42, n=47, P>0.001. Fifty-two percent of the 68 students assigned to mindfulness (n=35) used the iPad app for mindfulness home practice at least once; of those, 10% used it 10 or more times. CONCLUSION: Eight weeks of classroom-based mindfulness, with limited home practice, reduced self-reported anxiety compared to usual health class, and withstood baseline expectancy effects in this group of high school students, a majority who come from high income families. CLINICAL IMPLICATIONS: School- or community-based mindfulness may be an appropriate recommendation for adolescents who experience anxiety.

Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis.

Importance: Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients. Objective: To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain. Data Sources: For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched. Study Selection: Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain. Data Extraction and Synthesis: Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs. Main Outcomes and Measures: The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function. Results: Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d = -0.51; 95% CI, -0.76 to -0.26) and reduced opioid dose (Cohen d = -0.26; 95% CI, -0.44 to -0.08). Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = -0.70), hypnosis (Cohen d = -0.54), suggestion (Cohen d = -0.68), and cognitive behavioral therapy (Cohen d = -0.43) but not for other MBTs. Although most meditation (n = 4 [80%]), cognitive-behavioral therapy (n = 4 [57%]), and hypnosis (n = 12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias. Conclusions and Relevance: The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.

Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement.

Addiction neuroscience models posit that recurrent drug use increases reactivity to drug-related cues and blunts responsiveness to natural rewards, propelling a cycle of hedonic dysregulation that drives addictive behavior. Here, we assessed whether a cognitive intervention for addiction, Mindfulness-Oriented Recovery Enhancement (MORE), could restructure reward responsiveness from valuation of drug-related reward back to valuation of natural reward. Before and after 8 weeks of MORE or a support group control, prescription opioid users (N = 135) viewed opioid and natural reward cues while an electroencephalogram biomarker of target engagement was assessed. MORE was associated with decreased opioid cue-reactivity and enhanced capacity to regulate responses to opioid and natural reward cues. Increased positive affective responses to natural reward cues were associated with decreased craving and mediated MORE's therapeutic effects on opioid misuse. This series of randomized experiments provide the first neurophysiological evidence that an integrative behavioral treatment can remediate hedonic dysregulation among chronic opioid users.

Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial.

OBJECTIVE: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. METHOD: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. RESULTS: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p < .001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p = .048), which in turn predicted decreases in opioid misuse risk by follow-up (p = .02). CONCLUSIONS: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Impact of Psychological Interventions on Posttraumatic Stress Disorder and Pain Symptoms: A Systematic Review and Meta-Analysis.

OBJECTIVES: Posttraumatic stress disorder (PTSD) and pain often co-occur, introducing clinical challenges and economic burden. Psychological treatments are considered effective for each condition, yet it is not known which therapies have the potential to concurrently address PTSD and pain-related symptoms. MATERIALS AND METHODS: To conduct a systematic review and meta-analysis, databases were searched for articles published between January 2007 and December 2017 describing results from clinical trials of interventions addressing PTSD and pain-related symptoms in adults. Two independent reviewers finalized data extraction and risk of bias assessments. A random-effects model was used for meta-analysis and to calculate pooled and subgroup effect sizes (ESs) of psychological-only (single modality) and multimodal interventions. RESULTS: Eighteen trials (7 uncontrolled, 11 randomized controlled trials, RCTs), totaling 1583 participants, were included in the systematic review. RCT intervention types included exposure-based, cognitive-behavioral, and mindfulness-based therapies. Data from 10 RCTs (N=1, 35) were available for meta-analysis, which demonstrated moderate effect for reduced PTSD severity (ES=-0.55, confidence interval [CI]: -0.83, -0.26) and nonsignificant effect for pain intensity (ES=-0.14, CI: -0.43, 0.15) and pain interference (ES=-0.07, CI: -0.35, 0.20) outcomes. Findings from uncontrolled trials supported meta-analytic results from RCTs. Using GRADE assessment, the quality of evidence was deemed as moderate for RCTs and low for non-RCTs. DISCUSSION: Findings indicated that the majority of the interventions appeared to have a greater impact on reducing PTSD rather than pain-related symptoms. There remains a need to further develop interventions that consistently impact PTSD and pain-related outcomes when these 2 conditions co-occur.

Adherence to Practice of Mindfulness in Novice Meditators: Practices Chosen, Amount of Time Practiced, and Long-Term Effects Following a Mindfulness-Based Intervention.

In this study, we objectively tracked the duration, frequency, and the preferred practices chosen by novice mindfulness practitioners following a mindfulness meditation (MM) intervention. A sample of 55 mildly stressed participants, aged 50 to 80 years old, underwent an individual 6-week MM intervention and had their guided meditation home practice electronically recorded during the intervention and the 8-week post-intervention period. Participants' psychological well-being was assessed through self-report measures of mindfulness, quality of life, and symptoms of depression and stress. Results evidenced a high adherence to practice, with an average of ~23 minutes per day during the intervention and ~16 minutes per day in the follow-up period. Body scan, sitting meditation, and breathing space were the most popular meditation practices among participants. Our results showed significant alterations in self-reported measures over time, suggesting improvements in stress and overall quality of life. Changes in the self-report measures did not correlate with MM practice time, which suggests that other psychological phenomena, including quality of meditation practice, influence these outcomes.

Hypnosis Intervention Effects on Sleep Outcomes: A Systematic Review.

STUDY OBJECTIVES: Sleep improvement is a promising target for preventing and modifying many health problems. Hypnosis is considered a cost-effective and safe intervention with reported benefits for multiple health conditions. There is a growing body of research assessing the efficacy of hypnosis for various health conditions in which sleep was targeted as a primary or secondary outcome. This review aimed to investigate the effects of hypnosis interventions on sleep, to describe the hypnotic procedures, and to evaluate potential adverse effects of hypnosis. METHODS: We reviewed studies (prior to January 2017) using hypnosis in adults for sleep problems and other conditions comorbid with sleep problems, with at least one sleep outcome measure. Randomized controlled trials and other prospective studies were included. RESULTS: One hundred thirty-nine nonduplicate abstracts were screened, and 24 of the reviewed papers were included for qualitative analysis. Overall, 58.3% of the included studies reported hypnosis benefit on sleep outcomes, with 12.5% reporting mixed results, and 29.2% reporting no hypnosis benefit; when only studies with lower risk of bias were reviewed the patterns were similar. Hypnosis intervention procedures were summarized and incidence of adverse experiences assessed. CONCLUSIONS: Hypnosis for sleep problems is a promising treatment that merits further investigation. Available evidence suggests low incidence of adverse events. The current evidence is limited because of few studies assessing populations with sleep complaints, small samples, and low methodological quality of the included studies. Our review points out some beneficial hypnosis effects on sleep but more high-quality studies on this topic are warranted.

EEG Frequency Changes Prior to Making Errors in an Easy Stroop Task.

Background: Mind-wandering is a form of off-task attention that has been associated with negative affect and rumination. The goal of this study was to assess potential electroencephalographic markers of task-unrelated thought, or mind-wandering state, as related to error rates during a specialized cognitive task. We used EEG to record frontal frequency band activity while participants completed a Stroop task that was modified to induce boredom, task-unrelated thought, and therefore mind-wandering. Methods: A convenience sample of 27 older adults (50-80 years) completed a computerized Stroop matching task. Half of the Stroop trials were congruent (word/color match), and the other half were incongruent (mismatched). Behavioral data and EEG recordings were assessed. EEG analysis focused on the 1-s epochs prior to stimulus presentation in order to compare trials followed by correct versus incorrect responses. Results: Participants made errors on 9% of incongruent trials. There were no errors on congruent trials. There was a decrease in alpha and theta band activity during the epochs followed by error responses. Conclusion: Although replication of these results is necessary, these findings suggest that potential mind-wandering, as evidenced by errors, can be characterized by a decrease in alpha and theta activity compared to on-task, accurate performance periods.

A cognitive stressor for event-related potential studies: the Portland arithmetic stress task.

In this experiment, we developed and evaluated the Portland Arithmetic Stress Task (PAST) as a cognitive stressor to evaluate acute and sustained stress reactivity for event-related potential (ERP) studies. The PAST is a titrated arithmetic task adapted from the Montreal Imaging Stress Task (MIST), with added experimental control over presentation parameters, improved and synchronized acoustic feedback and generation of timing markers needed for physiological analyzes of real-time brain activity. Thirty-one older adults (M = 60 years) completed the PAST. EEG was recorded to assess feedback-related negativity (FRN) and the magnitude of the stress response through autonomic nervous system activity and salivary cortisol. Physiological measures other than EEG included heart rate, respiration rate, heart rate variability, blood pressure and salivary cortisol. These measures were collected at several time points throughout the task. Feedback-related negativity evoked-potential responses were elicited and they significantly differed depending on whether positive or negative feedback was received. The PAST also increased systolic blood pressure, heart rate variability and respiration rates compared to a control condition attentional task. These preliminary results suggest that the PAST is an effective cognitive stressor. Successful measurement of the feedback-related negativity suggests that the PAST is conducive to EEG and time-sensitive ERP experiments. Moreover, the physiological findings support the PAST as a potent method for inducing stress in older adult participants. Further research is needed to confirm these results, but the PAST shows promise as a tool for cognitive stress induction for time-locked event-related potential experiments.

Autism and Mind-Body Therapies: A Systematic Review.

BACKGROUND: Mind-body therapies are often used by people with autism spectrum disorders (ASD). However, there has been little examination into which types of mind-body therapies have been investigated for people with ASD and for what purposes. A systematic review was conducted to evaluate the existing evidence for mind-body therapies for people with ASD, particularly to determine the types of mind-body therapies used and the outcomes that are targeted. METHODS: PubMed, PsychInfo, and Scopus were searched using terms for ASD and mind-body therapies. Sixteen studies were selected for review; these studies tested interventions using mindfulness, meditation, yoga, Nei Yang Gong, and acceptance commitment therapy. Most study outcomes targeted behavior, psychological symptoms, and quality of life for children and adults with ASD as well as their parents. RESULTS: There was little overlap between studies on the types of mind-body therapies used and associated outcomes, and only three of the studies were randomized controlled trials. Most studies were small and uncontrolled. Some studies modified the mind-body therapies to increase accessibility for people with ASD. CONCLUSION: The evidence for mind-body therapies for people with ASD is limited and would benefit from larger randomized controlled trials.

Set shifting reaction-time improves following meditation or simple breathcounting in meditators and meditation-naïve participants: Data from naturalistic, ecological momentary-assessment devices.

A comparison is made between the performance of meditators and controls in a letter-number task-switching test. Data were recorded over a five-day period using a previously developed ecological momentary assessment paradigm. Participants consisted of naïve, novice, and experienced meditators, who completed a task-switching reaction time (RT) task before and after 20-min breath-counting sessions. There was a decrease in reaction time over testing days, p < .007, as well as a separate decrease in reaction time pre- to post-meditation, p < .001. RTs decreased each day, as expected, and post-meditation/breath-counting RTs were consistently faster than pre-meditation/breath-counting RTs. These results suggest a meditation effect separate from a learning effect.

Influence of emotional states on inhibitory gating: animals models to clinical neurophysiology.

Integrating research efforts using a cross-domain approach could redefine traditional constructs used in behavioral and clinical neuroscience by demonstrating that behavior and mental processes arise not from functional isolation but from integration. Our research group has been examining the interface between cognitive and emotional processes by studying inhibitory gating. Inhibitory gating can be measured via changes in behavior or neural signal processing. Sensorimotor gating of the startle response is a well-used measure. To study how emotion and cognition interact during startle modulation in the animal model, we examined ultrasonic vocalization (USV) emissions during acoustic startle and prepulse inhibition. We found high rates of USV emission during the sensorimotor gating paradigm and revealed links between prepulse inhibition (PPI) and USV emission that could reflect emotional and cognitive influences. Measuring inhibitory gating as P50 event-related potential suppression has also revealed possible connections between emotional states and cognitive processes. We have examined the single unit responses during the traditional gating paradigm and found that acute and chronic stress can alter gating of neural signals in regions such as amygdala, striatum and medial prefrontal cortex. Our findings point to the need for more cross-domain research on how shifting states of emotion can impact basic mechanisms of information processing. Results could inform clinical work with the development of tools that depend upon cross-domain communication, and enable a better understanding and evaluation of psychological impairment.

MEMORY FOR POETRY: MORE THAN MEANING?

The assumption has become that memory for words' sound patterns, or form, is rapidly lost in comparison to content. Memory for form is also assumed to be verbatim rather than schematic. Oral story-telling traditions suggest otherwise. The present experiment investigated if form can be remembered schematically in spoken poetry, a context in which form is important. We also explored if sleep could help preserve memory for form. We tested whether alliterative sound patterns could cue memory for poetry lines both immediately and after a delay of 12 hours that did or did not include sleep. Twelve alliterative poetry lines were modified into same alliteration, different alliteration, and no alliteration paraphrases. We predicted that memory for original poetry lines would be less accurate after 12 hours, same alliteration paraphrases would be falsely recognized as originals more often after 12 hours, and that the no-sleep group would make more errors. Different alliteration and no alliteration paraphrases were not expected to share this effect due to schematically different sound patterns. Our data support these hypotheses and provide evidence that memory for form is schematic in nature, retained in contexts in which form matters, and that sleep may help preserve memory for sound patterns.