The utility of completing adjuvant video lessons based on the unified protocol during psychotherapy: A retrospective study using a telehealth platform in routine clinical care.

Digital supplements to tele-psychotherapy are increasingly needed. The purpose of this retrospective study was to investigate the association between outcomes and the use of supplemental video lessons based on the Unified Protocol (UP), an empirically supported transdiagnostic treatment.Participants included 7,326 adults in psychotherapy for depression and/or anxiety. Partial correlations were calculated between number of UP video lessons completed and change in outcomes after 10 weeks, controlling for number of therapy sessions and baseline scores. Then, participants were divided into those who did not complete any UP video lessons (n = 2355) and those who completed at least 7/10 video lessons (n = 549), and propensity-matched on 14 covariates. Repeated measures analysis of variance compared these groups (n = 401 in each group) on outcomes.Among the entire sample, symptom severity decreased as the number of UP video lessons completed increased, with the exception of lessons on avoidance and exposure. Those watching at least 7 lessons showed significantly greater reduction in both depression and anxiety symptoms than those who did not watch any.Viewing supplemental UP video lessons in addition to tele-psychotherapy had a positive and significant association with symptom improvement and may provide an additional tool for clinicians to implement UP components virtually.

Hope, optimism, and self-efficacy predicting mental health and illness in a community sample exposed to Hurricane Harvey.

In 2017, Hurricane Harvey flooded more than 300,000 buildings causing an estimated $125 billion in damages and resulting in 68 deaths (National Hurricane Center). This actual or threatened loss of life and physical harm led many to report negative effects on mental well-being and greater mental illness. However, many individuals have been able to experience similar adverse events without a significant negative impact on their mental health and well-being. Positive thinking factors such as hope, optimism, and self-efficacy have been proposed as protective factors in the face of difficult life events. Hope, optimism, and self-efficacy are related but distinct constructs that have often been studied separately, but whose unique impact on well-being and mental illness is less clear, especially in the context of a natural hazard. The current study uses structural equation modeling to measure the unique contribution of hope, optimism, and hurricane-coping self-efficacy on mental well-being and mental illness in a community sample of 300 subjects who experienced Hurricane Harvey, recruited from Mechanical Turk.

CO2 reactivity as a biomarker of exposure-based therapy non-response: study protocol.

BACKGROUND: Exposure-based therapy is an effective first-line treatment for anxiety-, obsessive-compulsive, and trauma- and stressor-related disorders; however, many patients do not improve, resulting in prolonged suffering and poorly used resources. Basic research on fear extinction may inform the development of a biomarker for the selection of exposure-based therapy. Growing evidence links orexin system activity to deficits in fear extinction and we have demonstrated that reactivity to an inhaled carbon dioxide (CO2) challenge-a safe, affordable, and easy-to-implement procedure-can serve as a proxy for orexin system activity and predicts fear extinction deficits in rodents. Building upon this basic research, the goal for the proposed study is to validate CO2 reactivity as a biomarker of exposure-based therapy non-response. METHODS: We will assess CO2 reactivity in 600 adults meeting criteria for one or more fear- or anxiety-related disorders prior to providing open exposure-based therapy. By incorporating CO2 reactivity into a multivariate model predicting treatment non-response that also includes reactivity to hyperventilation as well as a number of related predictor variables, we will establish the mechanistic specificity and the additive predictive utility of the potential CO2 reactivity biomarker. By developing models independently within two study sites (University of Texas at Austin and Boston University) and predicting the other site's data, we will validate that the results are likely to generalize to future clinical samples. DISCUSSION: Representing a necessary stage in translating basic research, this investigation addresses an important public health issue by testing an accessible clinical assessment strategy that may lead to a more effective treatment selection (personalized medicine) for patients with anxiety- and fear-related disorders, and enhanced understanding of the mechanisms governing exposure-based therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05467683 (20/07/2022).

The explanatory role of fatigue severity in the relation between COVID-19 perceived stress and depression, anxiety, and panic severity.

The COVID-19 pandemic has had an adverse effect on anxiety and depression symptoms and disorders in the United States and worldwide. As such, there is considerable interest in better understanding the relationship between COVID-19 and anxiety and depressive disorders. Although individual differences in perceived stress have shown to be related to anxiety and depression in non-COVID-19 work, research has not examined potential factors underlying this relation in the context of COVID-19. Fatigue severity may be a promising mechanistic construct for perceived stress and anxiety and depression relations, as some work has found that perceived stress may predict elevated fatigue symptoms. As such, the current study sought to examine the potential explanatory role of fatigue severity in the relation between COVID-19 specific perceived stress and depression, anxiety, and panic symptoms among 563 adults (41.9% female, Mage = 38.26 years, SD = 12.15). Results suggested that COVID-19 perceived stress, via fatigue severity, significantly predicted depression, anxiety, and panic symptoms. These results provide initial empirical support for the role of fatigue severity in the relation between COVID-19 perceived stress and depression, anxiety, and panic symptoms. Future work would benefit from using longitudinal data to evaluate the current model.

"You have to be clean:" a qualitative study of pubic hair grooming behaviours among women living in Italy.

The majority of pubic hair and genital self-image research describes women living in the USA, UK and Australia. This may leave attitudes and behaviours across other cultures and geographic regions ambiguous. The purpose of this study was to describe pubic hair removal attitudes and behaviours among reproductive-age women living in Italy. Individual interviews were conducted with 46 women aged 18-45 years between June and July 2017, living in Florence, Italy and currently utilising the Italian healthcare system. Pubic hair removal was popular among participants. Women mainly removed pubic hair by waxing. Sexual partners influenced removal, as did cultural norms and the desire for cleanliness. Most participants indicated pubic hair removal onset during adolescence, often upon puberty. However, most participants had never discussed removal complications with providers. Pubic hair removal often related to a more positive genital self-image because of social norms surrounding hairlessness. Removal among this sample appears to differ from the literature in other contexts, with women living in Italy engaging in more frequent and earlier waxing. Findings offer opportunities for clinicians to proactively address safe pubic hair practices and women's genital concerns during consultations.

Examining the longitudinal effects and potential mechanisms of hope on COVID-19 stress, anxiety, and well-being.

Hope is a cognitive trait that predicts both resilience to and recovery from anxiety and stress-related disorders. The present study examines the prospective associations of hope with subsequent anxiety, stress, and well-being during the COVID-19 pandemic. Perceived emotional control, a transdiagnostic vulnerability factor, was also examined as a potential mediator of these relationships. American adults (N = 822) were recruited during the COVID-19 pandemic using Amazon mTURK and structural equation modeling was used to examine how trait hope predicted outcomes approximately one month later. Higher hope was associated with greater well-being and perceived emotional control, as well as lower levels of anxiety and COVID-19 perceived stress. Results also indicated an indirect effect of hope with all outcomes via perceived emotional control. These findings suggest that hope may associated with resilience to the chronic stressors associated with the COVID-19 pandemic.

The Potential Unique Impacts of Hope and Resilience on Mental Health and Well-Being in the Wake of Hurricane Harvey.

Natural disasters can lead to mental health problems, such as posttraumatic stress disorder (PTSD). Higher levels of loss and/or disruption and prior trauma exposure constitute risk factors for mental illness, whereas protective factors, including hope and resilience, support positive functioning. The present cross-sectional study used structural equation modeling to examine the relative influence of resilience and hope on mental health and well-being 1-3 months after Hurricane Harvey made landfall in August 2017, among a sample of 829 adults in the Greater Houston, Texas area. Resilience was more strongly associated with reduced PTSD symptoms, ß = -.31, 95% CI [-.42, -.21], than was hope, ß = -.17, 95% CI [-;.30, -.04], whereas hope was more strongly associated with components of well-being, ßs = .47-.63. Hope was positively associated with posttraumatic growth, ß = .30, 95% CI [.19, .41], whereas resilience was negatively associated with posttraumatic growth, ß = -.24, 95% CI [-.35, -.12]. These associations remained consistent after considering risk factors, although more variance in trauma-related outcomes was risk factors were included in the model. The present results suggest that considering the influence of both risk and resilience factors provides an enhanced picture of postdisaster mental health.

Hope, optimism, self-efficacy, and posttraumatic stress disorder: A meta-analytic review of the protective effects of positive expectancies.

OBJECTIVE: The present meta-analysis consolidated research examining how positive expectancies (e.g., hope, self-efficacy, and optimism) may protect against the development of posttraumatic stress disorder (PTSD). METHOD: Articles were identified by searching PILOTS, PsycINFO, PubMed, and ProQuest Dissertations and Theses databases. RESULTS: Aggregated results from 154 studies indicated that positive expectancies were associated with lower levels of PTSD symptoms. This relationship was stronger for coping-specific self-efficacy (k = 38, r = -.49; -.54 to -.43) and hope (k = 20, r = -.34; -.39 to -.28) compared with general self-efficacy (k = 45, r = -.25; -.30 to -.20) and optimism (k = 59, r = -.29; -.33 to -.25) when examining cross-sectional studies, and results were consistent in prospective studies. Age and gender did not moderate the cross-sectional relationships. CONCLUSIONS: These findings indicate that positive expectancies predict post-trauma resilience. Future research should identify moderators and examine positive expectancies as mechanisms of change in therapy.

The unexpected impact of expressive writing on posttraumatic stress and growth in Chinese American breast cancer survivors.

OBJECTIVE: The present study examined the impact of expressive writing on reducing posttraumatic stress disorder symptoms (PTSS) and facilitating posttraumatic growth (PTG) in Chinese American breast cancer survivors. METHOD: Ninety-six women who had completed primary treatments for breast cancer were randomly assigned to a cancer experience facts condition, an emotional disclosure condition, or a self-regulation condition and wrote on three occasions over 3 weeks. Participants completed outcome assessments at baseline and 1, 3, and 6 months after the last writing session. RESULTS: Surprisingly, results indicated that there was generally a small increase in PTSS (ESsg = .16) and a small decrease in PTG (ESsg = -.16) from baseline to the 6-month follow-up. Effect size comparisons and latent growth curve models also indicated that the cancer facts condition was generally associated with superior outcomes for both PTSS and PTG. CONCLUSIONS: These findings speak to the importance of examining whether interventions are equally efficacious in different cultures.

DPP6 domains responsible for its localization and function.

Dipeptidyl peptidase-like protein 6 (DPP6) is an auxiliary subunit of the Kv4 family of voltage-gated K(+) channels known to enhance channel surface expression and potently accelerate their kinetics. DPP6 is a single transmembrane protein, which is structurally remarkable for its large extracellular domain. Included in this domain is a cysteine-rich motif, the function of which is unknown. Here we show that this cysteine-rich domain of DPP6 is required for its export from the ER and expression on the cell surface. Disulfide bridges formed at C349/C356 and C465/C468 of the cysteine-rich domain are necessary for the enhancement of Kv4.2 channel surface expression but not its interaction with Kv4.2 subunits. The short intracellular N-terminal and transmembrane domains of DPP6 associates with and accelerates the recovery from inactivation of Kv4.2, but the entire extracellular domain is necessary to enhance Kv4.2 surface expression and stabilization. Our findings show that the cysteine-rich domain of DPP6 plays an important role in protein folding of DPP6 that is required for transport of DPP6/Kv4.2 complexes out of the ER.

Care of patients with deep inferior epigastric perforator reconstruction.

Recent trends reflect greater numbers of women opting for mastectomy for invasive breast cancer. Breast reconstruction, either at the time of mastectomy or later, is increasingly an option patients prefer. Although many women opt for implants, reconstruction using autologous tissue offers several advantages including tissue that feels more natural and will age naturally with the patient. The deep inferior epigastric perforator flap has emerged as an alternative to the transverse rectus abdominis myocutaneous flap and allows for preservation of the underlying abdominal muscle. As greater numbers of surgeons are able to offer this microvascular alternative, nurses will care for these postoperative patients in the intensive care unit and medical/surgical settings. This article reviews the evaluation of patients for deep inferior epigastric perforator reconstruction and the unique complexities of postoperative nursing care for these patients.

Are changes in joviality associated with cognitive behavioral treatment outcomes? Examining an emerging treatment target.

The present study expands on the growing body of research on the effects of cognitive behavioral therapy (CBT) on positive affect. More specifically, we explore how CBT may promote increases in the Joviality subscale of the Positive and Negative Affect Schedule-Expanded Form (PANAS-X), a measure of self-rated affect that captures positive emotions, including joy and excitement, and how change in joviality may be associated with concurrent symptom change. We utilized data from a randomized equivalence trial comparing the efficacy of the unified protocol (UP) for transdiagnostic treatment of emotional disorders, a transdiagnostic CBT, against various well-established single disorder protocols (SDP) and waitlist control. First, we generated affect profiles for patients receiving CBT (either UP or SDP) or waitlist control, based on their baseline and posttreatment positive affect (PA) and negative affect (NA), compared with a clinical reference sample. We found that the affect profile for most patients receiving CBT shifted from high NA/low PA to low NA/high PA. Further, participants receiving CBT were more likely than individuals in the waitlist control to achieve this outcome. We then examined the PANAS-X Joviality subscale, which has been subject to very limited previous research. Change in joviality was associated with improvement in symptoms of both anxiety (B = -0.81, p = .00) and depression (B = -0.94, p = .00). Joviality increased more rapidly in individuals with more severe anxiety but not severe depression. We discuss the possible clinical implications of these preliminary results, including the role of treatment innovations incorporating a focus on increasing positive affect, particularly the emotions associated with joviality, while simultaneously decreasing negative affect. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Hope and PTSD.

This paper reviews the present literature examining how hope relates to PTSD and broader functioning after a trauma, including potential underlying mechanisms and significant factors impacting these relationships and the role of hope as a mechanism of change within interventions for PTSD. First, the ways in which trauma impacts hope are discussed. Afterwards, an overview is provided of cross-sectional and prospective research indicating that greater hope reduces the risk of PTSD and promotes positive outcomes of adversity. Next, potential underlying mechanisms and determinants of the relationship between hope and adjustment are explored, including adaptive appraisals, productive coping, and social support. Finally, evidence supporting the role of hope as a mechanism of change in treatments for PTSD is reviewed.

Six Month Trajectories of COVID-19 Experiences and Associated Stress, Anxiety, Depression, and Impairment in American Adults.

Background: The COVID-19 pandemic has had a profound impact on health and well-being worldwide. There is increasing research seeking to better understand the psychological impact of COVID-19 experiences. However, this research has largely been limited in size and scope. Methods: The present study examined longitudinal trajectories of COVID-19 experiences on COVID-19 related stress, anxiety, depression, and functional impairment in a convenience sample of 788 American adults recruited through MTURK. Data was collected across four waves between March and October 2020. Results: COVID-19 experiences were consistently associated with higher odds of probable anxiety and depression diagnoses. COVID-19 related stress also predicted large proportions of variance in anxiety, depression, and functional impairment in latent variable analyses. Overtime, the results indicated that while anxiety and depression decreased, functional impairment remained stable. Conclusions: These findings highlight the emotional toll of the COVID-19 pandemic over time. Decreases in COVID-19 related stress, anxiety, and depression over time may reflect resiliency among respondents. Importantly, these results underscore the continued need for mental health services as associations between COVID-19 and functional impairment remained consistent over time.

Multiscale temporal integration organizes hierarchical computation in human auditory cortex.

To derive meaning from sound, the brain must integrate information across many timescales. What computations underlie multiscale integration in human auditory cortex? Evidence suggests that auditory cortex analyses sound using both generic acoustic representations (for example, spectrotemporal modulation tuning) and category-specific computations, but the timescales over which these putatively distinct computations integrate remain unclear. To answer this question, we developed a general method to estimate sensory integration windows-the time window when stimuli alter the neural response-and applied our method to intracranial recordings from neurosurgical patients. We show that human auditory cortex integrates hierarchically across diverse timescales spanning from ~50 to 400 ms. Moreover, we find that neural populations with short and long integration windows exhibit distinct functional properties: short-integration electrodes (less than ~200 ms) show prominent spectrotemporal modulation selectivity, while long-integration electrodes (greater than ~200 ms) show prominent category selectivity. These findings reveal how multiscale integration organizes auditory computation in the human brain.

Anxiety Sensitivity Moderates the Impact of COVID-19 Perceived Stress on Anxiety and Functional Impairment.

BACKGROUND: The COVID-19 pandemic has had a profound negative impact on mental health symptoms and daily life functioning across the United States and worldwide. Past work has revealed that perceived stress relates to poorer outcomes, however, little work to date has examined factors that may exacerbate these outcomes, and no work to date has examined this relation in terms of COVID-19. Anxiety sensitivity is a promising individual difference factor that has shown to be related to mental health and functional impairment. Anxiety Sensitivity is also a vulnerability factor related to heightened stress perception. METHOD: Therefore, the current study sought to examine the potential moderating role of anxiety sensitivity in the relation between COVID-19 specific perceived stress and global anxiety symptom severity, anxious arousal symptom severity, and functional impairment among 563 adults (58.1% male; M age = 38.3 years; SD = 12.15). RESULTS: Results indicated a statistically significant interaction between COVID-19 perceived stress and anxiety sensitivity with global anxiety symptom severity, anxious arousal symptom severity, and functional impairment. Post-hoc analysis indicated that COVID-19 perceived stress was associated with an increased likelihood of clinically significant global anxiety symptom severity and anxious arousal symptom severity at higher levels of anxiety sensitivity. CONCLUSIONS: The current study provides support for the role of anxiety sensitivity in identifying individuals at risk for clinically significant global anxiety symptom severity and anxious arousal symptom severity.

Clinical and laboratory evaluation of patients with SARS-CoV-2 pneumonia treated with high-titer convalescent plasma.

Here, we report on a phase IIa study to determine the intubation rate, survival, viral clearance, and development of endogenous Abs in patients with COVID-19 pneumonia treated with convalescent plasma (CCP) containing high levels of neutralizing anti-SARS-CoV-2 Abs. Radiographic and laboratory evaluation confirmed all 51 treated patients had COVID-19 pneumonia. Fresh or frozen CCP from donors with high titers of neutralizing Abs was administered. The nonmechanically ventilated patients (n = 36) had an intubation rate of 13.9% and a 30-day survival rate of 88.9%, and the overall survival rate for a comparative group based on network data was 72.5% (1625/2241). Patients had negative nasopharyngeal swab rates of 43.8% and 73.0% on days 10 and 30, respectively. Patients mechanically ventilated had a day-30 mortality rate of 46.7%; the mortality rate for a comparative group based on network data was 71.0% (369/520). All evaluable patients were found to have neutralizing Abs on day 3 (n = 47), and all but 1 patient had Abs on days 30 and 60. The only adverse event was a mild rash. In this study on patients with COVID-19 disease, we show therapeutic use of CCP was safe and conferred transfer of Abs, while preserving endogenous immune response.

The Impact of Covid-19 Experiences and Associated Stress on Anxiety, Depression, and Functional Impairment in American Adults.

BACKGROUND: The COVID-19 pandemic has had a profound impact on health and well-being worldwide and there is increasing recognition of the need to understand the psychological impact of COVID-19 experiences and stress in addition to the physical health consequences. METHODS: The present study examined how experiences related to COVID-19 and associated stress impact, anxiety, depression, and functional impairment in a convenience sample of 565 American adults (57.9% male) recruited through MTURK. RESULTS: COVID-19 experiences were consistently associated with higher odds of probable anxiety and depression diagnoses (ORs ≥ 3.0). COVID-19 associated stress also predicted large proportions of variance (R 2 ≥ 30) in anxiety, depression, health anxiety, and functional impairment in latent variable analyses. CONCLUSIONS: These findings highlight that personal experiences related to the diagnosis of COVID-19, mortality in acquaintances, and COVID-19 associated stress is associated with a greatly elevated risk of emotional disorder symptomatology and that the COVID-19 pandemic may result in increased demand for mental health services.

Examining Hope as a Transdiagnostic Mechanism of Change Across Anxiety Disorders and CBT Treatment Protocols.

Hope is a trait that represents the capacity to identify strategies or pathways to achieve goals and the motivation or agency to effectively pursue those pathways. Hope has been demonstrated to be a robust source of resilience to anxiety and stress and there is limited evidence that, as has been suggested for decades, hope may function as a core process or transdiagnostic mechanism of change in psychotherapy. The current study examined the role of hope in predicting recovery in a clinical trial in which 223 individuals with 1 of 4 anxiety disorders were randomized to transdiagnostic cognitive behavior therapy (CBT), disorder-specific CBT, or a waitlist controlled condition. Effect size results indicated moderate to large intraindividual increases in hope, that changes in hope were consistent across the five CBT treatment protocols, that changes in hope were significantly greater in CBT relative to waitlist, and that changes in hope began early in treatment. Results of growth curve analyses indicated that CBT was a robust predictor of trajectories of change in hope compared to waitlist, and that changes in hope predicted changes in both self-reported and clinician-rated anxiety. Finally, a statistically significant indirect effect was found indicating that the effects of treatment on changes in anxiety were mediated by treatment effects on hope. Together, these results suggest that hope may be a promising transdiagnostic mechanism of change that is relevant across anxiety disorders and treatment protocols.

The effect of body weight reduction using a lower body positive pressure treadmill on plantar pressure measures while running.

OBJECTIVE: To evaluate the effects of body weight reduction at 10% intervals on pressure distribution variables across regions of the foot while running. STUDY DESIGN: Crossover Study Design. SETTING: Laboratory. PARTICIPANTS: 12 recreational runners. MAIN OUTCOME MEASURES: Pressure-time integral, peak pressure, instance of peak pressure, contact area, contact time and center of pressure (COP) location at initial contact across four foot regions were measured while participants ran at self-selected speed on the Lower Body Positive Pressure Treadmill (LBPPT) at 100%, 90%, 80%, 70% and 60% of their body weight (%BW). RESULTS: As the %BW decreased, there were corresponding significant decreases in the pressure-time integral and peak pressures in all four regions of the foot. Significant differences within foot region and %BW for the other variables were infrequent. There was a significant anterior shift of the COP location at initial contact as the %BW decreased. CONCLUSION: LBPPT is useful for reducing the pressure across the entire foot. Additionally, the anterior translation of the COP location at initial contact with reduced %BW may provide an additional gait retraining tool for prevention and treatment of running injuries as reducing %BW moves the runner away from a rearfoot strike pattern.