Development and Validation of a Smartphone-Based App for the Longitudinal Assessment of Anxiety in Daily Life.

Current methods to assess human anxiety often ignore that anxiety is a dynamic process and have limitations such as high recall bias and low generalizability to real life. Smartphone apps using ecological momentary assessment (EMA) may overcome such limitations. We developed a smartphone app for the longitudinal evaluation of anxiety symptoms using EMA. We assessed the feasibility (retention and compliance) and psychometric properties (reliability and validity) of the app over 6 months in a sample of 99 participants with different levels of anxiety. The EMA-based smartphone app was highly feasible. It showed excellent within-person and between-person reliability, high convergent and moderate discriminant validity, and significant incremental validity. Assessing anxiety longitudinally using a smartphone and following EMA principles is feasible and can be reliable and valid. Studies combining EMA-based anxiety longitudinal assessments with other assessment methods deserve further research and may offer novel insights into human anxiety.

Diagnostic biomarkers for obsessive-compulsive disorder: A reasonable quest or ignis fatuus?

Obsessive-compulsive disorder (OCD) has been associated with a wide range of biological and neurocognitive findings, which could assist in the search for biomarkers. We conducted an umbrella review of systematic reviews and meta-analyses to assess and grade the strength of the evidence of the association between OCD and several potential diagnostic biomarkers while controlling for several potential biases. Twenty-four systematic reviews and meta-analyses were included, comprising 352 individual studies, more than 10,000 individuals with OCD, and covering 73 potential biomarkers. OCD was significantly associated with several neurocognitive biomarkers, with varying degrees of evidence, ranging from weak to convincing. A number of biochemical, neurophysiological, and neuroimaging biomarkers also showed statistically significant, albeit weak, associations with OCD. Analyses in unmedicated samples (123 studies) weakened the strength of the evidence for most biomarkers or rendered them non-significant. None of the biomarkers seem to have sufficient sensitivity and specificity to become a diagnostic biomarker. A more promising avenue for future biomarker research in OCD might be the prediction of clinical outcomes rather than diagnosis.

Risk and protective factors for anxiety and obsessive-compulsive disorders: an umbrella review of systematic reviews and meta-analyses.

BACKGROUND: A multitude of risk/protective factors for anxiety and obsessive-compulsive disorders have been proposed. We conducted an umbrella review to summarize the evidence of the associations between risk/protective factors and each of the following disorders: specific phobia, social anxiety disorder, generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder, and to assess the strength of this evidence whilst controlling for several biases. METHODS: Publication databases were searched for systematic reviews and meta-analyses examining associations between potential risk/protective factors and each of the disorders investigated. The evidence of the association between each factor and disorder was graded into convincing, highly suggestive, suggestive, weak, or non-significant according to a standardized classification based on: number of cases (>1000), random-effects p-values, 95% prediction intervals, confidence interval of the largest study, heterogeneity between studies, study effects, and excess of significance. RESULTS: Nineteen systematic reviews and meta-analyses were included, corresponding to 216 individual studies covering 427 potential risk/protective factors. Only one factor association (early physical trauma as a risk factor for social anxiety disorder, OR 2.59, 95% CI 2.17-3.1) met all the criteria for convincing evidence. When excluding the requirement for more than 1000 cases, five factor associations met the other criteria for convincing evidence and 22 met the remaining criteria for highly suggestive evidence. CONCLUSIONS: Although the amount and quality of the evidence for most risk/protective factors for anxiety and obsessive-compulsive disorders is limited, a number of factors significantly increase the risk for these disorders, may have potential prognostic ability and inform prevention.

Risk factors for posttraumatic stress disorder: An umbrella review of systematic reviews and meta-analyses.

Approximately one third of individuals who experience a severe traumatic event will develop posttraumatic stress disorder (PTSD). It is crucial to identify what factors may be associated with increased or decreased risk for PTSD. We conducted an umbrella review of systematic reviews and meta-analyses of risk/protective factors for PTSD and assessed and graded the evidence of the association between each factor and PTSD. Thirty-three systematic reviews and meta-analyses were included and 130 potential risk factors were identified. Of those, 57 showed a significant association with PTSD. Being female or being indigenous people of the Americas, among the sociodemographic factors; history of physical disease and family history of psychiatric disorder, among the pretrauma factors; and cumulative exposure to potentially traumatic experiences, trauma severity, and being trapped during an earthquake, among the peritrauma factors, showed convincing or highly suggestive evidence of an association with PTSD. Data from prospective studies were less conclusive. Our results have the potential of helping refine PTSD prediction models and contributing to the design of prevention strategies.

Deterioration rates in Virtual Reality Therapy: An individual patient data level meta-analysis.

Ample evidence supports the use of Virtual Reality (VR) for anxiety disorders. Nonetheless, currently there is no evidence about moderators or potential negative effects of VR treatment strategies. An Individual Patient Data (IPD) approach was employed with 15 retrieved datasets. The current study sample was composed of 810 patients. Randomized control trials (RCTs) for each primary outcome measure were performed, in addition to moderator analyses of the socio-demographic variables. Deterioration rates were 14 patients (4.0%) in VR, 8 (2.8%) in active control conditions, and 27 (15%) in the WL condition. With regard to receiving treatment, patients in a waiting list control condition had greater odds of deteriorating than in the two active conditions, odds ratios (ORs) 4.87, 95% confidence interval (CI) [0.05, 0.67]. In the case of the socio-demographic variables, none of them were associated with higher or lower odds of deterioration, with the exception of marital status in the WL condition; married people presented a significantly lower probability of deterioration, OR 0.19, 95% CI [0.05, 0.67]. Finally, when comparing pooled effects of VR versus all control conditions, the OR was 0.61 (95% CI 0.31-1.23) in favor of VR, although this result was not statistically significant. This study provides evidence about the deterioration rates of a therapeutic VR approach, showing that the number of deteriorated patients coincides with other therapeutic approaches, and that deterioration is less likely to occur, compared to patients in WL control groups.

Adaptación española del "Cuestionario de miedo a las arañas" (FSQ): validez, fiabilidad, sensibilidad al cambio terapéutico y estructura factorial / Spanish adaptation of the Fear of Spiders Questionnaire (FSQ): Validity, reliability, sensitivity to therapeutic change and factor structure

El objetivo del presente trabajo era evaluar las propiedades psicométricas y la estructura factorial de la versión española del "Cuestionario de miedo a las arañas" (FSQ), así como su sensibilidad al cambio terapéutico. Fueron evaluados 740 participantes con miedo a las arañas con el FSQ, el apartado de ansiedadrasgo del "Inventario de ansiedad estado-rasgo" (STAI-T) y el "Cuestionario de salud del paciente para la depresión" (PHQ-9). La versión española del FSQ mostró una excelente consistencia interna (alfa= 0,966), una buena validez divergente (r con el STAI-T= 0,108 y r con el PHQ-9= 0,081) y una adecuada fiabilidad test-retest (r= 0,799). El FSQ fue sensible al cambio terapéutico, t(49)= 2,70; p= 0,009; d= 0,25, y reveló una estructura bifactorial (Evitación y búsqueda de ayuda y Miedo al daño) que explicaba el 71% de la varianza total. La versión española del FSQ es un instrumento válido y fiable que permite evaluar el miedo a las arañas tanto en poblaciones clínicas como subclínicas

The goal of the study was to evaluate the psychometric properties and the factorial structure of the Spanish version of the Fear of Spiders Questionnaire (FSQ), as well as its sensitivity to therapeutic change. Seven hundred and forty participants with fear of spiders were evaluated with the FSQ, the anxiety-trait section of the State-Trait Anxiety Inventory (STAI-T) and the Patient Health Questionnaire for depression (PHQ-9). The Spanish version of the FSQ showed excellent internal consistency (aflfa= .966), good divergent validity (r with STAI-T= .108 and r with PHQ-9= .081) and adequate test-retest reliability (r= .799). The FSQ was sensitive to therapeutic change, t(49)= 2.70, p= .009, d= 0.25, and revealed a two-factor structure (Avoidance and seeking help, and Fear of harm) that explained 71% of the total variance. The Spanish version of the FSQ is a valid and reliable instrument that allows assessing the fear of spiders in both clinical and subclinical populations

Relationship between effortful control and facets of mindfulness in meditators, non-meditators and individuals with borderline personality disorder.

As dimensions of effortful control (EC), activation control, attentional control, and inhibitory control could mediate the relationship between mindfulness meditation practice and the facets of mindfulness (i.e., observing, describing, acting with awareness, non-judging and non-reacting to inner experience). In this study, we tested whether participant status: meditators (n = 330), healthy non-meditators (n = 254) and individuals with borderline personality disorder (BPD) diagnosis (n = 46) predicted the facets of mindfulness and if these potential effects were mediated through the three effortful control (EC) dimensions (activation, attentional and inhibitory control). Meditators scored higher than non-meditators on attentional and inhibitory control and on the facets of mindfulness with attentional and inhibitory control partially mediating this relationship between meditation status and mindfulness facets. Participants with BPD showed lower scores on EC along with lower scores on the facets of mindfulness compared with healthy non-meditators. All three aspects of EC partially mediated the relationship between BPD and mindfulness facets. Copyright © 2018 John Wiley & Sons, Ltd.

Attentional Control and Fear Extinction in Subclinical Fear: An Exploratory Study.

Attentional control (AC) and fear extinction learning are known to be involved in pathological anxiety. In this study we explored whether individual differences in non-emotional AC were associated with individual differences in the magnitude and gradient of fear extinction (learning and recall). In 50 individuals with fear of spiders, we collected measures of non-emotional AC by means of self-report and by assessing the functioning of the major attention networks (executive control, orienting, and alerting). The participants then underwent a paradigm assessing fear extinction learning and extinction recall. The two components of the orienting network functioning (costs and benefits) were significantly associated with fear extinction gradient over and above the effects of trait anxiety. Specifically, participants with enhanced orienting costs (i.e., difficulties in disengaging attention from cues not relevant for the task) showed faster extinction learning, while those with enhanced orienting benefits (i.e., attention facilitated by valid cues) exhibited faster extinction recall as measured by fear-potentiated startle and Unconditioned Stimulus expectancies, respectively. Our findings suggest that, in non-emotional conditions, the orienting component of attention may be predictive of fear extinction. They also show that the use of fear extinction gradients and the exploration of individual differences in non-emotional AC (using performance-based measures of attentional network functioning) can provide a better understanding of individual differences in fear learning. Our findings also may help to understand differences in exposure therapy outcomes.

Does fear extinction in the laboratory predict outcomes of exposure therapy? A treatment analog study.

Fear extinction models have a key role in our understanding of anxiety disorders and their treatment with exposure therapy. Here, we tested whether individual differences in fear extinction learning and fear extinction recall in the laboratory were associated with the outcomes of an exposure therapy analog (ETA). Fifty adults with fear of spiders participated in a two-day fear-learning paradigm assessing fear extinction learning and fear extinction recall, and then underwent a brief ETA. Correlational analyses indicated that enhanced extinction learning was associated with better ETA outcome. Our results partially support the idea that individual differences in fear extinction learning may be associated with exposure therapy outcome, but suggest that further research in this area is needed.

An Internet-based treatment for flying phobia (NO-FEAR Airlines): study protocol for a randomized controlled trial.

BACKGROUND: Flying phobia (FP) is a common and disabling mental disorder. Although in vivo exposure is the treatment of choice, it is linked to a number of limitations in its implementation. Particularly important, is the limited access to the feared stimulus (i.e., plane). Moreover, the economic cost of in vivo exposure should be specially considered as well as the difficulty of applying the exposure technique in an appropriate way; controlling important variables such as the duration of the exposure or the number of sessions. ICTs could help to reduce these limitations. Computer-assisted treatments have remarkable advantages in treating FP. Furthermore, they can be delivered through the Internet, increasing their advantages and reaching more people in need. The Internet has been established as an effective way to treat a wide range of mental disorders. However, as far as we know, no controlled studies exist on FP treatment via the Internet. This study aims to evaluate the efficacy of an Internet-based treatment for FP (NO-FEAR Airlines) versus a waiting list control group. Secondary objectives will be to explore two ways of delivering NO-FEAR Airlines, with or without therapist guidance, and study the patients' acceptance of the program. This paper presents the study protocol. METHODS/DESIGN: The study is a randomized controlled trial. A minimum of 57 participants will be randomly assigned to three conditions: a) NO-FEAR Airlines totally self-applied, b) NO-FEAR Airlines with therapist guidance, or c) a waiting list control group (6 weeks). Primary outcomes measures will be the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes will be included to assess other relevant clinical measures, such as the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Analyses of post-treatment flights will be conducted. Treatment acceptance and preference measures will also be included. Intention-to-treat and per protocol analyses will be conducted. DISCUSSION: An Internet-based treatment for FP could have considerable advantages in managing in vivo exposure limitations, specifically in terms of access to treatment, acceptance, adherence, and the cost-effectiveness of the intervention. This is the first randomized controlled trial to study this issue. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02298478 . Trial registration date 3 November 2014.

Retos en el desarrollo de intervenciones psicológicas y la práctica asistencial en salud mental / Challenges in the development of psychological interventions and care practice in mental health

Aunque hemos avanzado notablemente en el desarrollo de recursos preventivos y especialmente, en la eficacia de los tratamientos psicológicos que intentan paliar los trastornos mentales, estamos aún lejos de la situación óptima. Este trabajo se centra en dos grandes cuestiones que consideramos retos y necesidades fundamentales en este ámbito: (a) la necesidad de mejorar y extender la prevención, la intervención temprana y la promoción de la salud mental y (b) la necesidad de una mayor divulgación de los tratamientos psicológicos eficaces, el desarrollo de nuevas intervenciones y la mayor comprensión de los mecanismos de acción de los tratamientos psicológicos. El objetivo es promover la discusión entre los agentes implicados y reflexionar sobre las líneas de trabajo que creemos prioritarias

Although we have made significant progress in the development of preventive tools and especially in the efficacy of the psychological treatments, we are still far from an optimal situation. This paper focuses on two major issues which we consider fundamental challenges and urges in this area: (a) the need for improving and spreading prevention, early intervention, and the promotion of mental health and (b) the need for greater dissemination of effective psychological treatments, the development of new interventions and greater understanding of the mechanisms of action of psychological treatments. The aim is to promote discussion among all stakeholders and debate on those lines we think as priority

Long range temporal correlations in EEG oscillations of subclinically depressed individuals: their association with brooding and suppression.

Long-range temporal correlations (LRTC) in brain oscillations have been found to be associated with depression severity in clinically depressed patients. Less is known, however, about the relationships between LRTC and proneness to engage in depression-related cognitive emotion regulation (ER) strategies which characterize both clinically and subclinically depressed (SBD) people. In this study we applied detrended fluctuation analysis to the amplitude envelope of broad band, theta band, and alpha band spontaneous EEG oscillations of a group of SBD individuals and a group of non-depressed individuals (both groups from a sample of healthy adults, N = 120), to whom brooding and thought suppression questionnaires were administered. Between-groups differences were not found for any band scaling exponents at any brain location, but linear correlations pointed out several associations between exponents at frontal, central, parietal, temporal, and occipital sites and maladaptive ER strategies. These results suggest that alterations in brain dynamics are related with the proneness that depressive individuals show to engage in brooding and thought suppression in order to cognitively regulate their emotions.

Patient’s preferences regarding three computer-based exposure treatments for fear of flying / Preferencias de pacientes con miedo a volar sobre tres tratamientos de exposición con ordenador

This study analyses participants' preferences regarding three computeraided exposure treatments for fear of flying (FF): virtual reality exposure treatment assisted by a therapist (VRET), computer-aided exposure with a therapist present throughout exposure sessions (CAE-T), and self-administered computer-aided exposure (CAE-SA). Sixty participants with FF were randomly assigned to one of these treatments. At the end of a treatment, a demonstration of the other two treatment options was given and patients were asked to rate their preferences. At post-treatment, assessment data on treatment preferences were obtained from 48 participants (CAE-T n= 14; CAE-SA n= 16, and VRET n= 18). Participants favoured VRET as the most effective, the most recommended, but also they valued it as the most aversive. Attending to the specific treatment condition received by the participants, results showed that in VRET and CAE-T, participants assessed their own treatment as more preferred, more efficacious and more recommendable. Results suggest relevant features regarding the efficiency of computer-based treatments, and offer insights into improving computer-aided psychological interventions

Este estudio analiza las preferencias de los participantes sobre tres tratamientos de exposición basados en ordenador para el miedo a volar (MV): tratamiento de exposición mediante realidad virtual asistido por un terapeuta (RV), tratamiento de exposición asistido por ordenador con un terapeuta durante la exposición (CAFT-T) y tratamiento de exposición asistido por ordenador autoaplicado (CAFT-A). 60 participantes con MV fueron asignados aleatoriamente a uno de estos tratamientos. Al final del tratamiento, los participantes veían una demostración de las otras dos opciones y valoraban sus preferencias. En el posttratamiento, la evaluación de las preferencias se obtuvo para 48 participantes (CAFT-T n= 14; CAFT-A n= 16 y RV n= 18). Los participantes valoraron la RV como la más eficaz, más recomendada, pero también como la más aversiva. Atendiendo a la condición de tratamiento recibida, en las condiciones RV y CAFTT los participantes valoraron su propio tratamiento como el más preferido, más eficaz y más recomendable. Los resultados sugieren aspectos relevantes sobre la eficiencia de los tratamientos basados en ordenador y ofrecen ideas para mejorar las intervenciones psicológicas asistidas por ordenador

Heart rate complexity and attentional orienting: a new look at the role of vagal tone.

This study is aimed at elucidating (a) whether heart rate (HR) complexity measures are associated with the attentional orienting function, and (b) which of these measures better predicts orienting efficiency indexes. Vagal tone, sample entropy, scaling exponents ?1 and ?2, and fractal dimension (FD) were calculated in HR time series (n=109). Vagal tone, entropy, and FD were positively associated with orienting, while this association was negative for ?2. These results show that HR scaling properties, which underlie the role of vagal tone and reflect allometric control mechanisms, are associated with orienting deficits. FD was the best predictor of attentional orienting.

NO-FEAR Airlines: A Computer-aided Self-help Treatment for Flying Phobia.

In vivo exposure is the treatment of choice for specific phobias. However, this treatment is linked to a number of limitations in its implementation. Therefore, it is important to develop strategies for improving treatment adherence, acceptance, and dissemination of evidence-based treatments. Information and Communication Technologies, specifically, computerized programs boast advantages in treating flying phobia. NO-FEAR Airlines is a Computer-aided Self-help Treatment for this problem, which can be self-applied via Internet. NO-FEAR Airlines treatment protocol comprises three therapeutic components: psychoeducation, exposure and overlearning. Exposure is carried out through 6 scenarios that are composed by images and real sounds related to a flight in process. The aim of the present work is to describe NO-FEAR Airlines program.

Spontaneous emotion regulation and attentional control.

The current study aimed to explore whether self-reported attentional control (AC) and the attentional network functioning would predict spontaneous emotion downregulation after emotional induction. A total of 117 healthy volunteers were asked to continuously rate their discomfort while looking at affective pictures, as well as for a period of time after exposure. After controlling for trait anxiety, higher self-reported AC significantly predicted a greater spontaneous emotional downregulation after exposure to aversive pictures. Both higher self-reported AC and lower executive control network functioning (i.e., greater interference) predicted a faster spontaneous emotional downregulation after exposure to affectively neutral pictures. Results are discussed focusing on the relationship between AC and emotion regulation difficulties. (PsycINFO Database Record

Attentional control, attentional network functioning, and emotion regulation styles.

Attentional network functioning in emotionally neutral conditions and self-reported attentional control (AC) were analysed as predictors of the tendency to engage in dysfunctional emotion regulation strategies. Diminished attentional orienting predicted an increased tendency to engage in brooding rumination, and enhanced alertness predicted a greater chance of suppression, beyond trait anxiety and self-reported AC, which were not predictive of either rumination or suppression. This is the first study to show that some forms of dysfunctional emotion regulation are related to the attentional network functioning in emotionally neutral conditions. Results are discussed in relation to regulatory temperament and anxiety-related attentional biases literature.

The Effortful Control Scale for adults: psychometric properties of the Catalan version and its relationship to cognitive emotion regulation / La Escala de Control Intencional para adultos: propiedades psicométricas de la versión catalana y sus relaciones con la regulación emocional cognitiva

Los objetivos del estudio fueron (a) examinar las propiedades psicométricas de la versión catalana de la Escala de Control Intencional del Cuestionario de Temperamento en Adultos (forma breve) y (b) analizar las relaciones entre control intencional (CI), afectividad negativa (AN) y el uso de estrategias de regulación emocional (RE) cognitiva negativa. En una muestra de 353 estudiantes universitarios, el instrumento muestra unos niveles aceptables de consistencia interna, estabilidad temporal y validez convergente; sin embargo, sus propiedades psicométricas son menos satisfactorias que las que presentan otras versiones de este instrumento. Los índices de ajuste del análisis factorial confirmatorio revelan poca adecuación al modelo teórico de tres factores. Por otro lado, los resultados indican que la tendencia a implicarse en estrategias de RE cognitiva negativas está relacionada, principalmente, con la presencia de niveles elevados de AN. Además, aunque tales tendencias también están influenciadas por la capacidad de CI, los datos muestran que el CI no modera la relación entre AN, ansiedad y el uso de estrategias de RE cognitiva negativas (AU)

The goals of this study were (a) to examine the psychometric properties of a Catalan version of the Effortful control scale of the Adult Temperament Questionnaire short-form and (b) to analyze the relationships among effortful control (EC), negative affectivity (NA), and the use of negative cognitive emotion regulation (ER) strategies. In a sample of 353 college students, the instrument presents acceptable internal consistency, temporal stability and convergent validity; however, in general, psychometric properties are poorer than those reported for other versions. Confirmatory factor analysis fit indices revealed an overall poor fit for the three-factor theoretical model. Additionally, it has been found that the proneness to engage in negative cognitive ER strategies was mainly related with exhibiting high NA. Further, although such tendencies were also influenced by EC capabilities, data did not show EC moderating the relationships among NA, anxiety, and the use of negative cognitive ER strategies (AU)

Complexity of everyday life heart rate dynamics and attentional control in healthy students.

Effective regulation of emotions requires the ability to voluntarily manage attention, i.e. attentional control (AC), which has been related to heart rate variability and vagal tone in laboratory based research. In this study, we calculated the correlation dimension (CD), the fractal-like properties (scaling exponents ?1 and ?2, and fractal dimension) and the sample entropy of heart rate time series obtained from ECG recordings (4 hours long each) taken from a sample of healthy students (n=47) during everyday activities. AC was assessed through a self-reported questionnaire. As expected, a linear positive correlation was found between AC scores and CD and entropy, but no associations were found between AC and ?1 and fractal dimension. The association between AC and ?2 was negative and marginally significant. No associations were found between AC and linear heart rate variability measures. These results show that nonlinear measures of long, everyday life, heart rate time series may provide useful information about the AC ability of healthy students.

Resting parietal EEG asymmetry and cardiac vagal tone predict attentional control.

The present study explores both resting cortical EEG asymmetry and vagally-mediated heart rate variability (HRV), as an index for vagal tone, as physiological correlates of self-reported attentional control in a sample of 53 healthy young adults. Regression analyses indicate that higher vagally-mediated HRV and lower right-sided parietal activity in the ß2 frequency range (20-30Hz) are significant predictors of larger attentional control. Results are in line with some of the basic features of the neurovisceral integration model and stress the role of parietal areas in attentional control capabilities, thus aiming to consider attentional control as a trait-like disposition.