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1.
J Anxiety Disord ; 79: 102383, 2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33799142

RESUMO

Previous research has documented that fearful individuals avoid fear-relevant cues even if they incur costs in doing so. Paradigms that were previously used to study avoidance in the lab, manipulated reward contingencies in favor of selecting either fear-relevant or neutral cues, e.g., spiders versus butterflies. We, thus, developed a paradigm where the chance of monetary gains was linked with increasing probability of a fear-relevant or a neutral outcome. To this end, we modified the well-established Balloon Analogue Risk Task (BART) to include fear-relevant outcomes. Individuals with and without fear of spiders (N = 35) were offered the chance to inflate balloons, with more pumps resulting in larger gains. However, if the balloon exploded, this resulted in a loss of money - and at the same time in the presentation of a picture, either a fear-relevant spider or a neutral butterfly (emotional Balloon Analogue Risk Task; eBART). We operationalized risk aversion as the number of pumps and dysfunctionality of decision strategy as the amount of money that participants earned. In addition, decisional conflict was measured by response times for each decision. The data indicate, that spider-fearful individuals were generally more risk-averse and much more so in trials with fear-relevant stimuli as part of the negative outcome. Overall, this resulted in smaller amount of money that spider-fearful individuals earned compared to spider non-fearful individuals. Interestingly, spider-fearful compared to spider non-fearful individuals generally responded more hesitantly on all trials, and more so when they feared to encounter a spider. This research introduces a new paradigm and provides ecologically valid evidence for costly avoidance behavior in spider-fearful individuals. The eBART may be a promising new research tool to examine risk avoidance with emotionally relevant stimuli.

3.
Sci Rep ; 11(1): 7960, 2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846417

RESUMO

Theoretically, panic disorder and agoraphobia pathology can be conceptualized as a cascade of dynamically changing defensive responses to threat cues from inside the body. Guided by this trans-diagnostic model we tested the interaction between defensive activation and vagal control as a marker of prefrontal inhibition of subcortical defensive activation. We investigated ultra-short-term changes of vagally controlled high frequency heart rate variability (HRV) during a standardized threat challenge (entrapment) in n = 232 patients with panic disorder and agoraphobia, and its interaction with various indices of defensive activation. We found a strong inverse relationship between HRV and heart rate during threat, which was stronger at the beginning of exposure. Patients with a strong increase in heart rate showed a deactivation of prefrontal vagal control while patients showing less heart rate acceleration showed an increase in vagal control. Moreover, vagal control collapsed in case of imminent threat, i.e., when body symptoms increase and seem to get out of control. In these cases of defensive action patients either fled from the situation or experienced a panic attack. Active avoidance, panic attacks, and increased sympathetic arousal are associated with an inability to maintain vagal control over the heart suggesting that teaching such regulation strategies during exposure treatment might be helpful to keep prefrontal control, particularly during the transition zone from post-encounter to circa strike defense.Trial Registration Number: ISRCTN80046034.

4.
Eur J Neurosci ; 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33742482

RESUMO

Visual scene processing is modulated by semantic, motivational, and emotional factors, in addition to physical scene statistics. An open question is to what extent those factors affect low-level visual processing. One index of low-level visual processing is the contrast response function (CRF), representing the change in neural or psychophysical gain with increasing stimulus contrast. Here we aimed to (a) establish the use of an electrophysiological technique for assessing CRFs with complex emotional scenes and (b) examine the effects of motivational context and emotional content on CRFs elicited by naturalistic stimuli, including faces and complex scenes (humans, animals). Motivational context varied by expectancy of threat (a noxious noise) versus safety. CRFs were measured in 18 participants by means of sweep steady-state visual evoked potentials. Results showed a facilitation in visuocortical sensitivity (contrast gain) under threat, compared with safe conditions, across all stimulus categories. Facial stimuli prompted heightened neural response gain, compared with scenes. Within the scenes, response gain was smaller for scenes high in emotional arousal, compared with low-arousing scenes, consistent with interference effects of emotional content. These findings support the notion that motivational context alters the contrast sensitivity of cortical tissue, differing from changes in response gain (activation) when visual cues themselves carry motivational/affective relevance.

5.
Cogn Emot ; : 1-16, 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33761825

RESUMO

Decoding someone's facial expressions provides insights into his or her emotional experience. Recently, Automatic Facial Coding (AFC) software has been developed to provide measurements of emotional facial expressions. Previous studies provided first evidence for the sensitivity of such systems to detect facial responses in study participants. In the present experiment, we set out to generalise these results to affective responses as they can occur in variable social interactions. Thus, we presented facial expressions (happy, neutral, angry) and instructed participants (N = 64) to either actively mimic, to look at them passively (n = 21), or to inhibit their own facial reaction (n = 22). A video stream for AFC and an electromyogram (EMG) of the zygomaticus and corrugator muscles were registered continuously. In the mimicking condition, both AFC and EMG differentiated well between facial expressions in response to the different emotional pictures. In the passive viewing and in the inhibition condition AFC did not detect changes in facial expressions whereas EMG was still highly sensitive. Although only EMG is sensitive when participants intend to conceal their facial reactions, these data extend previous findings that Automatic Facial Coding is a promising tool for the detection of intense facial reaction.

6.
Med Decis Making ; : 272989X211004147, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33783266

RESUMO

OBJECTIVE: The COVID-19 pandemic pushed some of the most well-developed health care systems to their limits. In many cases, this has challenged patient-centered care. We set out to examine individuals' attitudes toward shared decision making (SDM) and to identify predictors of participation preference during the pandemic. METHODS: We conducted an online survey with a large convenience sample (N = 1061). Our main measures of interest were participants' generic and COVID-19-related participation preference as well as their acceptance and distress regarding a triage vignette. We also assessed anxiety, e-health literacy, and aspects of participants' health. We conducted group comparisons and multiple linear regression analyses on participation preference as well as triage acceptance. RESULTS: In generic decision making, most participants expressed a strong need for information and a moderate participation preference. In the hypothetical case of COVID-19 infection, most preferred physician-led decisions. Generic participation preference was the strongest predictor of COVID-19-related participation preference, followed by age, education, and anxiety. Furthermore, both higher generic and COVID-19-related participation preferences predicted lower triage acceptance. CONCLUSION: Our findings demonstrate potential health care recipients' attitudes toward SDM during a severe health care crisis and emphasize that participation preference varies according to the context.

7.
Eur Neuropsychopharmacol ; 44: 105-120, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33483252

RESUMO

There is a recurring debate on the role of the serotonin transporter gene linked polymorphic region (5-HTTLPR) in the moderation of response to cognitive behavioral therapy (CBT) in anxiety disorders. Results, however, are still inconclusive. We here aim to perform a meta-analysis on the role of 5-HTTLPR in the moderation of CBT outcome in anxiety disorders. We investigated both categorical (symptom reduction of at least 50%) and dimensional outcomes from baseline to post-treatment and follow-up. Original data were obtained from ten independent samples (including three unpublished samples) with a total of 2,195 patients with primary anxiety disorder. No significant effects of 5-HTTLPR genotype on categorical or dimensional outcomes at post and follow-up were detected. We conclude that current evidence does not support the hypothesis of 5-HTTLPR as a moderator of treatment outcome for CBT in anxiety disorders. Future research should address whether other factors such as long-term changes or epigenetic processes may explain further variance in these complex gene-environment interactions and molecular-genetic pathways that may confer behavioral change following psychotherapy.

8.
Urologe A ; 60(1): 45-51, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33331963

RESUMO

Patient empowerment includes measures that promote their autonomy and self-determination in the physician-patient relationship. In addition to successful medical treatment, goals include long-term treatment satisfaction and the best possible quality of life for the patients and their social environment. Various initiatives and projects from German urology are already used to empower our patients. Entscheidungshilfe Prostatakrebs (decision aid for prostate cancer) and the German language decision aid for advanced bladder cancer and for the choice of urinary diversion are implemented under the umbrella of the PatientenAkademie (patient academy) of German Urologists. With more than 12,000 users, Entscheidungshilfe Prostatakrebs is very well established in urological care in Germany. The randomized evaluation study with planned 1200 participants is close to the successful completion of recruitment. Another project from the German urology sector is the project "antiCoagulation Help App for SurgERy" (CHASER). The aim is to develop a smartphone-based decision aid for the perioperative management of patients undergoing antithrombotic therapy. Online support groups can also contribute to empowerment and have been analyzed systematically for prostate cancer patients. A large randomized study on this topic is currently in preparation. Continuing advances in digitalization can thus provide us with useful support in order to provide individual information to our patients. The German Urological Association and its PatientenAkademie have been committed to this for many years.


Assuntos
Urologia , Alemanha , Humanos , Masculino , Participação do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Urologistas
9.
Patient Educ Couns ; 2020 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-33248869

RESUMO

OBJECTIVES: Emotional distress can be a potential barrier to shared decision making (SDM), yet affect is typically not systematically assessed in medical consultation. We examined whether urological patients report anxiety or depression prior to a consultation and if emotional distress predicts decisional conflict thereafter. METHODS: We recruited a large sample of urological outpatients (N = 397) with a range of different diagnoses (42 % oncological). Prior to a medical consultation, patients filled in questionnaires, including the Hospital Anxiety and Depression Scale. After the consultation, patients completed the Decisional Conflict Scale. We scored the rate of anxiety and depression in our sample and conducted multiple regression analysis to examine if emotional distress before the consultation predicts decisional conflict thereafter. RESULTS: About a quarter of patients reported values at or above cut-off for clinically relevant emotional distress. Emotional distress significantly predicted a higher degree of decisional conflict. There were no differences in emotional distress between patients with and without uro-oncological diagnosis. CONCLUSIONS: Emotional distress is common in urology patients - oncological as well as non-oncological. It predicts decisional conflict after physician consultation. PRACTICE IMPLICATIONS: Emotional distress should be systematically assessed in clinical consultations. This may improve the process and outcome of SDM.

10.
Front Psychol ; 11: 567905, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33224060

RESUMO

In the ongoing coronavirus disease 2019 (COVID-19) pandemic, media reports have caused anxiety and distress in many. In some individuals, feeling distressed by information may lead to avoidance of information, which has been shown to undermine compliance with preventive health behaviors in many health domains (e.g., cancer screenings). We set out to examine whether feeling distressed by information predicts higher avoidance of information about COVID-19 (avoidance hypothesis), and whether this, in turn, predicts worse compliance with measures intended to prevent the spread of COVID-19 (compliance hypothesis). Thus, we conducted an online survey with a convenience sample (N = 1,059, 79.4% female) and assessed distress by information, information avoidance, and compliance with preventive measures. Furthermore, we inquired about participants' information seeking behavior and media usage, their trust in information sources, and level of eHealth literacy, as well as generalized anxiety. We conducted multiple linear regression analyses to predict distress by information, information avoidance, and compliance with preventive measures. Overall, distress by information was associated with better compliance. However, distress was also linked with an increased tendency to avoid information (avoidance hypothesis), and this reduced compliance with preventive measures (compliance hypothesis). Thus, distress may generally induce adaptive behavior in support of crisis management, unless individuals respond to it by avoiding information. These findings provide insights into the consequences of distress by information and avoidance of information during a global health crisis. These results underscore that avoiding information is a maladaptive response to distress by information, which may ultimately interfere with effective crisis management. Consequently, we emphasize the need to develop measures to counteract information avoidance.

11.
Cortex ; 131: 164-178, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32866901

RESUMO

The face of a friend indicates safety, the face of a foe can indicate threat. Here, we examine the effects of verbal instructions ('beware of this person') on the perception of unknown persons. Focusing on visual attention, face identity and facial expression information is examined during instructed threat-of-shock or safety. However, shocks never occurred. Participants quickly acquired instructed threat associations, and electrocortical processing differentiated threat- from safe-identities as well as emotional and neutral facial expressions. Importantly, face encoding varied as a joint function of identity and facial expression, as revealed by pronounced N170 amplitudes to smiling threat-identities. Moreover, instructions readily reversed previously learned affective associations leading to attention allocation and memory updating as reflected by N170, EPN and P3 amplitudes toward new threat-identities displaying angry expressions. These findings demonstrate that person perception flexibly re-adjusts according to minimal information. Intriguingly, perceptual biases occur even though the anticipated aversive consequence does not occur, with implications for research on stereotyping and anxious psychopathology.

12.
Front Psychol ; 11: 1388, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32636788

RESUMO

Facial expressions provide insight into a person's emotional experience. To automatically decode these expressions has been made possible by tremendous progress in the field of computer vision. Researchers are now able to decode emotional facial expressions with impressive accuracy in standardized images of prototypical basic emotions. We tested the sensitivity of a well-established automatic facial coding software program to detect spontaneous emotional reactions in individuals responding to emotional pictures. We compared automatically generated scores for valence and arousal of the Facereader (FR; Noldus Information Technology) with the current psychophysiological gold standard of measuring emotional valence (Facial Electromyography, EMG) and arousal (Skin Conductance, SC). We recorded physiological and behavioral measurements of 43 healthy participants while they looked at pleasant, unpleasant, or neutral scenes. When viewing pleasant pictures, FR Valence and EMG were both comparably sensitive. However, for unpleasant pictures, FR Valence showed an expected negative shift, but the signal differentiated not well between responses to neutral and unpleasant stimuli, that were distinguishable with EMG. Furthermore, FR Arousal values had a stronger correlation with self-reported valence than with arousal while SC was sensitive and specifically associated with self-reported arousal. This is the first study to systematically compare FR measurement of spontaneous emotional reactions to standardized emotional images with established psychophysiological measurement tools. This novel technology has yet to make strides to surpass the sensitivity of established psychophysiological measures. However, it provides a promising new measurement technique for non-contact assessment of emotional responses.

13.
J Neural Transm (Vienna) ; 127(11): 1527-1537, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32468273

RESUMO

While DNA methylation patterns have been studied for a role in the pathogenesis of anxiety disorders, the role of the enzymes establishing DNA methylation-DNA methyltransferases (DNMTs)-has yet to be investigated. In an effort to investigate DNMT genotype-specific effects on dimensional anxiety traits in addition to the categorical phenotype of panic disorder, 506 panic disorder patients and 3112 healthy participants were assessed for anxiety related cognition [Agoraphobic Cognitions Questionnaire (ACQ)], anxiety sensitivity [Anxiety Sensitivity Index (ASI)] as well as pathological worry [Penn State Worry Questionnaire (PSWQ)] and genotyped for five single nucleotide polymorphisms (SNPs) in the DNMT3A (rs11683424, rs1465764, rs1465825) and DNMT3B (rs2424932, rs4911259) genes, which have previously been found associated with clinical and trait-related phenotypes. There was no association with the categorical phenotype panic disorder. However, a significant association was discerned between DNMT3A rs1465764 and PSWQ scores in healthy participants, with the minor allele conveying a protective effect. In addition, a marginally significant association between questionnaire scores (PSWQ, ASI) in healthy participants and DNMT3B rs2424932 was detected, again with the minor allele conveying a protective effect. The present results suggest a possible minor role of DNMT3A and DNMT3B gene variation in conveying resilience towards anxiety disorders. As the observed associations indicated a protective effect of two SNPs particularly with pathological worry, future studies are proposed to explore these variants in generalized anxiety disorder rather than panic disorder.

14.
Emotion ; 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32191086

RESUMO

For the realm of visual cues, it has been well documented that attention is preferentially oriented toward emotionally relevant cues. Preliminary evidence suggests that emotional cues from other sensory modalities may also steer visual attention toward emotional pictures. However, more research is needed to elucidate the mechanisms that are involved. Therefore, a novel design was used to investigate whether emotional sounds promote attentional orientation toward emotional pictures. To this end, 48 participants viewed pairs of pictures with either neutral or unpleasant content in a free-viewing paradigm. In addition, neutral or unpleasant sounds were presented either on the left-hand or on the right-hand side of the monitor. Eye movements were recorded as an index of visual spatial attention toward the pictures. Most interestingly, position and valence of the sounds independently modulated visual orienting towards unpleasant pictures. For initial capture and sustained attention, orienting towards unpleasant pictures was significantly enhanced when any sound was heard on the same side as the unpleasant picture. In addition, unpleasant sounds (irrespective of the side) boosted leftward bias of initial attention toward emotionally congruent pictures. Taken together, this study clearly shows that emotional auditory cues guide visual spatial allocation of attention specifically to emotionally congruent pictures. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

15.
Emotion ; 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31829719

RESUMO

Anxiety can boost the detection of potential threats in many ways. There is evidence that one and the same facial expression can be perceived differently depending on whether it is seen in a neutral or in a threatening situation. The present study investigated how aversive anticipation influences the accuracy of facial emotion recognition and the perceived emotional intensity of faces that had their objective emotional intensity manipulated. Forty-three participants categorized and rated the intensity of morphed faces (20%, 40%, 60%, and 80%) of fearful, angry, and happy expressions. Differently colored picture frames indicated either threat of electric shock or safety. Threat of shock enhanced the categorization accuracy specifically for fearful faces. During threat, 80% fearful and happy faces, and all levels of angry faces (20%-80%) were rated as more intense. In addition, we found that more trait-anxious individuals more frequently erroneously categorized neutral faces as fearful. Thus, state anxiety enhanced accurate fear categorization and boosted the perceived intensity of emotional faces, whereas trait anxiety led to a biased threat perception in nonthreatening faces. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

16.
Mol Psychiatry ; 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31712720

RESUMO

Panic disorder (PD) has a lifetime prevalence of 2-4% and heritability estimates of 40%. The contributory genetic variants remain largely unknown, with few and inconsistent loci having been reported. The present report describes the largest genome-wide association study (GWAS) of PD to date comprising genome-wide genotype data of 2248 clinically well-characterized PD patients and 7992 ethnically matched controls. The samples originated from four European countries (Denmark, Estonia, Germany, and Sweden). Standard GWAS quality control procedures were conducted on each individual dataset, and imputation was performed using the 1000 Genomes Project reference panel. A meta-analysis was then performed using the Ricopili pipeline. No genome-wide significant locus was identified. Leave-one-out analyses generated highly significant polygenic risk scores (PRS) (explained variance of up to 2.6%). Linkage disequilibrium (LD) score regression analysis of the GWAS data showed that the estimated heritability for PD was 28.0-34.2%. After correction for multiple testing, a significant genetic correlation was found between PD and major depressive disorder, depressive symptoms, and neuroticism. A total of 255 single-nucleotide polymorphisms (SNPs) with p < 1 × 10-4 were followed up in an independent sample of 2408 PD patients and 228,470 controls from Denmark, Iceland and the Netherlands. In the combined analysis, SNP rs144783209 showed the strongest association with PD (pcomb = 3.10 × 10-7). Sign tests revealed a significant enrichment of SNPs with a discovery p-value of <0.0001 in the combined follow up cohort (p = 0.048). The present integrative analysis represents a major step towards the elucidation of the genetic susceptibility to PD.

17.
BMC Health Serv Res ; 19(1): 556, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399089

RESUMO

BACKGROUND: Employees insured in pension insurance, who are incapable of working due to ill health, are entitled to a disability pension. To assess whether an individual meets the medical requirements to be considered as disabled, a work capacity evaluation is conducted. However, there are no official guidelines on how to perform an external quality assurance for this evaluation process. Furthermore, the quality of medical reports in the field of insurance medicine can vary substantially, and systematic evaluations are scarce. Reliability studies using peer review have repeatedly shown insufficient ability to distinguish between high, moderate and low quality. Considering literature recommendations, we developed an instrument to examine the quality of medical experts' reports. METHODS: The peer review manual developed contains six quality domains (formal structure, clarity, transparency, completeness, medical-scientific principles, and efficiency) comprising 22 items. In addition, a superordinate criterion (survey confirmability) rank the overall quality and usefulness of a report. This criterion evaluates problems of inner logic and reasoning. Development of the manual was assisted by experienced physicians in a pre-test. We examined the observable variance in peer judgements and reliability as the most important outcome criteria. To evaluate inter-rater reliability, 20 anonymous experts' reports detailing the work capacity evaluation were reviewed by 19 trained raters (peers). Percentage agreement and Kendall's W, a reliability measure of concordance between two or more peers, were calculated. A total of 325 reviews were conducted. RESULTS: Agreement of peer judgements with respect to the superordinate criterion ranged from 29.2 to 87.5%. Kendall's W for the quality domain items varied greatly, ranging from 0.09 to 0.88. With respect to the superordinate criterion, Kendall's W was 0.39, which indicates fair agreement. The results of the percentage agreement revealed systemic peer preferences for certain deficit scale categories. CONCLUSION: The superordinate criterion was not sufficiently reliable. However, in comparison to other reliability studies, this criterion showed an equivalent reliability value. This report aims to encourage further efforts to improve evaluation instruments. To reduce disagreement between peer judgments, we propose the revision of the peer review instrument and the development and implementation of a standardized rater training to improve reliability.


Assuntos
Revisão por Pares/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Avaliação da Capacidade de Trabalho , Avaliação da Deficiência , Humanos , Pensões , Reprodutibilidade dos Testes
18.
Front Psychol ; 10: 1676, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31417450

RESUMO

Although it is an adaptive mechanism that danger usually elicits fear, it seems that fearful individuals overestimate the danger associated with their feared objects or situations. Previous research has not systematically distinguished between the estimated risk of an encounter with fear-relevant stimuli and the expected unpleasant outcomes of such encounters. Furthermore, it is not clear if biased risk perception is specific to an individual's fear or generalized to all negative events. In an online-survey (N = 630) we assessed the estimated risk to encounter fear-relevant stimuli and the expectations of negative outcomes of such encounters. Items contained three domains (spiders, snakes, and everyday fear triggers). In regression analyses we examined the specific associations between fear and risk estimations. In addition, we compared subgroups with specific fears and low fearful individuals. While an individual's fear score was not related to the estimated risk of an encounter with fear-specific stimuli, it was related to an overestimation of negative outcomes in all domains. The perceived risk of aversive outcomes was most pronounced for an individual's specific fear. Furthermore, an individual's specific fear was most predictive of the estimated risk of a negative fear-relevant outcome. Highly fearful individuals overestimate the risk of negative outcomes of fear-relevant encounters. Specifically, they dread outcomes of encounters with their feared object. Differentiating fear-relevant components of risk perception provides insights into the cognitions which may motivate maladaptive avoidance behavior.

19.
Front Psychol ; 10: 1272, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249540

RESUMO

The peak-end memory bias has been well documented for the retrospective evaluation of pain. It describes that the retrospective evaluation of pain is largely based on the discomfort experienced at the most intense point (peak) and at the end of the episode. This is notable because it means that longer episodes with a better ending can be remembered as less aversive than shorter ones; this is even if the former had the same peak in painfulness and an overall longer duration of pain. Until now, this bias has not been studied in the domain of anxiety despite the high relevance of variable levels of anxiety in the treatment of anxiety disorders. Therefore, we set out to replicate the original studies but with an induction of variable levels of anxiety. Of 64 women, half watched a clip from a horror movie which ended at the most frightening moment. The other half watched an extended version of this clip with a moderately frightening ending. Afterward, all participants were asked to rate the global anxiety which was elicited by the video. When the film ended at the most frightening moment, participants retrospectively reported more anxiety than participants who watched the extended version. This is the first study to document that the peak-end bias can be found in the domain of anxiety. These findings require replication and extension to a treatment context to evaluate its implications for exposure therapy.

20.
Transl Psychiatry ; 9(1): 150, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31123309

RESUMO

Major depressive disorder and the anxiety disorders are highly prevalent, disabling and moderately heritable. Depression and anxiety are also highly comorbid and have a strong genetic correlation (rg ≈ 1). Cognitive behavioural therapy is a leading evidence-based treatment but has variable outcomes. Currently, there are no strong predictors of outcome. Therapygenetics research aims to identify genetic predictors of prognosis following therapy. We performed genome-wide association meta-analyses of symptoms following cognitive behavioural therapy in adults with anxiety disorders (n = 972), adults with major depressive disorder (n = 832) and children with anxiety disorders (n = 920; meta-analysis n = 2724). We estimated the variance in therapy outcomes that could be explained by common genetic variants (h2SNP) and polygenic scoring was used to examine genetic associations between therapy outcomes and psychopathology, personality and learning. No single nucleotide polymorphisms were strongly associated with treatment outcomes. No significant estimate of h2SNP could be obtained, suggesting the heritability of therapy outcome is smaller than our analysis was powered to detect. Polygenic scoring failed to detect genetic overlap between therapy outcome and psychopathology, personality or learning. This study is the largest therapygenetics study to date. Results are consistent with previous, similarly powered genome-wide association studies of complex traits.


Assuntos
Transtornos de Ansiedade/genética , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Transtorno Depressivo Maior/genética , Transtorno Depressivo Maior/terapia , Estudo de Associação Genômica Ampla/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Adulto , Criança , Humanos
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