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1.
PLoS One ; 16(4): e0249765, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33852620

RESUMO

Humans need meaningful social interactions, but little is known about the consequences of not having them. We examined meaningful social interactions and the lack thereof in patients diagnosed with major depressive disorder (MDD) or social phobia (SP) and compared them to a control group (CG). Using event-sampling methodology, we sampled participants' everyday social behavior 6 times per day for 1 week in participants' natural environment. We investigated the quality and the proportion of meaningful social interactions (when they had meaningful social interactions) and degree of wishing for and avoidance of meaningful social interactions (when they did not have meaningful social interactions). Groups differed on the quality and avoidance of meaningful social interactions: Participants with MDD and SP reported perceiving their meaningful social interactions as lower quality (in terms of subjective meaningfulness) than the CG, with SP patients reporting even lower quality than the MDD patients. Further, both MDD and SP patients reported avoiding meaningful social interactions significantly more often than the CG. Although the proportion of meaningful social interactions was similar in all groups, the subjective quality of meaningful social interactions was perceived to be lower in MDD and SP patients. Future research might further identify what variables influenced the reinforcement of the MDD and SP patients so that they engaged in the same number of meaningful social interactions even though the quality of their meaningful social interactions was lower. Increasing awareness of what happens when patients do or do not have meaningful social interactions will help elucidate a potentially exacerbating or maintaining factor of the disorders.

2.
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.

3.
Global Health ; 17(1): 43, 2021 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-33832501

RESUMO

BACKGROUND: The negative impact of COVID-19 pandemic on public mental health can be persistent and substantial over a long period of time, but little is known regarding what psychological factors or processes can buffer such impact. The present study aimed to examine the mediating roles of coping, psychological flexibility and prosociality in the impacts of perceived illness threats toward COVID-19 on mental health. METHOD: Five-hundred and fourteen Hong Kong citizens (18 years or above) completed an online survey to measure illness perceptions toward COVID-19, coping, psychological flexibility, prosociality, and mental health, together with their socio-demographic variables. Structural equation modelling was used to explore the explanatory model that was the best-fit to illustrate the relationships between these constructs. RESULTS: Serial mediation structural equation model showed that only psychological flexibility (unstandardised beta coefficient, ß = - 0.12, 95% CI [- 0.20, - 0.02], p = 0.031) and prosociality (unstandardised ß = 0.04, 95% CI [0.01, 0.08], p = 0.001) fully mediated the relationship between illness perceptions toward COVID-19 and mental health. In addition, psychological flexibility exerted a direct effect on prosociality (standardised ß = 0.22, 95% CI [0.12, 0.32], p < 0.001). This best-fit model explained 62% of the variance of mental health. CONCLUSIONS: Fostering psychological flexibility and prosocial behaviour may play significant roles in mitigating the adverse effects of COVID-19 and its perceived threats on public mental health.


Assuntos
Adaptação Psicológica , Saúde Mental , Comportamento Social , Adolescente , Adulto , Estudos Transversais , Feminino , Hong Kong , Humanos , Masculino , Adulto Jovem
4.
Artigo em Inglês | MEDLINE | ID: mdl-33919888

RESUMO

This study aimed to compare the mediation of psychological flexibility, prosociality and coping in the impacts of illness perceptions toward COVID-19 on mental health among seven regions. Convenience sampled online survey was conducted between April and June 2020 from 9130 citizens in 21 countries. Illness perceptions toward COVID-19, psychological flexibility, prosociality, coping and mental health, socio-demographics, lockdown-related variables and COVID-19 status were assessed. Results showed that psychological flexibility was the only significant mediator in the relationship between illness perceptions toward COVID-19 and mental health across all regions (all ps = 0.001-0.021). Seeking social support was the significant mediator across subgroups (all ps range = <0.001-0.005) except from the Hong Kong sample (p = 0.06) and the North and South American sample (p = 0.53). No mediation was found for problem-solving (except from the Northern European sample, p = 0.009). Prosociality was the significant mediator in the Hong Kong sample (p = 0.016) and the Eastern European sample (p = 0.008). These findings indicate that fostering psychological flexibility may help to mitigate the adverse mental impacts of COVID-19 across regions. Roles of seeking social support, problem-solving and prosociality vary across regions.


Assuntos
Adaptação Psicológica , Controle de Doenças Transmissíveis , Hong Kong/epidemiologia , Humanos
5.
BMC Psychiatry ; 21(1): 165, 2021 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-33761921

RESUMO

BACKGROUND: Movement is a basic component of health. Little is known about the spatiotemporal movement of patients with mental disorders. The aim of this study was to determine how spatiotemporal movement of patients related to their symptoms and wellbeing. METHOD: A total of 106 patients (inpatients (n = 69) and outpatients (n = 37)) treated for a wide range of mental disorders (transdiagnostic sample) carried a GPS-enabled smartphone for one week at the beginning of treatment. Algorithms were applied to establish spatiotemporal clusters and subsequently related to known characteristics of these groups (i.e., at the hospital, at home). Symptomatology, Wellbeing, and Psychological flexibility were also assessed. RESULTS: Spatiotemporal patterns of inpatients and outpatients showed differences consistent with predictions (e.g., outpatients showed higher active areas). These patterns were largely unassociated with symptoms (except for agoraphobic symptoms). Greater movement and variety of movement were more predictive of wellbeing, however, in both inpatients and outpatients. CONCLUSION: Measuring spatiotemporal patterns is feasible, predictive of wellbeing, and may be a marker of patient functioning. Ethical issues of collecting GPS data are discussed.


Assuntos
Hospitais Psiquiátricos , Transtornos Mentais , Humanos , Pacientes Internados , Transtornos Mentais/terapia , Movimento , Pacientes Ambulatoriais
6.
Sci Rep ; 10(1): 21220, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33277579

RESUMO

The tension between selfishness and prosocial behavior is crucial to understanding many social interactions and conflicts. Currently little is known how to promote prosocial behaviors, especially in naturally occurring relationships outside the laboratory. We examined whether a psychological micro-intervention would promote prosocial behaviors in couples. Across two studies, we randomized dyads of couples to a micro-intervention (15 min), which increased prosocial behaviors by 28% and decreased selfish behaviors by 35% a week later in behavioral games in a dose-response manner. Using event sampling methodology, we further observed an increase in prosocial behaviors across one week that was most pronounced in participants who received the intervention. These results from the laboratory and everyday life are important for researchers interested in prosocial behavior and selfishness and have practical relevance for group interactions.

7.
Psychother Psychosom ; : 1-5, 2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33333528

RESUMO

INTRODUCTION: Stress and social isolation are potent predictors of negative health outcomes and are impacted in mood and anxiety disorders. Difficulties in social interactions have been particularly noted in people diagnosed with major depression disorder (MDD) and social phobia (SP). It remains poorly understood, however, how these variables interact on a moment-to-moment basis and which variables moderate this relationship. Psychological flexibility, or the ability to be open to experiences while maintaining engagement in valued activities, may help moderate the relationship between stress and social interaction. OBJECTIVE: This study examined these variables in participants diagnosed with MDD and SP and compared them to a control group. METHODS: Participants were diagnosed with a mental disorder (n = 118 MDD; n = 47 SP) or were in the control group consisting of participants without MDD or SP (n = 119). Using the event sampling methodology (ESM), participants were queried six times per day for 7 days about stress, social interactions, and emotional response (rigid vs. flexible). RESULTS: Higher current stress levels were related to more social interactions. This relationship was even stronger in situations when response flexibility was increased, especially in the clinical groups. CONCLUSIONS: Data suggest that a healthy psychological process (flexible emotional responding) buffers the relationship between stress and social interactions. We discuss how these variables interact and whether these patterns may paradoxically contribute to the maintenance of psychopathology.

8.
PLoS One ; 15(12): e0244809, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382859

RESUMO

BACKGROUND: The COVID-19 pandemic triggered vast governmental lockdowns. The impact of these lockdowns on mental health is inadequately understood. On the one hand such drastic changes in daily routines could be detrimental to mental health. On the other hand, it might not be experienced negatively, especially because the entire population was affected. METHODS: The aim of this study was to determine mental health outcomes during pandemic induced lockdowns and to examine known predictors of mental health outcomes. We therefore surveyed n = 9,565 people from 78 countries and 18 languages. Outcomes assessed were stress, depression, affect, and wellbeing. Predictors included country, sociodemographic factors, lockdown characteristics, social factors, and psychological factors. RESULTS: Results indicated that on average about 10% of the sample was languishing from low levels of mental health and about 50% had only moderate mental health. Importantly, three consistent predictors of mental health emerged: social support, education level, and psychologically flexible (vs. rigid) responding. Poorer outcomes were most strongly predicted by a worsening of finances and not having access to basic supplies. CONCLUSIONS: These results suggest that on whole, respondents were moderately mentally healthy at the time of a population-wide lockdown. The highest level of mental health difficulties were found in approximately 10% of the population. Findings suggest that public health initiatives should target people without social support and those whose finances worsen as a result of the lockdown. Interventions that promote psychological flexibility may mitigate the impact of the pandemic.


Assuntos
/epidemiologia , Saúde Mental , Pandemias , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
9.
Int. j. clin. health psychol. (Internet) ; 20(2): 91-99, mayo-ago. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-199088

RESUMO

BACKGROUND/OBJECTIVE: The manifestation of functional impairment in patients' daily lives and interference with things they value is poorly understood. If values are compromised in patients, as theory suggests, social contexts (and the lack thereof) are especially important - though this is currently unexplored. We therefore examined whether daily values-consistent behavior was associated with the importance of a value and whether it involved social or non-social activity. METHOD: Using Event Sampling Methodology, we examined daily values-consistent behavior in 57 transdiagnostic inpatients and 43 transdiagnostic outpatients at the beginning of treatment. Patients' values-consistent behavior, its importance, and (social vs non-social) context was sampled six times per day during a one-week intensive longitudinal examination. RESULTS: Across both groups, the probability of subsequent values-consistent behavior increased if (1) it was judged as more important by the patient or (2) if it was embedded in a social context. The probability of reporting values-consistent behavior was higher for outpatients than inpatients. CONCLUSIONS: Clinicians are encouraged to examine the values of their patients more closely and to especially monitor important and/or social values. Incorporating these into clinical work might increase patients' values-consistent behavior, which can play a role in reducing suffering


ANTECEDENTES/OBJETIVO: La interferencia funcional en la experiencia cotidiana y los valores personales de pacientes está insuficientemente estudiada. Si sus valores son perturbados, los contextos sociales -y su carencia- son especialmente importantes, pero esto permanece inexplorado. Examinamos si los comportamientos coherentes con los valores están asociados a la importancia acordada e implicación en actividades sociales/no sociales. MÉTODO: Se empleó metodología de muestreo de eventos para examinar la coherencia del comportamiento diario con los valores de 57 pacientes en clínica hospitalaria y 43 en clínica ambulatoria al comienzo de un tratamiento transdiagnóstico. A través de una investigación longitudinal intensiva durante siete días, el comportamiento coherente con los valores, su importancia y el contexto de la actividad en curso (social/no social) fueron muestreados seis veces por día. RESULTADOS: En ambos grupos, la probabilidad de comportamiento coherente con los valores aumentó cuando (1) este era considerado como más importante y (2) cuando este se produjo en un contexto social. La probabilidad de tal comportamiento fue mayor para los pacientes en tratamiento ambulatorio que para aquellos en tratamiento clínico. CONCLUSIONES: Se recomida explorar los valores de los pacientes, particularmente aquellos juzgados como más importantes y/o sociales. Su incorporación en la práctica clínica podría promover la coherencia entre valores y comportamientos subsecuentes


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Senso de Coerência , Valores Sociais , Pacientes Ambulatoriais/psicologia , Pacientes Internados/psicologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Estudos Longitudinais
10.
Int J Clin Health Psychol ; 20(2): 91-99, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32550848

RESUMO

Background/Objective: The manifestation of functional impairment in patients' daily lives and interference with things they value is poorly understood. If values are compromised in patients, as theory suggests, social contexts (and the lack thereof) are especially important - though this is currently unexplored. We therefore examined whether daily values-consistent behavior was associated with the importance of a value and whether it involved social or non-social activity. Method: Using Event Sampling Methodology, we examined daily values-consistent behavior in 57 transdiagnostic inpatients and 43 transdiagnostic outpatients at the beginning of treatment. Patients' values-consistent behavior, its importance, and (social vs non-social) context was sampled six times per day during a one-week intensive longitudinal examination. Results: Across both groups, the probability of subsequent values-consistent behavior increased if (1) it was judged as more important by the patient or (2) if it was embedded in a social context. The probability of reporting values-consistent behavior was higher for outpatients than inpatients. Conclusions: Clinicians are encouraged to examine the values of their patients more closely and to especially monitor important and/or social values. Incorporating these into clinical work might increase patients' values-consistent behavior, which can play a role in reducing suffering.

11.
Psychophysiology ; 57(5): e13551, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32072653

RESUMO

Wearable devices capable of capturing psychophysiological signals are popular. However, such devices have, yet, to be established in experimental and clinical research. This study, therefore, compared psychophysiological data (skin conductance level (SCL), heart rate (HR), and heart rate variability (HRV)) captured with a wearable device (Microsoft band 2) to those of a stationary device (Biopac MP150), in an experimental pain induction paradigm. Additionally, the present study aimed to compare two analytical techniques of HRV psychophysiological data: traditional (i.e., peaks are detected and manually checked) versus automated analysis using Python programs. Forty-three university students (86% female; Mage = 21.37 years) participated in the cold pressor pain induction task. Results showed that the majority of the correlations between the two devices for the mean HR were significant and strong (rs > .80) both during baseline and experimental phases. For the time-domain measure of mean RR (function of autonomic influences) of HRV, the correlations between the two devices at baseline were almost perfect (rs = .99), whereas at the experimental phase were significantly strong (rs > .74). However, no significant correlations were found for mean SCL (p> .05). Additionally, automated analysis led to similar features for HRV stationary data as the traditional analysis. Implications for data collection include the establishment of a methodology to compare stationary to mobile devices and a new, more cost efficient way of collecting psychophysiological data. Implications for data analysis include analyzing the data faster, with less effort and allowing for large amounts of data to be recorded.

12.
J Anxiety Disord ; 70: 102189, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32070861

RESUMO

OBJECTIVE: The study explored the duration and frequency of depersonalization (DP) and derealization (DR) in embarrassing social interactions in the everyday life of individuals with social phobia (SP), major depressive disorder (MDD) and controls. METHODS: Experience sampling was used (seven days, five surveys per day). A total of N = 165 patients (n = 47 SP, n = 118 MDD) and n = 119 controls were included. DP/DR were assessed whenever an interaction has been indicated as embarrassing. RESULTS: Individuals with SP and MDD experienced more embarrassing social interactions than controls and, accordingly, more DP/DR. The frequency of DP in embarrassing social interactions was, compared to controls, only significantly higher in MDD (no difference between SP and MDD). Regarding DR, there were no between-group differences. The groups also did not differ regarding duration of DP/DR. CONCLUSIONS: The study is the first to demonstrate in an ecologically valid manner that DP/DR regularly occur in relation to feelings of embarrassment in controls and in individuals suffering from SP or MDD. DP and DR might be responses to strong emotions, like embarrassment, or might be attempts at coping. The higher emergence of embarrassment itself might be viewed as an indicator of maladaptation. Treatment interventions correcting for these misinterpretations might reduce DP/DR.

13.
J Sleep Res ; 29(5): e12957, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-31850590

RESUMO

High stress levels can influence sleep quality negatively. If this also applies to anticipatory stress is poorly documented, however. Across insomnia severity levels, this study examined participants' evening levels of (a) anticipatory stress and (b) their skills hypothesized to downregulate the impact of stress, namely openness to internal experiences and continuous engagement in meaningful activities (openness and engagement) and their association with the quality of the subsequent night's sleep. The moderating role of insomnia severity was also tested. We used a quasi-experimental longitudinal design with Experience Sampling Method using smartphones over the course of 1 week (3,976 assessments; 93.2% of prompted queries). Participants recorded their sleep quality, anticipatory stress, and openness and engagement within their daily context. Participants included in the study were diagnosed with major depressive disorder (n = 118), social phobia (n = 47) or belonged to the control group (n = 119). Both anticipatory stress and openness and engagement predicted subsequent sleep quality. Diagnostic group was associated with overall sleep quality, but did not interact with the predictors. These findings were invariant across levels of self-reported insomnia severity. Furthermore, openness and engagement and anticipatory stress did not interact in their effect on sleep quality. The results suggest that both stress reduction and increased openness and engagement are associated with improved subjective sleep quality on a day to day basis, regardless of insomnia severity. Targeting these variables may help improve sleep quality. Future research should disentangle the effects of openness and engagement on anticipatory stress.

14.
Clin Psychol Rev ; 75: 101810, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31884147

RESUMO

BACKGROUND: Non-responsiveness to treatment occurs in approximately one third of patients. Randomized clinical trials of psychotherapy options for these patients are scarce and systematic knowledge about whether psychotherapy is a viable option is lacking. OBJECTIVES: This meta-analysis aimed to 1) determine the amount of evidence available for treatment non-response using psychotherapy relative to pharmacological procedures; 2) systematically review randomized controlled psychotherapy trials (RCTs) used to treat non-responders; and 3) examine whether some psychotherapies are more efficacious than others. DATA SOURCES: Online databases were systematically examined and references of relevant systematic reviews were hand-searched. STUDY ELIGIBILITY CRITERIA: RCTs that administered a psychotherapy new to non-responders were considered. All Mood and Anxiety Disorders were considered. No limitations were made with respect to type of treatment. REVIEW METHOD: A meta-analytic review of the psychotherapy RCTs for treatment non-responders. RESULTS: Results showed that psychotherapy was successful in treating treatment non-responders with a medium to large effect size. Between-group comparisons did not reveal significant differences in treatment effects for any of the assessed disorder or treatment types. Effects were maintained at follow-up. CONCLUSIONS: Psychotherapy is a viable treatment option for treatment non-responders. More attention to this group of patients is needed and more research with better quality studies is warranted. Recommendations are discussed.

15.
Memory ; 27(9): 1194-1203, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31311430

RESUMO

Psychological treatment and assessment necessarily rely on patients' recall. Yet several empirical studies have documented a gap between memory and real-life experience (i.e., memory-experience gap; MeG). We investigated and compared the MeG of sadness, social anxiety, happiness, and physical activity for participants diagnosed with a major depressive disorder (MDD), a social phobia (SP), and participants without such diagnoses (CG). The study included 118 participants diagnosed with a MDD, 47 with a SP, and 119 CG. Using event-sampling methods (ESM), participants were asked via smartphone to report their experiences throughout a week and then to recall those again retrospectively at the end of the study week. Results indicate significant differences in the MeG with respect to the experience that was salient to them (e.g., MDD group - sadness; SP group - social anxiety; CG group - happiness). Furthermore, all groups showed a MeG for physical activity and, the results indicate significant group differences in the magnitude of the MeGs. This study demonstrated the presence of a MeG in individuals in a MDD, SP, and CG group and in positive and negative affective experiences. Differential patterns across the samples contribute to a better understanding of this gap and its implications.


Assuntos
Transtorno Depressivo Maior/psicologia , Emoções , Exercício Físico/psicologia , Memória , Fobia Social/psicologia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Rememoração Mental , Pessoa de Meia-Idade , Adulto Jovem
16.
BMC Psychiatry ; 19(1): 173, 2019 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182051

RESUMO

BACKGROUND: Acceptance and Commitment Therapy (ACT) has been successfully established in hundreds of efficacy trials. It is less understood, however, how ACT works in real-world settings. Furthermore, little is known about how contextual variables such as treatment setting (inpatient vs. outpatient), social network and environment of the patient impact outcome. METHODS: This paper describes the methods of the Choose Change study that compares transdiagnostic inpatients (n = 85) and outpatients (n = 85) with varying degrees of treatment experience and treatment success (i.e., no previous treatment vs. previous remission vs. treatment-resistant). Patients received ACT during an intensive treatment phase lasting approximately twelve treatment sessions, and were accompanied up to twelve months following intensive treatment. Main outcomes include symptoms, functioning, and well-being. Multiple levels of data are investigated, including treatment context, weekly assessments, a behavioral approach test, multiple follow-up phases, and ambulatory assessment using Event Sampling Methodology, to examine patients' daily context. DISCUSSION: We aim to investigate antecedents, consequences, and inherent processes that contribute to the maintenance or fluctuations of psychological disorders and the efficacy of ACT treatment. Furthermore, this study intends to increase understanding of how accurately participants can report on their own experiences, in order to expand our knowledge of how to probe for such information in the future. The results of Choose Change will provide basic clinical theory and clinical care with important and meaningful insights into the effectiveness of ACT, trans diagnostically, in in- and outpatients, and in a naturalistic setting. TRIAL REGISTRATION: This study was retrospectively registered in the ISRCTN Registry (registration number ISRCTN11209732 ) on May 20th 2016.


Assuntos
Terapia de Aceitação e Compromisso/métodos , Transtornos Mentais/terapia , Adulto , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Resultado do Tratamento
17.
Transl Psychiatry ; 9(1): 75, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30718541

RESUMO

Preclinical studies point to a pivotal role of the orexin 1 (OX1) receptor in arousal and fear learning and therefore suggest the HCRTR1 gene as a prime candidate in panic disorder (PD) with/without agoraphobia (AG), PD/AG treatment response, and PD/AG-related intermediate phenotypes. Here, a multilevel approach was applied to test the non-synonymous HCRTR1 C/T Ile408Val gene variant (rs2271933) for association with PD/AG in two independent case-control samples (total n = 613 cases, 1839 healthy subjects), as an outcome predictor of a six-weeks exposure-based cognitive behavioral therapy (CBT) in PD/AG patients (n = 189), as well as with respect to agoraphobic cognitions (ACQ) (n = 483 patients, n = 2382 healthy subjects), fMRI alerting network activation in healthy subjects (n = 94), and a behavioral avoidance task in PD/AG pre- and post-CBT (n = 271). The HCRTR1 rs2271933 T allele was associated with PD/AG in both samples independently, and in their meta-analysis (p = 4.2 × 10-7), particularly in the female subsample (p = 9.8 × 10-9). T allele carriers displayed a significantly poorer CBT outcome (e.g., Hamilton anxiety rating scale: p = 7.5 × 10-4). The T allele count was linked to higher ACQ sores in PD/AG and healthy subjects, decreased inferior frontal gyrus and increased locus coeruleus activation in the alerting network. Finally, the T allele count was associated with increased pre-CBT exposure avoidance and autonomic arousal as well as decreased post-CBT improvement. In sum, the present results provide converging evidence for an involvement of HCRTR1 gene variation in the etiology of PD/AG and PD/AG-related traits as well as treatment response to CBT, supporting future therapeutic approaches targeting the orexin-related arousal system.


Assuntos
Agorafobia , Aprendizagem da Esquiva/fisiologia , Cérebro/fisiopatologia , Terapia Cognitivo-Comportamental , Medo/fisiologia , Receptores de Orexina/genética , Avaliação de Resultados em Cuidados de Saúde , Transtorno de Pânico , Adulto , Agorafobia/genética , Agorafobia/fisiopatologia , Agorafobia/terapia , Estudos de Casos e Controles , Cérebro/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/genética , Transtorno de Pânico/fisiopatologia , Transtorno de Pânico/terapia , Fenótipo , Adulto Jovem
18.
Psychother Res ; 29(4): 503-513, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-28965476

RESUMO

BACKGROUND AND OBJECTIVES: Acceptance and Commitment Therapy (ACT), a behavioral therapy that targets psychological flexibility (PF), has been shown to be efficacious across a wide range of problems, including chronic work-related stress and perceived stress. ACT's effect on the multiple levels of the acute stress response (i.e., subjective and biological) is less well understood. The aim of the current study was to test whether ACT, by working toward PF, would reduce both the endocrine and subjective evaluations of participants' acute stress response. METHODS: Participants (n = 35) were randomized to an ACT condition or waitlist (WL). Participants in the ACT condition received a two-day ACT workshop on how to flexibly deal with stress. All participants completed a standardized laboratory stress test. RESULTS: The ACT and WL groups did not differ on main comparisons of the endocrine response (i.e., cortisol) or subjective evaluation. Baseline levels of PF moderated some outcomes. Avoidant participants had a stronger endocrine stress reaction if they received the ACT intervention. LIMITATIONS: The control condition was a WL and not an active intervention comparison. CONCLUSIONS: ACT is not useful in reducing the acute stress response and may even be iatrogenic, at least during tasks with little real-world impact for their personal values. Clinical or methodological significance of this article: This was one of the first studies to investigate the impact of an ACT intervention on biological parameters. The short-term intervention did not attenuate acute endocrine stress levels or subjective stress appraisals. Future studies should investigate which interventions and under which conditions attenuate acute and long-term stress responses.


Assuntos
Terapia de Aceitação e Compromisso/métodos , Avaliação de Resultados em Cuidados de Saúde , Estresse Psicológico/metabolismo , Estresse Psicológico/fisiopatologia , Estresse Psicológico/terapia , Adulto , Feminino , Humanos , Hidrocortisona/metabolismo , Masculino , Listas de Espera , Adulto Jovem
19.
Health Psychol Rev ; 13(4): 490-503, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-29402185

RESUMO

Most health behaviour intervention efforts are adapted from the typical psychological treatment experience and may not take into serious consideration theories specifically developed to describe the process of adaptation to illness. This paper presents a proposal for the combination of a theory about the experience of and adaptation to illness, that is, the Common Sense Model of Self-Regulation (CSM), and an efficient psychological theory and therapy, Acceptance and Commitment Therapy (ACT). Past combinations of CSM with cognitive or cognitive-behavioural interventions have focussed almost only on specific aspects of this model (mostly, illness representations and action plans) and left out other, equally important for a fruitful adaptation to illness, recommendations of the model (e.g., regarding the system coherence). Therefore, the development of the proposed combination is to try to match a broad array of the CSM aspects with the principles, intervention techniques and methods employed by ACT, in order to produce a 'double-pillared' intervention strategy that may prove especially effective for promoting patients' adaptation to a chronic condition and enhancing their well-being and health.


Assuntos
Terapia de Aceitação e Compromisso , Doença Crônica/psicologia , Doença Crônica/terapia , Autocontrole , Adaptação Psicológica , Humanos , Modelos Psicológicos
20.
Int. j. clin. health psychol. (Internet) ; 18(3): 201-208, sept.-dic. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-182046

RESUMO

Background/Objective: Lower levels in well-being have been observed in individuals with Major Depression (MDD) and Social Phobia (SP), but well-planned direct comparisons with control individuals, not suffering from a mental disorder, are lacking. Furthermore, MDD is highly comorbid with anxiety disorders, and SP with depressive disorders. This study is among the first to examine differences in well-being in individuals with a clinical diagnosis of MDD or SP compared to individuals with no such diagnosis and to test differences in well-being within the combined diagnostic categories respective with and without anxiety-depressive comorbidity. Method: Participants were 119 individuals with a diagnosis of MDD, 47 SP and 118 controls. Results: Results revealed that overall well-being as well as emotional, psychological, and social well-being were lower in the MDD and SP group compared to the control group. Individuals with comorbidity reported lower well-being than individuals without comorbidity. Conclusions: These findings have clinical implications as presence of comorbidity may require a different therapeutic approach than with no comorbidity


Antecedentes/Objetivo: Se han observado niveles bajos de bienestar en individuos con depresión grave (DG) y fobia social (FS). Sin embargo, las comparaciones directas planificadas con individuos controles que no padecen ningún trastorno mental son escasas. Además, la DG se suele presentar con trastornos de ansiedad, y la FS con trastornos depresivos. Este estudio es uno de los primeros en examinar las diferencias entre el bienestar en individuos con un diagnóstico clínico de DG o FS, comparados con individuos sin dicho diagnóstico y en comprobar las diferencias de bienestar dentro de cada categoría de diagnóstico en realación a individuos con y sin comorbilidad. Método: Participaron 119 individuos con un diagnóstico de DG, con base en la SCID, 47 con FS y 118 controles. Resultados: Los resultados revelaron que el bienestar general, así como el bienestar emocional, psicológico y social eran inferiores en el grupo de DG y FS en comparación con el grupo control. Los individuos con comorbilidad informaron un menor bienestar que los individuos sin comorbilidad. Conclusiones: Estos resultados tienen repercusión clínica, pues la presencia de la comorbilidad puede requerir un acercamiento terapéutico diferente al de un único trastorno


Assuntos
Humanos , Masculino , Feminino , Adulto , Seguridade Social/psicologia , Depressão/psicologia , Fobia Social/psicologia , Diagnóstico Duplo (Psiquiatria) , Escalas de Graduação Psiquiátrica Breve , Estudos de Casos e Controles , Fatores Socioeconômicos
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