Treatment fears in anxiety disorders: development and validation of the treatment ambivalence questionnaire.

OBJECTIVES: There are a number of effective psychological interventions for anxiety disorders. Anecdotal and empirical evidence indicates that clients are often highly apprehensive about commencing therapy. However, to date, there have been no empirical studies of the content of individuals' fears about beginning a psychological treatment for anxiety problems. Here we describe the development and initial validation of the Treatment Ambivalence Questionnaire (TAQ), a 30-item self-report measure of concerns about commencing psychological treatment for anxiety. METHODS: Participants were a large group of individuals with a principal diagnosis of an anxiety disorder who were referred to a specialty anxiety disorders clinic. Participants completed the TAQ as well as several general self-report instruments before commencing treatment. RESULTS: The TAQ exhibited good internal consistency and, based on exploratory factor analyses, the items yielded three subscales: (a) fears of the personal consequences of engaging in treatment (e.g., personality change), (b) fears of negative or adverse reactions to treatment (e.g., not getting better), and (c) concerns about the inconvenience of engaging in treatment (e.g., treatment will be time-consuming). Confirmatory factor analysis supported this factor structure. Scores on the TAQ did not simply represent general symptom severity or distress. Preliminary data on the relation of TAQ scores to treatment outcome suggested either no relationship or a small relationship. CONCLUSION: The TAQ may be a useful means of normalizing treatment fears, identifying and addressing specific fears, and identifying people who may benefit from treatment readiness interventions.

Posttraumatic stress disorder treatment preference: Prolonged exposure therapy, cognitive processing therapy, or medication therapy?

To investigate preferences for evidence-based treatments for posttraumatic stress disorder (PTSD) and the role of likely PTSD in those preferences. Undergraduate students (N = 119) and participants recruited from trauma support groups (N = 126) read descriptions of front-line recommended treatments for PTSD, including prolonged exposure therapy (PE), cognitive-processing therapy (CPT), and medication therapy (MT). Participants selected their treatment of choice and provided ratings of the credibility and their personal reactions to each treatment. Participants generally preferred psychotherapeutic treatments (CPT and PE) over MT, and this finding persisted when considering likely PTSD. Trauma support group participants and students with no likely PTSD showed preference towards CPT over PE, and students with likely PTSD preferred both CPT and PE over MT. In both groups, credibility and personal reaction ratings were also generally higher for the psychotherapeutic treatments than MT, with the highest ratings of credibility and personal reactions for CPT. There was a significant interaction between treatment type and likely PTSD for credibility and personal reaction ratings among students, such that students with likely PTSD had lower credibility and personal reaction ratings to MT. Determining preference for PTSD treatment has important implications for maximizing treatment efficacy, adherence, and engagement. Our results indicate that individuals generally prefer psychotherapeutic treatments, highlighting the need to increase the availability and utilization of evidence-based psychotherapeutic treatments for PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Knowledge gained from the Brief Traumatic Brain Injury Screen--implications for treating Canadian military personnel.

OBJECTIVE: To compare physical and mental health outcomes of Canadian military personnel with probable mild traumatic brain injury (mTBI) to outcomes of those without and to report implications for collaboration and treatment. METHODS: One hundred forty-seven soldiers attending the Operational Stress Injury Clinic at Parkwood Hospital, London, Ontario, were screened for mTBI and completed several other measures of mental and physical health. Scores from these measures were compared across two groups (positive vs. negative screens for mTBI) using an independent samples t-test. RESULTS: Thirty-four of 147 participants screened positively for mTBI. Soldiers with probable mTBI were more likely to have poorer physical health but were less likely to engage in problem drinking than those who screened negatively for mTBI. CONCLUSIONS: In this initial study, we found that the wide range of physical and mental health difficulties experienced by Canadian military personnel with probable mTBI necessitates an interdisciplinary collaborative care model.

Pregnancy enhances sustained Ca2+ bursts and endothelial nitric oxide synthase activation in ovine uterine artery endothelial cells through increased connexin 43 function.

Endothelium-mediated vasodilation is specifically enhanced in uterine circulation during pregnancy, and production of nitric oxide (NO) is increased in response to a wide array of agonists. Uterine artery endothelial cells from nonpregnant (NP-UAECs) or pregnant (P-UAECs) ewes maintained in culture still show a pregnancy-enhanced difference in ATP-stimulated endothelial NO synthase (eNOS; official symbol NOS3) activation, even though NOS3 protein, purinergic receptors, and associated cell signaling proteins are expressed at equal levels. We have also shown that the pregnancy-enhanced endothelial cell NO response to ATP requires an enhanced and sustained capacitative entry phase that is likely mediated via canonical transient receptor potential protein/inositol 1,4,5-trisphosphate receptor type 2 interaction. In this study, we now show by simultaneous video imaging of individual Fura-2-loaded cells that the pregnancy-enhanced capacitative entry phase is not continuous and equal in all cells, but is in fact mediated as a series of periodic [Ca(2+)](i) bursts within individual cells. Not only does pregnancy increase the number of bursts over a longer time period in individual cells, but also a greater proportion of cells exhibit this burst activity, and at high cell density this occurs in a synchronous manner. The mediator of cell synchronization is connexin 43 (Cx43) gap junctions because 1) Cx43 is readily detectable by Western blot analysis in UAECs, whereas Cx40 and Cx37 are weakly detected or absent, and 2) pregnancy-specific enhancement of [Ca(2+)](i) bursts by ATP is blocked by inhibitory loop peptides selective to Cx43 ((43,37)GAP27) but not by a scrambled control peptide or (40)GAP27 or (40,37)GAP26 peptides, which are specific to Cx40 or Cx37. The relationship between Ca(2+) bursts and NOS3 activation is further established by the finding that (43,37)GAP27 inhibits ATP-stimulated NOS3 activation but has no effect on cell mitogenesis. We conclude that it is pregnancy-enhanced gap junction communication between cells that underlies pregnancy enhancement of capacitative entry via TRPC3 and, in turn, NOS3 activation. Such improved gap junction function allows greater and more sustained [Ca(2+)](i) responses to agents such as ATP within a single cell, as well as the additional recruitment of greater numbers of cells to the response in a coordinated and synchronous manner to support enhanced NO production.

Pregnancy-enhanced Ca2+ responses to ATP in uterine artery endothelial cells is due to greater capacitative Ca2+ entry rather than altered receptor coupling.

Uterine artery endothelial cells (UAEC) derived from pregnant (P-UAEC) and nonpregnant (NP-UAEC) ewes retain pregnancy-specific differences in cell signaling as well as vasodilator production through passage 4. In particular, when P- and NP-UAEC are stimulated with ATP over a 2.5 min recording period, they exhibit similar initial transient peaks in the intracellular free Ca(2+) concentration ([Ca(2+)](i)), but the P-UAEC show a heightened sustained phase. In order to establish whether this was due to an altered subclass of purinergic receptor (P2), both the dose dependency of [Ca(2+)](i) responses to ADP and UTP and the profile of purinergic receptor expression are determined in NP- and P-UAEC. Our findings indicate that while several isoforms of P2X and P2Y receptors are present, it is P2Y2 that is responsible for the ATP-induced initial transient peak in both cell types. We also characterized several key components of the ATP-induced Ca(2+) signaling cascade, including the inositol 1,4,5-trisphosphate receptor and G-proteins, but could not confirm any pregnancy-specific variation in the protein expression that correlated with pregnancy-specific differences in prolonged Ca(2+) signaling. We thus investigated whether such a difference may be inherent to the cell itself rather than specific to the purinergic receptor-signaling pathway. Using thapsigargin (Tg), we were able to demonstrate that the initial Tg-sensitive intracellular pool of Ca(2+)is nearly identical with the capacity in both cell types, but the P-UAEC is nonetheless capable of greater capacitative Ca(2+) entry (CCE) than NP-UAEC. Furthermore, CCE induced by Tg could be dramatically inhibited by 2-aminoethoxydiphenyl borate, suggesting a role for store-operated channels in the ATP-induced [Ca(2+)](i) response. We conclude that changes at the level of capacitative entry mechanisms rather than switching of receptor subtype or coupling to phospholipase C underlies pregnancy adaptation of UAEC at the level of Ca(2+)signaling.

Pregnancy-enhanced store-operated Ca2+ channel function in uterine artery endothelial cells is associated with enhanced agonist-specific transient receptor potential channel 3-inositol 1,4,5-trisphosphate receptor 2 interaction.

We have previously shown that endothelial cells (EC) derived from the uterine artery (UA) of both pregnant (P-UAEC) and nonpregnant (NP-UAEC) ewes show a biphasic intracellular free Ca(2+) ([Ca(2+)](i)) response after ATP stimulation. In each case, the initial transient peak, caused by the release of Ca(2+) from the intracellular Ca(2+) stores, is mediated by purinergic receptor-Y2 and is very similar in both cell types. However, the sustained phase in particular, caused by the influx of extracellular Ca(2+), is heightened in the P-UAEC, and associates with an increased ability of the cells to demonstrate enhanced capacitative Ca(2+) entry (CCE) via store-operated channels (SOCs). Herein we demonstrated that the difference in the sustained [Ca(2+)](i) response is maintained for at least 30 min. When 2-aminoethoxydiphenyl borate (2APB) (an inhibitor of the inosital 1,4,5-trisphosphate receptor (IP3R) and possibly SOC) was used in conjunction with ATP, it was capable of completely inhibiting CCE. Since 2APB can inhibit SOC in some cell types and 2APB was capable of inhibiting CCE in the UAEC model, the role of SOC in CCE was first evaluated using the classical inhibitor La(3+). The ATP-induced sustained phase was inhibited by 10 microM La(3+), implying a role for SOC in the [Ca(2+)](i) response. Since canonical transient receptor potential channels (TRPCs) have recently been identified as putative SOCs in many cell types, including EC, the expression levels of several isoforms were evaluated in UAEC. Expression of TRPC3 and TRPC6 channels in particular was detected, but no significant difference in expression level was found between NP- and P-UAEC. Nonetheless, we were able to show that IP3R2 interacts with TRPC3 in UAEC, forming a protein complex, and that this interaction is considerably enhanced in an agonist sensitive manner by pregnancy. Thus, while IP3R and TRPC isoforms are not altered in their expression by pregnancy, enhanced functional interaction of TRPC3 with IP3R2 may underlie pregnancy-enhanced CCE in the UAEC model and so explain the prolonged [Ca(2+)](i) sustained phase seen in response to ATP.

Pregnancy-specific changes in uterine artery endothelial cell signaling in vivo are both programmed and retained in primary culture.

Ovine uterine artery (UA) endothelial cells (UAEC) maintained in culture to passage 4 retain pregnancy-specific changes in vasodilator production, which in turn is associated with differences in Ca(2+) and ERK 1/2 signaling. The question remains whether this is an accurate portrayal of the situation in vivo, or more simply whether these same signaling responses seen at passage 4 accurately reflect those functioning in the cells in vivo. Small groups of endothelial nitric oxide synthase-positive cells from both pregnant and nonpregnant ewes were freshly isolated and used to image changes in the intracellular free calcium concentration ([Ca(2+)](i)) using fura 2 and to detect ERK 1/2 phosphorylation by immunocytochemistry. Furthermore, detailed comparisons of mRNA species were made between freshly isolated and cultured (passage 4) cells using cDNA microarray analysis and verified, where possible, using PowerBlot analysis. Freshly isolated cells showed no detectable [Ca(2+)](i) elevation in response to angiotensin II, epidermal growth factor, basic fibroblast growth factor, or vascular endothelial growth factor but did respond to ATP in a dose-dependent (1-300 microM) manner. At higher doses of ATP, [Ca(2+)](i) elevation was sustained longer and showed a high incidence of regular oscillations in cells from pregnant compared with nonpregnant ewes. Also, ATP and basic fibroblast growth factor treatment caused activation of ERK 1/2 in significantly greater numbers of freshly isolated cells from pregnant than from nonpregnant ewes. cDNA microarray analysis showed results consistent with endothelium but revealed few differences in mRNA species and levels between freshly isolated and passage 4 cells or between the pregnant and nonpregnant ewes. In conclusion, our data show for the first time that pregnancy-specific changes in Ca(2+) and ERK 1/2 signaling are indeed observed in freshly isolated UA endothelium. This suggests in turn that such pregnancy-specific changes in UA endothelial function in vivo in response to a variety of agonists during pregnancy are both programmed at the level of cell signaling and retained in culture.

Thought dismissability in obsessive-compulsive disorder versus panic disorder.

This study sought to better understand the persistence of obsessive-compulsive disorder (OCD) by studying the dismissability of obsessional thoughts in individuals with OCD relative to the dismissability of panic-relevant thoughts in individuals with panic disorder with or without agoraphobia (PD/A). Individuals with a principal diagnosis of OCD (n = 25) or PD/A (n = 25) completed a thought replacement task in which they replaced a primary obsession (target thought for the OCD group) or a primary panic-relevant thought (target thought for the PD/A group), with a neutral thought, signaling when the target thought occurred and when the neutral thought was in mind. The OCD group had more target thoughts and appraised the recurrence of the target thought more negatively. Whereas mood state did not change in the PD/A group, it declined in the OCD group, and this change was predicted by negative appraisal of target thought recurrences, but not amount of time thinking the target thought. These findings suggest that in vivo appraisal of the recurrence of obsessions may be a unique, key mechanism in the persistence of OCD and that the identification and exploration of appraisal of thought recurrences may be an especially important target in its treatment.

Predictors of posttraumatic stress disorder, depression, and suicidal ideation among Canadian Forces personnel in a National Canadian Military Health Survey.

Despite efforts to elucidate the relationship between traumatic event exposure and adverse mental health outcomes, our ability to understand why only some trauma-exposed individuals become emotionally affected remains challenged. The aim of the current study is to determine the relations between social support, religiosity, and number of lifetime traumatic events experienced on past-12 month posttraumatic stress disorder (PTSD), depression, and suicidal ideation (SI) in a nationally representative sample of Canadian Forces personnel. The current study used data from the Canadian Community Health Survey Cycle 1.2 - Canadian Forces Supplement. The impact of a number of predictive and mediating factors was assessed using structural equation modeling. Social support and number of lifetime traumatic events experienced were significant predictors of past-year PTSD, depression, and SI; however PTSD did not mediate the relationship between number of traumatic events and SI nor between social support and SI. Conversely, depression mediated the relationship between number of traumatic events and SI. Possible mechanisms for these findings and their implications are discussed.

A multilevel analysis of the interpersonal behavior of socially anxious people.

We investigate the interpersonal behavior of socially anxious (SA) and non-socially anxious (NSA) individuals at three different levels of analysis, focusing on the dimensions of warmth and dominance. Study 1 examines self-reported general interaction styles, Study 2 explores behavior occurring within the context of a single interaction, and in Study 3 we focus on the performance of a single conversational act (a disagreement). Studies 1 and 2 adopt the framework of Interpersonal Circumplex Theory (IPC; Kiesler, 1983), which is well suited for studying trait-level and interaction-level social behaviors, while Study 3 is grounded in Politeness Theory (PT; Brown & Levinson, 1987), which can be used to analyze individual acts at the microstructural level. The potential mutual relevance of PT and IPC is also discussed.