Emotional bias training as a treatment for anxiety and depression: evidence from experimental medicine studies in healthy and medicated samples

Abstract Background Anxiety and depression are leading causes of disability worldwide, yet individuals are often unable to access appropriate treatment. There is a need to develop effective interventions that can be delivered remotely. Previous research has suggested that emotional processing biases are a potential target for intervention, and these may be altered through brief training programs. Methods We report two experimental medicine studies of emotional bias training in two samples: individuals from the general population (n = 522) and individuals currently taking antidepressants to treat anxiety or depression (n = 212). Participants, recruited online, completed four sessions of EBT from their own home. Mental health and cognitive functioning outcomes were assessed at baseline, immediately post-training, and at 2-week follow-up. Results In both studies, our intervention successfully trained participants to perceive ambiguous social information more positively. This persisted at a 2-week follow-up. There was no clear evidence that this change in emotional processing transferred to improvements in symptoms in the primary analyses. However, in both studies, there was weak evidence for improved quality of life following EBT amongst individuals with more depressive symptoms at baseline. No clear evidence of transfer effects was observed for self-reported daily stress, anhedonia or depressive symptoms. Exploratory analyses suggested that younger participants reported greater treatment gains. Conclusions These studies demonstrate the effectiveness of delivering a multi-session online training program to promote lasting cognitive changes. Given the inconsistent evidence for transfer effects, EBT requires further development before it can be considered as a treatment for anxiety and depression.

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Emotional bias training as a treatment for anxiety and depression: Evidence from experimental medicine studies in healthy and medicated samples

10.31234/osf.io/xvkb2 ◽

2020 ◽

Author(s):

Steph Suddell ◽

Maren Müller-Glodde ◽

Jim Alexander Lumsden ◽

Chung Yen Looi ◽

Kiri Granger ◽

...

Keyword(s):

Depressive Symptoms ◽

Emotional Processing ◽

Anxiety And Depression ◽

Experimental Medicine ◽

Transfer Effects ◽

Cognitive Changes ◽

Effective Interventions ◽

Two Samples ◽

Emotional Bias

Anxiety and depression are leading causes of disability worldwide, yet individuals are often unable to access appropriate treatment. There is a need to develop effective interventions that can be delivered remotely. Previous research has suggested that emotional processing biases are a potential target for intervention, and these may be altered through brief training programs. We report two experimental medicine studies of emotional bias training in two samples: individuals from the general population (n = 522) and individuals currently taking antidepressants to treat anxiety or depression (n = 212). Participants, recruited online, completed 4 sessions of EBT from their own home. Mental health and cognitive functioning outcomes were assessed at baseline, immediately post-training, and at two-week follow-up. In both studies, our intervention successfully trained participants to perceive ambiguous social information more positively. This persisted at two-week follow-up. There was inconsistent evidence that this change in emotional processing transferred to improvements in symptoms and functional outcomes. In both studies there was weak evidence for an improvement in quality of life following EBT amongst individuals with more depressive symptoms at baseline. No clear evidence of transfer effects was observed for self-reported daily stress, anhedonia or depressive symptoms. However, exploratory analyses suggested that younger participants reported greater treatment gains. These studies demonstrate the effectiveness of delivering a multi-session online training program to promote lasting cognitive changes. Given the inconsistent evidence for transfer effects, EBT requires further development before it can be recommended as a treatment for anxiety and depression.

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Effect of Anxiety and Depression on Survival of Cancer Patients, a 13 Year Follow-up

Asian Pacific Journal of Cancer Care ◽

10.31557/apjcc.2021.6.1.9-13 ◽

2021 ◽

Vol 6 (1) ◽

pp. 9-13

Author(s):

Suriati Mohamed Saini ◽

Susan Tan Mooi Koon ◽

Mohamad Adam Bujang ◽

Gerard Lim Chin Chye ◽

Shalisah Sharip ◽

...

Keyword(s):

Depressive Symptoms ◽

Cancer Patients ◽

Depression Scale ◽

Cox Proportional Hazards ◽

Anxiety Symptoms ◽

High Rate ◽

Anxiety And Depression ◽

Risk Of Death ◽

Increased Risk

Introduction: Anxiety and depression occur at a high rate in cancer patients. However, debate remains regarding the effect of anxiety and depression on cancer survival. Objective: This study aimed to determine the effect of anxiety and depressive symptoms on the survival of cancer patients. Methods: The subjects consisted of 112 cancer patients who attended the Oncology and Radiotherapy outpatient clinic Hospital Kuala Lumpur, Malaysia, in 1999. Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) questionnaire at inception. Information on patients’ mortality status for extended 13 years follow-up (in 2011) was obtained from the National Registration Department death records. Overall survival for each anxiety and depressive symptoms scores in HADS at 13 years was calculated using Cox proportional hazards regression analysis. Results: Cancer patients experienced more anxiety (83%) compared to depressive symptoms (40.2%). The mean (S.D.) HADS scores for depressive symptoms were 9.9 (2.5), and the anxiety symptoms score was 12.6 (2.1). At 13 years, half of the patients (50.9%) had died. No significant effect of anxiety (p=0.399, 95% C.I.= 6.2-8.4) or depressive symptoms at inception (p=0.749, 95% C.I.= 5.9-8.4) towards cancer patients’ survival was found at 13 years follow-up. Conclusion: The occurrence of anxiety symptoms among cancer patients in this study was 2-folds higher than depressive symptoms. However, no significant increased risk of death was found in cancer patients with anxiety or depressive symptoms at 13 years follow-up. It may imply that as time extended, survival in cancer patients may be related to various interacting elements, and intervening health factors are of importance.

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Symptoms of anxiety and depression in patients with stable coronary heart disease: prognostic value and consideration of pathogenetic links

European Journal of Cardiovascular Prevention & Rehabilitation ◽

10.1097/hjr.0b013e3280142a02 ◽

2007 ◽

Vol 14 (4) ◽

pp. 547-554 ◽

Cited By ~ 67

Author(s):

Dietrich Rothenbacher ◽

Harry Hahmann ◽

Bernd Wüsten ◽

Wolfgang Koenig ◽

Hermann Brenner

Keyword(s):

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Depressive Symptoms ◽

Hazard Ratio ◽

Anxiety Symptoms ◽

Anxiety And Depression ◽

Manifest Anxiety ◽

Cardiovascular Disease Event

Background We evaluated the association of symptoms of anxiety and depression with fatal and non-fatal cardiovascular disease events among patients with coronary heart disease and considered several potential underlying pathogenetic links. Design This was a prospective cohort study. Methods In this study, including coronary heart disease patients undergoing an in-patient rehabilitation program, symptoms of anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal cardiovascular disease events were determined during a 3-year follow-up. Results Of the 1052 patients with CHD 16.1% showed a borderline and 8.3% a manifest anxiety symptoms score, whereas 11.8 and 5.9% showed a borderline and manifest depressive symptoms score, respectively. During the 3-year follow-up fatal and non-fatal cardiovascular disease events were observed in 73 (6.9%) patients. After adjustment for covariates, patients having manifest anxiety symptoms had a statistically significant hazard ratio (HR) of 2.32 [95% confidence interval (CI) 1.14-4.74] for a cardiovascular disease event, and patients with depressive symptoms had an HR of 1.47 (95% CI 0.62-3.51) compared to other patients. In a model considering anxiety and depressive symptom scores simultaneously, the hazard ratio for a cardiovascular disease event associated with anxiety symptoms increased to 3.31 (95% CI 1.32-8.27), whereas the hazard ratio associated with depressive symptoms decreased (HR 0.62; 95% CI 0.20-1.87). We found a positive association of increased anxiety scores with body mass index and systolic blood pressure. Conclusions The study suggests an important role especially for symptoms of anxiety for long-term prognosis of patients with known coronary heart disease. It furthermore suggests that several pathogenetic links may partly explain the increased risk.

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A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms.

Journal of Clinical Oncology ◽

10.1200/jco.1991.9.6.1004 ◽

1991 ◽

Vol 9 (6) ◽

pp. 1004-1011 ◽

Cited By ~ 105

Author(s):

J C Holland ◽

G R Morrow ◽

A Schmale ◽

L Derogatis ◽

M Stefanek ◽

...

Keyword(s):

Depressive Symptoms ◽

Cancer Patients ◽

Muscle Relaxation ◽

Progressive Muscle Relaxation ◽

Disease Stage ◽

Anxiety And Depression ◽

Cancer Centers ◽

Effective Interventions ◽

Patient Reported ◽

Initial Session

A randomized nonblinded study was performed in three cancer centers to test over a 10-day period the efficacy of (1) a triazolobenzodiazepine, alprazolam, 0.5 mg three times a day and (2) use of a behavioral technique in which patients were trained in progressive muscle relaxation at an initial session with a behavioral psychologist and then asked to listen at home to an audiotape of the session three times a day. Of 147 cancer patients who met entry levels of distress and completed the study, uncontrolled for site or disease stage, 70 were randomized to drug, 77 to relaxation. Four measures of anxiety and depression were used: Covi, Raskin, Affects Balance, and Symptoms Checklist-90 (SCL-90). Results showed that both treatment arms resulted in significant (P less than .001) decrease in observer and patient-reported anxious and depressed mood symptoms. Although both treatment arms were effective, patients receiving the drug showed a slightly more rapid decrease in anxiety and greater reduction of depressive symptoms. These findings confirm efficacy of both alprazolam and relaxation to reduce cancer-related anxiety and depression. As safe, inexpensive, and effective interventions, physicians should consider their use in cancer patients experiencing anxiety and depressive symptoms.

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Depressive Symptoms at Discharge from Rehabilitation Predict Future Cardiovascular-Related Hospitalizations

Cardiology ◽

10.1159/000375231 ◽

2015 ◽

Vol 131 (2) ◽

pp. 80-85 ◽

Cited By ~ 7

Author(s):

Fiorenza Angela Meyer ◽

Eva Hugentobler ◽

Stefanie Stauber ◽

Matthias Wilhelm ◽

Hansjörg Znoj ◽

...

Keyword(s):

Depressive Symptoms ◽

Depression Scale ◽

Sociodemographic Factors ◽

Rehabilitation Program ◽

Anxiety And Depression ◽

Hospital Anxiety ◽

Depression Subscale ◽

Increased Risk ◽

Depressive Patients

Objectives: Depression is associated with poor prognosis in patients with cardiovascular disease (CVD). We hypothesized that depressive symptoms at discharge from a cardiac rehabilitation program are associated with an increased risk of future CVD-related hospitalizations. Methods: We examined 486 CVD patients (mean age = 59.8 ± 11.2) who enrolled in a comprehensive 3-month rehabilitation program and completed the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). At follow-up we evaluated the predictive value of depressive symptoms for CVD-related hospitalizations, controlling for sociodemographic factors, cardiovascular risk factors, and disease severity. Results: During a mean follow-up of 41.5 ± 15.6 months, 63 patients experienced a CVD-related hospitalization. The percentage of depressive patients (HADS-D ≥8) decreased from 16.9% at rehabilitation entry to 10.7% at discharge. Depressive symptoms at discharge from rehabilitation were a significant predictor of outcome (HR 1.32, 95% CI 1.09-1.60; p = 0.004). Patients with clinically relevant depressive symptoms at discharge had a 2.5-fold increased relative risk of poor cardiac prognosis compared to patients without clinically relevant depressive symptoms independently of other prognostic variables. Conclusion: In patients with CVD, depressive symptoms at discharge from rehabilitation indicated a poor cardiac prognosis.

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Short- and medium-term impact of a residential weight-loss camp for overweight adolescents

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2012-0107 ◽

2014 ◽

Vol 26 (1) ◽

pp. 33-38 ◽

Cited By ~ 4

Author(s):

Helena Fonseca ◽

Antonio Labisa Palmeira ◽

Sandra Martins ◽

Pedro Dias Ferreira

Keyword(s):

Depressive Symptoms ◽

Evidence Base ◽

Ongoing Research ◽

Obese Adolescents ◽

Effective Interventions ◽

Weak Evidence ◽

Effect Of Treatment ◽

Residential Camp

Abstract Introduction: Management of adolescent obesity in clinical practice has been usually centered on the promotion of healthy eating and an active lifestyle, with a weak evidence base. In search of creative and more effective interventions, our objective was to evaluate the immediate and follow-up effectiveness of a residential camp program for obese adolescents. Methods: A total of 28 obese adolescents (15 girls), mean age 13.3±1.7 years and body mass index (BMI) 30.3±5.4 kg/m2, who were attending a tertiary health unit, enrolled in a 2-week camp. The activities were prepared and supervised by different specialists. All adolescents were assessed for anthropometric and psychosocial variables including body image, self-esteem, quality of life and depressive symptoms. Evaluations were conducted on the first and last day of the camp and at 6 months’ follow-up. The effect of treatment was analyzed using analysis of variance (ANOVA) mixed models. Results: At the end of the camp, weight was reduced by –2.7±1.2%, BMI by –0.8±0.4 units and waist circumference by –2.8±9.8 cm. A reduction in depressive symptoms was identified, with greater reductions in BMI associated with a more significant improvement in depressive symptoms. At the 6 months’ follow-up only girls maintained BMI reduction, with boys having increased their BMI. Discussion: In the short-term the camp was effective in reducing BMI and improving depressive symptoms. Only girls were able to proceed with BMI reduction at 6 months. These gender differences should be further explored. Ongoing research is examining the maintenance of these improvements.

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Cathartic Effect of Suicide Attempts Not Limited to Depression

Crisis ◽

10.1027//0227-5910.24.2.73 ◽

2003 ◽

Vol 24 (2) ◽

pp. 73-78 ◽

Cited By ~ 21

Author(s):

Yves Sarfati ◽

Blandine Bouchaud ◽

Marie-Christine Hardy-Baylé

Keyword(s):

Quality Of Life ◽

Depressive Symptoms ◽

Personality Traits ◽

Rating Scales ◽

Suicide Attempts ◽

World Health ◽

Life Questionnaire ◽

Short Term

Summary: The cathartic effect of suicide is traditionally defined as the existence of a rapid, significant, and spontaneous decrease in the depressive symptoms of suicide attempters after the act. This study was designed to investigate short-term variations, following a suicide attempt by self-poisoning, of a number of other variables identified as suicidal risk factors: hopelessness, impulsivity, personality traits, and quality of life. Patients hospitalized less than 24 hours after a deliberate (moderate) overdose were presented with the Montgomery-Asberg Depression and Impulsivity Rating Scales, Hopelessness scale, MMPI and World Health Organization's Quality of Life questionnaire (abbreviated versions). They were also asked to complete the same scales and questionnaires 8 days after discharge. The study involved 39 patients, the average interval between initial and follow-up assessment being 13.5 days. All the scores improved significantly, with the exception of quality of life and three out of the eight personality traits. This finding emphasizes the fact that improvement is not limited to depressive symptoms and enables us to identify the relative importance of each studied variable as a risk factor for attempted suicide. The limitations of the study are discussed as well as in particular the nongeneralizability of the sample and setting.

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Maternal anxiety and depression in pregnancy and DNA methylation of the NR3C1 glucocorticoid receptor gene

Epigenomics ◽

10.2217/epi-2020-0022 ◽

2020 ◽

Author(s):

Alexandra E Dereix ◽

Rachel Ledyard ◽

Allyson M Redhunt ◽

Tessa R Bloomquist ◽

Kasey JM Brennan ◽

...

Keyword(s):

Dna Methylation ◽

Depressive Symptoms ◽

Trait Anxiety ◽

Cpg Island ◽

Depression Scale ◽

Maternal Anxiety ◽

Anxiety And Depression ◽

Pregnancy Anxiety ◽

Glucocorticoid Receptor Gene ◽

Island Shore

Aim: To quantify associations of anxiety and depression during pregnancy with differential cord blood DNA methylation of the glucorticoid receptor ( NR3C1). Materials & methods: Pregnancy anxiety, trait anxiety and depressive symptoms were collected using the Pregnancy Related Anxiety Scale, State-Trait Anxiety Index and Edinburgh Postnatal Depression Scale, respectively. NR3C1 methylation was determined at four methylation sites. Results: DNA methylation of CpG 1 in the NR3C1 CpG island shore was higher in infants born to women with high pregnancy anxiety (β 2.54, 95% CI: 0.49–4.58) and trait anxiety (β 1.68, 95% CI: 0.14–3.22). No significant association was found between depressive symptoms and NR3C1 methylation. Conclusion: We found that maternal anxiety was associated with increased NR3C1 CpG island shore methylation.

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POS1234 IMPACT OF THE CHANGE IN ADMINISTRATION ROUTE OF TOCILIZUMAB AND ABATACEPT, DUE TO THE COVID-19 LOCKDOWN ON DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3126 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 900.1-900

Author(s):

L. Diebold ◽

T. Wirth ◽

V. Pradel ◽

N. Balandraud ◽

E. Fockens ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Physical Activity ◽

Disease Activity ◽

Univariate Analysis ◽

Route Of Administration ◽

Anxiety And Depression ◽

Administration Route ◽

Factors Associated ◽

The Impact

Background:Among therapeutics used to treat rheumatoid arthritis (RA), Tocilizumab (TCZ) and Abatacept (ABA) are both biologic agents that can be delivered subcutaneously (SC) or intravenously (IV). During the first COVID-19 lockdown in France, all patients treated with IV TCZ or IV ABA were offered the option to switch to SC administration.Objectives:The primary aim was to assess the impact of changing the route of administration on the disease activity. The second aim was to assess whether the return to IV route at the patient’s request was associated with disease activity variation, flares, anxiety, depression and low physical activity during the lockdown.Methods:We conducted a prospective monocentric observational study. Eligibility criteria: Adult ≥ 18 years old, RA treated with IV TCZ or IV ABA with a stable dose ≥3 months, change in administration route (from IV to SC) between March 16, 2020, and April 17, 2020. The following data were collected at baseline and 6 months later (M6): demographics, RA characteristics, treatment, history of previous SC treatment, disease activity (DAS28), self-administered questionnaires on flares, RA life repercussions, physical activity, anxiety and depression (FLARE, RAID, Ricci &Gagnon, HAD).The primary outcome was the proportion of patients with a DAS28 variation>1.2 at M6. Analyses: Chi2-test for quantitative variables and Mann-Whitney test for qualitative variables. Factors associated with return to IV route identification was performed with univariate and multivariate analysis.Results:Among the 84 patients who were offered to switch their treatment route of administration, 13 refused to change their treatment. Among the 71 who switched (48 TCZ, 23 ABA), 58 had a M6 follow-up visit (13 lost of follow-up) and DAS28 was available for 49 patients at M6. Main baseline characteristics: female 81%, mean age 62.7, mean disease duration: 16.0, ACPA positive: 72.4%, mean DAS28: 2.01, previously treated with SC TCZ or ABA: 17%.At M6, the mean DAS28 variation was 0.18 ± 0.15. Ten (12.2%) patients had a DAS28 worsening>1.2 (ABA: 5/17 [29.4%] and TCZ: 5/32 [15.6%], p= 0.152) and 19 patients (32.8%) had a DAS28 worsening>0.6 (ABA: 11/17 [64.7%] and TCZ: 8/32 [25.0%], p= 0.007).At M6, 41 patients (77.4%) were back to IV route (26 TCZ, 15 ABA) at their request. The proportion of patients with a DAS28 worsening>1.2 and>0.6 in the groups return to IV versus SC maintenance were 22.5%, 42.5% versus 11.1% and 22.2% (p=0.4), respectively. The univariate analysis identified the following factors associated with the return to IV route: HAD depression score (12 vs 41, p=0.009), HAS anxiety score (12 vs 41, p=0.047) and corticosteroid use (70% vs 100%, p=0.021), in the SC maintenance vs return to IV, respectively.Conclusion:The change of administration route of TCZ and ABA during the first COVID-19 lockdown was infrequently associated with a worsening of RA disease. However, the great majority of the patients (77.4%) request to return to IV route, even without disease activity worsening. This nocebo effect was associated with higher anxiety and depression scores.Disclosure of Interests:None declared

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COVID-19 Lockdown Effect on Not Institutionalized Patients with Dementia and Caregivers

Healthcare ◽

10.3390/healthcare9070893 ◽

2021 ◽

Vol 9 (7) ◽

pp. 893

Author(s):

Rita Moretti ◽

Paola Caruso ◽

Mauro Giuffré ◽

Claudio Tiribelli

Keyword(s):

Medical Condition ◽

Direct Consequence ◽

Anxiety And Depression ◽

Behavioral Reactions ◽

Old Patients ◽

Subcortical Vascular Dementia ◽

Behavior Disturbances ◽

Institutionalized Patients ◽

Severity Degree

SARS-COV-2 is a severe medical condition. Old patients are very vulnerable, but they have been studied only as institutionalized patients. During the lock-down, little attention is dedicated to old, demented patients who lived at home. This study wants to examine their behavioral reactions by video-phone follow-up. We conducted a longitudinal study in subcortical vascular dementia (sVAD) patients. We enrolled 221 sVAD, not institutionalized patients. We divided sVAD patients into low-medium grade sVAD (A) and severe sVAD (B), based on neuroimaging severity degree and executive alterations. At baseline, at the end of lock-down, and two months later, global behavioral symptoms were recorded for each patient. We found significantly higher scores of general behavioral deterioration, anxiety, delusions, hallucinations and apathy after controlling for sVAD severity. The direct consequence was a drastic increment of psychotropic drugs prescribed and employed during the lock-down. Moreover, caregivers’ stress has been evaluated, together with their anxiety and depression levels. During the lock-down, their scores increased and reflected a severe worsening of their behavior. Our data demonstrate that social isolation induces a severe perception of loneliness and abandonment; these fears can exacerbate behavior disturbances in old-aged frail persons. Thus, these can be considered as indirect victims of SARS-COV-2.

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