Measuring maladaptive avoidance: from animal models to clinical anxiety

Avoiding stimuli that predict danger is required for survival. However, avoidance can become maladaptive in individuals who overestimate threat and thus avoid safe situations as well as dangerous ones. Excessive avoidance is a core feature of anxiety disorders, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). This avoidance prevents patients from confronting maladaptive threat beliefs, thereby maintaining disordered anxiety. Avoidance is associated with high levels of psychosocial impairment yet is poorly understood at a mechanistic level. Many objective laboratory assessments of avoidance measure adaptive avoidance, in which an individual learns to successfully avoid a truly noxious stimulus. However, anxiety disorders are characterized by maladaptive avoidance, for which there are fewer objective laboratory measures. We posit that maladaptive avoidance behavior depends on a combination of three altered neurobehavioral processes: (1) threat appraisal, (2) habitual avoidance, and (3) trait avoidance tendency. This heterogeneity in underlying processes presents challenges to the objective measurement of maladaptive avoidance behavior. Here we first review existing paradigms for measuring avoidance behavior and its underlying neural mechanisms in both human and animal models, and identify how existing paradigms relate to these neurobehavioral processes. We then propose a new framework to improve the translational understanding of maladaptive avoidance behavior by adapting paradigms to better differentiate underlying processes and mechanisms and applying these paradigms in clinical populations across diagnoses with the goal of developing novel interventions to engage specific identified neurobehavioral targets.

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An Explorative Study to Assess the Prevalence of Social Anxiety Disorder (SAD) and Its Determinants among High School Students of Selected High School of Bagalkot

Introduction: As per research studies have shown that social anxiety disorder has a worldwide prevalence of 5 to 10% and a lifetime prevalence rate of 8.4% to 15% among high school students.1 Rural Indian children are facing this problem of lethal evil more as compared to Urban high school students in India. Objective: To assess the prevalence of social anxiety disorder [sad] and its determinants among high school students of selected high school of Bagalakote. Methods: Descriptive survey approach was used for the study with cross sectional survey design. 120 high school students between 14 years to 16 years of age were selected Disproportionate stratified random sampling technique method from high school students studying in selected high school of Bagalkot. The data regarding determinants was collected by structured interview schedule and self-report method. The Social Phobia Inventory (abbreviated as SPIN) is a five point scale was used to categories the high school students according to their social anxiety disorders. The association was explored by Chi square test, Fisher’s exact probability test and linear regression. Results: Total 120 high school students were responded for Social Phobia Inventory (SPIN) scale, in that level of social anxiety disorders had reveals that majority 83.3% had non phobic, 15.8% had mild and 0.8% had moderate, there is no extremely phobic. A significant association was found between the social anxiety disorders of adolescents and their selected socio-demographic variables like monthly income (χ2= 21.199; P<0.05). Conclusion: The findings revealed that there was a positive correlation found between the psychological wellbeing and academic performance among adolescents, recommended health education, early recommended understanding the social anxiety disorder and its determinants by their students especially among the fresher`s. Effectiveness of teaching programmes regarding impact of its determinants on level of social anxiety disorders among adolescents can be done had positive effect on adolescents health, which were also statistically significant. Key words: Social anxiety disorder, Determinants, Adolescents, high school students, academic performance, Spin scale.

Heterogeneity in PFC-amygdala connectivity in middle childhood, and concurrent interrelations with inhibitory control and anxiety symptomology.

The prefrontal cortex (PFC) is a key brain area in considering adaptive regulatory behaviors. This includes regulatory projections to regions of the limbic system such as the amygdala, where the nature of functional connections may confer lower risk for anxiety disorders. The PFC is also associated with behaviors like executive functioning. Inhibitory control is a behavior encompassed by executive functioning, and is generally viewed favorably for adaptive socioemotional development. Yet, some research suggests that high levels of inhibitory control may actually be a risk factor for some maladaptive developmental outcomes, like anxiety disorders. In a sample of 51 children ranging from 7-9 years old, we examined resting state functional connectivity between regions of the PFC and the amygdala. We used Subgrouping Group Iterative Multiple Model Estimation (S-GIMME) to identify and characterize data-driven subgroups of individuals with similar networks of connectivity between these brain regions. Generated subgroups were collapsed into children characterized by the presence or absence of recovered connections between the PFC and amygdala. We then tested whether inhibitory control, as measured by a stop signal task, moderated the relation between these subgroups and child-reported anxiety symptoms. We found an inverse relation between stop-signal reaction times and reported count of anxiety symptoms when controlling for connectivity group, suggesting that greater inhibitory control was actually related to greater anxiety symptoms, but only when accounting for patterns of PFC-amygdala connectivity. These data suggest that there is a great deal of heterogeneity in the nature of functional connections between the PFC and amygdala during this stage of development. The findings also provide support for the notion of high levels of inhibitory control as a risk factor for anxiety, but trait-level biopsychosocial factors may be important to consider in assessing the nature of risk.

Minimising Young Children’s Anxiety through Schools (MY-CATS): Protocol for a Cluster Randomised Controlled Trial to Evaluate the Effectiveness and Cost-effectiveness of an Online Parent-led Intervention Compared With Usual School Practice for Young Children Identified as at-risk for Anxiety Disorders

BackgroundIdentifying and supporting young children who are at-risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prevention and early intervention programmes. Delivering an online intervention through schools to parents of young children who have one or more of these risks could maximise reach.The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of delivering an online parent-led intervention, compared with usual school provision only, for children (aged 4-7) identified as at-risk for anxiety disorders on the basis of at least one risk factor. We also aim to identify the characteristics of children who do and do not benefit from intervention and mechanisms of change from the intervention.MethodsThe design will be a parallel group, superiority cluster randomised controlled trial, with schools (clusters) randomised to intervention or usual school practice arms in a 1:1 ratio stratified according to level of deprivation within the school. The study will recruit and randomise at least 60 primary/infant schools in England, and on the basis of recruiting 60 schools, we will recruit 1080 trial participants (540 per arm). Parents of all children (aged 4-7) in sampled Reception, Year 1, and Year 2 classes will be invited to complete screening questionnaires. Children who screen positive on the basis of anxiety symptoms, and/or behavioural inhibition, and/or parent anxiety symptoms will be eligible for the trial. Parents/carers of children in schools allocated to the intervention arm will be offered a brief online intervention; schools in both arms will continue to provide any usual support for children and parents throughout the trial. Assessments will be completed at: screening, baseline (before randomisation), 6-weeks, 12-weeks, and 12-months post randomisation. The primary outcome will be the absence/presence of an anxiety disorder diagnosis at 12-months. DiscussionThe trial will determine if delivering an online intervention for parents of young children at-risk of anxiety disorders identified through screening in schools is effective and cost-effective. Trial registration: ISRCTN 82398107. Prospectively registered on 14.1.2021. https://www.isrctn.com/ISRCTN82398107

Efficacy of the unified protocol for transdiagnostic cognitive-behavioral treatment for depressive and anxiety disorders: a randomized controlled trial

Background The efficacy of the unified protocol of the transdiagnostic treatment for emotional disorders (UP) has been poorly studied in patients with depressive disorders. This study aimed to examine the efficacy of UP for improving depressive symptoms in patients with depressive and/or anxiety-related disorders. Methods This assessor-blinded, randomized, 20-week, parallel-group, superiority study compared the efficacy of the UP with treatment-as-usual (UP-TAU) v. wait-list with treatment-as-usual (WL-TAU). Patients diagnosed with depressive and/or anxiety disorders and with depressive symptoms participated. The primary outcome was depressive symptoms assessed by GRID-Hamilton depression rating scale (GRID-HAMD) at 21 weeks. The secondary outcomes included assessor-rated anxiety symptoms, severity and improvement of clinical global impression, responder and remission status, and loss of principal diagnosis. Results In total, 104 patients participated and were subjected to intention-to-treat analysis [mean age = 37.4, s.d. = 11.5, 63 female (61%), 54 (51.9%) with a principal diagnosis of depressive disorders]. The mean GRID-HAMD scores in the UP-TAU and WL-TAU groups were 16.15 (s.d. = 4.90) and 17.06 (s.d. = 6.46) at baseline and 12.14 (s.d. = 5.47) and 17.34 (s.d. = 5.78) at 21 weeks, with a significant adjusted mean change difference of −3.99 (95% CI −6.10 to −1.87). Patients in the UP-TAU group showed significant superiority in anxiety and clinical global impressions. The improvement in the UP-TAU group was maintained in all outcomes at 43 weeks. No serious adverse events were observed in the UP-TAU group. Conclusions The UP is an effective approach for patients with depressive and/or anxiety disorders.

Anxiety disorders and age-related changes in physiology

Background Anxiety disorders are leading contributors to the global disease burden, highly prevalent across the lifespan and associated with substantially increased morbidity and early mortality. Aims The aim of this study was to examine age-related changes across a wide range of physiological measures in middle-aged and older adults with a lifetime history of anxiety disorders compared with healthy controls. Method The UK Biobank study recruited >500 000 adults, aged 37–73, between 2006 and 2010. We used generalised additive models to estimate non-linear associations between age and hand-grip strength, cardiovascular function, body composition, lung function and heel bone mineral density in a case group and in a control group. Results The main data-set included 332 078 adults (mean age 56.37 years; 52.65% women). In both genders, individuals with anxiety disorders had a lower hand-grip strength and lower blood pressure, whereas their pulse rate and body composition measures were higher than in the healthy control group. Case–control group differences were larger when considering individuals with chronic and/or severe anxiety disorders, and differences in body composition were modulated by depression comorbidity status. Differences in age-related physiological changes between females in the anxiety disorder case group and healthy controls were most evident for blood pressure, pulse rate and body composition, whereas this was the case in males for hand-grip strength, blood pressure and body composition. Most differences in physiological measures between the case and control groups decreased with increasing age. Conclusions Findings in individuals with a lifetime history of anxiety disorders differed from a healthy control group across multiple physiological measures, with some evidence of case–control group differences by age. The differences observed varied by chronicity/severity and depression comorbidity.

Effectiveness and Efficacy of Therapeutic Interventions Performed by Nurses for Anxiety Disorders: A Systematic Review

BACKGROUND: Anxiety disorders are characterized by excessive anxiety, fear, and behavioral disorders that can lead the individual to have losses in daily, social, and work activities, generating a negative impact on their quality of life. AIM: To evaluate the quality of evidence of the therapeutic interventions performed by nurses for anxiety disorders. METHOD: An analysis of the quality of evidence was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The systematic review protocol was registered in the Prospective Register of Systematic Reviews (Prospero), CRD420202939. RESULTS: The interventions performed by nurses were effective ( d = 0.44), with significant improvement in reducing anxiety levels, reducing drug use, and improving self-control. CONCLUSIONS: The study indicates that therapeutic interventions performed by nurses are beneficial for individuals who suffer from anxiety disorders, with significant improvement in reducing anxiety levels, reducing medication use, improving self-control, and remission of anxiety symptoms.

Validating A Smartphone-Based Biomarker Tool Lyfas in Screening Anxiety Disorders

Lyfas is a smartphone-based biomedical application that captures the cardiovascular autonomic biomarkers (CVb), surrogating for mental health attributes. SD1/SD2 biomarker assesses the sympathovagal balance and is considered to be a potential indicator of Lyfas anxiety score (LAS). A total of 1837 males and 973 females took Lyfas (hypersensitivity-checked) and Hamilton Anxiety Rating Scale (HAM-A) self-scoring tests. LAS has been statistically validated by Linear regressions, one-way ANOVA, t-stat, correlations (r), and Bland Altman agreement assessment with respect to HAM-A. Sensitivity, specificity, precision, accuracy, Fscore, and Youden’s index (j-stat) are computed. Results show that (i) Lyfas is not a very hypersensitive instrument (mean-variance is 0.6). (ii) It can predict HAM-A with 94.7% accuracy (R2) and is a statistically significant model (p <0.05). (iii) LAS and HAM-A are positively correlated by 97%, the t-stat value of 5.38 for the population indicates that the two instruments have a significant mean difference. (iv) Bland Altman test showcases the overall agreement of 12.95% due to different modes and scales of measurements. (v) on average, LAS is 87.78% accurate, 86.82% precise, and its’ 65.2% j-stat value proves that Lyfas is a novel industry-standard smartphone biomarker application that can be used to accurately screen anxiety disorders.