New research suggests hope is a trait that can predict resilience and recovery from anxiety disorders.
In a new study, clinical psychologist Dr. Matthew Gallager and colleagues examined the role of hope in predicting recovery in a clinical trial of adults in cognitive behavior therapy (CBT) for common anxiety disorders.
Historically, the concept of hope has long stirred opinion. In the 16th century, German theologian Martin Luther celebrated its power, claiming “Everything that is done in this world is done by hope.” Two centuries later, Benjamin Franklin warned that “He that lives upon hope will die fasting.”
In the study, Gallagher — University of Houston associate professor of clinical psychology — assessed the role of hope in predicting recovery among a clinical trial of 223 adults. In the trial, adults were receiving cognitive-behavior therapy (CBT) for one of four common anxiety disorders: social anxiety disorder, panic disorder, generalized anxiety disorder and obsessive-compulsive disorder.
Gallagher discovered that psychotherapy can result in clear increases in hope and that changes in hope are associated with changes in anxiety symptoms. His findings appear in the journal Behavior Therapy.
“In reviewing recovery during CBT among the diverse clinical presentations, hope was a common element and a strong predictor of recovery,” said Gallagher. He also reports that moderate-to-large increases in hope and changes in hope were consistent across the five separate CBT treatment protocols.
In terms of psychotherapy, hope represents the capacity of patients to identify strategies or pathways to achieve goals and the motivation to effectively pursue those pathways.
Significantly, the results of this study indicate that hope gradually increases during the course of CBT, and increases in hope were greater for those in active treatment than for those in the waitlist comparison.
The magnitude of these changes in hope were consistent across different CBT protocols and across the four anxiety disorders examined, which underscores the broad relevance of instilling hope as an important factor in promoting recovery during psychotherapy.
“Our results can lead to a better understanding of how people are recovering and it’s something therapists can monitor. If a therapist is working with a client who isn’t making progress, or is stuck in some way, hope might be an important mechanism to guide the patient forward toward recovery,” said Gallagher.
Hope is closely related to other positive psychology constructs, such as self-efficacy and optimism, that have also been shown to have clear relevance to promoting resilience to and recovery from emotional disorders, said Gallagher.
Gallagher’s research is part of a larger project examining the efficacy of CBT for anxiety disorders led by Dr. David H. Barlow, founder and director emeritus of the Boston University Center for Anxiety and Related Disorders.
Source: University of Houston
A new study has found that a majority of family members and caregivers of children with atopic dermatitis, the most common form of eczema, suffer from anxiety and depression.
For the study, researchers from the PHI University Clinic of Dermatology assessed the impact of an atopic dermatitis diagnosis on the families of 35 children between the ages of 1 and 6. The researchers, who evaluated 83 family members and caregivers, found that all of them reported at least mild severity anxiety, with some showing moderate severity anxiety. Almost three in four — 74 percent — were also found to have depression.
According to the study’s findings, depression and anxiety scores were associated with the persistence and longevity of atopic dermatitis.
The researchers noted they did not find an association between scores and the severity of the disease, meaning that depression or anxiety was not observed to increase where atopic dermatitis was more severe.
Atopic dermatitis, the most common form of eczema, affects between 10 and 20 percent of the pediatric population of Europe. It causes the skin to become itchy, red, dry, and cracked. It is a chronic condition that most often occurs in people who have allergies and can develop alongside asthma and hay fever.
Patients with the condition are also known to suffer insomnia, anxiety, and psychosocial stress, linked to the physical manifestation of their eczema, according to the researchers.
For the study, researchers used the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating scale (HAM-A).
The researchers also asked participants what their greatest concerns were. The most frequent worry was the information families and caregivers receive about the nature of the disease, since atopic dermatitis is a long-term condition that requires complex and costly medical treatments.
“The chronicity and complexity of chronic dermatitis often leads to overlooked anxiety and depression in family members and caregivers, but our results show the extent of this cannot be overstated,” said lead researcher Dr. Vesna Grivcheva-Panovska.
“In the future, we must take a widened approach to the management of atopic dermatitis, not only of the patients but of their families as well.”
The research was presented at the 2019 European Academy of Dermatology and Venereology (EADV) Congress.
Source: Spink Health
Heart patients with depression, anxiety or stress are more likely to drop out of cardiac rehabilitation, according to a new Australian study published in the European Journal of Preventive Cardiology.
Cardiac rehabilitation is a medically supervised program designed to improve cardiovascular health for patients who have experienced a heart attack, heart failure, angioplasty or heart surgery.
For the study, researchers examined the prevalence and impact of depression, anxiety and stress in patients attending cardiac rehabilitation at two hospitals in Sydney, Australia between 2006 and 2017. A total of 4,784 patients completed the Depression Anxiety Stress Scale questionnaire.
The findings show that approximately 18%, 28% and 13% of participants had moderate to extremely severe depression, anxiety or stress, respectively.
Patients with moderate symptoms of depression (24% versus 13%), anxiety (32% versus 23%) or stress (18% versus 10%) were significantly more likely to quit cardiac rehabilitation compared to those with no or mild symptoms.
“Heart patients living with depression are more likely to feel despondent and hopeless, which reduces their ability to manage their symptoms,” said study author Angela Rao, of the University of Technology Sydney, Australia.
“They may minimize successes and exaggerate failures, thereby reducing their motivation to exercise and complete a cardiac rehabilitation program.”
“Anxiety may lead to fear of another cardiac event and stop people from being active,” she continued. “Depression and anxiety can also impair the ability to retain new information needed to make health-related behavior changes.”
After a heart attack or procedure to open blocked arteries, patients should be encouraged to quit smoking, take up exercise, improve their diet, reduce stress, and control blood pressure and cholesterol; these can be achieved through cardiac rehabilitation.
“Depression can dampen positive intentions to exercise even when receiving support from health professionals and being aware of the benefits,” said Rao.
“People with anxiety may underestimate their abilities, for example to walk on a treadmill during a rehabilitation class.”
Around one half of patients with moderate depression or anxiety who completed cardiac rehabilitation did not show significant improvements in these conditions.
Depression, anxiety and stress were related, with one increasing the likelihood of the other. Patients with anxiety or stress were more than four times more likely to be depressed than those without.
Anxiety was three times more common in patients with (versus without) depression and more than five times more frequent in patients with (versus without) stress.
“These relationships were independent of age, sex, clinical characteristics, medication use and quality of life,” said Rao.
Rao urges clinicians to screen for depression and anxiety at the beginning and end of rehabilitation to identify those needing extra help. Stress management, cognitive-behavioral therapies, meditation and mindfulness can be included to improve mental health and raise participation.
Source: European Society of Cardiology
New research has identified brain circuitry differences that might be associated with suicidal behavior in individuals with mood disorders.
The study provides a promising lead toward tools that can predict which individuals are at the highest risk for suicide, according to researchers at the University of Utah Health and the University of Illinois at Chicago.
Suicide rates are rising steadily among young adults, especially those with mood disorders, such as depression. More than half of individuals who commit suicide saw a health professional within the past 30 days, but they did not necessarily seek care for mood problems, the researchers note.
“At present, we have very few tools to identify individuals who may be at high risk for suicide-related behavior,” said Dr. Scott Langenecker, a professor of psychiatry at the University of Utah Health and senior author on the study. “Right now, we go on self-report and clinician judgment. Those are good, but they’re not great.”
Previous studies identified brain circuits associated with mood disorders: The cognitive control network (CCN), which is involved in executive function, problem-solving and impulsivity; the salience and emotional network (SEN), which is involved in emotion processing and regulation; and the default mode network (DMN), which is active when individuals are engaged in self-focused thought.
However, these studies focused primarily on depression, according to the researchers.
“This is one of the first studies to try to understand brain mechanisms that may be relevant to suicide risk,” said Dr. Jonathan Stange, an assistant professor of psychiatry at the University of Illinois at Chicago and first author on the study.
The study used resting-state functional MRI (fMRI), which captured brain images while participants were rested and calm, to assess the connectivity of these circuits in 212 young adults at the University of Illinois at Chicago and the University of Michigan.
“For risk factors involved in suicide, the tasks we have to measure are pretty nonspecific and inexact,” Langenecker said. “If we go to the level of the resting-state networks, we’re actually asking the brain to tell us which brain networks and connections are most relevant.”
The study included individuals with mood disorders and a history of suicide attempts, those with mood disorders and a history of suicidal thoughts, those with mood disorders and no history of suicidal behavior or thoughts, and healthy controls. All study participants with mood disorders were in remission, the researchers noted.
Compared with other study participants — even those with mood disorders and a history of suicidal thoughts — people with a history of suicide attempts showed less connectivity in the CCN and between the CCN and DMN, neural circuitry associated with cognitive control and impulsivity, according to the study’s findings.
These differences could present a target for treatment, according to the researchers.
“If we could figure out how to improve connectivity within this brain circuit, we might be able to reduce suicide risk in the future,” Stange said.
Stange and Langenecker emphasize the research is still in its early stages. This was a small study, with only 18 participants with mood disorders and a history of suicide attempts. It will have to be replicated in a larger number of participants, they said.
In addition, the researchers note it is not yet clear whether individuals with mood disorders and at risk for suicide have a different disease from those without such risk, or whether all individuals with mood disorders are at varying degrees of risk for suicide.
The study was published in Psychological Medicine.
Source: The University of Illinois at Chicago
In the largest and most diverse genetic study to date of post-traumatic stress disorder (PTSD), scientists reveal that PTSD has a strong genetic component similar to other psychiatric disorders.
The findings are published in the journal Nature Communications.
Despite much research, it has remained unclear why some people go on to develop PTSD after a traumatic event while others do not. Some researchers suggest that the disorder is only a social construct, but other studies point to the fact that genetics may be involved.
In the new study, researchers from the University of California (UC) San Diego School of Medicine and more than 130 additional institutions participating in the Psychiatric Genomics Consortium suggest that genetics may account for between five and 20 percent of the variability in PTSD risk following exposure to a traumatic event.
“Our long-term goal is to develop tools that might help clinicians predict who is at greatest risk for PTSD and personalize their treatment approaches,” said the study’s first and corresponding author Caroline Nievergelt, Ph.D., associate professor of psychiatry at UC San Diego School of Medicine and associate director of neuroscience in the Center of Excellence for Stress and Mental Health at the Veterans Affairs San Diego Healthcare System.
“We can’t always protect people from trauma. But we can treat them in the best ways possible, at the best time.”
The findings show that, like other psychiatric disorders and many other human traits, PTSD is highly polygenic, meaning it is associated with thousands of genetic variants throughout the genome, each making a small contribution to the disorder.
According to the findings, six genomic regions called “loci” contain variants strongly associated with disease risk, providing some clues about the biological pathways involved in PTSD.
“Based on these findings, we can say with certainty that there is just as much of a genetic component to PTSD risk as major depression and other mental illnesses,” said senior author Dr. Karestan Koenen, associate member of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard.
“Our limited ability to study the living human brain and uncover the biological roots of PTSD has contributed to the lack of treatments and the stigma around this debilitating condition. Genetics helps us make new discoveries, find opportunities for new therapies, and counter that stigma,” she said.
Since many behavioral traits and psychiatric disorders have some shared genetic factors, the researchers also looked for genetic correlations between PTSD and 235 other disorders, behaviors and physical traits. They discovered significant overlap with 21, including depression, schizophrenia, neuroticism, insomnia, asthma and coronary artery disease.
“Similar to other mental disorders, the genetic contribution to PTSD correlates with that for many other traits,” said Koenen, who is also professor of psychiatric epidemiology in the Harvard T.H. Chan School of Public Health. “Further research is needed to determine what this means — whether some of the same genes that influence risk for PTSD also influence risk for other diseases like, for example, depression.”
To conduct the study, the team collaborated with the Psychiatric Genomics Consortium’s PTSD working group and Cohen Veterans Bioscience, a non-profit organization dedicated to accelerating PTSD and traumatic brain injury research.
The team built an international network of more than 200 researchers, assembling data and DNA samples from more than 60 groups of people with PTSD and control subjects, including the UK Biobank.
The data included more than 200,000 people, which is 10 times larger than the first Psychiatric Genomics Consortium PTSD study, published in 2017. The study group is also the most ancestrally diverse for any psychiatric genetics study to date, with more than 23,000 people with PTSD of European ancestry and more than 4,000 of African ancestry. It also included both civilians and members of the military.
“Our study is distinguished by the fact that it’s international and is highly diverse,” Nievergelt said. “There’s greater representation here than in most studies to date.”
The team used the data to conduct a genome-wide association study (GWAS), using statistical tests to measure the effect of common genetic variants at millions of points across the genome on someone’s likelihood of developing PTSD.
The study uncovered DNA variants at six loci that were significantly tied to PTSD risk. Three of the six loci were specific to certain ancestral backgrounds — two European and one African — and three were only detected in men.
The six loci hint that inflammatory and immune mechanisms may be at play in the disorder, which is consistent with findings from previous research.
Overall, the researchers conclude that PTSD’s heritability — the level of influence genetics has on the variability of PTSD risk in the population — is between five and 20 percent, with some variability by gender. These findings were similar across different ancestral groups.
The research team also developed a polygenic score that could potentially predict one’s risk of developing PTSD following a traumatic event. Polygenic scores take into account the effects of millions of genetic variations and create a measure that can predict a person’s risk of developing a certain trait or disorder.
The team tested their scores on data from men in the UK Biobank dataset, finding that those with the highest scores had 0.4-fold greater odds of developing than those with the lowest scores.
Similarly, when applied to data from the Million Veterans Program — a study of how genes, lifestyle and military exposures impact health and illness — individuals with the highest scores had a significant increase in re-experiencing traumatic memories — a key PTSD symptom.
The researchers assert that polygenic scores are not ready for clinical use. Even larger studies with more diverse datasets are needed to improve the accuracy of PTSD prediction and confirm the genetic findings.
Source: University of California- San Diego
New research finds that performance anticipation at work or school may hinder your ability to remember what happened before your presentation or performance. Investigators also discovered that the presence of an audience may be an important factor in pre-performance memory deficit.
University of Waterloo researchers designed the study to explore what is called the next-in-line effect. “Performance anticipation could weaken memory because people tend to focus on the details of their upcoming presentation instead of paying attention to information that occurs before their performance,” says lead author Noah Forrin.
“People who experience performance anxiety may be particularly likely to experience this phenomenon.”
Forrin and his co-authors experimented with a variety of techniques that enhance memory, including the production effect — we can remember something best if we say it aloud.
One of the study’s co-authors, psychology professor Colin MacLeod, coined the term production effect from previous research. Prior studies have identified that reading aloud involves at least three distinct processes that help to encode memory: articulation, audition and self-reference.
Research by Forrin and MacLeod has demonstrated that reading aloud is better for memory than reading silently, writing, or hearing another person speak aloud. In the new study, however, the findings suggest that the production effect has a downside: When people anticipate reading aloud, they may have worse memory for information they encounter before reading aloud.
The researchers conducted four experiments with 400 undergraduate students and found that students have worse memory for words that they read silently when they anticipate having to read upcoming words aloud (compared to when they anticipate having to read upcoming words silently).
“Our results show that performance anticipation may be detrimental to effective memory encoding strategies,” said Forrin. “Students frequently have upcoming performances — whether for class presentations or the expectation of class participation.”
“We are currently examining whether the anticipation of those future performances reduces students’ learning and memory in the classroom.”
Forrin suggests that a strategy to avoid pre-performance memory deficits relates to scheduling.
“Try to get your performance over with by being the first student in class (or employee in a meeting) to present. After that, you can focus on others’ presentations without anticipating your own.”
The paper, “Wait for it… performance anticipation reduces recognition memory,” appears in the Journal of Memory and Language.
Source: University of Waterloo