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Breaking the vicious circle of fear and avoidance in children with abdominal pain: A mediation analysis.
Lalouni, M, Hesser, H, Bonnert, M, Hedman-Lagerlöf, E, Serlachius, E, Olén, O, Ljótsson, B
Journal of psychosomatic research. 2021;:110287
Abstract
OBJECTIVES Exposure-based cognitive behavioral therapy via internet (Internet-CBT) has been shown to reduce symptoms and increase quality of life for children with functional abdominal pain disorders (FAPDs), but the mechanisms of change are unknown. The objective was to examine whether a change in symptom-specific fear and avoidance, i.e., gastrointestinal-specific anxiety (GI-anxiety) and gastrointestinal-specific avoidance (GI-avoidance), mediated changes in parent-reported abdominal symptoms for children receiving Internet-CBT compared with children receiving treatment as usual. A further aim was to assess if baseline levels of the proposed mediators moderated the mediation. METHODS Weekly assessments of child-reported mediators and parent-reported outcome from 90 children aged 8-12 who were included in a randomized controlled trial were used in univariate and multivariate growth models to test the direct effect of treatment on outcome and the indirect effects via mediators and moderated mediation. RESULTS Treatment condition significantly predicted the slope of the mediators (a-path), in favor of Internet-CBT, and mediators were correlated with the outcome (b-path). The indirect effects of the mediators on the outcome (cross-product of the a and b-paths) were significantly different from zero for both GI-avoidance, ab = 1.43, 95%CI [0.42, 3.23]; and GI-anxiety ab = 1.58, 95%CI [0.43, 3.62]. Baseline levels of the proposed mediators moderated the size of the mediation. CONCLUSIONS GI-anxiety and GI-avoidance were mediators of change in Internet-CBT and high levels of the mediators at baseline were associated with larger mediated effects. Healthcare professionals should be aware of, and inform families about, the potential benefits of reducing symptom-specific fear and avoidance.
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Intervention to reduce hypoglycemia fear in parents of young kids using video-based telehealth (REDCHiP).
Patton, SR, Clements, MA, Marker, AM, Nelson, EL
Pediatric diabetes. 2020;(1):112-119
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OBJECTIVE To evaluate the efficacy of a new video-based telehealth intervention to reduce hypoglycemia fear in parents of young children with type 1 diabetes. METHODS We randomized 42 parents to either immediate treatment (reducing emotional distress for childhood hypoglycemia in parents, REDCHiP; n = 22) or a waitlist control (WAITLIST; n = 21) condition. REDCHiP parents completed a 10-session video-based telehealth intervention, while WAITLIST parents continued in usual care. After 14-weeks, WAITLIST parents completed the telehealth treatment. We examined for between group changes in parental hypoglycemia fear and parenting stress (n = 18 per condition), 3-month maintenance of treatment effects for parents randomized to REDCHiP (n = 15), and pre-post changes for the entire sample (n = 36). RESULTS Mostly mothers participated (97.6%). They reported a mean age of 35.2 ± 5.0 years at pre-treatment. Children were 4.4 ± 1.4 years old and 59.5% boys. Between group comparisons showed a significant reduction in hypoglycemia fear (P = .04) and a trend toward reduction in parenting stress-frequency (P = .092) for REDCHiP parents compared to WAITLIST parents. After the three-month maintenance period, REDCHiP parents reported significant reductions in hypoglycemia fear, parenting stress-frequency, and parenting stress-difficulty (P's < .01) compared to pre-treatment. When all parents received the telehealth treatment, we also observed significant reductions in hypoglycemia fear, parenting stress-frequency, and parenting stress-difficulty (P's < .001), and sensitivity analyses revealed a significant reduction in child glycated hemoglobin for children who entered the treatment above target (P < .05). CONCLUSION Our new video-based telehealth intervention appears to reduce hypoglycemia fear and parenting stress and may help parents of very young children with T1D to better achieve optimal child glycemic control when children are above target.
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The effects of trans-cranial direct current stimulation intervention on fear: A systematic review of literature.
Yosephi, MH, Ehsani, F, Daghiani, M, Zoghi, M, Jaberzadeh, S
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2019;:7-13
Abstract
Intensifying fear and fear of pain may lead to some diseases such as panic disorder, phobias, post-traumatic stress disorder (PTSD), anxiety disorders, depression, etc. A number of studies indicated positive effect of transcranial direct current stimulation (tDCS) on controlling fear and some studies did not observe any effect or even negative effect on decreasing fear. Due to lack of consensus in the findings of research, we aimed to systematically review studies, which investigated the effect of tDCS on fear. A literature search was conducted using the databases of PubMed, Science Direct, OVID, CINAHL, PEDro, Cochrane, Scopus and MEDLINE. Fear, fear memory, fear of pain, anxiety, post-traumatic stress disorder, electrical brain stimulation were applied as keywords. The valid assessment scale was used to evaluate the methodological quality of the included studies. The results of this systematic review revealed that the cathodal tDCS (c-tDCS) on the left dorsolateral prefrontal cortex (DLPFC) as compared to anodal tDCS (a-tDCS) could significantly reduce fear and modulate the fear memory. In addition, the findings of this study showed that the c-tDCS has positive effect on behavioural parameters of fear, while it cannot change biochemical parameters of fear during limited sessions of intervention. Application of c-tDCS on the left DLPFC could significantly reduce fear and modulate the fear memory.
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Overestimation of Risk and Increased Fear of Long-term Complications of Diabetes in People with Type 1 and 2 Diabetes.
Arend, F, Müller, UA, Schmitt, A, Voigt, M, Kuniss, N
Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association. 2019;(10):645-652
Abstract
OBJECTIVE The quality report of the disease management programmes of North Rhine Westphalia 2016 showed prevalences for long-term complications (neuropathy, nephropathy, retinopathy) of less than 30% for people with diabetes type 1 (DM1) and type 2 (DM2). The aim of this study was to assess risk expectations and fear regarding long-term complications of diabetes in people with DM1 and DM2. METHODS We assessed risk expectations and fear regarding diabetes complications in people with DM1 (n=110) and DM2 (n=143 without insulin, n=249 with insulin) visiting an University outpatient department of metabolic diseases. Fear of long-term complications was measured with the "Fear of Complications Questionnaire (FCQ)" (range 0-45 points, scores ≥30 suggest elevated fear). Participants were asked to estimate general and personal risks of long-term complications 10 years after developing diabetes in %. RESULTS Elevated fear of complications (FCQ scores ≥30) was observed in 34.5, 25.9, and 43.0% of those with DM1, DM2 without insulin and DM2 with insulin, respectively. Participants estimated a mean general risk of diabetes-related complications after 10 years amounting to 45.9±15.8% (DM1), 49.7±15.4% (DM2 without insulin), and 52.5±16.4% (DM2 with insulin) and personal risk with 52.5±24.4% (DM1), 45.8±22.7% (DM2 without insulin), and 54.1±23.4% (DM2 with insulin), respectively. Higher risk expectations were associated with higher fear of complications (p<0.001). CONCLUSION Risk estimations regarding long-term complications were exaggerated in people with DM1 and DM2. About one third of the participants reported elevated fear of complications. Participants' risk expectations and fear regarding diabetes complications appear excessive compared to population-based prevalence rates.
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[Psychiatric symptoms in a child with gluten sensitivity].
Kraijenhoff, GPS, Smit, MJM, van Vlerken, RHT, Mearin Manrique, ML
Nederlands tijdschrift voor geneeskunde. 2019
Abstract
BACKGROUND Non-celiac gluten sensitivity (NCGS) is a diagnosis that is increasingly being reported. Psychiatric symptoms can be a rare but serious manifestation of this new clinical entity. CASE REPORT A 13-year-old girl consulted the paediatrician with abdominal pain, diarrhoea, bloating, and compulsive thoughts and fears; these disappeared on a gluten-free diet. Celiac disease and wheat allergy were excluded. Double-blind placebo-controlled gluten challenge confirmed the diagnosis NCGS. CONCLUSION Consider a diagnosis of NCGS in patients with psychiatric symptoms in combination with abdominal symptoms.
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No association between fear of hypoglycemia and blood glucose variability in type 1 diabetes: The cross-sectional VARDIA study.
Saulnier, PJ, Briet, C, Gand, E, Chaillous, L, Dubois, S, Bonnet, F, Leguerrier, AM, Fradet, G, Delcourt Crespin, I, Kerlan, V, et al
Journal of diabetes and its complications. 2019;(8):554-560
Abstract
AIMS: In type 1 diabetes (T1D), treatment efficacy is limited by the unpredictability of blood glucose results and glycemic variability (GV). Fear of Hypoglycemia (FOH) remains a major brake for insulin treatment optimization. We aimed to assess the association of GV with FOH in participants with T1D in an observational cross-sectional study performed in 9 French Diabetes Centres (NCT02790060). METHODS Participants were T1D for ≥5 years, aged 18-75 years, on stable insulin therapy for ≥3 months. The coefficient of variation (CV) of blood glucose and mean amplitude of glycemic excursions (MAGE) were used to assess GV from 7-point self-monitoring of blood glucose (SMBG). FOH was assessed using the validated French version of the Hypoglycemia Fear Survey-II (HFS-II) questionnaire. RESULTS Among a total of 570 recruited participants, 298 were suitable for analysis: 46% women, 58% on continuous subcutaneous insulin infusion [CSII], mean age 49 ± 16 years, HbA1c 7.5 ± 0.9%, HFS-II score 67 ± 18 and 12% with recent history of severe hypoglycemia during the previous 6 months, mean CV 39.8 ± 9.7% and MAGE 119 ± 42 mg/dL. CV and MAGE did not significantly correlate with HFS-II score (R = -0.05;P = 0.457 and R = 0.08;P = 0.170). Participants with severe hypoglycemia in the previous 6 months had higher HFS scores. Participants with higher HFS scores presented more hypoglycemias during follow-up. CONCLUSIONS FOH as determined using the HFS-II questionnaire was not associated with 7-point SMBG variability in participants with T1D, but was associated with a positive history of severe hypoglycemia. Higher FOH was associated with higher frequency of hypoglycemia during follow-up.
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Efficacy of an internet-based exposure treatment for flying phobia (NO-FEAR Airlines) with and without therapist guidance: a randomized controlled trial.
Campos, D, Bretón-López, J, Botella, C, Mira, A, Castilla, D, Mor, S, Baños, R, Quero, S
BMC psychiatry. 2019;(1):86
Abstract
BACKGROUND Internet-based treatments appear to be a promising way to enhance the in vivo exposure approach, specifically in terms of acceptability and access to treatment. However, the literature on specific phobias is scarce, and, as far as we know, there are no studies on Flying Phobia (FP). This study aims to investigate the effectiveness of an Internet-based exposure treatment for FP (NO-FEAR Airlines) that includes exposure scenarios composed of images and sounds, versus a waiting-list control group. A secondary aim is to explore two ways of delivering NO-FEAR Airlines, with and without therapist guidance. METHODS A randomized controlled trial (RCT) was conducted in which 69 participants were allocated to: 1) NO-FEAR Airlines totally self-applied, 2) NO-FEAR Airlines with therapist guidance, 3) a waiting-list control group. Primary outcome measures were the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes included the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Behavioral outcomes (post-treatment flights and safety behaviors) were also included. Mixed-model analyses with no ad hoc imputations were conducted for primary and secondary outcome measures. RESULTS NO-FEAR Airlines (with and without therapist guidance) was significantly effective, compared to the waiting list control group, on all primary and secondary outcomes (all ps < .05), and no significant differences were found between the two ways of delivering the intervention. Significant improvements on diagnostic status and reliable change indexes were also found in both treatment groups at post-treatment. Regarding behavioral outcomes, significant differences in safety behaviors were found at post-treatment, compared to the waiting list. Treatment gains were maintained at 3- and 12-month follow-ups. CONCLUSION FP can be treated effectively via the Internet. NO-FEAR Airlines helps to enhance the exposure technique and provide access to evidence-based psychological treatment to more people in need. These data are congruent with previous studies highlighting the usefulness of computer-assisted exposure programs for FP, and they contribute to the literature on Internet-based interventions. To the best of our knowledge, this is the first RCT to investigate the effectiveness of an Internet-based treatment for FP and explore two ways of delivering the intervention (with and without therapist guidance). TRIAL REGISTRATION Clinicaltrials.gov: NCT02298478 ( https://clinicaltrials.gov/ct2/show/NCT02298478 ). Trial registration date 3 November 2014.
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Mechanisms underlying the effects of n-3 polyunsaturated fatty acids on fear memory processing and their hypothetical effects on fear of cancer recurrence in cancer survivors.
Okubo, R, Chen, C, Sekiguchi, M, Hamazaki, K, Matsuoka, YJ
Prostaglandins, leukotrienes, and essential fatty acids. 2018;:14-23
Abstract
The relationship of n-3 polyunsaturated fatty acids (PUFAs) and gut microbiota with brain function has been extensively reported. Here, we review how n-3 polyunsaturated fatty acids affect fear memory processing. n-3 PUFAs may improve dysfunctional fear memory processing via immunomodulation/anti-inflammation, increased BDNF, upregulated adult neurogenesis, modulated signal transduction, and microbiota-gut-brain axis normalization. We emphasize how n-3 PUFAs affect this axis and also focus on the hypothetical effects of PUFAs in fear of cancer recurrence (FCR), the primary psychological unmet need of cancer survivors. Its pathophysiology may be similar to that of post-traumatic stress disorder (PTSD), which involves dysfunctional fear memory processing. Due to fewer adverse effects than psychotropic drugs, nutritional interventions involving n-3 PUFAs should be acceptable for physically vulnerable cancer survivors. We are currently studying the relationship of FCR with n-3 PUFAs and gut microbiota in cancer survivors to provide them with a nutritional intervention that protects against FCR.
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Psychological outcomes of evening and night closed-loop insulin delivery under free living conditions in people with Type 1 diabetes: a 2-month randomized crossover trial.
Kropff, J, DeJong, J, Del Favero, S, Place, J, Messori, M, Coestier, B, Farret, A, Boscari, F, Galasso, S, Avogaro, A, et al
Diabetic medicine : a journal of the British Diabetic Association. 2017;(2):262-271
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AIM: To assess the impact on fear of hypoglycaemia and treatment satisfaction with an artificial pancreas system used for 2 consecutive months, as well as participant acceptance of the artificial pancreas system. METHODS In a randomized crossover trial patient-related outcomes associated with an evening-and-night artificial pancreas and sensor-augmented pump therapy were compared. Both intervention periods lasted 8 weeks. The artificial pancreas acceptance questionnaire (range 0-90, higher scores better), Hypoglycaemia Fear Survey II (range 0-72, higher scores worse) and Diabetes Treatment Satisfaction Questionnaire (range 0-36, higher scores better) were completed by 32 participants. Semi-structured interviews were conducted after study completion in a subset of six participants. Outcomes were compared using a repeated-measures anova model or paired t-test when appropriate. RESULTS The total artificial pancreas acceptance questionnaire score at the end of the artificial pancreas period was 69.1 (sd 14.7; 95% CI 63.5, 74.7), indicating a positive attitude towards the artificial pancreas. No significant differences were found among the scores at baseline, end of sensor-augmented pump therapy period or end of the artificial pancreas period with regard to fear of hypoglycaemia [28.2 (sd 17.5), 23.5 (sd 16.6) and 23.5 (sd 16.7), respectively; P = 0.099] or diabetes treatment satisfaction [29.0 (sd 3.9), 28.2 (sd 5.2) and 28.0 (sd 7.1), respectively; P = 0.43]. Themes frequently mentioned in the interviews were 'positive effects at work', 'improved blood glucose', 'fewer worries about blood glucose', but also 'frequent alarms', 'technological issues' and 'demand for an all-in-one device'. CONCLUSIONS The psychological outcomes of artificial pancreas and sensor-augmented pump therapy were similar. Current artificial pancreas technology is promising but user concerns should be taken into account to ensure utility of these systems.
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Early-Life Adversity and Physical and Emotional Health Across the Lifespan: A Neuroimmune Network Hypothesis.
Nusslock, R, Miller, GE
Biological psychiatry. 2016;(1):23-32
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Children who experience chronic stressors are vulnerable to emotional and physical health problems across the lifespan. This phenomenon raises questions for scientists and clinicians alike. How does adversity get under the skin of the developing child? Through what mechanisms does it confer vulnerability to a heterogeneous set of mental and physical illnesses? And how does it instantiate risk across different life stages, engendering vulnerability to conditions that develop shortly after stressor exposure-like depression-and conditions that manifest decades later, like heart disease? Although answers to these questions have started to emerge, research has typically focused on single diseases or organ systems. To understand the plethora of health problems associated with childhood adversity, we argue that the field needs a second generation of research that recognizes multidirectional transactions among biological systems. To help facilitate this process, we propose a neuroimmune network hypothesis as a heuristic framework for organizing knowledge from disparate literatures and as a springboard for generating integrative research. Drawing on existing data, we argue that early-life adversity amplifies crosstalk between peripheral inflammation and neural circuitries subserving threat-related, reward-related, and executive control-related processes. This crosstalk results in chronic low-grade inflammation, thereby contributing to adiposity, insulin resistance, and other predisease states. In the brain, inflammatory mediators act on cortico-amygdala threat and cortico-basal ganglia reward, circuitries in a manner that predisposes individuals to self-medicating behaviors like smoking, drug use, and consumption of high-fat diets. Acting in concert with inflammation, these behaviors accelerate the pathogenesis of emotional and physical health problems.