Feasibility of an emotion regulation intervention for patients in cardiac rehabilitation

Cardiac rehabilitation is important to improve physical activity and reduce cardiovascular disease risk factors among people who have experienced a major cardiac event. However, poor emotion regulation can make it difficult to change cardiovascular risk factors. The purpose of this paper was to assess the feasibility of the Regulating Emotions to improve Nutrition Exercise and reduce Stress (RENEwS) intervention, an education program aimed at improving emotion regulation strategies among patients in cardiac rehabilitation. Fourteen cardiac rehabilitation patients (mean age 61 years) enrolled in 5 weekly RENEwS sessions. Qualitative analysis of participants’ comments was used to assess eight elements of feasibility. Fifty-seven percent of participants completed the intervention. Participants thought the intervention was feasible, with strengths in the areas of acceptability, demand, adaptation, integration, and implementation. Other comments regarding practicality, expansion, and perceived efficacy provide guidance for intervention refinement.Kelly L. Wierenga was supported in this work as The Nurses Charitable Trust of Greater Miami Scholar of the American Nurses Foundation and by NINR grants T32NR015433 and P30NR015326. David M. Fresco was supported by NHLBI Grant R01HL119977, NINR Grant P30NR015326, NCCIH Grant R61AT009867, and NICHD Grant R21HD095099. Megan Alder was supported by NINR grant P30NR015326 and T32NR015433. This secondary analysis was from a P30 pilot study in the SMART Center: Brain-Behavior Connections in Self-Management Science directed by Dr. Shirley Moore at CWRU (P30NR015326). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health

Changes in Functional Connectivity Following Treatment With Emotion Regulation Therapy

Emotion regulation therapy (ERT) is an efficacious treatment for distress disorders (i.e., depression and anxiety), predicated on a conceptual model wherein difficult to treat distress arises from intense emotionality (e.g., neuroticism, dispositional negativity) and is prolonged by negative self-referentiality (e.g., worry, rumination). Individuals with distress disorders exhibit disruptions in two corresponding brain networks including the salience network (SN) reflecting emotion/motivation and the default mode network (DMN) reflecting self-referentiality. Using resting-state functional connectivity (rsFC) analyses, seeded with primary regions in each of these networks, we investigated whether ERT was associated with theoretically consistent changes across nodes of these networks and whether these changes related to improvements in clinical outcomes. This study examined 21 generalized anxiety disorder (GAD) patients [with and without major depressive disorder (MDD)] drawn from a larger intervention trial (Renna et al., 2018a), who completed resting state fMRI scans before and after receiving 16 sessions of ERT. We utilized seed-based connectivity analysis with seeds in the posterior cingulate cortex (PCC), right anterior insula, and right posterior insula, to investigate whether ERT was associated with changes in connectivity of nodes of the DMN and SN networks to regions across the brain. Findings revealed statistically significant treatment linked changes in both the DMN and SN network nodes, and these changes were associated with clinical improvement corresponding to medium effect sizes. The results are discussed in light of a nuanced understanding of the role of connectivity changes in GAD and MDD, and begin to provide neural network support for the hypothesized treatment model predicated by ERT

DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection

STUDY OBJECTIVES: The study had three primary goals. First, we estimated survey-assessed DSM-5 insomnia disorder rates in pregnancy, and described associated sociodemographics, and sleep-wake and mental health symptoms. Second, we derived cutoffs for detecting DSM-5 insomnia disorder using common self-report measures of sleep symptoms. Third, we identified clinically relevant cut-points on measures of nocturnal cognitive and somatic arousal. METHODS: Ninety-nine women (85.9% in the 2nd trimester) completed online surveys including DSM-5 insomnia disorder criteria, the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Presleep Arousal Scale’s Cognitive (PSASC) and Somatic (PSASS) factors, and Edinburgh Postnatal Depression Scale. RESULTS: DSM-5 insomnia disorder rate was 19.2%. Insomnia was associated with depression, suicidality, nocturnal cognitive and somatic arousal, and daytime sleepiness. An ISI scoring method that aligns with DSM-5 criteria yielded excellent metrics for detecting insomnia disorder and good sleep. Regarding quantitative cutoffs, ISI ≥ 10 and ISI ≥ 11 (but not ISI ≥ 15) were supported for detecting DSM-5 insomnia, whereas ISI ≤ 7 and ISI ≤ 9 performed well for detecting good sleep. PSQI cutoff of 5 was supported for detecting insomnia and good sleep. The optimal cutoff for nocturnal cognitive arousal was PSASC ≥ 18, whereas the optimal cutoff for somatic arousal was PSASS ≥ 13. CONCLUSIONS: Insomnia disorder affects a large segment of pregnant women. Empirically derived cutoffs for insomnia, good sleep, cognitive arousal, and somatic arousal may inform case identification and future perinatal sleep research methodology

Preliminary Efficacy of an Emotion Regulation Intervention on Physical Activity and Depressive and Anxious Symptoms in Individuals in Cardiac Rehabilitation

Background: For the 720 000 Americans expected to experience a new acute cardiac event this year, cardiac rehabilitation is an important part of recovery. Symptoms of depression and anxiety undermine recovery efforts, leaving recovering patients at risk for diminished functional capacity and heightened risk of mortality. Poor emotion regulation can worsen symptoms of depression and anxiety and hinder recovery efforts. Objective: The purpose of this randomized controlled trial was to evaluate the early efficacy testing of a theoretically based emotion regulation treatment (Regulating Emotions to Improve Self-management of Nutrition, Exercise, and Stress [RENEwS]) designed to assist survivors of an acute cardiac event in cardiac rehabilitation to optimize recovery. Methods: Survivors of an acute cardiac event in cardiac rehabilitation (n = 30, 83% men) were randomized to five 1-hour in-person group sessions of RENEwS or a phone-based attention-control group. Participants completed measures of depression and anxiety symptoms at 3 time points. Moderate to vigorous physical activity (MVPA) was objectively measured for 7 days at each time point using waist-worn actigraphy monitors. Between-group differences were calculated using analysis of variance with Cohen f effect sizes calculated to evaluate initial efficacy. Results: There was no statistically significant difference in depression, anxiety, or MVPA over time based on group assignment (all P > .05). Compared with attention control participants, in RENEwS participants, preliminary effects showed greater reductions in depression (Cohen f = 0.34) and anxiety (Cohen f = 0.40) symptoms but only modest improvements in MVPA from baseline to 5 months (Cohen f = 0.08). Conclusions: Findings show that RENEwS is a promising emotion regulation intervention to enhance cardiac rehabilitation and potentially decrease symptoms of depression and anxiety.Kelly L. Wierenga was supported in this work as The Nurses Charitable Trust of Greater Miami Scholar of the American Nurses Foundation and by NINR grants T32NR015433 and P30NR015326. David M. Fresco was supported by NHLBI Grant R01HL119977, NINR Grant P30NR015326, NCCIH Grant R61AT009867, NIMH Grant R01MH118218, NICHD Grant R21HD095099, and NCI Grant R01CA244185. Megan Alder was supported by NINR grant P30NR015326 and T32NR015433. This secondary analysis was from a P30 pilot study in the SMART Center: Brain-Behavior Connections in Self-Management Science directed by Dr. Shirley Moore at CWRU (P30NR015326). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health

Efficacy of a Manualized and Workbook-Driven Individual Treatment for Social Anxiety Disorder

Social anxiety disorder is a prevalent and impairing disorder for which viable cognitive-behavioral therapies exist. However, these treatments have not been easily packaged for dissemination and may be underutilized as a result. The current study reports on the findings of a randomized controlled trial of a manualized and workbook-driven individual cognitive-behavioral treatment for social anxiety disorder (Hope, Heimberg, Juster, & Turk, 2000; Hope, Heimberg, & Turk, 2006). This treatment package was derived from an empirically supported group treatment for social anxiety disorder and intended for broad dissemination, but it has not previously been subjected to empirical examination on its own. As a first step in that examination, 38 clients seeking treatment for social anxiety disorder at either the Adult Anxiety Clinic of Temple University or the Anxiety Disorders Clinic of the University of Nebraska–Lincoln were randomly assigned to receive either immediate treatment with this cognitive-behavioral treatment package or treatment delayed for 20 weeks. Evaluation at the posttreatment/postdelay period revealed substantially greater improvements among immediate treatment clients on interviewer-rated and self-report measures of social anxiety and impairment. Three-month follow-up assessment revealed maintenance of gains. Clinical implications and directions for future research are discussed

Europe’s Farm to Fork Strategy and Its Commitment to Biotechnology and Organic Farming: Conflicting or Complementary Goals?

The European Commission's Farm to Fork (F2F) strategy, under the European Green Deal, acknowledges that innovative techniques, including biotechnology, may play a role in increasing sustainability. At the same time, organic farming will be promoted, and at least 25% of the EU's agricultural land shall be under organic farming by 2030. How can both biotechnology and organic farming be developed and promoted simultaneously to contribute to achieving the Sustainable Development Goals (SDGs)? We illustrate that achieving the SDGs benefits from the inclusion of recent innovations in biotechnology in organic farming. This requires a change in the law. Otherwise, the planned increase of organic production in the F2F strategy may result in less sustainable, not more sustainable, food systems

Inter-brain synchronization in the practice of Tibetan monastic debate

Objectives: Although mindfulness meditation is the familiar and researched form of mental training derived from Buddhism, it represents but one form of practice. Monastic debate is an interactive and dyadic analytical meditation practice that originates from the Tibetan Buddhist tradition where monastics seek to jointly deepen their understanding of complicated philosophical issues. To date, monastic debate and analytic meditation have yet to be examined in the context of scientific investigation. Methods: In the current study, we examined the neural correlates of this analytical meditation practice by means of hyperscanning electroencephalography, a method well-suited for examining social interactions. Results: Consistent with the idea that analytical meditation helps to train concentration, we observed that over the course of the debate, mid-frontal theta oscillations—a correlate of absorption—increased significantly. This increase was stronger for more experienced monks as compared with monks at the beginning of their education. In addition, we found evidence for increases in synchrony in frontal alpha oscillations between paired debaters during moments of agreement as compared with disagreement on a set of premises. Conclusions: Together, these findings provide an initial understanding of Tibetan monastic debate and analytical meditation using neuroscientific methods

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

The node of Ranvier in CNS pathology.

Healthy nodes of Ranvier are crucial for action potential propagation along myelinated axons, both in the central and in the peripheral nervous system. Surprisingly, the node of Ranvier has often been neglected when describing CNS disorders, with most pathologies classified simply as being due to neuronal defects in the grey matter or due to oligodendrocyte damage in the white matter. However, recent studies have highlighted changes that occur in pathological conditions at the node of Ranvier, and at the associated paranodal and juxtaparanodal regions where neurons and myelinating glial cells interact. Lengthening of the node of Ranvier, failure of the electrically resistive seal between the myelin and the axon at the paranode, and retraction of myelin to expose voltage-gated K(+) channels in the juxtaparanode, may contribute to altering the function of myelinated axons in a wide range of diseases, including stroke, spinal cord injury and multiple sclerosis. Here, we review the principles by which the node of Ranvier operates and its molecular structure, and thus explain how defects at the node and paranode contribute to neurological disorders