The Roles of Safety Behaviour in the Cognitive-Behavioural Treatment of Anxiety Disorders

Safety behaviour, which includes idiosyncratic strategies aimed at reducing anxiety and avoiding or averting perceived catastrophe, has been conceptualized in cognitive-behavioural models of anxiety disorders as having an anti-therapeutic, anxiety-maintaining function. There is substantial empirical support for its proposed negative effects in the context of exposure-based treatments for anxiety disorders. However, other hypotheses and findings suggest that incorporation of safety behaviour into such treatments might instead facilitate gains and/or enhance treatment acceptability. This research aimed to further understand the role of safety behaviour in the treatment of anxiety disorders. In Study 1, an experimental paradigm was used to examine the effect of ‘safety gear’ on belief change. Spider fearful participants were asked to evaluate the validity of a targeted negative belief about spiders during a brief session with a live tarantula while either using or not using protective gear during the session. The results demonstrated that negative beliefs declined equally and robustly in both groups after the session. Study 2 investigated treatment acceptability and preference as a function of safety behaviour use (judicious vs. discouraged) and treatment rationale (cognitive vs. extinction). Clinically anxious participants and undergraduate students provided acceptability ratings and preference ranks for four written vignettes describing a course of CBT for fear or anxiety. Treatment descriptions promoting judicious safety behaviour use received significantly higher acceptability ratings than those discouraging its use. Descriptions that presented a cognitive versus an extinction rationale were also rated as more acceptable. The most highly ranked treatment included judicious safety behaviour use under a cognitive rationale. The same pattern of results was observed in both participant groups. Study 3 involved the development and psychometric evaluation of a novel self-report measure of safety behaviour, the Safety Behaviour Inventory (SBI), using a large undergraduate student sample and a smaller sample of clinically anxious participants. Exploratory and confirmatory factor analyses and analyses of reliability and validity were conducted. Preliminary support was obtained for the discriminant and construct validity of a four-factor SBI. The combined results of these studies are discussed in terms of cognitive-behavioural theories and treatments of anxiety disorders, and future research directions are suggested

Incorporating the Judicious Use of Safety Behavior Into Exposure-Based Treatments for Anxiety Disorders: A Study of Treatment Acceptability

This analog study investigated treatment acceptability and preference as a function of safety behavior use (judicious vs. discouraged) and treatment rationale (cognitive vs. extinction). Thirty-two clinically anxious participants and 437 undergraduate students provided ratings of acceptability and adherence, as well as preference ranks for four written vignettes describing a course of cognitive-behavioral therapy (CBT) for fear or anxiety. Treatment descriptions promoting judicious safety behavior use received significantly higher acceptability and adherence ratings compared to those discouraging its use. Descriptions that presented a cognitively based rationale, compared to an extinction-based rationale, were also rated as both significantly more acceptable and easier to adhere to. The highest preference rank was for treatment that included judicious safety behavior use, conveyed via a cognitive rationale. A similar pattern of results was observed in both participant groups. These findings suggest that the judicious incorporation of safety behavior into CBT has the potential to reduce treatment refusal and dropout. Results are discussed in terms of their implications for cognitive-behavioral and exposure-based treatments.</jats:p

MDCT: Angiography of anatomical variations of the celiac trunk and superior mesenteric artery

The aim of this study was to detect and describe the existence and incidence of anatomical variations of the celiac trunk and superior mesenteric artery. The study was conducted on 150 persons, who underwent abdominal Multi- Detector Computer Tomography (MDCT) angiography, from April 2010 until November 2012. CT images were obtained with a 64-row MDCT scanner in order to analyze the vascular anatomy and anatomical variations of the celiac trunk and superior mesenteric artery. In our study, we found that 78% of patients have a classic anatomy of the celiac trunk and superior mesenteric artery. The most frequent variation was the origin of the common hepatic artery from the superior mesenteric artery (10%). The next variation, according to frequency, was the origin of the left gastric artery direct from the abdominal aorta (4%). The arc of Buhler as an anastomosis between the celiac trunk and superior mesenteric artery, was detected in 3% of cases, as was the presence of a common trunk of the celiac trunk and superior mesenteric artery (in 3% of cases). Separate origin of the splenic artery and the common hepatic artery was present in 2% of patients. The MDCT scanner gives us an insight into normal anatomy and variations of the abdominal blood vessels, which is very important in the planning of surgical interventions, especially transplantation, as well as in the prevention of complications due to ischemia

Induction of NTPDase1/CD39 by Reactive Microglia and Macrophages Is Associated With the Functional State During EAE

Purinergic signaling is critically involved in neuroinflammation associated with multiple sclerosis (MS) and its major inflammatory animal model, experimental autoimmune encephalomyelitis (EAE). Herein, we explored the expression of ectonucleoside triphosphate diphosphohydrolase1 (NTPDase1/CD39) in the spinal cord, at the onset (Eo), peak (Ep), and end (Ee) of EAE. Several-fold increase in mRNA and in NTPDase1 protein levels were observed at Eo and Ep. In situ hybridization combined with fluorescent immunohistochemistry showed that reactive microglia and infiltrated mononuclear cells mostly accounted for the observed increase. Colocalization analysis revealed that up to 80% of Iba1 immunoreactivity and ∼50% of CD68 immunoreactivity was colocalized with NTPDase1, while flow cytometric analysis revealed that ∼70% of mononuclear infiltrates were NTPDase1+ at Ep. Given the main role of NTPDase1 to degrade proinflammatory ATP, we hypothesized that the observed up-regulation of NTPDase1 may be associated with the transition between proinflammatory M1-like to neuroprotective M2-like phenotype of microglia/macrophages during EAE. Functional phenotype of reactive microglia/macrophages that overexpress NTPDase1 was assessed by multi-image colocalization analysis using iNOS and Arg1 as selective markers for M1 and M2 reactive states, respectively. At the peak of EAE NTPDase1 immunoreactivity showed much higher co-occurrence with Arg1 immunoreactivity in microglia and macrophages, compared to iNOS, implying its stronger association with M2-like reactive phenotype. Additionally, in ∼80% of CD68 positive cells NTPDase1 was coexpressed with Arg1 compared to negligible fraction coexpresing iNOS and ∼15% coexpresing both markers, additionally indicating prevalent association of NTPDase1 with M2-like microglial/macrophages phenotype at Ep. Together, our data suggest an association between NTPDase1 up-regulation by reactive microglia and infiltrated macrophages and their transition toward antiinflammatory phenotype in EAE

Systematic bioinformatic analyses of nutrigenomic modifications by polyphenols associated with cardiometabolic health in humans: Evidence from targeted nutrigenomic studies

Cardiometabolic disorders are among the leading causes of mortality in the human population. Dietary polyphenols exert beneficial effects on cardiometabolic health in humans. Molecular mechanisms, however, are not completely understood. Aiming to conduct in-depth integrative bioinformatic analyses to elucidate molecular mechanisms underlying the protective effects of polyphenols on cardiometabolic health, we first conducted a systematic literature search to identify human intervention studies with polyphenols that demonstrate improvement of cardiometabolic risk factors in parallel with significant nutrigenomic effects. Applying the predefined inclusion criteria, we identified 58 differentially expressed genes at mRNA level and 5 miRNAs, analyzed in peripheral blood cells with RT-PCR methods. Subsequent integrative bioinformatic analyses demonstrated that polyphenols modulate genes that are mainly involved in the processes such as inflammation, lipid metabolism, and endothelial function. We also identified 37 transcription factors that are involved in the regulation of polyphenol modulated genes, including RELA/NFKB1, STAT1, JUN, or SIRT1. Integrative bioinformatic analysis of mRNA and miRNA-target pathways demonstrated several common enriched pathways that include MAPK signaling pathway, TNF signaling pathway, PI3K-Akt signaling pathway, focal adhesion, or PPAR signaling pathway. These bioinformatic analyses represent a valuable source of information for the identification of molecular mechanisms underlying the beneficial health effects of polyphenols and potential target genes for future nutrigenetic studies

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

Safety behaviour does not interfere with exposure therapy : the case of specific phobia

Safety behaviour consists of actions, thoughts, and/or protective objects that fearful individuals use to reduce their anxiety. It can potentially interfere with the progress of exposure therapy, which entails exposing patients to a feared stimulus or situation, but other hypotheses suggest that it may not be entirely detrimental to treatment effectiveness. This study aims to elucidate the role of safety behaviour in exposure-based treatments for anxiety disorders and uses a paradigm of exposure treatment for snake fear. Participants are randomized to one of two conditions, whereby they use either safety gear, such as gloves and goggles, or do not use any safety gear during 45 minutes of systematic exposure to a live snake. Measures are administered pre-treatment, immediately following treatment, and 10 minutes post-treatment to assess participants' fear-related cognitions, subjective ratings of fear, and their distance of closest approach to the snake. The results demonstrate that exposure treatment for snake fear is effective irrespective of safety behaviour use, as indicated by pre- to post-treatment differences for both groups of participants on all outcome measures. It was found that participants who used safety gear reported cognitive change equivalent to those who did not use safety gear post-treatment, supporting the notion that use of safety behaviour during exposure treatment may promote adaptive cognitive change. Results are discussed in terms of cognitive-behavioural theories of and treatments for anxiety disorders