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Trials Jun 2024According to the World Health Organization, alcohol is a major global public health problem, leading to a significant increase in illness and death. To treat alcohol use...
CONTEXT
According to the World Health Organization, alcohol is a major global public health problem, leading to a significant increase in illness and death. To treat alcohol use disorders, new therapeutic tools are being promoted, among which virtual reality (VR) shows promise. Previous research has demonstrated the efficacy of VR in reducing alcohol cravings in patients, but there is a lack of data on its effectiveness in maintaining abstinence or reducing consumption in recently abstinent individuals. The E-Reva study aims to compare the efficacy of a treatment strategy combining virtual reality cue exposure therapy (VR-CET) and cognitive behavioral therapy (CBT) with conventional CBT in reducing alcohol consumption and craving in patients with alcohol use disorder (AUD). In addition to this primary objective, the study will compare the effects of VR-CET combined with CBT on anxiety, depression, rumination, and feelings of self-efficacy versus conventional CBT.
METHODS
This prospective randomized controlled trial will be conducted over 8 months in four addiction departments in France. It includes two parallel groups: i) the VR-CET + CBT group, and ii) the CBT-only group, which serves as a control group. Participants will be recruited by the investigating doctor in the addiction centers. The sample will consist of 156 patients diagnosed with AUD and abstinent for at least 15 days. Both treatment groups will participate in four group CBT sessions followed by four individual sessions: i) the VR-CET group will be exposed to virtual environments associated with alcohol-related stimuli, ii) the CBT-only group will receive traditional CBT sessions. After completion of the 8 sessions, patients will be followed up for 6 months. The primary outcome is the cumulative number of standard drinks consumed at 8 months, assessed using the TLFB method.
DISCUSSION
Despite the promise of VR-CET to reduce the desire to drink, the effect on alcohol consumption remains uncertain in the existing literature. Our protocol aims to address the limitations of previous research by increasing sample size, targeting consumption reduction, and incorporating neutral environments. E-Reva aims to enrich the literature on the use of VR in the treatment of AUD and open new perspectives for future interventions.
TRIAL REGISTRATION
ClinicalTrials.gov ID NCT06104176, Registered 2023/11/13 ( https://clinicaltrials.gov/study/NCT06104176?id=NCT06104176&rank=1 ). N° IDRCB: 2022-A02797-36. Protocol version 1.0, 12/05/2023.
Topics: Humans; Cognitive Behavioral Therapy; Virtual Reality Exposure Therapy; Randomized Controlled Trials as Topic; Alcoholism; Prospective Studies; Treatment Outcome; Craving; Multicenter Studies as Topic; Alcohol Abstinence; France; Time Factors; Adult; Male; Female; Middle Aged; Cues; Virtual Reality; Alcohol Drinking
PubMed: 38937776
DOI: 10.1186/s13063-024-08271-x -
HNO Jun 2024Belching is the act of expelling air from the stomach or esophagus into the pharynx. Although the process is regarded as physiological, excessive belching might be... (Review)
Review
Belching is the act of expelling air from the stomach or esophagus into the pharynx. Although the process is regarded as physiological, excessive belching might be associated with a significant burden for affected patients in the sense of a belching disorder. Diagnosis of a belching disorder is often challenging, and its differentiation from other conditions such as rumination syndrome, singultus, or aerophagia can be difficult. Treatment of these disorders also represents a challenge for otorhinolaryngologists. Hence, the aim of this review is to provide an interdisciplinary overview of these clinical syndromes and provide practical guidance for their diagnosis and treatment.
PubMed: 38935275
DOI: 10.1007/s00106-024-01495-y -
Psychological Trauma : Theory,... Jun 2024Posttraumatic stress disorder (PTSD) and separation anxiety often show high comorbidity after trauma, which complicates the course of disease and treatment response....
Longitudinal associations between posttraumatic stress disorder, separation anxiety, and rumination among adolescents: Disentangling within-person and between-person associations.
OBJECTIVE
Posttraumatic stress disorder (PTSD) and separation anxiety often show high comorbidity after trauma, which complicates the course of disease and treatment response. However, it is unclear how PTSD and separation anxiety comorbidity occur. According to the cognitive model of PTSD, rumination may be a key cognitive process linking the two constructs. Thus, this study aimed to examine the relation between PTSD and separation anxiety and to assess the mediating role of rumination in this relation among adolescents after trauma.
METHOD
A follow-up survey was conducted among 204 adolescent survivors of the Ya'an earthquake, at 6 months (T1), 12 months (T2), and 18 months (T3). A random-intercept cross-lagged panel model was used for data analysis to disentangle within-person dynamics from stable between-person differences.
RESULTS
The results showed that at the within-person level, PTSD increased separation anxiety via rumination, and early PTSD further exacerbated later PTSD through increased rumination and separation anxiety.
CONCLUSIONS
These findings highlight the mediating role of rumination, elucidate the relation between PTSD and separation anxiety, and provide theoretical support for the development of transdiagnostic clinical interventions and treatments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
PubMed: 38934940
DOI: 10.1037/tra0001721 -
Behavioral Sciences (Basel, Switzerland) May 2024People with generalized anxiety disorder tend to have sleep problems, and studies have found correlations between metacognition, rumination, and sleep, but it is unclear...
People with generalized anxiety disorder tend to have sleep problems, and studies have found correlations between metacognition, rumination, and sleep, but it is unclear how metacognition and rumination work in people with a tendency towards generalized anxiety disorder. The goal of this paper is to investigate the correlation between metacognition, rumination, and sleep in university students with a tendency towards generalized anxiety disorder, and the mediating role of rumination in the effect of metacognition on sleep. The Generalized Anxiety Disorder Scale (GAD-7), the Meta-Cognition Questionnaire (MCQ-30), the Ruminative Responses Scale (RRS), and the Insomnia Severity Index (ISI) were used to investigate and psychometrically measure 566 university students in Anyang Normal College. The results of correlation analysis showed significant positive correlations between metacognition and sleep, ruminative thinking and sleep, and metacognition and rumination in university students with a tendency towards generalized anxiety disorder. Mediation analysis showed that rumination partially mediated the effect of metacognition on sleep, with the mediating effect accounting for 51.1% of the total effect. There is a strong correlation between metacognition, rumination, and sleep in university students with a tendency towards generalized anxiety disorder, and both metacognition and rumination can predict sleep, while metacognition can affect sleep through the mediating effect of rumination.
PubMed: 38920776
DOI: 10.3390/bs14060444 -
The Journal of Clinical Psychiatry Jun 2024. Sex differences in suicide attempts have been widely recognized across domains such as depression and rumination. The relationship between depression, rumination, and...
. Sex differences in suicide attempts have been widely recognized across domains such as depression and rumination. The relationship between depression, rumination, and suicide attempts in mood disorders has been studied before; however, how they interact across sexes remains unclear. This study aimed to examine the sex differences in the relationship between depression, rumination, and suicide attempts in Chinese adolescents with mood disorders. We recruited 681 adolescents with mood disorders who met ICD-10 criteria for having unipolar or bipolar depression with a current depressive episode at the time of the study and collected demographic and clinical data. The prevalence of suicide attempts in female adolescents with mood disorders (64.36%) was significantly higher than that in male adolescents with mood disorders (49.47%), with an odds ratio of 1.84 (95% CI, 1.31-2.59). Regression analysis showed that PHQ-9 was independently associated with suicide attempts among male adolescents with mood disorders, while in female adolescents with mood disorders, total scores of PHQ-9 and RRS-10 were independently associated with suicide attempts. Importantly, in female adolescents with mood disorders, the mediating effect of RRS-10 total score on the relationship between PHQ-9 and suicide attempts was significant (standardized β = 0.005, = 0.003, 95% CI, 0.002-0.008), the mediating effect accounted for 31.25% of the total effect of depressive symptoms on suicide attempts. Our study suggests that there are sex differences in depression, rumination, and suicide attempts and in the interaction between them in adolescents with mood disorders. These sex differences may have important clinical implications, both for improving strategies to detect suicidal behaviors and for developing better early intervention programs for this population.
Topics: Humans; Suicide, Attempted; Adolescent; Male; Female; Sex Factors; Rumination, Cognitive; Mood Disorders; Bipolar Disorder; Depressive Disorder; China; Prevalence
PubMed: 38917361
DOI: 10.4088/JCP.23m15136 -
European Journal of Cardiovascular... Jun 2024Brain fog and fatigue are common issues after acute coronary syndrome. However, little is known about the nature and impact of these experiences in spontaneous coronary...
AIMS
Brain fog and fatigue are common issues after acute coronary syndrome. However, little is known about the nature and impact of these experiences in spontaneous coronary artery dissection (SCAD) survivors. The aims of this study were to understand the experiences of brain fog and the coping strategies used after SCAD.
METHODS AND RESULTS
Participants were recruited from the Victor Chang Cardiac Research Institute Genetics Study database and were considered eligible if their event occurred within 12-months. Seven semi-structured online focus groups were conducted between December to January 2021-2022, with this study reporting findings related to brain fog and fatigue. Interviews were transcribed and thematically analysed using an iterative approach. Participants (N=30) were a mean age of 52.2 ((9.5) and mostly female (n=27, 90%). The overarching theme of brain fog after SCAD included four main themes: how brain fog is experienced, perceived causes, impacts, and how people cope. Experiences included memory lapses, difficulty concentrating and impaired judgement, and perceived causes included medication, fatigue and tiredness, and menopause and hormonal changes. Impacts of brain fog included rumination, changes in self-perception, disruption to hobbies/pastimes, and limitations at work. Coping mechanisms included setting reminders and expectations, being one's own advocate, lifestyle and self-determined medication adjustments, and support from peers.
CONCLUSION
Brain fog is experienced by SCAD survivors and the impacts are varied and numerous, including capacity to work. SCAD survivors reported difficulty understanding causes and found their own path to coping. Recommendations for clinicians are provided.
PubMed: 38916979
DOI: 10.1093/eurjcn/zvae097 -
Nordic Journal of Psychiatry Jun 2024While mood instability is strongly linked to depression, its ramifications remain unexplored. In patients diagnosed with unipolar depression (UD), our objective was to...
OBJECTIVE
While mood instability is strongly linked to depression, its ramifications remain unexplored. In patients diagnosed with unipolar depression (UD), our objective was to investigate the association between mood instability, calculated based on daily smartphone-based patient-reported data on mood, and functioning, quality of life, perceived stress, empowerment, rumination, recovery, worrying and wellbeing.
METHODS
Patients with UD completed daily smartphone-based self-assessments of mood for 6 months, making it possible to calculate mood instability using the Root Mean Squared Successive Difference (rMSSD) method. A total of 59 patients with UD were included. Data were analyzed using mixed effects regression models.
RESULTS
There was a statistically significant association between increased mood instability and increased perceived stress (adjusted model: : 0.010, 95% CI: 0.00027; 0.021, = 0.044), and worrying (adjusted model: : 0.0060, 95% CI: 0.000016; 0.012, = 0.049), and decreased quality of life (adjusted model: : -0.0056, 95% CI: -0.011; -0.00028, = 0.039), recovery (adjusted model: : -0.032, 95% CI: -0.0059; -0.00053, = 0.019) and wellbeing. There were no statistically significant associations between mood instability and functioning, empowerment, and rumination ('s >0.09).
CONCLUSION
These findings underscore the significant influence of mood instability on patients' daily lives. Identification of mood fluctuations offer potential insights into the trajectory of the illness in these individuals.
PubMed: 38905155
DOI: 10.1080/08039488.2024.2369179 -
Psychoneuroendocrinology May 2024Disruptions in appetite-regulating hormones may contribute to the development and/or maintenance of avoidant/restrictive food intake disorder (ARFID). No study has...
Disruptions in appetite-regulating hormones may contribute to the development and/or maintenance of avoidant/restrictive food intake disorder (ARFID). No study has previously assessed fasting levels of orexigenic ghrelin or anorexigenic peptide YY (PYY), nor their trajectory in response to food intake among youth with ARFID across the weight spectrum. We measured fasting and postprandial (30, 60, 120 minutes post-meal) levels of ghrelin and PYY among 127 males and females with full and subthreshold ARFID (n = 95) and healthy controls (HC; n = 32). We used latent growth curve analyses to examine differences in the trajectories of ghrelin and PYY between ARFID and HC. Fasting levels of ghrelin did not differ in ARFID compared to HC. Among ARFID, ghrelin levels declined more gradually than among HC in the first hour post meal (p =.005), but continued to decline between 60 and 120 minutes post meal, whereas HC plateaued (p =.005). Fasting and PYY trajectory did not differ by group. Findings did not change after adjusting for BMI percentile (M(SD) = 37(35); M(SD) = 53(26); p =.006) or calories consumed during the test meal (M(SD) = 294(118); M(SD) = 384 (48); p <.001). These data highlight a distinct trajectory of ghrelin following a test meal in youth with ARFID. Future research should examine ghrelin dysfunction as an etiological or maintenance factor of ARFID.
PubMed: 38896990
DOI: 10.1016/j.psyneuen.2024.107063 -
Journal of Affective Disorders Jun 2024Higher functional connectivity within the default mode network (DMN) has been found in functional magnetic resonance imaging (fMRI) studies of major depressive disorder...
BACKGROUND
Higher functional connectivity within the default mode network (DMN) has been found in functional magnetic resonance imaging (fMRI) studies of major depressive disorder (MDD). We used electroencephalogram (EEG) coherence as an index of functional connectivity to examine group differences in DMN between the MDD and healthy control (HC) groups during the resting state.
METHODS
MDD patients with comorbid anxiety symptoms (n = 154) and healthy controls (n = 165) completed the questionnaires of depression, anxiety, and rumination. A 19-channel EEG recording was measured under resting state for all participants. EEG coherences of the delta, theta, alpha, beta, and high beta in the anterior DMN (aDMN), posterior DMN (pDMN), aDMN-pDMN, DMN-parahippocampal gyrus (PHG), and DMN-temporal gyrus were compared between the two groups. The correlations between rumination, anxiety, and DMN coherence were examined in the MDD group.
RESULTS
(1) No difference was found in the delta, theta, alpha, and beta within the DMN brain regions between the two groups; the MDD group showed higher high beta coherence within DMN brain regions than the HC group. (2) Rumination was negatively correlated with theta coherence of aDMN, and positively correlated with beta coherence of aDMN and with alpha coherence of pDMN and DMN-PHG. (3) Anxiety was positively correlated with high beta coherence of aDMN, pDMN, and DMN-PHG.
CONCLUSIONS
MDD patients with comorbid anxiety symptoms exhibited hypercoherence within the DMN brain regions. Hypercoherences were related to symptoms of rumination, and anxiety may be a biomarker for MDD patients with comorbid anxiety symptoms.
PubMed: 38889861
DOI: 10.1016/j.jad.2024.06.041 -
JAMA Network Open Jun 2024Racial discrimination increases the risk of adverse brain health outcomes, potentially via neuroplastic changes in emotion processing networks. The involvement of deep...
IMPORTANCE
Racial discrimination increases the risk of adverse brain health outcomes, potentially via neuroplastic changes in emotion processing networks. The involvement of deep brain regions (brainstem and midbrain) in these responses is unknown. Potential associations of racial discrimination with alterations in deep brain functional connectivity and accelerated epigenetic aging, a process that substantially increases vulnerability to health problems, are also unknown.
OBJECTIVE
To examine associations of racial discrimination with brainstem and midbrain resting-state functional connectivity (RSFC) and DNA methylation age acceleration (DMAA) among Black women in the US.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study was conducted between January 1, 2012, and February 28, 2015, and included a community-based sample of Black women (aged ≥18 years) recruited as part of the Grady Trauma Project. Self-reported racial discrimination was examined in association with seed-to-voxel brain connectivity, including the locus coeruleus (LC), periaqueductal gray (PAG), and superior colliculus (SC); an index of DMAA (Horvath clock) was also evaluated. Posttraumatic stress disorder (PTSD), trauma exposure, and age were used as covariates in statistical models to isolate racial discrimination-related variance. Data analysis was conducted between January 10 and October 30, 2023.
EXPOSURE
Varying levels of racial discrimination exposure, other trauma exposure, and posttraumatic stress disorder (PTSD).
MAIN OUTCOMES AND MEASURES
Racial discrimination frequency was assessed with the Experiences of Discrimination Scale, other trauma exposure was evaluated with the Traumatic Events Inventory, and current PTSD was evaluated with the PTSD Symptom Scale. Seed-to-voxel functional connectivity analyses were conducted with LC, PAG, and SC seeds. To assess DMAA, the Methylation EPIC BeadChip assay (Illumina) was conducted with whole-blood samples from a subset of 49 participants.
RESULTS
This study included 90 Black women, with a mean (SD) age of 38.5 (11.3) years. Greater racial discrimination was associated with greater left LC RSFC to the bilateral precuneus (a region within the default mode network implicated in rumination and reliving of past events; cluster size k = 228; t85 = 4.78; P < .001, false discovery rate-corrected). Significant indirect effects were observed for the left LC-precuneus RSFC on the association between racial discrimination and DMAA (β [SE] = 0.45 [0.16]; 95% CI, 0.12-0.77).
CONCLUSIONS AND RELEVANCE
In this study, more frequent racial discrimination was associated with proportionately greater RSFC of the LC to the precuneus, and these connectivity alterations were associated with DMAA. These findings suggest that racial discrimination contributes to accelerated biological aging via altered connectivity between the LC and default mode network, increasing vulnerability for brain health problems.
Topics: Humans; Female; Racism; Adult; Black or African American; Aging; Middle Aged; Epigenesis, Genetic; Cohort Studies; DNA Methylation; Stress Disorders, Post-Traumatic; Magnetic Resonance Imaging
PubMed: 38869898
DOI: 10.1001/jamanetworkopen.2024.16588