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Learning & Memory (Cold Spring Harbor,... Sep 2017Fear, which can be expressed innately or after conditioning, is triggered when a danger or a stimulus predicting immediate danger is perceived. Its role is to prepare... (Review)
Review
Fear, which can be expressed innately or after conditioning, is triggered when a danger or a stimulus predicting immediate danger is perceived. Its role is to prepare the body to face this danger. However, dysfunction in fear processing can lead to psychiatric disorders in which fear outweighs the danger or possibility of harm. Although recognized as highly debilitating, pathological fear remains insufficiently treated, indicating the importance of research on fear processing. The neurobiological basis of normal and pathological fear reactions is reviewed in this article. Innate and learned fear mechanisms, particularly those involving the amygdala, are considered. These fear mechanisms are also distinguished in specific phobias, which can indeed be nonexperiential (implicating innate, learning-independent mechanisms) or experiential (implicating learning-dependent mechanisms). Poor habituation and poor extinction are presented as dysfunctional mechanisms contributing to persistence of nonexperiential and experiential phobias, respectively.
Topics: Animals; Brain; Fear; Humans; Instinct; Neurobiology; Phobic Disorders
PubMed: 28814472
DOI: 10.1101/lm.044115.116 -
Journal of Perinatal Medicine Feb 2018To identify the prevalence of and to determine the risk factors for developing a fear of childbirth (tokophobia).
OBJECTIVE
To identify the prevalence of and to determine the risk factors for developing a fear of childbirth (tokophobia).
METHODS
We evaluated 191 pregnant women during Parenting and Childbirth Classes. Participants were approached when attending Parenting and Childbirth Classes between June 2014 and September 2014 and were asked to complete several questionnaires related to depression (CES-D), anxiety (STAI X1 and X2), satisfaction with life (SWLS), delivery expectation/experience (W-DEQ), and specific fears.
RESULTS
Most (90%) of the responders were nulliparous. As many as 75% of the participants reported low to moderate tokophobia, whereas 25% exhibited high or very high fear of childbirth. Pathological fear occurred in 1.6% of the participants. The most significant was the fear of having an episiotomy followed by fear of having no control on the situation and fear of pain. An association exists between a preferred elective cesarean birth and tokophobia.
CONCLUSIONS
The results draw attention to the need for early detection and treatment of fear of childbirth. The data may help identifying women at risk that require prenatal psychological intervention.
Topics: Adult; Cesarean Section; Delivery, Obstetric; Fear; Female; Humans; Parturition; Phobic Disorders; Pregnancy; Pregnant Women; Prevalence; Risk Factors; Slovenia; Surveys and Questionnaires
PubMed: 28379837
DOI: 10.1515/jpm-2016-0282 -
BMJ Case Reports Jan 2022A 35-year-old primigravida presented with significant anxiety symptoms at 26 weeks' gestation. Symptoms were preceded by a nightmare about her upcoming labour. She...
A 35-year-old primigravida presented with significant anxiety symptoms at 26 weeks' gestation. Symptoms were preceded by a nightmare about her upcoming labour. She developed repetitive intrusive thoughts of being trapped emotionally and physically in her pregnancy. Her symptoms were suggestive of new-onset claustrophobia associated with pregnancy, which has not been previously reported on. Her symptoms ameliorated with a combination of cognitive-behavioural therapy and pharmacotherapy (sertraline and low dose quetiapine). The later stages of pregnancy were associated with minimal symptoms and the resolution of her subjective 'entrapment'. A subsequent pregnancy resulted in similar although less severe symptomatology. No postpartum anxiety symptoms were demonstrated on both occasions. Anxiety symptoms can adversely impact both the mother and fetus, and thus correct identification and management of pregnancy-related claustrophobia improved symptomatology and functioning and allowed for earlier detection and reduced symptomatology in a subsequent pregnancy.
Topics: Adult; Cognitive Behavioral Therapy; Female; Gestational Age; Humans; Mothers; Phobic Disorders; Postpartum Period; Pregnancy
PubMed: 35027381
DOI: 10.1136/bcr-2021-246568 -
Journal of Affective Disorders Dec 2016There is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD).
BACKGROUND
There is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD).
GOAL
This study investigated whether GAD and PD could be discriminated through differences in developmental etiological factors including childhood parental loss/separation, psychological disorders, and maternal and paternal attachment.
METHOD
Twenty people with adult generalized anxiety disorder (GAD), 20 with adult panic disorder (PD), 11 with adult comorbid GAD and PD, and 21 adult non-anxious controls completed diagnostic interviews to assess symptoms of mental disorders in adulthood and childhood. Participants also reported on parental attachment, loss and separation.
RESULTS
Childhood diagnoses of GAD and PD differentiated clinical groups from controls as well as from each other, suggesting greater likelihood for homotypic over heterotypic continuity. Compared to controls, specific phobia was associated with all three clinical groups, and childhood depression, social phobia, and PTSD were uniquely associated with adult GAD. Both maternal and paternal attachment also differentiated clinical groups from controls. However, higher levels of subscales reflecting maternal insecure avoidant attachment (e.g., no memory of early childhood experiences and balancing/forgiving current state of mind) emerged as more predictive of GAD relative to PD. There were no group differences in parental loss or separation.
CONCLUSIONS
These results support differentiation of GAD and PD based on developmental risk factors. Recommendations for future research and implications of the findings for understanding the etiology and symptomatology of GAD and PD are discussed.
Topics: Adolescent; Adult; Anxiety Disorders; Comorbidity; Female; Humans; Male; Panic Disorder; Parenting; Phobia, Social; Phobic Disorders; Risk Factors; Young Adult
PubMed: 27466747
DOI: 10.1016/j.jad.2016.07.008 -
Emotion (Washington, D.C.) Feb 2010Mindfulness-based stress reduction (MBSR) is an established program shown to reduce symptoms of stress, anxiety, and depression. MBSR is believed to alter emotional... (Clinical Trial)
Clinical Trial
Mindfulness-based stress reduction (MBSR) is an established program shown to reduce symptoms of stress, anxiety, and depression. MBSR is believed to alter emotional responding by modifying cognitive-affective processes. Given that social anxiety disorder (SAD) is characterized by emotional and attentional biases as well as distorted negative self-beliefs, we examined MBSR-related changes in the brain-behavior indices of emotional reactivity and regulation of negative self-beliefs in patients with SAD. Sixteen patients underwent functional MRI while reacting to negative self-beliefs and while regulating negative emotions using 2 types of attention deployment emotion regulation-breath-focused attention and distraction-focused attention. Post-MBSR, 14 patients completed neuroimaging assessments. Compared with baseline, MBSR completers showed improvement in anxiety and depression symptoms and self-esteem. During the breath-focused attention task (but not the distraction-focused attention task), they also showed (a) decreased negative emotion experience, (b) reduced amygdala activity, and (c) increased activity in brain regions implicated in attentional deployment. MBSR training in patients with SAD may reduce emotional reactivity while enhancing emotion regulation. These changes might facilitate reduction in SAD-related avoidance behaviors, clinical symptoms, and automatic emotional reactivity to negative self-beliefs in adults with SAD.
Topics: Adult; Anxiety Disorders; Brain; Emotions; Female; Humans; Interpersonal Relations; Magnetic Resonance Imaging; Male; Meditation; Phobic Disorders; Stress, Psychological
PubMed: 20141305
DOI: 10.1037/a0018441 -
Journal of Clinical Oncology : Official... Nov 2019Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall... (Meta-Analysis)
Meta-Analysis
PURPOSE
Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall efficacy of available psychological interventions on FCR remains unknown. We therefore evaluated this in the present systematic review and meta-analysis.
METHODS
We searched key electronic databases to identify trials that evaluated the effect of psychological interventions on FCR among patients with and survivors of cancer. Controlled trials were subjected to meta-analysis, and the moderating influence of study characteristics on the effect were examined. Overall quality of evidence was evaluated using the GRADE system. Open trials were narratively reviewed to explore ongoing developments in the field (PROSPERO registration no.: CRD42017076514).
RESULTS
A total of 23 controlled trials (21 randomized controlled trials) and nine open trials were included. Small effects (Hedges's ) were found both at postintervention ( = 0.33; 95% CI, 0.20 to 0.46; < .001) and at follow-up ( = 0.28; 95% CI, 0.17 to 0.40; .001). Effects at postintervention of contemporary cognitive behavioral therapies (CBTs; = 0.42) were larger than those of traditional CBTs ( = 0.24; β = .22; 95% CI, .04 to .41; = .018). At follow-up, larger effects were associated with shorter time to follow-up (β = -.01; 95% CI, -.01 to -.00; = .027) and group-based formats (β = .18; 95% CI, .01 to .36; = .041). A GRADE evaluation indicated evidence of moderate strength for effects of psychological intervention for FCR.
CONCLUSION
Psychological interventions for FCR revealed a small but robust effect at postintervention, which was largely maintained at follow-up. Larger postintervention effects were found for contemporary CBTs that were focused on processes of cognition-for example, worry, rumination, and attentional bias-rather than the content, and aimed to change the way in which the individual relates to his or her inner experiences. Future trials could investigate how to further optimize and tailor interventions to individual patients' FCR presentation.
Topics: Adaptation, Psychological; Adult; Aged; Cancer Survivors; Cognitive Behavioral Therapy; Fear; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasms; Phobic Disorders; Randomized Controlled Trials as Topic; Risk Factors; Treatment Outcome
PubMed: 31532725
DOI: 10.1200/JCO.19.00572 -
Schizophrenia Bulletin Feb 2018
Topics: Adult; Humans; Implosive Therapy; Male; Phobic Disorders; Psychotic Disorders
PubMed: 25908618
DOI: 10.1093/schbul/sbv049 -
BMJ (Clinical Research Ed.) Sep 2003
Topics: Anti-Anxiety Agents; Cognitive Behavioral Therapy; Fear; Humans; Phobic Disorders
PubMed: 12958087
DOI: 10.1136/bmj.327.7414.515 -
British Medical Journal Jan 1975
Topics: Agoraphobia; Behavior Therapy; Humans; Life Style; Phobic Disorders; Psychoanalytic Therapy; Psychosurgery
PubMed: 1120241
DOI: 10.1136/bmj.1.5948.40-a -
British Medical Journal Nov 1974
Topics: Agoraphobia; Anti-Anxiety Agents; Benzodiazepines; Desensitization, Immunologic; Humans; Phobic Disorders; Psychosurgery; Psychotherapy
PubMed: 4154125
DOI: No ID Found