Increased body sway in phobic patients exposed to images of spiders

Objective: The aim of the present study was to analyze the body sway response in specific phobia (SP) patients and healthy controls while viewing neutral, phobic, and disgusting images. Methods: The participants' heart rate (HR) and skin conductance were also recorded during the procedure. Nineteen patients with arachnophobia and 19 healthy volunteers matched by age, gender, and years of education underwent a postural control test on a stabilometric platform. Results: The platform recorded increased body sway in the SP group when exposed to spider images (SPI). The SP group presented increases in most parameters (SD, velocity, frequency, area, p ≤ 0.05) when viewing pictures of the SPI category. Psychometric measures of subjective anxiety (State-Trait Anxiety Inventory, STAI) and physiological states (HR; skin conductance responses; spontaneous fluctuations in skin conductance) showed increased anxiety (p ≤ 0.05) in the SP group compared to healthy volunteers. High anxiety levels were observed throughout the assessment, including the task of exposure to SPI (p ≤ 0.05). No significant effect or correlation was found between skin conductance and body sway measures (p > 0.05). Conclusions: The results of the postural control test suggest the occurrence of a defensive escape response in SP, in agreement with previous evidence.

Adaptation of cognitive behaviour therapy in childhood obsessive-compulsive disorder: a case study

Cognitive behaviour therapy (CBT) has been proved to be one of the most well-researched and effective therapy. It has been found effective in many clinical conditions in children and adolescents as well. Application of therapeutic processes gets complicated by the facts that childhood and adolescent problems do not come in neat packages and tend to overlap and/or coexist. For instance, there is much overlap among clinical problems like anxiety, depression, behavioural problems, and between reading and writing difficulties, and attention and hyperactivity. Many behavioural and emotional disturbances in children are also associated with specific medical conditions. The relationship between physical and/or medical conditions and emotional and behavioural disorders in children and adolescent has been documented in various studies. This demands attention to the therapeutic intervention to the childhood problems with greater monitoring and modulation. Use of CBT in childhood and adolescent problems for efficiency and convenience may be grouped into externalising and internalising disorders, and the management techniques may be formulated and tailored to meet the two opposing dimensions. In this case study, index client was an eight years old girl who presented with compulsive behaviour along with anxiety and fear, and the application of CBT techniques, its adaptability and efficacy in this case of obsessive-compulsive disorder (OCD), with specific phobia would be discussed.

Realidad Virtual como Tratamiento para la Fobia Específica a las Arañas: Una Revisión Sistemática / Virtual Reality as a Treatment for Spider Phobia: A Systematic Review

Resumen El creciente interés que ha traído el estudio de las fobias y entre ellas la fobia específica, ha dado lugar al uso diverso de tratamientos, que incluyen la realidad virtual como técnica innovadora. El presente estudio tuvo como objetivo evaluar el impacto de la Realidad Virtual (RV) como tratamiento para la fobia específica a las arañas, a través de una revisión sistemática de investigaciones que hayan sido publicadas en los últimos 10 años (2008 a 2018) en la base de datos Scopus. La revisión sistemática se realizó bajo los lineamientos de la metodología PRISMA. Inicialmente, se identificaron 309 artículos que contaban con los términos de búsqueda en título, resumen y palabras clave, posteriormente, se seleccionaron 109 estudios experimentales ya culminados, se excluyeron otras fobias específicas y otros tipos de tecnologías, siendo seleccionados 10 artículos para análisis a texto completo, incluyendo así solo 5 artículos para la revisión, que usaban la realidad virtual como tratamiento. Acorde a los resultados se encontró evidencia que sugiere que este tipo de intervenciones pueden ser relativamente eficaces para abordar esta problemática, ya que los resultados indican disminución significativa en indicadores clínicos, pero existen también varias limitaciones de orden metodológico. Se espera que esta revisión sistemática promueva investigaciones que usen la realidad virtual como tratamiento para la fobia específica a las arañas, mejorando las limitaciones identificadas en el estudio.

Abstract The growing interest that has brought the study of phobias and among them the specific phobia, has given rise to the diverse use of treatments, which include virtual reality as an innovative technique. The objective of this study was to evaluate the impact of Virtual Reality (VR) as a treatment for spider-specific phobia, through a systematic review of research that has been published in the last 10 years (2008 to 2018) in the Scopus database. The systematic review was carried out under the guidelines of the PRISMA methodology, which were thus excluded; taking into account the search terms in title, summary and keywords, 309 articles were identified, 109 experimental studies were already completed, other specific phobias and other types of technologies were excluded, 10 articles were selected for full-text analysis, including so only 5 articles for the review, which used virtual reality as a treatment. According to the results, evidence was found that suggests that this type of treatment may be relatively effective in addressing this problem, since the results indicate a significant decrease in clinical indicators, but there are also several methodological limitations. It is expected that this systematic review will promote Research that uses virtual reality as a treatment for spider-specific phobia, improving the limitations identified in the study.

Anxiety Disorders - Assessment and Management in General Practice

@#The objective of this article is to provide an update on the diagnosis, assessment, and management of anxiety disorders in adults. This article covers the following disorders: panic disorder, panic attacks, specific phobia, social anxiety disorder and generalized anxiety disorder. Selective mutism and separation anxiety disorder, being childhood anxiety disorders, will not be covered. Obsessive compulsive disorder and post-traumatic stress disorder, which are not categorized as anxiety disorders in DSM-5, will not be covered. Anxiety and related disorders are common mental health disorders but are under-diagnosed and undertreated. Most cases of anxiety disorders present first to the primary care physician and can be managed in primary care.It is important to take a detailed history of the patient’s symptoms and their severity and duration, enquire about psychosocial stressors, as well as symptoms that may be suggestive of a medical condition and also to assess suicidality. A combined approach of psycho-education, relaxation training, and medications give the best results. SSRIs are first line pharmacologic treatment for most anxiety disorders. There is a need to stress that benzodiazepines have no role in the long-term treatment of anxiety disorders. They should not be given for more than 2 to 4 weeks. Treatment for generalized anxiety disorder should be for at least 32 weeks as high relapse rates are reported after discontinuing medications.

Trypophobia: an investigation of clinical features

Objective: Trypophobia refers to the fear of, or aversion to, clusters of holes. We assessed clinical features of trypophobia and investigated whether it most resembled a specific phobia or obsessive-compulsive disorder. Methods: An online survey was conducted to gather information on sociodemographic variables, course and duration, severity, associated features, comorbid psychiatric diagnoses, and levels of psychological distress and impairment in individuals with trypophobia. The survey also explored whether such individuals experienced more fear or disgust, and whether symptoms showed more resemblance to a specific phobia or to obsessive-compulsive disorder. Associations of symptom severity and duration with degree of impairment were investigated. Results: One hundred and ninety-five individuals completed the questionnaire. Symptoms were chronic and persistent. The most common associated comorbidities were major depressive disorder and generalized anxiety disorder. Trypophobia was associated with significant psychological distress and impairment. The majority of individuals experienced disgust rather than fear when confronted with clusters of holes, but were more likely to meet DSM-5 criteria for specific phobia than for obsessive-compulsive disorder. Symptom severity and duration were associated with functional impairment. Conclusions: Given that individuals with trypophobia suffer clinically significant morbidity and comorbidity, this condition deserves further attention from clinicians and researchers.

Ansiedade em Provas: um Estudo na Obtenção da Licença para Dirigir / Anxiety in Tests: a Case Study in Obtaining a Driver License / La Ansiedad en Pruebas: in Estudio de Caso de la Obtención de la Licencia de Conducción

Resumo Situações de avaliação geram ansiedade e dentre elas está a prova prática de direção para a obtenção da licença para dirigir, essa ansiedade pode perturbar o desempenho e impedir a obtenção da habilitação. O presente estudo visou analisar: (a) a fundamentação teórica que embasa a intervenção terapêutica em casos de ansiedade em avaliações e provas; e (b) o processo terapêutico de uma cliente que procurou terapia comportamental após tentativas fracassadas na obtenção da licença para dirigir. A relevância da análise funcional da ansiedade e dos repertórios de enfrentamento da ansiedade foi considerada. Em seguida, um estudo de caso foi relatado: uma paciente com um histórico de seis reprovações no teste prático para a obtenção da licença para dirigir e níveis altos de ansiedade. Esse estudo demonstrou que um preparo apropriado e a intervenção terapêutica contribuíram para reduzir a ansiedade e promover a condição necessária para a obtenção da licença para dirigir. Estudos adicionais deverão ser realizados de modo a se obter uma melhor compreensão da relação entre a ansiedade e o desempenho, especialmente no que diz respeito ao processo de obtenção de uma licença para dirigir....(AU)

Abstract Tests usually cause anxiety and among them is the practical driving test, this anxiety might disrupt the performance and hinder the achievement of the license. The current study aimed to examine: (a) the theoretical foundation that supports the therapeutic intervention in cases of anxiety during tests, and (b) the therapeutic process of a client who sought behavioral therapy after having failed a number of times in getting his driver license. The relevance of the functional analysis of anxiety, and of the repertoires for coping with it was considered. Then a case study was reported: a patient with high levels of anxiety and with a history of six failures on the practical driving test. This study demonstrated that an appropriate preparation and a therapeutic intervention helped in reducing anxiety and in promoting the necessary condition to obtain the driver license. Additional studies should be conducted to get a better understanding of the relationship between anxiety and performance, particularly regarding the process of obtaining a driver license....(AU)

Resumen Las pruebas usualmente generan ansiedad, y en el caso específico del examen práctico para obtener la licencia de conducir, esa ansiedad puede perjudicar el rendimiento y dificultar su consecución. El presente estudio se propuso examinar: (a) el fundamento teórico que apoya la intervención terapéutica en casos de ansiedad durante situaciones de evaluación y pruebas, y (b) el proceso terapéutico de un cliente que acudió a la terapia conductual después de varios intentos no exitosos para la obtención de su licencia de conducir. Fue considerada la pertinencia del análisis funcional de la ansiedad así como de los repertorios para hacerle frente. A continuación se describió un estudio de caso: un paciente con altos niveles de ansiedad y con un histórico de seis reprobaciones en el examen práctico para obtener la licencia de conducir. Este estudio demostró que una preparación adecuada y una intervención terapéutica ayudaron a reducir la ansiedad y a promover las condiciones necesarias para la obtención de la licencia de conducir. Estudios adicionales deben ser realizados para obtener una mejor comprensión de la relación entre la ansiedad y el desempeño, en particular con respecto al proceso de obtención de una licencia para conducir....(AU)

The prevalence of psychiatric morbidity among school children.

Background: Children need special care as they undergo a complex process of emotional, physical and social changes. Prevalence of mental disorders among children has been reported to be 14-20% in various studies. Objectives: To study the prevalence of psychiatric morbidity and factors influencing its prevalence among school children studying in 6th to 12th standard. Material and Methods: The study was conducted on a sample of 500 children studying in 6th to 12th standard of three schools of Faridkot city. Students suffering from any progressive neurological disease and suffering from any medical illness were excluded from study. Three schools of the city were included in study. Results: Our study revealed that 16.8% were having psychiatric morbidity. The order in which psychiatric morbidity was found was Specific isolated (17.8%), Non organic sleep disorders (13.1%),Tension headache(11.9%),Hyperkinetic Disorder and sleep terror was found in 7.1% while Generalized Anxiety Disorder was present in 4.8% students and Depression was found in 4.8%students. Conclusion: The results of the study have implications for clinical training, practice and policy initiatives. Integrating mental health into general health care, effective mass media coverage, networking between mental health-professionals and other health professionals, community-based health services and involvement of professionals from the education sector would be essential.

Tratamento de fobia específica por dessensibilização e reprocessamento por meio dos movimentos oculares / Treatment of specific phobia through eye movement desensitization and reprocessing / Tratamiento de la fobia específica por desensibilización y reprocesamiento a traves de los movimientos oculares

A fobia específica é caracterizada pela presença de um medo persistente e recorrente que é excessivo e irracional a um objeto ou situação específica que desencadeia uma forte reação de ansiedade. Diversos estudos têm sido realizados com intuito de avaliar a eficácia da dessensibilização e reprocessamento através dos movimentos oculares (EMDR), e tem sido comprovado que é um método bem-sucedido para tratamento de fobia específica, ansiedade, depressão, traumas e queixas somáticas. O caso do presente artigo descreve o trabalho terapêutico realizado com uma mulher de 42 anos com fobia a próteses dentárias através da intervenção EMDR. No final da intervenção, a paciente perdeu o medo às próteses, já não revelando respostas de ansiedade e de desconforto, mantendo-se estável durante o período de follow-up, um mês após a intervenção. Esses resultados repercutiram-se na melhoria da sua qualidade de vida, ao nível da sua vida pessoal, social e profissional.

The specific phobia is characterized by a persistent and recurring fear that is excessive and irrational to a specific object or situation, triggering a strong anxiety reaction. Several studies have been conducted in order to assess the effectiveness of eye movement desensitization and reprocessing (EMDR) and it has been proven to be a successful method for the treatment of specific phobias, anxiety, depression, trauma and somatic complaints. The case of this article describes the therapeutic work done with a forty-two years old’ woman that has phobia to dentures using the intervention of EMDR. At the end of the intervention, the patient lost the fear of prosthetics, no longer revealing responses of anxiety and discomfort and remained stable during the follow-up one month after the intervention. These results had an impact on improving their quality of life, in terms of her personal, social and professional life.

La fobia específica se caracteriza por la presencia de un miedo persistente y recurrente que es excesivo o irracional a un objeto o situación especifica que desencadena una fuerte reacción de ansiedad. Varios estudios han sido realizados con el fin de evaluar la eficacia de desensibilización y reprocesamiento mediante estudio de los movimientos oculares (EMDR) y ha sido comprobado que es un método exitoso para el tratamiento de la fobia específica, ansiedad, depresión, traumas y quejas somáticas. El presente artículo describe el trabajo terapéutico realizado con una mujer de cuarenta y dos años con fobia a prótesis dentarias a través de la intervención EMDR. En el final de la intervención, la paciente perdió el miedo a las prótesis, no evidenciando señales de ansiedad y de desconforto, manteniéndose estable durante el periodo de follow-up, un mes después de la intervención. Eses resultados repercutieran en una notable mejoría de su calidad de vida a nivel personal, social y profesional.

Neuroimaging in specific phobia disorder: a systematic review of the literature / Neuroimagem do transtorno de fobia específica: uma revisão sistemática da literatura

OBJECTIVE: Specific phobia (SP) is characterized by irrational fear associated with avoidance of specific stimuli. In recent years, neuroimaging techniques have been used in an attempt to better understand the neurobiology of anxiety disorders. The objective of this study was to perform a systematic review of articles that used neuroimaging techniques to study SP. METHOD:A literature search was conducted through electronic databases, using the keywords: imaging, neuroimaging, PET, spectroscopy, functional magnetic resonance, structural magnetic resonance, SPECT, MRI, DTI, and tractography, combined with simple phobia and specific phobia. One-hundred fifteen articles were found, of which 38 were selected for the present review. From these, 24 used fMRI, 11 used PET, 1 used SPECT, 2 used structural MRI, and none used spectroscopy. RESULT: The search showed that studies in this area were published recently and that the neuroanatomic substrate of SP has not yet been consolidated. CONCLUSION: In spite of methodological differences among studies, results converge to a greater activation in the insula, anterior cingulate cortex, amygdala, and prefrontal and orbitofrontal cortex of patients exposed to phobia-related situations compared to controls. These findings support the hypotheses of the hyperactivation of a neuroanatomic structural network involved in SP.

A Fobia Específica (SP do inglês) é caracterizada por medos irracionais associados à evitação de estímulos específicos. Nos últimos anos, técnicas de neuroimagem vêm sendo empregadas na tentativa de melhor compreender a neurobiologia dos transtornos de ansiedade. O objetivo do presente estudo é realizar uma revisão sistemática dos artigos que utilizaram neuroimagem para estudar a SP. A busca na literatura foi realizada por intermédio de indexadores eletrônicos, utilizando-se as palavras-chave: imaging, neuroimaging, PET, spectroscopy, functional magnetic ressonance, structural magnetic ressonance, SPECT, MRI, DTI e tractography, cruzadas individualmente com os termos simple phobia e specific phobia. Foram encontrados 115 artigos, sendo 38 deles selecionados para a presente revisão. Desses, 24 usaram fMRI, 11 usaram PET, 1 usou SPECT, 2 usaram MRI estrutural e nenhum artigo de espectroscopia. Verifica-se que os estudos na área foram publicados recentemente e que, até o momento, o substrato neuroanatômico deste transtorno não está consolidado. Apesar das diferenças metodológicas entre os estudos, os resultados convergem para maior ativação na ínsula, cíngulo anterior, amídala e córtex préfrontal e orbitofrontal dos pacientes expostos a situações phobia related quando comparados aos controles. Esses achados reforçam hipóteses a respeito da hiperativação de uma determinada rede de estruturas neuroanatômicas envolvidas no transtorno de SP.

Consistencia entre el reporte verbal y los efectos psicofisiológicos registrados en el tratamiento de una fobia específica empleando la técnica de la Desensibilización Sistemática (DS) / Consistency between verbal report and psychophysiological effects registered in the treatment of a specific phobia using Systematic Desensitization

En la presente investigación se empleó un diseño cuasi-experimental de caso único AB para evaluar la consistencia del reporte verbal basado en Unidades Subjetivas de Ansiedad (USAS) y los efectos psicofisiológicos registrados en la aplicación de la técnica de la Desensibilización Sistemática, empleando el componente imaginario de ésta en un caso de fobia específica a las aves. Los resultados no mostraron una consistencia entre el informe verbal del sujeto, en el cual reportó, tanto cero USAS para 10 escenas ansiógenas, como una disminución en la activación fisiológica, y las medidas obtenidas en los equipos que registraban el pulso y la RGP. El pulso mostró una tendencia al aumento mientras que la RGP una tendencia a mantener los mismos niveles.

In the present research a quasi- experimental AB single case research design was used to assess the consistency of a verbal report based on Subjective Units of Discomfort (SUDS) and the psycho-physiological measures of pulse and galvanic skin response (GSR) when applying the systematic desensitization technique and using only its imaginary component in the treatment of a specific phobia to birds. The results found didn’t show a consistency between the participant’s verbal report, in which both cero SUDS were reported for 10 ansiogenic scenes and a decrease in the physiological arousal, and the measurements obtained by the equipment that registered pulse and GSR. In contrast, the pulse showed an increasing tendency and the GSR registered a tendency to maintain the same levels.