Psychosocial determinants of anxiety about the COVID-19 pandemic.

Pandemic health threats can cause considerable anxiety, but not all individuals react similarly. To understand the sources of this variability, we applied a theoretical model developed during the H1N1 pandemic of 2009 to quantify relationships among intolerance of uncertainty, stress appraisals, and coping style that predict anxiety about the COVID-19 pandemic. We surveyed 1579 U.S. Amazon Mechanical Turk workers in April 2020. Using structural equation modeling, we found that individuals who were more intolerant of uncertainty reported higher appraisals of threat, stress, and other-control, which predicted higher anxiety when emotion-focused coping was engaged, and lower anxiety when problem-focused coping was engaged. Political affiliation moderated these effects, such that conservatives relied more on self-control and other-control appraisals to mitigate anxiety than independents or liberals. These results show that how people appraise and cope with their stress interacts with political ideology to shape anxiety in the face of a global health threat.

Proximal threats promote enhanced acquisition and persistence of reactive fear-learning circuits.

Physical proximity to a traumatic event increases the severity of accompanying stress symptoms, an effect that is reminiscent of evolutionarily configured fear responses based on threat imminence. Despite being widely adopted as a model system for stress and anxiety disorders, fear-conditioning research has not yet characterized how threat proximity impacts the mechanisms of fear acquisition and extinction in the human brain. We used three-dimensional (3D) virtual reality technology to manipulate the egocentric distance of conspecific threats while healthy adult participants navigated virtual worlds during functional magnetic resonance imaging (fMRI). Consistent with theoretical predictions, proximal threats enhanced fear acquisition by shifting conditioned learning from cognitive to reactive fear circuits in the brain and reducing amygdala-cortical connectivity during both fear acquisition and extinction. With an analysis of representational pattern similarity between the acquisition and extinction phases, we further demonstrate that proximal threats impaired extinction efficacy via persistent multivariate representations of conditioned learning in the cerebellum, which predicted susceptibility to later fear reinstatement. These results show that conditioned threats encountered in close proximity are more resistant to extinction learning and suggest that the canonical neural circuitry typically associated with fear learning requires additional consideration of a more reactive neural fear system to fully account for this effect.

What if? Neural activity underlying semantic and episodic counterfactual thinking.

Counterfactual thinking (CFT) is the process of mentally simulating alternative versions of known facts. In the past decade, cognitive neuroscientists have begun to uncover the neural underpinnings of CFT, particularly episodic CFT (eCFT), which activates regions in the default network (DN) also activated by episodic memory (eM) recall. However, the engagement of DN regions is different for distinct kinds of eCFT. More plausible counterfactuals and counterfactuals about oneself show stronger activity in DN regions compared to implausible and other- or object-focused counterfactuals. The current study sought to identify a source for this difference in DN activity. Specifically, self-focused counterfactuals may also be more plausible, suggesting that DN core regions are sensitive to the plausibility of a simulation. On the other hand, plausible and self-focused counterfactuals may involve more episodic information than implausible and other-focused counterfactuals, which would imply DN sensitivity to episodic information. In the current study, we compared episodic and semantic counterfactuals generated to be plausible or implausible against episodic and semantic memory reactivation using fMRI. Taking multivariate and univariate approaches, we found that the DN is engaged more during episodic simulations, including eM and all eCFT, than during semantic simulations. Semantic simulations engaged more inferior temporal and lateral occipital regions. The only region that showed strong plausibility effects was the hippocampus, which was significantly engaged for implausible CFT but not for plausible CFT, suggestive of binding more disparate information. Consequences of these findings for the cognitive neuroscience of mental simulation are discussed.

Neural activity associated with repetitive simulation of episodic counterfactual thoughts.

When people revisit past autobiographical events they often imagine alternative ways in which such events could have occurred. Often these episodic counterfactual thoughts (eCFT) are momentary and fleeting, but sometimes they are simulated frequently and repeatedly. However, little is known about the neural differences between frequently versus infrequently repeated eCFT. The current study explores this issue. In a three-session study, participants were asked to simulate alternative ways positive, negative, and neutral autobiographical memories could have occurred. Half of these eCFT were repeatedly re-simulated while the other half were not. Immediately after, participants were asked to simulate all these eCFT again while undergoing fMRI. A partial least squares analysis on the resultant fMRI data revealed that eCFT that were not frequently repeated preferentially engaged brain regions including middle (BA 21) and superior temporal gyri (BA 38/39), middle (BA 11) and superior frontal gyri (BA 9), and hippocampus. By contrast, frequently repeated eCFT preferentially engaged regions including medial frontal gyri (BA 10), anterior cingulate cortex, insula, and inferior parietal lobule (BA 40). Direct contrasts for each type of eCFT were also conducted. The results of these analyses suggest differential contributions of regions traditionally associated with eCFT, such as BA 10, anterior cingulate cortex, and hippocampus, as a function of kind of eCFT and frequency of repetition. Consequences for future research on eCFT and rumination are considered.

Counterfactual Plausibility and Comparative Similarity.

Counterfactual thinking involves imagining hypothetical alternatives to reality. Philosopher David Lewis (1973, 1979) argued that people estimate the subjective plausibility that a counterfactual event might have occurred by comparing an imagined possible world in which the counterfactual statement is true against the current, actual world in which the counterfactual statement is false. Accordingly, counterfactuals considered to be true in possible worlds comparatively more similar to ours are judged as more plausible than counterfactuals deemed true in possible worlds comparatively less similar. Although Lewis did not originally develop his notion of comparative similarity to be investigated as a psychological construct, this study builds upon his idea to empirically investigate comparative similarity as a possible psychological strategy for evaluating the perceived plausibility of counterfactual events. More specifically, we evaluate judgments of comparative similarity between episodic memories and episodic counterfactual events as a factor influencing people's judgments of plausibility in counterfactual simulations, and we also compare it against other factors thought to influence judgments of counterfactual plausibility, such as ease of simulation and prior simulation. Our results suggest that the greater the perceived similarity between the original memory and the episodic counterfactual event, the greater the perceived plausibility that the counterfactual event might have occurred. While similarity between actual and counterfactual events, ease of imagining, and prior simulation of the counterfactual event were all significantly related to counterfactual plausibility, comparative similarity best captured the variance in ratings of counterfactual plausibility. Implications for existing theories on the determinants of counterfactual plausibility are discussed.

Emotional intensity in episodic autobiographical memory and counterfactual thinking.

Episodic counterfactual thoughts-imagined alternative ways in which personal past events might have occurred-are frequently accompanied by intense emotions. Here, participants recollected positive and negative autobiographical memories and then generated better and worse episodic counterfactual events from those memories. Our results suggest that the projected emotional intensity during the simulated remembered/imagined event is significantly higher than but typically positively related to the emotional intensity while remembering/imagining the event. Furthermore, repeatedly simulating counterfactual events heightened the emotional intensity felt while simulating the counterfactual event. Finally, for both the emotional intensity accompanying the experience of remembering/imagining and the projected emotional intensity during the simulated remembered/imagined event, the emotional intensity of negative memories was greater than the emotional intensity of upward counterfactuals generated from them but lower than the emotional intensity of downward counterfactuals generated from them. These findings are discussed in relation to clinical work and functional theories of counterfactual thinking.

Characterizing the subjective experience of episodic past, future, and counterfactual thinking in healthy younger and older adults.

Recent evidence demonstrates remarkable overlap in the neural and cognitive mechanisms underlying episodic memory, episodic future thinking, and episodic counterfactual thinking. However, the extent to which the phenomenological characteristics associated with these mental simulations change as a result of ageing remains largely unexplored. The current study employs adapted versions of the Memory Characteristics Questionnaire and the Autobiographical Interview to compare the phenomenological characteristics associated with both positive and negative episodic past, future, and counterfactual simulations in younger and older adults. Additionally, it explores the influence of perceived likelihood in the experience of such simulations. The results indicate that, across all simulations, older adults generate more external details and report higher ratings of vividness, composition, and intensity than young adults. Conversely, younger adults generate more internal details across all conditions and rated positive and negative likely future events as more likely than did older adults. Additionally, both younger and older adults reported higher ratings for sensory, composition, and intensity factors during episodic memories relative to future and counterfactual thoughts. Finally, for both groups, ratings of spatial coherence and composition were higher for likely counterfactuals than for both unlikely counterfactuals and future simulations. Implications for the psychology of mental simulation and ageing are discussed.

Comprehensive assessment and management of athletes with sport concussion.

UNLABELLED: Currently, the popular approach to post-concussion management of the athlete relies upon the use of a multidisciplinary team of healthcare providers, all typically coordinated by a physician. That core team is often supplemented by nurses, psychotherapists, coaches, teachers, the athletic director, and, of course, family members. However, access to such a model is frequently limited by financial, geographical, and numerous other factors. In the absence of such resources, a thorough clinical evaluation and management by an available, ongoing healthcare provider, quite often the sports physical therapist, becomes necessary.The authors recommend that the professional who coordinates the athlete's post-concussion healthcare should focus efforts upon a comprehensive assessment and tailored treatment plan specific to the athlete's post-concussive symptoms. Assessment of both pre-morbid function and post-injury physical, cognitive, psychosocial, emotional, and behavioral issues, including the patient's support system, can assist the clinician with identifying specific constraints to sport, academic, social, and vocational activity participation. Hence, the assessment provides structure to the athlete's individualized treatment plan. Successful specialized interventions that address the multi-faceted impairments of sport related concussion frequently require knowledge of resources in a variety of other healthcare professions, in order to facilitate appropriate and necessary treatment referrals.Initial assessment should be followed by repeat monitoring throughout treatment, and spanning a variety of environments, in order to ensure the athlete's full recovery prior to return, not only to sport participation, but also to involvement in social, academic, and/or employment related life activities. LEVEL OF EVIDENCE: 5.

Throwing arm dominance in collegiate baseball pitching: a biomechanical study.

BACKGROUND: Left-handed individuals make up about 10% of the general population, yet left-handers comprise approximately 30% of the pitching staffs in Major League and Division I college baseball. Despite speculation regarding differences between right- and left-handed pitchers, distinction between right- and left-handed pitching mechanics has not been documented in the literature at any level of play. HYPOTHESIS: Left-hand-dominant pitchers display similar pitching mechanics and upper extremity joint loads when compared to their right-hand-dominant counterparts. STUDY DESIGN: Controlled laboratory study. METHODS: Three-dimensional, high-speed (240-Hz) video data were collected on fastballs from 84 collegiate baseball pitchers. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing shoulder and elbow were calculated. The 28 left-handed pitchers in the database were matched with 28 right-handed pitchers for age, height, mass, and ball velocity, and paired t tests were used to compare the kinematic and kinetic parameters. RESULTS: Six parameters were found to have statistically significant differences between left- and right-handed pitchers. Passive nonthrowing shoulder external rotation (right, 113 degrees +/- 9 degrees ; left, 124 degrees +/- 8 degrees ), elbow flexion at stride-foot contact (right, 79 degrees +/- 16 degrees ; left, 94 degrees +/- 20 degrees ), and shoulder abduction during acceleration (right, 72 degrees +/- 11 degrees ; left, 105 degrees +/- 8 degrees ) were greater in left-handed pitchers than right-handed pitchers. Shoulder abduction at stride-foot contact (right, 115 degrees +/- 13 degrees ; left, 73 degrees +/- 10 degrees ), shoulder horizontal abduction at stride-foot contact (right, 25 degrees +/- 12 degrees ; left, 15 degrees +/- 12 degrees ), and peak horizontal adduction angular velocity (right, 707 +/- 185 deg/s; left, 551 +/- 160 deg/s) were less for the left-handed pitchers. CONCLUSION: Biomechanical differences between left- and right-handed pitchers have been demonstrated in a collegiate population. CLINICAL RELEVANCE: The results of the current study indicate that left-handed pitchers may be at increased risk for certain shoulder injuries compared with their right-handed counterparts. Information has been provided for athletes, coaches, and sports medicine providers to further improve preventive and rehabilitative protocols for college pitchers. The results of the study also suggest that different normative data sets may need to be developed for left- and right-handed pitchers, independently of one another.

Relationships between throwing mechanics and shoulder distraction in collegiate baseball pitchers.

A distraction force occurs at the shoulder joint in all throwing motions. At the professional level, the relationship between this force and pitching mechanics has been explained. Three-dimensional, high-speed (240 Hz) video data were collected on fastballs from 48 collegiate baseball pitchers. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing arm elbow and shoulder joints were calculated. Multiple linear regression analysis was used to investigate the relationships between shoulder distraction and pitching mechanics. Shoulder distraction stress averaged 81% body weight for the collegiate pitchers. The mean ball velocity was 81 mph. Ten parameters of pitching mechanics accounted for 89% of the variance in shoulder distraction. Two of the variables (maximum shoulder abduction torque and elbow angle at release) previously shown to affect shoulder distraction in professional baseball pitchers appear to be important for collegiate pitchers as well. These data provide a scientific basis for clinicians, athletes, and coaches to establish methods to reduce distraction force at the shoulder joint through modification of pitching mechanics.

Treatment of stress fractures in athletes with intravenous pamidronate.

OBJECTIVE: To determine if the use of a second-generation biphosphonate, pamidronate, is an effective treatment option for stress fractures in intercollegiate athletes. Pamidronate is successfully used to increase bone mass in patients with Charcot arthropathy and osteoporosis. DESIGN: Case series. SETTING: Academic sports medicine clinic with primary responsibility for intercollegiate athletics. PARTICIPANTS: Five intercollegiate female athletes. INTERVENTIONS: Intravenous pamidronate administered weekly for a total of 5 treatments. MAIN OUTCOME MEASUREMENT: Athletes' ability to continue training without restrictions. RESULTS: Four of 5 treated athletes were able to continue training and competition within 1 week of treatment. CONCLUSIONS: Pamidronate may be a useful adjunct to the treatment of stress fractures.

Biomechanics of youth windmill softball pitching.

BACKGROUND: Limited research attention has been paid to the potentially harmful windmill softball pitch. No information is available regarding lower extremity kinetics in softball pitching. HYPOTHESIS: The stresses on the throwing arm of youth windmill pitchers are clinically significant and similar to those found for college softball pitchers. STUDY DESIGN: Descriptive laboratory study. METHODS: Three-dimensional, high-speed (240-Hz) video and stride foot force plate (1200 Hz) data were collected on fastballs from 53 youth softball pitchers. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing-arm elbow and shoulder joints were calculated. Kinetic parameters were compared to those reported for baseball pitchers. RESULTS: Elbow and shoulder joint loads were similar to those found for baseball pitchers and college softball pitchers. Shoulder distraction stress averaged 94% body weight for the youth pitchers. Stride foot ground reaction force patterns were not similar to those reported for baseball pitchers. Vertical and braking force components under the stride foot were in excess of body weight. CONCLUSIONS: Excessive distraction stress and joint torques at the throwing-arm elbow and shoulder are similar to those found in baseball pitchers, which suggests that windmill softball pitchers are at risk for overuse injuries. Normative information regarding upper and lower extremity kinematics and kinetics for 12- to 19-year-old softball pitchers has been established.

Sacral stress fractures: an unusual cause of low back pain in an athlete.

STUDY DESIGN: A case report of a sacral stress fracture causing low back pain in an athlete. OBJECTIVE: To document the occurrence of sacral stress fractures in athletes and to recommend it in the differential diagnosis of low back pain, especially in runners and volleyball players. SUMMARY OF BACKGROUND DATA: Low back pain is common both in the general population and in athletes. Athletes place high physical demands on their bodies, which often lead to stress fractures. Sacral stress fractures can cause back pain and are often not included in the differential diagnosis of back pain. METHODS: The authors were involved in the care and treatment of this patient and reviewed all medical records, radiologic tests, and related literature. RESULTS: In a 16-year-old volleyball player with a 4-week history of low back pain, magnetic resonance imaging of her pelvis revealed a stress fracture of the left sacral ala. She was treated with nonsteroidal anti-inflammatory agents, rest, and conditioning exercises and had a good functional outcome. CONCLUSION: Sacral stress fractures should be included in the differential diagnosis of athletes with low back pain, particularly runners and volleyball players. To the authors' best knowledge, this is the first report of a volleyball player with a sacral stress fracture. A review of the literature yielded 29 cases of sacral stress fractures in athletes, mainly runners.