Effectiveness of Low-Resolution Brain Electromagnetic Tomography Z Score Neurofeedback Comparison with Cognitive Rehabilitation in Depression and Anxiety in Opioid Use Disorder.

Background: Previous studies have shown that conventional neurofeedback (NFB) and cognitive rehabilitation can improve psychological outcomes in people with opioid use disorders (OUDs). However, the effectiveness of Low-Resolution Brain Electromagnetic Tomography (LORETA) Z-score neurofeedback (LZNFB) and attention bias modification training (ABMT) on depression and anxiety of these people has not been investigated yet. The present study aims to compare the effect of these two methods on depression and anxiety of men with OUD under methadone maintenance therapy (MMT). Methods: In this randomized controlled clinical trial with a pre-test, post-test, and follow-up design, 30 men with OUD under MMT were randomly assigned into three groups of LZNFB, ABMT, and control (MMT alone). The LZNFB group underwent LZNFB at 20 sessions. The ABMT using the dot-probe task was provided individually to the second group for 2 weeks at 15 sessions. The Beck Anxiety Inventory and the Beck Depression Inventory were completed by the participants before, immediately after, and 1-month after interventions. The collected data were analyzed in SPSS v.22 software. Results: Both intervention groups showed a significant reduction in anxiety and depression at the post-test phase (p < 0.05), where LZNFB group showed more decrease in anxiety and depression than the ABMT group. This decrease continued in the follow-up period. Conclusion: Both LZNFB and ABMT with the dot-robe task are effective in reducing depression and anxiety of men with OUD under MMT. However, LZNFB is more effective. These findings add to the growing body of literature supporting the effectiveness of NFB and cognitive rehabilitation therapy in treating addiction-related comorbidities.

Disrupted resting-state functional connectivity of frontal network in opium use disorder.

Opioid use disorder (OUD) as a chronic relapsing disorder is initially driven by dysfunction of brain reward networks and associated with several psychiatric disorders. Resting-state EEG was recorded in 24 healthy participants as well as 31 patients with OUD. Healthy participants do not meet OUD criteria. After pre-processing of the raw EEG, functional connectivity in the frontal network using eLORETA and all networks using graph analysis method were calculated. Patients with OUD had higher electrical neuronal activity compared to healthy participants in higher frequency bands. The statistical analysis revealed that patients with OUD had significantly decreased phase synchronization in ß1 and ß2 frequency bands compared with the healthy group in the frontal network. Regarding global network topology, we found a significant decrease in the characteristic path length and an increase in global efficiency, clustering coefficient, and transitivity in patients compared with the healthy group. These changes indicated that local specialization and global integration of the brain were disrupted in OUD and it suggests a tendency toward random network configuration of functional brain networks in patients with OUD. Disturbances in EEG-based brain network indices might reflect an altered cortical functional network in OUD. These findings might provide useful biomarkers to understand cortical brain pathology in opium use disorder.

A comparison of Barkley's behavioral inhibition model (1997) with Barkley's updated executive functioning model in predicting adult ADHD symptoms: A preliminary report using structural equation modeling.

One of the most comprehensive approaches to explaining attention-deficit/hyperactivity disorder (ADHD) symptoms is Barkley's behavioral inhibition model (BBIM) (1997), in which behavioral inhibition (BI) plays a primary role. Due to the substantial role of working memory (WM) in explaining ADHD symptoms, Barkley recently updated his model and elevated WM from a mediator variable (in BBIM) to a primary position as an exogenous variable alongside BI, and titled his new model as Barkley's updated executive functioning model (BUEFM). However, since the information about the explanatory power of the new model is sparse, this study aims to investigate the impact of this change in WM role by comparing these two models to explain ADHD symptoms. The study involved a sample of 184 (96 females and 88 males) undergraduate students with high ADHD symptoms who were selected using the purposive sampling method. For assessing models, we have utilized four tools that include: CNS-Vital Sign Test Battery; Barkley Deficit in Executive Functioning Scale; self-verbalization questionnaire (SVQ); and trail making test. We analyzed the data by running structural equation modeling (SEM) analysis using IBM AMOS software version 22. The results show that Model Comparison Measurement (e.g. AIC was 197.583 and 144.614 for BBIM and BUEFM, respectively) and Model Fit Indices (e.g. root mean square error of approximation (RMSEA) obtained 0.076 and 0.067 for BBIM and BUEFM, respectively) representing that BUEFM had a better value than BBIM, which means that the BUEFM was considered better fitting to the data. The findings of this study show that BUEFM has more Predictive power than BBIM to predict symptoms of ADHD through the motor control fluency (MOT) variable.

Mental Health, Burnout, and Job Stressors Among Healthcare Workers During the COVID-19 Pandemic in Iran: A Cross-Sectional Survey.

Introduction: The COVID-19 pandemic has caused increasing levels of mental health problems such as anxiety and depression among doctors, nurses and other healthcare workers in hospitals or health centers. The main objective of this study was to assess the mental health, job stressors, and burnout among healthcare workers in Iran. Materials and Methods: A cross-sectional study was performed in the primary healthcare centers and hospitals affiliated with six of the medical universities in Iran. The selection of participants was done using multi-center convenient sampling. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Copenhagen Burnout Inventory were used for gathering data through an online platform. Data related to job stressors were obtained using a validated checklist. Data analysis was performed using Chi-square and multiple regression tests and the phi coefficient. Results: The results of our study showed that 53% of the healthcare workers of the hospitals and primary healthcare centers enrolled in our study either had generalized anxiety disorder or major depressive disorder or both disorders. Moderate and high levels of burnout were seen among 48.9% of the study participants. The prevalence of mental disorders and burnout were significantly higher among the female healthcare workers compared to the male (p = 0.0001) and a higher rate of mental disorder and burnout was also seen among healthcare workers of hospitals compared to those working in primary healthcare centers (p = 0.024). "Worry about children and old members of family," "family worries for my health condition" and "lack of specific effective treatment for COVID-19" were found to be predictive of mental disorder and burnout. The most prevalent job stressor among the total sample was "low payment or income during the COVID-19 period". Conclusion: The results of our study revealed high psychological distress and burnout among healthcare workers of the hospitals during the fourth peak of the COVID-19 pandemic in Iran. This study highlights the need for health officials to pay attention to the job stressors of healthcare workers and obliges them to perform effective interventions to address their needs and concerns.

Comparing LORETA Z Score Neurofeedback and Cognitive Rehabilitation Regarding Their Effectiveness in Reducing Craving in Opioid Addicts.

Introduction: Previous studies have shown that conventional neurofeedback and cognitive modification treatments have numerous psychological benefits for patients with substance use disorders. However, the effectiveness of LORETA (Low-Resolution Brain Electromagnetic Tomography) Z Score Neurofeedback (LZNFB) and cognitive rehabilitation therapy in reducing opioid craving has not been investigated. Thus, the present study aimed to compare the effectiveness of LZNFB and cognitive rehabilitation therapy with Methadone Maintenance Treatment (MMT) in reducing craving in patients with opioid use disorder. Methods: Thirty patients with opioid use disorder undergoing MMT were randomly assigned into three groups: LZNFB with MMT, cognitive rehabilitation with MMT (as experimental groups), and MMT alone control group. The LZNFB and cognitive rehabilitation groups received 20 and 15 sessions of treatment, respectively. The three groups were assessed using several questionnaires and dot-probe task at pretest, posttest, and one-month follow-up. Results: The results showed that both experimental groups accomplished a significantly greater reduction in opioid craving than MMT alone group at posttest and follow-up (P<0.05). The LZNFB plus MMT group showed a greater decrease in opioid craving than the cognitive rehabilitation plus MMT group. In addition, the cognitive rehabilitation plus MMT group experienced greater improvement in attentional bias towards craving cues than the LZNFB with MMT group at posttest and follow-up. Finally, the LZNFB plus MMT group and cognitive rehabilitation plus MMT group got higher scores on the recovery assessment scale than MMT alone group at posttest and follow-up. According to study results, LZNFB training is more effective than cognitive rehabilitation in decreasing cravings and improving the quality of life in addiction to opioids. Conclusion: The current study's findings provided preliminary support for the effectiveness of LZNFB and cognitive rehabilitation in reducing opioid craving, improving attentional bias towards craving cues, and the quality of life among Iranian opioid use patients. Highlights: LZNFB training showed higher decrease in opioid craving than the Cognitive rehabilitation in opioid addicts.Cognitive rehabilitation group experienced greater improvement on attentional bias towards craving cues than LZNFB.LZNFB and Cognitive rehabilitation with MMT group got higher scores on the recovery assessment scale than MMT alone group.LZNFB training is more effective than Cognitive Rehabilitation in decreasing of craving in addiction. opioids. Plain Language Summary: Addiction is a chronic relapsing disease that makes many problems for human society. Routine medical treatments are not completely effective and they have relapse. New forms of non-medical treatments such as neurofeedback and cognitive rehabilitation are effective and safe without impressive side effects . This article shows the efficacy of above mentioned interventions for decrease craving and control of this problem.

Risk Factors Associated with Cyberbullying, Cybervictimization, and Cyberbullying-Victimization in Iran's High School Students.

Objective: This study aimed at finding the risk and protective factors of cyberbullying. Method : A total of 425 high school students (199 boys and 226 girls) were selected using a cluster randomized procedure. The risk and protective factors included gender, internet use, self-esteem, dark triad traits (Machiavellianism, narcissism and psychopathy), school bullying perpetration, school bullying victimization, interparental conflict, and school climate. Results: The results of multinomial logistic regression showed that being male, school bullying perpetration, and school bullying victimization can significantly increase the chances of being a cyberbully-victim and spending one hour or less on the internet can significantly decrease the chances of being a cyberbully-victim. Conclusion: This study provides important implications for any prevention and intervention programs for cyberbullying, which must consider the roles of traditional bullying, gender differences, and internet use in cyberbullying behavior.

Evidence for an increase in cannabis use in Iran - A systematic review and trend analysis.

BACKGROUND AND AIMS: Cannabis is the most widely used illicit substance globally. In this systematic review, we examined the prevalence and trends of cannabis use and cannabis use disorder in Iran. METHODS: We searched International and Iranian databases up to March 2021. Pooled prevalence of use among sex subgroups of the general population, university and high school students, combined youth groups, and high-risk groups was estimated through random-effects model. Trends of various use indicators and national seizures were examined. RESULTS: Ninety studies were included. The prevalence estimates of last 12-month cannabis use were 1.3% (95%CI: 0.1-3.6) and 0.2% (95%CI: 0.1-0.3) among the male and female Iranian general population, respectively. The prevalence of cannabis use disorder among general population in national studies rose from 0% in 2001 to 0.5% in 2011. In the 2016-2020 period, the pooled prevalence estimates of last 12-month cannabis use were 4.9% (95% CI: 3.4-6.7) and 0.3% (95% CI: 0.0-1.3) among males and females of "combined youth groups", respectively. The linear trend of last 12-month cannabis use among males of "combined youth groups" and among female university students increased significantly from 2000 to 2020. CONCLUSIONS: Prevalence of cannabis use in Iran is low compared to many countries. However, there is strong evidence of an increase in cannabis use among the youth and some evidence for an increase in cannabis use disorder.

The Effectiveness of Attention Bias Modification with and without Trans Cranial Direct Current Stimulation in Chronic Low Back Pain.

Objective: The present study aimed to compare the effect of ABM (attention bias modification) with and without tDCS (transcranial direct current stimulation) on attention bias, pain intensity, and disability due to pain and pain-related psychological consequences, such as depression, anxiety, and stress. Method : Using convenience sampling, 60 individuals who met the criteria for chronic low back pain (LBP) were selected and randomly assigned in to 2 experimental groups and 2 control and sham-tDCS groups. The experimental ABM group received 5 sessions of the dot-probe task, while the second experimental group received 5 sessions of dot-probe task combined with tDCS. Results: The findings indicated that ABM and ABM+tDCS could reduce attention bias and pain-related psychological consequences significantly, compared to the control and sham groups. Also, attention bias and pain outcomes (depression, anxiety, disability due to pain and pain intensity) remained in ABM+tDCS group than in ABM group in a 1-month follow-up. Conclusion: It was found that tDCS + ABM had no additional effects at the end of intervention, but led to more long-lasting effects in 1-month follow-up. Randomized clinical trial registry number: IRCT20171107037306N1.

Effectiveness of midwife-led brief counseling intervention on post-traumatic stress disorder, depression, and anxiety symptoms of women experiencing a traumatic childbirth: a randomized controlled trial.

BACKGROUND: This study investigated the effectiveness of brief midwife-led counseling based on Gamble and colleagues' approach in decreasing post-traumatic stress disorder, depression, and anxiety symptoms among a group of women who had experienced a traumatic childbirth. METHODS: From among 270 pregnant women screened to participate in the study, 90 women experienced a traumatic childbirth. They were randomly assigned into two groups: intervention (n = 45) and control group (n = 45). We did a face-to-face counseling session within 72 h after giving birth and a telephone counseling session four to 6 weeks after giving birth for the intervention group. The control group only received the postnatal routine care. The outcome measures were post-traumatic stress disorder, depression, and anxiety symptoms. RESULTS: At the three-month follow-up, the intervention group showed significantly higher improvement on post-traumatic stress disorder, depression, and anxiety symptoms compared to the control group. CONCLUSIONS: Gamble and colleagues' midwife-led brief counseling could be an effective approach to reduce psychological distress of women who have experienced a traumatic childbirth. TRIAL REGISTRATION NUMBER: IRCT201608285417N2, Date of Registration: 2/21/2017.

Victimization in traditional and cyberbullying as risk factors for substance use, self-harm and suicide attempts in high school students.

BACKGROUND: Traditional bullying (or peer bullying) is considered a common and unpleasant experience among students and has serious consequences such as mental health problems and unhealthy behavior. In recent years, another type of bullying named cyberbullying has emerged as a growing problem with negative effects on school achievement, physiology, and mental health of its victims. OBJECTIVE: The purpose of this research is to examine and compare the roles of traditional and cyberbullying victimization in substance use, self-harm and suicide attempts. METHODS: This was a cross-sectional study and conducted in 2019. A total of 425 high school students were selected for the study in Kermanshah, Iran. For conducting the survey, a multi-stage cluster randomized procedure was used and 18 classes in six different high schools in three urban areas were selected. A total of 400 students (mean age 16.61 years, 53.2% girls) responded to the survey, and it provided usable information for the research. Data were analyzed through binary logistic regression analyses. RESULTS: The analysis results revealed that 54.2% of students (n = 217) have experienced traditional or cyber victimization. Any kind of victimization was associated with self-harm. Cyber victimization alone and the combination of cyber plus traditional victimization showed significant association with suicide and substance use. Risk of substance use, self-harm, and suicide was higher when students experienced both types of bullying than when they experienced just one kind of bullying alone. CONCLUSIONS: The results of this study suggest that traditional and cyber victims may require immediate intervention to reduce the negative effects of victimization. Also, prevention programs should consider the possible relationship between traditional and cyber victimization and substance use, self-harm, and suicide.

Transcranial Direct Current Stimulation on Opium Craving, Depression, and Anxiety: A Preliminary Study.

OBJECTIVES: Transcranial direct current stimulation can be effective in reducing the craving for food, alcohol, and methamphetamine. Because its effects have not been tested on patients with opium use disorder, we investigated its efficacy when it is combined with a standard methadone maintenance therapy protocol. METHODS: We carried out a pretest-posttest control group method to evaluate the effect of transcranial direct current stimulation at the dorsolateral prefrontal cortex (right anodal/left cathodal) on opium craving, depression, and anxiety symptoms. We considered opium craving as a primary outcome as well as depression and anxiety symptoms as secondary outcomes. Sixty participants with opium use disorder were randomly assigned into 3 groups (n = 20 for each group): (1) an active transcranial direct current stimulation with methadone maintenance treatment (active tDCS group), (2) sham transcranial direct current stimulation with methadone maintenance treatment (sham tDCS group), and (3) only methadone maintenance treatment (methadone maintenance treatment group). All participants completed the Desire for Drug Questionnaire, Obsessive-Compulsive Drug Use Scale, Beck Depression Inventory II, and Beck Anxiety Inventory a week before and a week after the treatment. The outcomes were assessed by independent assessors who were blind to the treatment conditions. RESULTS: The active tDCS group had a significant reduction in opium craving, depression, and anxiety symptoms compared with the other 2 groups. CONCLUSIONS: Our results provide a preliminary support for using the transcranial direct current stimulation along with methadone maintenance therapy in the treatment of patients with opium use disorder.

Risk and protective factors for substance use among Iranian university students: a national study.

BACKGROUND: Substance use is a major mental health concern among university students. It may result in behavioral and academic problems, psychiatric disorders, and infectious diseases. Thus, this study investigated the risk and protective factors of substance use among Iranian university students. METHODS: This was a cross-sectional study. A number of 7330 students were selected from 30 universities in Iran. The participants completed a researcher-designed questionnaire. It measured life time, previous year and previous month's substance use, demographic characteristics, and a body of risk and protective factors including, religious beliefs, self-esteem, stress and psychological pressure, sensation seeking, attention seeking, anger and aggression, depression and anxiety, parents' positive attitude towards substance use, lack of intimacy between family members, plus substance use, smoking cigarettes or hookah, alcohol consumption, and prescribed medications use by their family members, easy access to illegal drugs, peers' positive attitude towards substance use, peers' drug use, perceived prevalence of substance use among students, and negative attitude toward university. The data were analyzed using descriptive statistics and multivariate logistic regression analysis. RESULTS: Participants' anger and aggression, depression and anxiety, participants' positive attitude towards substances, low level of religious beliefs, peers and family member's substance use, and parent's positive attitude towards substance significantly and strongly predicted using cigarette/hookah, alcohol, hard drugs, and prescribed medications. Having a negative attitude toward university significantly predicted using all types of substance (except for prescribed medications). Low self-esteem predicted using cigarette/hookah, and alcohol use. Perceived availability of illegal drugs predicted hard drugs and prescribed medications' consumption. Finally, peers' positive attitude toward drugs anticipated cigarette/hookah use. CONCLUSION: Prevention programs are most needed among Iranian students. They should be comprehensive in nature and focus on students' psychoeducation about substances and their related negative consequences, plus promotion of students' life skills, and integrate family- and peer-based preventive interventions.

Effects of Increase in Amplitude of Occipital Alpha & Theta Brain Waves on Global Functioning Level of Patients with GAD.

INTRODUCTION: The basic objective of this study is to investigate the effects of alpha and theta brain waves amplitude increase in occipital area on reducing the severity of symptoms of generalized anxiety disorder and to increase the global functioning level in patients with GAD. METHODS: This study is a quasi-experimental study with pre-test and post-test with two groups. For this purpose, 28 patients who had been referred to Sohrawardi psychiatric and clinical psychology center in Zanjan were studied based on the interview with the psychiatrist, clinical psychologist and using clinical diagnostic criteria for the Diagnostic and Statistical Manual of Mental Disorders text revision - the DSM-IV-TR Fourth Edition diagnosis of GAD, 14 subjects were studied in neurofeedback treatment group and 14 subjects in the waiting list group. Patients in both groups were evaluated at pre-test and post-test with General Anxiety Disorder Scale (GAD-7) and Global Assessment Functioning Scale (GAFs). The treatment group received fifteen 30-minute alpha training sessions and fifteen 30-minute theta brain training sessions in occipital area by neurofeedback training (treatment group). This evaluation was performed according to the treatment protocol to increase the alpha and theta waves. And no intervention was done in the waiting list group. But due to ethical issues after the completion of the study all the subjects in the waiting list group were treated. RESULTS: The results showed that increase of alpha and theta brain waves amplitude in occipital area in people with GAD can increase the global functioning level and can reduce symptoms of generalized anxiety disorder in a treatment group, but no such change was observed in the waiting list group. DISCUSSION: Increase of alpha and theta brain waves amplitude in occipital area can be useful in the treatment of people with GAD.

Substance use avoidance among Iranian male adolescents: a comparison of three versions of the theory of reasoned action.

The theory of reasoned action (TRA) is one of the most common models in predicting health-related behaviors and is used more often in health education studies. This study aimed to add two control constructs (perceived behavioral control - PBC and self-efficacy - SE) to the TRA and compare them using the structural equation modeling (SEM) for substance use avoidance among Iranian male adolescents in order to find out which model was a better fit in predicting the intention. This was a cross-sectional study carried out in Tehran, Iran. Data were collected from a random sample of high school male students (15-19 years of age) using a questionnaire containing items related to the TRA plus items reflecting two additional constructs (SE and PBC). In all, 433 students completed the questionnaires. The results obtained from SEM indicated a better fit to the data for the TRA with SE compared to the TPB (TRA with PBC) and TRA (χ2/df=2.55, RMSEA=0.072, CFI=0.96, NFI=0.94, NNFI=0.95, SRMR=0.058). Comparing SE and PBC, the results showed that self-efficacy was a better control construct in improving the TRA and predicting substance use avoidance intention (41%). The TRA with SE had a better model fit than TPB and the original version of the TRA.

Smoking status in Iranian male adolescents: a cross-sectional study and a meta-analysis.

The present study aimed to estimate the prevalence of smoking status and its associated factors in Iranian adolescents and a meta-analysis of recent cross-sectional studies in order to estimate the corresponding prevalence for all Iranian adolescents. In a cross-sectional study, 1064 male high school students in Zanjan city (northwest of Iran) were recruited. A self-administered questionnaire was used for smoking status and associated factors. Through the meta-analysis, all relevant published studies were reviewed. Almost one-third of adolescents (34.2%, n=354) have experienced smoking either experimentally (23.4%, n=242), or regularly (10.8%, n=112). Multivariate analysis showed that older age (OR=1.20; 95% CI: 1.05-1.37), risky behaviors (OR=1.83; 1.25-2.68), Tramadol medication (OR=2.19; 1.54-3.11), low self-esteem (OR=1.07; 1.03-1.11), positive attitude toward smoking (OR=1.15; 1.09-1.21), positive thinking about smoking (OR=1.07; 1.01-1.14) and having smoker friends (OR=1.94; 1.36-2.77) were significantly associated with cigarette smoking in adolescents. Meta-analysis results showed that 7% of Iranian adolescents are regular smokers and 27% are experimenters. Increasing prevalence of smoking in Iranian adolescents is a major concern for public health. Controlling risky behaviors and increasing health education are recommended.