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Chaplains are an integral part of mental health treatment within the Veterans Health Administration (VHA) and over the past decade, efforts have been made to integrate chaplain services into behavioral health treatment. One unique duty of chaplains is to conduct spiritual assessments, which are characterized as collaborative discussions with veterans to understand their overall religious and belief system, identify spiritual injuries, and how to integrate one's spiritual values into medical care. Although spiritual assessments in Veterans Affairs Medical Centers have evolved throughout the years to adopt a more structured approach, spiritual assessments can vary depending on site, clinical setting, and medical center. The present study sought to examine chaplains' perspectives on standardizing spiritual assessments and incorporating empirically validated measures into the assessments. Thematic analysis was conducted on two focus groups of chaplains from a large VHA medical center. Overall, chaplains appeared interested in standardizing spiritual assessments, with an expressed desire to maintain their current conversational format. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prior research has demonstrated that angry participants exhibit biased threat detection whereby they are more likely to misidentify neutral objects as guns. Yet, it is unclear whether independent components of anger, such as conceptual knowledge about anger or the affective features of an anger instance, could lead to altered bias alone. Consistent with constructionist theories of emotion, the present set of two experiments demonstrates that threat-detection bias only differs significantly between participants in an emergent-anger condition, who had engaged both components of anger (i.e., conceptual knowledge of anger and negative, high arousal affect), and participants in a control condition, who had engaged neither. Study 2 demonstrates that this pattern of findings also extends to another threat-relevant emotional state (i.e., fear). Implications for studying anger and fear, and emotions more generally, as constructed mental experiences are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Gradient mapping is an important technique to summarize high dimensional biological features as low dimensional manifold representations in exploring brain structure-function relationships at various levels of the cerebral cortex. While recent studies have characterized the major gradients of functional connectivity in several brain structures using this technique, very few have systematically examined the correspondence of such gradients across structures under a common systems-level framework. Using resting-state functional magnetic resonance imaging, here we show that the organizing principles of the isocortex, and those of the cerebellum and hippocampus in relation to the isocortex, can be described using two common functional gradients. We suggest that the similarity in functional connectivity gradients across these structures can be meaningfully interpreted within a common computational framework based on the principles of predictive processing. The present results, and the specific hypotheses that they suggest, represent an important step toward an integrative account of brain function.

BACKGROUND In the veteran community, chronic pain is particularly prevalent and often debilitating. Until recently, veterans with chronic pain were offered primarily pharmacological intervention options, which rarely suffice and can also have negative health consequences. To better address chronic pain in veterans, the Veterans Health Administration has invested in novel, nonpharmacological behavior interventions that target both pain management and chronic pain–related functional issues. One approach, acceptance and commitment therapy (ACT) for chronic pain, is supported by decades of efficacy evidence for improving pain outcomes; however, ACT can be difficult to obtain owing to issues such as a lack of trained therapists or veterans having difficulty committing to the time and resources needed for the full clinician-led ACT protocol. Given the strong ACT evidence base combined with access limitations, we set out to develop and evaluate Veteran ACT for Chronic Pain (VACT-CP), an online program guided by an embodied conversational agent to improve pain management and functioning. OBJECTIVE The aims of this study are to develop, iteratively refine, and then conduct a pilot feasibility randomized controlled trial (RCT) of a VACT-CP group (n=20) versus a waitlist and treatment-as-usual control group (n=20). METHODS This research project includes 3 phases. In phase 1, our research team consulted with pain and virtual care experts, developed the preliminary VACT-CP online program, and conducted interviews with providers to obtain their feedback on the intervention. In phase 2, we incorporated feedback from phase 1 into the VACT-CP program and completed initial usability testing with veterans with chronic pain. In phase 3, we are conducting a small pilot feasibility RCT, with the primary outcome being assessment of usability of the VACT-CP system. RESULTS This study is currently in phase 3; recruitment for the RCT began in April 2022 and is expected to continue through April 2023. Data collection is expected to be completed by October 2023, with full data analysis completed by late 2023. CONCLUSIONS The findings from this research project will provide information on the usability of the VACT-CP intervention, as well as secondary outcomes related to treatment satisfaction, pain outcomes (pain-related daily functioning and pain severity), ACT processes (pain acceptance, behavioral avoidance, and valued living), and mental and physical functioning. CLINICALTRIAL ClinicalTrials.gov NCT03655132; https://clinicaltrials.gov/ct2/show/NCT03655132 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/45887

The periaqueductal grey (PAG) is a small midbrain structure that surrounds the cerebral aqueduct, regulates brain–body communication, and is often studied for its role in “fight-or-flight” defense responses. We used ultra-high field 7-Tesla fMRI to resolve the PAG in humans and distinguish it from the cerebral aqueduct, examining itsin vivofunction in humans during a working memory task (N = 87)—i.e., a setting that required physiological mobilization, but no “threat”. During both low and moderate task-elicited cognitive demand, we observed BOLD signal intensity increases in bilateral ventrolateral PAG (vlPAG), consistent with the columnar organization of PAG function identified in non-human animal research. Changes in physiological activity during the task (phasic skin conductance response (SCR) amplitudes, cardiac interbeat interval, respiratory rate) were correlated with PAG BOLD estimates across subjects, and showed some evidence of spatial organization within the PAG, but no spatial organization overlapping with the task-elicited increase in bilateral vlPAG. These findings suggest that the PAG coordinates and regulates bodily activity, even in the absence of threat.

The superior colliculus is often studied for its role in visually guided behaviors, but research in non-human animals indicates it is a midbrain hub for processing sensory information from multiple domains, including interoception (which is associated with affect). We used ultra-high field 7-Tesla fMRI to extend this work to humans, modeling superior colliculus BOLD signal intensity during visual or somatosensory stimulation (N = 40 in each sensory modality), both under aversive and neutral affective intensity. As hypothesized, the superior colliculus showed increased BOLD signal intensity in the dorsal and ventral subregions during visual and somatosensory stimulation, respectively. The entire superior colliculus also showed increased BOLD signal intensity during aversive compared to neural conditions. The superior colliculus BOLD signal intensity also correlated with a preregistered set of brain regions involved in visual, somatosensory, and interoceptive processing.

ImportanceFew evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions.ObjectiveTo examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI.Design, Setting, and ParticipantsThis multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to September 1, 2019); outcomes were assessed at 12 weeks and 6 months. Statistical analysis was conducted between January 1, 2019, and December 31, 2020.InterventionsProblem-solving treatment taught skills to improve problem-solving. Health education provided didactic health information. Both were delivered by telephone weekly for 12 weeks.Main Outcomes and MeasuresThe primary outcome was reduction from baseline to 12 weeks in self-report of disability (World Health Organization Disability Assessment Schedule). Secondary outcomes were reductions in self-report of problem-solving impairment and objective problem-solving. Exploratory outcomes were reductions in pain, pain disability, and fatigue.ResultsA total of 268 veterans (mean [SD] age, 52.9 [7.3] years; 88.4% male; 66.8% White) were randomized to PST (n = 135) or health education (n = 133). Most participants completed all 12 sessions of PST (114 of 135 [84.4%]) and health education (120 of 133 [90.2%]). No difference was found between groups in reductions in disability at the end of treatment. Results suggested that PST reduced problem-solving impairment (moderate effect, 0.42; P = .01) and disability at 6 months (moderate effect, 0.39; P = .06) compared with health education.Conclusions and RelevanceIn this randomized clinical trial of the efficacy of PST for GWI, no difference was found between groups in reduction in disability at 12 weeks. Problem-solving treatment had high adherence and reduced problem-solving impairment and potentially reduced disability at 6 months compared with health education. These findings should be confirmed in future studies.Trial RegistrationClinicalTrials.gov Identifier: NCT02161133

We examined the superior colliculus (SC) with ultra-high resolution 7-Tesla fMRI during an N-back working memory task. We observed both increased BOLD signal intensity and functional connectivity that followed a layer-dependent pattern predicted from anatomical connections between SC and other brain structures important for visual processing, motor control, and executive function. Our results highlight a role for the human SC in cognitive functions that usually associated with the cerebral cortex.

Sleep disturbances, including chronic insomnia and sleep apnea, are major concerns for US veterans, with rising rates and detrimental effects on physical, mental, and social well-being. Sleep disturbances in veterans are also underdiagnosed and undertreated for reasons that include limited sleep clinician availability, long wait times, and the time commitment for treatment. Greater use of sleep health information technologies could improve access to assessment and treatment of sleep disturbances. However, the assessment of acceptance of these technologies among veterans is still ongoing. This mixed-method study combines data from two separate but similar randomized controlled trials to assess acceptance of sleep health information technologies for veterans with chronic insomnia. Sleep health information technologies included in these trials were the following: (1) a WatchPAT sleep monitor for home-based sleep assessment, including detection of sleep apnea, and (2) the VA mobile app Cognitive Behavioral Therapy for Insomnia (CBT-i Coach), which supports self-management of insomnia. The combined sample of 37 veterans receiving care within one New England VA medical center completed a six-week trial using both health information technology tools. Participants completed a survey and interview at the end of the 6 weeks. Overall, participants found the tools acceptable, easy to use, and useful and reported they would use them in the future. Thus, these sleep health information technologies appear to provide an acceptable remote option for assessing and managing sleep issues for veterans. ClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000 and ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354.

The theory of constructed emotion is a systems neuroscience approach to understanding the nature of emotion. It is also a general theoretical framework to guide hypothesis generation for how actions and experiences are constructed as the brain continually anticipates metabolic needs and attempts to meet those needs before they arise (termed allostasis). In this review, we introduce this framework and hypothesize that allostatic dysregulation is a trans-disorder vulnerability for mental and physical illness. We then review published findings consistent with the hypothesis that several symptoms in major depressive disorder (MDD), such as fatigue, distress, context insensitivity, reward insensitivity, and motor retardation, are associated with persistent problems in energy regulation. Our approach transforms the current understanding of MDD as resulting from enhanced emotional reactivity combined with reduced cognitive control and, in doing so, offers novel hypotheses regarding the development, progression, treatment, and prevention of MDD.

Is there a universal mapping of physiology to emotion, or do these mappings vary substantially by person or situation? Psychologists, philosophers, and neuroscientists have debated this question for decades. Most previous studies have focused on differentiating emotions on the basis of accompanying autonomic responses using analytical approaches that often assume within-category homogeneity. In the present study, we took an alternative approach to this question. We determined the extent to which the relationship between subjective experience and autonomic reactivity generalizes across or depends upon the individual and situation for instances of a single emotion category, specifically, fear. Electrodermal activity and cardiac activity - two autonomic measures that are often assumed to show robust relationships with instances of fear - were recorded while participants reported fear experience in response to dozens of fear-evoking videos related to three distinct situations: spiders, heights, and social encounters. We formally translated assumptions from diverse theoretical models into a common framework for model comparison analyses. Results exceedingly favored a model that assumed situation-dependency in the relationship between fear experience and autonomic reactivity, with subject variance also significant, but constrained by situation. Models that assumed generalization only across situations or individuals performed much worse by comparison. These results call into question the assumption of generalizability of autonomic-subjective mappings across instances of fear, such as in translational research from non-human animals to humans, and suggest the benefits of adopting a situated approach to understanding the autonomic correlates of fear experience.