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The article provides up-to-date scientific data on the clinical phenotype of depression in children and adolescents that were exposed to significant psychological trauma as a result of hostilities, terrorism, natural disasters, abuse, physical and sexual violence. The review presents the latest data on the prevalence of depression due to various traumatic factors, comorbidity of mental and neurological disorders, possible mechanisms of their relationship, treatment recommendations. Post-traumatic depressions (PTD) are widespread in children and adolescents and negatively affect the quality of life and significantly increase the risk of suicide and self-harming behavior. The presence of depression worsens the prognosis of post-traumatic stress disorder, the treatment response. Several psychotherapeutic interventions, including cognitive-behavioral therapy and eye-movement desensitization, are effective in the treatment of PTD. Psychopharmacological drugs, in particular antidepressants and mood stabilizers, have limited proven efficacy in PTD in pediatric practice. The use of these drugs in comorbid mental and neurological conditions has a higher level of evidence. Conclusions. Depression in children and adolescents due to psychological trauma remains an understudied topic. Future research should focus on the efficacy of pharmacological approaches to the treatment of posttraumatic depression and comorbid mental and neurological disorders, which is especially important for countries with low access to specialized psychotherapeutic care., У статті наведені сучасні наукові дані щодо клінічного фенотипу депресій у дітей та підлітків, які зазнали значущої психологічної травматизації в результаті воєнних дій, тероризму, природних катастроф, жорстокого поводження, фізичного та сексуального насильства. Обговорюються дані щодо поширеності депресій, зумовлених різними травматичними чинниками, коморбідності з психічними та неврологічними розладами, розглянуті можливі механізми їх взаємозв’язку, терапевтичні рекомендації. Посттравматичні депресії (ПТД) поширені серед дітей та підлітків, негативно впливають на якість життя та суттєво збільшують ризик суїциду та самоушкоджуючої поведінки. Наявність депресії погіршує прогноз перебігу посттравматичного стресового розладу, ефективність його терапії. Окремі психотерапевтичні втручання, зокрема когнітивно-поведінкова терапія та десенсибілізація рухами очей, є ефективними методами терапії ПТД. Психофармакологічні лікарські засоби (ПЛЗ), зокрема антидепресанти та стабілізатори настрою, мають обмежену доведену ефективність при ПТД у педіатричній практиці. Більший рівень доказовості має застосування цих ПЛЗ при коморбідних психічних та неврологічних розладах. Висновки. Депресія у дітей та підлітків внаслідок психологічної травматизації залишається недостатньо дослідженим розладом психіки. Майбутні дослідження мають бути направлені на вивчення ефективності фармакотерапевтичних підходів до лікування посттравматичної депресії та коморбідних психічних та неврологічних розладів, що є особливо важливим для країн з низьким доступом до спеціалізованої психотерапевтичної допомоги.

This article describes and examines a method of spatial suppression of extremely strong interfering signals (ISs) capable of complete desensitization and even damage of victim receivers’ input circuits. This method not only protects victim receivers but also allows them to reliably receive desired signals in the presence of such ISs, using adaptive hybrid nulling whose first stage is performed at the receivers’ analog inputs and the second stage is carried out in the receivers’ digital portions.

Congenital Zika Syndrome (CZS) is characterized by changes in cranial morphology associated with heterogeneous neurological manifestations and cognitive and behavioral impairments. In this syndrome, longitudinal neuroimaging could help clinicians to predict developmental trajectories of children and tailor treatment plans accordingly. However, regularly acquiring magnetic resonance imaging (MRI) has several shortcomings besides cost, particularly those associated with childrens' clinical presentation as sensitivity to environmental stimuli. The indirect monitoring of local neural activity by non-invasive functional near-infrared spectroscopy (fNIRS) technique can be a useful alternative for longitudinally accessing the brain function in children with CZS. In order to provide a common framework for advancing longitudinal neuroimaging assessment, we propose a principled guideline for fNIRS acquisition and analyses in children with neurodevelopmental disorders. Based on our experience on collecting fNIRS data in children with CZS we emphasize the methodological challenges, such as clinical characteristics of the sample, desensitization, movement artifacts and environment control, as well as suggestions for tackling such challenges. Finally, metrics based on fNIRS can be associated with established clinical metrics, thereby opening possibilities for exploring this tool as a long-term predictor when assessing the effectiveness of treatments aimed at children with severe neurodevelopmental disorders.

Does Eye Movement and Desensitization and Reprocessing (EMDR) therapy affect the accuracy of memories? This recurrent issue in recent memory research bears relevance to expert witness work in the courtroom. In this review, we will argue that several crucial aspects of EMDR may be detrimental to memory. First, research has shown that eye movements undermine the quality and quantity of memory. Specifically, eye movements have been shown to decrease the vividness and emotionality of autobiographical experiences and amplify spontaneous false memory levels. Second, a sizeable proportion of EMDR practitioners endorse the controversial idea of repressed memories and discuss the topic of repressed memory in therapy. Third, in the Dutch EMDR protocol, patients are instructed to select the target image by using flawed metaphors of memory (e.g., memory works as a video). Such instructions may create demand characteristics to the effect that people over-interpret imagery during therapy as veridical memories. Collectively, the corpus of research suggests that several components of EMDR therapy (i.e., performing eye movements, therapist beliefs and therapeutic instructions) may undermine the accuracy of memory, which can be risky if patients, later on, serve as witnesses in legal proceedings. ispartof: MEMORY vol:29 issue:9 pages:1254-1262 ispartof: location:England status: published

In Parkinson's disease, both motor and neuropsychiatric complications unfold as consequence of both incremental striatal dopaminergic denervation and intensifying long-term dopaminergic treatment. Together, this leads to 'dopaminergic sensitization' steadily increasing motor and behavioral responses to dopaminergic medication that result in the detrimental sequalae of long-term dopaminergic treatment. We review the clinical presentations of 'dopaminergic sensitization', including rebound off and dyskinesia in the motor domain, and neuropsychiatric fluctuations and behavioral addictions with impulse control disorders and dopamine dysregulation syndrome in the neuropsychiatric domain. We summarize state-of-the-art deep brain stimulation, and show that STN-DBS allows dopaminergic medication to be tapered, thus supporting dopaminergic desensitization. In this framework, we develop our integrated debatable viewpoint of "changing gears", i.e., we suggest rethinking earlier use of subthalamic nucleus deep brain stimulation, when the first clinical signs of dopaminergic motor or neuropsychiatric complications emerge over the steadily progressive disease course. In this sense, subthalamic deep brain stimulation may help reduce longitudinal motor and neuropsychiatric symptom expression - importantly, not by neuroprotection but by supporting dopaminergic desensitization through postoperative medication reduction. Therefore, we suggest considering STN-DBS early enough before patients encounter potentially irreversible psychosocial consequences of dopaminergic complications, but importantly not before a patient shows first clinical signs of dopaminergic complications. We propose to consider neuropsychiatric dopaminergic complications as a new inclusion criterion in addition to established motor criteria, but this concept will require validation in future clinical trials. This article is protected by copyright. All rights reserved.

Background/purpose Oral health care provision in long-term care settings is often limited by specific behaviors exhibited by residents, which may be interpreted as a refusal of care. Such behaviors can be attributed to oral tactile hypersensitivity (TH), which is characterized by aberrations in the perception of oral stimuli. TH is also associated with a decline in ingestion and swallowing function. The purpose of this study was to examine the effectiveness of a technique for mitigating TH (TMH) among institutionalized older persons. Materials and methods In this study, 18 institutionalized older persons (Mean age, 90.6 ± 4.5 years; 92.9% females) with TH were randomized to a control group or an intervention group. Pre- and post-intervention assessments were conducted for seven participants in each group. Routine oral care was provided by the facility's staff in both groups. TMH in the intervention group was performed by a dental hygienist over a 3-month period. Results In the intervention group, the number of areas with TH was significantly reduced (P = 0.027). No significant change was observed in the control group. Conclusion The results of this study suggest that TMH can effectively mitigate TH. Our findings provide clinicians with an additional treatment option for hypersensitivity in older patients. Additional long-term studies with larger sample sizes are required to confirm the effectiveness of this technique.

This study examines the application of relaxation as a technique of counseling guidance to reduce anxiety in facing semester exams at STKIP Andi Matappa. The objectives of this study were: (1) to find out how the description of the implementation of systematic desensitization behavioral counseling techniques in reducing anxiety in facing student semester exams at STKIP Andi Matappa, (2) knowing how to describe the level of anxiety facing student semester exams before and after giving behavioral counseling of desensitization techniques systematic at STKIP Andi Matappa, and (3) knowing whether there is an effect of the application of systematic desensitization technique behavioral counseling on anxiety facing student semester exams at STKIP Andi Matappa. The results showed: (1) The level of student anxiety in facing the semester exams at STKIP Andi Matappa during the implementation of systematic desensitization technique behavioral counseling was in the very high category. (2) The level of student anxiety in facing semester exams at STKIP Andi Matappa during the implementation of systematic desensitization technique behavioral counseling is in the high category. (3) there is an influence on the level of student anxiety in facing the semester exams at STKIP Andi Matappa at the time of implementing the systematic desensitization technique behavioral counseling is in the low category.

Drug addiction is considered as a global epidemic which drastically affects millions of people worldwide, damaging an individual’s physiological, social, and psychological facets. One of the constructs that has been determined as an essential factor in the development of a variety of addictive behaviors is self-regulation. It plays an important role in predicting, maintaining, and treating addiction. In this study, the efficacy of Desensitization of Triggers and Urge Reprocessing (DeTUR), an Eye Movement Desensitization Reprocessing (EMDR) addiction protocol, in improving self-regulation was tested among fourteen (14) in-house clients of two drug treatment and rehabilitation centers using sequential explanatory mixed method research design wherein Self-regulation Inventory-Short Version (SRI-S) and individual interviews were employed. Results explicitly proved that self-regulation scores obtained significantly differed before, after, and even the delivery of delayed posttest using the EMDR as an intervention. The study confirmed that EMDR enhances the clients’ self-regulations (Overall SRI) and the sub-areas: positive actions, controllability, expressions of feelings and needs, assertiveness, and well-being seeking. Themes generated using thematic analysis further established a basis for the efficacy of EMDR.Keywords: drug addiction, self-regulation, Eye-movement Desensitization Reprocessing (EMDR), Desensitization of Triggers and Urge Reprocessing (DeTUR)

This study intended to observe mental symptoms among physicians in Turkey during the COVID-19 pandemic and to investigate the factors leading to such symptoms. The study participants were contacted via their smartphones between April 23 and 27, 2020, and invited to fill out an online questionnaire which included questions from the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI). The mean age of the 406 physicians who participated in the study was 42.9 ± 10.1 years, and 53.4% were men (n: 217). During the pandemic, 66.7% had decreased working hours. Lack of COVID-related training, difficulty obtaining personal protective equipment (PPE), working in a COVID unit, and current psychiatric disease were found to be among the predictors of emotional burnout. Female gender, lack of COVID training, difficulty obtaining PPE, working in a COVID unit, and current psychiatric disease predicted desensitization. Facilitating continuous and comprehensive support mechanisms aimed at protecting physicians’ mental health is of great importance during epidemics.

Aims Medical procedures and hospitalizations can be experienced as traumatic and can lead to post-traumatic stress reactions. Eye movement desensitization and reprocessing (EMDR) shows promising results but very few long-term studies have been published. Therefore, our aim was to test the long-term (8 months post-treatment) effectiveness of EMDR in children and adolescents with medically related subthreshold post-traumatic stress disorder (PTSD). Methods and results Seventy-four children (including 39 with congenital or acquired heart disease) aged 4–15 (M = 9.6 years) with subthreshold PTSD after previous hospitalization were included into a parallel group randomized controlled trial. Participants were randomized to EMDR (n = 37) or care-as-usual (CAU) (n = 37; medical care only). The primary outcome was PTSD symptoms of the child. Secondary outcomes were symptoms of depression and blood–injection–injury (BII) phobia, sleep problems, and health-related quality of life (HrQoL) of the child. Assessments of all outcomes were planned at baseline and 8 weeks and 8 months after the start of EMDR/CAU. We hypothesized that the EMDR group would show significantly more improvements on all outcomes over time. Both groups showed improvements over time on child’s symptoms of PTSD (only parent report), depression, BII phobia, sleep problems, and most HrQoL subscales. GEE analyses showed no significant differences between the EMDR group (nT2 = 33, nT3 = 30) and the CAU group (nT2 = 35, nT3 = 32) on the primary outcome. One superior effect of EMDR over time was found for reducing parent-reported BII phobia of the child. Conclusion EMDR did not perform better than CAU in reducing subthreshold PTSD up to 8 months post-treatment in previously hospitalized children. Possible explanations and clinical implications are discussed.

Background Posttraumatic stress disorder (PTSD) may develop after exposure to a traumatic event. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychological treatment for PTSD. It is yet unclear whether eye movements also reduce stress reactivity in PTSD patients. This study aims to test whether eye movements, as provided during Eye Movement Desensitization (EMD), are more effective in reducing stress reactivity in PTSD patients as compared to a retrieval-only control condition. Methods The study includes participants who meet criteria of PTSD of the public psychological services in Jakarta and Bandung, Indonesia. One hundred and ten participants are randomly assigned to either an (1) Eye Movement Desensitization group (n = 55) or (2) retrieval-only control group (n = 55). Participants are assessed at baseline (T0), post-treatment (T1), 1 month (T2), and at 3 months follow-up (T3). Participants are exposed to a script-driven imagery procedure at T0 and T1. The primary outcome is heart rate variability (HRV) stress reactivity during script-driven imagery. Secondary outcomes include heart rate (HR), pre-ejection period (PEP), saliva cortisol levels, PTSD symptoms, neurocognitive functioning, symptoms of anxiety and depression, perceived stress level, and quality of life. Discussion If the EMD intervention is effective in reducing stress reactivity outcomes, this would give us more insight into the underlying mechanisms of EMDR’s effectiveness in PTSD symptom reduction. Trial registration ISRCTN registry ISRCTN55239132. Registered on 19 December 2017.

This paper aims to map out the adaptive causal pathways of processes underlying capsaicin consumption and the desensitization process of the TRPV1 receptor as a feedback loop together with pain and pleasure perception. In order to map out these causal capsaicin pathways, adaptive causal network modeling was applied, which is a way of modeling biological, neural, mental and social processes from an adaptive causal modeling perspective.

Las neurociencias han jugado un papel muy importante desde finales del siglo XX y los inicios del siglo XXI, en el estudio del comportamiento humano y el trauma psicológico, actualmente se cuenta con herramientas muy poderosas como las neuroimágenes para observar la actividad cerebral en tiempo real, estas permiten observar la actividad eléctrica y/o química de las áreas cerebrales que propician o no la regulación de la emocionalidad y el comportamiento. Se realizó una revisión y recolección de información de los últimos estudios realizados basándonos en fuentes confiables de consulta. La terapia EMDR es un modelo psicoterapéutico, fue descubierto y desarrollado por la doctora Francine Shapiro, en 1987. Consta de 8 fases: 1. Historia 2. Preparación 3. Evaluación 4. Desensibilización 5. Instalación 6. Chequeo corporal 7. Cierre y 8. Reevaluación (Shapiro, 2017). Incluye un protocolo de las tres vertientes: Pasado – Presente - Futuro. Recientemente se han publicado datos importantes de resultados de investigaciones en las que se evidencia el cambio en la activación de las áreas cerebrales antes, durante y después de la terapia EMDR. Propiciando el alivio del sufrimiento humano generado por trauma psicológico.

It has been proposed that exposure to violent video games (VVGs) resulted in alterations of social behaviors such as increased aggression. The most damaging reported effect of playing VVGs is neural desensitization to violent stimuli and this is a major concern given the reported number of players and time spent playing major video game titles. The aim of this study was to investigate the existence of neural desensitization that was reported at the P300 component of event-related potentials (ERPs) in response to violent stimuli. Eighty-seven participants were recruited and placed into one of two conditions based on their video gaming behavior (violent games players and nonplayers). ERPs were recorded from participants who passively viewed violent and neutral images selected from the International Affective Picture System (IAPS). The participants then played a VVG, postplaying ERPs were recorded while viewing the neutral and violent IAPS images. The mean amplitudes of the P300 were analyzed with respect to condition, time, and content. There was a significant effect of image but not of VVG player and nonplayer. The results were interpreted as evidence against the neural desensitization hypothesis. The findings of this study are consistent with imaging research and the implications for the reported negative effects of playing VVGs are discussed.

Background: Autism is a neurological disorder which can be associated with impaired behavioural patterns, expressive and receptive communication difficulties and challenges with social interaction. When combined these challenges can make dental treatment difficult. Therefore, dentists need to be skilled in appropriate dental management strategies for children with autism who attend their clinics for treatment. Rationale: Previous literature reviews have identified the use of traditional behavioural management techniques, such as physical restraints and general anaesthesia. This study aims to update the existing reviews and report effective contemporary techniques. Aim of the review: This literature review aims to document and record current dental strategies and techniques in treating children with autism. Methods: A systematic literature search within PubMed and EBSCO Host using the search terms “Dental strategies” OR dental techniques OR Dental manag* OR dental treat* OR dentist AND autism AND Child* was carried out. The search yielded 10 articles, once exclusion and inclusion criteria were applied and each article was assessed using the qualitative and quantitative CASP tools. Results: Four main themes emerged from a thematic analysis of the 10 articles: 1) Desensitization strategies. 2) Educational strategies. 3) Behavioural approaches. 4) Anaesthesia interventions. Evidence showed that current dental strategies like inter- professional collaboration and some visual strategies using the electronic screen media were particularly effective in treating children with autism within the clinical setting. Conclusion: A range of strategies in providing dental treatment to children with autism were identified. These strategies include desensitization, by various techniques (e.g. visual strategies and social stories, desensitization appointments), educational strategies (e.g. inter-professional collaboration), behavioural strategies and local anaesthesia. However, there is limited evidence regarding the effectiveness of these techniques particularly local anaesthesia and communication supports. Future research is needed to ascertain the effectiveness of these techniques, both in their own right and comparatively with each other.

In this paper, a second-order adaptive network model is presented for the effects of supernormal stimuli. The model describes via the underlying mechanisms in the brain how responses on stimuli occur in absence of a supernormal stimulus. Moreover, it describes how these normal responses are lost after a supernormal stimulus occurs and due to that adaptive desensitization takes place. By simulated example scenarios, it was evaluated that the model describes the expected dynamics. By stationary point analysis correctness of the implemented model with respect to its design was verified.

Aim: To evaluate the efficacy of different possible and non-pharmacological techniques in eliminating the discomfort of local anaesthesia injection during dental procedures. Introduction: Dental anxiety and fear of needles are one of the most common problems seen by dental practitioners; several methods are currently used to lower the discomfort of local anaesthesia injection during dental procedures. The desensitization of injection sites is one of the recommended strategies. Among chemical anaesthetic topical agents that are effective but might have allergic side effects, using some non-pharmacological and safe techniques might be useful. Materials and Methods: Randomly chosen patients receiving LA underwent pre-injection intervention that included heat, cold and pressure. This was compared with a control of no pre-injection intervention. Pain score in ice and LA spray pre-injection intervention. It clearly shows that the pain levels in the LA spray technique are higher than those in the Ice technique. Results: Comparing the pain score of ice as a pre-injection intervention between males and females it was found that males have lower pain scores than females. Conclusion: This study shows a significant advantage of the non-pharmacological method over the pharmacological method. Hence further research could help standardize ice application pre-injection for a more nontoxic and natural method of reducing pain during an LA injection. It can also prove beneficial when LA does not work due to an acidic environment.

Premier HealthCare, a member of the YAI Network, specializes in outpatient healthcare services (such as primary care, dentistry, psychiatry, rehabilitation, psychotherapy, psychological testing, and nutrition) for people with intellectual and developmental disabilities in New York City. This is one of the most in need, yet underserved, groups of medical and dental patients. Many people with autism spectrum disorder (ASD) have difficulty understanding the significance of healthcare procedures and become overwhelmed by the unfamiliar environment and sensory input of medical and dental practices. They may also have difficulty with communication and socialization, which can exacerbate anxiety and challenging behaviors such as self-stimulation, self-injury, aggression, and tantrums. Additionally, this heightened level of stress can potentially translate into disruptive behaviors or physical reactions to avoid treatment. These challenges combined with a lack of healthcare professionals trained and experienced in working with people with ASD can result in ineffective preventative care and high-cost procedures. At Premier HealthCare, a desensitization program was initiated to increase functional participation in medical and dental exams and decrease use of physical restraints or general anesthesia for people with ASD. An interdisciplinary team of occupational therapists, behavior analysts, doctors, nurses, and dentists collaborate to address how to make medical and dental procedures more tolerable for patients with special needs using a protocol comprising of four main stages: evaluation, treatment, generalization, and maintenance. They work with caregivers to provide person-centered individualized care, ultimately leading to decreased anxiety, fear, and aggressive behaviors; increased participation; and better health outcomes for people with autism.

Minority youth, because of structural, ecological, and societal inequalities, are at heightened risk of reporting depression and experiencing negative sanctions associated with delinquency. Sociological theories suggest that greater exposure to ecological risk factors at the peer, family, school and community levels are associated with elevated rates of youth depression and delinquency. Desensitization theory posits that repeated exposures to ongoing stressors result in a numbing of psychological and behavioral responses. Thus, it remains unclear whether racial/ethnic differences exist with regards to how contextual stressors correlate with depression and delinquency. Using a sample of 616 Black, 687 Latinx, and 1,318 White youth, this study explores racial/ethnic differences across four ecological risk factors of risky peers, low family warmth, poor school engagement, and community violence as they relate to youth delinquency and depression. Data were collected through in-school survey of youth from 16 public schools surrounding a major city in the Midwest. Significant racial/ethnic differences provided partial support for the desensitization theory. Among Black youth, the magnitude of relationships between ecological risk factors and delinquency was significantly weaker for three of the four predictors and for all four predictors of depression in comparison to White youth. Among Latinx youth, the magnitude of relationships between ecological risk factors was significantly weaker for depression, but not delinquency, in comparison to White youth. Results indicate that ecological risk factors may have differential associations to youth depression and delinquency, which may call for culturally tailored intervention approaches.

The fear of the dentist, dental anxiety and dental phobia continue to concern the medical world, seeking to elucidate the causes, calculate the prevalence and its implications on the oral health of the population, as well as identify the most effective methods to combat it. The survey included 208 patients, who were treated and investigated, in the period 2018-2019. The questionnaire consisted of 15 questions, structured in 3 sections: socio-demographic data, oral hygiene habits and past experience, during dental treatment, with analysis of dental anxiety, using modified MDAS. The mean value of MDAS in the study group was 11.7 ± 4. Most of the respondents (80%) had medium or low dental anxiety. High levels of anxiety were observed in 20% of patients, including 12% with dental phobia. A statistically significant correlation was found between the mean values of the MDAS and sex (p = 0.030), age (p

An online questionnaire survey investigated (1) management and (2) treatment methods for firework fears in dogs employed by dog owners and their (perceived) effectiveness. A PCA on data from 1225 respondents revealed four management strategies (i.e. interventions during firework exposure): the principal components “Environmental modification” (e.g. providing a hiding place, keeping windows and blinds closed, and playing music), “Feed/Play” (providing the dog with chews, play and food during fireworks in general, as well as contingent on loud bangs), “Alternative” (use of calming nutraceuticals, pheromones, herbal products, homeopathic products, Bach flowers, and essential oils) and “Interaction” (allowing body contact, petting and talking to the dog when loud bangs occurred). To explore possible effects of these management methods on fear development, the components were correlated with a score for fear progression. Of the four components, only “Feed/Play” was statistically associated with an improvement in fear responses to fireworks. To evaluate the effectiveness of various treatment strategies, owners were asked to select from a range of options which interventions they had used and whether they considered them as effective. With prescription medication (N=202), improvements were noted by 69% of owners, with high success rates reported for the most frequently prescribed drugs, alprazolam (91%) and Sileo® (74%). While individual products were not evaluated, the reported success rates for the categories “pheromones” (N=316), “herbal products” (N=282), “nutraceuticals” (N=211), “essential oils” (N=183), “homeopathic remedies” (N=250) and “Bach flowers” (N=281) were all in the range of 27-35%, which is not higher than would be expected based on a placebo effect. Pressure vests were deemed as effective by 44% of respondents (N=300). Counterconditioning (providing desirable stimuli after the occurrence of noises) was the most successful training technique according to the owners (N=694), with a reported effectiveness of over 70%. Relaxation training (N=433) was reported to be almost as successful at 69%, while noise CDs (N=377) were effective in 55% of cases. Thus, counterconditioning, relaxation training and anxiolytic medication appear to be the most effective strategies in the treatment of firework fears in dogs. On this basis it is recommended that ad-hoc counterconditioning and relaxation training should complement the standard behavioral technique of desensitization/ counterconditioning with noise recordings.HighlightsAn online survey on treatment options for firework fears in dogs was performedFeeding or playing with dogs during fireworks was associated with fear improvementSuccess was highest for ad-hoc counterconditioning, relaxation training and medicationSuccess was similar for pheromones, nutraceuticals and other alternative productsSuccess rates for these alternative products are consistent with a placebo effect

This research investigated the desensitization signs shown by the Lebanese audience to the violence portrayed on Game of Thrones and Breaking Bad. The research’s study was a qualitative case study of the theory of desensitization applied on two Lebanese participants, each watching respectively the series Breaking Bad and Game of Thrones. The participants were chosen based on the fact that one had never watched Breaking Bad and the second had never watched Game of Thrones. The participants were interviewed pre-series, and then throughout the exposure to several episodes. The descriptive experiment led to the results that after repeated exposure to Game of Thrones and Breaking Bad, the Lebanese viewer, even if already tolerant to on-screen violence, showed desensitization signs to the violence, drugs, incest and rape portrayed on-screen in the two series. Key words: Television series, desensitization, Lebanese audience.

Purpose of the study: This paper is a study on the novel A Clockwork Orange by Anthony Burgess. It is an analysis of Alex’s psychological condition and a study on the Ludovico experiment in relation to other popular experiments in psychology. The paper brings to light the dark and evil side of adolescence. Methodology: This study uses a psychological approach in analyzing the character of the protagonist Alex. Various psychological theories are applied in this paper to interpret this novel. Main Findings: Examining Alex’s depiction in the novel, he is presumed as a sociopath with a narcissistic personality disorder. The Ludovico experiment which stole the limelight in this novel is a behavioral modification technique, powered by negative reinforcement. Despite being a fictional experiment and a product of Burgess’s imagination, the Ludovico experiment is stemmed out of Ivan Pavlov’s classical conditioning. This experiment also complements Watson and Rayner’s ‘Little Albert’ experiment. The termination of Alex’s free will by the Ludovico experiment is reversed by the flooding method of desensitization. Applications of this study: The novel, A Clockwork Orange is brimming with psychological theories, hence a fascinating book to the psychologists. The protagonist Alex, continues to remain as a case-study amongst the scholars of psychology. Novelty/Originality of this study: The final chapter in the novel has various interpretations. The reversal of Alex’s condition is caused by the flooding method of desensitization. While the cause of reversal holds varied comprehension, the flooding method seems like the fitting one.

Hoppers respond not only to stimuli from the ground surfaces but also to cues generated by their own behaviors. This leads to desensitization because although the afferent and reafferent signals have distinct causes, they are carried by the same sensory channels. From a behavioral viewpoint, it may be necessary to distinguish between signals from the two causes especially when monitoring changes in the external environment separate from those due to self-movement. We were able to separate afferent sensory stimuli from self-generated, reafferent signals using an action-oriented perception system and dynamic programming approach. This effort addressed the question of how the nerve system selects which particular degree of freedom (DOF) to cancel reafferent input. We have proposed an internal one-DOF model characterizing the motor control system during hopping, allowing the generation of an estimated ground reaction signal to drive natural shock absorption of the leg.

Previous research showed mixed evidence on how violent video game exposure (VVGE) may affect empathy for pain in the brain. This study applied an event-related potential (ERPs) approach to improve understanding of how habitual and short-term violent game play may affect top-down and bottom-up empathy for pain brain responses. A total of 58 male participants with different levels of habitual VVGE performed a pain judgment task before and after 40 min of violent game play while their brain responses were recorded. Results showed that only late cognitive-evaluative ERP responses (P3, P625) were sensitive to the pictures’ painfulness, which were also affected by both habitual VVGE and short- term violent game play. As expected, participants with no habitual VVGE showed an ERP pain effect before game play: higher P3 and P625 amplitudes for painful versus nonpainful pictures. In contrast, a similar ERP pain effect was not observed in participants with high VVGE before game play, suggesting habitual desensitization. Short-term violent game play resulted in lower P3 and P625 amplitudes for painful pictures in the no VVGE group, indicating short-term desensitization. We discuss the observed VVGE desensitization effects in terms of top-down regulation of an empathetic response induced by painful stimuli. Though such adaptation could be beneficial in a violent game environment, possible long-term consequences associated with reduced empathic responsiveness in a social context should be further studied. In all, our findings contribute to the debate on the effects of VVGE on the brain by pro- viding first ERP evidence suggesting empathy for pain desensitization.

Children with autism spectrum disorders (ASD) are at risk for oral health disparities. With the dramatic rise in ASD prevalence to 1 in 54 children, it is likely that an increasing number of dental practitioners will encounter or be asked to treat children with ASD. This paper reviews explanations related to the increasing prevalence of ASD, provides reasons why children with ASD are at increased risk for poor oral health, and discusses unique interprofessional collaborations between dental practitioners and occupational therapists. Occupational therapists and dentists can work together to plan modifications to the dental environment or adapt dental protocols to reduce some of the barriers encountered by those with ASD, provide desensitization strategies before the clinic visit, or help a child with emotional regulation during clinical treatments.

Background and objectivesFor many psychotherapies, like Eye Movement and Desensitization Reprocessing (EMDR) therapy, there is an ongoing discussion about the role of specific versus non-specific mechanisms in their effectiveness However, experimental research directly examining the potential role of non-specific mechanisms is scarce. Here, we address the role of a non-specific factor that is often put forward for EMDR, namely treatment effectiveness expectations, within a laboratory model of EMDR therapy.MethodsIn a lab-based (N = 96) and an online experiment (N = 173), we gave participants verbal instructions to manipulate their treatment expectations. Instructions emphasized EMDR's effectiveness or ineffectiveness. Then, participants were asked to recollect an unpleasant autobiographical memory with or without making eye-movements.ResultsIn line with previous studies, we found significant reductions of reported vividness and emotionality of negative autobiographical memories in the eye-movements condition. These reductions did not differ between the verbal suggestions conditions in both experiments, suggesting a limited effect of treatment effectiveness suggestions.LimitationsTreatment effectiveness expectations were not successfully manipulated by the suggestions manipulation. This suggests that treatment expectations may be more difficult to influence than anticipated, thus limiting the interpretation of our findings.ConclusionsThese findings tentatively corroborate the results of two earlier reports, suggesting that the effects of verbal suggestions about treatment effectiveness in a laboratory model of EMDR therapy may be limited.

Multi-modal Motion-assisted Memory Desensitization and Reprocessing Therapy (3MDR), an interactive, virtual-reality assisted, exposure-based intervention for PTSD, has shown promising results for treatment-resistant Posttraumatic Stress Disorder (TR-PTSD) among military members (MMs) and Veterans in Randomized Controlled Trials. Previous research has suggested that emotional regulation (ER) and emotional dysregulation (ED) may be factors which are correlated with symptom severity and maintenance of TR-PTSD. This embedded mixed-methods pilot study (n=9) sought to explore the impact of 3MDR on ER and ED of MMs and Veterans. Difficulties in Emotional Regulation Scale (DERS-18) data was collected at baseline, prior to each session, and at 1 week, 1 month and 3 months post-intervention and analyzed using a Wilcoxon signed-ranks test. Qualitative data collected from sessions, debriefs, and follow-up interviews were transcribed and descriptively analyzed. Results demonstrated statistically significant decreases in DERS-18 scores from pre-intervention to post-intervention at each timepoint. Qualitatively, participants perceived improvements in ER within specified DERS-18 domains. We describe how 3MDR’s unique and novel approach may address ED through cognitive-motor stimulation, narration, divergent thinking, reappraisal of aversive stimuli, dual-task processing, and reconsolidation of traumatic memories. Further investigation is underway to better understand the underlying neurobiological mechanisms by which 3MDR addresses ER and PTSD.

Exposure to different tones of movie violence has been shown to affect viewers in different ways. Particularly, exposure to violence designed to evoke a comedic reaction may cause an overall desensitization to violence, more so than violence of a serious nature. There is a significant gap in current literature regarding analysis of the nature of different tones of movie violence. This study seeks to explore said gap, particularly with regards to PG-13 rated movies. Eight PG-13 rated films were randomly selected from 1984 to 2019 and through a mixed-method approach, were each subjected to a content analysis. All eight of the films contained at least one instance of comedic violence, but the presence of serious violence was significantly more prevalent. Instances of comedic violence were all supported through stylistic and theoretical indications of comedy. This study finds that some of the most highly viewed films engage in the practice of making violence humorous, which has been found to have a negative effect on viewers. Future research should apply the method developed for this study on a broader scale and to different genres of film.

The purpose of this study is to analyze the manner in which, during an authoritarian civic-military regime in the late seventies in Chile, the State discursively generates a specific emotion – fear-- in functional contexts that allow the development of a global economic transformation project of the society -neoliberalism- on the basis of assumptions of the National Security Doctrine. Based on derivative fears of long and close emotional standing, desensitization and non-sense ideologies are activated breaking the structure of the previous sense of community.

This paper develops a mathematical model describing the potential buildup of high oxytocin concentrations in the maternal circulation during labor in terms of continuous Pitocin infusion rate, half-life and maternal weight. Oxytocin override of the degradation of oxytocin by placental oxytocinase is introduced to model the potential transfer of oxytocin from the maternal circulation across the placenta into the fetal circulation, and from there into the brain of the fetus. The desensitization unit D equal to 1.8E6 (pg-min)/ml is employed to establish a desensitization threshold, and by extension; a down-regulation threshold as a function of oxytocin override concentration and continuous Pitocin infusion time, that could be a factor in the subsequent development of autism among offspring. Epidemiological studies by Duke University (S.G. Gregory, 2013), Yale University (O. Weisman, 2015) and Harvard University (A.S. Oberg, 2016) are discussed regarding Pitocin use and offspring autism development for an explanation of the weak correlations they identified. The findings of the Harvard epidemiological study are re-interpreted regarding Pitocin use, and its conclusion questioned. Further evaluations of the findings of these three epidemiological studies are called for to incorporate medical information on quantity of Pitocin used, continuous Pitocin infusion rate, length of labor and maternal weight to determine if a correlation can be established with offspring autism development above an empirically determined desensitization threshold for Pitocin use. Suggestions for research are discussed, including an alternative to continuous Pitocin infusion, pulsatile infusion of Pitocin during labor induction, that may mitigate possible offspring autism development.HIGHLIGHTSBuildup of oxytocin (OT) in the maternal circulation mathematically modeled.Relationship of OT half-life and OT concentration in maternal circulation identified.OTR Desensitization related to Pitocin infusion time and OT override concentration.Weak correlations for autism development in epidemiological studies explained.Examination called for of medical records of Pitocin use in epidemiological studies.OUTLINE OF PAPERIntroductionDevelopment and application of mathematical model – Sections 1 through 6, notably: Figures 1 through 4Discussion of oxytocin receptor desensitization as it pertains to mathematical model – Sections 7 and 8Influence of mathematical model on interpretation of epidemiological studies – Sections 9 and 10Research considerations – Section 11, notably:Subsection 11.1 – Call for detailed epidemiological analysis of selected medical information indicated by mathematical model Subsection 11.2 – Review of pulsatile Pitocin infusion to mitigate possible offspring autism development indicated by mathematical model

The potential for the development of psychopathology in aolescent refugees and asylees is high due to the trauma inherent in their experience. Yet, psychopathology rooted in trauma has proven amenable to treatment. Nonetheless, as most clinicians are monolingual, the language difference between clinician and client may be a barrier of desensitization and processing typically characteristic of trauma therapy. Thus, this study aimed to describe qualitative differences in speech production among native and non-native narratives using Linguistic Inquiry and Word Count (LIWC) processing software (Pennebaker et al. 2015) to understand if the current best practice will function similarly in these populations. We compared 10 adolescent immigrants (50% male) who narrated events that provoked their migration to the U.S. in their second language (L2; i.e., English) to 10 age- and gender-matched adolescents narrating in their first language (L1; i.e., Spanish). Results revealed L1 narratives were significantly higher in their use of/talk about anger, cognitive processes, discrepancy, tentativeness, perceptual processes, ingestion, relativity, time, work, and home. L2 narratives were higher in their use of/talk about positive emotions, death, causation, health, motion, space, and fillers. Findings have implications for the efficacy of treatments using discourse to ameliorate symptoms related to trauma in non-native languages. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40653-019-00263-3) contains supplementary material, which is available to authorized users.

Introduction: Desensitization to violence is the result of exposure to violence. It reduces the negative emotions in cognitive and physiological responses to violence and can even generate a positive response to it.Method: A mixed sequential method yielding a transactional analytic design for Exploratory Factor Analysis and Confirmatory Factor Analysis with a sample of 1720 participants of 25 different high schools and a juvenile detention center. Followed by convergent validity (as a criterion validity) with a different sample.Results: The EFA’s cumulative explained variance was 52% with a GFI of .98 with a three-factor model: sensitivity to violence, amusement with physical violence, and enjoyment of psychological violence. The CFA showed scores above .50 in Average Explained Variance in every factor, and an ideal model fit in every measure (CFI, AGFI, RMSEA, SRMR, and ECVI). The remaining factors are only those related with enjoying or amusement with violent behavior, indicating that the desensitization to violence is related not only with the normalization and legitimation of violence, but the increasing of the performance and amusement of it.Discussion or Conclusion: The scale of desensitization to violence for adolescents has adequate psychometric properties and can be a valuable instrument to generate intervention or prevention programs, especially for its intimate relationship with high scores in people interned because of their criminal behavior.

Objective To assess the influence of clinical, psychological, and psychophysical variables on long-term clinical outcomes after the application of either physical therapy or surgery in women presenting with carpal tunnel syndrome (CTS). Methods A secondary analysis of a randomized trial investigating the efficacy of manual therapy including desensitization maneuvers of the central nervous system against surgery in 120 women with CTS was performed. Clinical outcomes including pain intensity, function, or symptom severity were assessed at 6 and 12 months post-intervention. Participants completed at baseline several clinical (pain intensity, function, and symptom severity), psychological (depression), and psychophysical (pressure pain thresholds and pain extent) variables, which were included as predictors. Multiple regression analyses were conducted to assess the relationship between baseline variables and clinical outcomes at 6 and 12 months post-intervention. Results The regression models indicated that higher scores of each clinical outcome (ie, intensity of pain or symptom severity) at baseline predicted better outcomes at 6 and 12 months post-intervention (from 15% to 65% of variance) in both groups. Lower pressure pain thresholds over the carpal tunnel at baseline predicted poorer clinical outcomes at 6 and 12 months post-intervention (from 5% to 20% of variance) in the physical therapy group, whereas higher depressive symptoms at baseline contributed to poorer outcomes at 6 and 12 months post-intervention (from 5% to 15% of the variance) within the surgery group. Conclusion This study found that baseline localized pressure pain sensitivity and depression were predictive of long-term clinical outcomes in women with CTS following physical therapy or surgery, respectively.

We study desensitization to crime in a lab experiment by showing footage of criminal acts to a group of subjects, some of whom have been previously victimized. We measure biological markers of stress and behavioral indices of cognitive control before and after treated participants watch a series of real, crime-related videos (while the control group watches non-crime-related videos). Not previously victimized participants exposed to the treatment video show significant changes in cortisol level, heart rate, and measures of cognitive control. Instead, previously victimized individuals who are exposed to the treatment video show biological markers and cognitive performance comparable to those measured in individuals exposed to the control video. These results suggest a phenomenon of desensitization or habituation of victims to crime exposure. Fil: Di Tella, Rafael. Harvard Business School; Fil: Freira, Lucía. Universidad Torcuato di Tella; Argentina Fil: Gálvez, Ramiro Heraclio. Universidad Torcuato di Tella; Argentina Fil: Schargrodsky, Ernesto Santiago. Universidad Torcuato di Tella; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Física de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Física de Buenos Aires; Argentina Fil: Shalom, Diego. Universidad Torcuato di Tella; Argentina Fil: Sigman, Mariano. Universidad Torcuato di Tella; Argentina

Many conventional antidepressants can quickly raise the levels of extracellular serotonin, yet their positive effects on mood ensues only weeks later. This delay in efficacy is a clinical problem that has proven difficult to overcome. Early investigation noted that the initial increases in extracellular serotonin engaged strong feedback inhibition of serotonin neurons via 5-HT(1A) autoreceptors, resulting in a profound reduction in their firing rate. Over the course of chronic treatment, however, firing rate returned to normal and the inhibition via 5-HT(1A) receptor agonists was attenuated. The coincident timeline of these phenomena led to the influential hypothesis that the relationship was causal and that gradual loss of feedback inhibition mediated by 5-HT(1A) receptors was critical to the delayed therapeutic onset. Simple and appealing, the desensitization hypothesis has taken strong hold, yet much of the supporting evidence is circumstantial and there are several observations that would refute a causal relationship. In particular, even though 5-HT(1A) receptors may desensitize, there is evidence that feedback inhibition mediated by remaining receptors persists. That is, baseline serotonin firing rate returns to normal not because of 5-HT(1A) desensitization but rather despite ongoing feedback inhibition. Thus, while 5-HT(1A) receptors remain important for emotional behavior, it may be other slow-adaptive changes triggered by antidepressants that allow for therapeutic effects, such as those involving glutamatergic synaptic plasticity.

A psychotherapeutic regimen that uses alternating bilateral sensory stimulation (ABS) has been used to treat post-traumatic stress disorder. However, the neural basis that underlies the long-lasting effect of this treatment—described as eye movement desensitization and reprocessing—has not been identified. Here we describe a neuronal pathway driven by the superior colliculus (SC) that mediates persistent attenuation of fear. We successfully induced a lasting reduction in fear in mice by pairing visual ABS with conditioned stimuli during fear extinction. Among the types of visual stimulation tested, ABS provided the strongest fear-reducing effect and yielded sustained increases in the activities of the SC and mediodorsal thalamus (MD). Optogenetic manipulation revealed that the SC–MD circuit was necessary and sufficient to prevent the return of fear. ABS suppressed the activity of fear-encoding cells and stabilized inhibitory neurotransmission in the basolateral amygdala through a feedforward inhibitory circuit from the MD. Together, these results reveal the neural circuit that underlies an effective strategy for sustainably attenuating traumatic memories. Bilateral sensory stimulation, which is used to treat post-traumatic stress disorder in humans, alleviates fear memory in mice through a circuit involving the superior colliculus and the medial thalamus.

Blood group and tissue incompatibilities remain significant barriers to achieving transplantation. Although no patient should be labeled “un-transplantable” due to blood group or tissue incompatibility, all candidates should be provided with individualized and realistic counseling regarding their anticipated wait times for deceased donor or kidney paired donation matching, with early referral to expert centers for desensitization when needed. Vital is the careful selection of patients whose health status is such that desensitizing treatment is less likely to cause serious harm and whose anti-HLA antibody status is such that treatment is likely to accomplish the goal of increasing organ offers with an acceptable final crossmatch. Exciting new developments have re-energized the interest and scope of desensitization in the times ahead.

Patients exhibiting high percent calculated panel reactive antibodies (cPRA) have limited access to transplantation. A sliding scale prioritization scheme was introduced to the allocation system in December of 2014 to particularly support patients with a cPRA ≥98. While many highly sensitized patients benefited from the change, patients with cPRA >99.9 remain disadvantaged and may benefit from desensitization1 . Other highly sensitized patients with an HLA incompatible living donor may also benefit from combining kidney paired donation and desensitization. Thus far, several desensitization approaches have been reported, with equivocal results.

Whiplash injuries are a global health problem and a significant financial burden for both health care systems, and for insurance providers. The diverse symptomatology after whiplash injury both in the somatic, emotional and behavioral sphere prompted separation of the Whiplash Associated Disorders (WAD) as a separate category of diseases. The exact mechanism of whiplash injury is still under debate and theories explaining pathogenesis of WAD are very diverse ranging from purely biomechanical to neurophysiological, emphasizing central sensitization but the core disability seems to be strictly connected to somatosensory dysfunction. As a result, the optimal algorithm of rehabilitation has not been established and data published in the current literature on effectiveness of such algorithms are inconsistent. Based on the prsesnted here of Head Neutral Reference Point (HNRP), the objective of central desensitization is to restore valid somatosensory output from Cranio - cervical Junction (CCJ). This new concept of rehabilitation after whiplash presented here is based on clinical observations and is supported by initial results.

The significant role of serotonin (5-hydroxytryptamine [5-HT]) in the pathogenesis and early development of schizophrenia has been established by contemporary research through the assessment of structural and pharmacological neuroimaging, blood metabolites, cerebrospinal fluid, genome polymorphisms, and other valid indicators of abnormal serotonergic activity in prodromal, ultra-high-risk, and schizophrenic patient groups. A modern approach toward understanding the complex psychophysiology behind schizophrenia will be outlined through the demonstration of 5-HT1A and 5-HT2A receptors as key modulators within the spectrum of negative symptoms associated with schizoaffective disorders, including a variety of disturbances in cognition, behavior, mood, social function, perception of reality, and hormonal response to stressors. This paper will review the evidence for attributing the risk of schizophrenia onset to early defects in serotonergic neurotransmission and explore the perspective of selective serotonin receptor inhibitor (SSRI) pharmacotherapy as a method of treatment and intervention for prodromal and ultra-high-risk patients by increasing 5-HT1A receptor sensitivity levels and modifying the transcription of 5-HT1A receptor-associated gene expression in these groups.

An ability to accurately recognize negative emotions in others can initiate pro-social behavior and prevent anti-social actions. Thus, it remains of an interest of scholars studying effects of violent video games. While exposure to such games was linked to slower emotion recognition, the evidence regarding accuracy of emotion recognition among players of violent games is weak and inconsistent. The present research investigated the relationship between violent video game exposure (VVGE) and accuracy of negative emotion recognition. We assessed the level of self-reported VVGE in hours per day and the accuracy of the recognition using the Facial Expressions Matching Test. The results, with adolescents (Study 1; N = 67) and with adults (Study 2; N = 151), showed that VVGE was negatively related to accurate recognition of negative emotion expressions, even if controlled for age, gender, and trait empathy, but no causal direction could be assessed. In line with the violent media desensitization model, our findings suggest that higher self-reported VVGE relates to lower recognition of negative emotional expressions of other people. On the one hand, such lower recognition of negative emotions may underlie inaccurate reactions in real-life social situations. On the other hand, lower sensitivity to social cues may help players to better focus on their performance in a violent game.

How animals respond to repeatedly applied stimuli, and how animals respond to mechanical stimuli in particular, are important questions in behavioral neuroscience. We study adaptation to repeated mechanical agitation using theDrosophilalarva. Vertical vibration stimuli elicit a discrete set of responses in crawling larvae: continuation, pause, turn, and reversal. Through high-throughput larva tracking, we characterize how the likelihood of each response depends on vibration intensity and on the timing of repeated vibration pulses. By examining transitions between behavioral states at the population and individual levels, we investigate how the animals habituate to the stimulus patterns. We identify time constants associated with desensitization to prolonged vibration, with re-sensitization during removal of a stimulus, and additional layers of habituation that operate in the overall response. Known memory-deficient mutants exhibit distinct behavior profiles and habituation time constants. An analogous simple electrical circuit suggests possible neural and molecular processes behind adaptive behavior.

On the basis of converging research, we concluded that the controversial topic of unconscious blockage of psychological trauma (i.e., repressed memory) remains very much alive in clinical, legal, and academic contexts. In his commentary, Brewin (this issue, p. 443) conducted a cocitation analysis and concluded that scholars do not adhere to the concept of unconscious repression. Furthermore, he argued that previous survey research did not specifically assess unconscious repression. Here, we present critical evidence that runs counter to his claims. First, we inspected his cocitation analysis and found that some scholars support notions that are closely related to unconscious repression. Furthermore, we conducted another analysis on the basis of articles' similarity. Again, we found examples of scholars specifically endorsing unconscious repressed memories. Second, as opposed to what Brewin reports, recent survey research now exists that bears directly on people's beliefs regarding unconscious repression. This work reveals that large percentages of people (e.g., students and eye-movement desensitization and reprocessing [EMDR] clinicians) endorse the concept of unconscious repressed memories. The belief in unconscious repressed memory can continue to contribute to harmful consequences in clinical, legal, and academic domains (e.g., false accusations of abuse). ispartof: PERSPECTIVES ON PSYCHOLOGICAL SCIENCE vol:16 issue:2 pages:454-460 ispartof: location:United States status: published

Food allergies are common and affect 6‐8% of children in the United States; they pose a significant burden on the quality of life of children with allergy and their caregivers due to multiple daily restrictions. Despite the recommended dietary avoidance, reactions tend to occur due to unintentional exposure to the allergenic food trigger. Fear of accidental ingestions with potentially severe reactions, including anaphylaxis and death, creates anxiety in individuals with food allergy. Oral immunotherapy has emerged as a form of active and potentially disease-modifying treatment for common food allergies encountered in childhood. The efficacy of oral immunotherapy is high, with the majority of participants achieving desensitization and, as a result, protection from trace exposures and improved quality of life. The main risk of oral immunotherapy consists of allergic reactions to treatment. In general, rates of allergic reactions and anaphylaxis are reported to be higher in individuals pursuing therapy options, but most subjects who undergo oral immunotherapy will likely experience mild or moderate reactions during treatment. Adverse events tend to reduce in both frequency and number in the maintenance period. The use of immune modulators alongside oral immunotherapy has been suggested, with the aim to improve efficacy and safety, and to facilitate the overall process. It is evident that the landscape of food allergy management is changing and that the future looks brighter, with different options emerging over time. The process of how to choose the appropriate option becomes a discussion between the clinician and the patient, which involves a joint review of the current medical evidence but also the patient's preference for balancing particular attributes of the treatment. By working together, providers and patients will ensure achievement of the best possible outcome for children with food allergies.

[Figure][1] Tuning out COVID-19? Even health workers may struggle with pandemic “message fatigue.” Image copyright [iStock.com/NicolasMcComber][2]. No standalone file use permitted. As the pandemic wears on, some experts caution that growing desensitization to public health messages

Food allergies are common, affecting 6–8% of the children in the United States. There is a significant burden on the quality of life of allergic children and their caregivers, due to multiple dietary, social and psychological restrictions. Peanut allergy affects approximately 2–5% of the school-age children. Despite the recommended dietary avoidance, reactions tend to occur due to unintentional exposures and the fear of accidental ingestions potentially resulting in anaphylaxis and death, which creates a lot of anxiety in peanut-allergic individuals. Peanut oral immunotherapy (POIT) has emerged as a form of active treatment and has shown high efficacy in research trials with the majority of participants achieving desensitization and protection from trace exposures. An improved quality of life has also been noted following successful POIT. The risks of POIT should be balanced against the benefits resulting from successful treatment for each individual. Rates of allergic reactions and anaphylaxis are reported to be higher in individuals pursuing therapy, but most subjects will experience mild or moderate reactions during treatment. The landscape of peanut allergy management is changing and the future offers more options for patients than were previously available. Shared decision-making, which is the process of how to choose between different available options, becomes an ongoing discussion between the clinician and the patient, which will ensure achievement of the best possible outcome for the peanut-allergic child. This is a multistep process that evaluates the benefits and risks of therapy or no therapy, as well as patient and family preferences and we review it in detail in this manuscript with the aim to provide clinicians with a practical approach.