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Objectives: Nonpharmacologic pain management strategies are needed because of the growing opioid epidemic. While studies have examined the efficacy of virtual reality (VR) for pain reduction, there is little research in adult inpatient settings, and no studies comparing the relative efficacy of standard animated computer-generated imagery (CGI) VR to Video Capture VR (360 degrees 3D/stereoscopic Video Capture VR). Here, we report on a randomized controlled trial of the relative efficacy of standard CGI VR versus Video Capture VR (matched for content) and also compared the overall efficacy of VR to a waitlist control group., Materials and Methods: Participants (N=103 hospitalized inpatients reporting pain) were randomized to 1 of 3 conditions: (1) waitlist control, (2) CGI VR, or (3) Video Capture VR. The VR and waitlist conditions were 10 minutes in length. Outcomes were assessed pretreatment, post-treatment, and after a brief follow-up., Results: Consistent with hypotheses, both VR conditions reduced pain significantly more relative to the waitlist control condition (d=1.60, P<0.001) and pain reductions were largely maintained at the brief follow-up assessment. Both VR conditions reduced pain by ∼50% and led to improvements in mood, anxiety, and relaxation. Contrary to prediction, the Video Capture VR condition was not significantly more effective at reducing pain relative to the CGI VR condition (d=0.25, P=0.216). However, as expected, patients randomized to the Video Capture VR rated their experience as more positive and realistic (d=0.78, P=0.002)., Discussion: Video Capture VR was as effective as CGI VR for pain reduction and was rated as more realistic., Competing Interests: This research was graciously funded by a University of Texas at Austin “Lift” grant (Austin, TX). M.B.P. reports grants from the National Institutes of Health (Bethesda, MD), Defense Advanced Research Projects Agency (Arlington County, VA), Department of Defense, National Institute on Disability Independent Living Rehabilitation and Research (Washington, DC), and book royalties from Oxford University Press (Oxford, UK) and Academic Press (Cambridge, MA). J.A.J.S. reports grants from the Cancer Prevention and Research Institute of Texas (Austin, TX) and National Institute on Drug Abuse (Bethesda, MD) and personal fees from Big Health Ltd. (San Francisco, CA), Aptinyx (Evanston, IL), Elsevier (Amsterdam, Netherlands), and the American Psychological Association (Worcester, MA), Oxford University Press (Oxford, UK). M.W.O. is a paid speaker and is further compensated as an Advisory Board member for Big Health (San Francisco, CA). The other authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Depression is a highly heterogeneous disorder, and meta-analyses of mindfulness-based interventions show moderate efficacy for reducing depressive symptoms. However, the mechanisms governing their efficacy remain unclear, highlighting the need for hypothesis-generating analyses to guide future research., Methods: We used Bayesian network analysis in three cross-sectional samples (N  = 1135) of undergraduates and participants from the community to identify links between individual symptoms of depression and specific facets of mindfulness. In two exploratory studies, we assessed depression using the Patient Health Questionnaire ( n  = 384) or the Depression Anxiety and Stress Scale ( n  = 350) and mindfulness using the Five-Facet Mindfulness Scale., Results: Across these samples and measures, exploratory analyses indicated that non-judging was a central bridge between facets of mindfulness and symptoms of depression. We confirmed this finding in a pre-registered replication ( n  = 401) using a recently developed confirmatory testing framework for network analysis. Non-judging was consistently a central bridge in the networks and specifically linked to the symptoms of depression related to feelings of failure and worthlessness., Conclusions: These findings provide strong evidence that non-judging is an essential feature of mindfulness in the context of depression and provides direction for future research testing mindfulness-oriented treatment prescriptions for depression., Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-021-01726-1., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)

Objective: Previous research has shown that first responders exhibit elevated rates of psychopathology. Factors predicting the development of this psychopathology, however, remain understudied. This study longitudinally examined predictors of posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in first responders. Method: Participants included 135 emergency medical service (EMS) providers. Multiple linear regressions were used to model predictors of change in PTSD, depression, and anxiety symptomatology from baseline to 3-month follow-up. Baseline levels of social support, sleep, emotional stability, and perceived stress were examined as potential predictors. Results: Results revealed that (a) increases in PTSD symptoms, (b) increases in depression symptoms, and (c) increases in anxiety symptoms at 3-month follow-up were each predicted by worse sleep and lower social support at baseline. In particular, the sleep subscale of disturbed sleep and the social support subscale of appraisal appeared to be driving these effects. Conclusion: These results highlight the importance of social support and sleep hygiene in protecting against increases in psychopathology symptoms in EMS providers, and set the stage for future interventions to target sleep disturbances and encourage deeper social connections in order to foster resilience in first responders. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: Numerous studies have shown that level of exposure to combat-related stressors is a robust risk factor for posttraumatic stress disorder (PTSD) and depression among military personnel deployed to a warzone. Threat perception of warzone experiences assessed retrospectively has been consistently linked to increased risk for PTSD and depression months or even years after returning from deployment. However, little is known about concurrent relations between perceived threat, deployment stress, and stress-related symptoms during deployment. Using a novel in-theater web-based assessment system, we investigated the unique and joint contribution of threat perception and deployment stressors in predicting the emergence of PTSD and depression symptoms during deployment., Method: Soldiers (N = 150) completed assessments of deployment stressors, perceived threat, PTSD symptoms, and depression symptoms throughout deployment to Iraq., Results: Results revealed that perceived threat potentiated the increase in PTSD symptoms as a result of increases in deployment stressors. In contrast, perceived threat, but not warzone stressors, uniquely predicted depression symptoms., Conclusions: Results highlight the important role of threat perception as a risk marker for the acute experience of depression and PTSD symptoms during deployment. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Exposure to war zone stressors is common, yet only a minority of soldiers experience clinically meaningful disturbance in psychological function. Identification of biomarkers that predict vulnerability to war zone stressors is critical for developing more effective treatment and prevention strategies not only in soldiers but also in civilians who are exposed to trauma. We investigated the role of the serotonin transporter linked polymorphic region (5-HTTLPR) genotype in predicting the emergence of post-traumatic stress disorder (PTSD), depressive and anxiety symptoms as a function of war zone stressors. A prospective cohort of 133 U.S. Army soldiers with no prior history of deployment to a war zone, who were scheduled to deploy to Iraq, was recruited. Multilevel regression models were used to investigate associations between 5-HTTLPR genotype, level of war zone stressors, and reported symptoms of PTSD, depression and anxiety while deployed to Iraq. Level of war zone stressors was associated with symptoms of PTSD, depression and anxiety. Consistent with its effects on stress responsiveness, 5-HTTLPR genotype moderated the relationship between level of war zone stressors and symptoms of emotional disturbance. Specifically, soldiers carrying one or two low functioning alleles (S or LG ) reported heightened symptoms of PTSD, depression and anxiety in response to increased levels of exposure to war zone stressors, relative to soldiers homozygous for the high functioning allele (LA ). These data suggest that 5-HTTLPR genotype moderates individual sensitivity to war zone stressors and the expression of emotional disturbance including PTSD symptoms. Replication of this association along with identification of other genetic moderators of risk can inform the development of biomarkers that can predict relative resilience vs. vulnerability to stress., (© 2015 World Psychiatric Association.)

Introduction: Erectile dysfunction is a highly publicized and prevalent condition with marked adverse effects on men's social, emotional, and quality of life. Although several instruments have emerged for assessing erectile dysfunction and its impact on men's quality of life, none of the existing instruments provide a specific assessment of men's erectile performance anxiety., Aim: This article reports on the development and psychometric evaluation of the Erectile Performance Anxiety Index (EPAI)--a 10-item self-report scale designed to fill an important gap in the assessment of male erectile dysfunction., Methods: A total of 207 men ranging in age from 18 to 79 took part in the study. All subjects completed an online battery consisting of the EPAI, along with measures of related sexual functioning, social anxiety, state anxiety, and depressive symptoms. A small subset of study participants (N = 42) completed the EPAI a second time for determining test-retest reliability., Main Outcome Measure: Test-retest reliability was determined by Pearson's product-moment correlations. Internal reliability was assessed using Cronbach's alpha. Factor validity was evaluated by a maximum likelihood factor analysis with oblique rotation. Convergent and discriminant validity was assessed by comparing the strength of association between the EPAI and measures varying in their hypothesized shared variance with the construct of erectile performance anxiety., Results: The EPAI demonstrated excellent internal consistency, with Cronbach's alpha = 0.93 and excellent test-retest reliability (r = 0.85) over an average period of 3.5 weeks. Results of an exploratory factor analysis revealed a one-factor solution that accounted for 63% of the total variance. Preliminary evidence supports the convergent and discriminant validity of the EPAI., Conclusion: Results support the use of the EPAI as a reliable, valid, and efficient instrument for the assessment of erectile performance anxiety. Potential research and clinical applications are discussed., (© 2013 International Society for Sexual Medicine.)

Background: Striking parallels are observed when comparing the literature on the 5-HTTLPR of the serotonin transporter gene (SLC6A4) to the testosterone (T) literature on measures of stress reactivity and neural activity. Short (S) allele carriers and individuals higher in testosterone levels show exaggerated stress responses, amygdala hyperactivity, and reduction of amygdala-prefrontal cortex coupling when exposed to threat., Methods: Three studies tested the hypothesis that higher T, S carriers would show increased cortisol responses to threat., Results: Supporting the hypothesis, a T × 5-HTTLPR interaction was obtained across all studies. Threats to status via social exclusion (Study 1), cognitive/perceptual failure (Study 2), and physical competence (Study 3) all produced elevated cortisol levels in S carriers with higher T levels. An unexpected result was that 5-HTTLPR long (L) allele homozygotes with higher T showed lower cortisol levels in response to threat-a pattern of response that closely parallels that reported for psychopathic individuals. Finally, combining effect sizes across studies showed that the likelihood that these effects were due to Type 1 errors was quite low., Conclusions: What emerges from these studies is a novel yet reliable, and synergistic relationship between 5-HTTLPR genotype and testosterone on stress reactivity, possibly conferring vulnerability for multiple neuropsychiatric disorders., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The present study investigated the influence of personality pathology assessed both dimensionally and categorically on acute clinical response to group cognitive-behavioral treatment in a large sample of panic disorder patients (N = 173) meeting DSMIII-R criteria for panic disorder with or without agoraphobia. Nearly one-third of the sample met for one or more personality disorders, with the majority meeting for a Cluster C diagnosis. Patients with one or more comorbid personality disorders displayed higher baseline and higher post treatment scores across multiple indices of panic disorder severity compared to those without personality disorders. After controlling for panic disorder severity at baseline, the presence of both Cluster C and Cluster A Pers-Ds predicted a poorer outcome, whereas when assessed dimensionally, only Cluster C symptoms predicted a poorer treatment response. However, the influence of personality pathology was modest relative to that of baseline panic disorder severity., (Copyright © 2011. Published by Elsevier Ltd.)

Research among adults has consistently shown that people holding negative self-views prefer negative over positive feedback. The present study tested the hypothesis that this preference is less robust among pre-adolescents, such that it will be mitigated by a preceding positive event. Pre-adolescents (n = 75) holding positive or negative global self-esteem were randomized to a favorable or unfavorable peer evaluation outcome. Next, preferences for positive versus negative feedback were assessed using an unobtrusive behavioral viewing time measure. As expected, results showed that after being faced with the success outcome children holding negative self-views were as likely as their peers holding positive self-views to display a significant preference for positive feedback. In contrast, children holding negative self-views displayed a stronger preference for negative feedback after being faced with the unfavorable outcome that matched their pre-existing self-views.

Research on treatments for reducing pathological worry is limited. In particular, academic worry is a common theme in generalized anxiety disorder (GAD) samples as well as non-clinical student samples. Given the high cost of anxiety disorders to society, research is needed to examine the efficacy of self-administered treatments designed to reduce pathological worry. The primary goal of this study was to investigate the benefits of three self-administered interventions for reducing academic worry. College students (N = 113) experiencing clinically significant academic worry were randomized to either: (a) worry exposure (WE); (b) expressive writing (EW); (c) relaxation consisting of pulsed audio-photic stimulation (APS); or (d) waitlist control (WLC). Participants were instructed to practice their interventions three times per week for one month and completed home practice logs online to track treatment adherence. Academic worry, general anxiety, and perceived stress were assessed at baseline and post-treatment. Academic worry and general anxiety were also assessed at a three-month follow-up. Those assigned to the WE and APS conditions showed significant improvement relative to EW and WLC at post-treatment. All treatment conditions showed continued improvement by follow-up, with no between-group differences. Treatment and public health implications are discussed., (2010 Elsevier Ltd. All rights reserved.)

We examined differences in a visual search-based latent inhibition (LI) task in 48 non-treatment seeking individuals diagnosed with obsessive-compulsive disorder (OCD) and 26 non-OCD controls, using a visual search-based LI task as a function of participants' primary obsessional presentation based on the autogenous-reactive subtype model of obsessions (Lee & Kwon, 2003; Lee & Telch, 2007). We hypothesized that LI would be significantly attenuated among OCD participants whose primary obsessions were characterized by aversive impulses, images, or thoughts with sexual, aggressive, blasphemous, and repulsive themes (autogenous obsessions) due to their weakened attentional inhibitory mechanisms and elevated schizotypal personality features, as compared with those whose primary obsessions were characterized by somewhat realistic aversive mental intrusions about contamination, mistakes, accidents, or disarray (reactive obsession) and non-OCD controls. Results showed that those primarily displaying autogenous obsessions failed to display LI, whereas those primarily displaying reactive obsessions and non-OCD controls displayed significant LI effects. Our data suggest that the magnitude of LI varies as a function of primary obsessional presentations among individuals with OCD., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Cognitive theories posit that exposure-based treatments exert their effect on social anxiety by modifying judgmental biases. The present study provides a conservative test of the relative roles of changes in judgmental biases in governing social anxiety reduction and addresses several limitations of previous research. Longitudinal, within-subjects analysis of data from 53 adults with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) social phobia diagnosis revealed that reductions in probability and cost biases accounted for significant variance in fear reduction achieved during treatment. However, whereas the reduction in probability bias resulted in fear reduction, the reduction in cost bias was merely a consequence of fear reduction. A potential implication is that exposure-based treatments for social anxiety might focus more attention on correcting faulty appraisals of social threat occurrence., (((c) 2006 APA, all rights reserved).)

We examined children's behavioral coping in response to an in vivo peer rejection manipulation. Participants (N=186) ranging between 10 and 13 years of age, played a computer game based on the television show Survivor and were randomized to either peer rejection (i.e., being voted out of the game) or non-rejection control. During a five-min. post-feedback waiting period children's use of several behavioral coping strategies was assessed. Rejection elicited a marked shift toward more negative affect, but higher levels of perceived social competence attenuated the negative mood shift. Children higher in depressive symptoms were more likely to engage in passive and avoidant coping behavior. Types of coping were largely unaffected by gender and perceived social competence. Implications are discussed.