Randomized trial estimating effects of hypnosis versus progressive muscle relaxation on medical students’test anxiety and attentional bias

BACKGROUND Test anxiety is prevalent among medical students and leads to impaired academic performance.Test-related attentional bias has been identified as an important maintaining factor in test-anxious individuals.AIM To evaluate whether hypnosis and progressive muscle relaxation(PMR)could modify medical college students’test anxiety and attentional bias.METHODS A total of 598 medical students were screened.The participants were divided into higher and lower test anxiety groups according to their scores on the test anxiety scale(TAS).Ninety medical college students with high TAS score were randomly assigned to a hypnosis or PMR group.Another 45 students with low TAS score were included,forming a baseline control group.The intervention was conducted weekly for 6 wk,and each session lasted approximately 30 min.The total intervention time and the number of intervention sessions for the hypnosis and PMR groups were equal.Data were collected at the pretest,posttest,and 2-mo follow-up.RESULTS Hypnosis group participants had a significantly lower TAS score at posttest(t=-21.827,P<0.001)and at follow-up(t=-14.824,P<0.001),compared to that at pretest.PMR group participants also had a significantly lower TAS score at posttest(t=-10.777,P<0.001)and at follow-up(t=-7.444,P<0.001),compared to that at pretest.At the posttest level,the hypnosis group had a significantly lower TAS score than the PMR group(t=-3.664,P<0.001).At the follow-up level,the hypnosis group also had a significantly lower TAS score than the PMR group(t=-2.943,P=0.004).Clinically significant improvement was found in both the hypnosis and PMR groups(hypnosis=64.0%;PMR=62.22%).Hypnosis was more effective than PMR in reducing test anxiety among medical college students.Hypnosis could modify attentional bias toward threatening stimuli,but PMR could not.CONCLUSION These results suggest that attentional bias plays an important role in test anxiety treatment.

Attentional Bias in Anxious Youth: Clinical Applications

Over the past decade,the clinical applications of cognitive psychology and neuropsychology methods have increased in popularity,permeating the clinical,education,and public health sectors.At the federal level,NIMH and the Institute of Education Sciences are regarding clinical-translation research as a top priority area for empirical investigation,and several national organizations including APA,the National Academy of Neuropsychology,the Society for Neuroscience,and the Neurocognitive Therapies/Translational Research Special Interest Group are recognizing the important influence of neuroscience and neuropsychology in understanding clinical pathology and guiding intervention plans.This line of inquiry has opened significant avenues for research and innovation in clinical practice,and the study of attentional bias in the etiology,assessment,and treatment of anxiety disorders is one of these important avenues.In recent years,researchers have extended early findings about the neurocognitive processes underpinning threat bias to enhance our understanding of risk factors and mechanisms of anxiety disorders,and inform the development of novel applications for clinical assessment and intervention.However,studies exploring these practical applications of attentional bias and dot probe methodology with anxious children and adolescents lag far behind.The following chapter will briefly review the literature on the clinical implications and direct clinical utility of cognitive psychology methods for measuring attentional threat bias in anxious youth.Applications for enhancing clinical assessment and intervention will be reviewed and discussed.Ultimately,advancing our knowledge of brain-behavior relationships,cognitive mechanisms of therapeutic change,and the efficacy of novel neurocognitive interventions may contribute to a better understanding of emotional and behavior disorders in children and the development of targeted interventions that result in greater treatment efficacy.

Cognitive attentional syndrome and metacognitive beliefs as potential treatment targets for metacognitive therapy in bipolar disorder

Most treatment guidelines emphasize the use of psychotropic drugs for both the acute and maintenance treatment of bipolar disorder(BD).However,relying only on psychotropics without adjunctive psychosocial interventions may be insufficient in treating patients with BD.Given its unique view in the explanation of psychopathological states,metacognitive therapy(MCT)might be helpful for BD.Metacognitive theory posits that psychopathology is a result of the cognitive attentional syndrome(CAS)and that it is influenced and maintained by dysfunctional metacognitive beliefs,perseverative thinking,attentional biases,and dysfunctional coping strategies.In this review,literature data regarding these areas in BD are examined.Studies suggest that perseverative thinking might be among the emotion regulation strategies endorsed in individuals with BD.Regarding attentional biases,literature data show that state-dependent,moodchanging attentional biases and a ruminative self-focused attention are present.Studies also suggest that cognitive self-consciousness is higher in BD compared to controls.It is seen that maladaptive coping strategies are frequently reported in BD,and that these strategies are associated with depression severity,negative affect and relapse risk.Studies focusing on dysfunctional metacognitive beliefs in BD reported that individuals with BD had higher scores for negative metacognitive beliefs,self-consciousness,need to control thoughts,and a lack of cognitive confidence.Also,dysfunctional metacognitive beliefs were associated with depressive symptomatology.These findings suggest that the components of CAS and dysfunctional metacognitive beliefs are evident in BD.For a subgroup of patients with BD who fail to respond to evidence-based psychopharmacological and adjunctive psychotherapeutic interventions,MCT might be an alternative way to consider as a treatment option.In conclusion,taken the available data together,we propose a sequential treatment protocol for BD,mainly based on the MCT treatment plan of depressive disorders.

Using eye movements in the dot-probe paradigm to investigate attention bias in illness anxiety disorder

BACKGROUND Illness anxiety disorder(IAD)is a common,distressing,and debilitating condition with the key feature being a persistent conviction of the possibility of having one or more serious or progressive physical disorders.Because eye movements are guided by visual-spatial attention,eye-tracking technology is a comparatively direct,continuous measure of attention direction and speed when stimuli are oriented.Researchers have tried to identify selective visual attention biases by tracking eye movements within dot-probe paradigms because dot-probe paradigm can distinguish these attentional biases more clearly.AIM To examine the association between IAD and biased processing of illness-related information.METHODS A case-control study design was used to record eye movements of individuals with IAD and healthy controls while participants viewed a set of pictures from four categories(illness-related,socially threatening,positive,and neutral images).Biases in initial orienting were assessed from the location of the initial shift in gaze,and biases in the maintenance of attention were assessed from the duration of gaze that was initially fixated on the picture per image category.RESULTS The eye movement of the participants in the IAD group was characterized by an avoidance bias in initial orienting to illness-related pictures.There was no evidence of individuals with IAD spending significantly more time viewing illness-related images compared with other images.Patients with IAD had an attention bias at the early stage and overall attentional avoidance.In addition,this study found that patients with significant anxiety symptoms showed attention bias in the late stages of attention processing.CONCLUSION Illness-related information processing biases appear to be a robust feature of IAD and may have an important role in explaining the etiology and maintenance of the disorder.

Effect of Electro-acupuncture Intervention on Cognition Attention Bias in Heroin Addiction Abstinence—A Dot-probe-based Event-related Potential Study

Objective：To study the changes of cognitive attention-related brain function in the heroin addicts before and after electro-acupuncture（EA） intervention for exploring the concerned neuro-mechanism of addictive relapse and the central action role of EA intervention.Methods：Adopting event-related potential（ERP） technique,the ERP at 64 electrode spots in 10 heroin addicts（test group） were recorded before and after EA intervention with dot-probe experimental form during implementing cognitive task on positive emotional clue （PEC）,negative emotional clues（NEC）,and heroin-related clue（HRC）.The P200 amplitude components on the selected observation points（Fz,Cz,and Pz） were analyzed and compared with those obtained from 10 healthy subjects as the control.Results：Before EA,the ERP of attention on HRC in the test group was higher than that on PEC and NEC（P0.05） and significantly higher than that in the control group（P0.05）;after EA,the P200 amplitude of attention on HRC at Cz and Pz was significantly lowered（P0.05） and that on PEC at Fz was significantly elevated（P0.05）.After EA,the P200 amplitude at Pz was ranked as NECPECHRC,but in the control group,it showed PECHRC at all three observation points and PECNEC at Pz.Conclusion：Heroin addicts show attention bias to HRC,which could be significantly reduced by EA intervention,illustrating that EA could effectively inhibit the attention bias to heroin and so might have potential for lowering the relapse rate.

Psychophysiological effects of rhythmic music combined with aerobic exercise in college students with minimal depressive symptoms

Mental health problems are common during the transition from adolescence to young adulthood.Previous studies reported that rhythmic music plus aerobic exercise can have a beneficial effect on emotional state.We examined whether the beneficial effect differed between aerobic exercise interventions with or without rhythmic music.A sample of 94 college students who either had no depressive symptoms(n=47)or minimal depressive symptoms(n=47)underwent 30-min interventions in a randomized and counterbalanced order:rest,rhythmic music,aerobic exercise and aerobic exercise plus rhythmic music.Response time and accuracy of selective attention to positive and negative images were recorded using the spatial cueing paradigm.Participants’heart rate during all conditions and perceived exertion after each condition were measured to clarify physiological and perceptual responses,respectively.The results revealed that a multimodal intervention combining aerobic exercise and rhythmic music had a significant facilitatory effect on attentional bias to positive emotional cues in minimal depressive participants(t=-2.336,p=0.024),including less perceived exertion and higher heart rate after/during the intervention process.The single-modality intervention of aerobic exercise had significant positive effects for individuals with no depressive symptoms(t=2.510,p=0.016).The multimodal intervention was more effective than the single-modality intervention for individuals with minimal depressive symptoms,but the single-modality aerobic exercise intervention was more effective for individuals with no depressive symptoms,providing new evidence for the specificity of the intervention effect for people with different degrees of depressive symptoms.