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Prior clinical trials have shown consistent clinical benefit for Capnometry Guided Respiratory Intervention (CGRI), a prescription digital therapeutic for the treatment of panic disorder (PD) and post-traumatic stress disorder (PTSD). The purpose of this study is to report real-world outcomes in a series of patients treated with the intervention in clinical practice. This paper reports pre- and post-treatment self-reported symptom reduction, measures of respiratory rate and end-tidal carbon dioxide levels, drop-out and adherence rates drawn from an automatic data repository in a large real-world series of patients receiving CGRI for panic disorder and PTSD. Patients used the intervention in their homes, supported by telehealth coaching. Patients meeting symptom criteria for panic disorder (  = 1,395) or posttraumatic stress disorder (  = 174) were treated following assessment by a healthcare professional. Capnometry Guided Respiratory Intervention is a 28-day home-based treatment that provides breath-to-breath feedback of respiratory rate and exhaled carbon dioxide levels, aimed at normalizing respiratory style and increasing patients' mastery for coping with symptoms of stress, anxiety, and panic. Health coaches provide initial training with weekly follow up during the treatment episode. Remote data upload and monitoring facilitates individualized coaching and aggregate outcomes analysis. Self-reported Panic Disorder Severity Scale (PDSS) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) scores were obtained at pre-treatment and post-treatment. Panic disorder (PD) patients showed a mean pre-to-post-treatment reduction in total PDSS scores of 50.2% (  < 0.001,  = 1.31). Treatment response rates for PD (defined as a 40% or greater reduction in PDSS total scores) were observed in 65.3% of the PD patients. PTSD patients showed a pre-to-post-treatment reduction in total PCL-5 scores of 41.1% (  < 0.001,  = 1.16). The treatment response rate for PTSD (defined as a ≥10-point reduction in PCL-5 scores) was 72.4%. In an additional analysis of response at the individual level, 55.7% of panic disorder patients and 53.5% of PTSD patients were classified as treatment responders using the Reliable Change Index. Patients with both normal and below-normal baseline exhaled CO levels experienced comparable benefit. Across the 28-day treatment period, mean adherence rates of 74.8% (PD) and 74.9% (PTSD) were recorded during the 28-day treatment. Dropout rates were 10% (PD) and 11% (PTSD) respectively. The results from this cohort of 1,569 patients treated with the CGRI intervention demonstrate significant rates of symptom reduction and adherence consistent with prior published clinical trials. The brief duration of treatment, high adherence rates, and clinical benefit suggests that CGRI provides an important addition to treatment options for panic disorder and PTSD.

Background Exposure-based therapy is an effective first-line treatment for anxiety-, obsessive–compulsive, and trauma- and stressor-related disorders; however, many patients do not improve, resulting in prolonged suffering and poorly used resources. Basic research on fear extinction may inform the development of a biomarker for the selection of exposure-based therapy. Growing evidence links orexin system activity to deficits in fear extinction and we have demonstrated that reactivity to an inhaled carbon dioxide (CO 2 ) challenge—a safe, affordable, and easy-to-implement procedure—can serve as a proxy for orexin system activity and predicts fear extinction deficits in rodents. Building upon this basic research, the goal for the proposed study is to validate CO 2 reactivity as a biomarker of exposure-based therapy non-response. Methods We will assess CO 2 reactivity in 600 adults meeting criteria for one or more fear- or anxiety-related disorders prior to providing open exposure-based therapy. By incorporating CO 2 reactivity into a multivariate model predicting treatment non-response that also includes reactivity to hyperventilation as well as a number of related predictor variables, we will establish the mechanistic specificity and the additive predictive utility of the potential CO 2 reactivity biomarker. By developing models independently within two study sites (University of Texas at Austin and Boston University) and predicting the other site’s data, we will validate that the results are likely to generalize to future clinical samples. Discussion Representing a necessary stage in translating basic research, this investigation addresses an important public health issue by testing an accessible clinical assessment strategy that may lead to a more effective treatment selection (personalized medicine) for patients with anxiety- and fear-related disorders, and enhanced understanding of the mechanisms governing exposure-based therapy. Trial registration ClinicalTrials.gov Identifier: NCT05467683 (20/07/2022).

This experiment tested whether peer approval and disapproval experiences can cause immediate change in children's state self-esteem. Children's narcissistic traits and evaluator perceived popularity were examined as potential moderators. A total of 333 preadolescents (M = 10.8 years) completed personal profiles on the Internet that were ostensibly judged by a jury consisting of popular and unpopular peers. Participants randomly received negative, neutral, or positive feedback from the jury. Next, they could examine the feedback that each individual judge gave them. As expected, peer disapproval decreased self-esteem, especially in children high in narcissism. In contrast, peer approval increased self-esteem. Moreover, disapproved children's self-esteem recovery was dependent on the extent to which they subsequently viewed positive feedback from popular judges. These findings support sociometer theory.

Loneliness, perceived stress, depression, and anxiety have increased during the COVID-19 pandemic. Many of existing mindfulness and compassion-based intervention are effective, but are time-intensive, decreasing overall accessibility and scalability. Single-session interventions (SSIs) serve as a promising alternative. The current pre-registered randomized clinical trial evaluated a newly developed, manualized, mindfulness-based single-session intervention. 91 adults were randomly assigned to one of three conditions: (1) one-hour mindfulness only telehealth intervention; (b) one-hour mindfulness and compassion telehealth intervention; or (c) one-week waitlist control (before randomization to an active intervention). Intervention sessions were conducted by graduate students in clinical psychology. The primary outcome was self-reported loneliness; secondary outcomes were self-reported perceived stress, depression, and anxiety. Using Bayesian multilevel models, we found that compared to the waitlist-control, the inclusion of a compassion component led to meaningful reductions in perceived stress b = -3.75, 95% HDI [-6.95, -0.59], anxiety b = -3.79, 95% HDI [-6.99, -0.53], and depression b = -3.01, 95% HDI [-5.22, -0.78], but not loneliness at the 1-week follow-up. Results suggest that a single-session mindfulness and compassion intervention may lead to meaningful reductions in perceived stress, symptoms of anxiety, and symptoms of depression, but not loneliness. Implications of these findings are discussed.

BackgroundSocial anxiety is a prevalent mental health concern. Models of social anxiety incorporate multifaceted components from cognitive appraisals to attention as factors maintaining the disorder. Multimodal research investigating multiple facets of social anxiety simultaneously offers an important avenue to advance our understanding of the disorder.MethodsThe current study tested a novel, internet-based simulated teleconferencing interaction social stressor challenge and included the collection of self-report, eye-tracking, and auditory vocal data during the challenge. Participants (N = 262) completed two interactions. The pre-recorded male and female audience members (assigned to display interest or uninterest) discussed a topic and then prompted the participant to speak on that topic.ResultsFidelity indices revealed that most participants rated the interactions with the simulated audience as realistic; reported heightened subjective distress during the simulated teleconferencing interactions; and correctly rated audience members’ level of interest. As predicted, social anxiety predicted participants’ subjective distress during the simulated teleconferencing interactions. Findings from audio vocal and eye tracking analyses largely corresponded to prior research – indicating that social anxiety influences audio vocal responses and patterns of attention during social stressors.ConclusionsTaken together, these findings suggest that the simulated teleconferencing interaction framework introduced here offers a potentially useful approach for the remote investigation of mechanisms underpinning social anxiety.

Preclinical findings suggest that transcranial infrared laser stimulation (TILS) improves fear extinction learning and cognitive function by enhancing prefrontal cortex (PFC) oxygen metabolism. These findings prompted our investigation of treating pathological fear using this non-invasive stimulation approach either alone to the dorsolateral PFC (dlPFC), or to the ventromedial PFC (vmPFC) in combination with exposure therapy. Volunteers with pathological fear of either enclosed spaces, contamination, public speaking, or anxiety-related bodily sensations were recruited for this randomized, single-blind, sham-controlled trial with four arms: (a) Exposure + TILS_vmPFC ( = 29), (b) Exposure + sham TILS_vmPFC ( = 29), (c) TILS_dlPFC alone ( = 26), or (d) Sham TILS _dlPFC alone ( = 28). Post-treatment assessments occurred immediately following treatment. Follow-up assessments occurred 2 weeks after treatment. A total of 112 participants were randomized [age range: 18-63 years; 96 females (85.71%)]. Significant interactions of Group × Time and Group × Context indicated differential treatment effects on retention (i.e. between time-points, averaged across contexts) and on generalization (i.e. between contexts, averaged across time-points), respectively. Among the monotherapies, TILS_dlPFC outperformed SHAM_dlPFC in the initial context, = -13.44, 95% CI (-25.73 to -1.15), = 0.03. Among the combined treatments, differences between EX + TILS_vmPFC and EX + SHAM_vmPFC were non-significant across all contrasts. TILS to the dlPFC, one of the PFC regions implicated in emotion regulation, resulted in a context-specific benefit as a monotherapy for reducing fear. Contrary to prediction, TILS to the vmPFC, a region implicated in fear extinction memory consolidation, did not enhance exposure therapy outcome.

Evidence suggests a link between smaller hippocampal volume (HV) and post-traumatic stress disorder (PTSD). However, there has been little prospective research testing this question directly and it remains unclear whether smaller HV confers risk or is a consequence of traumatization and PTSD. U.S. soldiers ( = 107) completed a battery of clinical assessments, including structural magnetic resonance imaging pre-deployment. Once deployed they completed monthly assessments of traumatic-stressors and symptoms. We hypothesized that smaller HV would potentiate the effects of traumatic stressors on PTSD symptoms in theater. Analyses evaluated whether total HV, lateral (right left) HV, or HV asymmetry (right - left) moderated the effects of stressor-exposure during deployment on PTSD symptoms. Findings revealed no interaction between total HV and average monthly traumatic-stressors on PTSD symptoms = -0.028, = 0.681 [95% confidence interval (CI) -0.167 to 0.100]. However, in the context of greater exposure to average monthly traumatic stressors, greater right HV was associated with fewer PTSD symptoms = -0.467, = 0.023 (95% CI -0.786 to -0.013), whereas greater left HV was unexpectedly associated with greater PTSD symptoms = 0.435, = 0.024 (95% CI 0.028-0.715). Our findings highlight the importance of considering the complex role of HV, in particular HV asymmetry, in predicting the emergence of PTSD symptoms in response to war-zone trauma.

It has recently become feasible to study selective visual attention to social cues in increasingly ecologically valid ways. In this secondary analysis, we examined gaze behavior in response to the actions of others in a social context. Participants ( N = 84) were asked to give a 5-minute speech to a five-member audience that had been filmed in 360° video, displayed in a virtual reality headset containing a built-in eye tracker. Audience members were coached to make movements that would indicate interest or lack of interest (e.g., nodding vs. looking away). The goal of this paper was to analyze whether these actions influenced the speaker’s gaze. We found that participants showed reliable evidence of gaze towards audience member actions in general, and towards audience member actions involving their phone specifically (compared with other actions like looking away or leaning back). However, there were no differences in gaze towards actions reflecting interest (like nodding) compared with actions reflecting lack of interest (like looking away). Participants were more likely to look away from audience member actions as well, but there were no specific actions that elicited looking away more or less. Taken together, these findings suggest that the actions of audience members are broadly influential in motivating gaze behaviors in a realistic, contextually embedded (public speaking) setting. Further research is needed to examine the ways in which these findings can be elucidated in more controlled laboratory environments as well as in the real world.

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.

Although there are good theoretical reasons to believe that youth who are high in alienation (i. e., estranged from society, significant others, and themselves) are prone to behave aggressively, empirical evidence is lacking. The present experiment tested whether alienation moderates the effects of acute peer rejection on aggression in youth. Participants (N = 121 ; mean age = 11.5 years) completed a personal profile (e. g., \"How do you describe yourself?\") that was allegedly evaluated online by a panel of peer judges. After randomly receiving negative or positive feedback from peer judges, participants were given the opportunity to aggress against them (i. e., by reducing their monetary reward and by posting negative comments about them online). As predicted, alienation increased participants' aggression against peers who had rejected them, but not against peers who had praised them, even after controlling for peer-nominated chronic rejection and peer-nominated aggression. Thus, alienated youth are more aggressive than others when they experience acute peer rejection.