fear
Research Papers
Evaluation of Cognitive Behavioral Therapy on Improving Pain, Fear Avoidance, and Self-Efficacy in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis
BACKGROUND: Cognitive-behavioral therapy (CBT) is commonly adopted in pain management programs for patients with chronic low back pain (CLBP). However, the benefits of CBT are still unclear. OBJECTIVES: This review investigated the effectiveness of CBT on pain, disability, fear avoidance, and self-efficacy in patients with CLBP. METHODS: Databases including PubMed, EMBASE, Web of Science, Cochrane Library, and PsycINFO were searched. RCTs examining the effects of CBT in adults with CLBP were included. The data about the outcome of pain, disability, fear avoidance, and self-efficacy were retained. Subgroup analysis about the effects of CBT on posttreatment was conducted according to CBT versus control groups (waiting list/usual care, active therapy) and concurrent CBT versus CBT alone. A random-effects model was used, and statistical heterogeneity was explored. RESULTS: 22 articles were included. The results indicated that CBT was superior to other therapies in improving disability (SMD -0.44, 95% CI -0.71 to -0.17, P < 0.05), pain (SMD -0.32, 95% CI -0.57 to -0.06, P < 0.05), fear avoidance (SMD -1.24, 95% CI -2.25 to -0.23, P < 0.05), and self-efficacy (SMD 0.27, 95% CI 0.15 to 0.40, P < 0.05) after intervention. No different effect was observed between CBT and other therapies in all the follow-up terms. Subgroup analysis suggested that CBT in conjunction with other interventions was in favor of other interventions alone to reduce pain and disability (P < 0.05). CONCLUSION: CBT is beneficial in patients with CLBP for improving pain, disability, fear avoidance, and self-efficacy in CLBP patients. Further study is recommended to investigate the long-term benefits of CBT. This meta-analysis is registered with Prospero (registration number CRD42021224837).
View Full Paper →Pattern of anxiety, insecurity, fear, panic and/or phobia observed by quantitative electroencephalography (QEEG)
Stress is a response in which an individual wants to have more control over a situation. A constant state of stress is called anxiety. Some patients deny symptoms. An instrument can help arrive at a diagnosis. Objective: Using TQ-7 QEEG, this study aimed to evaluate the association of symptoms of anxiety, insecurity, fear, panic and phobia with hot temporals defined as Beta (15-23 Hz) >17% and High-Beta waves (23-38 Hz) >10% at T3 and T4. Methods: Five hundred and forty-three patients of both genders with ages ranging from 16-59 years were evaluated, divided into two groups: Control (without hot temporals: n=274) and Case Group (with hot temporals: n=269). The Chi-square test was used (p-values ≤0.05). Results: There was a significant association (p-value <0.001) between the symptoms related to amygdala activation, expressed in the temporals (Beta >17% and High-Beta >10%). (Anxiety, T3=89.6% - T4=88.8%; T3=92.6% - T4=93.3%), (Fear, T3=80.7% - T4=84.4%; T3=82.9% - T4=95.9%), (Insecurity, T3=82.2% - T4=81.4%; T3=69.5% - T4=97.8%), (Panic, T3=52.4 - T4=72.5%; T3=90.3% - T4=74.0%), (Phobia, T3=17.5% - T4=22.7%; T3=19.7% - T4=27.1%), when compared to the respective controls (Beta control, T3=8.4%, 10.2%, 21.2%, 1.1%, 0.4% and T4=11.3%, 4.4%, 23.0%, 2.6%, 1.1%) (High-Beta control, T3=4.0%, 6.9%, 6.2%, 0.4%, 0.0% and T4=17.5%, 6.2%, 3.3%, 4.0%, 0.7%). Conclusion: Anxiety, insecurity, fear, panic and phobia are observed by QEEG when the levels of total Beta >17% and High-Beta waves >10% at T3 and T4.
View Full Paper →Self-Regulation of Anterior Insula with Real-Time fMRI and Its Behavioral Effects in Obsessive-Compulsive Disorder: A Feasibility Study
INTRODUCTION: Obsessive-compulsive disorder (OCD) is a common and chronic condition that can have disabling effects throughout the patient's lifespan. Frequent symptoms among OCD patients include fear of contamination and washing compulsions. Several studies have shown a link between contamination fears, disgust over-reactivity, and insula activation in OCD. In concordance with the role of insula in disgust processing, new neural models based on neuroimaging studies suggest that abnormally high activations of insula could be implicated in OCD psychopathology, at least in the subgroup of patients with contamination fears and washing compulsions. METHODS: In the current study, we used a Brain Computer Interface (BCI) based on real-time functional magnetic resonance imaging (rtfMRI) to aid OCD patients to achieve down-regulation of the Blood Oxygenation Level Dependent (BOLD) signal in anterior insula. Our first aim was to investigate whether patients with contamination obsessions and washing compulsions can learn to volitionally decrease (down-regulate) activity in the insula in the presence of disgust/anxiety provoking stimuli. Our second aim was to evaluate the effect of down-regulation on clinical, behavioural and physiological changes pertaining to OCD symptoms. Hence, several pre- and post-training measures were performed, i.e., confronting the patient with a disgust/anxiety inducing real-world object (Ecological Disgust Test), and subjective rating and physiological responses (heart rate, skin conductance level) of disgust towards provoking pictures. RESULTS: Results of this pilot study, performed in 3 patients (2 females), show that OCD patients can gain self-control of the BOLD activity of insula, albeit to different degrees. In two patients positive changes in behaviour in the EDT were observed following the rtfMRI trainings. Behavioural changes were also confirmed by reductions in the negative valence and in the subjective perception of disgust towards symptom provoking images. CONCLUSION: Although preliminary, results of this study confirmed that insula down-regulation is possible in patients suffering from OCD, and that volitional decreases of insula activation could be used for symptom alleviation in this disorder.
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