Tag Archives: #anxiety

How a Specific Synapse Type Regulates Anxiety-like Behavior (Neuroscience)

Experiments conducted on genetically modified mice clarify the role of a protein in regulating properties of specific hippocampal neural circuits

The mechanisms behind the organization of neuronal synapses remain unclear owing to the sheer number of genes, proteins, and neuron types involved. In a recent study, Daegu Gyeongbuk Institute of Science and Technology scientists conducted a series of experiments in genetically modified mice to clarify the role of two proteins in regulating the development of inhibitory synapses in the hippocampus, in the context of anxiety-related behaviors, paving the way to better understand the brain.

The correct functioning of our brain, as well as that of other animals, depends on a very intricate interplay between multiple types of neurons. These interactions are orchestrated by multitudes of synaptic proteins; thus, pinpointing their specific functions is extremely challenging. In particular, the molecular mechanisms that regulate the plasticity of synapses are not completely understood.

Synapse plasticity is crucial for animals to correctly respond and adapt to their environment at the behavioral level. Over the past decade, several studies have focused on two proteins that are related to synapses mediated by GABA, the most important inhibitory neurotransmitter in mammals. Npas4, the first of the two, is closely related to shaping inhibitory synapse organization, but it fulfills many different roles across various brain regions. Contrarily, IQSEC3, the second protein, is exclusively found in ‘GABAergic’ synapses and is believed to be a target of Npas4, though this has not been conclusively demonstrated in live animals. Now, in a recent study published in Cell Reports, a team of scientists from Daegu Gyeongbuk Institute of Science and Technology (DGIST), Korea, report findings of their study on mice that shed light on the specific functions of Npas4 and IQSEC3 in a specific brain region, called the hippocampus.

First, both in neuronal cell cultures and in mice, the scientists demonstrated that Npas4 promotes the expression of IQSEC3 and, most importantly, facilitates the organization of GABAergic synapses in a specific synapse of hippocampal neurons. Then, through behavioral experiments and subsequent chemogenetic approaches applied on genetically modified mice, the scientists observed that the specific GABAergic synapses organized by Npas4 and IQSEC3 are directly linked to anxiety-like behaviors. More specifically, mice with dysregulated IQSEC3 expression responded differently from control mice in experimental scenarios that would normally induce anxiety-related responses. “Our research may help us understand how abnormalities in anxiety-like behavior occur and design circuit-based therapeutic approaches for correcting them,” remarks Professor Ji Won Um from the Department of Brain and Cognitive Sciences at DGIST, who led the study.         

The team plans to continue investigating the role of IQSEC3 in different type of synapses and neural circuits using even more sophisticated genetic approaches. Clarifying the molecular mechanisms of the brain will surely pave the way to breakthroughs in brain medicine, as Dr. Um explains: “Understanding synapses is instrumental in grasping the pathogenesis of neuropsychiatric and neurodevelopmental disorders because various forms of synaptic dysfunctions occur in such diseases. Thus, basic neuroscience research is unquestionably essential for making progress in this regard.

Let us hope further studies add more pieces to the gigantic puzzle that is comprehending the brain.

Finding the Clue: How a Specific Synapse Type Regulates Anxiety-like Behavior 이미지2
The chemicals, proteins, and genes involved in the development and functioning of synapses vary across different neuron types and brain regions, making it very challenging to pinpoint the specific function each of them plays. © DGIST
Finding the Clue: How a Specific Synapse Type Regulates Anxiety-like Behavior 이미지3
Experiments with genetically modified mice are crucial for understanding the relationship between specific genes and protein and changes in behavior. © DGIST

Associated Links
Research Paper on Journal of Cell Reports
DOI: 10.1016/j.celrep.2021.109417

Journal Reference
Seungjoon Kim,  Dongseok Park,  Jinhu Kim,  Dongwook Kim, Hyeonho Kim, Takuma Mori, Hyeji Jung, Dongsu Lee, Sookyung Hong, Jongcheol Jeon, Katsuhiko Tabuchi, Eunji Cheong, Jaehoon Kim, Ji Won Um, and Jaewon Ko “Npas4 regulates IQSEC3 expression in hippocampal somatostatin interneurons to mediate anxiety-like behavior”, Cell Report,  on-line published on 20th Jul, 2021.

Featured image: Part of the research team at the Department of Brain and Cognitive Sciences at DGIST. Clockwise from the back-left are Professor Ji Won Um, Professor Jaewon Ko, and Master’s and Doctorate integrated students Seungjoon Kim, Jinhu Kim, and Dongseok Park. © DGIST

Provided by DGIST

Research Shows Consuming Prebiotic Supplements Once a Day Has a Positive Impact on Anxiety Levels and Overall Wellbeing (Medicine)

A new study from the University of Surrey has found that 4-weeks of daily galacto-oligosaccharides (GOS) prebiotic intake can reduce anxiety levels and result in an overall improvement in wellbeing in young women.

In a paper published in the journal Scientific Reports, researchers from Surrey investigated whether the daily consumption of a prebiotic food supplement could improve overall wellbeing in a group of 18 to 25 year-olds. The study found that those who received a daily dose of prebiotics improved mental wellbeing by reducing anxiety levels and had better gut health than the control group.

Researchers studied a group of 64 healthy female participants with no current or previous clinical diagnoses of anxiety. Participants received either a daily dose of the prebiotic galacto-oligosaccharides (GOS) or a placebo for 28 days.

All those involved in the trial completed surveys about their health experiences, including mood, anxiety and sleep quality and provided a stool sample for gut microbiome sequencing analysis.

Dr Kathrin Cohen Kadosh, Reader in Developmental Cognitive Neuroscience at the University of Surrey and Head of the Social Brain and Development Lab, said:

“This new research marks a significant step forward in that we were able to show that we can use a simple and safe food supplement such as prebiotics to improve both the abundance of beneficial gut bacteria in the gut and to improve mental health and wellbeing in young women.”

Dr Nicola Johnstone, Research Fellow from the University of Surrey, said:

“This is an exciting study that brings together different dimensions in mental health research; finding prebiotic effects in a sub-clinical group shows promise for translational clinical research on multiple markers of mental health.”

Featured image credit: gettyimages

Provided by University of Surrey

Listening to Music Linked to Significant Reduction in Anxiety/Pain After Major Heart Surgery (Medicine)

Unlike drugs, music has no known side effects and may be worth offering to patients.

Listening to music is linked to a significant reduction in anxiety and pain after major heart surgery, finds a pooled data analysis of the available evidence, published in the online journal Open Heart.

As music has neither risks nor known side effects, unlike drugs, but may influence health outcomes, clinicians should consider it for patients scheduled for major heart surgery, suggest the researchers.

Heart surgery patients are often anxious before their procedure, and often experience severe pain afterwards, despite being given sedatives and strong pain relief, say the researchers.

A postoperative stint in intensive care then exposes them to stressors known to increase anxiety and pain, such as noise, sleeplessness, and mechanical ventilation. These, in turn, may also increase length of hospital stay and the need for additional medication.

Previous research has indicated that listening to music around the time of any surgery may help to quell patients’ anxiety and ease their pain.

To see if music might also help patients undergoing major heart surgery and reduce their length of hospital stay and need for drugs and mechanical ventilation, etc, the researchers searched five electronic databases, looking for relevant clinical trials, published in English up to October 2019.

They reviewed the results of 20 studies, involving 1169 patients, and pooled the data from 16, involving 987 patients.

Most (90%) of the procedures in the included studies were predominantly coronary artery bypass grafts and/or valve replacement.

Validated scales and scoring systems were used to measure anxiety and pain: State Trait Anxiety Inventory; Visual Analogue Scale; Numeric Rating Scale; and the Hospital Anxiety and Depression Scale.

The type of music was usually described as relaxing and free of strong rhythms and percussion (60%), and was mostly provided through headphones (70%).

Patients chose their preferred music from either pre-selected lists (40%), lists selected by the researcher (35%), or opted for their own playlists (15%).

The music sessions were either repeated several times on one day or over several days, or once daily over several days. In 14 studies the music was provided only after surgery; in five, it was provided before, during, and after the procedure.

Patients in the comparison groups received a scheduled rest (8 studies), standard care (6), headphones/earphones without music (4), breathing exercises (1) or a blank tape during surgery combined with standard care afterwards (1).

The pooled data analysis showed that listening to music significantly reduced anxiety and pain after major heart surgery.

The first postoperative music session was associated with the equivalent reduction of 4 points on the StateTrait Anxiety Inventory and of 1.05 points on the Visual Analogue Scale/Numeric Rating Scale for anxiety.

And it was associated with a reduction of 1.26 points on the Visual Analogue Scale/Numeric Rating Scale for pain.

But the effect on pain wasn’t observed when the researchers pooled the data from studies providing music before surgery only, or those offering a mixture of time periods.

Only a few studies took this approach, however, say the researchers.

Several days of listening to music also reduced anxiety for up to 8 days after surgery.

But listening to music wasn’t associated with any significant effects on the use of opioids; length of hospital stay; time spent on mechanical ventilation; blood pressure; heart rate; or breathing rate.

But, again, this may be because these outcomes weren’t the primary focus of most of the included studies, suggest the researchers.

Several limiting factors need to be taken into consideration, when interpreting the findings, they caution.

These include the moderate to high risk of potential bias across the included studies, and the inability to ensure patients didn’t know which group they had been assigned. The timing, duration, and type of music also varied widely across the studies, some of which included only small numbers of patients.

Further research will therefore be needed before definitive conclusions can be drawn, suggest the researchers.

Nevertheless, they conclude that listening to music is a “promising” option for major heart surgery patients.

“Since music intervention has neither risks nor known side effects, but may have a positive effect on patients’ health outcomes, healthcare professionals should consider providing perioperative music for patients undergoing cardiac surgery,” they suggest.

Reference: Ellaha Kakar, Ryan J Billar, Joost van Rosmalen, Markus Klimek, Johanna J M Takkenberg and Johannes Jeekel, “Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis”, BMJ, Volume 8, Issue 1, 2021. http://dx.doi.org/10.1136/openhrt-2020-001474

Provided by BMJ

One Word to Help You Overcome Negative Thoughts (Psychology)

Harnessing the power of positive thinking.

Over the years, I have written about the positive impact of one word—the most powerful I have seen to date—that stops and overturns negative thoughts. I first learned about this amazing word at a professional conference about cognitive behavioral therapy (CBT) strategies. 

CBT is based on these core principles:

  • Emotional struggles are due to faulty or unhelpful ways of thinking.
  • Psychological problems are based, on learned patterns of problematic thinking and unhelpful behavior.
  • People suffering from emotional struggles can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.
  • Efforts to change rigid, distorted, and unhelpful thinking patterns lead to improved emotional health. 

For years, my many counseling and coaching clients have overwhelmingly agreed that the word I am soon going to share with you is very helpful. This word overcomes discouragement and inaction. It turns negative, self-defeating thoughts of all kinds into productive ones.

As I further explain in my latest book, The Anxiety, Depression, & Anger Toolbox for Teens, challenging your negative thoughts with more adaptive ones is the key to calming down and problem solving. Aren’t these the two most valuable skills for a productive life? 

This one-word, negative thought buster I am about to share with you, sparks more positive moods, boosts self-esteem, and will make you a more productive, self-assured person.”  I am going to also give you sample soundbites for how to use it. 


The magic word to overcome negative thinking is “Nevertheless.” Let’s look at some examples of how you can use it:

  • “I am hesitant to write this Psychology Today post today because some haters may say I don’t know what I am talking about. Nevertheless, it helps me feel empowered knowing that my counseling and coaching clients find “Nevertheless” very helpful.”
  • “I’m so depressed. I just don’t want to do anything today. Nevertheless, I owe it to myself to try to go for a walk because it will likely get me out of my head and help me feel better.” 
  • “I’m so angry at those people for not inviting me to join that group zoom call. I feel so abandoned right now. Nevertheless, I’m going to see if I can get some feedback about what is going on. Worse comes to worst, I will reach out to these others I know to cultivate closer fitting friendships.”
  • “I am nervous to try to branch out and try making some new friends. Nevertheless, I will feel better knowing I am trying to connect with others rather than willfully staying disconnected.” 
  • “I’m upset and cookies are my comfort food to binge on. Nevertheless, I will find a better way to deal with my feelings. The more I work on self-control, the more I will feel I have earned an occasional cookie indulgence versus destructively thinking, ‘I deserve one’.”
  • “I’m going to fail this test because the teacher is horrible, nevertheless, I am going to start studying and give it my best.”
  • “I am so angry at her because it feels like she never listens to my point of view. Nevertheless, if I allow myself to calm down, and state a positive intention to work things out, that will likely get us to a better place than continuing to brood about this current conflict.”

If you try using this word, “Nevertheless” in earnest, you’ll likely see its power. “Nevertheless” allows us to pause and realize that we have choices. There are always reasons (or excuses) to succumb to negative thinking patterns and to do what’s unhealthy, unproductive, or even morally questionable. Nevertheless, we can still choose to do the right thing.

You may question if the word, “nevertheless”, will help you move past your negative thoughts and the chaos that comes with them. Nevertheless, if you give it a try, you will likely find that this word packs a lot of punch to knock out your negative thoughts.

References: (1) Bernstein, J. (2020). The Anxiety, Depression, & Anger Toolbox for Teens, Eau Claire, WI: PESI Publishing. (2) Bernstein, J. (2015). 10 Days to a Less Defiant Child (2nd Ed.) Perseus Books, New York, NY. (3) Bernstein J. (2009) Liking the Child You Love, Perseus Books, New York, NY. (4) Bernstein, J. (2019). The Stress Survival Guide for Teens. Oakland, CA: New Harbinger Publications. (5) Bernstein, J. (2017). Letting go of Anger—Card deck for teens. Eau Claire, WI: PESI Publishing. (6) Bernstein, J. (2003) Why Can’t You Read My Mind?  Perseus Books, New York, NY.

Copyright of this article totally belongs to Jeffrey Bernstein, who is a psychologist and the author of seven books, including 10 Days to a Less Defiant Child. This article is republished here from psychology today under common creative licenses

One Psychedelic Experience May Lessen Trauma of Racial Injustice (Psychology)

Lower stress, depression recalled after using drug, study finds.

A single positive experience on a psychedelic drug may help reduce stress, depression and anxiety symptoms in Black, Indigenous and people of color whose encounters with racism have had lasting harm, a new study suggests.

A growing body of research has suggested psychedelics, such as psilocybin mushrooms, have a place in therapy. Photo: Getty Images

The participants in the retrospective study reported that their trauma-related symptoms linked to racist acts were lowered in the 30 days after an experience with either psilocybin (Magic Mushrooms), LSD or MDMA (Ecstasy).

“Their experience with psychedelic drugs was so powerful that they could recall and report on changes in symptoms from racial trauma that they had experienced in their lives, and they remembered it having a significant reduction in their mental health problems afterward,” said Alan Davis, co-lead author of the study and an assistant professor of social work at The Ohio State University.

Overall, the study also showed that the more intensely spiritual and insightful the psychedelic experience was, the more significant the recalled decreases in trauma-related symptoms were.

A growing body of research has suggested psychedelics have a place in therapy, especially when administered in a controlled setting. What previous mental health research has generally lacked, Davis noted, is a focus on people of color and on treatment that could specifically address the trauma of chronic exposure to racism.

Alan Davis © Ohio state news

Davis partnered with co-lead author Monnica Williams, Canada Research Chair in Mental Health Disparities at the University of Ottawa, to conduct the research.

“Currently, there are no empirically supported treatments specifically for racial trauma. This study shows that psychedelics can be an important avenue for healing,” Williams said.

The study is published online in the journal Drugs: Education, Prevention and Policy.

The researchers recruited participants in the United States and Canada using Qualtrics survey research panels, assembling a sample of 313 people who reported they had taken a dose of a psychedelic drug in the past that they believed contributed to “relief from the challenging effects of racial discrimination.” The sample comprised adults who identified as Black, Asian, Hispanic, Native American/Indigenous Canadian, Native Hawaiian and Pacific Islander.

Once enrolled, participants completed questionnaires collecting information on their past experiences with racial trauma, psychedelic use and mental health symptoms, and were asked to recall a memorable psychedelic experience and its short-term and enduring effects. Those experiences had occurred as recently as a few months before the study and as long ago as at least 10 years earlier.

The discrimination they had encountered included unfair treatment by neighbors, teachers and bosses, false accusations of unethical behavior and physical violence. The most commonly reported issues involved feelings of severe anger about being subjected to a racist act and wanting to “tell someone off” for racist behavior, but saying nothing instead.

Researchers asked participants to recall the severity of symptoms of anxiety, depression and stress linked to exposure to racial injustice in the 30 days before and 30 days after the experience with psychedelic drugs. Considering the probability that being subjected to racism is a lifelong problem rather than a single event, the researchers also assessed symptoms characteristic of people suffering from discrimination-related post-traumatic stress disorder (PTSD).

“Not everybody experiences every form of racial trauma, but certainly people of color are experiencing a lot of these different types of discrimination on a regular basis,” said Davis, who also is an adjunct faculty member in the Johns Hopkins University Center for Psychedelic and Consciousness Research. “So in addition to depression and anxiety, we were asking whether participants had symptoms of race-based PTSD.”

Participants were also asked to report on the intensity of three common kinds of experiences people have while under the influence of psychedelic drugs: a mystical, insightful or challenging experience. A mystical experience can feel like a spiritual connection to the divine, an insightful experience increases people’s awareness and understanding about themselvess, and a challenging experience relates to emotional and physical reactions such as anxiety or difficulty breathing.

All participants recalled their anxiety, depression and stress symptoms after the memorable psychedelic experience were lower than they had been before the drug use. The magnitude of the positive effects of the psychedelics influenced their reduction in symptoms.

“What this analysis showed is that a more intense mystical experience and insightful experience, and a less intense challenging experience, is what was related to mental health benefits,” Davis said.

The researchers noted in the paper that the study had limitations because the findings were based on participant recall and the entire sample of recruited research volunteers had reported benefits they associated with their psychedelic experience – meaning it cannot be assumed that psychedelics will help all people of color with racial trauma. Davis and Williams are working on proposals for clinical trials to further investigate the effects of psychedelics on mental health symptoms in specific populations, including Black, Indigenous and people of color.

“This was really the first step in exploring whether people of color are experiencing benefits of psychedelics and, in particular, looking at a relevant feature of their mental health, which is their experience of racial trauma,” Davis said. “This study helps to start that conversation with this emerging treatment paradigm.”

This work was funded by the University of Ottawa, the Canada Research Chairs Program and the National Institutes of Health. Additional co-authors included Yitong Xin of Ohio State’s College of Social Work; Nathan Sepeda of Johns Hopkins; Pamela Grigas and Sinead Sinnott of the University of Connecticut; and Angela Haeny of Yale School of Medicine.

Provided by Ohio State University

How to Make the Holiday Special? (Psychology)

Lisa Firestone suggest 8 ways to connect to a sense of peace and warmth as 2020 comes to an end.

This season is usually reserved for celebration and gathering, but today, many of us are experiencing something very different. And while you may be getting tired of hearing about how different the holidays look this year, you’re probably still bearing the emotional impact of what that means. These next couple weeks are likely to hit us with waves of grief, loneliness, disappointment, anxiety, and all that same uncertainty that has woven its way through 2020. So, how can we honor these feelings and still create a holiday that is meaningful to us? Here are eight suggestions to help us connect with the sense of peace, gratitude, and warmth that we’re yearning for right now.

  1. Allow Yourself to Feel Sad

On any given year, the holidays can be bittersweet, as we remember loved ones who are no longer with us. This year, our sadness extends to those we can’t be with in person. It’s important to take the pauses we naturally need to honor these feelings. Trying to constantly keep calm and carry on is exhausting and can disconnect us from our feelings in general. It can also lead us to have dips in our mood and energy.

Giving ourselves the time and space to feel our feelings fully can actually revitalize us. When we don’t express our sadness (or our anger for that matter) in a clear, direct way, we often turn it against ourselves, feeling more down, drained, and self-critical. Letting out our sadness can be like letting a wave pass over us. Yes, it will rise and peak, but it will also pass. And although, the feeling may return, each time we release it, it will leave us more in touch with ourselves and stronger in the moments we wish to carry on and be there for others. Accepting our pain in this way can also make the joyful moments more precious.

  1. Have a Real Conversation About What You’re Feeling With Loved Ones

The underlying poignancy of this year is not something we can cover up with wrapping paper. While we may be feeling fatigued when it comes to video chatting, it’s important not to hold back when we speak to close friends and family and not leave things unsaid. If there was ever a time to be open and expressive about how we’re doing, that time is now. Having a real conversation about what we’re going through is essential. It allows the people we care for to really know and understand us. It fosters a feeling of closeness despite any physical distance, and it opens the door for the other person to open up to us. If we’re struggling, we should not try to hide it..

It’s way too easy when we’re isolated to let a “critical inner voice” take over that tells us we’re not important, that we shouldn’t bother others, or that they don’t care. Having this voice in our heads is like living with an internal enemy, and we must treat it as one by resisting its directives. Make a time to talk to friends or call out of the blue when you need someone. Let them know what you’re experiencing, what challenges you’re facing, and what they mean to you. Certain emotions are going to hit each of us at different times. Being there for one another at these moments, while being open and vulnerable is a genuine way to connect to ourselves and others and will help us all through this time.

  1. Create a New Tradition

Many of us are mourning the loss of traditions that we typically share, or we’re trying to configure those traditions to ensure the safety of our loved ones. It’s okay to feel sad about this absence and still summon our creativity to uncover a new way to make meaning in this moment. This isn’t about putting pressure on ourselves to invent a perfect plan. Instead, we should meet ourselves exactly where we’re at.

For some of us, that may mean carving out a specific moment to relax in whatever way makes us feel safe or soothed. Some examples from friends I’ve heard recently have included meditating, baking for friends and family, reading by the fire, cooking a certain meal, watching an old movie, exchanging gifts via Zoom, keeping a list of things they’re thankful for, decorating their house, making photo albums, and writing handwritten cards to loved ones.

  1. Do Something For Yourself

Not to sound cheesy, but I mean it when I say that if there is one thing to celebrate this year, it’s you. We have all gotten through a very tough time, and there is nothing selfish about giving yourself a gift in whatever form holds value to you personally. Take time to explore and invest in something that matters to you. For some people, these are acts of self-care. For others, that may mean seeking opportunities to develop or learn more about themselves through therapy or an online course. Allow yourself to reflect on the strength it’s taken to get you where you are. Give yourself permission to get creative and let your mind to wander as you think of activities that will offer you a sense of peace or fulfillment. Finally, be sure to give yourself time to enjoy the rewards of whatever you choose for yourself.

  1. Volunteer

Giving is always a gift to ourselves, particularly at moments when we feel down or isolated. Looking for ways to volunteer virtually or reach out to others is an act of generosity, but also one of self-care. Shifting our focus outward allows us the freedom to step outside ourselves, which can be a true offering in these times when we are spending so much more time alone or at home.

  1. Keep a Gratitude Journal

Keeping a daily list of what we’re thankful for is always a good idea. Gratitude has a wide range of mental health benefits, and the simple task shifts our focus to the positive aspects of our lives. Despite a great deal of darkness clouding this year, we can each get in touch with the points of light in and around us that keep us going and continue to offer us meaning.

  1. Take Advantage of the Quiet Moments

One small, simple shift that has helped people during this time is to focus on the peace that quiet moments offer. Holidays, in general, can be chaotic, and for some, overwhelming. There may be certain benefits of using this time to reflect and feel present. Naturally, not all moments will feel calm and centering right now, but with more time staying home, we can try to take time to be still, paying attention to our sensory experience, and connecting more deeply to our gratitude.

  1. Keep Hope Alive

One thing we need to remember is that this moment will pass. Life will always be full of ups and downs, but this year has truly been unlike any other. While we may be feeling beat down, we’re still moving forward, and there’s real reason to be hopeful looking ahead. We’ve all made strides to get through a really hard time. The lessons we’ve learned and continue to learn will stay with us forever. This holiday may not be what we were hoping, but we have every reason to keep hope alive and well, front and center to whatever way we celebrate. Thanks to the tireless work of people around the world, things will get better. And just as we’ve withstood the bad, we will be there to revel in the good.

This article is originally written by Lisa Firestone, who is a clinical psychologist, an author, and the Director of Research and Education for the Glendon Association. This article is republished here from psychology today under common creative licenses.

Testosterone Nasal Spray to Treat Anxiety Disorders (Medicine)

A testosterone-containing nasal spray received its second U.S. patent and its first patent in Europe, making it the first testosterone therapy licensed to treat anxiety disorders.

Research has shown that although there is no difference in anxiety disorders among prepubescents, puberty introduces a sharp uptick in anxiety disorders in girls, who naturally have about one-tenth the amount of testosterone as boys. © University of Texas

Although testosterone therapy is most often marketed and prescribed to men suffering from “low T” — testosterone deficiency or hypogonadism — researchers with The University of Texas at Austin and MedCara Pharmaceuticals developed a nasal spray in response to a long-standing research question about why women are twice as likely as men to develop anxiety disorders.

“A growing body of research points to testosterone’s importance in the etiology of anxiety disorders,” said Robert Josephs, a professor of psychology at UT Austin who along with MedCara pharmacist Craig Herman developed the spray.

Research has shown that although there is no difference in anxiety disorders among prepubescents, puberty introduces a sharp uptick in anxiety disorders in girls, who naturally have about one-tenth the amount of testosterone as boys. The researchers speculated that men’s higher concentrations of circulating testosterone may protect against anxiety and began developing a treatment to address the issue.

“With this second U.S. patent and a first European patent supporting these claims, we’re one step closer to introducing a new weapon in the ongoing battle against mental illness,” said Josephs, who is also an adjunct professor of psychiatry in UT Austin’s Dell Medical School.

The first patent for his invention was issued in April 2019, with broad claims as a treatment option for fear-based disorders. This second U.S. patent, however, has the power to change the way testosterone therapy is used and how anxiety disorders are treated.

Although testosterone is not currently prescribed for anxiety, Josephs hopes that a short-term, fast-acting testosterone product might be prescribed alongside a lower dosage of benzodiazepines — such as Xanax or Klonopin — for treating anxiety disorders such as PTSD and OCD.

“Although benzodiazepines work well, they have strong sedative effects,” Josephs said. “Testosterone is not sedating.”

The aqueous-based nasal spray also addresses a current market need for comfortable, controlled, and fast-acting dosages of testosterone for people struggling with “low T” or a decreased libido. Traditional testosterone supplements, including drops, transdermal creams and gels, injections and subcutaneous “seeds,” can take days and/or multiple doses to reach full potential. Testosterone is in high demand, with prescriptions increasing fivefold since 2011.

The nasal spray (U.S. Patent No. 10,258,63, issued April 16, 2019; U.S. Patent No. 10,751,348, issued Aug. 25, 2020) has been licensed to Acerus Pharmaceuticals Corporation, which has the flexibility under the current agreement to use the technology in whatever medical field it deems most appropriate.

A Chinese patent is also forthcoming, paving the way for the psychology professor’s invention to be available worldwide.

Provided by University of Texas at Austin

How Fear of the Unknown Influences Decision-making (Psychology)

Fear of unknown is a risk factor for addiction.

The dictionary definition of uncertainty is experiencing an unknown, unpredictability, and unfamiliarity. We live in a world filled with uncertainty. It is hard to predict what will happen to us in the future.


The capacity to tolerate unknowns fuel the experience of anxiety and worry. Individuals with high intolerance of uncertainty (IU) are vulnerable to increased worry and distress in the face of uncertainty. Experiencing “what if” questions are common among those who experience severe anxiety, which is a source of impairments in their lives (Carleton, 2016).

Anxiety is an emotion caused by unpredictable potential threats that may occur in the future. Anxiety is potential harm rather than certain harm. Uncertainty impairs our ability to prepare for future events. Anxiety felt in the face of uncertainty can result in maladaptive behaviors such as impulsive decision making and unhealthy behaviors.

Intolerance of uncertainty is a cognitive bias that affects how a person perceives, interprets, and responds to uncertain situations. For example, if you have social anxiety, you are uncertain how you may look asking a question. The negative experience of uncertainty could lead you to exaggerate the threat (e.g., I am going to look stupid and will be humiliated). People who are the most intolerant of uncertainty are more likely to take efforts to try to control the situation or avoid uncertainty (McEvoy & Mahoney, 2012). This explains why a shy student may not volunteer to ask questions.  

Higher IU is associated with a tendency to make hasty decisions to alleviate distress in stressful situations. Waiting in uncertain situations tends to be perceived as highly unpleasant, leading to poor choices (Luhmann et al., 2011). Not surprisingly, IU has been linked to indecisiveness.

Higher IU is a risk factor for developing an addiction if substance abuse is used as a way of coping in the face of unavoidable uncertainty. For example, drinking alcohol is used as an avoidance strategy to cope with worry and distress (Gorka, et al., 2016). Those who have the tendency to find uncertain outcomes distressing and unpleasant are likely to find alcohol use to be highly motivating which sets the stage for continued and escalated drinking (Kraemer et al., 2015).

IU can also lead to an eating disorder in attempts to control the anxiety (Kesby et al., 2109). For instance, women with Anorexia Nervosa (AN) experience significantly higher degrees of IU compared to women with other types of eating disorders. Food restriction in AN may, in part, represent an attempt to avoid the fear of gaining weight and/or obsession with thinness. Thus, the fear of the unknown in individuals with AN represents a vulnerability factor for the inflexible mindset.

The capacity to tolerate unknowns is likely to be determined and maintained by a complex interplay of many factors, such as genes, temperament, and self-efficacy (McEvoy and Mahoney, 2012). Intolerance to uncertainty is a personality trait that runs in the family. A meta-analysis found that 40% of individual differences in personality traits have genetic origins. It is possible that genetic factors predispose one to develop IU. These genes may also interact with environmental factors such as stressful life events, parental neglect, and abusive parenting styles.  

The intolerance of uncertainty also varies with control (or self-efficacy). Control can be thought of as the belief that one has at one’s disposal a response that can influence the aversiveness of an event. People with a high level of fear of unknowns will likely have limited perceptions of self-efficacy, and a greater need for predictability.

In sum, the presence of uncertainty is often unpleasant, and individuals’ reactions vary along a continuum in terms of the extent to which they are comfortable with uncertainty. Research shows that treatments designed to increase acceptance of uncertainty and exposure to uncertainty are successful in increasing tolerance for uncertainty (Olatunji, 2019).

References: (1) Carleton RN (2016). Into the unknown: a review and synthesis of contemporary models involving uncertainty, Journal of Anxiety Disorders, vol. 39, pp. 30–43. (2) Gorka SM, Hee D, Lieberman L, Mittal VA, Phan KL, Shankman SA (2016) Reactivity to uncertain threat as a familial vulnerability factor for alcohol use disorder. Psychol Med 46:3349–3358. (3) Kesby, A., Maguire, S., Vartanian, L.R., Grisham, J.R (2018), Intolerance of uncertainty and eating disorder behaviour: Piloting a consumption task in a non-clinical sample. Journal of Behavior Therapy and Experimental Psychiatry; 65:101492. (4) Kraemer KM, McLeish AC, O’Bryan EM (2105). The role of intolerance of uncertainty in terms of alcohol use motives among college students. Addict. Behav. 42:162–166. (5) Luhmann C, Ishida K, Hajcak G (2011). Intolerance of uncertainty and decisions about delayed, probabilistic rewards. Behav Ther. 42(3):378. (6) McEvoy PM, Mahoney AEJ (2012). To be sure, to be sure: Intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behav Ther.;43(3):533–45. (7) Olatunji BO (2019). The Cambridge Handbook of Anxiety and Related Disorders. Cambridge University Press.

This article is originally written by Shahram Heshmat, who is an associate professor emeritus of health economics of addiction at the University of Illinois at Springfield. This article is republished here from psychology today under common creative licenses

Nightmares Linked With Anxiety And Insomnia In Heart Patients (Cardiology)

Heart patients with weekly nightmares are five times more likely to feel depressed or anxious and even more likely to have difficulty sleeping compared to those without frequent nightmares. That’s the finding of a study published today in the European Journal of Cardiovascular Nursing, a journal of the European Society of Cardiology (ESC).

“Health professionals should ask patients if they experience bad dreams as a warning sign for depression, anxiety, or trouble sleeping,” said Dr. Kohno. “Psychological disorders and insomnia are linked with the development and progression of heart disease and upsetting dreams could be a clue that patients need extra prevention efforts.”

“Our study shows strong associations between depression, anxiety, insomnia, and bad dreams in patients with heart disease,” added study author Dr. Takashi Kohno of Keio University School of Medicine, Tokyo, Japan. “As this was an observational study, it cannot determine the cause-effect relationship, but it may be bidirectional. In other words, depression, anxiety and insomnia may cause nightmares, and nightmares could lead to depression, anxiety and insomnia.”

Previous research has shown that frequent nightmares are associated with sleep and psychological disorders in the general population. This was the first study to investigate this relationship in patients with heart diseases. It also examined whether heart medications were connected with unpleasant dreams.

The study included 1,233 patients admitted with various heart diseases to Keio University Hospital. The average age was 64 years and 25% were women. Nightmares, sleep and psychological characteristics were assessed with self-reported questionnaires and sleep-disordered breathing (when breathing stops and starts during sleep) was measured using overnight pulse oximetry (a measure of blood oxygen levels).

Nearly 15% of patients had at least one nightmare per month, and 3.6% had at least one nightmare per week (defined as frequent nightmares). Women were more likely to have frequent unpleasant dreams compared to men. Some 45.9% of patients reported insomnia, 18.5% had depression, 16.9% had anxiety, and 28.0% had sleep-disordered breathing.

Frequent nightmares were not associated with heart medications and sleep-disordered breathing, but were linked with depression, anxiety, and insomnia. Patients with weekly bad dreams were five times more likely to be depressed (odds ratio [OR]=4.61; 95% confidence interval [CI]=2.03-10.48), five times more likely to be anxious (OR=5.32; 95% CI=2.36-12.01), and seven times more likely to have insomnia (OR=7.15; 95% CI=2.41-21.22).

Dr. Kohno said: “The prevalence of nightmares and frequent nightmares in the general population, reported by other groups, is similar to the experience of heart patients in our study. We showed that in people with heart disease, women are more likely than men to have persistent bad dreams—this also mirrors findings in the general public. The strong associations among frequent nightmares, insomnia, and psychological disorders we observed reflects prior research in healthy people, suggesting that these relationships could be universal regardless of the presence of heart diseases.”

He concluded: “Nightmares may be an alert for underlying psychological or sleep problems that should be addressed to avoid new, or worsening, heart problems. Healthcare professionals should include a question about bad dreams in their assessments.”

References: Horie H, Kohno T, Kohsaka S, et al. Frequent nightmares and its associations with psychological and sleep disturbances in hospitalized patients with cardiovascular diseases. Eur J Cardiovasc Nurs. 2020. DOI: 10.1093/eurjcn/zvaa016

Provided by European Society of Cardiology