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BackgroundGeneralized anxiety disorder (GAD) is characterized by excessive worry that is difficult to control and has high comorbidity with mood disorders including depression. Individuals experience long wait times for diagnosis and often face accessibility barriers to treatment. There is a need for a digital solution that is accessible and acceptable to those with GAD. ObjectiveThis paper aims to describe the development of a digital intervention prototype of acceptance and commitment therapy (ACT) for GAD that sits within an existing well-being app platform, BioBase. A pilot feasibility study evaluating acceptability and usability is conducted in a sample of adults with a diagnosis of GAD, self-referred to the study. MethodsPhase 1 applied the person-based approach (creation of guiding principles, intervention design objectives, and the key intervention features). In Phase 2 participants received the app-based therapeutic and paired wearable for 2 weeks. Self-report questionnaires were obtained at baseline and posttreatment. The primary outcome was psychological flexibility (Acceptance and Action Questionnaire-II [AAQ-II]) as this is the aim of ACT. Mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) and symptoms of anxiety (7-item Generalized Anxiety Disorder Assessment [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were also assessed. Posttreatment usability was assessed via self-report measures (System Usability Scale [SUS]) in addition to interviews that further explored feasibility of the digital intervention in this sample. ResultsThe app-based therapeutic was well received. Of 13 participants, 10 (77%) completed the treatment. Results show a high usability rating (83.5). Participants found the digital intervention to be relevant, useful, and helpful in managing their anxiety. Participants had lower anxiety (d=0.69) and depression (d=0.84) scores at exit, and these differences were significantly different from baseline (P=.03 and .008 for GAD-7 and PHQ-9, respectively). Participants had higher psychological flexibility and well-being scores at exit, although these were not significantly different from baseline (P=.11 and .55 for AAQ-II and WEMWBS, respectively). ConclusionsThis ACT prototype within BioBase is an acceptable and feasible digital intervention in reducing symptoms of anxiety and depression. This study suggests that this intervention warrants a larger feasibility study in adults with GAD.

BackgroundThe prevalence of workplace-related stress and anxiety is high, resulting in stress-related physical and mental illness. Digital self-guided interventions aimed at key areas of workplace design may be able to provide remote anxiolytic effects. ObjectiveThe aim of this feasibility study is to assess changes in anxiety and mental well-being after use of the BioBase programme, a mobile phone platform for psycho-educational modules, tools, and real-time feedback of physiological data. MethodsA 4-week observational study was carried out in 55 healthy adults who were screened for stress with the Depression Anxiety Stress Scale (DASS) Stress subscale. Participants completed anxiety (6-item State-Trait Anxiety Inventory [STAI]) and mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) questionnaires at baseline and at 4 weeks. Feedback questionnaires were administered after 4 weeks. ResultsAfter 4 weeks of using the programme and controlling for any effect of being paid to take part in the study, STAI significantly decreased (baseline mean 45.52 [SD 13.2]; 4-week mean 39.82 [SD 11.2]; t54=–3.51; P

BackgroundUniversity students in the United Kingdom are experiencing increasing levels of anxiety. A program designed to increase awareness of one’s present levels of well-being and suggest personalized health behaviors may reduce anxiety and improve mental well-being in students. The efficacy of a digital version of such a program, providing biofeedback and therapeutic content based on personalized well-being metrics, is reported here. ObjectiveThe aim of this study was to test the efficacy and sustained effects of using a mobile app (BioBase) and paired wearable device (BioBeam), compared with a waitlist control group, on anxiety and well-being in university students with elevated levels of anxiety and stress. MethodsThe study employed a randomized, waitlist-controlled trial with assessments at baseline, 2 weeks, postintervention (4 weeks), and follow-up (6 weeks). Participants were eligible if they were current full-time undergraduate students and (1) at least 18 years of age, (2) scored >14 points on the Depression, Anxiety, and Stress Scale-21 items (DASS-21) stress subscale or >7 points on the DASS-21 anxiety subscale, (3) owned an iOS mobile phone, (4) did not have any previous psychiatric or neurological conditions, (6) were not pregnant at the time of testing, and (7) were able to read and understand English. Participants were encouraged to use BioBase daily and complete at least one course of therapeutic content. A P value ≤.05 was considered statistically significant. ResultsWe found that a 4-week intervention with the BioBase program significantly reduced anxiety and increased perceived well-being, with sustained effects at a 2-week follow-up. Furthermore, a significant reduction in depression levels was found following the 4-week usage of BioBase. ConclusionsThis study shows the efficacy of a biofeedback digital intervention in reducing self-reported anxiety and increasing perceived well-being in UK university students. Results suggest that digital mental health interventions could constitute a novel approach to treat stress and anxiety in students, which could be combined or integrated with existing therapeutic pathways. Trial RegistrationOpen Science Framework (OSF.io) 2zd45; https://osf.io/2zd45/

Unemployment and underemployment have consistently been shown to be higher in autistic adults relative to non-autistic adults. This may be due, in part, to a lack of workplace accommodations being made for autistic people. One factor that may contribute to employment inequalities in autistic people is differences in attitudes towards interpersonal touch. This study acts as a preliminary investigation into whether employed autistic and non-autistic participants differ in their attitudes towards touch in the workplace, and in their loneliness and wellbeing. The current dataset was drawn from a larger online survey (the Touch Test) designed to explore attitudes and experiences towards touch. We found that employed autistic participants had more negative attitudes to general, social and workplace touch relative to non-autistic participants. Autistic participants also experienced greater loneliness and reduced wellbeing. Attachment-related anxiety was the only significant predictor of wellbeing in employed autistic adults. However, attachment-related anxiety, general attitudes to touch and the role of touch in the workplace predicted wellbeing in employed non-autistic adults. With regards to loneliness, general attitudes to touch and the role of touch in the workplace predicted loneliness in autistic participants. We also replicated the finding that a greater proportion of autistic participants were unemployed relative to non-autistic participants. Collectively, this research highlights the importance of considering touch in research investigating employment, and its impact on loneliness and wellbeing, in autistic participants., Author(s): Tegan Penton [sup.1] , Natalie Bowling [sup.2] , Aikaterini Vafeiadou [sup.1] , Claudia Hammond [sup.3] , Geoffrey Bird [sup.4] [sup.5] , Michael J Banissy [sup.1] [sup.6] Author Affiliations: (1) [...]

Despite the heterogeneity in autism, socioemotional difficulties are often framed as universal. Increasing evidence, however, suggests that socioemotional difficulties may be explained by alexithymia, a distinct yet frequently co-occurring condition. If, as some propose, autistic traits are responsible for socioemotional impairments, then alexithymia may itself be a symptom of autism. We aimed to determine whether alexithymia should be considered a product of autism or regarded as a separate condition. Using factor-analytic and network approaches, we provide evidence that alexithymic and autistic traits are distinct. We argue that: (1) models of socioemotional processing in autism should conceptualise difficulties as intrinsic to alexithymia; and (2) assessment of alexithymia is crucial for diagnosis and personalised interventions.

Gaze direction is an important stimulus that signals key details about social (dis)engagement and objects in our physical environment. Here, we explore how gaze direction influences the perceiver's processing of bodily information. Specifically, we examined how averted versus direct gaze modifies the operation of effector-centered representations (i.e., specific fingers) versus movement-centered representations (i.e., finger actions). Study 1 used a stimulus-response compatibility paradigm that tested the priming of a relevant effector or relevant movement, after observing videos of direct or averted gaze. We found a selective priming of relevant effectors, but only after averted gaze videos. Study 2 found similar priming effects with symbolic direction cues (averted arrows). Study 3 found that averted gaze cues do not influence generic spatial compatibility effects, and thus, are specific to body representations. In sum, this research suggests that both human and symbolic averted cues selectively prime relevant body-part representations, highlighting the dynamic interplay between our bodies, minds, and environments.

It has been argued that autistic individuals have difficulties with face memory but typical face perception. However, only one previous study has examined both face memory and face perception in the same individuals, and this study was conducted with a small group of autistic children. Here, face recognition was examined with a group of autistic adults using two face perception tasks (including one designed to avoid a neurotypical bias) and a standard test of face memory. Self-reported face recognition difficulties in everyday life were also recorded. The group of adults with autism scored lower than a matched neurotypical control group on all face tasks and reported more problems with face recognition in everyday life. On the whole, results suggest difficulties with both face perception and face memory in autistic adults, although it should be noted that a wide range of scores were recorded from the autistic individuals, with some scoring in the neurotypical range.

A new task ('CARER') was used to test claims of reduced empathy in autistic adults. CARER measures emotion identification (ability to identify another's affective state), affective empathy (degree to which another's affective state causes a matching state in the Empathiser) and affect sharing (degree to which the Empathiser's state matches the state they attribute to another). After controlling for alexithymia, autistic individuals showed intact affect sharing, emotion identification and affective empathy. Results suggested reduced retrospective socio-emotional processing, likely due to a failure to infer neurotypical mental states. Thus, autism may be associated with difficulties inferring another's affective state retrospectively, but not with sharing that state. Therefore, when appropriate measures are used, autistic individuals do not show a lack of empathy.

The reduced efficacy of voluntary imitation in autism is suggested to be underpinned by differences in sensorimotor processing. We examined whether the imitation of novel atypical biological kinematics by autistic adults is enhanced by imitating a model in a predictable blocked practice trial order. This practice structure is expected to facilitate trial-totrial sensorimotor processing, integration and encoding of biological kinematics. The results showed that neurotypical participants were generally more effective at imitating the biological kinematics across all experimental phases. Importantly, and compared to a pre-test where imitation was performed in a randomised (unpredictable) trial order, the autistic participants learned to imitate the atypical kinematics more effectively following an acquisition phase of repeatedly imitating the same model during blocked practice. Data from the post-test showed that autistic participants remained effective at imitating the atypical biological kinematics when the models were subsequently presented in a randomised trial order. These findings show that the reduced efficacy of voluntary imitation in autism can be enhanced during learning by facilitating trial-to-trial processing and integration of sensorimotor information using blocked practice.

The perception of subsecond durations in adults with autism spectrum disorder (hereafter 'autism'; n = 25 Experiment 1, n = 21 Experiment 2) and matched typical adults (n = 24 Experiment 1, n = 22 Experiment 2) was examined by requiring participants to perform an action in time with auditory (Experiment 1) or visual (Experiment 2) events. Individuals with autism performed comparably to typical participants in the auditory task and exhibited less temporal error relative to their typical counterparts in the visual task. These findings suggest that perception of subsecond intervals is intact in autism, if not enhanced. Results support recent Bayesian theories of enhanced visual-perceptual precision in people with autism, and extend empirical support into the precision of subsecond temporal estimates.

Theories of emotion ascribe a fundamental role to the processing of bodily signals (interoception) in emotional experience. Despite evidence consistent with this, current knowledge is limited by a focus on interoceptive accuracy and laboratory-based interoception measures. This experience-sampling study examines how state interoceptive attention and state emotional experience are related in everyday life, providing the first data to our knowledge examining: (1) within-subject fluctuations in interoceptive attention across domains, and (2) the relationship between trait and state interoception. Compared with rates of exteroceptive attention (auditory attention: engaged 83% of the time), interoceptive signals captured attention approximately 20% of the time, with substantial within- and between-person variability across domains. There were relationships between interoceptive attention and emotion in daily life (greater attention being associated with more negative valence and fatigue) that were specific to interoceptive attention (different patterns were observed with exteroceptive attention). State measures of interoceptive (but not exteroceptive) attention were correlated with the trait interoceptive attention, but not accuracy. Results underscore the relationship between interoceptive attention and emotion, providing new insights into interoceptive attention and the structure of interoceptive ability. Future research should examine the source(s) of within- and between-person variability in interoceptive and exteroceptive attention and its relationship with emotional experience. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'. [ABSTRACT FROM AUTHOR]

ObjectiveTo describe the clinical epidemiology of extubation failure in a multicenter cohort of patients treated in pediatric cardiac ICUs.DesignRetrospective cohort study using prospectively collected clinical registry data.SettingPediatric Cardiac Critical Care Consortium registry.PatientsAll patients admitted to the CICU at Pediatric Cardiac Critical Care Consortium hospitals.InterventionsNone.Measurements and main resultsAnalysis of all mechanical ventilation episodes in the registry from October 1, 2013, to July 31, 2014. The primary outcome of extubation failure was reintubation less than 48 hours after planned extubation. Repeated-measures analysis using generalized estimating equations to account for within patient and center correlation was performed to identify risk factors for extubation failure. Adjusted extubation failure rates for each hospital were calculated using logistic regression controlling for patient factors. Of 1,734 mechanical ventilation episodes (1,478 patients at eight hospitals) ending in a planned extubation, there were 100 extubation failures (5.8%). In multivariable analysis, only longer duration of mechanical ventilation was significantly associated with extubation failure (p = 0.01); the failure rate was 4% when ventilated less than 24 hours, 9% after 24 hours, and 13% after 7 days. For 503 patients intubated and extubated in the cardiac operating room, 15 patients (3%) failed extubation within 48 hours (12 within 24 hr). Case-mix-adjusted extubation failure rates ranged from 1.1% to 9.8% across hospitals. Patients failing extubation had greater median cardiac ICU length of stay (15 vs 3 d; p < 0.001) and in-hospital mortality (7.9 vs 1.2%; p < 0.001).ConclusionsThough extubation failure is uncommon overall, there may be opportunities to improve extubation readiness assessment in patients ventilated more than 24 hours. These data suggest that extubation in the operating room after cardiac surgery can be done with a low failure rate. We observed variation in extubation failure rates across hospitals, and future investigation must elucidate the optimal strategies of high-performing centers to reduce ventilation time while limiting extubation failures.

Accumulating evidence indicates that co-occurring alexithymia underlies several facets of the social-emotional difficulties common in individuals with autism spectrum disorder. The mechanisms involved, however, remain poorly understood because measuring alexithymia relies heavily on self-report. To address this issue, carefully matched groups of individuals with autism spectrum disorder and comparison participants rated 70 emotion-inducing pictures on subjectively experienced arousal while skin conductance responses were monitored objectively. The results demonstrated reliable correlations between these subjective and objective measures, and in both groups, around 25% of individual differences in this correlation (i.e. in emotion-relevant interoception) were accounted for by self-reported alexithymia. In the context of the wider literature, this suggests that alexithymia involves a disruption in how physiological arousal modulates the subjective experience of feelings in those with and without a diagnosis of autism spectrum disorder. Since mindfulness-based therapies foster greater awareness of thoughts, feelings and bodily sensations, the findings also have implications for how the symptoms and consequences of alexithymia (e.g. anxiety) might be ameliorated.