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In shaky times, focus on past successes, if overly anxious, depressed

Overly anxious and depressed people’s judgment can improve if they focus on what they get right, instead of what they get wrong.

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The more chaotic things get, the harder it is for people with clinical anxiety and/or depression to make sound decisions and to learn from their mistakes. On a positive note, overly anxious and depressed people’s judgment can improve if they focus on what they get right, instead of what they get wrong, suggests a new UC Berkeley study.

The findings, published in the journal eLife, are particularly salient in the face of a COVID-19 surge that demands tactical and agile thinking to avoid illness and even death.

UC Berkeley researchers tested the probabilistic decision-making skills of more than 300 adults, including people with major depressive disorder and generalized anxiety disorder. In probabilistic decision making, people, often without being aware of it, use the positive or negative results of their previous actions to inform their current decisions.

The researchers found that the study participants whose symptoms intersect with both anxiety and depression — such as worrying a lot, feeling unmotivated or not feeling good about themselves or about the future — had the most trouble adjusting to changes when performing a computerized task that simulated a volatile or rapidly changing environment.

Conversely, emotionally resilient study participants, with few, if any, symptoms of anxiety and depression, learned more quickly to adjust to changing conditions based on the actions they had previously taken to achieve the best available outcomes.

“When everything keeps changing rapidly, and you get a bad outcome from a decision you make, you might fixate on what you did wrong, which is often the case with clinically anxious or depressed people,” said study senior author Sonia Bishop, a professor of neuroscience at UC Berkeley. “Conversely, emotionally resilient people tend to focus on what gave them a good outcome, and in many real-world situations that might be key to learning to make good decisions.”

That doesn’t mean people with clinical anxiety and depression are doomed to a life of bad decisions, Bishop said. For example, individualized treatments, such as cognitive behavior therapy, could improve both decision-making skills and confidence by focusing on past successes, instead of failures, she noted.

The study expands on Bishop’s 2015 study, which found that people with high levels of anxiety made more mistakes when tasked with making decisions during computerized assignments that simulated both stable and rapidly changing environments. Conversely, non-anxious study participants quickly adjusted to the changing patterns in the task.

For this latest study, Bishop and her team looked at whether people with depression would also struggle to make sound decisions in volatile environments and whether this would hold true when challenged with different versions of the task.

“We wanted to see if this weakness was unique to people with anxiety, or if it also presented in people with depression, which often goes hand in hand with anxiety,” Bishop said. “We also sought to find out if the problem was a general one or specific to learning about potential reward or potential threat.

The first experiment involved 86 men and women aged between 18 and 50. The group included people diagnosed with generalized anxiety disorder, major depressive disorder, people who showed symptoms of anxiety or depression, but no formal diagnoses of these disorders, and people with neither anxiety nor depression.

In a laboratory setting, study participants played a game on a computer screen in which they repeatedly chose between two shapes — a circle and a square. One shape, if selected, would deliver a mild to moderate electrical shock, and another would deliver a monetary prize. The probability of a shape delivering a reward or a shock was predictable at some points in the task, and volatile in others. Participants with high levels of symptoms common to depression and anxiety had trouble keeping pace with these changes.

In the second experiment, 147 U.S. adults, with varying degrees of anxiety and depression were recruited via Amazon’s Mechanical Turk crowdsourcing marketplace and given the same task remotely. This time, they chose between red and yellow squares on a screen. They still received monetary rewards, but instead of being penalized with electric shocks, they lost money.

The results echoed those of the in-laboratory outcomes. Overall, having symptoms common to both anxiety and depression predicted who would struggle most with making sound decisions in the face of changing circumstances, regardless of whether they were rewarded or punished for getting things right or wrong, compared to their emotionally resilient counterparts.

“We found that people who are emotionally resilient are good at latching on to the best course of action when the world is changing fast,” Bishop said “People with anxiety and depression, on the other hand, are less able to adapt to these changes. Our results suggest they might benefit from cognitive therapies that redirect their attention to positive, rather than negative, outcomes.”

In addition to Bishop, co-authors of the study are Christopher Gagne at UC Berkeley and the Max Planck Institutes in Germany, and Ondrej Zika and Peter Dayan at the Max Planck Institutes.

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Patients who are overweight or obese at risk of more severe COVID-19

COVID-19 patients with obesity were more likely to require oxygen and had a 73 per cent greater chance of needing invasive mechanical ventilation. Similar but more modest results were seen in overweight patients. No link was found between being overweight or obese and dying in hospital from COVID-19.

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Patients who are overweight or obese have more severe COVID-19 and are highly likely to require invasive respiratory support, according to a new international study.

The research, led by the Murdoch Children’s Research Institute (MCRI) and The University of Queensland and published in Diabetes Care, found obese or overweight patients are at high risk for having worse COVID-19 outcomes. They are also more likely to require oxygen and invasive mechanical ventilation compared to those with a healthy weight.

MCRI researcher Dr Danielle Longmore said the findings, which highlighted the relationship between obesity and increased COVID-19 disease burden, showed the need to urgently introduce strategies to address the complex socio-economic drivers of obesity, and public policy measures such as restrictions on junk food advertising.

“Although taking steps to address obesity in the short-term is unlikely to have an immediate impact in the COVID-19 pandemic, it will likely reduce the disease burden in future viral pandemics and reduce risks of complications like heart disease and stroke,” she said.

The study looked at hospitalised SARS-CoV-2 patients from 18 hospitals in 11 countries including China, America, Italy, South Africa and The Netherlands.

Among the 7244 patients aged 18 years and over, 34.8 per cent were overweight and 30.8 per cent were obese.

COVID-19 patients with obesity were more likely to require oxygen and had a 73 per cent greater chance of needing invasive mechanical ventilation. Similar but more modest results were seen in overweight patients. No link was found between being overweight or obese and dying in hospital from COVID-19.

Cardiovascular and pre-existing respiratory diseases were associated with increased odds of in-hospital deaths but not a greater risk for needing oxygen and mechanical ventilation. For patients with pre-existing diabetes, there was increased odds of needing invasive respiratory support, but no additionally increase in risk in those with obesity and diabetes.

Men were at an increased risk of severe COVID-19 outcomes and needing invasive mechanical ventilation. In those aged over 65 years, there was an increased chance of requiring oxygen and higher rates of in-hospital deaths.

The University of Queensland’s Dr Kirsty Short, who co-led the research, said almost 40 per cent of the global population was overweight or obese.

“Obesity is associated with numerous poor health outcomes, including increased risk of cardiometabolic and respiratory disease and more severe viral disease including influenza, dengue and SARS-CoV-1,” she said.

Dr Short said while previous reports indicated that obesity was an important risk factor in the severity of COVID-19, almost all this data had been collected from single sites and many regions were not represented. Moreover, there was a limited amount of evidence available about the effects of being overweight or obese on COVID-19 severity.

“Given the large scale of this study we have conclusively shown that being overweight or obese are independent risk factors for worse outcomes in adults hospitalised with COVID-19,” she said.

MCRI Professor David Burgner, who co-led the research, said the data would help inform immunisation prioritisation for higher-risk groups.

“At the moment, the World Health Organization has not had enough high-quality data to include being overweight or obese as a risk factor for severe COVID-19 disease. Our study should help inform decisions about which higher-risk groups should be vaccinated as a priority,” he said.

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Omega-3 supplements do double duty in protecting against stress

A high daily dose of an omega-3 supplement may help slow the effects of aging by suppressing damage and boosting protection at the cellular level during and after a stressful event, new research suggests.

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A high daily dose of an omega-3 supplement may help slow the effects of aging by suppressing damage and boosting protection at the cellular level during and after a stressful event, new research suggests.

Researchers at The Ohio State University found that daily supplements that contained 2.5 grams of omega-3 polyunsaturated fatty acids, the highest dose tested, were the best at helping the body resist the damaging effects of stress.

Compared to the placebo group, participants taking omega-3 supplements produced less of the stress hormone cortisol and lower levels of a pro-inflammatory protein during a stressful event in the lab. And while levels of protective compounds sharply declined in the placebo group after the stressor, there were no such decreases detected in people taking omega-3s.

The supplements contributed to what the researchers call stress resilience: reduction of harm during stress and, after acute stress, sustained anti-inflammatory activity and protection of cell components that shrink as a consequence of aging.

The potential anti-aging effects were considered particularly striking because they occurred in people who were healthy but also sedentary, overweight and middle-aged – all characteristics that could lead to a higher risk for accelerated aging.

“The findings suggest that omega-3 supplementation is one relatively simple change people could make that could have a positive effect at breaking the chain between stress and negative health effects,” said Annelise Madison, lead author of the paper and a graduate student in clinical psychology at Ohio State.

The research is published today (Monday, April 19, 2021) in the journal Molecular Psychiatry.

Madison works in the lab of Janice Kiecolt-Glaser, professor of psychiatry and psychology and director of the Institute for Behavioral Medicine Research at Ohio State. This paper is a secondary analysis of one of Kiecolt-Glaser’s earlier studies showing that omega-3 supplements altered a ratio of fatty acid consumption in a way that helped preserve tiny segments of DNA in white blood cells.

Those short fragments of DNA are called telomeres, which function as protective caps at the end of chromosomes. Telomeres’ tendency to shorten in many types of cells is associated with age-related diseases, especially heart disease, and early mortality.

In the initial study, researchers were monitoring changes to telomere length in white blood cells known as lymphocytes. For this new study, the researchers looked at how sudden stress affected a group of biological markers that included telomerase, an enzyme that rebuilds telomeres, because levels of the enzyme would react more quickly to stress than the length of telomeres themselves.

Specifically, they compared how moderate and high doses of omega-3s and a placebo influenced those markers during and after an experimental stressor. Study participants took either 2.5 grams or 1.25 grams of omega-3s each day, or a placebo containing a mix of oils representing a typical American’s daily intake.

After four months on the supplements, the 138 research participants, age 40-85, took a 20-minute test combining a speech and a math subtraction task that is known to reliably produce an inflammatory stress response.

Only the highest dose of omega-3s helped suppress damage during the stressful event when compared to the placebo group, lowering cortisol and a pro-inflammatory protein by an average of 19% and 33%, respectively.

Results from blood samples showed that both doses of omega-3s prevented any changes in telomerase levels or a protein that reduces inflammation in the two hours after participants experienced the acute stress, meaning any needed stress-related cell repair – including telomere restoration – could be performed as usual. In the placebo group, those repair mechanisms lost ground: Telomerase dropped by an average of 24% and the anti-inflammatory protein decreased by an average of at least 20%.

“You could consider an increase in cortisol and inflammation potential factors that would erode telomere length,” Madison said. “The assumption based on past work is that telomerase can help rebuild telomere length, and you want to have enough telomerase present to compensate for any stress-related damage.

“The fact that our results were dose-dependent, and we’re seeing more impact with the higher omega-3 dose, would suggest that this supports a causal relationship.”

The researchers also suggested that by lowering stress-related inflammation, omega-3s may help disrupt the connection between repeated stress and depressive symptoms. Previous research has suggested that people with a higher inflammatory reaction to a stressor in the lab may develop more depressive symptoms over time.

“Not everyone who is depressed has heightened inflammation – about a third do. This helps explain why omega-3 supplementation doesn’t always result in reduced depressive symptoms,” Kiecolt-Glaser said. “If you don’t have heightened inflammation, then omega-3s may not be particularly helpful. But for people with depression who do, our results suggest omega-3s would be more useful.”

The 2.5-gram dose of omega-3s is much higher than what most Americans consume on a daily basis, but study participants showed no signs of having problems with the supplements, Madison said.

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Heart patients advised to move more to avoid heart attacks and strokes

To prevent heart disease, European guidelines recommend at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous intensity aerobic physical activity or an equivalent combination.

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Elevated blood pressure, high cholesterol and diabetes increase the risk of heart disease. But a large study today reveals that in people with these conditions, increasing activity levels is associated with a reduced likelihood of heart events and mortality. The research is presented at ESC Preventive Cardiology 2021, an online scientific congress of the European Society of Cardiology (ESC).

Study author Dr. Esmée Bakker of Radboud University Medical Center, Nijmegen, the Netherlands said: “Previous research showed that improvements in physical activity are beneficial to health. However, those studies were performed in the general population. In our study, we were interested to see if there were similar effects in individuals with cardiovascular risk factors such as high blood pressure, high cholesterol, and diabetes.”

The study included 88,320 individuals from the LifeLines Cohort Study. Participants underwent a physical examination and completed questionnaires about their medical history and lifestyle including exercise. The questionnaires were repeated after approximately four years.

Study participants were divided into five groups according to activity levels at baseline and four years: large reduction, moderate reduction, no change, moderate improvement, and large improvement. Participants were followed-up for a median of seven years after the first assessment for the occurrence of cardiovascular disease or death.

A total of 18,502 (21%) individuals had high blood pressure, high cholesterol, and/or diabetes at the start of the study. The average age of this group was 55 years. After adjusting for age, sex, and baseline physical activity, the researchers found that those with a moderate to large improvement in physical activity were around 30% less likely to develop cardiovascular disease or die during follow-up compared to those who did not change their activity level.

The remaining 69,808 (79%) participants did not have high blood pressure, high cholesterol, or diabetes at the start of the study. The average age of this group was 43 years. After adjusting for age, sex, and baseline physical activity, the researchers found that those with large reductions in physical activity had a 40% higher risk of cardiovascular disease or death compared to those who did not change their activity level.

Dr. Bakker said: “Our study suggests that to prevent heart attacks and strokes and boost longevity, healthy individuals should maintain their physical activity levels, while those with risk factors need to become more active. The associations we found were even more pronounced in people who were relatively sedentary at the start of the study, indicating that inactive people have the most to gain.”

To prevent heart disease, European guidelines recommend at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous intensity aerobic physical activity or an equivalent combination.

Dr. Bakker said: “If you are currently sedentary, walking is a good activity to start with. If you are already hitting the recommended amount, try doing 10 minutes more each day or increasing the intensity.”

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