Purpose: We investigated the effects of threat and trait anxiety on state anxiety and how that affects police officers’ actions during an arrest. Most experiments on police performance under anxiety test the performance of one particular skill. Yet, police work often involves concerted use of a combination of skills. Methods: We created situations – with two different levels of threat – in which officers had to choose and initiate their actions to control and arrest a non-cooperative suspect. We examined whether threat, trait anxiety and state anxiety influenced decision-making (e.g., choosing the appropriate actions) and performance (e.g., quality of communication and the execution of skills). Results: Trait anxiety affected the level of state anxiety, but not any of the decision-making and performance variables. As for decision-making, results showed that only threat determined which action officers took to gain control over the suspect. As for performance, higher levels of state anxiety were accompanied by lower scores of overall performance, communication, proportionality of applied force and quality of skill execution. Conclusion: It is concluded that state anxiety not only impairs performance of single perceptual-motor tasks, but also relevant accompanying skills such as communicating and applying appropriate force. We argue that police training should focus on an integrated set of decision-making and perceptual-motor skills and not just on the performance of isolated motor skills.
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When the pressure is on and anxiety levels increase it is not easy to perform well. In search of mechanisms explaining the anxiety-performance relationship, we revisit the integrated model of anxiety and perceptual-motor performance (Nieuwenhuys and Oudejans, 2012) and provide a critical review of contemporary literature. While there is increasing evidence that changes in attentional control affect the execution of goal-directed action, based on our model and emerging evidence from different scientific disciplines, we argue for a more integrated, process-based approach. That is, anxiety can affect performance on different levels of operational control (i.e., attentional, interpretational, physical) and - moving beyond the execution of action - have implications for different aspects of perceptual-motor behavior, including situational awareness and decision making.
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Purpose: Law enforcement may require police officers to inhibit intuitive responses to high threat and thereby affect their emotional reaction and operational effectiveness. Upon this premise, the current study reports two experiments which compare the impact of two relevant shot execution strategies on police officers’ shooting performance under high threat, including (1) fire at an armed assailant and then step away from the assailant's line of fire (‘fire-step’) or (2) step away from the assailant's line of fire and then fire (‘step-fire’). Method: In Experiment 1, 15 experienced police officers performed both shot execution strategies against a stationary assailant who occasionally shot back with coloured soap cartridges (high threat), while we measured their state anxiety, movement times and shot accuracy. In Experiment 2, the same 15 officers remained stationary and fired at the assailant who now performed both shot execution strategies in random order, thereby providing an indication of the risk (i.e., chance to get hit) associated with performing either strategy. Results: Experiment 1 showed that officers preferred using the step-fire strategy and that using this strategy resulted in lower levels of anxiety, increased time for aiming and more accurate shooting than the fire-step strategy. Experiment 2, however, indicated that the step-fire strategy also increases one's chance of getting hit. Conclusions: Findings suggest that inhibition of preferred responses under high threat (as in the fire-step strategy) may increase state anxiety and negatively affect shooting performance in police officers. Future work is needed to reveal underlying mechanisms and explore implications for practice.
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This article describes musicians' lifelong and lifewide learning as it was investigated through biographical research. Key developments in the professional lives of 32 musicians were examined, focusing on critical incidents and educational interventions in their life, educational and career span. The main thread was the question of how these musicians learn. After analysis, three conceptual entities were established in the biographies, the first being musicians' artistic, generic and educational leadership; second, the interconnection between their varied learning styles; and third, their need for an adaptive and responsive learning environment within a reflexive and reflective institutional culture. Two biographical examples of musicians suffering from performance anxiety are described, focusing on their leadership, learning styles and subsequent transformative and transitional learning when developing coping strategies. The article concludes with directions for teaching and learning that can be extrapolated from the findings of biographical research.
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Objective: To examine the underlying factor structure and psychometric properties of the Assessment of Self-management in Anxiety and Depression (ASAD) questionnaire, which was specifically designed for patients with (chronic) anxiety and depressive disorders. Moreover, this study assesses whether the number of items in the ASAD can be reduced without significantly reducing its precision. Methods: The ASAD questionnaire was completed by 171 participants across two samples: one sample comprised patients with residual anxiety or depressive symptoms, while the other consisted of patients who have been formally diagnosed with a chronic anxiety or depressive disorder. All participants had previously undergone treatment. Both exploratory (EFA) and confirmatory factor analyses (CFA) were conducted. Internal consistency and test–retest reliability were also assessed. Results: Both EFA and CFA indicated three solid factors: Seeking support, Daily life strategies and Taking ownership [Comparative Fit Index = 0.80, Tucker Lewis Index = 0.78, Root Mean Square Error of Approximation = 0.09 (CI 0.08–1.00), Standardized Root Mean Square Residual = 0.09 ($2 = 439.35, df = 168)]. The ASAD was thus reduced from 45 items to 21 items, which resulted in the ASAD-Short Form (SF). All sub-scales had a high level of internal consistency (> a = 0.75) and test–retest reliability (ICC > 0.75). Discussion: The first statistical evaluation of the ASAD indicated a high level of internal consistency and test–retest reliability, and identified three distinctive factors. This could aid patients and professionals’ assessment of types of self-management used by the patient. Given that this study indicated that the 21-item ASAD-SF is appropriate, this version should be further explored and validated among a sample of patients with (chronic or partially remitted) anxiety and depressive disorders. Alongside this, to increase generalizability, more studies are required to examine the English version of the ASAD within other settings and countries.
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Abstract Objectives The aim of this review is to establish the effectiveness of psychological relapse prevention interventions, as stand-alone interventions and in combination with maintenance antidepressant treatment (M-ADM) or antidepressant medication (ADM) discontinuation for patients with remitted anxiety disorders or major depressive disorders (MDD). Methods A systematic review and a meta-analysis were conducted. A literature search was conducted in PubMed, PsycINFO and Embase for randomised controlled trials (RCTs) comparing psychological relapse prevention interventions to treatment as usual (TAU), with the proportion of relapse/recurrence and/or time to relapse/recurrence as outcome measure. Results Thirty-six RCTs were included. During a 24-month period, psychological interventions significantly reduced risk of relapse/recurrence for patients with remitted MDD (RR 0.76, 95% CI: 0.68–0.86, p<0.001). This effect persisted with longer follow-up periods, although these results were less robust. Also, psychological interventions combined with M-ADM significantly reduced relapse during a 24-month period (RR 0.76, 95% CI: 0.62–0.94, p = 0.010), but this effect was not significant for longer follow-up periods. No meta-analysis could be performed on relapse prevention in anxiety disorders, as only two studies focused on relapse prevention in anxiety disorders. Conclusions In patients with remitted MDD, psychological relapse prevention interventions substantially reduce risk of relapse/recurrence. It is recommended to offer these interventions to remitted MDD patients. Studies on anxiety disorders are needed.
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Young professional dancers find themselves in a demanding environment. GJH within dancers is often seen as aesthetically beneficial and a sign of talent but was found to be potentially disabling. Moreover, high-performing adolescents and young adults (HPAA), in this specific lifespan, might be even more vulnerable to anxiety-related disability. Therefore, we examined the development of the association between the presence of Generalized Joint Hypermobility (GJH) and anxiety within HPAA with a one-year follow-up. In 52.3% of the HPAA, anxiety did not change significantly over time, whereas GJH was present in 28.7%. Fatigue increased significantly in all HPAA at one year follow-up (respectively, females MD (SD) 18(19), p < 0.001 and males MD (SD) 9(19), p < 0.05). A significantly lower odds ratio (ß (95% CI) 0.4 (0.2–0.9); p-value 0.039) for participating in the second assessment was present in HPAA with GJH and anxiety with a 55% dropout rate after one year. This confirms the segregation between GJH combined with anxiety and GJH alone. The fatigue levels of all HPAA increased significantly over time to a serious risk for sick leave and work disability. This study confirms the association between GJH and anxiety but especially emphasizes the disabling role of anxiety. Screening for anxiety is relevant in HPAA with GJH and might influence tailored interventions.
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The purpose of this article is the presentation of a multidimensional guideline for the diagnosis of anxiety and anxiety-related behavior problems in people with intellectual disability (ID), with a substantial role for the nurse in this diagnostic process. DESIGN AND METHODS: The guideline is illustrated by a case report of a woman with ID with severe problems. FINDINGS: It appears that a multidimensional diagnostic approach involving multidisciplinary team efforts can result in a more accurate diagnosis and improved subsequent treatment. PRACTICE IMPLICATIONS: Nurses should be engaged in the diagnostic process because of their ability to make direct observations and to actively participate in carrying out all parts of the guideline.
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Let op het is Open Access maar met speciale Elsevier user rights, zie https://www.elsevier.com/about/policies/open-access-licenses/elsevier-user-license Background The presence of a comorbid borderline personality disorder (BPD) may be associated with an increase of suicidal behaviors in patients with depressive and anxiety disorders. The aim of this study is to examine the role of borderline personality traits on recurrent suicide attempts. Methods The Netherlands Study on Depression and Anxiety included 1838 respondents with lifetime depressive and/or anxiety disorders, of whom 309 reported at least one previous suicide attempt. A univariable negative binomial regression analysis was performed to examine the association between comorbid borderline personality traits and suicide attempts. Univariable and multivariable negative binomial regression analyses were performed to identify risk factors for the number of recurrent suicide attempts in four clusters (type and severity of axis-I disorders, BPD traits, determinants of suicide attempts and socio-demographics). Results In the total sample the suicide attempt rate ratio increased with 33% for every unit increase in BPD traits. A lifetime diagnosis of dysthymia and comorbid BPD traits, especially the symptoms anger and fights, were independently and significantly associated with recurrent suicide attempts in the final model (n=309). Limitations The screening of personality disorders was added to the NESDA assessments at the 4-year follow-up for the first time. Therefore we were not able to examine the influence of comorbid BPD traits on suicide attempts over time. Conclusions Persons with a lifetime diagnosis of dysthymia combined with borderline personality traits especially difficulties in coping with anger seemed to be at high risk for recurrent suicide attempts. For clinical practice, it is recommended to screen for comorbid borderline personality traits and to strengthen the patient's coping skills with regard to anger.
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Background: Existing studies have yet to investigate the perspectives of patients and professionals concerning relapse prevention programs for patients with remitted anxiety or depressive disorders in primary care. User opinions should be considered when optimizing the use and implementation of interventions. Objective: This study aimed to evaluate the GET READY relapse prevention programs for patients with remitted anxiety or depressive disorders in general practice. Methods: Semistructured interviews (N=26) and focus group interviews (N=2) with patients and mental health professionals (MHPs) in the Netherlands were performed. Patients with remitted anxiety or depressive disorders and their MHPs who participated in the GET READY study were interviewed individually. Findings from the interviews were tested in focus group interviews with patients and MHPs. Data were analyzed using thematic analysis. Results: Participants were positive about the program because it created awareness of relapse risks. Lack of motivation, lack of recognizability, lack of support from the MHP, and symptom severity (too low or too high) appeared to be limiting factors in the use of the program. MHPs play a crucial role in motivating and supporting patients in relapse prevention. The perspectives of patients and MHPs were largely in accordance, although they had different perspectives concerning responsibilities for taking initiative. Conclusions: The implementation of the GET READY program was challenging. Guidance from MHPs should be offered for relapse prevention programs based on eHealth. Both MHPs and patients should align their expectations concerning responsibilities in advance to ensure optimal usage. Usage of blended relapse prevention programs may be further enhanced by diagnosis-specific programs and easily accessible support from MHPs.
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