Expressed emotion and airway conductance in children with bronchial asthma

Central nervous system signatures of affect in asthma: associations with emotion-induced bronchoconstriction, airway inflammation, and asthma control

The effects of asthma on affect have been noted for some time, but little is known about associated brain processes. We therefore examined whether emotion-induced bronchoconstriction, airway inflammation, and asthma control are related to specific patterns of brain activity during processing negative affective stimuli. Fifteen adults with asthma viewed alternating blocks of distressing film clips (negative condition), affectively neutral film clips (neutral condition), and a crosshair image (baseline condition) while undergoing blood oxygenation level-dependent (BOLD) functional MRI (fMRI). Block-design fMRI analysis evaluated the BOLD response to "negative-baseline" and "neutral-baseline" contrasts. Airway response to these film clips was also assessed with impulse oscillometry in a separate session. Measures of airway inflammation [fractional exhaled nitric oxide (FE_NO)] and asthma control [Asthma Control Questionnaire (ACQ)] were additionally obtained. A whole brain voxel-based regression analysis of contrast maps was performed against respiratory resistance increase during negative and neutral films, FE_NO, and ACQ. Peak airway obstruction to negative affective stimulation was associated with stronger activation of the anterior and middle cingulate gyrus, including the dorsal anterior cingulate cortex (dACC). Stronger airway inflammation and lower asthma control were associated with reduced activation to negative stimuli in the superior frontal gyrus, middle cingulate gyrus, and supplementary motor area. Activation of the dACC in negative-affect-induced airway obstruction could be part of an integrated defensive response to critical environmental change. In addition, reduced frontal and limbic activation during processing of negative affect may reflect consequences of pathophysiological processes for CNS functioning. NEW & NOTEWORTHY This functional magnetic resonance imaging study shows, for the first time, that the degree of airway constriction due to negative affective stimuli in asthma is associated with stronger response to these stimuli in the dorsal anterior and middle cingulate cortex. Asthma patients with stronger airway inflammation and reduced asthma control also show reduced activation in a number of cortical and subcortical areas relevant for affective processing and breathing control.

Effects of acute psychological stress induced in laboratory on physiological responses in asthma populations: A systematic review

BACKGROUND

Psychological stress has long been suspected to have a deleterious effect on asthma, with acute psychological stress being associated with physiological responses in asthma patients.

OBJECTIVES

The purpose of this systematic review was to provide a narrative synthesis of the impact of acute laboratory psychological stress on physiological responses among asthma patients.

METHODS

An extensive search was conducted by two independent authors using Pubmed, PsycINFO, PsyArticles and the Cochrane Library electronic databases (up to September 2016). English and French articles which assessed physiological responses during or post-stress and compare them to baseline or pre-stress values were included.

RESULTS

Thirty-two studies met the inclusion criteria. Studies indicated that exposure to active stressors (e.g., arithmetic tasks) was associated with an increase in sympathetic nervous system (SNS) responses, cortisol, and inflammatory responses, but had little effect on the caliber of the bronchi. Exposure to passive stressors (e.g., watching stressful movies or pictures) was also associated with an increase in SNS responses and with mild bronchoconstriction. However, a paucity of data for passive stressors limited conclusions on other measures.

CONCLUSIONS

In patients with asthma, both active and passive stressors seem to be associated with an increased activation of the SNS. Passive stressors seem to have a more immediate, deleterious impact on the airways than active stressors, but the latter may be associated with delayed inflammatory driven an asthma exacerbation. Further studies are needed to understand the impact of acute stressors on the physiological mechanisms associated with asthma, particularly HPA and immune markers. Systematic review registration number: CRD42015026431.

Current perspectives on symptom perception in asthma: a biomedical and psychological review

Symptom perception in patients with asthma is often inadequate. Patients may fail to perceive serious airway obstruction or suffer from breathlessness without objective cause. These extremes are associated with fatal asthma and excessive use of medicines, respectively. This article covers symptom perception in a multidisciplinary perspective. A presentation of current definitions and methods for studying symptom perception in asthma is followed by a summary of theories on the origin of breathlessness. Next, biomedical and psychological factors influencing symptom perception are examined. Preliminary biomedical research emphasizes neural pathway impairment, but causal factors remain inconclusive, particularly regarding the overperception of symptoms. Psychological studies suggest that the accuracy of symptom perception is influenced by (a) competition between asthmatic and nonasthmatic sensory information, (b) negative emotions, and (c) acquired response tendencies (e.g. habituation to symptoms, repression of symptoms, selective perception, and false interpretation of symptoms). These factors may favor either blunted perception or overperception. Empirical data in support of psychological factors are still insufficient. Methodological problems and procedures to improve symptom perception are discussed.

Psychological aspects of asthma

Asthma can be affected by stress, anxiety, sadness, and suggestion, as well as by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders. Asthma and these psychological states and traits may mutually potentiate each other through direct psychophysiological mediation, nonadherence to medical regimen, exposure to asthma triggers, and inaccuracy of asthma symptom perception. Defensiveness is associated with inaccurate perception of airway resistance and stress-related bronchoconstriction. Asthma education programs that teach about the nature of the disease, medications, and trigger avoidance tend to reduce asthma morbidity. Other promising psychological interventions as adjuncts to medical treatment include training in symptom perception, stress management, hypnosis, yoga, and several biofeedback procedures.

Symptom perception in asthma: a multidisciplinary review

Clinical observations and research show that symptom perception in asthma is, at worst, inaccurate or often biased in two directions: (1) blunted perception, (2) overperception (both involving airway obstruction manifested in low or high breathlessness). Theoretically breathlessness occurs during respiratory labor or blood gas changes. However, pathophysiological factors and asthma severity are inconsistently related to perceptual accuracy. Consequently, symptom perception within the biomedical perspective is not well understood. Possible psychological influences, varying from the stimulus level to emotions and high-order reasoning, are discussed.

Psychophysiologic reactivity in asthmatic children: a cholinergically mediated confluence of pathways

OBJECTIVE

The purpose of this study was to determine the suitability of a newly developed experimental paradigm, designed to assess relationships among emotional responsivity, physiologic (autonomic) reactivity, airway reactivity, and pulmonary function in asthmatic children under controlled conditions of ecologically valid emotional stimulation.

METHOD

Twenty-four children, aged 8 through 17, with moderate to severe asthma viewed the movie, E.T., the Extra-Terrestrial, while having their heart and respiration rate and oxygen saturation continuously measured and recorded. Airway reactivity was assessed by the methacholine challenge test, and pre- and postmovie pulmonary function by spirometry. Self-report of emotion was recorded for targeted scenes.

RESULTS

Findings indicated that emotional responsivity and physiologic reactivity to the movie were associated with increased airway reactivity and with decreased pulmonary function.

CONCLUSIONS

The pattern of results suggests cholinergically mediated psychophysiologic pathways of emotional influence in the asthmatic process for some asthmatic children. A heuristic biopsychosocial model of these pathways is presented.

Irrational beliefs and emotionality in adolescents with and without bronchial asthma

Asthmatic adolescents (N = 129) between the ages of 12 and 18 were assembled into three groups on the basis of severity of illness and were compared with each other and with a fourth group of 74 healthy, nonasthmatic adolescents. Differences in selective cognitive (irrational beliefs) and emotional (anxiety, depression, and hostility) characteristics were examined. Multivariate analysis indicated that irrational beliefs in the importance of approval and the lack of control of emotions, along with self-reported anxiety, depression, or hostility, were strongly associated with disease severity. Whereas adolescents with mild asthma closely resembled the physically healthy comparison group, adolescents with moderate and severe asthma exhibited a cognitive-emotional complex that can be described as maladaptive or dysfunctional. Implications of these results for the treatment of asthma are discussed.

Asthma and emotion: a review

This review of the empirical literature on the relationship between asthma and emotion presents an explanatory model of the connection between them. Asthmatics tend to report and display a high level of negative emotion, and asthma exacerbations have been linked temporally to periods of heightened emotionality. Causality may be bidirectional. Hypothesized mediators for the relationship between asthma and emotionality include vagal and alpha-sympathetic hyperreactivity, predominant obstruction in the larger airways, individual response stereotypy, direct effects of emotion-related facial muscle tension on the airways, the emotional effects of asthma medications, heightened respiratory drive, and hyperventilation. Predictions are presented for research on this model of asthma and emotion, and for the psychological treatment of asthma.

Assisting the parent of a child with asthma

The parents of an asthmatic child are frequently faced with complex decisions that have to take into account the child's asthma as well as more general developmental needs. At times these parents may feel overwhelmed and doubt their ability to make reasonable decisions. If there is discomfort with some aspect of the treatment plan, the parents may remain silent. Denial, minimization, anger, withdrawal and noncompliance may occur. This paper offers suggestions for practicing pediatricians in regard to helping parents cope more effectively with childhood asthma. Specific issues dealt with are discipline, school issues, athletic participation, maintenance of the child's peer relationships, avoiding parental conflict, the use of support systems, behavioral aspects of medical management, and when to refer for psychiatric consultation.

Individual knowledge of emotions in asthmatic children

Twenty male asthmatic children (ages 9-11) and their controls were interviewed regarding their concept of emotion using the interview format developed by Harris et al. (1981). The purpose of the study was to examine the asthmatic children's views on the nature and effects of happiness, anger and fear, together with strategies of self-control. The results indicate that healthy and asthmatic children have a different individual view of emotion. The most relevant finding concerns the different way in which healthy and asthmatic children consider fear: the most frequent view of fear in healthy children is similar to a behaviouristic model of emotion, while asthmatic children express a notion very similar to a cognitive model. Regarding anger, almost all healthy children believe themselves capable of exerting self-control whether on the inner mental components or on its outer expression, where a change of direction of mental processes is the only way asthmatic children see to modify their anger. The implications of these findings both for a description of asthmatic personality and therapy are outlined.

Expression of emotion in asthmatic children and their mothers

The present study assessed how general asthmatic children's deficit in the facial expression of emotion is that we found in previous studies. Furthermore, the emotional behavior of the patients' mothers was explored. Eighteen children with bronchial asthma (ages 7.6 to 12.6), and eighteen control children were subjected to two frustrating achievement situations. They had to solve a difficult puzzle under time pressure by themselves, and with the verbal assistance of their healthy mothers. Facial expressions of emotion and heart rate were recorded from children and mothers. No deficit in emotion expression was observed in the asthmatic group. To the contrary, asthmatic children showed more expressions of anger/aggression and emotion expressions in total during the last phase of the 'child alone' condition. Moreover, in both experimental conditions they showed more unspecified facial movements than control children. Mothers of asthmatic children expressed more happiness than their controls. Heart rate data did not differentiate between target and control groups during any phase of the experiment. These findings counter psychodynamically based assumptions on emotional behavior of asthmatics and their mothers.

Nonverbal expressiveness and EMG activity in tension headache sufferers and controls

This study explored the relationship between musculoskeletal responses and nonverbal expressiveness in response to psychosocial stress. Muscle-contraction headache subjects and normal controls were confronted with a psychological stressor while forehead and neck EMG activity were recorded. Indices of nonverbal expressiveness (head and hand movements, facial tension, facial activity, and facial expressiveness) were obtained concomitantly with the muscle data. The headache subjects showed greater muscle activation than the controls in response to stress, greater evidence of facial tension, and less evidence of facial and bodily expressiveness. Overall, these data provided support for the notion that under some conditions a negative relationship exists between expressiveness and somatic activation.