Body vigilance in nonclinical and anxiety disorder samples: structure, correlates, and prediction of health concerns

Interoception in anxiety, depression, and psychosis: a review

Research has examined the relationship between interoception and anxiety, depression, and psychosis; however, it is unclear which aspects of interoception have been systematically examined, what the combined findings are, and which areas require further research. To answer these questions, we systematically searched and narratively synthesised relevant reviews, meta-analyses, and theory papers (total n = 34). Existing systematic reviews and meta-analyses (anxiety n = 2; depression n = 2; psychosis n = 0), focus on cardiac interoceptive accuracy (heartbeat perception), and indicate that heartbeat perception is not systematically impaired in anxiety or depression. Heartbeat perception might be poorer in people with psychosis, but further evidence is needed. Other aspects of interoception, such as different body systems and processing levels, have been studied but not systematically reviewed. We highlight studies examining these alternative bodily domains and levels, review the efficacy of interoception-based psychological interventions, and make suggestions for future research.

Funding

Wellcome Trust UK.

Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance

Background

The occurrence of COVID-19 led to the rapid development of several vaccines which were distributed around the world. Even though there had been a vast amount of information about both virus and vaccination, this process was potentially related to increased anxiety and thus affected the vaccination process.

Objective

The present study examined anxiety levels and body vigilance in subjects reporting for COVID-19 vaccination at different vaccination sites.

Methods

Instruments used included general socio-demographic questionnaires and specifically constructed ones such as generalized anxiety disorder (GAD), body vigilance scale (BVS), and coronavirus anxiety scale (CAS).

Results

A total of 227 subjects enrolled in the study reported mild GAD and CAS scores and relatively low scores on BVS. When the subjects were divided according to a vaccination site (under supervision and non-supervised), it turned out that subjects vaccinated under supervision were more anxious (higher GAD and CAS) and had their body vigilance increased.

Conclusion

In conclusion, there is a need for highlighting the importance of efficient planning and organization of vaccination process, since to a certain extent it is driven by both anxiety and body vigilance.

Salivary CRP predicts treatment response to virtual reality exposure therapy for social anxiety disorder

BACKGROUND

Social anxiety disorder (SAD) places a profound burden on public health and individual wellbeing. Systemic inflammation may be important to the onset and maintenance of SAD, and anti-inflammatory treatments have shown promise in relieving symptoms of SAD. In the present study, we conducted secondary analyses on data from a randomized clinical trial to determine whether C-reactive protein (CRP) concentrations and social anxiety symptoms decreased over the course of virtual reality exposure therapy, and whether changes in social anxiety symptoms as a function of treatment varied as a function of CRP.

METHOD

Adult participants (N = 78) with a diagnosis of SAD (59 % female) were randomized to receive exposure therapy alone, or exposure therapy supplemented with scopolamine. Social anxiety symptoms, salivary CRP, and subjective units of distress were measured across three exposure therapy sessions, at a post-treatment extinction retest, and at a 1-month follow-up.

RESULTS

CRP decreased over the course of treatment, b = -0.03 (SE = 0.01), p =.02 95 %CI [-0.06, -0.004], as did all social anxiety symptom domains and subjective distress. Higher CRP was associated with greater decreases from pre-treatment to 1-month follow-up in fear, b = -0.45 (SE = 0.15), p =.004 95 %CI [-0.74, -0.15], and avoidance, b = -0.62 (SE = 0.19), p =.002 95 %CI [-1.01, -0.23], and in-session subjective distress from pre-treatment to post-treatment, b = -0.42 (SE = 0.21), p =.05 95 %CI [-0.83, -0.001]. However, declines in CRP were not correlated with declines in fear, r = -0.07, p =.61, or avoidance, r = -0.10, p =.49, within-persons.

CONCLUSIONS

Virtual reality exposure therapy may be associated with an improvement in systemic inflammation in patients with severe SAD. Pre-treatment CRP may also be of value in predicting which patients stand to benefit the most from this treatment.

Role of interoceptive fear and maladaptive attention and behaviors in the escalation of psychopathology-a network analysis

The complex interplay of fear, attention, and behavior toward bodily sensations with psychopathological symptoms and how they mutually influence and potentially reinforce one another remains to be fully elucidated. In this study, we used a network analytical approach to unravel these complex interactions. Specifically, we aimed to identify central symptoms and etiologically relevant factors that might be associated with anxiety and depressive core symptoms. To this end, the following clusters were assessed in 791 adults: interoceptive fear, interoceptive attention, maladaptive behaviors related to bodily sensations, and core symptoms of anxiety and depression. This network was modeled using a Gaussian Graphical Model. Central variables (nodes) were identified using centrality indices and bridge analysis. Self-examination and attention to bodily sensations emerged as central nodes. Moreover, time spent paying attention to bodily sensations, fear of anxiety-related sensations, and self-examination were identified as central bridge nodes, that is, central nodes connecting psychopathologically relevant symptom clusters. The present study indicates that fear of bodily sensations, the amount of attention and time spent focusing on somatic sensations, and self-examination are central factors. The findings suggest potential targets for future longitudinal studies on the impact of these factors for the escalation of anxiety and depressive symptoms.

Altered resting-state cerebellar-cerebral functional connectivity in patients with panic disorder before and after treatment

The study aimed to investigate the functional connectivity (FC) between the cerebellum and intrinsic cerebral networks in patients with panic disorder (PD), and to observe changes in the cerebellar-cerebral FC following pharmacotherapy. Fifty-four patients with PD and 54 healthy controls (HCs) underwent clinical assessments and functional magnetic resonance imaging scans before and after a 5-week paroxetine treatment. Seed-based cerebellar-cerebral FC was compared between the PD and HC groups, as well as between patients with PD before and after treatment. Additionally, the correlations between FC and clinical features of PD were analyzed. Compared to HCs, patients with PD had altered cerebellar-cerebral FC in the default mode, affective-limbic, and sensorimotor networks. Moreover, a negative correlation between cerebellar-insula disconnection and the severity of depressive symptoms in patients with PD (Pearson correlation, r = -0.424, p = 0.001, Bonferroni corrected) was found. After treatment, most of the enhanced FCs observed in patients with PD at baseline returned to levels similar to those observed in HCs. However, the reduced FC at baseline did not significantly change after treatment. The findings suggest that patients with PD have specific deficits in resting-state cerebellar-cerebral FC and that paroxetine may improve PD by restoring the balance of cerebellar-cerebral FC. These findings emphasize the crucial involvement of cerebellar-cerebral FC in the neuropsychological mechanisms underlying PD and in the potential pharmacological mechanisms of paroxetine for treating PD.

An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

Development of a Scale to Examine Responses to Bodily Sensations

OBJECTIVE

Individual differences in the perception of bodily sensations is known to be associated with affective symptomatology. However, the way people psychologically respond to everyday bodily sensations has not been examined in a systematic and balanced way. Thus, we developed the Bodily Sensations Response Scale (BSRS) to evaluate participants' self-reported cognitive, emotional, and behavioral responses to their bodily sensations. We investigated the scale's factor structure and its psychometric properties in two studies.

METHOD

In Study 1, 297 participants completed the 50-item BSRS and exploratory factor analysis (EFA) was performed on the responses. In Study 2 (N = 284), confirmatory factor analysis (CFA) was used to confirm the factor structure of the 32-item BSRS identified in Study 1.

RESULTS

In Study 1, the EFA identified a 32-item three-factor solution as the best fit for the data. Factor 1 described a defeat response to bodily sensations, Factor 2 described an acceptance response, and Factor 3 described a sensitization response. In Study 2, the three-factor solution was shown not to be parsimonious. Rather, CFA identified that the 27-item BSRS had two interpretable factors (Defeat and Acceptance) that explained participants' psychological responses to bodily sensations. The Defeat subscale was moderately to strongly correlated with awareness of bodily sensations (i.e., Body Perception Questionnaire-Short Form scores) and depression, anxiety, and stress symptom severity (i.e., Depression Anxiety Stress Scales-21 scores), whereas the Acceptance subscale was unrelated or only slightly negatively correlated to awareness of bodily sensations and depression, anxiety, and stress symptoms.

CONCLUSION

The 27-item BSRS provides a psychometrically robust assessment of the way in which people psychologically respond to everyday bodily sensations. The measure can assist researchers to better understand how people psychologically process their salient bodily sensations and how this is linked to psychopathology.

Anxiety trajectories among cancer survivors during the COVID-19 pandemic

PURPOSE

To describe trajectories of general and bodily vigilance anxiety among cancer survivors during COVID-19 and examine associated factors.

DESIGN

Longitudinal survey study (May-December 2020).

SAMPLE

Colorado-based cancer survivors (N = 147).

METHODS

Latent class growth analyses were used to examine trajectories for two types of anxiety (general and body vigilance), and to evaluate associations with fear of cancer recurrence (FCR), loneliness, and emotional approach coping.

FINDINGS

Anxiety levels remained stable over time. Most participants were best characterized by the mild general anxiety and moderate bodily vigilance anxiety classes. FCR predicted both general and bodily vigilance anxiety class, and loneliness distinguished between mild and moderate bodily vigilance anxiety classes.

CONCLUSIONS

Current cancer survivors experienced mild general anxiety and moderate body vigilance anxiety during the early pandemic with no detectable improvement over time, and FCR consistently predicted anxiety outcomes.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

These findings provide insight into the anxiety profiles of cancer survivors during COVID-19 and possible therapeutic targets.

Psychological Correlates of Health anxiety in Response to the Coronavirus (COVID-19) Pandemic: a Cross-Sectional Online Study in Iran

Current models suggest health anxiety as a fundamental variable associated with fear and anxiety related to COVID-19. The investigation was carried out in separate two studies on the Iranian population. The first study aims to test the COVID-19 Anxiety Inventory (N = 202). The findings indicate a two-factor structure of the scale. Participants (N = 1638) completed the online survey anonymously in the second study, including the COVID-19 Anxiety Inventory, Short Health Anxiety Inventory, The Intolerance of Uncertainty Scale, Anxiety Sensitivity Index-3, Body Vigilance Scale, Depression Anxiety Stress Scales 21, and Contamination Cognitions Scale. Results showed that health anxiety, anxiety sensitivity, and body vigilance would significantly contribute to fears of contracting COVID-19. Moreover, the findings support a central role of intolerance of uncertainty in predicting COVID-19 anxiety. The study results provided both theoretical and practical implications for understanding psychosocial predictors during the COVID-19 pandemic.

Severe COVID-19 anxiety among adults in the UK: protocol for a cohort study and nested feasibility trial of modified cognitive-behavioural therapy for health anxiety

INTRODUCTION

Some people are so anxious about COVID-19 that it impairs their functioning. However, little is known about the course of severe COVID-19 anxiety or what can be done to help people who experience it.

METHODS AND ANALYSIS

Cohort study with a nested feasibility trial with follow-up at 3 and 6 months. We recruited 306 people who were aged 18 and over, lived in the UK and had severe COVID-19 anxiety (indicated by a score of 9 or more on the Coronavirus Anxiety Scale (CAS)). To take part in the nested feasibility trial, participants also had to have a score of 20 or more on the Short Health Anxiety Inventory. We excluded people from the trial if they had had COVID-19 within the previous 4 weeks, if they were currently self-isolating or if they were already receiving psychological treatment.We publicised the study nationally through adverts, social media and posts on message boards. We also recruited participants via clinicians working in primary and secondary care NHS services in London. All those in the active arm will be offered 5-10 sessions of remotely delivered modified cognitive-behavioural therapy for health anxiety (CBT-HA). We will examine the proportion of participants who remain above threshold on the CAS at 3 and 6 months and factors that influence levels of COVID-19 anxiety over 6 months using mixed effects logistic regression. The key feasibility metrics for the nested trial are the level of uptake of CBT-HA and the rate of follow-up.

ETHICS AND DISSEMINATION

Approved by Leicester Central Research Ethics Committee (reference: 20/EM/0238). The results of the study will be published in peer-reviewed scientific journals.

TRIAL REGISTRATION NUMBER

ISRCTN14973494.

Transcranial direct current stimulation does not improve clinical and neurophysiological outcomes in panic disorder: A randomized sham-controlled trial

AIM

Emerging evidence suggests that transcranial direct current stimulation (tDCS) has anxiolytic effects and may enhance emotional processing of threat and reduce threat-related attentional bias. Panic disorder (PD) is considered to be a fear network disorder along with prefrontal activity alterations. We aim to assess the effect of tDCS on clinical and physiological parameters in PD for the first time.

METHODS

In this triple-blind randomized sham-controlled pilot study, 30 individuals with PD were allocated into active and sham groups to receive 10 sessions of tDCS targeting the dorsolateral prefrontal cortex bilaterally at 2 mA for 20-min duration over 2 weeks. The clinical severity, threat-related attentional bias, interoceptive accuracy, and emotional recognition were assessed before, immediately after, and 1 month after tDCS.

RESULTS

Active tDCS, in comparison to sham, did not elicit more favorable clinical and neuropsychological/physiological outcomes in PD.

CONCLUSION

The present study provides the first clinical and neurobehavioral results of prefrontal tDCS in PD and indicates that prefrontal tDCS was not superior to sham in PD.

Heart-Focused Anxiety Among Trauma-Exposed Latinx Young Adults: Relations to General Depression, Suicidality, Anxious Arousal, and Social Anxiety

Rates of traumatic event exposure, posttraumatic stress (PTS), and co-occurring mental health symptoms and disorders are conditionally higher among Latinx individuals compared to other racial/ethnic populations. Importantly, Latinx persons are a heterogeneous population, and certain subgroups endorse higher rates of negative mental health outcomes than others, including Latinx young adults born in the USA. Yet, there is little understanding of individual difference factors among trauma-exposed US born Latinx young adults that may be involved in mental health burden among this group. The present investigation sought to evaluate the potential explanatory relevance of heart-focused anxiety as an individual difference factor regarding some of the most common co-occurring mental health problems among trauma-exposed populations. Specifically, we tested whether heart-focused anxiety was related to increased co-occurring anxious arousal symptoms, depression, social anxiety, and suicidality among 169 (84% female, M_age=23.15 years, SD=6.07) trauma-exposed Latinx young adults. Results indicated that heart-focused anxiety was a statistically significant predictor of general depression (ΔR² = .02, F(1, 161) = 4.25, p = .041), suicidality (ΔR² = .10, F(1, 161) = 21.49, p < .001), anxious arousal (ΔR² = .11, F(1, 161) = 27.31, p < .001), and social anxiety (ΔR² = .03, F(1, 161) = 7.93, p = .005). Overall, this work offers empirical evidence that individual differences in heart-focused anxiety are related to more severe co-occurring anxiety and depressive symptomatology among a particularly at risk Latinx segment of the Latinx population (non-immigrant Latinx young adults s with previous trauma history).

Fear one, fear them all: A systematic review and meta-analysis of fear generalization in pathological anxiety

It is a defining feature of anxiety disorders that fear is elicited by a circumscribed class of stimuli rather than by only one specific exemplar of that class. Therefore, fear generalization, a mechanism by which associative fear extends from one conditioned stimulus to similar cues, has been central to theories on anxiety. Yet, experimental evidence for the link between generalization and pathological anxiety, as well as its moderators, has not been formally integrated. This systematic review and meta-analysis of empirical findings clarifies the relationship between fear generalization and pathological anxiety. In conclusion, enhanced fear generalization is associated with several anxiety disorders and stress-related disorders, which is supported statistically by a small, but robust effect size of g = 0.44 for risk ratings as an index of fear generalization. However, empirical results are inconsistent across disorders and they rarely allow for conclusions on their causality in the disorders' etiology. Therefore, based on theoretical considerations, we recommend directions for intensified research, especially on the causal relationship between overgeneralization and pathological fear.

Steady-state visual evoked potentials differentiate between internally and externally directed attention

While attention to external visual stimuli has been extensively studied, attention directed internally towards mental contents (e.g., thoughts, memories) or bodily signals (e.g., breathing, heartbeat) has only recently become a subject of increased interest, due to its relation to interoception, contemplative practices and mental health. The present study aimed at expanding the methodological toolbox for studying internal attention, by examining for the first time whether the steady-state visual evoked potential (ssVEP), a well-established measure of attention, can differentiate between internally and externally directed attention. To this end, we designed a task in which flickering dots were used to generate ssVEPs, and instructed participants to count visual targets (external attention condition) or their heartbeats (internal attention condition). We compared the ssVEP responses between conditions, along with alpha-band activity and the heartbeat evoked potential (HEP) - two electrophysiological measures associated with internally directed attention. Consistent with our hypotheses, we found that both the magnitude and the phase synchronization of the ssVEP decreased when attention was directed internally, suggesting that ssVEP measures are able to differentiate between internal and external attention. Additionally, and in line with previous findings, we found larger suppression of parieto-occipital alpha-band activity and an increase of the HEP amplitude in the internal attention condition. Furthermore, we found a trade-off between changes in ssVEP response and changes in HEP and alpha-band activity: when shifting from internal to external attention, increase in ssVEP response was related to a decrease in parieto-occipital alpha-band activity and HEP amplitudes. These findings suggest that shifting between external and internal directed attention prompts a re-allocation of limited processing resources that are shared between external sensory and interoceptive processing.

Mindfulness-Based Interventions and Body Awareness

Body awareness (BA) has long been proposed as a working mechanism of mindfulness-based interventions (MBIs), yet research on the mediating role of BA is scarce. Hence, the present study assesses the impact of an 8-week MBI on self-reported and indirect measures of BA, investigates the potential mediating role of BA in the relationship between an MBI and symptomatology, evaluates the impact of an MBI on important psychological processes (i.e., experiential avoidance, rumination, self-efficacy, and self-discrepancy), and explores whether these variables act alongside BA in mediating the relationship between an MBI and symptomatology. A non-randomized controlled trial was conducted with 148 participants (n = 89 in the MBI group; n = 59 in the control group) who completed questionnaires assessing BA and the above-mentioned psychological processes before and after an MBI. A sub-sample of participants (n = 86) completed a task that evaluates BA indirectly. Results showed a significant effect of MBI on the self-reported BA but not on the indirect measure of BA. The MBI significantly reduced symptomatology, and this effect was mediated by regulatory and belief-related dimensions of BA. Multiple mediator models showed a significant mediation via various pathways involving improved BA and various transdiagnostic psychological processes.

Anxiety disorders in patients with noncardiac chest pain: association with health-related quality of life and chest pain severity

BACKGROUND

Patients with noncardiac chest pain (NCCP) report more severe symptoms and lowered health-related quality of life when they present with comorbid panic disorder (PD). Although generalized anxiety disorder (GAD) is the second most common psychiatric disorder in these patients, its impact on NCCP and health-related quality of life remains understudied. This study describes and prospectively compares patients with NCCP with or without PD or GAD in terms of (1) NCCP severity; and (2) the physical and mental components of health-related quality of life.

METHODS

A total of 915 patients with NCCP were consecutively recruited in two emergency departments. The presence of comorbid PD or GAD was assessed at baseline with the Anxiety Disorder Schedule for DSM-IV. NCCP severity at baseline and at the six-month follow-up was assessed with a structured telephone interview, and the patients completed the 12-item Short-Form Health Survey Version 2 (SF-12v2) to assess health-related quality of life at both time points.

RESULTS

Average NCCP severity decreased between baseline and the six-month follow-up (p < .001) and was higher in the patients with comorbid PD or GAD (p < .001) at both time points compared to those with NCCP only. However, average NCCP severity did not differ between patients with PD and those with GAD (p = 0.901). The physical component of quality of life improved over time (p = 0.016) and was significantly lower in the subset of patients with PD with or without comorbid GAD compared to the other groups (p < .001). A significant time x group interaction was found for the mental component of quality of life (p = 0.0499). GAD with or without comorbid PD was associated with a lower mental quality of life, and this effect increased at the six-month follow-up.

CONCLUSIONS

Comorbid PD or GAD are prospectively associated with increased chest pain severity and lowered health-related quality of life in patients with NCCP. PD appears to be mainly associated with the physical component of quality of life, while GAD has a greater association with the mental component. Knowledge of these differences could help in the management of patients with NCCP and these comorbidities.

Predicting COVID-19-related anxiety: The role of obsessive-compulsive symptom dimensions, anxiety sensitivity, and body vigilance

The novel coronavirus disease (COVID-19), first detected in December of 2019 and declared a global pandemic in March of 2020, continues to pose a serious threat to public health and safety worldwide. Many individuals report anxiety in response to this threat, and at high levels, such anxiety can result in adverse mental health outcomes and maladaptive behavioral responses that have consequences for the health of communities more broadly. Predictors of excessive anxiety in response to COVID-19 are understudied. Accordingly, the present study examined psychological factors that predict more intense COVID-19-related anxiety. 438 community members completed measures assessing COVID-19-related anxiety as well as psychological variables hypothesized to predict anxious responding to the threat of COVID-19. As expected, obsessive-compulsive symptoms related to contamination, the fear of arousal-related body sensations (i.e., anxiety sensitivity), and body vigilance each predicted more severe anxiety related to the pandemic. Obsessive-compulsive symptoms related to responsibility for causing harm also emerged as a predictor. Study limitations and implications are discussed.

Deontological Guilt and Disgust Sensitivity Modulate Moral Behaviour

OBJECTIVE

Deontological Guilt (DG), and Altruistic Guilt (AG) emerge from the appraisal of violating an internalized rule or an altruistic principle, respectively. DG is strictly connected with Disgust Sensitivity and plays a key role in the development and maintenance of Obsessive-Compulsive Disorder (OCD). Previous studies investigated how DG affects responses to hypothetical moral dilemmas, however how DG and Disgust Sensitivity interact modulating moral behavior is still unknown.

METHODS

STUDY 1. 46 healthy participants performed an ecological paradigm in which people can spontaneously decide to lie to obtain a reward (egoistic lie) or give it away (altruistic lie) after three emotional inductions: DG, AG or neutral. Furthermore, OCD traits, Morality, Guilt Propensity and Disgust Sensitivity were assessed by means of questionnaires. STUDY 2. 27 participants from the original sample were retested during the COVID-19 lockdown in Italy to ascertain whether the pandemic modified traits related to morality, disgust, guilt or OCD symptoms and whether these changes modulated moral behavior (measured by a task in which cheating was associated to higher pay-offs).

RESULTS

STUDY 1. Compared to the neutral, after the DG induction participants produced less altruistic and more egoistic lies. This effect was stronger in participants with high Disgust Sensitivity. STUDY 2. During the COVID-19 lockdown participants became more sensitive to the Authority pillar of the Moral Foundations and more sensitive to Disgust: this increment in deontological morality affected (im) moral behavior depending on changes in Disgust Sensitivity.

CONCLUSIONS

Our data suggest that people with high Disgust Sensitivity are more affected by deontological inductions which translate to higher immorality, supposedly by lowering their moral self-image. These results might have important clinical implications as they suggest that addressing Disgust Sensitivity in therapy, might also decrease the effect of guilt on patients' behavior.

Psychosocial predictors of virus and social distancing fears in undergraduate students living in a US COVID-19 "hotspot"

The COVID-19 pandemic is positioned to exact a substantial mental health toll on the global population. Heightened fears of viral contamination and fears of the negative consequences of social distancing (e.g., fears related to home confinement, fears of loneliness and isolation) might contribute to the distress caused by the pandemic. Cross-sectional data were collected from undergraduates (N = 608) residing in a U.S. pandemic "hotspot" at the time of data collection (between 7 April to 9 May, 2020). Outcome variables included viral contamination fears and social distancing fears. Predictor variables included biological sex, underlying medical vulnerability, number of recent viral symptoms, presence of positive COVID-19 test in social network, anxiety, depression, stress, emotion dysregulation, intolerance of uncertainty, body vigilance, and health anxiety. Female sex, anxiety severity, intolerance of uncertainty, and health anxiety uniquely predicted fears of viral contamination. Female sex and depression severity uniquely predicted fears of social distancing. Multiple anxiety-related vulnerabilities are potential intervention targets for reducing viral contamination fears. Depression is a potential intervention target for social distancing fears. Females might be at greater risk for both types of fears.

Understanding Pain Catastrophizing: Putting Pieces Together

The present narrative review addresses issues concerning the defining criteria and conceptual underpinnings of pain catastrophizing. To date, the concept of pain catastrophizing has been extensively used in many clinical and experimental contexts and it is considered as one of the most important psychological correlate of pain chronicity and disability. Although its extensive use, we are still facing important problems related to its defining criteria and conceptual understanding. At present, there is no general theoretical agreement of what catastrophizing really is. The lack of a consensus on its definition and conceptual issues has important consequences on the choice of the pain management approaches, defining and identifying problems, and promoting novel research. Clinical and research work in absence of a common theoretical ground is often trivial. It is very surprising that clinical and experimental work has grown extensively in the past years, without a common ground in the form of a clear definition of pain catastrophizing and overview of its conceptual basis. Improving the efficacy and efficiency of pan catastrophizing related treatments requires an understanding of the theoretical construct. So far, most interventions have only demonstrated modest effects in reducing pain catastrophizing. Therefore, clarifying the construct may be an important precursor for developing more targeted and effective interventions, thereby easing some of the burden related to this aspect of pain. In our review, we have extracted and de-constructed common elements that emerge from different theoretical models with the aim to understand the concept of catastrophizing, which components can be modulated by psychological interventions, and the general role in pain processing. The analysis of the literature has indicated essential key elements to explain pain catastrophizing: emotional regulation, catastrophic worry (as repetitive negative thinking), rumination, behavioral inhibition and behavioral activation (BIS/BAS) systems, and interoceptive sensitivity. The present paper attempts to integrate these key elements with the aim to re-compose and unify the concept within a modern biopsychosocial interpretation of catastrophizing.

Web-Based Relaxation Intervention for Stress During Social Isolation: Randomized Controlled Trial

BACKGROUND

Relaxation practices might be helpful exercises for coping with anxiety and stressful sensations. They may be of particular utility when used in web-based interventions during periods of social isolation.

OBJECTIVE

This randomized study aimed to test whether web-based relaxation practices like natural sounds, deep respiration, and body scans can promote relaxation and a positive emotional state, and reduce psychomotor activation and preoccupation related to the COVID-19 pandemic.

METHODS

Participants were randomly assigned to one of three experimental conditions. Each condition was characterized by a single online session of a guided square breathing exercise, a guided body scan exercise, or natural sounds. The participants listened to one of the fully automated audio clips for 7 minutes and pre-post completed self-assessed scales on perceived relaxation, psychomotor activation, level of preoccupation associated with COVID-19, and emotional state. At the end of the session, qualitative reports on subjective experience were also collected.

RESULTS

Overall, 294 participants completed 75% of the survey and 240 completed the entire survey as well as one of three randomly assigned interventions. Perceived relaxation, psychomotor activation/stress, and preoccupation related to COVID-19 showed a positive improvement after participants listened to the audio clips. The same pattern was observed for the valence and perceived dominance of the emotional state. The square breathing and body scan exercises yielded superior results compared to natural sounds in lowering perceived stress.

CONCLUSIONS

This study provides a novel insight that can guide the development of future low-cost web-based interventions to reduce preoccupation and stress in the general population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/19236.

Psychological Predictors of Anxious Responses to the COVID-19 Pandemic: Evidence from Pakistan

OBJECTIVE

COVID-19 epidemic can be associated with a variety of anxious responses and safety behaviors. The present research explored the psychological implications associated with COVID-19 during the outbreak in 2020 to date. Pakistani media has given particular attention to this outbreak in the region.

METHODS

Three hundred and forty-seven undergraduate university students from Pakistan completed a battery of questionnaires focusing fear of COVID-19, associated safety behaviors, factual knowledge of COVID-19, and other psychological pointers hypothesized to be as predictors of anxious responses to COVID-19 threat and associated safety behaviors.

RESULTS

The sample appeared to be fearful of COVID-19 and this fear was related to disgust sensitivity, anxiety sensitivity-related physical concerns, body vigilance, contamination cognitions, and general distress. Results suggested that the tendency of overestimating the severity of contamination and anxiety sensitivity towards physical concerns are significant predictors of COVID-19 related fear and consequent safety behaviors.

CONCLUSION

It is suggested that people with a greater concern of contamination are likely to respond fearfully to COVID-19 and that people with higher fear of COVID-19 are likely to feel contamination concerns.

Dimensions of interoception in obsessive-compulsive disorder

Interoceptive sensibility (IS) refers to the subjective experience of perceiving and being aware of one's internal body sensations, and is typically evaluated using self-report questionnaires or confidence ratings. Here we evaluated IS in 81 patients with OCD and 76 controls using the Multidimensional Scale of Interoceptive Awareness (MAIA), which contains 8 subscales assessing adaptive and maladaptive responses to sensation. Compared to controls, OCD patients showed hyperawareness of body sensations. Patients also demonstrated a more maladaptive profile of IS characterized by greater distraction from and worry about unpleasant sensations, and reduced tendency to experience the body as safe and trustworthy. These findings were independent of medication status and comorbidities in the patient group. Correlational analyses showed that subscales of the MAIA were differentially associated with OCD symptom dimensions. These findings indicate that patients with OCD show abnormality of IS that is independent of confounding factors related to medication and comorbidities and associated with different OCD symptom dimensions. Future work would benefit from examining neural correlates of these effects and evaluating whether dimensions of IS are impacted by treatments for the disorder.

Healthcare communication distress scale: Pilot factor analysis and validity

OBJECTIVE

To develop psychometrically an evidence-based, patient-centred measure of patient-practitioner communication. We explored the underlying constructs of a self-report questionnaire measuring adult patients' enduring perceptions of their emotional experiences when communicating with primary healthcare practitioners.

METHODS

A cross-sectional on-line survey included 16 items from a piloted questionnaire, as well as existing measures of generalised anxiety, psychological distress, and body vigilance. Exploratory factor analysis and hierarchical multiple regression were used to explore underlying constructs in an Australian sample (N = 220).

RESULTS

A 6-item communication distress factor and a 3-item environmental arousal factor were supported, indicating good face validity and internal consistency. Bivariate correlations support convergent and discriminant validity for both factors. Hierarchical analysis exploring predictors of communication distress included sex, age, and chronic condition status; and scores on body vigilance, anxiety, distress, and environmental arousal in healthcare. Environmental arousal was the most important significant predictor of communication distress.

CONCLUSION

The patient communication questionnaire can be developed into a brief scale to measure patient distress associated with engaging with, and communicating in, healthcare settings.

PRACTICE IMPLICATIONS

A brief self-report measure to identify patients' communication distress and environmental arousal could assist in clinical practice and provide useful data in healthcare communication research.

An Internet-Based Intervention to Alleviate Stress During Social Isolation With Guided Relaxation and Meditation: Protocol for a Randomized Controlled Trial

Background

Psychophysiological stress and decreased well-being are relevant issues during prolonged social isolation periods. Relaxation practices may represent helpful exercises to cope with anxiety and stressful sensations.

Objective

The aim of this research protocol is to test whether remote relaxation practices such as natural sounds, deep respiration, and body scan meditation promote relaxation and improved emotional state and reduce psychomotor activation and the preoccupation related to the coronavirus disease (COVID-19) pandemic.

Methods

The study population will consist of 3 experimental groups that will randomly receive one of 3 internet-based audio clips containing a single session of guided breathing exercise, guided body scan exercise, or natural sounds. The participants will listen to the fully automated audio clip for 7 minutes and complete pre-post self-assessment scales on their perceived relaxation, psychomotor activation, level of worry associated with COVID-19, and emotional state. At the end of the session, the participants will also be asked to provide qualitative reports on their subjective experiences.

Results

Analyses will be performed to test the differences in the efficacy of the different audio clips in an internet-based intervention on 252 participants (84 per group), investigating whether natural sounds or remote guided practices such as deep respiration and body scan meditation positively enhance the participants’ perceived psychological state.

Conclusions

The study will provide information on if and to what extent guided practices can help in reducing psychological side effects related to social isolation during the COVID-19 pandemic.

International Registered Report Identifier (IRRID)

PRR1-10.2196/19236

"My own flesh and blood": The implications of child maltreatment for the orientation towards the body among dyads of mothers and daughters

BACKGROUND

Orientation to bodily signals reflects the ways in which individuals interpret their bodily sensations. Such orientation is formed within early interpersonal context. Findings reveal that trauma may result in catastrophic and fearful orientation towards bodily signals. However, not much is known regarding the link between trauma and orientation towards the body as manifested within a family intergenerational context.

OBJECTIVE

This study examines the link between child maltreatment, complex posttraumatic stress symptoms (CPTS symptoms), and a posttraumatic orientation to bodily signals among dyads of mothers and their young adult daughters.

PARTICIPANTS AND SETTING

194 mother-daughter dyads (mothers' mean age = 56, SD = 6.3; daughters' mean age = 26, SD = 3.03) completed self-reported questionnaires, assessing child maltreatment (CTQ), CPTS symptoms (ITQ), and orientation to bodily signals (pain catastrophizing, anxiety sensitivity-physical, body vigilance).

RESULTS

Orientation to bodily signals was associated with child maltreatment, through the mediation of CPTS symptoms among mothers (indirect effects between 0.13-0.28; p > 0.021) and daughters (indirect effects between 0.21-0.11; p > 0.032). Mothers' child maltreatment was associated with daughters' child maltreatment (effect = 0.35; p < 0.001), and mothers' orientation to bodily signals was associated with daughters' orientation (effects between 0.19-0.27; p < 0.016). Daughters' orientation to bodily signals was partially associated with mothers' child maltreatment through mothers' CPTS symptoms and orientation to body (indirect effect = 0.064; p = 0.023).

CONCLUSIONS

Child maltreatment is implicated in posttraumatic orientation towards bodily signals. Such secondary processes may be intergenerationally transmitted.

The Role of Disease Conviction: Exploring Its Effects on Chest Pain and Anxiety-Related Models of Non-cardiac Chest Pain

The aim of this study was to investigate the role of disease conviction in the chest pain and life interference of patients with non-cardiac chest pain (NCCP), after controlling for anxiety sensitivity and body vigilance. While all three psychological constructs are theoretically implicated and empirically associated with the experience of NCCP, no research has examined the influence of disease conviction in the context of other relevant constructs. The sample included 229 participants with NCCP who were recruited after a medical evaluation failed to elicit an organic explanation for their chest pain. Hierarchical regression analyses revealed that while anxiety sensitivity significantly predicted chest pain severity and interference, only body vigilance contributed significant additional variance to chest pain severity, and only disease conviction contributed significant additional variance to chest pain interference. While anxiety sensitivity, body vigilance, and disease conviction all appear to affect those with NCCP, it seems that their impact is manifest in different domains (i.e., pain perception vs. psychosocial impairment).

Atypical bodily self-awareness in vicarious pain responders

Vicarious perception refers to the ability to co-represent the experiences of others. Prior research has shown considerable inter-individual variability in vicarious perception of pain, with some experiencing conscious sensations of pain on their own body when viewing another person in pain (conscious vicarious perception/mirror-pain synaesthesia). Self-Other Theory proposes that this conscious vicarious perception may result from impairments in self-other distinction and maintaining a coherent sense of bodily self. In support of this, individuals who experience conscious vicarious perception are more susceptible to illusions of body ownership and agency. However, little work has assessed whether trait differences in bodily self-awareness are associated with conscious vicarious pain. Here we addressed this gap by examining individual difference factors related to awareness of the body, in conscious vicarious pain responders. Increased self-reported depersonalization and interoceptive sensibility was found for conscious vicarious pain responders compared with non-responders, in addition to more internally oriented thinking (associated with lower alexithymia). There were no significant differences in trait anxiety. Results indicate that maintaining a stable sense of the bodily self may be important for vicarious perception of pain, and that vicarious perception might also be enhanced by attention towards internal bodily states. This article is part of a discussion meeting issue 'Bridging senses: novel insights from synaesthesia'.

Do body-related sensations make feel us better? Subjective well-being is associated only with the subjective aspect of interoception

According to the proposition of several theoretical accounts, the perception of the bodily cues, interoceptive accuracy and interoceptive sensibility, has a significant positive impact on subjective well-being. Others assume a negative association; however, empirical evidence is scarce. In this study, 142 young adults completed questionnaires assessing subjective well-being, interoceptive sensibility, and subjective somatic symptoms and participated in measurements of proprioceptive accuracy (reproduction of the angle of the elbow joint), gastric sensitivity (water load test), and heartbeat tracking ability (Schandry task). Subjective well-being showed weak to medium positive associations with interoceptive sensibility and weak negative associations with symptom reports. No associations with measures of interoceptive accuracy were found. Gastric sensitivity as opposed to heartbeat perception and proprioceptive accuracy moderated the association between interoceptive sensibility and well-being. Thus, subjective well-being is associated only with the self-reported (perceived) aspect of interoception but not related to the sensory measures of interoceptive accuracy.

Altered Interoceptive Processing in Generalized Anxiety Disorder-A Heartbeat-Evoked Potential Research

Generalized anxiety disorder (GAD) is one of the most common anxiety disorders. The brain's dysfunctional processing of interoceptive information is increasingly recognized as an important component of anxiety disorders. However, the neural mechanisms remain insufficiently understood. In the present study, patients with GAD and healthy control participants underwent an eyes-closed (EC) resting state (interoception) and eyes-open (EO) resting state (exteroception) without paying conscious attention to heartbeat. Electrocardiography (ECG) and electroencephalography (EEG) signals were recorded at the same time. The results show that in healthy controls, the heartbeat-evoked brain potential (HEP) was modulated by the conditions, with a significantly higher amplitude under EC than EO, while this was not the case in GAD patients. Further analysis revealed that the dysfunction of HEP modulation in GAD patients may be attributed to excessive interoceptive processing under EO, with a marginally higher HEP in GAD than in the healthy controls. Finally, the right prefrontal HEP amplitude during EC condition was significantly correlated with the severity of the patients' anxiety symptoms. Our results suggest that altered cortical processing of interoceptive signals may play an important role in the pathophysiology of generalized anxiety disorder.

Validation of the Chinese version of the Health Cognitions Questionnaire in Chinese college students

PURPOSE

The cognitive behavioral model is considered the most comprehensive for explaining the pathogenesis of health anxiety (HA). The model proposes 4 dysfunctional beliefs that play a vital role in developing and sustaining HA: a) the likelihood of contracting or having an illness, b) awfulness of the illness, c) difficulty coping with illness, and d) inadequacy of medical services. The Health Cognitions Questionnaire (HCQ), widely used in English populations, was developed for assessing these core cognitions. As HA is a growing problem in China, we translated the HCQ into a Chinese version (CHCQ) and examined its psychometric properties. These core cognitions were compared among individuals with and without medical conditions.

METHODS

A set of questionnaires that included the CHCQ and the Short Health Anxiety Inventory (SHAI) was used to gather data from 1,319 Chinese college students. After 4 weeks, 145 of the students completed the CHCQ again. The validity, reliability, and measurement invariance were evaluated among individuals with various medical conditions.

RESULTS

The final CHCQ included 19 items. A 4-factor structure was well suited to the data. Good internal consistency (Cronbach's α for total score was 0.849, subscales ranged from 0.753 to 0.841), test-retest reliability (the interclass correlation coefficient for total score was 0.762, subscales ranged from 0.626 to 0.683), and criterion validity of the CHCQ were demonstrated. Measurement and structural invariance were established. Individuals with a diagnosed disease scored higher on the likelihood-of-illness subscale (Cohen's d =0.22, p < 0.01) than those without an illness.

CONCLUSION

The CHCQ shows promise for the assessment of 4 core HA-related cognitions in the Chinese population.

Alexithymia mediates the relationship between interoceptive sensibility and anxiety

A number of empirical and theoretical reports link altered interoceptive processing to anxiety. However, the mechanistic understanding of the relationship between the two remains poor. We propose that a heightened sensibility for interoceptive signals, combined with a difficulty in attributing these sensations to emotions, increases an individual’s vulnerability to anxiety. In order to investigate this, a large sample of general population adults were recruited and completed self-report measures of interoceptive sensibility, trait anxiety and alexithymia. Results confirmed that the positive association between interoceptive sensibility and trait anxiety was partially mediated by alexithymia, such that those most at risk for clinically significant levels of trait anxiety have both significantly higher levels of interoceptive sensibility and alexithymia. A subsequent factor analysis confirmed the independence of the three measures. Altered interoceptive processing in combination with alexithymia, increased the risk for anxiety above and beyond altered interoceptive processing alone. We suggest that a heightened sensibility for interoceptive signals, combined with a difficulty in attributing these sensations to emotions, leaves these sensations vulnerable to catastrophizing interpretation. Interventions that target the attribution of bodily sensations may prove valuable in reducing anxiety.

How do illness-anxious individuals process health-threatening information? A systematic review of evidence for the cognitive-behavioral model

According to the cognitive-behavioral model, illness anxiety is developed and maintained through biased processing of health-threatening information and maladaptive responses to such information.

OBJECTIVE

This study is a systematic review of research that attempted to validate central tenets of the cognitive-behavioral model regarding etiological and maintenance mechanisms in illness anxiety.

METHODS

Sixty-two studies, including correlational and experimental designs, were identified through a systematic search of databases and were evaluated for their quality.

RESULTS

Outcomes were synthesized following a qualitative thematic approach under categories of theoretically driven mechanisms derived from the cognitive-behavioral model: attention, memory and interpretation biases, perceived awareness and inaccuracy in perception of somatic sensations, negativity bias, emotion dysregulation, and behavioral avoidance.

CONCLUSIONS

Findings partly support the cognitive-behavioral model, but several of its hypothetical mechanisms only receive weak support due to the scarcity of relevant studies. Directions for future research are suggested based on identified gaps in the existing literature.

Emotion Regulation Using Virtual Environments and Real-Time fMRI Neurofeedback

Neurofeedback (NFB) enables the voluntary regulation of brain activity, with promising applications to enhance and recover emotion and cognitive processes, and their underlying neurobiology. It remains unclear whether NFB can be used to aid and sustain complex emotions, with ecological validity implications. We provide a technical proof of concept of a novel real-time functional magnetic resonance imaging (rtfMRI) NFB procedure. Using rtfMRI-NFB, we enabled participants to voluntarily enhance their own neural activity while they experienced complex emotions. The rtfMRI-NFB software (FRIEND Engine) was adapted to provide a virtual environment as brain computer interface (BCI) and musical excerpts to induce two emotions (tenderness and anguish), aided by participants' preferred personalized strategies to maximize the intensity of these emotions. Eight participants from two experimental sites performed rtfMRI-NFB on two consecutive days in a counterbalanced design. On one day, rtfMRI-NFB was delivered to participants using a region of interest (ROI) method, while on the other day using a support vector machine (SVM) classifier. Our multimodal VR/NFB approach was technically feasible and robust as a method for real-time measurement of the neural correlates of complex emotional states and their voluntary modulation. Guided by the color changes of the virtual environment BCI during rtfMRI-NFB, participants successfully increased in real time, the activity of the septo-hypothalamic area and the amygdala during the ROI based rtfMRI-NFB, and successfully evoked distributed patterns of brain activity classified as tenderness and anguish during SVM-based rtfMRI-NFB. Offline fMRI analyses confirmed that during tenderness rtfMRI-NFB conditions, participants recruited the septo-hypothalamic area and other regions ascribed to social affiliative emotions (medial frontal / temporal pole and precuneus). During anguish rtfMRI-NFB conditions, participants recruited the amygdala and other dorsolateral prefrontal and additional regions associated with negative affect. These findings were robust and were demonstrable at the individual subject level, and were reflected in self-reported emotion intensity during rtfMRI-NFB, being observed with both ROI and SVM methods and across the two sites. Our multimodal VR/rtfMRI-NFB protocol provides an engaging tool for brain-based interventions to enhance emotional states in healthy subjects and may find applications in clinical conditions associated with anxiety, stress and impaired empathy among others.

Internet-based treatment for panic disorder: A three-arm randomized controlled trial comparing guided (via real-time video sessions) with unguided self-help treatment and a waitlist control. PAXPD study results

A growing body of evidence suggests that Internet-based cognitive behavioral treatments (ICBT) are effective to treat anxiety disorders. However, the effect of therapist guidance in ICBT is still under debate and guided ICBT offered in a real-time audio-video communication format has not yet been systematically investigated. This three-arm RCT compared the efficacy of guided with unguided ICBT (12 weeks intervention) and a waitlist (WL). A total of 111 individuals meeting the diagnostic criteria for panic disorder (PD) were randomly assigned to one of three conditions. Primary outcomes were the severity of self-report panic symptoms and diagnostic status. Secondary outcomes were symptoms of depression, functional impairment, catastrophic cognitions, fear of sensations and body vigilance. At post-treatment, both active conditions showed superior outcomes regarding PD and associated symptoms (guided ICBT vs. WL: d = 1.04-1.36; unguided ICBT vs. WL: d = 0.70-1.06). At post-treatment, the two active conditions did not differ significantly in self-reported symptom reduction (d = 0.21-0.54, all ps > 0.05), but the guided treatment was superior to the unguided treatment in terms of diagnostic status (χ² (1) = 13.15, p < 0.01). Treatment gains were maintained at successive follow-ups and the guided treatment became superior to the unguided treatment at 6 months follow-up (d = 0.72-1.05, all ps < 0.05).

Fear of hypoglycemia in patients with type 2 diabetes: The role of interoceptive accuracy and prior episodes of hypoglycemia

OBJECTIVE

Fear of hypoglycemia (FoH) is a limiting factor for diabetes self-management and can have detrimental effects on quality of life. However, relatively little is known about its underlying mechanisms. In line with findings on patients with anxiety disorders, we hypothesized that interoceptive accuracy (IA) might be positively linked to FoH in patients with type 2 diabetes (T2DM).

METHODS

133 patients with T2DM were screened according to the extreme quartiles of the Hypoglycemia Fear Survey worry subscale (HFS-W). Overall, 66 participants (HFS-W<4; HFS-W>17) were included in the present study. Participants completed questionnaires on sociodemographic and diabetes-related measures. Accuracy of heartbeat perception was assessed using the mental tracking task.

RESULTS

Contrary to expectations, IA did not differ significantly between patients with low and high FoH. A linear regression analysis demonstrated that the experience of mild hypoglycemia (β=0.32, p≤0.01) and its interaction with IA (β=-0.26, p=0.040) were significant predictors of FoH, indicating that low IA and a history of experiencing mild hypoglycemia are positively associated with FoH.

CONCLUSION

Our findings suggest a positive association of low IA in combination with prior episodes of hypoglycemia and FoH in patients with T2DM. The results are in line with recent findings on IA in patients with chronic somatic symptom distress more generally and contribute to our understanding of the relations between interoception, body related fears, and physical symptom perception.

Somatic symptom severity among primary care patients who are obese: examining the unique contributions of anxiety sensitivity, discomfort intolerance, and health anxiety

Prior research indicates the common presentation of somatic symptoms and obesity in primary care settings, as well as links between obesity and somatic symptoms. Anxiety sensitivity, discomfort intolerance, and health anxiety are three variables relevant to somatic symptoms. How those three variables relate to somatic symptom severity among individuals who are obese and the unique variance accounted for by each variable in somatic symptom severity remains unexamined. Among a large sample of primary care patients who are obese (N = 342), anxiety sensitivity, discomfort intolerance, and health anxiety collectively accounted for 35% of variance in somatic symptom severity beyond the effects of sociodemographic variables, body mass index, medical morbidity, and depression severity. Health anxiety accounted for the largest amount of unique variance in somatic symptom severity, potentially supporting the relevance of health anxiety to the presentation of increased somatic symptoms among patients who are obese.

When dyspnea gets worse: Suffocation fear and the dynamics of defensive respiratory responses to increasing interoceptive threat

In patients with anxiety and/or respiratory diseases, body sensations, particularly from the respiratory system, may increase in intensity and aversiveness and thus lead into defensive action (e.g., escape) or panic. The processes, however, that might contribute to the culmination of symptoms and the switch into defensive action have not been well understood yet. The current study aimed at evaluating an experimental paradigm to characterize the dynamics of defensive mobilization to body sensations increasing in intensity and aversiveness. Persons reporting low and high suffocation fear (SF; N = 69) were exposed to increasingly unpleasant feelings of dyspnea induced by inspiratory resistive loads and a breathing occlusion requiring voluntary breath holding. Respiratory responses were assessed along with subjective reports of anxiety and panic symptoms. Presentation of respiratory loads with increasing physical resistance led to increasingly unpleasant feelings of dyspnea. Twenty-eight participants terminated the exposure prematurely at least once. When dyspnea was severe, high compared to low SF persons exhibited an increased respiratory rate that was accompanied by reports of more intense panic symptoms. Premature terminations of exposure were preceded by a surge in anxiety, breathing frequency, and mouth pressure, and a decrease in tidal volume. We successfully established an experimental paradigm to assess changes in defensive responding with increasing intensity of an interoceptive threat. The current data foster our understanding of behavioral expression patterns observed in patients with anxiety and/or respiratory diseases and the processes involved in the culmination of bodily sensations and anxiety into panic.

Functional neuroanatomy in panic disorder: Status quo of the research

AIM

To provide an overview of the current research in the functional neuroanatomy of panic disorder.

METHODS

Panic disorder (PD) is a frequent psychiatric disease. Gorman et al (1989; 2000) proposed a comprehensive neuroanatomical model of PD, which suggested that fear- and anxiety-related responses are mediated by a so-called “fear network” which is centered in the amygdala and includes the hippocampus, thalamus, hypothalamus, periaqueductal gray region, locus coeruleus and other brainstem sites. We performed a systematic search by the electronic database PubMed. Thereby, the main focus was laid on recent neurofunctional, neurostructural, and neurochemical studies (from the period between January 2012 and April 2016). Within this frame, special attention was given to the emerging field of imaging genetics.

RESULTS

We noted that many neuroimaging studies have reinforced the role of the “fear network” regions in the pathophysiology of panic disorder. However, recent functional studies suggest abnormal activation mainly in an extended fear network comprising brainstem, anterior and midcingulate cortex (ACC and MCC), insula, and lateral as well as medial parts of the prefrontal cortex. Interestingly, differences in the amygdala activation were not as consistently reported as one would predict from the hypothesis of Gorman et al (2000). Indeed, amygdala hyperactivation seems to strongly depend on stimuli and experimental paradigms, sample heterogeneity and size, as well as on limitations of neuroimaging techniques. Advanced neurochemical studies have substantiated the major role of serotonergic, noradrenergic and glutamatergic neurotransmission in the pathophysiology of PD. However, alterations of GABAergic function in PD are still a matter of debate and also their specificity remains questionable. A promising new research approach is “imaging genetics”. Imaging genetic studies are designed to evaluate the impact of genetic variations (polymorphisms) on cerebral function in regions critical for PD. Most recently, imaging genetic studies have not only confirmed the importance of serotonergic and noradrenergic transmission in the etiology of PD but also indicated the significance of neuropeptide S receptor, CRH receptor, human TransMEMbrane protein (TMEM123D), and amiloride-sensitive cation channel 2 (ACCN2) genes.

CONCLUSION

In light of these findings it is conceivable that in the near future this research will lead to the development of clinically useful tools like predictive biomarkers or novel treatment options.

Specific expectancies are associated with symptomatic outcomes and side effect burden in a trial of chamomile extract for generalized anxiety disorder

OBJECTIVE

Patient expectancies are hypothesized to contribute to the efficacy and side effects of psychiatric treatments, but little research has investigated this hypothesis in the context of psychopharmacological therapies for anxiety. We prospectively investigated whether expectancies predicted efficacy and adverse events in oral therapy for Generalized Anxiety Disorder (GAD), controlling for confounding patient characteristics correlating with outcomes.

METHODS

Expectancies regarding treatment efficacy and side effects were assessed at baseline of an eight week open-label phase of a trial of chamomile for Generalized Anxiety Disorder (GAD). The primary outcome was patient-reported GAD-7 scores, with clinical response and treatment-emergent side-effects as secondary outcomes. Expectancies were used to predict symptomatic and side-effect outcomes.

RESULTS

Very few baseline patient characteristics predicted either type of expectancy. Controlling for a patient's predicted recovery based on their baseline characteristics, higher efficacy expectancies at baseline predicted greater change on the GAD-7 (adjusted β = -0.19, p = 0.011). Efficacy expectancies also predicted a higher likelihood of attaining clinical response (adjusted odds ratio = 1.69, p = 0.002). Patients with higher side effect expectancies reported more side effects (adjusted log expected count = 0.26, p = 0.038). Efficacy expectancies were unrelated to side effect reports (log expected count = -0.05, p = 0.680), and side effect expectancies were unrelated to treatment efficacy (β = 0.08, p = 0.306).

CONCLUSIONS

Patients entering chamomile treatment for GAD with more favorable self-generated expectancies for the treatment experience greater improvement and fewer adverse events. Aligning patient expectancies with treatment selections may optimize outcomes.

REGISTRATION

Trial Number NCT01072344 at ClinicalTrials.gov.

The impact of body vigilance on help-seeking for cancer 'alarm' symptoms: a community-based survey

Background

The act of detecting bodily changes is a pre-requisite for subsequent responses to symptoms, such as seeking medical help. This is the first study to explore associations between self-reported body vigilance and help-seeking in a community sample currently experiencing cancer ‘alarm’ symptoms.

Methods

Using a cross-sectional study design, a ‘health survey’ was mailed through primary care practices to 4913 UK adults (age ≥50 years, no cancer diagnosis), asking about symptom experiences and medical help-seeking over the previous three months. Body vigilance, cancer worry and current illness were assessed with a small number of self-report items derived from existing measures.

Results

The response rate was 42% (N = 2042). Almost half the respondents (936/2042; 46%) experienced at least one cancer alarm symptom. Results from logistic regression analysis revealed that paying more attention to bodily changes was significantly associated with help-seeking for cancer symptoms (OR = 1.44; 1.06-1.97), after controlling for socio-demographics, current illness and cancer worry. Being more sensitive to bodily changes was not significantly associated with help-seeking.

Conclusions

Respondents who paid attention to their bodily changes were more likely to seek help for their symptoms. Although the use of a cross-sectional study design and the limited assessment of key variables preclude any firm conclusions, encouraging people to be body vigilant may contribute towards earlier cancer diagnosis. More needs to be understood about the impact this might have on cancer-related anxiety.

Altered functional connectivity of interoception in illness anxiety disorder

Interoception collects all information coming from the body and is sustained by several brain areas such as insula and cingulate cortex. Here, we used resting-state functional magnetic resonance imaging to investigate functional connectivity (FC) of networks implied in interoception in patients with Illness anxiety disorders (IADs). We observed significantly reduced FC between the left extrastriate body area (EBA) and the paracentral lobule compared to healthy controls. Moreover, the correlation analysis between behavioural questionnaires and ROI to ROI FC showed that higher levels of illness anxiety were related to hyper-connectivity between EBA and amygdala and hippocampus. Scores on a questionnaire for interoceptive awareness were significantly correlated with higher FC between right hippocampus and nucleus accumbens bilaterally, and with higher connectivity between left anterior cingulate cortex (ACC) and left orbitofrontal cortex (OFC). Last, patients showed increased interoceptive awareness, measured by Self-Awareness Questionnaire (SAQ), and reduced capability in recognizing emotions, indicating inverse correlation between interoception and emotional awareness. Taken together our results suggested that, in absence of structural and micro-structural changes, patients with IADs show functional alteration in the neural network involved in the self-body representation; such functional alteration might be the target of possible treatments.

Pilot trial of a therapist-supported internet-delivered cognitive behavioural therapy program for health anxiety

Cognitive behavioural therapy (CBT) is an effective treatment for health anxiety, but more research is needed to evaluate accessible, low cost ways of delivering CBT. Internet CBT may be effective, but there are no iCBT programs available outside of Sweden. We developed the first English-language clinician-guided iCBT program for health anxiety and conducted an open pilot trial (n = 16) to examine its acceptability, and impact on health anxiety and comorbidity, disability, and the cognitive and behavioural factors thought to maintain the disorder (e.g., catastrophising, hypervigilance). 13/16 participants completed the program (81% adherence). We found large and significant reductions in health anxiety, depression, distress, anxiety and disability (g's > 1.0), dysfunctional cognitions, behaviours and body vigilance between pre- and post-treatment, which were maintained at 3-month follow-up. The results provide preliminary support for the use of iCBT for health anxiety. Randomised controlled efficacy trials are now needed to evaluate this program.

Processes Contributing to the Maintenance of Flying Phobia: A Narrative Review

Flying phobia is a highly prevalent anxiety disorder, which causes sufferers significant distress and life interference. The processes which maintain flying phobia remain poorly understood. A systematic search of the literature was performed to identify what research has been conducted into the processes which may be involved in the fear of flying and whether processes which are believed to maintain other anxiety disorder diagnoses have been investigated in flying phobia. The results of the literature review are presented and related to existing cognitive behavioral theory and research. The results indicate that little research has been conducted into a number of areas considered important in the wider cognitive behavioral literature on anxiety disorders: namely attention, mental imagery, memory, worry, and safety-seeking behaviors. The review proposes a hypothetical model, derived from cognitive behavioral theory, for the processes which may be involved in maintaining flying phobia, and considers a number of areas for future research.