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Rolland-Debord C, Goriounov I, Pitron V. [The psychological burden of asthma]. Rev Mal Respir 2021; 38:721-732. [PMID: 33992494 DOI: 10.1016/j.rmr.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/31/2021] [Indexed: 10/21/2022]
Abstract
The experience of living with asthma varies between patients. In some cases, the psychological experience can take a central place and determine the course of asthma. Asthmatic disease can be complicated by adaption disorders that hamper the treatment, or genuine anxiety and depressive disorders that require the intervention of mental health specialists. Even more, the psychological experience can influence the intensity and frequency of the physical symptoms themselves, for example when asthma is associated with a hyperventilation syndrome worsening the functional impact and complicating the treatment. In this article, we underline the significance of the psychological experience through several clinical vignettes of patients suffering from asthma. In particular, we discuss the role of denial, or conversely identification with the status of being a patient, and the importance of the emotional experience associated with the symptoms of asthma. We highlight the relevance of therapeutic education programs as well as cognitive-behavioral therapies and psycho-corporal techniques, such as relaxation, for the psychological care of asthmatic disease. Finally, we detail how to better recognize a hyperventilation syndrome associated with asthma, how it can be approached with the patient and the treatment options. Through these examples, we illustrate the relevance of a comprehensive approach that integrates the psychological experience into the care of asthmatic disease.
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Affiliation(s)
- C Rolland-Debord
- Service de pneumologie, médecine intensive et réanimation (SPMIR), département R3S, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France.
| | - I Goriounov
- Service de pneumologie, médecine intensive et réanimation (SPMIR), département R3S, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France
| | - V Pitron
- UMR 8129, ENS/EHESS/CNRS, IEC, PSL, institut Jean-Nicod, 29, rue d'Ulm, 75005 Paris, France; Service de psychiatrie adulte, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France
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2
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Livermore P, Gray S, Mulligan K, Stinson JN, Wedderburn LR, Gibson F. Being on the juvenile dermatomyositis rollercoaster: a qualitative study. Pediatr Rheumatol Online J 2019; 17:30. [PMID: 31215480 PMCID: PMC6582587 DOI: 10.1186/s12969-019-0332-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/22/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Juvenile Dermatomyositis is a rare, potentially life-threatening condition with no known cure. There is no published literature capturing how children and young people feel about their condition, from their perspective. This study was therefore unique in that it asked children and young people what is it like to live with Juvenile Dermatomyositis. METHODS Data were obtained from fifteen young people with Juvenile Dermatomyositis, between eight and nineteen years of age from one Paediatric Rheumatology department using audio-recorded interpretive phenomenology interviews. Data were analyzed phenomenologically, using a process that derives narratives from transcripts resulting in a collective composite of participants shared experiences, called a 'phenomenon'. RESULTS The overarching metaphor of a rollercoaster captures the phenomenon of living with Juvenile Dermatomyositis as a young person, with the ups and downs at different time points clearly described by those interviewed. The five themes plotted on the rollercoaster, began with confusion; followed by feeling different, being sick, steroidal and scared from the medications; uncertainty; and then ended with acceptance of the disease over time. CONCLUSION Young people were able to talk about their experiences about having Juvenile Dermatomyositis. Our findings will aid clinicians in their practice by gaining a deeper understanding of what daily life is like and highlighting ways to enhance psychosocial functioning. Hopefully, this study and any further resulting studies, will raise understanding of Juvenile Dermatomyositis worldwide and will encourage health care professionals to better assess psychosocial needs in the future.
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Affiliation(s)
- Polly Livermore
- University College London Great Ormond Street Institute of Child Health, London, UK. .,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK. .,NIHR Clinical Doctoral Research Nursing Fellow, Infection, Immunity and Inflammation, 6th Floor, Institute of Child Health, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Suzanne Gray
- 0000 0004 5345 7223grid.483570.dEvelina London Children’s Hospital, GSTT NHS Foundation Trust, London, UK
| | - Kathleen Mulligan
- 0000 0004 1936 8497grid.28577.3fCity, University of London, London, UK ,0000 0004 0426 7183grid.450709.fEast London NHS Foundation Trust, London, UK
| | - Jennifer N. Stinson
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children, Toronto, Canada ,0000 0001 2157 2938grid.17063.33Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Lucy R. Wedderburn
- 0000000121901201grid.83440.3bUniversity College London Great Ormond Street Institute of Child Health, London, UK ,0000 0001 2116 3923grid.451056.3NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK ,0000000121901201grid.83440.3bCentre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
| | - Faith Gibson
- 0000 0004 5902 9895grid.424537.3Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,0000 0004 0407 4824grid.5475.3School of Health Sciences, University of Surrey, Surrey, UK
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3
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Protective effect of heart rate variability biofeedback on stress-induced lung function impairment in asthma. Respir Physiol Neurobiol 2019; 262:49-56. [PMID: 30695733 DOI: 10.1016/j.resp.2019.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/10/2019] [Accepted: 01/25/2019] [Indexed: 01/09/2023]
Abstract
Psychological stress can provoke airway constriction in asthmatic patients, which may be because of autonomic nervous system dysfunction in asthma. We investigated the effect of enhancing respiratory sinus arrhythmia using heart rate variability biofeedback (HRV-BF) on spirometry performance and HRV indices during stress induced by Stroop Color-Word interference test in asthmatic patients and healthy volunteers. Stress caused decrease in FEV1%, FVC%, and PEF% compared to baseline in asthmatic patients, but not in healthy subjects. A single short duration episode of HRV-BF not only had a protective effect on stress-induced airway constriction, but also significantly augmented the level of FEV1% and FVC% as compared with their own baseline. Also, there was a significant correlation between HRV changes and the augmentation of spirometry performance in asthmatic patients receiving HRV-BF. Our findings indicated that even a single short duration episode of HRV-BF can decrease susceptibility to stress-induced lung function impairment in patients with asthma, which may be through the modulation of respiratory sinus arrhythmia.
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Stoeckel MC, Esser RW, Gamer M, von Leupoldt A. Breathlessness amplifies amygdala responses during affective processing. Psychophysiology 2018; 55:e13092. [PMID: 29667212 DOI: 10.1111/psyp.13092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022]
Abstract
Breathlessness is an aversive symptom in many prevalent somatic and psychiatric diseases and is usually experienced as highly threatening. It is strongly associated with negative affect, but the underlying neural processes remain poorly understood. Therefore, using fMRI, the present study examined the effects of breathlessness on the neural processing of affective visual stimuli within candidate brain areas including the amygdala, insula, and anterior cingulate cortex (ACC). During scanning, 42 healthy volunteers, mean (SD) age: 29.0 (6.0) years, 14 female, were presented with affective picture series of negative, neutral, and positive valence while experiencing either no breathlessness (baseline conditions) or resistive-load induced breathlessness (breathlessness conditions). Respiratory measures and self-reports suggested successful induction of breathlessness and affective experiences. Self-reports of breathlessness intensity and unpleasantness were significantly higher during breathlessness conditions, mean (SD): 45.0 (16.6) and 32.3 (19.8), as compared to baseline conditions, mean (SD): 1.9 (3.0) and 2.9 (5.5). Compared to baseline conditions, stronger amygdala activations were observed during breathlessness conditions for both negative and positive affective picture series relative to neutral picture series, while no such effects were observed in insula and ACC. The present findings demonstrate that breathlessness amplifies amygdala responses during affective processing, suggesting an important role of the amygdala for mediating the interactions between breathlessness and affective states.
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Affiliation(s)
- M Cornelia Stoeckel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland W Esser
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Gamer
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychology 1, University of Würzburg, Würzburg, Germany
| | - Andreas von Leupoldt
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Health Psychology, University of Leuven, Leuven, Belgium
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5
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Longitudinal co-variations between inflammatory cytokines, lung function and patient reported outcomes in patients with asthma. PLoS One 2017; 12:e0185019. [PMID: 28915273 PMCID: PMC5600400 DOI: 10.1371/journal.pone.0185019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/04/2017] [Indexed: 11/19/2022] Open
Abstract
Background Asthma is a chronic inflammatory respiratory disorder associated with reduced lung function and poor quality of life. The condition is also associated with poor self-rated health, a major predictor of objective health trajectories. Of biological correlates to self-rated health, evidence suggests a role for inflammatory cytokines and related sickness behaviours. However, this is mainly based on cross-sectional data, and the relation has not been investigated in patients with chronic inflammatory conditions. Objective To investigate inflammatory cytokines, lung function, sickness behaviour and asthma-related quality of life as determinants of self-rated health in patients with asthma, and to investigate if these variables co-vary over time. Methods Plasma cytokines (IL-5, IL-6), lung function (FEV1), sickness behaviour, asthma-related quality of life and self-rated health were assessed in 181 patients with allergic asthma aged 18–64 years in a one-year longitudinal study. Mixed effect regression models and Spearman’s correlation were performed to analyse the associations between repeated measurements. Results More sickness behaviour and poorer asthma-related quality of life were associated with poorer self-rated health (p’s<0.001). In men, both low and high levels of interleukin (IL)-6 and poorer lung function were related with poorer self-rated health (p’s<0.05). Over the year, improved asthma-related quality of life was associated with better self-rated health (Spearman’s rho = -0.34 women,-0.36 men, p’s<0.01). Further, if sickness behaviour decreased, self-rated health improved, but only in women (Rho = -0.21, p<0.05). Increased FEV1 in men was associated with an increase in IL-6 (Rho = 0.24, p<0.05) as well as improved self-rated health (Rho = -0.21, p<0.05) and asthma-related quality of life (Rho = 0.29, p<0.01) over the year. Conclusion The study highlights the importance of subjectively perceived sickness behaviour and asthma-related quality of life together with lung function as determinants of self-rated health in asthmatic patients. The importance of inflammatory activation for patient reported outcomes in chronic inflammatory conditions need further investigation.
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Chisholm A, Price DB, Pinnock H, Lee TT, Roa C, Cho SH, David-Wang A, Wong G, van der Molen T, Ryan D, Castillo-Carandang N, Yong YV. Personalising care of adults with asthma from Asia: a modified e-Dephi consensus study to inform management tailored to attitude and control profiles. NPJ Prim Care Respir Med 2017; 27:16089. [PMID: 28055000 PMCID: PMC5215112 DOI: 10.1038/npjpcrm.2016.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 08/10/2016] [Accepted: 09/25/2016] [Indexed: 12/05/2022] Open
Abstract
REALISE Asia—an online questionnaire-based study of Asian asthma patients—identified five patient clusters defined in terms of their control status and attitude towards their asthma (categorised as: ‘Well-adjusted and at least partly controlled’; ‘In denial about symptoms’; ‘Tolerating with poor control’; ‘Adrift and poorly controlled’; ‘Worried with multiple symptoms’). We developed consensus recommendations for tailoring management of these attitudinal–control clusters. An expert panel undertook a three-round electronic Delphi (e-Delphi): Round 1: panellists received descriptions of the attitudinal–control clusters and provided free text recommendations for their assessment and management. Round 2: panellists prioritised Round 1 recommendations and met (or joined a teleconference) to consolidate the recommendations. Round 3: panellists voted and prioritised the remaining recommendations. Consensus was defined as Round 3 recommendations endorsed by >50% of panellists. Highest priority recommendations were those receiving the highest score. The multidisciplinary panellists (9 clinicians, 1 pharmacist and 1 health social scientist; 7 from Asia) identified consensus recommendations for all clusters. Recommended pharmacological (e.g., step-up/down; self-management; simplified regimen) and non-pharmacological approaches (e.g., trigger management, education, social support; inhaler technique) varied substantially according to each cluster’s attitude to asthma and associated psychosocial drivers of behaviour. The attitudinal–control clusters defined by REALISE Asia resonated with the international panel. Consensus was reached on appropriate tailored management approaches for all clusters. Summarised and incorporated into a structured management pathway, these recommendations could facilitate personalised care. Generalisability of these patient clusters should be assessed in other socio-economic, cultural and literacy groups and nationalities in Asia.
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Affiliation(s)
| | - David B Price
- Department of Primary Care Respiratory Medicine, University of Aberdeen, Aberdeen, UK.,Observational & Pragmatic Research Institute Pte Ltd, Singapore
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Tan Tze Lee
- National University Hospital, Singapore, Singapore
| | - Camilo Roa
- Section of Pulmonary Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Sang-Heon Cho
- Seoul National University College of Medicine, Seoul, Korea
| | - Aileen David-Wang
- Section of Pulmonary Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Gary Wong
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Thys van der Molen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dermot Ryan
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Nina Castillo-Carandang
- Department of Clinical Epidemiology, College of Medicine; and Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Yee Vern Yong
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Chan PYS, Cheng CH, Jhu YJ, Chen CL, von Leupoldt A. Being Anxious, Thinking Positively: The Effect of Emotional Context on Respiratory Sensory Gating. Front Physiol 2016; 7:19. [PMID: 26909040 PMCID: PMC4754425 DOI: 10.3389/fphys.2016.00019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/14/2016] [Indexed: 12/27/2022] Open
Abstract
Respiratory sensory gating function has been found decreased by induced negative emotion in healthy adults. The increased ratio of the respiratory-related evoked potential (RREP) N1 peak amplitude for the second occlusion (S2) vs. the first occlusion (S1), S2/S1, is indicative of such decreased respiratory sensory gating. In this study, we tested the hypothesis that a positive emotional context would enhance respiratory sensory gating function in healthy individuals. In addition, we tested the modulating role of individual anxiety levels. We compared respiratory sensory gating in 40 healthy individuals by the paired inspiratory occlusion paradigm in a positive and neutral emotional context induced by emotional picture viewing. The results showed that the group averaged RREP N1 peak amplitudes S2/S1 ratios were significantly smaller in the positive compared to neutral context (0.49 vs. 0.64; p < 0.01). Further, analysis showed that the ratio decrease was due to a reduced response to the S2 and an enhanced response to S1 in the positive emotional context (p < 0.05). The subgroup analyses showed that in the positive emotional context, both individuals with low-moderate anxiety levels and those with no anxiety demonstrated a significant decrease of their S2/S1 ratio, but only those with low-moderate anxiety levels showed reduced S2 amplitudes compared to the neutral context (p < 0.01). In conclusion, our results suggest that a positive emotional context is related to better brain inhibitory mechanisms by filtering out repetitive respiratory stimuli in healthy individuals, especially in the presence of low-moderate anxiety levels. Further, investigation on how positive emotional contexts might contribute to improved respiratory sensory gating ability in clinical populations is necessary.
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Affiliation(s)
- Pei-Ying S Chan
- Department of Occupational Therapy, College of Medicine, and Healthy Ageing Research Center, Chang Gung UniversityTaoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at LinkouTaoyuan, Taiwan
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy, College of Medicine, and Healthy Ageing Research Center, Chang Gung UniversityTaoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at LinkouTaoyuan, Taiwan
| | - Ya-Jhih Jhu
- Department of Occupational Therapy, College of Medicine, and Healthy Ageing Research Center, Chang Gung UniversityTaoyuan, Taiwan; Division of Psychiatry, Taipei Veterans General Hospital at Yuan ShanYilan County, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial hospital at LinkouTaoyuan, Taiwan; Graduate Institute of Early Intervention, College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
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Baiardini I, Sicuro F, Balbi F, Canonica GW, Braido F. Psychological aspects in asthma: do psychological factors affect asthma management? Asthma Res Pract 2015; 1:7. [PMID: 27965761 PMCID: PMC5142316 DOI: 10.1186/s40733-015-0007-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/01/2015] [Indexed: 11/22/2022] Open
Abstract
Despite the regular treatment with inhaled corticosteroids (ICS) or ICS plus long-acting beta2-agonists, permits to control de majority of asthmatics, a significant proportion of patients does not respond to this treatment. This review was aimed to explore the role of psychological factors associated to the unsuccessful fulfilment of optimal levels of asthma control, especially in patients suffering from severe asthma. The results of a Medline search were 5510 articles addressed to different psychological key concepts, constructs and variables. This review will highlight how some selected psychological factors may have a burden on asthma management. Evidences are now available about the link between asthma (in terms of severity and control), some psychological aspects (subjective perception, alexithymia, coping style) and mental health (anxiety, depression). Taking into account this most probably bidirectional influence, a screening of mental symptoms and psychological aspects related to asthma, could lead to plan appropriate interventions to better control asthma and to improve the patient’s well-being.
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Affiliation(s)
- Ilaria Baiardini
- Allergy & Respiratory Diseases Department, Azienda Ospedaliera Universitaria IRCCS San Martino, Genoa, Italy
| | - Francesca Sicuro
- Allergy & Respiratory Diseases Department, Azienda Ospedaliera Universitaria IRCCS San Martino, Genoa, Italy
| | - Francesco Balbi
- Allergy & Respiratory Diseases Department, Azienda Ospedaliera Universitaria IRCCS San Martino, Genoa, Italy
| | - Giorgio Walter Canonica
- Allergy & Respiratory Diseases Department, Azienda Ospedaliera Universitaria IRCCS San Martino, Genoa, Italy
| | - Fulvio Braido
- Allergy & Respiratory Diseases Department, Azienda Ospedaliera Universitaria IRCCS San Martino, Genoa, Italy
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10
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Petersen S, Schroijen M, Mölders C, Zenker S, Van den Bergh O. Categorical interoception: perceptual organization of sensations from inside. Psychol Sci 2014; 25:1059-66. [PMID: 24570260 DOI: 10.1177/0956797613519110] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adequate perception of bodily sensations is essential to protect health. However, misinterpretation of signals from within the body is common and can be fatal, for example, in asthma or cardiovascular disease. We suggest that placing interoceptive stimuli into interoceptive categories (e.g., the category of symptoms vs. the category of benign sensations) leads to perceptual generalization effects that may underlie misinterpretation. In two studies, we presented stimuli inducing respiratory effort (respiratory loads) either organized into categories or located on a continuous dimension. We found pervasive effects of categorization on magnitude estimations, affective stimulus evaluations, stimulus recognition, and breathing behavior. These findings indicate the need for broadening perspectives on interoception to include basal processes of stimulus organization, in order for interoceptive bias to be understood. The results are relevant to a wide range of interoception-related phenomena, from emotion to symptom perception.
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Braido F. Failure in asthma control: reasons and consequences. SCIENTIFICA 2013; 2013:549252. [PMID: 24455432 PMCID: PMC3881662 DOI: 10.1155/2013/549252] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/26/2013] [Indexed: 05/05/2023]
Abstract
Clinical research showed that asthma control is an achievable target. However, real-life observations suggest that a significant proportion of patients suffer from symptoms and report lifestyle limitations with a considerable burden on patient's quality of life. The achievement of asthma control is the result of the interaction among different variables concerning the disease pattern and patients' and physicians' knowledge and behaviour. The failure in asthma control can be considered as the result of the complex interaction among different variables, such as the role of guidelines diffusion and implementation, some disease-related factors (i.e., the presence of common comorbidities in asthma such as gastroesophageal reflux disease (GERD), sleep disturbances and obstructive sleep apnea (OSA), and rhinitis) or patient-related factors (i.e., adherence to treatment, alexithymia, and coping strategies). Asthma control may be reached through a tailored treatment plan taking into account the complexity of factors that contribute to achieve and maintain this objective.
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Affiliation(s)
- Fulvio Braido
- Allergy & Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, 16132 Genoa, Italy
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12
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Psycho-emotional manifestations of valvular heart diseases: prospective assessment in mitral regurgitation. Am J Med 2013; 126:916-24. [PMID: 23932160 DOI: 10.1016/j.amjmed.2013.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/17/2013] [Accepted: 05/24/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To define the prevalence and consequences of post-traumatic stress disorder (PTSD) as an emotional response to cardiac diseases in patients with mitral regurgitation. METHODS We prospectively enrolled 186 patients with moderate or severe organic mitral regurgitation, presenting class I (absent) or II (minimal) dyspnea, who were compared with 80 controls of similar age (38 with completely normal cardiac function; 42 with mild mitral-valve prolapse; all with no, or at most mild, mitral regurgitation). Mitral-regurgitation severity and consequences were comprehensively measured, simultaneously with PTSD, anxiety, and depression. RESULTS PTSD prevalence was higher in mitral-regurgitation patients vs controls (23% vs 9%, P <.01). Although mitral-regurgitation objective severity (regurgitant volume 77.8 ± 28.9 vs 79.0 ± 27.5 mL, P = .8) and objective consequences (left-atrial volume 59.1 ± 20.9 vs 54.02 ± 15.6 mL, P = .1; right-ventricular systolic pressure 34.1 ± 11.4 vs 32.9 ± 7.2 mm Hg, P = .6) were similar with and without PTSD (all P ≥.1), patients with PTSD were more symptomatic (class II 74 vs 38%; fatigue 71% vs 38%, both P <.0001) and had higher anxiety and depressions scores (P <.0001). CONCLUSIONS PTSD is prevalent in organic moderate or severe mitral-regurgitation patients but is not determined by objective mitral-regurgitation severity or consequences. PTSD is linked to anxiety and depression and to symptoms usually considered cardiac, such as dyspnea. Thus, PTSD and psycho-emotional manifestations, linked to symptoms, represent important responses to chronic-valve disease that may affect clinical outcomes.
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13
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Janssens T, Ritz T. Perceived triggers of asthma: key to symptom perception and management. Clin Exp Allergy 2013; 43:1000-8. [PMID: 23957335 PMCID: PMC3748392 DOI: 10.1111/cea.12138] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 02/12/2013] [Accepted: 04/11/2013] [Indexed: 01/22/2023]
Abstract
Adequate asthma management depends on an accurate identification of asthma triggers. A review of the literature on trigger perception in asthma shows that individuals vary in their perception of asthma triggers and that the correlation between self-reported asthma triggers and allergy tests is only modest. In this article, we provide an overview of psychological mechanisms involved in the process of asthma triggers identification. We identify sources of errors in trigger identification and targets for behavioural interventions that aim to improve the accuracy of asthma trigger identification and thereby enhance asthma control.
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Hayen A, Herigstad M, Pattinson KTS. Understanding dyspnea as a complex individual experience. Maturitas 2013; 76:45-50. [PMID: 23849705 DOI: 10.1016/j.maturitas.2013.06.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 06/05/2013] [Indexed: 02/07/2023]
Abstract
Dyspnea is the highly threatening experience of breathlessness experienced by patients with diverse pathologies, including respiratory, cardiovascular, and neuromuscular diseases, cancer and panic disorder. This debilitating symptom is especially prominent in the elderly and the obese, two growing populations in the Western world. It has further been found that women suffer more strongly from dyspnea than men. Despite optimization of disease-specific treatments, dyspnea is often inadequately treated. The immense burden faced by patients, families and the healthcare system makes improving management of chronic dyspnea a priority. Dyspnea is a multidimensional sensation that encompasses an array of unpleasant respiratory sensations that vary according to underlying cause and patient characteristics. Biopsychological factors beyond disease pathology exacerbate the perception of dyspnea, increase symptom severity and reduce quality of life. Psychological state (especially comorbid anxiety and depression), hormone status, gender, body weight (obesity) and general fitness level are particularly important. Neuroimaging has started to uncover the neural mechanisms involved in the processing of sensory and affective components of dyspnea. Awareness of biopsychological factors beyond pathology is essential for diagnosis and treatment of dyspnea. Increasing understanding the interactions between biopsychological factors and dyspnea perception will enhance the development of symptomatic treatments that specifically address each patient's most pressing needs at a specific stage in life. Future neuroimaging research can provide objective markers to fully understand the role of biopsychological factors in the perception of dyspnea in the hope of uncovering target areas for pharmacologic and non-pharmacologic therapy.
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Affiliation(s)
- Anja Hayen
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, United Kingdom.
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15
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Trueba AF, Smith NB, Auchus RJ, Ritz T. Academic exam stress and depressive mood are associated with reductions in exhaled nitric oxide in healthy individuals. Biol Psychol 2013; 93:206-12. [PMID: 23410759 DOI: 10.1016/j.biopsycho.2013.01.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 01/26/2013] [Accepted: 01/28/2013] [Indexed: 12/26/2022]
Abstract
Nitric oxide (NO) has beneficial effects on cardiovascular and immune health. Stress and depression have been linked to a reduction in serum NO. In this study, we examined the effect of academic exam stress on the fraction of NO in exhaled air (FeNO) and spirometric lung function in 41 healthy college students. Participants completed assessments at mid-semester as well as in the early and late phase of an academic exam period. Negative affect, depressive mood, and salivary cortisol were elevated during exams, whereas FeNO and lung function decreased. Higher depressive mood was associated with lower FeNO, whereas higher negative affect was associated higher FeNO across time. These findings provide initial evidence that depression and prolonged stress can alter FeNO and lung function in healthy individuals, which could have adverse consequences for cardiovascular, airway, and immune health.
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Affiliation(s)
- Ana F Trueba
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
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Abstract
OBJECTIVE The present study addresses gaps in the literature on affect-biased health perceptions by (a) investigating health bias while considering both valence and arousal components of affect; (b) establishing the presence of, and variability in, affective health bias at the daily level; and (c) exploring daily health bias in a non-clinical, community sample of adults. DESIGN Participants were 477 adults (aged 33-80 years) who reported daily health events, health satisfaction and affect for up to 56 days. Health bias was present when the effect of a given day's health events on that day's health satisfaction was significantly moderated by that day's affect. Multilevel modelling was used to investigate fixed and random within-day effects. MAIN OUTCOME MEASURE Daily health satisfaction. RESULTS Significant interaction effects indicated the presence of health bias on the daily level: positively valenced affect buffered the negative impact of health events on health satisfaction, whereas negatively valenced affect exacerbated this association; additionally, valence emerged as the most salient characteristic of positive affect, whereas arousal was a differentiating factor for negative affect. CONCLUSION The results provide evidence that both valence and arousal components of affect are important to consider when investigating day-level health bias, and that these effects can be detected using a general population of adults.
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Affiliation(s)
- Brenda R Whitehead
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA.
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von Leupoldt A, Dahme B. The impact of emotions on symptom perception in patients with asthma and healthy controls. Psychophysiology 2012; 50:1-4. [PMID: 23215726 DOI: 10.1111/j.1469-8986.2012.01480.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/11/2012] [Indexed: 11/29/2022]
Abstract
Accurate perception of respiratory symptoms is highly important for course and treatment of asthma. Recent findings suggest that emotions can greatly impact respiratory symptom perception. This study compared the impact of emotions on respiratory symptom perception between patients with asthma and matched healthy controls. Pleasant and unpleasant emotional states were elicited by viewing emotional picture series while symptom reports and respiratory parameters were measured. Greater symptom report was observed for the unpleasant compared to the pleasant emotional state that was not related to respiratory parameters. Notably, this effect was comparable between patients with asthma and healthy controls. The present results suggest that the impact of emotions on respiratory symptom perception is a rather general phenomenon and not dependent upon previous experiences with asthma symptoms.
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Ritz T. Airway responsiveness to psychological processes in asthma and health. Front Physiol 2012; 3:343. [PMID: 22973233 PMCID: PMC3433706 DOI: 10.3389/fphys.2012.00343] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 08/08/2012] [Indexed: 12/16/2022] Open
Abstract
Psychosocial factors have been found to impact airway pathophysiology in respiratory disease with considerable consistency. Influences on airway mechanics have been studied particularly well. The goal of this article is to review the literature on airway responses to psychological stimulation, discuss potential pathways of influence, and present a well-established emotion-induction paradigm to study airway obstruction elicited by unpleasant stimuli. Observational studies have found systematic associations between lung function and daily mood changes. The laboratory-based paradigm of bronchoconstrictive suggestion has been used successfully to elicit airway obstruction in a substantial proportion of asthmatic individuals. Other studies have demonstrated modulation of airway responses to standard airway challenges with exercise, allergens, or pharmacological agents by psychological factors. Standardized emotion-induction techniques have consistently shown airway constriction during unpleasant stimulation, with surgery, blood, and injury stimuli being particularly powerful. Findings with various forms of stress induction have been more mixed. A number of methodological factors may account for variability across studies, such as choice of measurement technique, temporal association between stimulation and measurement, and the specific quality and intensity of the stimulus material, in particular the extent of implied action-orientation. Research has also begun to elucidate physiological processes associated with psychologically induced airway responses, with vagal excitation and ventilatory influences being the most likely candidate pathways, whereas the role of specific central nervous system pathways and inflammatory processes has been less studied. The technique of emotion-induction using films has the potential to become a standardized challenge paradigm for the further exploration of airway hyperresponsiveness mediated by central nervous system processes.
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Affiliation(s)
- Thomas Ritz
- Southern Methodist University Dallas, TX, USA
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Petersen S, A. van den Berg R, Janssens T, Van den Bergh O. Illness and symptom perception: A theoretical approach towards an integrative measurement model. Clin Psychol Rev 2011; 31:428-39. [DOI: 10.1016/j.cpr.2010.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 11/02/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022]
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Petersen S, Ritz T. The role of fearful beliefs in the relationship between situational self-awareness and report of breathing-related sensations. Br J Health Psychol 2011; 16:359-72. [DOI: 10.1348/135910710x509900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Weiss P, Rundell KW. Imitators of exercise-induced bronchoconstriction. Allergy Asthma Clin Immunol 2009; 5:7. [PMID: 20016690 PMCID: PMC2794850 DOI: 10.1186/1710-1492-5-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 11/17/2009] [Indexed: 11/10/2022] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is described by transient narrowing of the airways after exercise. It occurs in approximately 10% of the general population, while athletes may show a higher prevalence, especially in cold weather and ice rink athletes. Diagnosis of EIB is often made on the basis of self-reported symptoms without objective lung function tests, however, the presence of EIB can not be accurately determined on the basis of symptoms and may be under-, over-, or misdiagnosed. The goal of this review is to describe other clinical entities that mimic asthma or EIB symptoms and can be confused with EIB.
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Affiliation(s)
- Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, P.O. Box 208064, New Haven, CT 06520-8064, USA.
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Loving TJ, Crockett EE, Paxson AA. Passionate love and relationship thinkers: experimental evidence for acute cortisol elevations in women. Psychoneuroendocrinology 2009; 34:939-46. [PMID: 19250753 DOI: 10.1016/j.psyneuen.2009.01.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 01/02/2009] [Accepted: 01/22/2009] [Indexed: 10/21/2022]
Abstract
We assessed the impact of an individual difference variable, relationship-focused thinking, on women's acute salivary cortisol responses during and after a guided imagery task. Specifically, 29 healthy women, all of whom were experiencing high levels of passionate love, but varied on levels of relationship-focused thinking, were assigned to one of two experimental conditions: a partner reflection condition or a cross-sex friend reflection condition. Results indicated that women experiencing passionate love evidenced increased cortisol levels when asked to reflect on their romantic partner and relationship relative to women asked to reflect on a cross-sex friendship, but this difference was particularly pronounced and relatively long-lasting for those women characterized by a high amount of relationship-focused thinking. Our study significantly expands extant work on the passionate love-cortisol link by isolating the impact of a specific psychological variable, relationship-focused thinking, on the physiological experience of falling in love. We believe our work highlights the advances that can be made when established work in the close relationships and neuroendocrine fields are integrated.
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Affiliation(s)
- Timothy J Loving
- Department of Human Development and Family Sciences, The University of Texas at Austin, 1 University Station, Box A2700, Austin, TX 78712, USA.
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Janssens T, Verleden G, De Peuter S, Van Diest I, Van den Bergh O. Inaccurate perception of asthma symptoms: a cognitive-affective framework and implications for asthma treatment. Clin Psychol Rev 2009; 29:317-27. [PMID: 19285771 DOI: 10.1016/j.cpr.2009.02.006] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 12/25/2008] [Accepted: 02/13/2009] [Indexed: 01/12/2023]
Abstract
Inaccurate perception of respiratory symptoms is often found in asthma patients. Typically, patients who inaccurately perceive asthma symptoms are divided into underperceivers and overperceivers. In this paper we point out that this division is problematic. We argue that little evidence exists for a trait-like stability of under- and overperception and that accuracy of respiratory symptom perception is highly variable within persons and strongly influenced by contextual information. Particularly, expectancy and affective cues appear to have a powerful influence on symptom accuracy. Based on these findings and incorporating recent work on associative learning, attention and mental representations in anxiety and symptom perception, we propose a cognitive-affective model of symptom perception in asthma. The model can act as a framework to understand both normal perception as well as under- and overperception of asthma symptoms and can guide the development of affect-related interventions to improve perceptual accuracy, asthma control and quality of life in asthma patients.
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Affiliation(s)
- Thomas Janssens
- Research group on Health Psychology, Department of Psychology, University of Leuven, Belgium
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von Leupoldt A, Taube K, Schubert-Heukeshoven S, Magnussen H, Dahme B. Distractive Auditory Stimuli Reduce the Unpleasantness of Dyspnea During Exercise in Patients With COPD. Chest 2007; 132:1506-12. [PMID: 17890458 DOI: 10.1378/chest.07-1245] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Dyspnea is the primary symptom limiting exercise in patients with COPD. Recent research has demonstrated that psychological factors can substantially influence the perception of dyspnea, but little is known about the modulation of perceived intensity or unpleasantness of dyspnea by attentional distraction. Therefore, we examined the impact of distractive auditory stimuli on the perception of exercise-induced dyspnea and the affective state in patients with COPD during 6-min walking tests (6MWTs). METHODS Twenty patients with mild-to-severe COPD (mean FEV1, 55.9% predicted) underwent two 6MWTs. Under one exercise condition, distractive auditory stimuli were presented with headphones, while the other condition was performed without auditory distraction. Lung function (FEV1), heart rate (HR), pulse oximetric saturation (SpO2), perceived intensity of dyspnea (ie, visual analog scale for perceived intensity of dyspnea [VAS-I]), and perceived unpleasantness of dyspnea (visual analog scale for perceived unpleasantness of dyspnea [VAS-U]) were measured before and after exercise. In addition, the global level of dyspnea (Borg score), positive affectivity (PA), and negative affectivity were assessed after both conditions. RESULTS A similar exercise level during both conditions was confirmed by comparable results in FEV1, HR, SpO2, and distances walked. During auditory distraction, Borg scores and increases in VAS-U were smaller, while PA was higher compared to the nondistraction condition (p<0.05). VAS-I did not show differences across conditions. CONCLUSIONS Distractive auditory stimuli decrease the global level of exercise-induced dyspnea in patients with COPD by reducing the perceived unpleasantness of dyspnea and lead to an additional increase in PA. Auditory distraction might therefore serve as an intervention for the reduction of dyspnea during exercise in this patient group.
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Affiliation(s)
- Andreas von Leupoldt
- Department of Psychology, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
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