Repressive-defensive style and physiological reactivity among children and adolescents with asthma

Repressing distress in childhood: a defense against health-related stress

This paper is a review of empirical investigations of the repressive adaptive style in youth. Studies were selected on the basis of their adherence to Weinberger et al.'s (J Abnorm Psychol 88: 369-380, 1979) paradigm, consisting of the interaction between a measure of distress and a measure of defensiveness to categorize repressors. The presence of a repressive style of adaptation was identified in adolescence, especially among pediatric populations. Adolescent repressors were found to exhibit characteristics similar to those identified among adult samples (i.e., self-deception, biased self-reports, and inhibition of signals of distress). Only one study focused on young repressors' autonomic reactivity, which is another main characteristic of a repressive adaptive style in adulthood. Methodological inconsistencies between child studies are highlighted and weaknesses in the psychometric properties of defensiveness measures in childhood are discussed. Future investigations should examine the impact of a repressive adaptive style on health outcomes and behaviors to see if adult health data associated with a repressive style of adaptation are replicable in childhood.

Repressive coping style and autonomic reactions to two experimental stressors in healthy men and women

Autonomic and affective responses to two different stress tasks were measured in 45 males and 74 females, categorized as repressive, true low-anxious, true high-anxious, and defensive high-anxious. Electrodermal activity (EDA) was used as a measure of sympathetic activity and the high frequency (HF) spectral component of heart rate variability as a measure of parasympathetic activity. Contrary to our predictions, reactivity of repressors did not differ from the reactivity of true low-anxious participants. The results draw attention to previous inconsistent findings within the literature on repressive coping style and autonomic nervous system dysregulation. It is suggested that future research could benefit from the use of more consistent operationalizations of the repressive coping construct and from comparing alternative measures of repressive coping within the same study.

The influence of rumination and defensiveness on negative affect in response to experimental stress

Previous experiments investigating the influence of rumination on negative affect have often manipulated the timing and content of rumination, which may be problematic as rumination is phenomenologically experienced as uncontrollable. In the present experiment, rumination was not manipulated, but measured as an individual tendency before the experiment. Furthermore, it was tested whether defensiveness would reduce the higher degree of negative affect often associated with rumination. Fifty-six participants completed questionnaires measuring rumination and defensiveness and participated in a phrase completion task, rating negative affect before and after the task. Correlational analyses showed that rumination was positively associated (p < 0.05) with affect responses (r range = 0.35-0.61), whereas defensiveness was negatively associated with affect responses (r range =-0.27-0.32). Four groups of high and low rumination and defensiveness scorers were created using median splits. An ANOVA showed that scoring high on defensiveness did not reduce the negative affect experienced by high ruminating participants.

Psychological aspects of asthma

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

Psychiatric issues in pulmonary disease

This article has attempted to provide an overview of the clinical literature regarding the psychological issues facing patients with pulmonary disease, depending on when the illness begins in the life span, because different developmental tasks are disrupted. Patients must contend with side effects of medication that may mimic or exacerbate psychiatric disorders. The main drug interactions for psychiatrists to be aware of in this patient population occur between rifampin, or theophylline and psychotropic medications. In lung transplant recipients on cyclosporine therapy, the antidepressant drug nefazadone may cause increased cyclosporine levels. Psychiatrists must be aware of the risks, benefits, and survival statistics; educate patients; and ascertain whether the patient is competent to make medical decisions regarding treatment procedures.

Stress and airway resistance in children with asthma

OBJECTIVE

The present study implements an experimental paradigm to examine airway reactivity to stress in children with asthma and controls.

METHOD

114 children with asthma and 30 controls (ages 9-15) participated. The protocol involved 5 min of baseline physiological measurements followed by a 5-min stressful task. Skin conductance (EDG), skin temperature, and heart rate were measured continuously. Airway resistance was measured at baseline and after the task.

RESULTS

110 children (76% of the sample) were significantly "stressed" as shown by physiological changes. Asthmatics and controls differed on overall airway resistance, F(1, 108)=12.3, P<.001. The entire sample demonstrated a trend toward increased airway resistance in response to stress, F(1,108)=3.1, P<. 08. A portion of asthmatics (22%) had increases of greater than 20% of baseline airway resistance. Changes in airway resistance in response to stress were unrelated to asthma severity, F(2,78)=2.0, ns.

CONCLUSION

Children with asthma and controls demonstrate variation in airway function in response to stress, although increases are likely more meaningful for children with asthma. Further research is needed to examine the mechanisms underlying this response.