Negative Mood, Self-Focused Attention, and the Experience of Physical Symptoms: The Joint Impact Hypothesis

The Human Affectome

Over the last decades, theoretical perspectives in the interdisciplinary field of the affective sciences have proliferated rather than converged due to differing assumptions about what human affective phenomena are and how they work. These metaphysical and mechanistic assumptions, shaped by academic context and values, have dictated affective constructs and operationalizations. However, an assumption about the purpose of affective phenomena can guide us to a common set of metaphysical and mechanistic assumptions. In this capstone paper, we home in on a nested teleological principle for human affective phenomena in order to synthesize metaphysical and mechanistic assumptions. Under this framework, human affective phenomena can collectively be considered algorithms that either adjust based on the human comfort zone (affective concerns) or monitor those adaptive processes (affective features). This teleologically-grounded framework offers a principled agenda and launchpad for both organizing existing perspectives and generating new ones. Ultimately, we hope the Human Affectome brings us a step closer to not only an integrated understanding of human affective phenomena, but an integrated field for affective research.

Illness Perception and the Severity of Depression and Anxiety Symptoms in Patients with Multimorbidity: Observational Cohort Studies

INTRODUCTION

Many studies have shown a correlation between the patient's engagement in treatment and their perception of the illness.

AIM

The aim of this study has been to explore the link between the patient's perception of their illness with anxiety and depression, and to leverage this link to promote health education.

MATERIALS AND METHODS

The study was carried out using the following tools: the Hospital Anxiety and Depression Scale and the Illness Perception Questionnaire-Revised. The study participants included N = 143 patients.

RESULTS

The participants' age was statistically significantly associated with the expected duration of the illness (p < 0.01), the conviction that the treatment was effective (p < 0.01), and the perception of the severity of the disease symptoms (p < 0.05). The employment status was statistically significantly associated with the illness perception (p < 0.01). Anxiety and depression levels were statistically significantly associated with the perceived impact of the illness on life (p < 0.001) and emotional status (p < 0.001), the perceived control over the illness (p < 0.01), the potential for recovery (p < 0.001), the concern about the illness (p < 0.001), and the impact of the illness on emotional well-being (p < 0.001).

CONCLUSIONS

Individuals who perceived a high severity of illness symptoms also assessed that the illness significantly impacted their life and emotional state. The authors demonstrate a strong link of a "negative" perception of the illness with depression and anxiety. A better understanding of the illness predicted a less severe depression and lower anxiety.

IMPLICATIONS FOR PRACTICE

The results suggest that the study of illness perception holds significant potential to contribute effectively to educational and psychotherapeutic practices.

The relationship between expectancy, anxiety, and the nocebo effect: a systematic review and meta-analysis with recommendations for future research

Despite the theoretical prominence of expectancy and anxiety as potential mechanisms of the nocebo effect, not all studies measure expectancy and/or anxiety, and there are inconsistent findings among those that do. The present study sought to systematically review and meta-analyse available data to evaluate the relationship between expectancy, anxiety and the nocebo effect. The two key questions were: (1) whether nocebo manipulations influence expectancy and anxiety; and (2) whether expectancy and anxiety are associated with the subsequent nocebo effect. Fifty-nine independent studies (n = 3129) were identified via database searches to 1st August 2021. Nocebo manipulations reliably increased negative expectancy with a large effect (g = .837) and state anxiety with a small effect (g = .312). Changes in expectancy and state anxiety due to the nocebo manipulation were associated with larger nocebo effects (r = .376 and .234, respectively). However, there was no significant association between dispositional anxiety and the nocebo effect. These findings support theories that rely on situationally-induced expectancy and anxiety, but not dispositional anxiety, to explain nocebo effects. Importantly, being malleable, these findings suggest that interventions that target maladaptive negative expectancies and state anxiety could be beneficial for reducing the harm nocebo effects cause across health settings. Recommendations for future research are discussed.

A Microanalysis of Mood and Self-Reported Functionality in Stroke Patients Using Ecological Momentary Assessment

Post-stroke depression has been repeatedly associated with the degree of functional and cognitive impairment. The present study aimed to conduct a microanalysis on this association and examined the association between mood and self-reported functionality in 20 stroke patients (6 females, age: M = 59.9, SD = 5.2) using ecological momentary assessments (EMA), a structured diary method capturing moment-to-moment variations. Mood and self-reported functionality were recorded via a smartphone-app eight times a day for seven consecutive days during inpatient rehabilitation care. The patients answered on average to 73.2% of the received prompts. Variability in patients' responses was caused by differences both between and within patients. Multilevel regression analyses revealed that mood and self-reported functionality were significantly associated at the same point in time, but only patients' mood predicted their self-reported functionality at the next assessment point in time-lagged analyses. These results remained stable after controlling for between-person differences as patients' age, staff-ratings of their awareness of illness, and their degree of functional independence. Patients' mood appeared to affect their future ratings of their functionality but not the other way around.

Intrinsic functional brain connectivity patterns underlying enhanced interoceptive sensibility

BACKGROUND

Cumulative evidence has suggested that brain regions including the bilateral insula and the anterior cingulate cortex play critical roles in the processing of interoceptive information. However, the brain functional connectivity patterns underlying interoceptive sensibility (IS) and their role in the relationship between IS and self-reported bodily symptoms remain unknown. We aimed to investigate the intrinsic functional connectivity patterns associated with IS and how this modulates the relationship between IS and self-reported bodily symptoms.

METHODS

Resting-state functional magnetic resonance imaging was used to test the intrinsic large-scale functional connectivity in 459 healthy subjects. IS and self-reported bodily symptoms were assessed by questionnaires.

RESULTS

Individuals with greater IS had a stronger tendency to report bodily symptoms. Higher IS was correlated with decreased ventral anterior insula-superior temporal gyrus, dorsal anterior cingulate cortex-middle frontal cortex and amygdala-medioventral occipital cortex connectivity. The large-scale functional connectivity of cingulo-opercular task control network (CON)-default mode network, CON-subcortical network and CON-dorsal attention network moderated the association between IS and bodily symptoms.

LIMITATIONS

The Body Perception Questionnaire mainly reflects the self-perceived tendency to focus on negatively-valenced interoceptive sensations. Future research should distinguish neutral and negative IS in order to make the definition of IS clearer.

CONCLUSIONS

This study suggests that IS may be related to impaired intrinsic functional connectivity between brain areas related to multisensory integration and cognitive-affective control, resulting in increased vigilance-attention to bodily signals. These findings offer new empirical evidence for a better understanding of the intricate relationships between interoception and symptom reporting.

A Positive Mood Induction for Reducing the Formation of Nocebo Effects from Side Effect Information

BACKGROUND

Providing treatment side effect information can increase the occurrence of side effects through nocebo effects. Nocebo effects from side effect information raise a dilemma for health care, as there is an ethical obligation to disclose potential unpleasant treatment information to patients.

PURPOSE

To test the hypothesis that a positive mood induction can block the development of nocebo effects that result from treatment side effect information.

METHODS

In a laboratory setting, healthy participants were assigned to one of four conditions in a between-subjects randomized factorial trial. First, participants took part in a mood induction procedure, with half receiving a positive mood induction and the other half a neutral mood induction. Next, participants were told they would experience transcranial direct current stimulation (tDCS). Prior to a sham tDCS task, half of the participants were informed that headache pain is a side effect of tDCS, whereas the other half were not given this information.

RESULTS

In the neutral mood condition, the provision of headache side effect information lead to a greater occurrence of headaches, more frequent headaches, and a higher maximum level of headache pain as compared to those given no side effect information. In the positive mood condition, a similar increase in headache pain did not manifest from the provision of side effect information.

CONCLUSIONS

This is the first experiment to find that a positive mood induction can block the formation of nocebo effects that arise from side effect information. Inducing positive moods may be an effective strategy for reducing nocebo effects in a variety of clinical settings.

Impact of symptom focusing and somatosensory amplification on persistent physical symptoms: A three-year follow-up study

OBJECTIVE

The somatosensory amplification theory considers symptom focusing and somatosensory amplification as important perpetuating factors of persistent physical symptoms. We investigated whether symptom focusing and somatosensory amplification were associated with symptom severity and mental and physical functioning over a three-year period in patients with persistent physical symptoms (PPS).

METHODS

Baseline, 6-, 12-, 24- and 36-months follow-up data from the PROSPECTS study, a prospective cohort consisting of 325 patients with PPS, were used. We applied longitudinal mixed model analyses to investigate if symptom focusing (CBRQ Symptom Focusing Subscale) and somatosensory amplification (Somatosensory Amplification Scale) at baseline were associated with symptom severity (PHQ-15), mental and physical functioning (RAND-36 MCS and PCS) over three years, using all measurements.

RESULTS

Symptom focusing was associated with increased symptom severity and lower mental and physical functioning over time. Somatosensory amplification at baseline was associated with increased symptom severity and lower mental and physical functioning over time. Effect sizes were small. Associations with baseline symptom focusing decreased over time, associations with baseline somatosensory amplification were more stable. There was no interaction effect of both constructs, but they partly overlapped.

CONCLUSION

This is the first study to show that over an extended period, symptom focusing and somatosensory amplification are associated with symptom severity and lower mental and physical functioning in patients with PPS. These results support the impact of both symptom focusing and somatosensory amplification on the perpetuation of symptoms and lowered mental and physical functioning in individuals with PPS.

Self-Rated Health and Age-Related Differences in Ambulatory Blood Pressure: The Mediating Role of Behavioral and Affective Factors

OBJECTIVE

Despite the well-established association between self-rated health (SRH) and health, little is known about the potential psychobiological mechanisms responsible for such links and if these associations differ by age. The main goals of this study were to investigate the links between SRH and ambulatory blood pressure (ABP), if age moderated the risk, and the health behavior/affective mechanisms responsible for such links.

METHODS

A total of 188 men and women (94 married couples; ages, 18-63 years) completed a standard measure of SRH and a 1-day ABP assessment. Multilevel models were run to examine whether SRH was associated with daily ABP and whether these links were moderated by age. The Monte Carlo method was used to construct confidence intervals for mediation analyses.

RESULTS

Results indicated that poor SRH was associated with higher ambulatory systolic blood pressure (SBP; b = 3.14, SE = 0.68, p < .001) and diastolic blood pressure (DBP; b = 1.34, SE = 0.43, p = .002) levels. Age also moderated the links between SRH and ambulatory SBP (b = 0.19, SE = 0.08, p = .011) and DBP (b = 0.14, SE = 0.05, p = .004), with links being stronger in relatively older individuals. However, only daily life negative affect significantly mediated the age by SRH interaction for both ambulatory SBP and DBP.

CONCLUSIONS

These results highlight the potential psychobiological mechanisms linking SRH to longer-term health outcomes. Such work can inform basic theory in the area as well as intervention approaches that target such pathways.

Understanding persistent physical symptoms: Conceptual integration of psychological expectation models and predictive processing accounts

Persistent physical symptoms (PPS) are distressing, difficult to treat, and pose a major challenge to health care providers and systems. In this article, we review two disparate bodies of literature on PPS to provide a novel integrative model of this elusive condition. First, we draw on the clinical-psychological literature on the role of expectations to suggest that people with PPS develop dysfunctional expectations about health and disease that become increasingly immune to disconfirmatory information (such as medical reassurance) through cognitive reappraisal. Second, we invoke neuroscientific predictive processing accounts and propose that the psychological process of 'cognitive immunization' against disconfirmatory evidence corresponds, at the neurobiological and computational level, to too much confidence (i.e. precision) afforded to prior predictions. This can lead to an attenuation of disconfirming sensory information so that strong priors override benign bodily signals and make people believe that something serious is wrong with the body. Combining these distinct accounts provides a unifying framework for persistent physical symptoms and shifts the focus away from their causes to the sustaining mechanisms that prevent symptoms from subsiding spontaneously. Based on this integrative model, we derive new avenues for future research and discuss implications for treating people with PPS in clinical practice.

Emotionserleben und somatische Beschwerden

Zusammenfassung. Theoretischer Hintergrund: Aktuelle Modelle der Wahrnehmung körperlicher Beschwerden gehen davon aus, dass negative emotionale Zustände (z. B. Angst und Traurigkeit) eine zentrale Rolle bei der Symptomwahrnehmung spielen. Eine kausale Wirkung von Ärger auf den körperlichen Symptombericht wurde hingegen noch nicht ausreichend nachgewiesen. Fragestellung: Führt eine experimentelle Induktion von Ärger und Traurigkeit zu einem verstärkten Bericht körperlicher Beschwerden? Methode: 90 Studienteilnehmende wurden zufällig drei experimentellen Bedingungen zugewiesen. Mit einer autobiografischen Methodik wurden Ärger (n = 30) und Traurigkeit (n = 30) induziert. Eine dritte Gruppe (n = 30) diente als neutrale Kontrollbedingung. Bei allen Teilnehmenden wurden vor und nach der Induktion die Emotionswahrnehmung sowie der körperliche Symptombericht erhoben. Ergebnisse: Nach der Induktion von Ärger und Traurigkeit war ein Anstieg der intendierten Emotionen Ärger in der Gruppe „Ärger“, t (29) = -5.43, p < .001, und Traurigkeit in der Gruppe „Traurigkeit“ festzustellen, t (29) = -4.81, p < .001. Lediglich nach der Induktion von Traurigkeit, t (29) = -4.04, p < .001, nicht jedoch nach der Induktion von Ärger, t (29) = -1.52, p = .14, war eine Verstärkung des körperlichen Symptomberichts zu beobachten. Schlussfolgerungen: Die Ergebnisse belegen unterschiedliche Effekte negativer Emotionen (am Beispiel Ärger und Traurigkeit) auf den körperlichen Symptombericht. Implikationen der Befunde für zentrale psychopathologische Phänomene werden diskutiert.

Symptoms and the body: Taking the inferential leap

The relationship between the conscious experience of physical symptoms and indicators of objective physiological dysfunction is highly variable and depends on characteristics of the person, the context and their interaction. This relationship often breaks down entirely in the case of "medically unexplained" or functional somatic symptoms, violating the basic assumption in medicine that physical symptoms have physiological causes. In this paper, we describe the prevailing theoretical approach to this problem and review the evidence pertaining to it. We then use the framework of predictive coding to propose a new and more comprehensive model of the body-symptom relationship that integrates existing concepts within a unifying framework that addresses many of the shortcomings of current theory. We describe the conditions under which a close correspondence between the experience of symptoms and objective physiology might be expected, and when they are likely to diverge. We conclude by exploring some theoretical and clinical implications of this new account.

A cognitive–perceptual model of symptom perception in males and females: The roles of negative affect, selective attention, health anxiety and psychological job demands

Kolk et al.’s model of symptom perception underlines the effects of trait negative affect, selective attention and external stressors. The current study tested this model in 263 males and 498 females from an occupational sample. Trait negative affect was associated with symptom reporting in females only, and selective attention and psychological job demands were associated with symptom reporting in both genders. Health anxiety was associated with symptom reporting in males only. Future studies might consider the inclusion of selective attention, which was more strongly associated with symptom reporting than negative affect. Psychological job demands appear to influence symptom reporting in both males and females.

Delays in seeking cancer diagnosis in relation to beliefs about the curability of cancer in patients with different disease locations

This study is aimed at investigating factors leading to delayed oncologic examinations versus immediate consultation with a physician in patients with various cancers. We analysed the results of a study of patients (n = 291) reporting for their first oncologic examinations. We conducted structured interviews containing social, demographic and clinical data, the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory and Harris and Guten's health appraisal scores. Based on an analysis of decision-making trees, the results indicate that it is possible to predict beliefs regarding the curability of cancer and immediate versus delayed reporting to a physician. Delayed reports may be predicted on the basis of two factors: (1) a belief that cancer is incurable combined with increased state anxiety, 'good' or 'very good' self-appraisal of health and low depression; and (2) a belief that cancer is incurable accompanied by increased anxiety and depression. The characteristics of patients delaying a visit to the oncologist suggest the existence of three independent factors leading to both considerable (longer than nine months) and minor (up to one month) delays in seeking treatment.

The effects of a positive health priming intervention on somatic complaints

Somatic complaints are common and form a major burden. Previous studies suggested that such complaints might be increased by 'illness-related memory', for example due to worries about health. In this ambulatory study we tested whether we could decrease somatic complaints through enhancing the activation of health-related memory by a 'positive health'-priming intervention. Forty-three students were randomly assigned to the 'positive health'-group or a control group. Using online measures, participants reported negative affect (NA) and somatic complaints for a period of six days, while each morning performing the priming task. The intervention caused a decrease in somatic complaints but only for participants with low trait NA or low somatosensory amplification. These findings seem to suggest that priming or other interventions directed at activating positive health memory might reduce health complaints, but only in certain subgroups.

Understanding the Physical-Symptom Experience

Individuals tend to believe that the somatic sensations they are currently experiencing or have experienced accurately reflect their physical functioning; however, the experience of somatic symptoms is also affected by psychological and social factors. For two decades, the dominant perspective has been that the general tendency to experience negative emotions—negative affectivity (NA; also known as neuroticism or negative emotionality)—inflates physical-symptom reporting because persons high in NA are more likely to notice somatic changes and to label even minor or benign somatic changes as signs of illness. We review recent research suggesting that two components of NA—anxiety and depression, which are associated with distinctive cognitive-affective biases related to attention/encoding and recall, respectively—are more critical for the cognitive processing of somatic changes than is global NA per se. Specifically, anxiety is responsible for elevated reports of momentary symptoms, whereas depression is related to exaggerated recall of past symptoms. Understanding the distinctive roles of anxiety and depression in the experience of physical symptoms has implications for researchers and practitioners in the fields of personality, clinical science, health psychology, psychiatry, cognitive and affective neuroscience, and medicine.

Do Victims of Injustice Punish to Improve Their Mood?

Previous research has shown that angry people sometimes aggress to improve their mood. The present research tests whether people who have been treated unjustly seek revenge (i.e., retributive punishment) to improve their mood. The authors hypothesized that retributive punishment is generally not fuelled by a desire to improve one’s mood, whereas more destructive forms of aggression (e.g., venting one’s anger against people or inanimate objects) are. In Study 1, half of the participants were led to believe that their mood was frozen. In Study 2, half of the participants were led to believe that their mood would automatically improve at the end of the study by visiting a “good mood room” with snacks, beverages, and media. Retributive punishment was not affected by either mood management manipulation, whereas destructiveness was. Study 3 expands these findings by showing that retributive reactions were only reduced by a mood improvement manipulation when self-focus was induced.

Differentiation in the momentary rating of somatic symptoms covaries with trait emotional awareness in patients at risk for sudden cardiac death

OBJECTIVES

Somatic symptom ratings covary with neuroticism. Yet, people vary from one another in their ability to report their own emotions and differentiate them from bodily sensations. We hypothesized that stressed individuals with greater emotional awareness would experience somatic symptoms in a more differentiated way independent of neuroticism.

METHODS

Over 3 days, ecological momentary assessments were completed in 161 patients (72.6% female; mean age, 35 years) with Long QT Syndrome, a genetic disorder associated with increased risk for sudden cardiac death. Patients were paged randomly ten times per day to report their momentary experience of nine somatic symptoms (e.g., headache, sore throat, tiredness) as well as other variables. We examined the intercorrelation between somatic symptom ratings, reasoning that greater intercorrelation among ratings indicated less differentiation. Subjects completed measures of neuroticism, depression, and the Levels of Emotional Awareness Scale, a trait measure of the tendency to experience emotions in a complex and differentiated way.

RESULTS

Higher Levels of Emotional Awareness Scale-Self scores were associated with greater differentiation in the momentary rating of somatic symptoms (p < .001) in men and women independently. This association did not change after removing variance due to neuroticism, depression, or symptom intensity.

CONCLUSIONS

Among individuals stressed by having a life-threatening condition, those who are more emotionally aware report somatic symptoms in a more differentiated way. These findings regarding symptoms largely unrelated to the disorder are consistent with other evidence that medically unexplained physical symptoms, which tend to be nonspecific, may be accompanied by relatively undifferentiated negative affect.

Impact of personality and psychological distress on health-related quality of life in kidney transplant recipients

Health-related quality of life (HRQoL) has become an important outcome in the evaluation of kidney transplantation (KT). Although the medical and sociodemographic predictors of HRQoL in patients after KT are well known, there is still a lack of knowledge about the psychological factors involved. This study focuses on the role of personality and actual psychological distress in predicting HRQoL after KT. Sociodemographic (gender, age, education, average income), medical (glomerular filtration, serum albumin, number of co-morbid diseases) and psychological data (neuroticism, extroversion, psychological distress) were collected from 177 (60.5% male subjects; 48 +/- 12.1 years) kidney transplant recipients, and physical and mental HRQoL were measured using the SF-36. A univariate general linear model analysis was performed. Higher physical HRQoL was associated with younger age, higher education and income, a low number of co-morbid diseases, lower neuroticism and distress. Higher mental HRQoL was associated with higher education and income, longer time from KT, higher extroversion, lower neuroticism and distress. In both physical and mental HRQoL, actual distress was the best predictor, even when controlled for neuroticism. These results confirm the importance of psychological distress in patients and its impact on their HRQoL after KT and can be applied in intervention programs focused on increasing HRQoL.

Effects of exposure to the suffering of unknown persons on health-related cognitions, and the role of mood

The purpose of the present study was to examine whether exposure to the suffering of unknown persons, as an inevitable part of life, influences cognitions about health. Our assumption was that exposure to suffering affects cognitions in a negative way, as well as this influence being exerted directly and through negative mood. Eighty-nine participants were randomly assigned to two groups. The experimental group was exposed to a series of photos presenting situations of human suffering, whereas the control group was exposed to a series of photos showing relaxing situations. Participants in the experimental group reported higher health anxiety and health value, and lower internal health locus of control, in comparison to the control group. No differences were found in self-rated health. Exposure to suffering affected cognitions directly and through decrease in positive mood. It seems that an ‘in vitro’ exposure to human suffering activates a cognitive and emotional reaction, which affects evaluations about self and personal well-being.

The influence of negative emotions on pain: behavioral effects and neural mechanisms

The idea that pain can lead to feelings of frustration, worry, anxiety and depression seems obvious, particularly if it is of a chronic nature. However, there is also evidence for the reverse causal relationship in which negative mood and emotion can lead to pain or exacerbate it. Here, we review findings from studies on the modulation of pain by experimentally induced mood changes and clinical mood disorders. We discuss possible neural mechanisms underlying this modulatory influence focusing on the periaqueductal grey (PAG), amygdala, anterior cingulate cortex (ACC) and anterior insula as key players in both, pain and affective processing.

Influence of sad mood and old age schema on older adults' attention to physical symptoms

We examined how mood and activation of old age schema influenced attentional focus on physical symptoms in older adults. Seventy-one individuals aged 60 years or above participated in an experiment that manipulated mood and old age schema. They completed a modified Stroop task that measured attentional bias to physical symptoms. Controlling for baseline processing speed, the two variables had significant main and interaction effects on attentional focus on symptoms. Sad mood and old age schema independently minimized the bias to avoid attending to symptoms. When combined, these two variables contributed to greater attentional focus on symptoms. These findings highlight psychological influences on current attention to symptoms.

Self-Focused Attention, Perspective-Taking, and False Consensus

A quasi-experimental study examined the effects of self-focused attention on acknowledging or ignoring others’ perspectives. University students scoring high vs. low in private and public self-focus estimated the opinion of a fellow student. For these estimates, a relevant cue for the fellow student’s most probable opinion was provided or not. The results replicate earlier studies that have demonstrated that attention focused on the self enhances perspective-taking and reduces egocentrism when a cue for others’ perspectives is provided: High private self-focus (self-awareness) turned out to further perspective-taking and, thus, to reduce egocentrism under the critical condition of a cue being presented for the other’s perspective. These results, as well as earlier research, contradict findings by Fenigstein and Abrams (1993) , which were interpreted as showing that self-focus enhances egocentrism in a false consensus paradigm.

Health anxiety moderates the daytime cortisol slope

OBJECTIVES

Edwards et al. argue that a steeper daytime cortisol slope indicates increased symptom awareness [Edwards S, Hucklebridge F, Clow A, Evans P. Components of the diurnal cortisol cycle in relation to upper respiratory symptoms and perceived stress. Psychosom Med, 2003;65:320-7]. Theory suggests that health anxiety (HA) is associated with increased symptom awareness. Therefore, this study tests the hypothesis that higher levels of HA are associated with a steeper daytime cortisol slope and is the first to examine the daytime diurnal cortisol slope for HA.

METHODS

Forty-two healthy working adults completed measures of HA and neuroticism as well as indices to measure the severity and frequency of symptom reporting. Participants also provided eight consecutive days of salivary cortisol data. Two cortisol measures were taken each day -- once prior to lunch and once in the early evening -- the timing of these was synchronized to waking times. The data were analyzed using multilevel modeling.

RESULTS

The hypothesis was supported, with those scoring higher on HA showing a steeper daytime cortisol slope. There were no significant relationships between cortisol (average production and slope) and either neuroticism or symptom reporting (severity and frequency).

CONCLUSIONS

The results are interpreted as consistent with theories of HA that emphasis increased awareness of nonspecific symptoms.

Negative affect and chemical intolerance as risk factors for building-related symptoms: a controlled exposure study

OBJECTIVE

To assess whether differences in negative affect (NA) and chemical intolerance (CI) affect responses to chemical mixtures and stress in a controlled experimental model.

METHODS

Participants were 130 nonsmoking, healthy women, recruited from a university community. Participants completed the Positive and Negative Affect Scale and the Chemical Odor Intolerance Index. In separate sessions 1 week apart, they were exposed to volatile organic compounds (VOCs), VOCs with ozone (VOCs+O3), and ambient or filtered air with a 1-minute spike of VOCs (masked clean air). During each session, half of the participants performed a videotaped speech stressor and half performed simple arithmetic. Before, during, and after each session, salivary cortisol samples were collected, and subjects completed neurobehavioral tests and used a ratio scale to rate physical, cognitive, and anxiety symptoms.

RESULTS

Relative to low NA or low CI, neither the high NA nor the high CI groups reported significantly more symptoms in response to any exposure condition. High NA subjects reported more anxiety symptoms in response to the speech stressor but did not have higher cortisol than low NA subjects. High NA subjects, however, were more distressed by the experimental conditions than were low NA subjects. Low NA subjects reported more severe anxiety in the VOCs+O3 with psychological stress condition.

CONCLUSIONS

Subjects high in NA were more anxious after a stressor but were not more physically symptomatic in response to increasing chemical exposures. A disposition toward high or low CI did not result in a differential symptomatic response to controlled chemical exposures.

Elucidating the relationship between negative affectivity and symptoms: the role of illness-specific affective responses

BACKGROUND

More than 20 years of research confirm a positive association of trait negative affect (NA) with reports of physical symptoms. As the mechanisms underlying the association of trait NA and symptom reporting have not been identified, the meaning of the association remains unclear.

PURPOSE

We attempted to clarify the processes underlying this association by examining the relationship of trait NA and illness-specific worry to both vague, general symptoms and illness-specific symptoms. We tested the hypothesis that trait NA has both a "biasing" effect when ambiguous symptoms are interpreted as a sign of physical illness and an "accuracy" effect on the reports of illness-specific symptoms mediated by illness-specific worry.

METHOD

We examined the relationship of trait and state NA to symptoms reports in both cross-sectional and longitudinal data from inner-city adults with moderate and severe asthma.

RESULTS

Whereas high levels of trait NA were associated with reports of both asthma and nonasthma symptoms, only the relationship of trait NA to symptoms specific to asthma was mediated by asthma worry. In addition, these data showed that trait NA was not associated with the misattribution of symptoms to disease.

CONCLUSIONS

We concluded that NA motivates individuals, through asthma worry, to be more aware of illness-specific symptoms and correctly report and attribute these symptoms to asthma.

Impact of helping behaviors on the course of substance-use disorders in individuals with body dysmorphic disorder

OBJECTIVE

Alcoholics Anonymous and 12-step facilitated treatments for substance-use disorders (SUDs) encourage individuals with SUD to consider the needs of others and engage in helping behaviors as a method to become sober. SUDs are one of the most common comorbid disorders among individuals with body dysmorphic disorder (BDD). The purpose of this study is to examine prospectively the relationship between helping behaviors and the likelihood of SUD and BDD remission.

METHOD

Data on 163 individuals during the course of 3 years were derived from the Prospective Study of Body Dysmorphic Disorder, a longitudinal investigation of patterns and predictors of the course of BDD. Kaplan-Meier survival estimates were used to calculate probabilities of time to BDD and SUD remission. Cox regression analyses were conducted to calculate the relative likelihood of levels of helping behaviors as time-varying predictors of remission from both SUD and BDD.

RESULTS

The course of SUD and BDD was chronic for most subjects; the estimated probability of remission from an SUD across 3 years was .29 and .17 for a full BDD remission. Results indicated that increases in helping behaviors were significantly predictive of SUD remission (hazard ratio [HR] = 2.59, p = .0134). Helping behaviors were also predictive of BDD remission among those with or without SUD but at a trend level of significance (HR = 1.51, p = .0676).

CONCLUSIONS

These findings extend previous work reporting significant relationships between helping behaviors and positive long-term SUD outcomes. Implications of the mechanisms involved in the link between helping behaviors and remission from SUD and BDD are discussed.

Detecting emotional faces and features in a visual search paradigm: Are faces special?

In 2 experiments, participants were presented schematic faces with emotional expressions (threatening, friendly) in a neutral-faces context or neutral expressions in an emotional-faces context. These conditions were compared with detection performance in displays containing key features of emotional faces not forming the perceptual gestalt of a face. Supporting the notion of a threat detection advantage, Experiment 1 found that threatening faces were faster detected than friendly faces, whereas no difference emerged between the corresponding feature conditions. Experiment 2 increased task difficulty with a backward masking procedure and found corresponding results. In neither of the studies was the threat detection advantage associated with reduced accuracy. However, features were, in general, detected faster than faces when task difficulty was high.