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Guthrie AJ, Paredes-Echeverri S, Bleier C, Adams C, Millstein DJ, Ranford J, Perez DL. Mechanistic studies in pathological health anxiety: A systematic review and emerging conceptual framework. J Affect Disord 2024; 358:222-249. [PMID: 38718945 DOI: 10.1016/j.jad.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 04/02/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Pathological health anxiety (PHA) (e.g., hypochondriasis and illness anxiety disorder) is common in medical settings and associated with increased healthcare costs. However, the psychological and neurobiological mechanisms contributing to the development and maintenance of PHA are incompletely understood. METHODS We performed a systematic review to characterize the mechanistic understanding of PHA. PubMed, PsycINFO, and Embase databases were searched to find articles published between 1/1/1990 and 12/31/2022 employing a behavioral task and/or physiological measures in individuals with hypochondriasis, illness anxiety disorder, and PHA more broadly. RESULTS Out of 9141 records identified, fifty-seven met inclusion criteria. Article quality varied substantially across studies, and was overall inadequate. Cognitive, behavioral, and affective findings implicated in PHA included health-related attentional and memory recall biases, a narrow health concept, threat confirming thought patterns, use of safety-seeking behaviors, and biased explicit and implicit affective processing of health-related information among other observations. There is initial evidence supporting a potential overestimation of interoceptive stimuli in those with PHA. Neuroendocrine, electrophysiology, and brain imaging research in PHA are particularly in their early stages. LIMITATIONS Included articles evaluated PHA categorically, suggesting that sub-threshold and dimensional health anxiety considerations are not contextualized. CONCLUSIONS Within an integrated cognitive-behavioral-affective and predictive processing formulation, we theorize that sub-optimal illness and health concepts, altered interoceptive modeling, biased illness-based predictions and attention, and aberrant prediction error learning are mechanisms relevant to PHA requiring more research. Comprehensively investigating the pathophysiology of PHA offers the potential to identify adjunctive diagnostic biomarkers and catalyze new biologically-informed treatments.
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Affiliation(s)
- Andrew J Guthrie
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Paredes-Echeverri
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristina Bleier
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Caitlin Adams
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel J Millstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Ranford
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Petzke TM, Elspaß L, Köteles F, Van den Bergh O, Witthöft M. "And how did that make you feel?" - Repeated symptom queries enhance symptom reports elicited by negative affect. J Psychosom Res 2024; 181:111634. [PMID: 38453590 DOI: 10.1016/j.jpsychores.2024.111634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Negative affect, alexithymia, and other predisposing traits (such as health anxiety) can influence an individual's symptom perception. In this study, we used the affective picture paradigm (APP, Bogaerts et al., 2010) to induce symptoms using affective picture stimuli. We aimed to cross-sectionally test the effect of high vs low-frequency symptom queries and analyze the time course of the APP, including interactions with health anxiety and somatic symptom distress. METHODS Participants (N = 124) completed a modified APP and filled out various questionnaires. In the APP, participants were randomized to either a highly-frequent-query condition (18 symptom checklists) or a less-frequent-query condition (6 checklists). Data were analyzed using ANOVAs, cross-lagged panel models, moderation models, and multilevel models. RESULTS Both groups had comparable symptom baseline values, but people in the highly frequent as opposed to less frequent condition reported significantly higher symptom levels once the experiment started (F (1,120) = 14.319, p < .001, η2=.107). Symptom levels stayed stable over the course of the experiment and were best predicted by symptom levels at earlier timepoints in the experiment (β = 0.43 and β = 0.68, both p < .001). Health anxiety levels significantly predicted symptom levels (F(1,121) = 10.054, p = .002, η2=.077) and moderated the relation between condition and symptom levels (F(2,121) = 16.253, p < .001, η2=.212). CONCLUSION In terms of the predictive processing model (e.g.,[1]), repeated symptom queries following negative affective cues may activate prior beliefs about symptoms, resulting in elevated levels of symptom reports in interaction with health anxiety.
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Affiliation(s)
- Tara M Petzke
- Department of Clinical Psychology, Psychotherapy, or Experimental Psychopathology, Johannes-Gutenberg University Mainz, Mainz, Germany.
| | - Lina Elspaß
- Department of Clinical Psychology, Psychotherapy, or Experimental Psychopathology, Johannes-Gutenberg University Mainz, Mainz, Germany.
| | - Ferenc Köteles
- Department of General Psychology and Methodology, Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary.
| | | | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, or Experimental Psychopathology, Johannes-Gutenberg University Mainz, Mainz, Germany.
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Bjerre-Nielsen E, Kallesøe KH, Nielsen ES, Gehrt TB, Frostholm L, Rask CU. A New Experimental Design to Examine Cognitive Biases for Gastrointestinal Related Stimuli in Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1327. [PMID: 37628326 PMCID: PMC10453649 DOI: 10.3390/children10081327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
Cognitive biases toward disorder-specific stimuli are suggested as crucial to the development and maintenance of symptoms in adults with functional gastrointestinal disorders (FGID). Functional abdominal pain disorders (FAPD), a subtype of FGID, are common in children and adolescents, but the influence of cognitive biases is sparsely examined. This study aimed to (1) develop a new experimental design for assessing cognitive biases toward gastrointestinal stimuli in children and adolescents (aged 8 to 17 years) and (2) derive comparative data on bias toward gastrointestinal stimuli using a healthy "normative" sample. The online experimental design-BY-GIS (Bias in Youth toward GastroIntestinal-related Stimuli)-includes a word task and a picture task. Stimuli in both tasks are related to general and gastrointestinal symptoms, and the design includes three phases: (1) encoding, (2) free recall, and (3) recognition. Data were collected between April 2022 and April 2023 from 96 healthy participants (Mage = 12.32, 47.92% female). Adolescents were significantly better at recalling words than children (p = 0.03), whereas there were no significant gender or age differences with regard to recalling pictures (p > 0.05). Across age and gender, participants performed above chance level in the recognition phases of both tasks. The results support that the design is suitable within the age span.
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Affiliation(s)
- Ellen Bjerre-Nielsen
- Research Unit, Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Karen Hansen Kallesøe
- Research Unit, Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark
| | - Eva Skovslund Nielsen
- Research Unit, Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Tine Bennedsen Gehrt
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
- Center on Autobiographical Memory Research, Department of Psychology and Behavioural Sciences, Aarhus BSS, Bartholins Allé 11, 8200 Aarhus, Denmark
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Brendstrupgårdsvej 7, 8200 Aarhus, Denmark
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Research Unit, Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
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Gehrt TB, Macoveanu J, Bailey CJ, Fisher PM, Pallesen KJ, Frostholm L. Resting-state connectivity and neural response to emotional images in patients with severe health anxiety: An fMRI study. J Affect Disord 2023; 324:370-378. [PMID: 36587909 DOI: 10.1016/j.jad.2022.12.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Severe health anxiety is a disorder characterized by a persistent preoccupation with one's health. In behavioral studies, biases in the processing of health-related stimuli (e.g., pictures, words) are consistently associated with health anxiety symptoms. The neural correlates of the observed behavioral abnormalities remain however poorly understood. METHODS In this functional magnetic resonance imaging study, 22 treatment-seeking patients with severe health anxiety and 22 control participants performed a resting-state and a picture matching task. Immediately after the resting-state, participants completed a questionnaire quantifying their thoughts and feelings during rest along several dimensions. The picture task included images of health-related and neutral scenes and of disgusted and neutral faces. RESULTS Compared to controls, patients with health anxiety showed increased functional connectivity in the dorsolateral prefrontal cortex within the left fronto-parietal resting-state network, which correlated positively with the self-reported thought dimensions of Self, Health Concern, and Thought Suppression. In the picture matching task, no significant group differences were found in the hypothesised regions (amygdala and insula) or at a whole-brain level in response to either health-related versus neural scenes or disgust versus neutral faces contrasts. LIMITATIONS A relatively small sample size and that no information about patients declining to participate was obtained. CONCLUSIONS Our findings suggest that behavioral biases in health anxiety may be related to aberrant left dorsolateral prefrontal cortex functional connectivity at rest. In contrast, the health anxiety patients did not show significant hyperactivations of amygdala and insula during processing of emotional stimuli, contrasting findings in other anxiety disorders.
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Affiliation(s)
- Tine B Gehrt
- Center on Autobiographical Memory Research, Aarhus University, Denmark.
| | - Julian Macoveanu
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Patrick M Fisher
- Neurobiology Research Unit, Copenhagen University Hospital, Denmark
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Schwen Blackett D, Harnish SM. A Scoping Review on the Effects of Emotional Stimuli on Language Processing in People With Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4327-4345. [PMID: 36264665 PMCID: PMC9946294 DOI: 10.1044/2022_jslhr-22-00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Emotional stimuli have been shown to influence language processing (both language comprehension and production) in people with aphasia (PWA); however, this finding is not universally reported. Effects of emotional stimuli on language performance in PWA could have clinical and theoretical implications, yet the sparsity of studies and variability among them make it difficult to appraise the significance of this effect. The purpose of this scoping review was to (a) determine the extent and range of research examining the effect of emotional stimuli on language processing in PWA, (b) summarize and evaluate research findings, and (c) identify gaps in the literature that may warrant future study. METHOD PsycINFO, PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched for articles that compared performance in response to emotional and nonemotional stimuli on at least one language measure in one or more adults with aphasia. Data related to methods and results were extracted from each article and charted in Excel. RESULTS Five hundred forty unique articles were found, and 18 articles, consisting of 19 studies, met inclusion/exclusion criteria for this review. Of the 19 studies included, 11 studies reported enhanced performance on a language task for emotional compared to nonemotional stimuli, seven reported no difference, and one reported worse performance for emotional compared to nonemotional stimuli. Possible modulating variables such as task type, measurement, stimulus characteristics, and sample characteristics are discussed along with gaps in the literature. CONCLUSION The extent of research in this area is sparse; however, there does appear to be some early evidence for better performance in response to emotional over nonemotional stimuli in PWA for some, but not all, language processes investigated.
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Affiliation(s)
- Deena Schwen Blackett
- Department of Otolaryngology, College of Medicine, Medical University of South Carolina, Charleston
| | - Stacy M. Harnish
- Department of Speech and Hearing Science, College of Arts and Sciences, The Ohio State University, Columbus
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Beinhölzl N, Molloy EN, Zsido RG, Richter T, Piecha FA, Zheleva G, Scharrer U, Regenthal R, Villringer A, Okon-Singer H, Sacher J. The attention-emotion interaction in healthy female participants on oral contraceptives during 1-week escitalopram intake. Front Neurosci 2022; 16:809269. [PMID: 36161146 PMCID: PMC9500523 DOI: 10.3389/fnins.2022.809269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Previous findings in healthy humans suggest that selective serotonin reuptake inhibitors (SSRIs) modulate emotional processing via earlier changes in attention. However, many previous studies have provided inconsistent findings. One possible reason for such inconsistencies is that these studies did not control for the influence of either sex or sex hormone fluctuations. To address this inconsistency, we administered 20 mg escitalopram or placebo for seven consecutive days in a randomized, double-blind, placebo-controlled design to sixty healthy female participants with a minimum of 3 months oral contraceptive (OC) intake. Participants performed a modified version of an emotional flanker task before drug administration, after a single dose, after 1 week of SSRI intake, and after a 1-month wash-out period. Supported by Bayesian analyses, our results do not suggest a modulatory effect of escitalopram on behavioral measures of early attentional-emotional interaction in female individuals with regular OC use. While the specific conditions of our task may be a contributing factor, it is also possible that a practice effect in a healthy sample may mask the effects of escitalopram on the attentional-emotional interplay. Consequently, 1 week of escitalopram administration may not modulate attention toward negative emotional distractors outside the focus of attention in healthy female participants taking OCs. While further research in naturally cycling females and patient samples is needed, our results represent a valuable contribution toward the preclinical investigation of antidepressant treatment.
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Affiliation(s)
- Nathalie Beinhölzl
- Emotion and Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- *Correspondence: Nathalie Beinhölzl,
| | - Eóin N. Molloy
- Emotion and Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- University Clinic for Radiology and Nuclear Medicine, Otto Von Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Rachel G. Zsido
- Emotion and Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Max Planck School of Cognition, Leipzig, Germany
| | - Thalia Richter
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
- The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel
| | - Fabian A. Piecha
- Emotion and Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Gergana Zheleva
- Emotion and Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Ulrike Scharrer
- Emotion and Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Ralf Regenthal
- Division of Clinical Pharmacology, Rudolf Boehm Institute of Pharmacology and Toxicology, University Leipzig, Leipzig, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Max Planck School of Cognition, Leipzig, Germany
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Berlin School of Mind and Brain, MindBrainBody Institute, Charité—Berlin University of Medicine and Humboldt University Berlin, Berlin, Germany
| | - Hadas Okon-Singer
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
- The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel
| | - Julia Sacher
- Emotion and Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Max Planck School of Cognition, Leipzig, Germany
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Helios Park Hospital Leipzig, Leipzig, Germany
- Julia Sacher,
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Lecci L, Page GR, Keith JR, Neal S, Ritter A. The Effects of Health Anxiety and Litigation Potential on Symptom Endorsement, Cognitive Performance, and Physiological Functioning in the Context of a Food and Drug Administration Drug Recall Announcement. Front Psychol 2022; 13:818724. [PMID: 35769761 PMCID: PMC9236552 DOI: 10.3389/fpsyg.2022.818724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Drug recalls and lawsuits against pharmaceutical manufacturers are accompanied by announcements emphasizing harmful drug side-effects. Those with elevated health anxiety may be more reactive to such announcements. We evaluated whether health anxiety and financial incentives affect subjective symptom endorsement, and objective outcomes of cognitive and physiological functioning during a mock drug recall. Hundred and sixty-one participants reported use of over-the-counter pain medications and presented with a fictitious medication recall via a mock Food and Drug Administration (FDA) website. The opportunity to join a class-action lawsuit was manipulated. We assessed health anxiety, recalled drug usage, blood pressure, heart rate, and performance on a computerized Trail Making Test (TMT). Symptom endorsement was strongly predicted by health anxiety. When combined, three health anxiety measures explained 28.5% variance (Cohen’s d = 1.26). These effects remain strong after controlling for depression and anxiety. Litigation condition did not predict symptom endorsement. Blood pressure and heart rate were modestly predicted by health anxiety, but not by litigation condition. TMT performance was consistently predicted by health anxiety, with higher scores associated with poorer performance. Although there were no main effects for litigation, interactions consistently emerged for the TMT, with generally poorer performance for those with higher health anxiety in the non-litigation condition; whereas health anxiety was unrelated to performance for the litigation condition. All but one participant joined the litigation when given the opportunity, despite a healthy sample and minimal use of pain medication. Subsequent data from 67 individuals with no mention of the FDA scenario or litigation showed that health anxiety still significantly predicts symptom endorsement (12.6% variance), but the explained variance is less than half that obtained in the FDA scenario. The findings suggest that health anxiety plays a significant role in adverse symptom reporting, beyond anxiety or depression, and this effect is independent of the presence of the FDA recall. The lack of differences for health anxiety and symptom endorsement between litigation and non-litigation conditions rules out malingering. Although it is general practice in drug recalls to list potential adverse side effects caused by medications, this may elicit unintended symptom experiences and health anxious individuals may be more susceptible.
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Leonidou C, Constantinou E, Panteli M, Panayiotou G. Attentional processing of unpleasant stimuli in alexithymia: Early avoidance followed by attention maintenance bias. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2054531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Elena Constantinou
- Department of Psychology, University of Cyprus; Kios Research & Innovation Center of Excellence, University of Cyprus
| | - Maria Panteli
- Department of Psychology, University of Cyprus; Center of Applied Neuroscience, University of Cyprus
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Shi C, Taylor S, Witthöft M, Du X, Zhang T, Lu S, Ren Z. Attentional bias toward health-threat in health anxiety: a systematic review and three-level meta-analysis. Psychol Med 2022; 52:604-613. [PMID: 35341486 DOI: 10.1017/s0033291721005432] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Attentional bias toward health-threat may theoretically contribute to the development and maintenance of health anxiety, but the empirical findings have been controversial. This study aimed to synthesize and explore the heterogeneity in a health-threat related attentional bias of health-anxious individuals, and to determine the theoretical model that better represents the pattern of attentional bias in health anxiety. Four databases (Web of Science, PubMed, PsycINFO, and Scopus) were searched for relevant studies, with 17 articles (N = 1546) included for a qualitative review and 16 articles (18 studies) for a three-level meta-analysis (N = 1490). The meta-analytic results indicated that the health anxiety group, compared to the control group, showed significantly greater attentional bias toward health-threat (g = 0.256). Further analyses revealed that attentional bias type, paradigm, and stimuli type were significant moderators. Additionally, compared to the controls, health-anxious individuals displayed significantly greater attention maintenance (g = 0.327) but nonsignificant attention vigilance to health-threat (g = -0.116). Our results provide evidence for the attention maintenance model in health-anxious individuals. The implications for further research and treatment of elevated health anxiety in the context of coronavirus disease-2019 (COVID-19) were also discussed.
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Affiliation(s)
- Congrong Shi
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Steven Taylor
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Xiayu Du
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Tao Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Shan Lu
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
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Health anxiety and attentional control interact to predict uncertainty-related attentional biases. J Behav Ther Exp Psychiatry 2022; 74:101697. [PMID: 34678633 DOI: 10.1016/j.jbtep.2021.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Current theories of health anxiety and a growing body of empirical literature suggest that those high in health anxiety symptoms might find uncertainty itself threatening and demonstrate attentional biases for uncertainty-related information (ABU). Moreover, a dual processes model of attention would suggest that individual differences in attentional control might modify such a relationship. The present study was designed to explore this proposed health anxiety-ABU relationship and also to consider attentional control as a moderator of theoretical and clinical relevance. METHODS Undergraduate participants (N = 148) completed a self-report measure of health anxiety symptoms and two performance-based tasks to assess ABU and attentional control. RESULTS Hierarchical regression analyses showed a significant interaction between health anxiety and attention control in predicting attentional disengagement from, but not engagement with, uncertainty-related words. Specifically, results of the simple slopes analysis suggested that those with elevated health anxiety symptoms and better attentional control may use top-down attentional control processes to disengage their attention from distressing uncertainty-related stimuli faster than those with worse attentional control. LIMITATIONS The analogue sample is a study limitation. CONCLUSIONS Results provide new insights into the nature of attentional biases within health anxiety. Results are discussed in light of recent work on attentional control and avoidance-based psychopathology.
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"Health Comes First": Action Tendencies to Health-Related Stimuli in People with Health-Anxiety as Revealed by an Emotional Go/No-Go Task. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179104. [PMID: 34501693 PMCID: PMC8431473 DOI: 10.3390/ijerph18179104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
Abstract
The processing of health-related stimuli can be biased by health anxiety and anxiety sensitivity but, at the moment, it is far from clear whether health-related stimuli can affect motor readiness or the ability to inhibit action. In this preliminary study, we assessed whether different levels of health anxiety and anxiety sensitivity affect disposition to action in response to positive and negative health-related stimuli in non-clinical individuals. An emotional go/no-go task was devised to test action disposition in response to positive (wellness-related), and negative (disease-related) stimuli in non-clinical participants who also underwent well-validated self-report measures of health anxiety and anxiety sensitivity. The main results showed that both health anxiety and anxiety sensitivity biased participants' responses. Importantly, safety-seeking and avoidance behaviors differently affected action disposition in response to positive and negative stimuli. These preliminary results support the idea that health anxiety and anxiety sensitivity could determine a hypervigilance for health-related information with a different perturbation of response control depending on the valence of the stimuli. Health anxiety and health anxiety disorder do form a continuum; thus, capturing different action tendencies to health-related stimuli could represent a valuable complementary tool to detect processing biases in persons who might develop a clinical condition.
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Mayorga NA, Garey L, Viana A, Cardoso JB, Schmidt NB, Zvolensky MJ. Psychological Distress and Physical Health Symptoms in the Latinx Population During the COVID-19 Pandemic: Exploring the Role of Anxiety Sensitivity. COGNITIVE THERAPY AND RESEARCH 2021; 46:20-30. [PMID: 34177003 PMCID: PMC8214047 DOI: 10.1007/s10608-021-10243-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2021] [Indexed: 12/24/2022]
Abstract
Objective The outbreak of the novel 2019 SARS2-Coronavirus disease (COVID-19) has led to substantial physical and mental health consequences. Rates of mortality and hospitalization are highest among those of racial and ethnic minority persons, including Latinx persons. Further, Latinx persons have been experiencing elevated mental health problems in response to the pandemic compared to non-Latinx Whites. The current study examined whether individual differences in anxiety sensitivity (AS) related to more severe emotional distress associated with social distancing, financial strain, fear of COVID-19, and physical health symptoms stemming from the COVID-19 pandemic among Latinx adults. Methods Participants included 188 Latinx persons (31.4% female, Mage = 34.1 years, SD = 8.16) recruited via an online survey panel program. Results Results indicated that AS significantly contributed to increased severity of the emotional stress response associated with social distancing (ΔR2 = 0.15, p < 0.001), financial strain (ΔR2 = 0.15, p < 0.001), physical health symptoms (ΔR2 = 0.03, p = 0.006), and fear of COVID-19 (ΔR2 = 0.15, p < 0.001). These effects were evident over and above the variance accounted for by gender, years living in the United States, education, and work and home life COVID-19-related stress. Conclusions These cross-sectional findings suggest AS may be an important individual difference factor for better understanding mental health among Latinx persons in the context of the COVID-19 pandemic.
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Affiliation(s)
- Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX USA
| | - Andres Viana
- Department of Psychology, University of Houston, Houston, TX USA
- Texas Institute of Measurement, Evaluation, and Statistics, Houston, USA
| | - Jodi Berger Cardoso
- HEALTH Institute, University of Houston, Houston, TX USA
- Graduate College of Social Work, University of Houston, Houston, TX USA
| | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX USA
- HEALTH Institute, University of Houston, Houston, TX USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX 77204 USA
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13
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Maheu C, Singh M, Tock WL, Eyrenci A, Galica J, Hébert M, Frati F, Estapé T. Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research. Front Psychol 2021; 12:644932. [PMID: 33912113 PMCID: PMC8072115 DOI: 10.3389/fpsyg.2021.644932] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: Fear of Cancer Recurrence (FCR), Health Anxiety (HA), worry, and uncertainty in illness are psychological concerns commonly faced by cancer patients. In survivorship research, these similar, yet different constructs are frequently used interchangeably and multiple instruments are used in to measure them. The lack of clear and consistent conceptualization and measurement can lead to diverse or contradictory interpretations. The purpose of this scoping review was to review, compare, and analyze the current conceptualization and measurements used for FCR, HA, worry, and uncertainty in the breast cancer survivorship literature to improve research and practice. Inclusion Criteria: We considered quantitative, qualitative, and mixed methods studies of breast cancer survivors that examined FCR, HA, worry, or uncertainty in illness as a main topic and included a definition or assessment of the constructs. Methods and Analysis: The six-staged framework was used to guide the scoping review process. Searches of PubMed, CINAHL, and PsycINFO databases were conducted. The principle-based qualitative analysis and simultaneous content analysis procedures were employed to synthesize and map the findings. Findings: After duplicate removal, the search revealed 3,299 articles, of which 82 studies met the inclusion criteria. Several critical attributes overlapped the four constructs, for example, all were triggered by internal somatic and external cues. However, several unique attributes were found (e.g., a sense of loss of security in the body is observed only among survivors experiencing FCR). Overall, findings showed that FCR and uncertainty in illness are more likely to be triggered by cancer-specific factors, while worry and HA have more trait-like in terms of characteristics, theoretical features, and correlates. We found that the measures used to assess each construct were on par with their intended constructs. Eighteen approaches were used to measure FCR, 15 for HA, 8 for worry, and 4 for uncertainty. Conclusion: While consensus on the conceptualization and measurement of the four constructs has not yet been reached, this scoping review identifies key similarities and differences to aid in their selection and measurement. Considering the observed overlap between the four studied constructs, further research delineating the unique attributes for each construct is warranted.
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Affiliation(s)
- Christine Maheu
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Mina Singh
- Faculty of Health, School of Nursing, York University, Toronto, ON, Canada
| | - Wing Lam Tock
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Asli Eyrenci
- Department of Psychology, Faculty of Humanities and Social Sciences, Maltepe University, Istanbul, Turkey
| | - Jacqueline Galica
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, ON, Canada
| | - Maude Hébert
- Département des Sciences Infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Francesca Frati
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, QC, Canada
| | - Tania Estapé
- Psychosocial Oncology Department, Fundació per l'Educació i la Formació en Càncer (FEFOC) Fundació, Barcelona, Spain
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14
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Leonidou C, Panayiotou G. Attentional processing of information related to illness: Biases and associations with emotional response in young adults with different levels of illness anxiety. J Health Psychol 2020; 27:726-742. [PMID: 33106033 DOI: 10.1177/1359105320967435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
This study investigated attentional processing of illness-related information and associations with emotional reactivity. 100 young adults with low to high illness anxiety levels underwent free and cued viewing tasks, while eye-tracking and emotional reactivity were recorded. During free viewing, participants showed early orienting bias and sustained vigilance bias toward illness vs neutral pictures. Increased illness anxiety predicted vigilance bias to illness vs fearful pictures. During cued viewing, participants showed avoidance bias for illness vs neutral pictures, predicted by greater cardiac acceleration. Task nature appears to influence attentional processing patterns of illness stimuli. Preliminary evidence supports that attention allocation may be an emotion regulation mechanism.
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15
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Bakhshaie J, Lebowitz ER, Schmidt NB, Zvolensky MJ. Anxiety sensitivity and bodily kinematics. Behav Res Ther 2020; 133:103694. [PMID: 32738507 DOI: 10.1016/j.brat.2020.103694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 05/18/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
Anxiety sensitivity (AS) is an individual difference factor reflecting the fear of anxiety-related sensations and is one of the best researched risk factors for psychopathology. Decades of research have focused on exploring the relations between AS and clinical symptoms and disorders, although most of the research has employed self-report or interview-based methodologies to index primary dependent measures. No past research has sought to characterize the explanatory relevance of AS from a body kinematics perspective. The present study explored AS in relation to body kinematics to AS-specific images using a dual-task attentional control paradigm (i.e., approach versus avoidance) that employs AS-specific stimuli and motion-tracking technology. Participants included 108 young adults (58.3% female, M age = 25.3) who took part in a ball catching game to index their measures of behavioral engagement with the AS-specific and neutral stimuli presented at either side of the game environment. After adjusting for age, gender, race, handedness, physical functioning, and negative affectivity, self-reported AS was significantly associated with biokinematically-driven behavioral engagement with the AS-specific stimuli. The present study provides novel empirical evidence that AS is related to anxiety-related bodily kinematics. Future work is needed to extend the current results to clinical samples.
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Affiliation(s)
- Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Menninger, Houston, TX, USA.
| | - Eli R Lebowitz
- Yale Child Study Center, Yale University, New Haven, CT, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Cente, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA.
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16
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Stefan S, Zorila A, Brie E. General threat and health-related attention biases in illness anxiety disorder. A brief research report. Cogn Emot 2019; 34:604-613. [PMID: 31354048 DOI: 10.1080/02699931.2019.1645643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Illness anxiety disorder, formerly known as hypochondria, has been conceptualised in the psychological literature as an anxiety disorder, and its dimensional correlate is usually referred to as health anxiety. Similarly to other anxiety disorders, health anxiety has also been investigated in the context of attention biases as maintaining factors. However, so far, there is little consensus in the literature concerning the types of biases most relevant to health anxiety (i.e. facilitation, difficulty in disengaging, or avoidance), and whether biases occur towards generally threatening or specific stimuli. The current study aimed to investigate the presence of all three types of biases in relation to both general-threat and health-related threat pictures in clinical participants with illness anxiety disorder as compared to participants with low levels of health anxiety. The results showed a larger difficulty in disengagement bias for health-related threatening stimuli than for general-threatening stimuli in all participants regardless of group factor. No other significant effects were identified. Thus, attention biases follow a simiar pattern in illness anxiety and low-anxiety participants.
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Affiliation(s)
- Simona Stefan
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania.,The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Alexandru Zorila
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University, Cluj-Napoca, Romania.,Evidence-Based Assessment and Psychological Interventions Doctoral School, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Elena Brie
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
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17
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Leonidou C, Panayiotou G. How do illness-anxious individuals process health-threatening information? A systematic review of evidence for the cognitive-behavioral model. J Psychosom Res 2018; 111:100-115. [PMID: 29935741 DOI: 10.1016/j.jpsychores.2018.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 01/17/2023]
Abstract
UNLABELLED According to the cognitive-behavioral model, illness anxiety is developed and maintained through biased processing of health-threatening information and maladaptive responses to such information. OBJECTIVE This study is a systematic review of research that attempted to validate central tenets of the cognitive-behavioral model regarding etiological and maintenance mechanisms in illness anxiety. METHODS Sixty-two studies, including correlational and experimental designs, were identified through a systematic search of databases and were evaluated for their quality. RESULTS Outcomes were synthesized following a qualitative thematic approach under categories of theoretically driven mechanisms derived from the cognitive-behavioral model: attention, memory and interpretation biases, perceived awareness and inaccuracy in perception of somatic sensations, negativity bias, emotion dysregulation, and behavioral avoidance. CONCLUSIONS Findings partly support the cognitive-behavioral model, but several of its hypothetical mechanisms only receive weak support due to the scarcity of relevant studies. Directions for future research are suggested based on identified gaps in the existing literature.
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Affiliation(s)
| | - Georgia Panayiotou
- Department of Psychology, University of Cyprus, Cyprus; Center of Applied Neuroscience, University of Cyprus, Cyprus
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18
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The dot-probe task to measure emotional attention: A suitable measure in comparative studies? Psychon Bull Rev 2018; 24:1686-1717. [PMID: 28092078 DOI: 10.3758/s13423-016-1224-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
For social animals, attending to and recognizing the emotional expressions of other individuals is of crucial importance for their survival and likely has a deep evolutionary origin. Gaining insight into how emotional expressions evolved as adaptations over the course of evolution can be achieved by making direct cross-species comparisons. To that extent, experimental paradigms that are suitable for investigating emotional processing across species need to be developed and evaluated. The emotional dot-probe task, which measures attention allocation toward emotional stimuli, has this potential. The task is implicit, and subjects need minimal training to perform the task successfully. Findings in nonhuman primates, although scarce, show that they, like humans, have an attentional bias toward emotional stimuli. However, the wide literature on human studies has shown that different factors can have important moderating effects on the results. Due to the large heterogeneity of this literature, these moderating effects often remain unnoticed. We here review this literature and show that subject characteristics and differences in experimental designs affect the results of the dot-probe task. We conclude with specific recommendations regarding these issues that are particularly relevant to take into consideration when applying this paradigm to study animals.
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19
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Alexeeva I, Martin M. Evidence for mood-dependent attentional processing in asthma: attentional bias towards health-threat in depressive mood and attentional avoidance in neutral mood. J Behav Med 2018; 41:550-567. [PMID: 29626313 PMCID: PMC6061078 DOI: 10.1007/s10865-018-9919-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/16/2018] [Indexed: 11/26/2022]
Abstract
Attentional biases have been observed in populations with psychological disorders, but have been under-investigated in populations with physical illnesses. This study investigated potential attentional biases in asthma as a function of mood. Asthma (N = 45), and healthy (N = 39) participants were randomly allocated to a depressed or a neutral mood state induction. They completed a visual probe task that measured participants’ reaction times to health-threat and neutral pictures and words. Compared to the healthy controls, the asthma group showed attentional bias towards health-threat pictures in depressed mood, and avoidance of health-threat pictures in neutral mood. Attentional biases were found in a group with a physical illness as a function of induced mood. It is suggested that attentional processes in people with physical illness may be important in relation to symptom perception and illness management.
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Affiliation(s)
- Iana Alexeeva
- Medical Sciences Division, Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Maryanne Martin
- Medical Sciences Division, Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
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20
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Hughes AM, Gordon R, Chalder T, Hirsch CR, Moss-Morris R. Maximizing potential impact of experimental research into cognitive processes in health psychology: A systematic approach to material development. Br J Health Psychol 2017; 21:764-780. [PMID: 27659260 DOI: 10.1111/bjhp.12214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/19/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is an abundance of research into cognitive processing biases in clinical psychology including the potential for applying cognitive bias modification techniques to assess the causal role of biases in maintaining anxiety and depression. Within the health psychology field, there is burgeoning interest in applying these experimental methods to assess potential cognitive biases in relation to physical health conditions and health-related behaviours. Experimental research in these areas could inform theoretical development by enabling measurement of implicit cognitive processes that may underlie unhelpful illness beliefs and help drive health-related behaviours. However, to date, there has been no systematic approach to adapting existing experimental paradigms for use within physical health research. Many studies fail to report how materials were developed for the population of interest or have used untested materials developed ad hoc. The lack of protocol for developing stimuli specificity has contributed to large heterogeneity in methodologies and findings. PURPOSE In this article, we emphasize the need for standardized methods for stimuli development and replication in experimental work, particularly as it extends beyond its original anxiety and depression scope to other physical conditions. METHOD We briefly describe the paradigms commonly used to assess cognitive biases in attention and interpretation and then describe the steps involved in comprehensive/robust stimuli development for attention and interpretation paradigms using illustrative examples from two conditions: chronic fatigue syndrome and breast cancer. CONCLUSIONS This article highlights the value of preforming rigorous stimuli development and provides tools to aid researchers engage in this process. We believe this work is worthwhile to establish a body of high-quality and replicable experimental research within the health psychology literature. Statement of contribution What is already known on this subject? Cognitive biases (e.g., tendencies to attend to negative information and/or interpret ambiguous information in negative ways) have a causal role in maintaining anxiety and depression. There is mixed evidence of cognitive biases in physical health conditions and chronic illness; one reason for this may be the heterogeneous stimuli used to assess attention and interpretation biases in these conditions. What does this study add? Steps for comprehensive/robust stimuli development for attention and interpretation paradigms are presented. Illustrative examples are provided from two conditions: chronic fatigue syndrome and breast cancer. We provide tools to help researchers develop condition-specific materials for experimental studies.
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Affiliation(s)
- Alicia M Hughes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rola Gordon
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Colette R Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rona Moss-Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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21
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De Putter LMS, Van Yper L, Koster EHW. Obsessions and compulsions in the lab: A meta-analysis of procedures to induce symptoms of obsessive-compulsive disorder. Clin Psychol Rev 2017; 52:137-147. [PMID: 28119197 DOI: 10.1016/j.cpr.2017.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 12/23/2016] [Accepted: 01/12/2017] [Indexed: 11/26/2022]
Abstract
Efficacious induction procedures of symptoms of obsessive-compulsive disorder (OCD) are necessary in order to test central tenets of theories on OCD. However, the efficacy of the current range of induction procedures remains unclear. Therefore, this meta-analysis set out to examine the efficacy of induction procedures in participants with and without OCD symptoms. Moreover, we explored whether the efficacy varied across different moderators (i.e., induction categories, symptom dimensions of OCD, modalities of presentation, and level of individual tailoring). In total we included 4900 participants across 90 studies. The analyses showed that there was no difference in studies using subclinical and clinical participants, confirming the utility of analogue samples. Induction procedures evoked more symptoms in (sub)clinical OCD than in healthy participants, which was most evident in the contamination symptom dimension of OCD. Analysis within (sub)clinical OCD showed a large effect size of induction procedures, especially for the threat and responsibility category and when stimuli were tailored to individuals. Analysis within healthy participants showed a medium effect size of induction procedures. The magnitude of the effect in healthy individuals was stronger for mental contamination, thought-action fusion and threat inductions.
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22
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Lichtenstein-Vidne L, Okon-Singer H, Cohen N, Todder D, Aue T, Nemets B, Henik A. Attentional bias in clinical depression and anxiety: The impact of emotional and non-emotional distracting information. Biol Psychol 2017; 122:4-12. [DOI: 10.1016/j.biopsycho.2016.07.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 01/31/2023]
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23
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Schoth DE, Golding L, Johnson E, Liossi C. Anxiety sensitivity is associated with attentional bias for pain-related information in healthy children and adolescents. J Health Psychol 2016; 21:2434-44. [DOI: 10.1177/1359105315578303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This investigation explored the association between anxiety sensitivity and attentional bias for threatening information in children and adolescents ( N = 40). Participants completed a pictorial version of the visual-probe task, featuring pain-related, health-threat and general-threat images presented for 500 and 1250 ms. Regression analyses revealed significant associations between anxiety sensitivity and attentional bias towards pain-related images presented for 500 ms and between state anxiety and attentional bias towards general-threat images presented for 1250 ms. These results suggest that in children and adolescents, anxiety sensitivity is associated with attentional bias for negative information of personal relevance.
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24
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Nelson BD, Hodges A, Hajcak G, Shankman SA. Anxiety sensitivity and the anticipation of predictable and unpredictable threat: Evidence from the startle response and event-related potentials. J Anxiety Disord 2015; 33:62-71. [PMID: 26005838 PMCID: PMC4480216 DOI: 10.1016/j.janxdis.2015.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/30/2015] [Accepted: 05/01/2015] [Indexed: 12/11/2022]
Abstract
There is growing evidence that heightened sensitivity to unpredictable threat is a core mechanism of dysfunction in anxiety disorders. However, it is unclear whether anxiety sensitivity is also associated with sensitivity to unpredictable threat. In the present study, 131 participants completed the Anxiety Sensitivity Index-3, which includes physical concerns (PC), social concerns (SC), and cognitive concerns (CC) subscales, and a predictable vs. unpredictable threat-of-shock task. Startle eyeblink and ERP responses (N100, P300) to the acoustic startle probes were measured during the task. PC and CC were associated with heightened and attenuated, respectively, startle for the unpredictable (but not predictable) condition. CC were also associated with attenuated probe N100 for the unpredictable condition only, and PC were associated with increased P300 suppression across the predictable and unpredictable conditions. This study provides novel evidence that the different anxiety sensitivity dimensions demonstrate unique relationships with the RDoC domains "acute" and "potential" threat.
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25
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Kim S, Lee JH. Time course of attentional bias for health-related information in individuals with health anxiety. J Health Psychol 2014; 21:1527-35. [PMID: 25476571 DOI: 10.1177/1359105314557976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined whether particular coping strategies influence attentional bias in individuals with health anxiety. A total of 84 participants were divided into four groups on the basis of their health-anxiety level (high/low) and coping strategy (monitor/blunter). The participants were shown screens displaying health-related pictures paired with non-health-related pictures. As a result, the high health-anxiety group was more attentive to health stimuli than the low health-anxiety group, regardless of the coping strategy. When maintaining attention, the high health-anxiety blunter shifted attention away from health stimuli, whereas the high health-anxiety monitor shifted attention toward the stimuli. These results indicated differences in how individuals manage attention processing according to their coping strategy.
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Affiliation(s)
- Sujin Kim
- Chung-Ang University, Republic of Korea
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26
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Schrooten M, Vancleef L, Vlaeyen J. Attention allocation to ambiguous health/somatic threat cues. Eur J Pain 2014; 19:1002-11. [DOI: 10.1002/ejp.628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2014] [Indexed: 11/10/2022]
Affiliation(s)
- M.G.S. Schrooten
- Center for Health and Medical Psychology (CHAMP); Örebro University; Sweden
- Research Group Health Psychology; University of Leuven; Belgium
| | - L. Vancleef
- Department of Clinical Psychological Science; Maastricht University; The Netherlands
| | - J.W.S. Vlaeyen
- Research Group Health Psychology; University of Leuven; Belgium
- Department of Clinical Psychological Science; Maastricht University; The Netherlands
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27
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Attentional bias and metacognitions in cancer survivors with high fear of cancer recurrence. Psychooncology 2014; 24:416-23. [DOI: 10.1002/pon.3659] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/08/2014] [Accepted: 08/01/2014] [Indexed: 12/17/2022]
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28
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Fetzner MG, Asmundson GJG, Carey C, Thibodeau MA, Brandt C, Zvolensky MJ, Carleton RN. How do elements of a reduced capacity to withstand uncertainty relate to the severity of health anxiety? Cogn Behav Ther 2014; 43:262-74. [PMID: 24961385 DOI: 10.1080/16506073.2014.929170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Intolerance of uncertainty (IU)--a multidimensional cognitive vulnerability factor--is associated with a variety of anxiety disorders and health anxiety (HA). To date, few studies have assessed whether IU dimensions (prospective and inhibitory IU) are differentially associated with HA and whether their contributions are independent of anxiety sensitivity (AS). This study addressed these issues using independent community (n = 155; 81% women) and undergraduate (n = 560; 86% women) samples. Results indicated that prospective IU, but not inhibitory IU, had significant positive associations with HA in community dwellers and undergraduate students. AS somatic and cognitive concerns were also significant predictors among both samples. In addition, severity of IU dimensions among individuals reporting elevated HA were compared against individuals diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive-compulsive disorder. Results indicated minimal differences between those with elevated HA and each of the anxiety disorder diagnoses. Findings lend support to the unique transdiagnostic nature of IU and support commonalities between HA and anxiety disorders.
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29
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Weck F, Höfling V. Assessment of Implicit Health Attitudes: A Multitrait–Multimethod Approach and a Comparison Between Patients With Hypochondriasis and Patients With Anxiety Disorders. J Pers Assess 2014; 97:55-65. [DOI: 10.1080/00223891.2014.913253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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30
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Hearon BA, Quatromoni PA, Mascoop JL, Otto MW. The role of anxiety sensitivity in daily physical activity and eating behavior. Eat Behav 2014; 15:255-8. [PMID: 24854814 DOI: 10.1016/j.eatbeh.2014.03.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 01/27/2014] [Accepted: 03/11/2014] [Indexed: 11/16/2022]
Abstract
Anxiety sensitivity (AS), or the fear of somatic arousal, has been linked to both maladaptive eating behavior as well as exercise avoidance in both self-report and laboratory-based experiments. The current pilot study sought to extend these finding to the naturalistic setting. A sample of 32 adults completed affect and dietary monitoring and wore actigraphs across a three-day monitoring period. Results indicated that high AS was associated with greater calorie consumption overall in women and less consumption in men, and high AS predicted an increase in calories consumed following participants' greatest increase in negative affect in both sexes. For physical activity, results indicated an AS by BMI interaction such that obese individuals with high AS engaged in less moderate-intensity physical activity, whereas the opposite was true for normal weight individuals. These results indicate that AS may represent a double-edged risk factor for obesity contributing to both exercise avoidance and calorie consumption.
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Affiliation(s)
- Bridget A Hearon
- Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02215, United States; McLean Hospital and Harvard Medical School, 115 Mill Street, Belmont, MA 02478, United States.
| | - Paula A Quatromoni
- Sargent College, Boston University, 635 Commonwealth Ave., Boston, MA 02215, United States; Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States
| | - Joshua L Mascoop
- Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02215, United States
| | - Michael W Otto
- Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02215, United States
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Hou R, Moss-Morris R, Risdale A, Lynch J, Jeevaratnam P, Bradley BP, Mogg K. Attention processes in chronic fatigue syndrome: Attentional bias for health-related threat and the role of attentional control. Behav Res Ther 2014; 52:9-16. [DOI: 10.1016/j.brat.2013.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 10/09/2013] [Accepted: 10/14/2013] [Indexed: 11/17/2022]
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32
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Kaur A, Butow PN, Sharpe L. Health threat increases attentional bias for negative stimuli. J Behav Ther Exp Psychiatry 2013; 44:469-76. [PMID: 23872228 DOI: 10.1016/j.jbtep.2013.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/15/2013] [Accepted: 06/20/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Although there is some evidence that health anxiety is associated with attentional bias, relatively little research has examined the role of situational threat on bias. This study examined the effect of health threat on attentional bias for negative health words. METHODS Participants completed questionnaires and were then randomized to receive either threatening or reassuring health-related feedback. Following randomization, participants completed the emotional Stroop and dot-probe tasks in a counter-balanced order. RESULTS On the emotional Stroop task, all participants took longer to name the colour of negative words, as compared to positive and neutral words. However on the dot probe task, differences in attentional bias emerged based on feedback condition. Those receiving reassuring feedback displayed a bias away from negative words while those receiving threatening feedback did not display a bias either towards or away from negative words. Following reassuring feedback only, metacognitions were negatively correlated with attention towards positive health-related stimuli, suggesting another avenue for future research. CONCLUSIONS Health threats lead to an increase in the processing of negative information, and the effect of metacognitions on processing appears to be apparent only in the absence of health threat.
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Affiliation(s)
- Amar Kaur
- School of Psychology, The University of Sydney, NSW 2006, Australia.
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33
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Witthöft M, Mier D, Ofer J, Müller T, Rist F, Kirsch P, Bailer J, Diener C. Neuronal and behavioral correlates of health anxiety: results of an illness-related emotional Stroop task. Neuropsychobiology 2013; 67:93-102. [PMID: 23296017 DOI: 10.1159/000345545] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 10/24/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Health anxiety (HA) is defined as the objectively unfounded fear or conviction of suffering from a severe illness. Predominant attention allocation to illness-related information is regarded as a central process in the development and maintenance of HA, yet little is known about the neuronal correlates of this attentional bias. METHODS An emotional Stroop task with body symptom, illness, and neutral words was employed to elicit emotional interference in healthy participants with high (HA+, n = 12) and low (HA-, n = 12) HA during functional magnetic resonance imaging. RESULTS Prolonged reaction times for indicating the color of symptom words and a decrease in rostral anterior cingulate cortex (rACC) activation were seen in HA+ participants. Emotional interference effects on the behavioral level were negatively related to rACC activity over the whole group. Groups did not differ during the processing of threatening illness words. CONCLUSION The results indicate stronger attention allocation toward body symptom words already in subclinical HA. This attentional bias appears to be linked to hypoactivity of the rACC which impedes effective emotional interference reduction, leading instead to a ruminative processing of the stimulus content.
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Affiliation(s)
- Michael Witthöft
- Department of Clinical Psychology and Psychotherapy, Johannes Gutenberg University, Mainz, Germany.
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34
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Campbell ML, Gorka SM, McGowan SK, Nelson BD, Sarapas C, Katz AC, Robison-Andrew EJ, Shankman SA. Does anxiety sensitivity correlate with startle habituation? An examination in two independent samples. Cogn Emot 2013; 28:46-58. [PMID: 23746071 DOI: 10.1080/02699931.2013.799062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Individuals with anxiety disorders have previously demonstrated abnormal habituation to aversiveness over time. As anxiety sensitivity (AS), or an individuals' propensity to fear of anxiety-related sensations, has been shown to be a risk factor for anxiety disorders (particularly panic disorder), the present study examined whether AS was also associated with abnormal habituation. This association was examined in two independent samples of undergraduates (Ntotal=178). Habituation was operationalised as the reduction in startle response to multiple startle probes presented over 2.5 minutes and three definitions of this reduction were employed. Results indicated that individuals with higher levels of AS evidenced deficits in startle habituation, but the strength of this relationship was somewhat dependent on the definition of startle habituation, with the most robust definition being an analysis of participants' individual slopes across all nine blinks. The present findings suggest that startle habituation is a key mechanism underlying AS, and may help elucidate the role this risk factor plays in the pathogenesis of anxiety disorders.
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Affiliation(s)
- Miranda L Campbell
- a Department of Psychology , University of Illinois at Chicago , Chicago , IL , USA
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35
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Crombez G, Van Ryckeghem DM, Eccleston C, Van Damme S. Attentional bias to pain-related information: A meta-analysis. Pain 2013; 154:497-510. [DOI: 10.1016/j.pain.2012.11.013] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/15/2012] [Accepted: 11/21/2012] [Indexed: 12/22/2022]
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36
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Relationship between cognitive factors and anxiety in individuals with irritable bowel syndrome. Int J Behav Med 2013; 19:308-15. [PMID: 21935740 DOI: 10.1007/s12529-011-9195-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Individuals with irritable bowel syndrome (IBS) have high anxiety. There is insufficient information about the relationships between concrete cognitive contents and anxiety in IBS. PURPOSE The present study investigated the relationship between cognitive factors and anxiety in individuals with IBS. METHOD The participants were 1,087 college students (male, 506; female, 576; unidentified, 5; age, 19.72 ± 1.76 years) who completed a set of questionnaires that included the Rome II Modular Questionnaire (based on diagnostic criteria for IBS), Anxiety Sensitivity Index (ASI), Cognitive Appraisal Rating Scale (CARS; subscales: commitment, appraisal of effect, appraisal of threat, and controllability) for measuring symptom-related cognition, an item about attention to abdominal symptoms, the Hospital Anxiety and Depression Scale-Anxiety Scale (HADS-A), and an item regarding the presence of avoidant behavior due to anxiety of IBS symptoms. RESULTS The participants included 881 individuals without IBS and 206 individuals with IBS. Individuals with IBS had higher ASI and HADS-A scores than those of the individuals belonging to the control group (p < 0.001). Subscale scores of CARS (except those of controllability and attention to IBS symptoms) significantly correlated with the ASI and HADS-A scores (p < 0.01). Individuals with IBS and avoidant behavior had higher subscale scores of CARS (except those of controllability and attention to IBS symptoms) and higher HADS-A scores (p < 0.05). The hypothetical models containing ASI scores, subscale scores of CARS (except those of controllability), and HADS-A scores with and without attention to IBS symptoms exhibited a good fit. CONCLUSION Severe anxiety sensitivity in individuals with IBS related to their symptom-related cognition, and the altered cognition increases anxiety, leading to the possible development of a disabling condition.
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Jasper F, Witthöft M. Automatic Evaluative Processes in Health Anxiety and Their Relations to Emotion Regulation. COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-012-9484-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Lee H, Turkel JE, Cotter SP, Milliken JM, Cougle J, Goetz AR, Lesnick AM. Attentional bias toward personally relevant health-threat words. ANXIETY STRESS AND COPING 2012; 26:493-507. [PMID: 22881238 DOI: 10.1080/10615806.2012.713474] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Conflicting findings have emerged regarding the presence of attentional biases (ABs) in health anxiety, probably due to methodological limitations in the stimuli used in cognitive tasks and the assessment of health anxiety-relevant factors. The current study sought to examine ABs toward health-related threats using idiographically chosen health-threat words in a non-clinical sample. A modified dot-probe task using idiographically selected health-threat words was administered to an undergraduate sample. Self-report measures were administered to assess somatic, cognitive, and behavioral aspects of health anxiety, in addition to assessing negative affect, anxiety sensitivity, and experience of actual medical conditions. Results showed that behavioral and somatic aspects of health anxiety were significantly associated with AB toward personally relevant threat words, even after controlling for negative affect, anxiety sensitivity, and experience of actual medical conditions. Additional analyses revealed that these biases reflected difficulty disengaging attention from threat rather than a facilitated detection of threat. In contrast, illness-related cognitions were found to be unrelated to ABs. These findings suggest an association between threat-related ABs and excessive health-care seeking efforts.
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Affiliation(s)
- Hanjoo Lee
- a Department of Psychology , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
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39
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Okon-Singer H, Lichtenstein-Vidne L, Cohen N. Dynamic modulation of emotional processing. Biol Psychol 2012; 92:480-91. [PMID: 22676964 DOI: 10.1016/j.biopsycho.2012.05.010] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 05/22/2012] [Accepted: 05/28/2012] [Indexed: 11/26/2022]
Abstract
Recent findings suggest the processing of emotional stimuli is prioritized compared to neutral stimuli; however, it is not necessarily automatic and depends on several modulating factors. The current paper highlights three major factors that affect the reactions to emotional stimuli: (i) stimulus properties, (ii) task demands and attention, and (iii) individual characteristics. The evidence reviewed here suggests that individual characteristics shape the structure, function and connectivity within a neural network that is involved in the reactions to emotional stimuli. This neural network includes regions related to emotion and attention, in line with evidence for reciprocal connections between these two processes. Activation in this network further depends on the emotional value of a certain item, as well as physical features of the stimulus. This integrative view can lead to better understanding of the underlying mechanisms of emotional reactions, as well as better therapeutic approaches.
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Affiliation(s)
- Hadas Okon-Singer
- Department of Neurology, Max Planck Institute for Human Cognition and Brain Sciences, Leipzig, Germany.
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40
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Liossi C, Schoth DE, Bradley BP, Mogg K. Time-course of attentional bias for pain-related cues in chronic daily headache sufferers. Eur J Pain 2012; 13:963-9. [DOI: 10.1016/j.ejpain.2008.11.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 10/20/2008] [Accepted: 11/02/2008] [Indexed: 11/15/2022]
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41
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Health anxiety and attentional bias: the time course of vigilance and avoidance in light of pictorial illness information. J Anxiety Disord 2011; 25:1131-8. [PMID: 21890316 DOI: 10.1016/j.janxdis.2011.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 08/04/2011] [Accepted: 08/04/2011] [Indexed: 11/22/2022]
Abstract
Cognitive-behavioral models of health anxiety stress the importance of selective attention not only towards internal but also towards external health threat related stimuli. Yet, little is known about the time course of this attentional bias. The current study investigates threat related attentional bias in participants with varying degrees of health anxiety. Attentional bias was assessed using a visual dot-probe task with health-threat and neutral pictures at two exposure durations, 175ms and 500ms. A baseline condition was added to the dot-probe task to dissociate indices of vigilance towards threat and difficulties to disengage from threat. Substantial positive correlations of health anxiety, anxiety sensitivity, and absorption with difficulties to disengage from threat were detected at 500ms exposure time. At an early stage (i.e., at 175ms exposure time), we found significant positive correlations of health anxiety and absorption with orientation towards threat. Results suggest a vigilance avoidance pattern of selective attention associated with pictorial illness related stimuli in health anxiety.
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42
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The Impact of Attention Style on Directed Forgetting Among High Anxiety Sensitive Individuals. COGNITIVE THERAPY AND RESEARCH 2011. [DOI: 10.1007/s10608-011-9366-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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43
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Shields C, Murphy K. Selective Attention and Health Anxiety: Ill-Health Stimuli are Distracting for Everyone. COGNITIVE THERAPY AND RESEARCH 2011. [DOI: 10.1007/s10608-011-9351-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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44
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Relationships between affective states and decision-making. Int J Psychophysiol 2009; 74:259-65. [DOI: 10.1016/j.ijpsycho.2009.09.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 08/18/2009] [Accepted: 09/18/2009] [Indexed: 11/21/2022]
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45
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Nederkoorn C, Baltus M, Guerrieri R, Wiers RW. Heavy drinking is associated with deficient response inhibition in women but not in men. Pharmacol Biochem Behav 2009; 93:331-6. [DOI: 10.1016/j.pbb.2009.04.015] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 04/08/2009] [Accepted: 04/24/2009] [Indexed: 11/17/2022]
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46
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Hou R, Moss-Morris R, Bradley BP, Peveler R, Mogg K. Attentional bias towards health-threat information in chronic fatigue syndrome. J Psychosom Res 2008; 65:47-50. [PMID: 18582611 DOI: 10.1016/j.jpsychores.2008.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 03/11/2008] [Accepted: 03/20/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether individuals with chronic fatigue syndrome (CFS) show an attentional bias towards health-threat information. METHODS Attentional bias (AB) was assessed in individuals with CFS and healthy controls using a visual probe task which presented health-threat and neutral words and pictures for 500 ms. Self-report questionnaires were used to assess CFS symptoms, depression, anxiety, and social desirability. RESULTS Compared to a healthy control group, the CFS group showed an enhanced AB towards heath-threat stimuli relative to neutral stimuli. The AB was not influenced by the type of stimulus (pictures vs. words). CONCLUSION The finding of an AB towards health-threat information in individuals with CFS is supportive of models of CFS which underlie cognitive behavior therapy.
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Affiliation(s)
- Ruihua Hou
- School of Medicine, University of Southampton, Southampton, United Kingdom
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47
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Leen-Feldner EW, Blanchard L, Babson K, Reardon LE, Bacon AK, Zvolensky MJ. The moderating role of health fear on the relation between smoking status and panic symptoms among adolescents. J Anxiety Disord 2008; 22:772-80. [PMID: 17884329 DOI: 10.1016/j.janxdis.2007.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 08/06/2007] [Accepted: 08/15/2007] [Indexed: 11/29/2022]
Abstract
The present study examined the moderating role of health fear on the concurrent relation between smoking status and panic attack symptoms among 249 adolescents (132 females, M(age)=14.86 years). As hypothesized, youth high in health fear reported elevations in panic attack symptoms, whereas this relation was relatively weak among those low in health fear. Importantly, these associations were significant after controlling for age, gender, negative affectivity, and anxiety sensitivity. Also as expected, health fear did not moderate the association between smoking status and depressive symptoms, supporting model specificity. Results are discussed in terms of implications for the panic-smoking association among youth.
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Karademas EC, Christopoulou S, Dimostheni A, Pavlu F. Health anxiety and cognitive interference: Evidence from the application of a modified Stroop task in two studies. PERSONALITY AND INDIVIDUAL DIFFERENCES 2008. [DOI: 10.1016/j.paid.2007.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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Quartana PJ, Yoon KL, Burns JW. Anger suppression, ironic processes and pain. J Behav Med 2007; 30:455-69. [PMID: 17712618 DOI: 10.1007/s10865-007-9127-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022]
Abstract
Whether anger suppression exerts a causal influence on pain experience, and the mechanisms of such an influence, are not well understood. We report two experimental studies that examine the hypothesis that anger suppression paradoxically increases cognitive accessibility of anger, in turn coloring perceptions of succeeding pain in an anger-congruent fashion. The results of two experimental studies largely confirmed these predictions. Study 1 revealed that participants instructed to suppress emotions during anger-provocation experienced greater cold-pressor pain than those in the control condition. This difference was confined to perception of anger-specific qualities of pain. Study 2 replicated key findings of Study 1, but also provided partial evidence for increased cognitive accessibility of anger tied to anger suppression through self-report and modified dot-probe methodologies. Implications and limitations of these findings are discussed.
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Affiliation(s)
- Phillip J Quartana
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.
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50
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Enhanced Early Emotional Intrusion Effects and Proportional Habituation of Threat Response for Symptom and Illness Words in College Students with Elevated Health Anxiety. COGNITIVE THERAPY AND RESEARCH 2007. [DOI: 10.1007/s10608-007-9159-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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