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Shivak SM, Caissie DM, Power HA, Asmundson AJN, Wright KD. The relationship between maladaptive health beliefs, pandemic-related stress, and health anxiety during the COVID-19 pandemic. HEALTH PSYCHOLOGY REPORT 2023; 12:69-78. [PMID: 38425889 PMCID: PMC10900977 DOI: 10.5114/hpr/169169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/18/2023] [Accepted: 07/03/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Research has demonstrated that people experience specific distress and anxiety regarding COVID-19. This distress may consist of interconnected symptom categories corresponding to a COVID stress syndrome. Susceptibility to COVID stress syndrome may be related to one's maladaptive health beliefs; however, no research has investigated the association between maladaptive health beliefs and COVID stress. The present study explored the impact of health beliefs on COVID stress, health anxiety, and associated psychological constructs. PARTICIPANTS AND PROCEDURE This cross-sectional survey study included 221 adults (M age = 20.59, SD = 2.28). Participants completed an online survey including demographic questionnaires and self-report measures of health beliefs, COVID stress, health anxiety, and related psychological constructs. RESULTS Health anxiety, anxiety sensitivity, state/trait anxiety, intolerance of uncertainty, and depression accounted for significant variance in COVID stress (F(6, 214) = 11.18, R2 = .24, p < .001). Health beliefs (i.e., perceived likelihood of illness, medical service inadequacy, and difficulty coping) were associated with greater COVID stress, although health beliefs were not found to mediate the relationship between health anxiety and COVID stress. CONCLUSIONS Health beliefs were associated with greater COVID stress, although health beliefs did not mediate the relationship between health anxiety and COVID stress. The relationship between health anxiety and COVID stress may be better explained by other COVID-related cognitions (e.g., vaccine efficacy, dangerousness of COVID-19). The findings highlight the importance of peoples' health beliefs during the pandemic. Given anxiety's influence on peoples' behavioural responses to the pandemic, further research should identify COVID-specific cognitions for prevention of COVID stress and health anxiety.
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Inhibitory Learning-Based Exposure Therapy for Patients With Pathological Health Anxiety: Results From a Single Case Series Study. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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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Riegel M, Wierzba M, Wypych M, Ritchey M, Jednoróg K, Grabowska A, Vuilleumier P, Marchewka A. Distinct medial-tempora lobe mechanisms of encoding and amygdala-mediated memory reinstatement for disgust and fear. Neuroimage 2022; 251:118889. [PMID: 35065268 DOI: 10.1016/j.neuroimage.2022.118889] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
Abstract
Current models of episodic memory posit that retrieval involves the reenactment of encoding processes. Recent evidence has shown that this reinstatement process - indexed by subsequent encoding-retrieval similarity of brain activity patterns - is related to the activity in the hippocampus during encoding. However, we tend to re-experience emotional events in memory more richly than dull events. The role of amygdala - a critical hub of emotion processing - in reinstatement of emotional events was poorly understood. To investigate it, we leveraged a previously overlooked divergence in the role of amygdala in memory modulation by distinct emotions - disgust and fear. Here we used a novel paradigm in which participants encoded complex events (word pairs) and their memory was tested after 3 weeks, both phases during fMRI scanning. Using representational similarity analysis and univariate analyses, we show that the strength of amygdala activation during encoding was correlated with memory reinstatement of individual event representations in emotion-specific regions. Critically, amygdala modulated reinstatement more for disgust than fear. This was in line with other differences observed at the level of memory performance and neural mechanisms of encoding. Specifically, amygdala and perirhinal cortex were more involved during encoding of disgust-related events, whereas hippocampus and parahippocampal gyrus during encoding of fear-related events. Together, these findings shed a new light on the role of the amygdala and medial temporal lobe regions in encoding and reinstatement of specific emotional memories.
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Affiliation(s)
- Monika Riegel
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw 02-093, Poland; Department of Psychology, Columbia University, New York 10027, United States of America; Centre interfacultaire de gérontologie et d'études des vulnerabilities, University of Geneva, CH-Geneva 1211, Switzerland.
| | - Małgorzata Wierzba
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw 02-093, Poland
| | - Marek Wypych
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw 02-093, Poland
| | - Maureen Ritchey
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA 02467, United States of America
| | - Katarzyna Jednoróg
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw 02-093, Poland
| | - Anna Grabowska
- SWPS University of Social Sciences and Humanities, Warsaw 03-815, Poland
| | - Patrik Vuilleumier
- Department of Neuroscience, University Medical Center, Geneva CH-1211, Switzerland; Swiss Center for Affective Sciences, University of Geneva, Campus Biotech, CH-Geneva 1211, Switzerland; Geneva Neuroscience Center, University of Geneva, Geneva CH-1211, Switzerland
| | - Artur Marchewka
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw 02-093, Poland
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Sauer KS, Schmidt A, Jungmann SM, Bailer J, Witthöft M. Do patients with pathological health anxiety fear COVID-19? A time-course analysis of 12 single cases during the "first wave" of the COVID-19 pandemic in Germany. J Psychosom Res 2021; 152:110687. [PMID: 34875465 PMCID: PMC8632435 DOI: 10.1016/j.jpsychores.2021.110687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Pre-existing health anxiety is associated with an intensified affective response to the novel COVID-19 pandemic in the general population. Still, results on the reaction of people with a diagnosis of pathological health anxiety (i.e., hypochondriasis) are scarce. METHODS In the present study, we investigated the course of (health) anxiety related to SARS-CoV-2/COVID-19 in comparison to (health) anxiety related to other severe diseases (e.g., cancer) in a sample of 12 patients with the diagnosis of pathological health anxiety during the "first wave" of the COVID-19 pandemic in Germany. Both SARS-CoV-2 related anxiety and anxiety related to other severe diseases were assessed weekly over 16 measurement points (30.03.-19.07.2020) and primarily analyzed with fixed effects regression analyses. RESULTS Unexpectedly, SARS-CoV-2 related anxiety was on average significantly lower than anxiety related to other severe diseases (d = -0.54, p < .001) and not significantly associated with anxiety related to other severe diseases or pre-COVID-19 health anxiety. CONCLUSION It therefore appears premature to assume that SARS-CoV-2 related anxiety and other health worries are necessarily strongly interrelated and comparably high in people with pathological health anxiety.
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Affiliation(s)
- Karoline S Sauer
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany.
| | - Andrea Schmidt
- DIPF | Leibniz Institute for Research and Information in Education, Germany.
| | - Stefanie M Jungmann
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany.
| | - Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Germany.
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany.
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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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Gehrt TB, Niziurski JA, Frostholm L, Berntsen D. Encoding and retrieval biases for health-related scenes in patients with severe health anxiety .. Memory 2019; 27:1110-1121. [PMID: 31159637 DOI: 10.1080/09658211.2019.1626437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Severe health anxiety is a disorder characterised by excessive worries about harbouring or having a serious illness. The present study examines cognitive biases in evaluation and memory for health-related scenes in severe health anxiety in order to provide insights into the effect of these biases and the formation of illness intrusions in severe health anxiety. Twenty patients with severe health anxiety and 20 healthy participants completed a computerised task consisting of encoding, involuntary retrieval, voluntary retrieval and recognition of health-related, negative and neutral scenes. The results demonstrated that patients with severe health anxiety reported more negative emotional valence and greater physiological arousal to health-related scenes, both during encoding (ps < .031, ηp2 > .09) and retrieval (ps < .044, ds > 0.18). Furthermore, in contrast to the comparison group, patients with severe health anxiety did not show shorter retrieval time for health-related scenes during involuntary compared with voluntary retrieval (p = .789, d = 0.08), possibly due to greater demands on emotion regulation during involuntary retrieval. The results suggest an important role for negative emotional valence and physiological arousal to health-related stimuli in severe health anxiety, and highlight how cognitive biases in evaluation and memory might be at play in this disorder.
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Affiliation(s)
- Tine B Gehrt
- a Center on Autobiographical Memory Research , Aarhus University , Aarhus C , Denmark
| | - Julie A Niziurski
- a Center on Autobiographical Memory Research , Aarhus University , Aarhus C , Denmark.,b Department of Mathematics and Cognitive Psychology , Heinrich Heine Universität , Düsseldorf , Germany
| | - Lisbeth Frostholm
- c The Research Clinic for Functional Disorders , Aarhus University Hospital , Aarhus C , Denmark
| | - Dorthe Berntsen
- a Center on Autobiographical Memory Research , Aarhus University , Aarhus C , Denmark
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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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Mier D, Bailer J, Ofer J, Kerstner T, Zamoscik V, Rist F, Witthöft M, Diener C. Neural correlates of an attentional bias to health-threatening stimuli in individuals with pathological health anxiety. J Psychiatry Neurosci 2017; 42:200-209. [PMID: 28234209 PMCID: PMC5403665 DOI: 10.1503/jpn.160081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND An attentional bias to health-threat stimuli is assumed to represent the primary pathogenetic factor for the development and maintenance of pathological health anxiety (PHA; formerly termed "hypochondriasis"). However, little is known about the neural basis of this attentional bias in individuals with PHA. METHODS A group of patients with PHA, a group of depressed patients and a healthy control group completed an emotional Stroop task with health-threat (body symptom and illness) words and neutral control words while undergoing functional MRI. RESULTS We included 33 patients with PHA, 28 depressed patients and 31 controls in our analyses. As reflected in reaction times, patients with PHA showed a significantly stronger attentional bias to health-threat words than both control groups. In addition, patients with PHA showed increased amygdala and rostral anterior cingulate cortex activation for body symptom, but not for illness words. Moreover, only in patients with PHA amygdala activation in response to symptom words was positively associated with higher arousal and more negative valence ratings of the body symptom word material. LIMITATIONS A control group of patients with an anxiety disorder but without PHA would have helped to define the specificity of the results for PHA. CONCLUSION The attentional bias observed in patients with PHA is associated with hyperactivation in response to body symptom words in brain regions that are crucial for an arousal-related fear response (e.g., the amygdala) and for resolving emotional interference (e.g., the rostral anterior cingulate cortex). The findings have important implications for the nosological classification of PHA and suggest the application of innovative exposure-based interventions for the treatment of PHA.
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Affiliation(s)
- Daniela Mier
- Correspondence to: D. Mier, Department of Clinical Psychology, Central Institute of Mental Health, J5, 68159 Mannheim, Germany;
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Lee HJ, Goetz AR, Turkel JE, Siwiec SG. Computerized attention retraining for individuals with elevated health anxiety. ANXIETY STRESS AND COPING 2014; 28:226-37. [PMID: 24773231 DOI: 10.1080/10615806.2014.918964] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information. DESIGN This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words. METHODS Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18). RESULTS Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outperform ACC in reducing HA and other relevant emotional symptoms. However, both AMP and ACC evidenced overall significant symptom reduction in most of the outcome measures, including overall HA, anxiety sensitivity, general depression and anxiety, and somatic complaints. CONCLUSIONS Further research is needed to better understand the effects and mechanisms of AMP as a possible cognitive intervention for HA.
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Affiliation(s)
- Han-Joo Lee
- a Department of Psychology , University of Wisconsin-Milwaukee , PO Box 413, Milwaukee , WI 53201 , USA
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