White-coat effect induced by therapist's presence during speech therapy: study of post-stroke aphasic Japanese patients

Language as a Stressor in Aphasia

BACKGROUND: Persons with aphasia often report feeling anxious when using language while communicating. While many patients, caregivers, clinicians and researchers would agree that language may be a stressor for persons with aphasia, systematic empirical studies of stress and/or anxiety in aphasia remain scarce. AIM: The aim of this paper is to review the existing literature discussing language as a stressor in aphasia, identify key issues, highlight important gaps, and propose a program for future study. In doing so, we hope to underscore the importance of understanding aspects of the emotional aftermath of aphasia, which plays a critical role in the process of recovery and rehabilitation. MAIN CONTRIBUTION: Post stroke emotional dysregulation in persons with chronic aphasia clearly has adverse effects for language performance and prospects of recovery. However, the specific role anxiety might play in aphasia has yet to be determined. As a starting point, we propose to view language in aphasia as a stressor, linked to an emotional state we term "linguistic anxiety." Specifically, a person with linguistic anxiety is one in whom the deliberate, effortful production of language involves anticipation of an error, with the imminence of linguistic failure serving as the threat. Since anticipation is psychologically linked to anxiety and also plays an important role in the allostatic system, we suggest that examining physiologic stress responses in persons with aphasia when they are asked to perform a linguistic task would be a productive tool for assessing the potential relation of stress to "linguistic anxiety." CONCLUSION: Exploring the putative relationship between anxiety and language in aphasia, through the study of physiologic stress responses, could establish a platform for investigating language changes in the brain in other clinical populations, such as in individuals with Alzheimer's disease or persons with post traumatic stress disorder, or even with healthy aging persons, in whom "linguistic anxiety" might be at work when they have trouble finding words.

Assessed and distressed: white-coat effects on clinical balance performance

OBJECTIVES

While balance in young and older adults is known to change with the threat of standing on elevated surfaces, the potential for social anxiety to influence emotional states and balance performance during a clinical assessment is currently unknown.

METHODS

Nineteen young and 19 older healthy female adults volunteered for the study. The effects of age and clinical assessment on balance performance were examined using a 2×2 between- and within-subjects factorial design. Balance performance measures were derived from forceplate recordings of three different postural tasks. Psychological measures included fear of negative evaluation, state anxiety, and fear related to the completed balance tasks.

RESULTS

There was a significant increase in state anxiety and fear when participants performed balance tasks while being assessed by an evaluator. Compared to the control condition, both age groups leaned significantly further forward during the functional reach task when being assessed. While being assessed, older adults had significantly larger amplitudes and frequencies of center of pressure (COP) displacement during two-legged stance with eyes closed (EC) and significantly less stance time during one-legged standing compared to the control condition. In contrast, balance performance in young adults during one-legged or two-legged stance tasks was unchanged by clinical assessment.

CONCLUSIONS

Social anxiety associated with the clinical assessment of balance can have a negative influence on both emotional states and balance control. As a result, clinicians need to recognize and account or control for potential social anxiety effects on clinical balance performance in young and older adults in particular.