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Shi C, Du X, Chen W, Ren Z. Predictive roles of cognitive biases in health anxiety: A machine learning approach. Stress Health 2024:e3463. [PMID: 39126673 DOI: 10.1002/smi.3463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/18/2024] [Accepted: 08/04/2024] [Indexed: 08/12/2024]
Abstract
Prior work suggests that cognitive biases may contribute to health anxiety. Yet there is little research investigating how biased attention, interpretation, and memory for health threats are collectively associated with health anxiety, as well as the relative importance of these cognitive processes in predicting health anxiety. This study aimed to build a prediction model for health anxiety with multiple cognitive biases as potential predictors and to identify the biased cognitive processes that best predict individual differences in health anxiety. A machine learning algorithm (elastic net) was performed to recognise the predictors of health anxiety, using various tasks of attention, interpretation, and memory measured across behavioural, self-reported, and computational modelling approaches. Participants were 196 university students with a range of health anxiety severity from mild to severe. The results showed that only the interpretation bias for illness and the attention bias towards symptoms significantly contributed to the prediction model of health anxiety, with both biases having positive weights and the former being the most important predictor. These findings underscore the central role of illness-related interpretation bias and suggest that combined cognitive bias modification may be a promising method for alleviating health anxiety.
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Affiliation(s)
- Congrong Shi
- School of Educational Science, Anhui Normal University, Wuhu, China
| | - Xiayu Du
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, National Intelligent Society Governance Experiment Base (Education), School of Psychology, Central China Normal University, Wuhan, China
| | - Wenke Chen
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, National Intelligent Society Governance Experiment Base (Education), 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, National Intelligent Society Governance Experiment Base (Education), School of Psychology, Central China Normal University, Wuhan, China
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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 PMCID: PMC11298870 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] [Grants] [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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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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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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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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Jain FA, Connolly CG, Moore LC, Leuchter AF, Abrams M, Ben-Yelles RW, Chang SE, Ramirez Gomez LA, Huey N, Lavretsky H, Iacoboni M. Grief, Mindfulness and Neural Predictors of Improvement in Family Dementia Caregivers. Front Hum Neurosci 2019; 13:155. [PMID: 31156412 PMCID: PMC6530345 DOI: 10.3389/fnhum.2019.00155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/24/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Family dementia caregivers often suffer from an immense toll of grief while caring for their loved ones. We sought to identify the clinical relationship between grief, depression and mindfulness and identify neural predictors of symptomatology and improvement. Methods: Twenty three family dementia caregivers were assessed at baseline for grief, mindfulness and depression, of which 17 underwent functional magnetic resonance imaging (fMRI). During fMRI, caregivers were shown faces of either their dementia-stricken relative or that of a stranger, paired with grief-related or neutral words. In nine subjects, post fMRI scans were also obtained after 4 weeks of either guided imagery or relaxation. Robust regression was used to predict changes in symptoms with longitudinal brain activation (BA) changes as the dependent variable. Results: Grief and depression symptoms were correlated (r = 0.50, p = 0.01), and both were negatively correlated with mindfulness (r = -0.70, p = 0.0002; r = -0.52, p = 0.01). Relative to viewing strangers, caregivers showed pictures of their loved ones (picture factor) exhibited increased activation in the dorsal anterior cingulate gyrus and precuneus. Improvement in grief but not mindfulness or depression was predicted by increased relative BA in the precuneus and anterior cingulate (different subregions from baseline). Viewing grief-related vs. neutral words elicited activity in the medial prefrontal cortex and precuneus. Conclusions: Caregiver grief, depression and mindfulness are interrelated but have at least partially nonoverlapping neural mechanisms. Picture and word stimuli related to caregiver grief evoked brain activity in regions previously identified with bereavement grief. These activation foci might be useful as biomarkers of treatment response.
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Affiliation(s)
- Felipe A. Jain
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Colm G. Connolly
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Leonardo C. Moore
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Institute for Simulation and Training, University of Central Florida, Orlando, FL, United States
| | - Andrew F. Leuchter
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle Abrams
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ramzi W. Ben-Yelles
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sarah E. Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - Liliana A. Ramirez Gomez
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Nora Huey
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Marco Iacoboni
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Ahmanson-Lovelace Brain Mapping Center, Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States
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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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Feng C, Becker B, Huang W, Wu X, Eickhoff SB, Chen T. Neural substrates of the emotion-word and emotional counting Stroop tasks in healthy and clinical populations: A meta-analysis of functional brain imaging studies. Neuroimage 2018; 173:258-274. [DOI: 10.1016/j.neuroimage.2018.02.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 12/12/2022] Open
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Gropalis M, Bailer J, Weck F, Witthöft M. Optimierung von Expositionstherapie bei pathologischen Krankheitsängsten. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0285-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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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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Mutic S, Brünner YF, Rodriguez-Raecke R, Wiesmann M, Freiherr J. Chemosensory danger detection in the human brain: Body odor communicating aggression modulates limbic system activation. Neuropsychologia 2017; 99:187-198. [DOI: 10.1016/j.neuropsychologia.2017.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 01/23/2023]
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The role of emotional inhibitory control in specific internet addiction – an fMRI study. Behav Brain Res 2017; 324:1-14. [DOI: 10.1016/j.bbr.2017.01.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/21/2017] [Accepted: 01/27/2017] [Indexed: 01/30/2023]
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Bailer J, Witthöft M, Erkic M, Mier D. Emotion dysregulation in hypochondriasis and depression. Clin Psychol Psychother 2017; 24:1254-1262. [PMID: 28444850 DOI: 10.1002/cpp.2089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 03/17/2017] [Accepted: 03/23/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to explore whether certain aspects of emotion dysregulation (i.e., facets of alexithymia and rumination) are more closely linked to hypochondriasis than to depression and vice versa. METHODS Nineteen patients with hypochondriasis (HYP), 33 patients with depression, and 52 healthy control participants completed the Toronto Alexithymia Scale, the Response Styles Questionnaire, and additional symptom and illness behaviour scales. A clinical interview was used to establish DSM-IV diagnoses and to exclude all cases with more than one axis I diagnosis. RESULTS Depression patients reported more difficulties describing feelings and more symptom- and self-focused rumination than both HYP patients and healthy individuals, whereas HYP patients differed only from healthy individuals in regard to more difficulties in identifying feelings and more symptom-focused rumination. Multiple regression analyses, including all assessed facets of emotion dysregulation, showed that the degree of somatoform features (somatic symptoms, health anxiety, and illness behaviour) was specifically predicted by higher difficulties in identifying feelings scores, whereas depressive symptom levels were specifically predicted by higher rumination scores. CONCLUSIONS Specific associations were found between difficulties in identifying feelings and key features of HYP, whereas depression was linked to a more generalized pattern of emotion regulation deficits. KEY PRACTITIONER MESSAGE Emotion dysregulation can be found in hypochondriasis and depression Difficulties in identifying own feelings are specifically linked to somatic symptoms, health anxiety, and illness behaviour, whereas a more generalized pattern of emotion dysregulation is found in relation to depression Further research is needed to investigate whether the effectiveness of current treatments for depression, hypochondriasis, health anxiety, and related disorders could be improved by additional emotion regulation interventions.
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Affiliation(s)
- Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Maja Erkic
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
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Schreiber F, Witthöft M, Neng JMB, Weck F. Changes in negative implicit evaluations in patients of hypochondriasis after treatment with cognitive therapy or exposure therapy. J Behav Ther Exp Psychiatry 2016. [PMID: 26204567 DOI: 10.1016/j.jbtep.2015.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Previous studies using modified versions of the Affect Misattribution Procedure (AMP; Payne, Cheng, Govorun, & Stewart, 2005) have revealed that there is an implicit negative evaluation bias of illness-related information in patients with hypochondriasis (HYP), which might be a maintaining feature of HYP. However, there is no evidence on whether this bias might be targeted successfully by effective treatments, such as exposure therapy (ET) or cognitive therapy (CT). This is the first study to examine the change in negative implicit evaluations in a randomized controlled trial, including individual CT and ET, compared to a wait-list control group for HYP. METHODS An AMP with illness, symptom and neutral primes was used in 70 patients with HYP before and after treatment (wait-list respectively). RESULTS There was no significant change in negative implicit affective evaluations in both CT and ET, compared to wait-list. However, comparisons between the two active treatments revealed an interaction effect, that only for CT were the affective reactions on illness-as well as symptom-related prime trials (but not neutral primes) significantly more positive at post-compared to pre-treatment. In CT but not in ET, the reduction of implicit negative evaluation bias regarding symptom-related primes was significantly related to the reduction of self-reported health anxiety. LIMITATIONS The small subsample sizes for CT and ET, in comparison to wait-list, prohibit the detection of smaller effects. CONCLUSIONS Formal cognitive restructuring is necessary for reducing implicit negative evaluation bias in HYP, but the latter is not a prerequisite for reducing health anxiety. Thus, the importance of the negative implicit evaluation bias for the maintenance of HYP remains questionable.
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Affiliation(s)
- Franziska Schreiber
- Department of Clinical Psychology and Psychotherapy, Goethe-University, Frankfurt am Main, Germany.
| | - Michael Witthöft
- Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University, Mainz, Germany.
| | - Julia M B Neng
- Department of Clinical Psychology and Psychotherapy, Goethe-University, Frankfurt am Main, Germany.
| | - Florian Weck
- Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University, Mainz, Germany.
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Mier D, Witthöft M, Bailer J, Ofer J, Kerstner T, Rist F, Diener C. Cough Is Dangerous: Neural Correlates of Implicit Body Symptoms Associations. Front Psychol 2016; 7:247. [PMID: 26973558 PMCID: PMC4771748 DOI: 10.3389/fpsyg.2016.00247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/08/2016] [Indexed: 12/02/2022] Open
Abstract
The negative interpretation of body sensations (e.g., as sign of a severe illness) is a crucial cognitive process in pathological health anxiety (HA). However, little is known about the nature and the degree of automaticity of this interpretation bias. We applied an implicit association test (IAT) in 20 subjects during functional magnetic resonance imaging (fMRI) to investigate behavioral and neural correlates of implicit attitudes toward symptom words. On the behavioral level, body symptom words elicited strong negative implicit association effects, as indexed by slowed reaction times, when symptom words were paired with the attribute “harmless” (incongruent condition). fMRI revealed increased activation in the dorsolateral prefrontal cortex (DLPFC) and posterior parietal cortex for the comparison of incongruent words with control words, as well as with a lower significance threshold also in comparison to congruent words. Moreover, activation in the DLPFC, posterior parietal cortex, nucleus accumbens, and cerebellum varied with individual levels of HA (again, in comparison to control words, as well as with a lower significance threshold also in comparison to congruent words). Slowed reaction times as well as increased activation in dorsolateral prefrontal and posterior parietal cortex point to increased inhibitory demands during the incongruent IAT condition. The positive association between HA severity and neural activity in nucleus accumbens, dorsolateral prefrontal, and posterior parietal cortex suggests that HA is characterized by both intensified negative implicit attitudes and hampered cognitive control mechanisms when confronted with body symptoms.
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Affiliation(s)
- Daniela Mier
- 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 Mainz, Germany
| | - Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg Germany
| | - Julia Ofer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg Germany
| | - Tobias Kerstner
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg Germany
| | - Fred Rist
- Department of Clinical Psychology, University of Münster Germany
| | - Carsten Diener
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergGermany; School of Applied Psychology, SRH University of Applied SciencesHeidelberg, Germany
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Implicit affective evaluation bias in hypochondriasis: findings from the Affect Misattribution Procedure. J Anxiety Disord 2014; 28:671-8. [PMID: 25124504 DOI: 10.1016/j.janxdis.2014.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/29/2014] [Accepted: 07/04/2014] [Indexed: 11/23/2022]
Abstract
Cognitive theories of hypochondriasis (HYP) suggest that catastrophic misinterpretations of benign body sensations are a core feature for the maintenance of the disorder. There is tentative support from an analog sample that the interpretation of illness-related information also involves an implicit affective component. This is the first study to examine this negative affective evaluation bias implicitly in patients with HYP. An adapted version of the Affect Misattribution Procedure (AMP) with illness, symptom and neutral primes was used in 80 patients with HYP, and compared to 83 patients with an anxiety disorder (AD), as well as 90 healthy controls (CG). The HYP group showed significantly more negative affective reactions in illness prime trials, compared to both control groups, as well as more negative implicit evaluations on symptom prime trials, compared to the CG. Significant inverse relationships were observed only between the implicit evaluations of illness words and health anxiety questionnaires. Thus, an implicit negative affective evaluation bias of serious illnesses rather than symptoms is a unique feature of HYP.
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Wang S, Zhao Y, Chen S, Lin G, Sun P, Wang T. EEG biofeedback improves attentional bias in high trait anxiety individuals. BMC Neurosci 2013; 14:115. [PMID: 24099141 PMCID: PMC4124890 DOI: 10.1186/1471-2202-14-115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 09/13/2013] [Indexed: 11/10/2022] Open
Abstract
Background Emotion-related attentional bias is implicated in the aetiology and maintenance of anxiety disorders. Electroencephalogram (EEG) biofeedback can obviously improve the anxiety disorders and reduce stress level, and can also enhance attention performance in healthy subjects. The present study examined the effects and mechanisms of EEG biofeedback training on the attentional bias of high trait anxiety (HTA) individuals toward negative stimuli. Results Event-related potentials were recorded while HTA (n=24) and nonanxious (n=21) individuals performed the color-word emotional Stroop task. During the emotional Stroop task, HTA participants showed longer reaction times and P300 latencies induced by negative words, compared to nonanxious participants. The EEG biofeedback significantly decreased the trait anxiety inventory score and reaction time in naming the color of negative words in the HTA group. P300 latencies evoked by negative stimuli in the EEG biofeedback group were significantly reduced after the alpha training, while no significant changes were observed in the sham biofeedback group after the intervention. Conclusion The prolonged P300 latency is associated with attentional bias to negative stimuli in the HTA group. EEG biofeedback training demonstrated a significant improvement of negative emotional attentional bias in HTA individuals, which may be due to the normalization of P300 latency.
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Affiliation(s)
- Sheng Wang
- Department of Physiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China.
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