Somatosensory amplification - An old construct from a new perspective

The paper reviews and summarizes the history and the development of somatosensory amplification, a construct that plays a substantial role in symptom reports. Although the association with negative affect has been supported by empirical findings, another key elements of the original concept (i.e. body hypervigilance and the tendency of focusing on mild body sensations) have never been appropriately addressed. Recent findings indicate that somatosensory amplification is connected with phenomena that do not necessarily include symptoms (e.g. modern health worries, or expectations of symptoms and medication side effects), and also with the perception of external threats. In conclusion, somatosensory amplification appears to refer to the intensification of perceived external and internal threats to the integrity of the body ("somatic threat amplification") rather than amplification of perceived or actual bodily events only. Practical implications of this new approach are also discussed.

Attribution-Based Nocebo Effects. Perceived Effects of a Placebo Pill and a Sham Magnetic Field on Cognitive Performance and Somatic Symptoms

BACKGROUND

Negative non-specific (nocebo-like) effects of medications and electromagnetic fields are often described as results of mistaken attribution.

PURPOSE

The current study aimed to find empirical evidence supporting this theory.

METHOD

Participants completed questionnaires assessing modern health worries, health anxiety, and somatosensory amplification, were assigned to one of three conditions (placebo pill with sedative information, sham magnetic field, or control), and completed a 14-min vigilance task. Changes in physiological arousal (heart rate, heart rate variability, and skin conductance) and reported symptoms were also measured. Finally, causal attributions concerning cognitive performance and reported symptoms were assessed.

RESULTS

No increase in symptom reports and physiological arousal was measured in the two intervention groups. A perceived negative effect on cognitive performance was attributed to both sham conditions, and attributions were connected to modern health worries. A proportion of reported symptoms was ascribed to the placebo pill but not to the sham magnetic field. Symptom attributions were not related to any assessed psychological variables.

CONCLUSIONS

An aroused physiological state is not necessary for the automatic causal attribution process. Negative effects attributed to medication and environmental factors can be regarded as unavoidable side effects of human cognitive-emotional functioning; they might be alleviated, but cannot be completely eradicated.

Somatosensory Amplification Is a Predictor of Self-Reported Side Effects in the Treatment of Primary Hypertension: a Pilot Study

PURPOSE

Side effects consist of drug-specific and non-specific symptoms. Both components are based on bodily sensations that a person perceives after taking a drug and subsequently attributes to the drug. We suggest that somatosensory amplification (SSA) may explain a proportion of inter-individual differences in reports of side effects that cannot be accounted for by drug-specific safety profiles. This hypothesis was investigated in hypertensive patients starting a new pharmacotherapy.

METHOD

This longitudinal study included 50 patients (66 % women, aged 55 ± 14 years) with a diagnosis of primary hypertension. Patients completed the Somatosensory Amplification Scale (SSAS), started to take their new medication, and recorded side effects on a daily basis for 4 weeks.

RESULTS

After controlling for age, gender, number of pills taken, and previous personal and family experiences with medication side effects in the regression analyses, SSAS scores remained a significant predictor of reported side effects over the entire study period (weeks 1 and 2: β = .621, p < .001; weeks 3 and 4: β = .493, p = .003). In a subsample comprising patients taking the four most commonly used drug regimes, SSAS was a significant predictor of side effects, even when controlling for type of medication.

CONCLUSION

In this sample of patients undergoing anti-hypertensive pharmacotherapy, higher SSA scores predicted increased reports of medication side effects. To account for this tendency and to improve compliance with medication regimes, this group may require special education about the nocebo phenomenon.

Is somatosensory amplification a risk factor for an increased report of side effects? Reference data from the German general population

OBJECTIVE

The study investigates the association between somatosensory amplification and the reporting of side effects. It establishes a German version of the Somatosensory Amplification Scale and examines its psychometric properties in a representative sample of the German population.

METHODS

Sample size was 2.469, with 51% taking any medication. Participants answered the Somatosensory Amplification Scale, Generic Assessment of Side Effects Scale, and indicated whether they were taking any medication and the type of medication. Correlational analysis and binary logistic regression were performed.

RESULTS

When examining a subsample reporting both medication intake and general bodily symptoms, participants higher in somatosensory amplification rated more of their general bodily symptoms as medication-attributed side effects. However, somatosensory amplification scores were not associated with the intake of any type of medication. In the overall sample, higher somatosensory amplification scores were associated with an increased report of bodily symptoms. Additionally, participants with higher somatosensory amplification reported intake of a greater number of different medications. The psychometric properties of the translated scale were good, and previously established associations of somatosensory amplification with demographic variables (age, sex) were replicated.

CONCLUSION

Results suggest a possible attributional bias concomitant to somatosensory amplification which in turn may increase the reporting of side effects after medication intake.

The many faces of somatosensory amplification: The relative contribution of body awareness, symptom labeling, and anxiety

The questionnaire study aimed to evaluate the relative contribution of body awareness, subjective symptoms, and anxiety to the construct of somatosensory amplification in both healthy controls (n = 475) and patients visiting their general practitioner (n = 236). Regression analysis explained 52.0 percent of total variance of the somatosensory amplification scale scores. Body awareness was the most influential predictor (β = 0.489, p < 0.001) when considering all predictors simultaneously. The results suggest that dispositional interoceptive focus, as indicated by body awareness, may be an important aspect of somatosensory amplification, over and above dispositional anxiety or subjective symptom report.