Fear-related psychophysiological patterns are situation and individual dependent: A Bayesian model comparison approach

Is there a universal mapping of physiology to emotion, or do these mappings vary substantially by person or situation? Psychologists, philosophers, and neuroscientists have debated this question for decades. Most previous studies have focused on differentiating emotions on the basis of accompanying autonomic responses using analytical approaches that often assume within-category homogeneity. In the present study, we took an alternative approach to this question. We determined the extent to which the relationship between subjective experience and autonomic reactivity generalizes across, or depends upon, the individual and situation for instances of a single emotion category, specifically, fear. Electrodermal activity and cardiac activity-two autonomic measures that are often assumed to show robust relationships with instances of fear-were recorded while participants reported fear experience in response to dozens of fear-evoking videos related to three distinct situations: spiders, heights, and social encounters. We formally translated assumptions from diverse theoretical models into a common framework for model comparison analyses. Results exceedingly favored a model that assumed situation-dependency in the relationship between fear experience and autonomic reactivity, with subject variance also significant but constrained by situation. Models that assumed generalization across situations and/or individuals performed much worse by comparison. These results call into question the assumption of generalizability of autonomic-subjective mappings across instances of fear, as required in translational research from nonhuman animals to humans, and advance a situated approach to understanding the autonomic correlates of fear experience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Veteran Beliefs About the Causes of Gulf War Illness and Expectations for Improvement

BACKGROUND

Individuals' beliefs about the etiology of persistent physical symptoms (PPS) are linked to differences in coping style. However, it is unclear which attributions are related to greater expectations for improvement.

METHOD AND RESULTS

A cross-sectional regression analysis (N = 262) indicated that Veterans with Gulf War Illness (GWI) who attributed their GWI to behavior, (e.g., diet and exercise), had greater expectations for improvement (p = .001) than those who attributed their GWI to deployment, physical, or psychological causes (p values > .05).

CONCLUSIONS

Findings support the possible clinical utility of exploring perceived contributing factors of PPS, which may increase perceptions that improvement of PPS is possible.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02161133.

Adaptive thresholding increases sensitivity to detect changes in the rate of skin conductance responses to psychologically arousing stimuli in both laboratory and ambulatory settings

Psychophysiologists recording electrodermal activity (EDA) often derive measures of slow, tonic activity-skin conductance level (SCL)-and faster, more punctate changes-skin conductance responses (SCRs). A SCR is conventionally considered to have occurred when the local amplitude of the EDA signal exceeds a researcher-determined threshold (e.g., 0.05 μS), typically fixed across study participants and conditions. However, fixed SCR thresholds can preferentially exclude data from individuals with low SCL because their SCRs are smaller on average, thereby reducing statistical power for group-level analyses. Thus, we developed a fixed plus adaptive (FA) thresholding method that adjusts identification of SCRs based on an individual's SC at the onset of the SCR to increase statistical power and include data from more participants. We assess the utility of applying FA thresholding across two independent samples and explore age and race-related associations with EDA outcomes. Study 1 uses wired EDA measurements from 254 healthy adults responding to evocative images and sounds in a laboratory setting. Study 2 uses wireless EDA measurements from 20 children with autism in a clinical environment while they completed behavioral tasks. Compared to a 0.01, 0.03, and 0.05 μS fixed threshold, FA thresholding at 1.9% modestly increases statistical power to detect a difference in SCR rate between tasks with higher vs. lower subjective arousal and reduces exclusion of participants by up to 5% across both samples. This novel method expands the EDA analytical toolbox and may be useful in populations with highly variable basal SCL or when comparing groups with different basal SCL. Future research should test for reproducibility and generalizability in other tasks, samples, and contexts. IMPACT STATEMENTS: This article is important because it introduces a novel method to enhance sensitivity and statistical power in analyses of skin conductance responses from electrodermal data.

Treatment and life goals among veterans with Gulf War illness

Medically unexplained syndromes (MUS), also termed persistent physical symptoms, are both prevalent and disabling. Yet treatments for MUS are marked by high rates of patient dissatisfaction, as well as disagreement between patients and providers on the management of persistent physical symptoms. A better understanding of patient-generated goals could increase collaborative goal setting and promote person-centered care, a critical component of MUS treatment; yet research in this area is lacking. This paper aimed to develop a typology of treatment and life goals among Gulf War veterans with a medically unexplained syndrome (Gulf War Illness). We examined participants' responses to open-ended questions about treatment and life goals using Braun and Clarke's thematic analysis methodology. Results showed that treatment goals could be categorized into four overarching themes: 1) Get better/healthier, 2) Improve quality of life, 3) Improve or seek additional treatment, and 4) Don't know/Don't have any. Life goals were categorized into six overarching themes: 1) Live a fulfilling life, 2) Live a happy life, 3) Live a healthy life, 4) Be productive/financially successful, 5) Manage GWI, and 6) Don't know/Don't have any. Treatment goals were largely focused on getting better/healthier (e.g., improving symptoms), whereas life goals focused on living a fulfilling life. Implications for the treatment of Gulf War Illness and patient-provider communication are discussed. ClinicalTrials.gov Identifier: NCT02161133.

A functional account of stimulation-based aerobic glycolysis and its role in interpreting BOLD signal intensity increases in neuroimaging experiments

In aerobic glycolysis, oxygen is abundant, and yet cells metabolize glucose without using it, decreasing their ATP per glucose yield by 15-fold. During task-based stimulation, aerobic glycolysis occurs in localized brain regions, presenting a puzzle: why produce ATP inefficiently when, all else being equal, evolution should favor the efficient use of metabolic resources? The answer is that all else is not equal. We propose that a tradeoff exists between efficient ATP production and the efficiency with which ATP is spent to transmit information. Aerobic glycolysis, despite yielding little ATP per glucose, may support neuronal signaling in thin (< 0.5 µm), information-efficient axons. We call this the efficiency tradeoff hypothesis. This tradeoff has potential implications for interpretations of task-related BOLD "activation" observed in fMRI. We hypothesize that BOLD "activation" may index local increases in aerobic glycolysis, which support signaling in thin axons carrying "bottom-up" information, or "prediction error"-i.e., the BIAPEM (BOLD increases approximate prediction error metabolism) hypothesis. Finally, we explore implications of our hypotheses for human brain evolution, social behavior, and mental disorders.

Multimodal, Idiographic Ambulatory Sensing Will Transform our Understanding of Emotion

Emotions are inherently complex - situated inside the brain while being influenced by conditions inside the body and outside in the world - resulting in substantial variation in experience. Most studies, however, are not designed to sufficiently sample this variation. In this paper, we discuss what could be discovered if emotion were systematically studied within persons 'in the wild', using biologically-triggered experience sampling: a multimodal and deeply idiographic approach to ambulatory sensing that links body and mind across contexts and over time. We outline the rationale for this approach, discuss challenges to its implementation and widespread adoption, and set out opportunities for innovation afforded by emerging technologies. Implementing these innovations will enrich method and theory at the frontier of affective science, propelling the contextually situated study of emotion into the future.

Signal processing in the vagus nerve: Hypotheses based on new genetic and anatomical evidence

Each organism must regulate its internal state in a metabolically efficient way as it interacts in space and time with an ever-changing and only partly predictable world. Success in this endeavor is largely determined by the ongoing communication between brain and body, and the vagus nerve is a crucial structure in that dialogue. In this review, we introduce the novel hypothesis that the afferent vagus nerve is engaged in signal processing rather than just signal relay. New genetic and structural evidence of vagal afferent fiber anatomy motivates two hypotheses: (1) that sensory signals informing on the physiological state of the body compute both spatial and temporal viscerosensory features as they ascend the vagus nerve, following patterns found in other sensory architectures, such as the visual and olfactory systems; and (2) that ascending and descending signals modulate one another, calling into question the strict segregation of sensory and motor signals, respectively. Finally, we discuss several implications of our two hypotheses for understanding the role of viscerosensory signal processing in predictive energy regulation (i.e., allostasis) as well as the role of metabolic signals in memory and in disorders of prediction (e.g., mood disorders).

Cortical and subcortical mapping of the allostatic-interoceptive system in the human brain: replication and extension with 7 Tesla fMRI

The brain continuously anticipates the energetic needs of the body and prepares to meet those needs before they arise, a process called allostasis. In support of allostasis, the brain continually models the internal state of the body, a process called interoception. Using published tract-tracing studies in non-human animals as a guide, we previously identified a large-scale system supporting allostasis and interoception in the human brain with functional magnetic resonance imaging (fMRI) at 3 Tesla. In the present study, we replicated and extended this system in humans using 7 Tesla fMRI (N = 91), improving the precision of subgenual and pregenual anterior cingulate topography as well as brainstem nuclei mapping. We verified over 90% of the anatomical connections in the hypothesized allostatic-interoceptive system observed in non-human animal research. We also identified functional connectivity hubs verified in tract-tracing studies but not previously detected using 3 Tesla fMRI. Finally, we demonstrated that individuals with stronger fMRI connectivity between system hubs self-reported greater interoceptive awareness, building on construct validity evidence from our earlier paper. Taken together, these results strengthen evidence for the existence of a whole-brain system supporting interoception in the service of allostasis and we consider the implications for mental and physical health.

Correspondence of functional connectivity gradients across human isocortex, cerebellum, and hippocampus

Gradient mapping is an important technique to summarize high dimensional biological features as low dimensional manifold representations in exploring brain structure-function relationships at various levels of the cerebral cortex. While recent studies have characterized the major gradients of functional connectivity in several brain structures using this technique, very few have systematically examined the correspondence of such gradients across structures under a common systems-level framework. Using resting-state functional magnetic resonance imaging, here we show that the organizing principles of the isocortex, and those of the cerebellum and hippocampus in relation to the isocortex, can be described using two common functional gradients. We suggest that the similarity in functional connectivity gradients across these structures can be meaningfully interpreted within a common computational framework based on the principles of predictive processing. The present results, and the specific hypotheses that they suggest, represent an important step toward an integrative account of brain function.

An Online Acceptance and Mindfulness Intervention for Chronic Pain in Veterans: Development and Protocol for a Pilot Feasibility Randomized Controlled Trial

BACKGROUND

In the veteran community, chronic pain is particularly prevalent and often debilitating. Until recently, veterans with chronic pain were offered primarily pharmacological intervention options, which rarely suffice and can also have negative health consequences. To better address chronic pain in veterans, the Veterans Health Administration has invested in novel, nonpharmacological behavior interventions that target both pain management and chronic pain-related functional issues. One approach, acceptance and commitment therapy (ACT) for chronic pain, is supported by decades of efficacy evidence for improving pain outcomes; however, ACT can be difficult to obtain owing to issues such as a lack of trained therapists or veterans having difficulty committing to the time and resources needed for the full clinician-led ACT protocol. Given the strong ACT evidence base combined with access limitations, we set out to develop and evaluate Veteran ACT for Chronic Pain (VACT-CP), an online program guided by an embodied conversational agent to improve pain management and functioning.

OBJECTIVE

The aims of this study are to develop, iteratively refine, and then conduct a pilot feasibility randomized controlled trial (RCT) of a VACT-CP group (n=20) versus a waitlist and treatment-as-usual control group (n=20).

METHODS

This research project includes 3 phases. In phase 1, our research team consulted with pain and virtual care experts, developed the preliminary VACT-CP online program, and conducted interviews with providers to obtain their feedback on the intervention. In phase 2, we incorporated feedback from phase 1 into the VACT-CP program and completed initial usability testing with veterans with chronic pain. In phase 3, we are conducting a small pilot feasibility RCT, with the primary outcome being assessment of usability of the VACT-CP system.

RESULTS

This study is currently in phase 3; recruitment for the RCT began in April 2022 and is expected to continue through April 2023. Data collection is expected to be completed by October 2023, with full data analysis completed by late 2023.

CONCLUSIONS

The findings from this research project will provide information on the usability of the VACT-CP intervention, as well as secondary outcomes related to treatment satisfaction, pain outcomes (pain-related daily functioning and pain severity), ACT processes (pain acceptance, behavioral avoidance, and valued living), and mental and physical functioning.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03655132; https://clinicaltrials.gov/ct2/show/NCT03655132.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45887.

Improving the study of brain-behavior relationships by revisiting basic assumptions

Neuroimaging research has been at the forefront of concerns regarding the failure of experimental findings to replicate. In the study of brain-behavior relationships, past failures to find replicable and robust effects have been attributed to methodological shortcomings. Methodological rigor is important, but there are other overlooked possibilities: most published studies share three foundational assumptions, often implicitly, that may be faulty. In this paper, we consider the empirical evidence from human brain imaging and the study of non-human animals that calls each foundational assumption into question. We then consider the opportunities for a robust science of brain-behavior relationships that await if scientists ground their research efforts in revised assumptions supported by current empirical evidence.

Chaplains' perspectives on standardizing spiritual assessments

Chaplains are an integral part of mental health treatment within the Veterans Health Administration (VHA) and over the past decade, efforts have been made to integrate chaplain services into behavioral health treatment. One unique duty of chaplains is to conduct spiritual assessments, which are characterized as collaborative discussions with veterans to understand their overall religious and belief system, identify spiritual injuries, and how to integrate one's spiritual values into medical care. Although spiritual assessments in Veterans Affairs Medical Centers have evolved throughout the years to adopt a more structured approach, spiritual assessments can vary depending on site, clinical setting, and medical center. The present study sought to examine chaplains' perspectives on standardizing spiritual assessments and incorporating empirically validated measures into the assessments. Thematic analysis was conducted on two focus groups of chaplains from a large VHA medical center. Overall, chaplains appeared interested in standardizing spiritual assessments, with an expressed desire to maintain their current conversational format. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Veteran Acceptance of Sleep Health Information Technology: a Mixed-Method Study

Sleep disturbances, including chronic insomnia and sleep apnea, are major concerns for US veterans, with rising rates and detrimental effects on physical, mental, and social well-being. Sleep disturbances in veterans are also underdiagnosed and undertreated for reasons that include limited sleep clinician availability, long wait times, and the time commitment for treatment. Greater use of sleep health information technologies could improve access to assessment and treatment of sleep disturbances. However, the assessment of acceptance of these technologies among veterans is still ongoing. This mixed-method study combines data from two separate but similar randomized controlled trials to assess acceptance of sleep health information technologies for veterans with chronic insomnia. Sleep health information technologies included in these trials were the following: (1) a WatchPAT sleep monitor for home-based sleep assessment, including detection of sleep apnea, and (2) the VA mobile app Cognitive Behavioral Therapy for Insomnia (CBT-i Coach), which supports self-management of insomnia. The combined sample of 37 veterans receiving care within one New England VA medical center completed a six-week trial using both health information technology tools. Participants completed a survey and interview at the end of the 6 weeks. Overall, participants found the tools acceptable, easy to use, and useful and reported they would use them in the future. Thus, these sleep health information technologies appear to provide an acceptable remote option for assessing and managing sleep issues for veterans. ClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000 and ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354.

Effect of Problem-solving Treatment on Self-reported Disability Among Veterans With Gulf War Illness: A Randomized Clinical Trial

IMPORTANCE

Few evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions.

OBJECTIVE

To examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI.

DESIGN, SETTING, AND PARTICIPANTS

This multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to September 1, 2019); outcomes were assessed at 12 weeks and 6 months. Statistical analysis was conducted between January 1, 2019, and December 31, 2020.

INTERVENTIONS

Problem-solving treatment taught skills to improve problem-solving. Health education provided didactic health information. Both were delivered by telephone weekly for 12 weeks.

MAIN OUTCOMES AND MEASURES

The primary outcome was reduction from baseline to 12 weeks in self-report of disability (World Health Organization Disability Assessment Schedule). Secondary outcomes were reductions in self-report of problem-solving impairment and objective problem-solving. Exploratory outcomes were reductions in pain, pain disability, and fatigue.

RESULTS

A total of 268 veterans (mean [SD] age, 52.9 [7.3] years; 88.4% male; 66.8% White) were randomized to PST (n = 135) or health education (n = 133). Most participants completed all 12 sessions of PST (114 of 135 [84.4%]) and health education (120 of 133 [90.2%]). No difference was found between groups in reductions in disability at the end of treatment. Results suggested that PST reduced problem-solving impairment (moderate effect, 0.42; P = .01) and disability at 6 months (moderate effect, 0.39; P = .06) compared with health education.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial of the efficacy of PST for GWI, no difference was found between groups in reduction in disability at 12 weeks. Problem-solving treatment had high adherence and reduced problem-solving impairment and potentially reduced disability at 6 months compared with health education. These findings should be confirmed in future studies.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02161133.

The Qwantify app dataset: A remote experience sampling study of desire, emotion, and well-being

Experiences of desire—the feeling of wanting to have, do, or experience something—are pervasive and varied. Recent theoretical advances draw attention to characterizing this variation. Thus, this study investigated experiences of desire in everyday life and co-occurring social, physical, and emotional states, including facets of emotional experiences known to be related to well-being (e.g., perceived loneliness and stress). The Qwantify app was designed to run a remote experience sampling study. Through the app, participants were randomly alerted during their daily life to report on their experience in the moment. During the data collection period, any individual could download the freely available Qwantify app and participate in the study, without providing identifying information or communicating with researchers. Similar to other remote experience sampling studies, an incentive for participants to engage in the study was unlocking visualizations of their own data. Over 600 participants downloaded the app, completed the sign-up process, and responded to at least one experience sampling alert. Approximately 40% of these participants went on to respond to 50 alerts. The purpose of this report is to describe this experience sampling dataset such that it can be used to test a variety of hypotheses, including hypotheses regarding individual differences.

Affect and Social Judgment: The Roles of Physiological Reactivity and Interoceptive Sensitivity

Humans imbue the objects of their perception with affective meaning, a phenomenon called affective realism. The affective realism hypothesis proposes that a brain continually predicts the meaning of sensations (e.g., identifying a sound as a siren, or a visual array as a face) in part by representing the current state of the body and the immediate physiological impact that similar sensory events have entailed in the past. However, the precise contribution of physiological activity to experiences of affective realism remains unknown. In the present study, participants' peripheral physiological activity was recorded while they made social evaluative judgments of target faces displaying neutral expressions. Target faces were shown concurrent with affective images that were suppressed from reportable awareness using continuous flash suppression. Results revealed evidence of affective realism-participants judged target faces more positively when paired with suppressed positive stimuli than suppressed negative stimuli-but this effect was significantly less pronounced among individuals higher in cardiac interoceptive sensitivity. Moreover, while some modest differences in peripheral physiological activity were observed across suppressed affective stimulus conditions, physiological reactivity to affective stimuli did not directly predict social evaluative judgments. We explore the implications of these findings with respect to both theories of emotion and theories detailing a role for interoception in experiences of first-person subjectivity.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-022-00114-9.

Allostasis, Action, and Affect in Depression: Insights from the Theory of Constructed Emotion

The theory of constructed emotion is a systems neuroscience approach to understanding the nature of emotion. It is also a general theoretical framework to guide hypothesis generation for how actions and experiences are constructed as the brain continually anticipates metabolic needs and attempts to meet those needs before they arise (termed allostasis). In this review, we introduce this framework and hypothesize that allostatic dysregulation is a trans-disorder vulnerability for mental and physical illness. We then review published findings consistent with the hypothesis that several symptoms in major depressive disorder (MDD), such as fatigue, distress, context insensitivity, reward insensitivity, and motor retardation, are associated with persistent problems in energy regulation. Our approach transforms the current understanding of MDD as resulting from enhanced emotional reactivity combined with reduced cognitive control and, in doing so, offers novel hypotheses regarding the development, progression, treatment, and prevention of MDD.

Social Functioning in Individuals With Post-Traumatic Stress Disorder: A Systematic Review

Post-traumatic stress disorder (PTSD) can lead to multiple deleterious outcomes and has negative, sometimes debilitating, impacts on general functioning of those affected. This systematic review of 26 articles evaluates the existing literature on social functioning outcomes used in PTSD research, the association between PTSD and social functioning, and the impact of interventions for PTSD on social functioning. A review of 26 articles using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic reviews showed that PTSD was associated with significant impairment in global social functioning. This review also reveals the need for both standardized definitions and better assessment methods to operationalize social functioning and improve our ability to compare findings across studies. The literature also suggests that some evidence-based treatments for PTSD improve social functioning despite not explicitly targeting social functioning in the treatment. The findings of this review suggest that there are ample opportunities for improving both research and interventions to improve global social functioning in PTSD.

Allostasis as a core feature of hierarchical gradients in the human brain

This paper integrates emerging evidence from two broad scientific literatures into one common framework: (1) Hierarchical gradients of functional connectivity that reflect the brain’s large-scale structural architecture (e.g., a lamination gradient in the cerebral cortex) and (2) approaches to predictive processing and one of its specific instantiations called allostasis (i.e., the predictive regulation of energetic resources in the service of coordinating the body’s internal systems). This synthesis begins to sketch a coherent, neurobiologically-inspired framework suggesting that predictive energy regulation is at the core of human brain function, and by extension, psychological and behavioral phenomena, providing a shared vocabulary for theory building and knowledge accumulation.

Interoception as modeling, allostasis as control

The brain regulates the body by anticipating its needs and attempting to meet them before they arise - a process called allostasis. Allostasis requires a model of the changing sensory conditions within the body, a process called interoception. In this paper, we examine how interoception may provide performance feedback for allostasis. We suggest studying allostasis in terms of control theory, reviewing control theory's applications to related issues in physiology, motor control, and decision making. We synthesize these by relating them to the important properties of allostatic regulation as a control problem. We then sketch a novel formalism for how the brain might perform allostatic control of the viscera by analogy to skeletomotor control, including a mathematical view on how interoception acts as performance feedback for allostasis. Finally, we suggest ways to test implications of our hypotheses.

Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial

Background

Insomnia is a prevalent and debilitating disorder among veterans. Cognitive behavioral therapy for insomnia (CBTI) can be effective for treating insomnia, although many cannot access this care. Technology-based solutions and lifestyle changes, such as physical activity (PA), offer affordable and accessible self-management alternatives to in-person CBTI.

Objective

This study aims to extend and replicate prior pilot work to examine whether the use of a mobile app for CBTI (cognitive behavioral therapy for insomnia coach app [CBT-i Coach]) improves subjective and objective sleep outcomes. This study also aims to investigate whether the use of the CBT-i Coach app with adjunctive PA improves sleep outcomes more than CBT-i Coach alone.

Methods

A total of 33 veterans (mean age 37.61 years, SD 9.35 years) reporting chronic insomnia were randomized to use either the CBT-i Coach app alone or the CBT-i Coach app with a PA intervention over 6 weeks, with outcome measures of objective and subjective sleep at pre- and posttreatment.

Results

Although the PA manipulation was unsuccessful, both groups of veterans using the CBT-i Coach app showed significant improvement from baseline to postintervention on insomnia (P<.001), sleep quality (P<.001), and functional sleep outcomes (P=.002). Improvements in subjective sleep outcomes were similar in those with and without posttraumatic stress disorder and mild-to-moderate sleep apnea. We also observed a significant but modest increase in objective sleep efficiency (P=.02).

Conclusions

These findings suggest that the use of a mobile app–delivered CBTI is feasible and beneficial for improving sleep outcomes in veterans with insomnia, including those with comorbid conditions such as posttraumatic stress disorder or mild-to-moderate sleep apnea.

Trial Registration

ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354

Under-recognition of medically unexplained symptom conditions among US Veterans with Gulf War Illness

OBJECTIVE

Conditions defined by persistent "medically unexplained" physical symptoms and syndromes (MUS) are common and disabling. Veterans from the Gulf War (deployed 1990-1991) have notably high prevalence and disability from MUS conditions. Individuals with MUS report that providers do not recognize their MUS conditions. Our goal was to determine if Veterans with MUS receive an ICD-10 diagnosis for a MUS condition or receive disability benefits available to them for these conditions.

METHODS

A chart review was conducted with US Veterans who met case criteria for Gulf War Illness, a complex MUS condition (N = 204, M = 53 years-old, SD = 7). Three coders independently reviewed Veteran's medical records for MUS condition diagnosis or service-connection along with comorbid mental and physical health conditions. Service-connection refers to US Veterans Affairs disability benefits eligibility for conditions or injuries experienced during or exacerbated by military service.

RESULTS

Twenty-nine percent had a diagnosis of a MUS condition in their medical record, the most common were irritable colon/irritable bowel syndrome (16%) and fibromyalgia (11%). Slightly more Veterans were service-connected for a MUS condition (38%) as compared to diagnosed. There were high rates of diagnoses and service-connection for mental health (diagnoses 76% and service-connection 74%), musculoskeletal (diagnoses 86%, service-connection 79%), and illness-related conditions (diagnoses 98%, service-connection 49%).

CONCLUSION

Given that all participants were Gulf War Veterans who met criteria for a MUS condition, our results suggest that MUS conditions in Gulf War Veterans are under-recognized with regard to clinical diagnosis and service-connected disability. Veterans were more likely to be diagnosed and service-connected for musculoskeletal-related and mental health conditions than MUS conditions. Providers may need education and training to facilitate diagnosis of and service-connection for MUS conditions. We believe that greater acknowledgement and validation of MUS conditions would increase patient engagement with healthcare as well as provider and patient satisfaction with care.

Expertise in emotion: A scoping review and unifying framework for individual differences in the mental representation of emotional experience

Expertise refers to outstanding skill or ability in a particular domain. In the domain of emotion, expertise refers to the observation that some people are better at a range of competencies related to understanding and experiencing emotions, and these competencies may help them lead healthier lives. These individual differences are represented by multiple constructs including emotional awareness, emotional clarity, emotional complexity, emotional granularity, and emotional intelligence. These constructs derive from different theoretical perspectives, highlight different competencies, and are operationalized and measured in different ways. The full set of relationships between these constructs has not yet been considered, hindering scientific progress and the translation of findings to aid mental and physical well-being. In this article, we use a scoping review procedure to integrate these constructs within a shared conceptual space. Scoping reviews provide a principled means of synthesizing large and diverse literature in a transparent fashion, enabling the identification of similarities as well as gaps and inconsistencies across constructs. Using domain-general accounts of expertise as a guide, we build a unifying framework for expertise in emotion and apply this to constructs that describe how people understand and experience their own emotions. Our approach offers opportunities to identify potential mechanisms of expertise in emotion, encouraging future research on those mechanisms and on educational or clinical interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Daily physical activity and sleep in veterans: the role of insomnia severity

Physical activity (PA) is suggested as an easily accessible adjunctive lifestyle intervention for insomnia. It is not clear if PA is equally beneficial across different levels of insomnia severity. The current study examined the relationship between daily PA (steps) and sleep (duration, efficiency, and quality) across the spectrum of insomnia severity. Multilevel models estimated day-to-night relationships between PA and sleep, and if insomnia severity moderated these relationships. Days with greater PA were associated with nights with longer sleep duration. This was moderated by insomnia severity; PA was associated with longer sleep that night in participants with mild insomnia and associated with less sleep in those with severe insomnia. PA was not associated with sleep efficiency or quality. PA is potentially an easily accessible and impactful intervention to promote sleep duration in participants who are experiencing less severe sleep disturbance. More complex, resource-intensive interventions may be needed as insomnia severity increases.

Stress-evoked muscle activity in women with and without chronic myofascial face pain

BACKGROUND

Amplified muscle activity in reaction to daily life stressors might explain chronic pain in temporomandibular disorder (TMD).

OBJECTIVES

To assess whether patients with myofascial TMD pain (MFP) react to standardised stressors with greater masticatory muscle activity than demographically matched controls.

METHODS

A total of 124 female MFP patients and 46 demographically matched and pain-free controls rated distress while performing a series of standardised stress-reactivity tasks (viz., cold pressor test, mental arithmetic test, speech stressor test and reaction time/startle response test) as well as a vanilla baseline control task. Blood pressure was measured before and after each task, and electromyographic (EMG) activity was continuously recorded over the jaw-closing muscles and several non-masticatory muscles during each task. Linear mixed model analyses were used to test the hypothesis that case status, stress-reactivity task and muscle recording site influenced EMG activity.

RESULTS

Stress induction was successful, as evidenced by distress ratings and blood pressure measurements that were significantly elevated during performance of the stress tasks. Participants reported that some of the tasks were stressful in a way that resembled stressors experienced in their daily lives. Elevated muscle activity could be confirmed only for the reaction time/startle response task, where mean EMG activity was elevated more in cases than in controls, specifically in the jaw-closing muscles.

CONCLUSION

These data could not provide clear support for the theory that psychological stressors produce a differential increase in masticatory muscle activity in MFP patients than pain-free controls.

Emotional Granularity Increases With Intensive Ambulatory Assessment: Methodological and Individual Factors Influence How Much

Individuals differ in their ability to create instances of emotion that are precise and context-specific. This skill - referred to as emotional granularity or emotion differentiation - is associated with positive mental health outcomes. To date, however, little work has examined whether and how emotional granularity might be increased. Emotional granularity is typically measured using data from experience sampling studies, in which participants are prompted to report on their emotional experiences multiple times per day, across multiple days. This measurement approach allows researchers to examine patterns of responses over time using real-world events. Recent work suggests that experience sampling itself may facilitate increases in emotional granularity in depressed individuals, such that it may serve both empirical and interventional functions. We replicated and extended these findings in healthy adults, using data from an intensive ambulatory assessment study including experience sampling, peripheral physiological monitoring, and end-of-day diaries. We also identified factors that might distinguish individuals who showed larger increases over the course of experience sampling and examined the extent of the impact of these factors. We found that increases in emotional granularity over time were facilitated by methodological factors, such as number of experience sampling prompts responded to per day, as well as individual factors, such as resting respiratory sinus arrhythmia. These results provide support for the use of experience sampling methods to improve emotional granularity, raise questions about the boundary conditions of this effect, and have implications for the conceptualization of emotional granularity and its relationship with emotional health.

Interoception: The Secret Ingredient

Your brain keeps you alive and well by running a metabolic "budget" for your body. Our authors, who co-direct the Interdisciplinary Affective Science Laboratory at Northeastern University and Massachusetts General Hospital, explain how these budgetary activities, and the sensations they create inside your body, suggest surprising connections between brain, mind, body, and world.

Emotion and threat detection: The roles of affect and conceptual knowledge

Prior research has demonstrated that angry participants exhibit biased threat detection whereby they are more likely to misidentify neutral objects as guns. Yet, it is unclear whether independent components of anger, such as conceptual knowledge about anger or the affective features of an anger instance, could lead to altered bias alone. Consistent with constructionist theories of emotion, the present set of two experiments demonstrates that threat-detection bias only differs significantly between participants in an emergent-anger condition, who had engaged both components of anger (i.e., conceptual knowledge of anger and negative, high arousal affect), and participants in a control condition, who had engaged neither. Study 2 demonstrates that this pattern of findings also extends to another threat-relevant emotional state (i.e., fear). Implications for studying anger and fear, and emotions more generally, as constructed mental experiences are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Investigating the relationship between emotional granularity and cardiorespiratory physiological activity in daily life

Emotional granularity describes the ability to create emotional experiences that are precise and context-specific. Despite growing evidence of a link between emotional granularity and mental health, the physiological correlates of granularity have been under-investigated. This study explored the relationship between granularity and cardiorespiratory physiological activity in everyday life, with particular reference to the role of respiratory sinus arrhythmia (RSA), an estimate of vagal influence on the heart often associated with positive mental and physical health outcomes. Participants completed a physiologically triggered experience-sampling protocol including ambulatory recording of electrocardiogram, impedance cardiogram, movement, and posture. At each prompt, participants generated emotion labels to describe their current experience. In an end-of-day survey, participants elaborated on each prompt by rating the intensity of their experience on a standard set of emotion adjectives. Consistent with our hypotheses, individuals with higher granularity exhibited a larger number of distinct patterns of physiological activity during seated rest, and more situationally precise patterns of activity during emotional events: granularity was positively correlated with the number of clusters of cardiorespiratory physiological activity discovered in seated rest data, as well as with the performance of classifiers trained on event-related changes in physiological activity. Granularity was also positively associated with RSA during seated rest periods, although this relationship did not reach significance in this sample. These findings are consistent with constructionist accounts of emotion that propose concepts as a key mechanism underlying individual differences in emotional experience, physiological regulation, and physical health.

Differences in Uptake of Low-Dose CT Scan for Lung Cancer among White and Black Adult Smokers in the United States-2017

To study racial/ethnic differences in the utilization of low-dose computerized tomography (LDCT) scan for lung cancer among adult smokers. Cross-sectional data (n=2,640) of adults aged 55-74, were from the 2017 Behavioral Risk Factor Surveillance System, Lung Cancer Screening module. Weighted, multivariable logistic regression was conducted. Most, 70.9%, were White and 52.2% male. About 16.0 % reported receiving LDCT scan in the past 12 months, 12.0% of Blacks and 17.4% of Whites. More Whites (55.0%) had ≥30 pack-years smoking history than Blacks (20%). Blacks had lower odds, .52 (CI: 0.28-0.96) of receiving LDCT scan than Whites. The odds of receiving LDCT scan were higher for those who were male, who tried to quit smoking in the past year, and for those with more education, health insurance, high blood pressure, lung disease, or cancer history (other than skin or lung cancer). This study suggests racial differences in the use of LDCT scan.

Social interoception and social allostasis through touch: Legacy of the Somatovisceral Afference Model of Emotion

John Cacioppo and colleagues' Somatovisceral Afference Model of Emotion (SAME) highlighted the importance of interoception in emotional experience. Here we compare how the SAME and the more recent theory of constructed emotion (TCE) view the role of interoceptive signals in creating emotional experiences. We describe the characteristics of touch sensations that are carried by thin, unmyelinated fibers called C-tactile afferents (CTs) to the posterior insula, and are thus deemed interoceptive despite their typically social (external) origin. We explore how this social interoceptive input might contribute to the emotion-related effects of social touch more generally, and speculate that all social touch, with or without CT afferent stimulation, can directly influence allostasis, or the predictive regulation of short- and long-term energy resources required by the body. Finally, we describe several features of CT-optimal touch that make it a potentially useful tool to help illuminate basic interoceptive mechanisms, emotion-related phenomena, and disorders involving atypical affect or somatosensation. These proposed ideas demonstrate the long intellectual reach of John Cacioppo and Gary Berntson's highly productive scientific collaboration, which was formative for the fields of social neuroscience, social psychophysiology, and affective neuroscience.

Functions of Interoception: From Energy Regulation to Experience of the Self

We review recent work on the functions of interoceptive processing, by which the nervous system anticipates, senses, and integrates signals originating from the body. We focus on several exemplar functions of interoception, including energy regulation (ingestion and excretion), memory, affective and emotional experience, and the psychological sense of self. We emphasize two themes across these functions. First, the anatomy of interoceptive afferents makes it difficult to manipulate or directly measure interoceptive signaling in humans. Second, recent evidence shows that multimodal integration occurs across interoceptive modalities and between interoceptive and exteroceptive modalities. Whereas exteroceptive multimodal integration has been studied relatively extensively, fundamental questions remain regarding multimodal integration that involves interoceptive modalities. Future empirical work is required to better understand how and where multimodal interoceptive integration occurs.

The N400 indexes acquisition of novel emotion concepts via conceptual combination

The ability to learn new emotion concepts is adaptive and socially valuable as it communicates culturally held understandings about values, goals, and experiences. Yet, little work has examined the underlying mechanisms that allow for new emotion concepts and words to be integrated into the conceptual system. One such mechanism may be conceptual combination, or the ability to form novel concepts by dynamically combining previously acquired conceptual knowledge. In this study, we used event-related potentials (ERPs) to investigate the electrophysiological correlates of novel emotion concept acquisition via conceptual combination. Participants were briefly trained on 30 novel emotion combinations, each consisting of two English emotion words (the components; e.g., "sadness + fatigue") and a pseudoword (the target; e.g., "despip"). Participants then completed a semantic congruency task while ERPs were recorded. On each trial, two components were presented serially, followed by a target; participants judged whether the target was a valid combination of the preceding components. Targets could be correct or incorrect trained pseudowords, or new untrained pseudowords. Furthermore, components could be presented in reversed order (e.g., "fatigue" then "sadness") or as synonyms (e.g., "exhaustion" for "fatigue"). Consistent with our main hypotheses, we found a main effect of target, such that the correct combinations showed reduced N400 amplitudes when compared to both incorrect and untrained pseudowords. Critically, this effect held regardless of how the preceding components were presented, suggesting deeper semantic learning. These results extend prior findings on conceptual combination and novel word learning, and are congruent with predictive processing accounts of brain function.

Comparing supervised and unsupervised approaches to emotion categorization in the human brain, body, and subjective experience

Machine learning methods provide powerful tools to map physical measurements to scientific categories. But are such methods suitable for discovering the ground truth about psychological categories? We use the science of emotion as a test case to explore this question. In studies of emotion, researchers use supervised classifiers, guided by emotion labels, to attempt to discover biomarkers in the brain or body for the corresponding emotion categories. This practice relies on the assumption that the labels refer to objective categories that can be discovered. Here, we critically examine this approach across three distinct datasets collected during emotional episodes—measuring the human brain, body, and subjective experience—and compare supervised classification solutions with those from unsupervised clustering in which no labels are assigned to the data. We conclude with a set of recommendations to guide researchers towards meaningful, data-driven discoveries in the science of emotion and beyond.

Context-aware experience sampling reveals the scale of variation in affective experience

Emotion research typically searches for consistency and specificity in physiological activity across instances of an emotion category, such as anger or fear, yet studies to date have observed more variation than expected. In the present study, we adopt an alternative approach, searching inductively for structure within variation, both within and across participants. Following a novel, physiologically-triggered experience sampling procedure, participants' self-reports and peripheral physiological activity were recorded when substantial changes in cardiac activity occurred in the absence of movement. Unsupervised clustering analyses revealed variability in the number and nature of patterns of physiological activity that recurred within individuals, as well as in the affect ratings and emotion labels associated with each pattern. There were also broad patterns that recurred across individuals. These findings support a constructionist account of emotion which, drawing on Darwin, proposes that emotion categories are populations of variable instances tied to situation-specific needs.

Interrelationships between symptom burden and health functioning and health care utilization among veterans with persistent physical symptoms

Background

Between 10 and 50% of primary care patients present with persistent physical symptoms (PPS). Patients with PPS tend to utilize excessive or inappropriate health care services, while being stuck in a deleterious cycle of inactivity, deconditioning, and further worsening of symptoms and disability. Since military deployment (relative to non-deployment) is associated with greater likelihood of PPS, we examined the interrelationships of health care utilization, symptom burden and functioning among a sample of recently deployed Veterans with new onset persistent physical symptoms.

Methods

This study analyzed a cohort of 790 U.S. soldiers who recently returned from deployment to Iraq or Afghanistan. Data for this analysis were obtained at pre- and post-deployment. We used moderation analyses to evaluate interactions between physical symptom burden and physical and mental health functioning and four types of health care utilization one-year after deployment, after adjusting for key baseline measures.

Results

Moderation analyses revealed significant triple interactions between physical symptom burden and health functioning and: primary care (F = 3.63 [2, 303], R²Δ = .02, p = 0.03), specialty care (F = 6.81 [2, 303] R²Δ =0.03, p < .001), allied therapy care (F = 3.76 [2, 302], R²Δ = .02, p = 0.02), but not mental health care (F = 1.82 [1, 303], R²Δ = .01, p = .16), one-year after deployment.

Conclusions

Among U.S. Veterans with newly emerging persistent physical symptoms one-year after deployment, increased physical symptom burden coupled with decreased physical and increased mental health functioning was associated with increased medical care use in the year after deployment. These findings support whole health initiatives aimed at improving health function/well-being, rather than merely symptom alleviation.

Coping with Medically Unexplained Physical Symptoms: the Role of Illness Beliefs and Behaviors

BACKGROUND

Medically unexplained syndromes (MUS) are both prevalent and disabling. While illness beliefs and behaviors are thought to maintain MUS-related disability, little is known about which specific behavioral responses to MUS are related to disability or the way in which beliefs and behaviors interact to impact functioning. The purpose of the present study was to examine the relationship between illness beliefs and disability among patients with MUS, and assess the extent to which behaviors mediate this relationship.

METHODS

The study examined data from the baseline assessment of a multi-site randomized controlled trial (RCT). Participants were 248 veterans with MUS. Illness beliefs, behavioral responses to illness, and disability were assessed through self-report questionnaire. Data were analyzed using mediation analysis.

RESULTS

Threat-related beliefs predicted greater disability through decreased activity and increased practical support seeking. Protective beliefs predicted less disability through reductions in all-or-nothing behavior and limiting behavior.

CONCLUSIONS

These outcomes suggest that all-or-nothing behavior, limiting behavior, and practical support seeking are important in the perpetuation of disability among those with MUS. This has implications for improving MUS treatment by highlighting potential treatment targets.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02161133.

Applying the Theory of Constructed Emotion to Police Decision Making

Law enforcement personnel commonly make decisions in stressful circumstances, where the costs associated with errors are high and sometimes fatal. In this paper, we apply a powerful theoretical approach, the theory of constructed emotion (TCE), to understand decision making under evocative circumstances. This theory posits that the primary purpose of a brain is to predictively regulate physiological resources to coordinate the body's motor activity and learning in the short term, and to meet the body's needs for growth, survival, and reproduction in the long term. This process of managing the brain and body's energy needs, called allostasis, is based on the premise that a brain anticipates bodily needs and attempts to meet those needs before they arise (e.g., vestibular activity that raises sympathetic nervous system activity before standing), because this is more efficient than responding to energetic needs after the fact. In this view, all mental events-cognition, emotion, perception, and action-are shaped by allostasis, and thus all decision making is embodied, predictive, and concerned with balancing energy needs. We also posit a key role for the autonomic nervous system (ANS) in regulating short-term energy expenditures, such that the ANS influences experience and behavior under stressful circumstances, including police decision making. In this paper, we first explain the core features of the TCE, and then offer insights for understanding police decision making in complex, real-world situations. In so doing, we describe how the TCE can be used to guide future studies of realistic decision making in occupations in which people commonly make decisions in evocative situations or under time pressure, such as in law enforcement.

Physiological indices of challenge and threat: A data-driven investigation of autonomic nervous system reactivity during an active coping stressor task

We utilized a data-driven, unsupervised machine learning approach to examine patterns of peripheral physiological responses during a motivated performance context across two large, independent data sets, each with multiple peripheral physiological measures. Results revealed that patterns of cardiovascular response commonly associated with challenge and threat states emerged as two of the predominant patterns of peripheral physiological responding within both samples, with these two patterns best differentiated by reactivity in cardiac output, pre-ejection period, interbeat interval, and total peripheral resistance. However, we also identified a third, relatively large group of apparent physiological nonresponders who exhibited minimal reactivity across all physiological measures in the motivated performance context. This group of nonresponders was best differentiated from the others by minimal increases in electrodermal activity. We discuss implications for identifying and characterizing this third group of individuals in future research on physiological patterns of challenge and threat.

Mobile App Use for Insomnia Self-Management: Pilot Findings on Sleep Outcomes in Veterans

Background

Sleep disturbance is a major health concern among US veterans who have served since 2001 in a combat theater in Iraq or Afghanistan. We report subjective and objective sleep results from a pilot trial assessing self-management–guided use of a mobile app (CBT-i Coach, which is based on cognitive behavioral therapy for insomnia) as an intervention for insomnia in military veterans.

Objective

The primary aim of this study was to evaluate changes in subjective and objective sleep outcomes from pre to postintervention.

Methods

Subjective outcomes included the Insomnia Severity Index, the Pittsburgh Sleep Quality Inventory, and sleep-related functional status. A wearable sleep monitor (WatchPAT) measured objective sleep outcomes, including sleep efficiency, percent rapid eye movement (REM) during sleep, sleep time, and sleep apnea. A total of 38 participants were enrolled in the study, with 18 participants being withdrawn per the protocol because of moderate or severe sleep apnea and 9 others who dropped out or withdrew. Thus, 11 participants completed the full 6-week CBT-i Coach self-management intervention (ie, completers).

Results

Completer results indicated significant changes in subjective sleep measures, including reduced reports of insomnia (Z=–2.68, P=.007) from pre (mean 16.63, SD 5.55) to postintervention (mean 12.82, SD 3.74), improved sleep quality (Z=–2.37, P=.02) from pre (mean 12.82, SD 4.60) to postintervention (mean 10.73, SD 3.32), and sleep-related functioning (Z=2.675, P=.007) from pre (mean 13.86, SD 3.69) to postintervention (mean 15.379, SD 2.94). Among the objective measures, unexpectedly, objective sleep time significantly decreased from pre to postintervention (χ²₂=7.8, P=.02). There were no significant changes in percent REM sleep or sleep efficiency.

Conclusions

These findings suggest that the CBT-i Coach app can improve subjective sleep and that incorporating objective sleep measures into future, larger clinical trials or clinical practice may yield important information, particularly by detecting previously undetected sleep apnea.

Trial Registration

ClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000

Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment

Background: The mutual maintenance model proposes that post-traumatic stress disorder (PTSD) symptoms and chronic physical symptoms have a bi-directional temporal relationship. Despite widespread support for this model, there are relatively few empirical tests of the model and these have primarily examined patients with a traumatic physical injury. Objective: To extend the assessment of this model, we examined the temporal relationship between PTSD and physical symptoms for military personnel deployed to combat (i.e., facing the risk of death) who were not evacuated for traumatic injury. Methods: The current study used a prospective, longitudinal design to understand the cross-lagged relationships between PTSD and physical symptoms before, immediately after, 3 months after, and 1 year after combat deployment. Results: The cross-lagged results showed physical symptoms at every time point were consistently related to greater PTSD symptoms at the subsequent time point. PTSD symptoms were related to subsequent physical symptoms, but only at one time-point with immediate post-deployment PTSD symptoms related to physical symptoms at three months after deployment. Conclusion: The findings extend prior work by providing evidence that PTSD and physical symptoms may be mutually maintaining even when there is not a severe traumatic physical injury.

A web-based physical activity intervention benefits persons with low self-efficacy in COPD: results from a randomized controlled trial

Promoting physical activity (PA) is of top priority in chronic obstructive pulmonary disease (COPD). This study examines the influence of an internet-delivered intervention on the relationship between exercise self-efficacy and changes in PA, physical health, and exercise capacity in COPD. 112 U.S. Veterans with COPD were randomized to either a comparison (pedometer alone) or an intervention group (pedometer plus access to an internet-mediated PA intervention). There was a significant interaction between baseline exercise self-efficacy and randomization group on change in PA. In the comparison group, there was a significant relationship between higher baseline exercise self-efficacy and greater change in PA, whereas in the intervention group, improvements in PA were independent of level of baseline self-efficacy. Similar patterns were found with physical health and exercise capacity as outcomes. The use of an internet-mediated intervention significantly benefited persons with COPD who had low baseline self-efficacy to increase PA and physical health.Clinical trial registration The randomized clinical trial was registered on ClinicalTrials.gov (NCT01772082).

Psychological impact of mass violence depends on affective tone of media content

Exposure to media coverage of mass violence has been shown to predict poorer mental health symptomology. However, it is unknown whether such media coverage can have ubiquitous effects on average community members, extending to biological and perceptual processes that underlie everyday decision making and behavior. Here, we used a repeated-measures design over the first anniversary of the Boston Marathon bombings to track participants' self-reported distress, their eye blink startle reactivity while viewing images of the bombings, and their ability to perceptually distinguish armed from unarmed individuals in a behavioral shooting task. We leveraged a computational linguistics method in which we sampled news content from the sources our participants most commonly self-reported reading, and then quantified both the extent of news coverage about the marathon and the affective tone of that news coverage. Results revealed that participants experienced greater current distress, greater physiological reactivity to threats, and poorer perceptual sensitivity when recent news coverage of the marathon contained more affectively negative words. This is the first empirical work to examine relationships between the media's affective tone in its coverage of mass violence and individuals' threat perception and physiological threat reactivity.

Faith-Based Groups as a Bridge to the Community for Military Veterans: Preliminary Findings and Lessons Learned in Online Surveying

This report examines responses to a brief online survey, comparing how faith-based (n = 27) and non-faith-based (n = 61) organizations engage with Veteran populations as well as the supportive services they provide. Data were analyzed using two-sample z-tests and Chi-squared tests. No significant differences were noted between respondents for self-reported confidence in responding to health care issues/concerns or engagement with Veteran populations. Faith-based respondents were found to provide significantly less mental health, suicide prevention, education/outreach, and other services, while providing significantly more spiritual care. There appears to be ample opportunity for expanding the supportive services provided by faith-based organizations.

Helpful ways providers can communicate about persistent medically unexplained physical symptoms

BACKGROUND

Communication between patients and providers about persistent "medically unexplained" physical symptoms (MUS) is characterized by discordance. While the difficulties are well documented, few studies have examined effective communication. We sought to determine what veterans with Gulf War Illness (GWI) perceive as the most helpful communication from their providers. Veterans with GWI, a type of MUS, have historically had complex relationships with medical providers. Determining effective communication for patients with particularly complex relationships may help identify the most critical communication elements for all patients with MUS.

METHODS

Two hundred and-ten veterans with GWI were asked, in a written questionnaire, what was the most useful thing a medical provider had told them about their GWI. Responses were coded into three categories with 10 codes.

RESULTS

The most prevalent helpful communication reported by patients was when the provider offered acknowledgement and validation (N = 70). Specific recommendations for managing GWI or its symptoms (N = 48) were also commonly reported to be helpful. In contrast, about a third of the responses indicated that nothing about the communication was helpful (N = 63). There were not differences in severity of symptoms, disability or healthcare utilization between patients who found acknowledgement and validation, specific recommendations or nothing helpful.

CONCLUSIONS

Previous research has documented the discord between patients and providers regarding MUS. This study suggests that most patients are able to identify something helpful a provider has said, particularly acknowledgement and validation and specific treatment recommendations. The findings also highlight missed communication opportunities with a third of patients not finding anything helpful.

An Open-Source Feature Extraction Tool for the Analysis of Peripheral Physiological Data

Electrocardiogram, electrodermal activity, electromyogram, continuous blood pressure, and impedance cardiography are among the most commonly used peripheral physiological signals (biosignals) in psychological studies and healthcare applications, including health tracking, sleep quality assessment, disease early-detection/diagnosis, and understanding human emotional and affective phenomena. This paper presents the development of a biosignal-specific processing toolbox (Bio-SP tool) for preprocessing and feature extraction of these physiological signals according to the state-of-the-art studies reported in the scientific literature and feedback received from the field experts. Our open-source Bio-SP tool is intended to assist researchers in affective computing, digital and mobile health, and telemedicine to extract relevant physiological patterns (i.e., features) from these biosignals semi-automatically and reliably. In this paper, we describe the successful algorithms used for signal-specific quality checking, artifact/noise filtering, and segmentation along with introducing features shown to be highly relevant to category discrimination in several healthcare applications (e.g., discriminating patterns associated with disease versus non-disease). Further, the Bio-SP tool is a publicly-available software written in MATLAB with a user-friendly graphical user interface (GUI), enabling future crowd-sourced modification to these tools. The GUI is compatible with MathWorks Classification Learner app for inference model development, such as model training, cross-validation scheme farming, and classification result computation.

When Words Hurt: Affective Word Use in Daily News Coverage Impacts Mental Health

Media exposure influences mental health symptomology in response to salient aversive events, like terrorist attacks, but little has been done to explore the impact of news coverage that varies more subtly in affective content. Here, we utilized an existing data set in which participants self-reported physical symptoms, depressive symptoms, and anxiety symptoms, and completed a potentiated startle task assessing their physiological reactivity to aversive stimuli at three time points (waves) over a 9-month period. Using a computational linguistics approach, we then calculated an average ratio of words with positive vs. negative affective connotations for only articles from news sources to which each participant self-reported being exposed over the prior 2 weeks at each wave of data collection. As hypothesized, individuals exposed to news coverage with more negative affective tone over the prior 2 weeks reported significantly greater physical and depressive symptoms, and had significantly greater physiological reactivity to aversive stimuli.