Cognitive-physiological discordance as an etiological factor in psychophysiologic disorders

Heart rate perception and expectation impact laboratory-induced perceived stress

Previous studies have shown that the human capacity to gauge one's own physiological state is notoriously flawed. The cause for the mismatch between perceived and physiological stress has not yet been properly identified. In this study, we assumed that cardioceptive accuracy (CAc) is positively associated with cardiovascular reactivity, and CAc and expectation about stress might account for the discrepancy between perceived and physiological stress. In a crossover experiment, we assessed cardioceptive accuracy in two ways (mental heartbeat tracking task and perception of heart rate), and induced physiological (handgrip exercise) and mental (N-back task) stress in 64 university students (51 % male, mean age 22.2). We assessed cardiac and electrodermal activity, and expected and perceived stress. We found that indicators of cardioceptive accuracy were not associated with cardiovascular reactivity. However, heart rate perception moderated the association between the change in heart rate and perceived stress in the physical but not in the mental task. Whereas heartbeat tracking accuracy was not associated with perceived stress. Moreover, perceived stress was predicted by the expected stress but not by the change in heart rate and electrodermal activity in the mental stress task. In conclusion, heart rate perception and expectation of stress may shape perceived stress more than actual physiological changes in moderate acute stress.

Vague sensations. About the background and consequences of discordance between actual and perceived physiological changes

Empirical evidence consistently shows that discordance, also called dissociation or discrepancy, between actual physiological (mainly visceral) events and their perceived counterparts is substantial. On the one hand, we typically do not perceive actual visceral events occurring in our bodies; on the other hand, sometimes we do perceive bodily changes that do not really take place. This narrative review presents the available empirical findings on the discordance, and summarizes possible explanations that approach the phenomenon from the viewpoint of evolution, cognitive development, and predictive processing. Also, the role of top-down factors, such as expectations and experiences is discussed. Finally, practically relevant consequences of the discordance are presented using the examples of mind-body practices, the placebo and nocebo phenomenon, and medically unexplained symptoms. It is concluded that the discordance between actual and perceived body changes can have a negative impact on health, mainly through issues with adherence and other behavioral factors. The existence of actual-perceived discordance should be taught and demonstrated in the elementary and high school, as well as in many areas of higher education.

Female Sexual Dysfunction-Medical and Psychological Treatments, Committee 14

INTRODUCTION

Since the millennium we have witnessed significant strides in the science and treatment of female sexual dysfunction (FSD). This forward progress has included (i) the development of new theoretical models to describe healthy and dysfunctional sexual responses in women; (ii) alternative classification strategies of female sexual disorders; (iii) major advances in brain, hormonal, psychological, and interpersonal research focusing on etiologic factors and treatment approaches; (iv) strong and effective public advocacy for FSD; and (v) greater educational awareness of the impact of FSD on the woman and her partner.

AIMS

To review the literature and describe the best practices for assessing and treating women with hypoactive sexual desire disorder, female sexual arousal disorder, and female orgasmic disorders.

METHODS

The committee undertook a comprehensive review of the literature and discussion among themselves to determine the best assessment and treatment methods.

RESULTS

Using a biopsychosocial lens, the committee presents recommendations (with levels of evidence) for assessment and treatment of hypoactive sexual desire disorder, female sexual arousal disorder, and female orgasmic disorders.

CONCLUSION

The numerous significant strides in FSD that have occurred since the previous International Consultation of Sexual Medicine publications are reviewed in this article. Although evidence supports an integrated biopsychosocial approach to assessment and treatment of these disorders, the biological and psychological factors are artificially separated for review purposes. We recognize that best outcomes are achieved when all relevant factors are identified and addressed by the clinician and patient working together in concert (the sum is greater than the whole of its parts). Kingsberg SA, Althof S, Simon JA, et al. Female Sexual Dysfunction-Medical and Psychological Treatments, Committee 14. J Sex Med 2017;14:1463-1491.

Frontal alpha asymmetry and sexually motivated states

Anterior alpha asymmetry of electroencephalographic (EEG) signals has been suggested to index state approach (or avoidance) motivation. This model has not yet been extended to high approach-motivation sexual stimuli, which may represent an important model of reward system function. Sixty-five participants viewed a neutral and a sexually motivating film while their EEG was recorded, and reported their sexual feelings after each film. Greater alpha power in the left hemisphere during sexually motivated states was evident. A positive relationship between self-reported mental sexual arousal and alpha asymmetry was identified, where coherence between these indicators was higher in women. Notably, coherence was stronger when mental versus physical sexual arousal was rated. Alpha asymmetry appears to offer a new method for further examining this novel coherence pattern across men and women.

Regulation of emotions during experimental stress in alexithymia

OBJECTIVE

The aim of this study was to examine whether deficits in emotion regulation manifest as a relative lack of congruence between subjective reports of emotion and autonomic activity when confronted with stressors.

METHODS

A pool of 830 university students was screened using the Toronto Alexithymia Scale-Revised for deficits in emotion regulation associated with alexithymia. Those meeting a criterion floor cutoff and other inclusion criteria composed the experimental group and were matched on age, gender, and race to those in the control group. A final sample size of 94 students (47 in each group) was presented with experimental stressor tasks (the Stroop task and a conversation task) in counterbalanced order while autonomic activity data (heart rate and skin conductance) and subjective reports of negative affect were continuously collected during baseline, stressor exposure, and recovery periods. Data were analyzed to determine relative differences in congruence between the autonomic and subjective measures.

RESULTS

Data suggested that participants high in emotion regulation deficits reported consistently higher subjective negative affect relative to those without such deficits throughout baseline, stressor exposure, and recovery periods. However, autonomic activity remained nearly identical in both groups across phases. Explicit tests of group differences in congruence between autonomic and subjective emotion measures also partly supported evidence of subjective hyperarousal.

CONCLUSIONS

Deficits in emotion regulation, as evidenced in those with high levels of the alexithymic trait, appear to manifest as chronically elevated subjective negative affect relative to autonomic activity regardless of the level of environmental demands. Theoretical and clinical implications of these findings are discussed.

The reporting of specific physical symptoms for mental distress in general practice

OBJECTIVE

Do patients report specific physical symptoms in the presence of mental distress, taking into account the presence of somatic disease?

METHODS

Cross-sectional data were collected from 1458 participants in eight general practices in The Netherlands. Electronic patient records provided information on somatic disease. Questionnaires included the Hospital Anxiety and Depression Scale (HADS) to measure mental distress and the Physical Symptom Checklist (PSC).

RESULTS

Patients reporting mental distress reported all types of physical symptoms more often than did patients without mental distress. Multivariate analyses in women, corrected for the presence of somatic disease, did not substantially change the univariate pattern. Odds ratios were particularly high (>6) for feeling tired or having low energy, fatigue without exertion and forgetfulness.

CONCLUSION

It is the level of mental distress rather than gender or somatic disease that accounts for the reporting of any physical symptom. Fatigue might be an exception, but here, the classification as "physical" rather then "mental" is somewhat ambiguous.

Symptom perception in asthma: a multidisciplinary review

Clinical observations and research show that symptom perception in asthma is, at worst, inaccurate or often biased in two directions: (1) blunted perception, (2) overperception (both involving airway obstruction manifested in low or high breathlessness). Theoretically breathlessness occurs during respiratory labor or blood gas changes. However, pathophysiological factors and asthma severity are inconsistently related to perceptual accuracy. Consequently, symptom perception within the biomedical perspective is not well understood. Possible psychological influences, varying from the stimulus level to emotions and high-order reasoning, are discussed.

Sex differences in physical symptoms: the contribution of symptom perception theory

Health surveys, studies on physical symptom reporting, and medical registration of physical complaints find consistent sex differences in symptom reporting, with women having the higher rates. By and large, this female excess of physical symptoms is independent from the symptom measure, response format and time frame used, and the population under study. As most studies concern healthy individuals, the sex difference can not simply be attributed to a greater physical morbidity in women. In this paper we propose a number of explanations for this phenomenon, based on a biopsychosocial perspective on symptom perception. We discuss a symptom perception model that brings together factors and processes from the extant literature which are thought to affect symptom reporting, such as somatic information, selection of information through attention and distraction, attribution of somatic sensations, and the personality factors somatisation and negative affectivity. Finally, we discuss the explanations for sex differences in physical symptoms that arise from the model.

Chronic back pain, acute postoperative pain and the activation of diffuse noxious inhibitory controls (DNIC)

The effect of the presence of either chronic or acute clinical pain on pain threshold and on the nociceptive flexion reflex (RIII) threshold was studied. The experimental pain sensation and the flexion reflex were evoked by trains of short electrical pulses. It was hypothesized that both kinds of clinical pain would be able to induce 'diffuse noxious inhibitory controls' (DNIC) and thereby raise the 2 experimental thresholds. Patients with chronic low back pain, patients with postoperative pain from oral surgery, and pain-free subjects were tested in 3 conditions: during baseline, after i.v. administration of a placebo, and after i.v. administration of naloxone. In comparison with 2 pain-free control groups, the 2 pain groups had a significantly higher pain threshold in all conditions. However, the RIII threshold was not significantly elevated in chronic or acute pain patients compared to controls. Naloxone had no effect on the RIII or pain threshold in any of the groups. It is concluded that the increased pain threshold which is frequently found in chronic pain patients, and which could be confirmed in the present study, does not result from a DNIC effect. The adaptation level theory offers an alternative explanation. Also, the acute postoperative pain in this study did not seem to induce DNIC. Because other forms of acute pain have been found to be effective in activating DNIC, future research should establish which pains are and which pains are not effective.