1
|
Périard IAC, Dierolf AM, Lutz A, Vögele C, Voderholzer U, Koch S, Bach M, Asenstorfer C, Michaux G, Mertens VC, Schulz A. Frontal alpha asymmetry is associated with chronic stress and depression, but not with somatoform disorders. Int J Psychophysiol 2024; 200:112342. [PMID: 38614440 DOI: 10.1016/j.ijpsycho.2024.112342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
Cardinal characteristics of somatoform disorders (SFDs) are worry of illness, and impaired affective processing. We used relative frontal alpha asymmetry (FAA), a method to measure functional lateralization of affective processing, to investigate psychobiological correlates of SFDs. With alpha activity being inversely related to cortical network activity, relative FAA refers to alpha activity on the right frontal lobe minus alpha activity on the left frontal lobe. Less relative left frontal activity, reflected by negative FAA scores, is associated with lower positive and greater negative affectivity, such as observed in depression. Due to its negative affective component (illness anxiety), we expected to find less relative left frontal activity pattern in SFDs, and positive associations with self-reported chronic stress and depression symptoms. We recorded resting-state EEG activity with 64 electrodes, placed in a 10-10 system in 26 patients with a primary SFD, 23 patients with a major depressive disorder and 25 healthy control participants. The groups did not differ in FAA. Nevertheless, across all participants, less relative left frontal activity was associated with chronic stress and depression symptoms. We concluded that FAA may not serve as an indicator of SFDs. As the relationship of FAA and depressive symptoms was fully mediated by chronic stress, future studies have to clarify whether the association between FAA and chronic stress may represent a shared underlying factor for the manifestation of mental health complaints, such as depression.
Collapse
Affiliation(s)
- Isabelle Anne-Claire Périard
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Institute of Medical Psychology, Charité University Medical Center Berlin, Berlin, Germany; Department of Developmental and Cognitive Psychology, University of Regensburg. Regensburg, Germany
| | - Angelika Margarete Dierolf
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Annika Lutz
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Claus Vögele
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Clinic for Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Stefan Koch
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Michael Bach
- Practice for Psychosomatics and Stress Medicine, Vienna, Austria
| | | | - Gilles Michaux
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; GesondheetsZentrum, Fondation Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Vera-Christina Mertens
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - André Schulz
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Institute for Cognitive and Affective Neuroscience, Trier University, Trier, Germany.
| |
Collapse
|
2
|
Qiu R, Bai X, Li Y, Shi X, Song D, Zhang Y. Factors Associated With Pain Catastrophizing in Patients With Chronic Neuropathic Pain: A Cross-Sectional Study. Pain Manag Nurs 2024:S1524-9042(24)00145-0. [PMID: 38704246 DOI: 10.1016/j.pmn.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/24/2024] [Accepted: 04/06/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Pain catastrophizing is a significant factor in the recovery of patients with chronic pain. This topic has not received the warranted attention in clinical practice, while the outcomes of pain interventions have been suboptimal. This study explores the current situation of pain catastrophizing in patients with chronic neuropathic pain, its influencing factors, and further analyzes the complex relationship between these factors. METHODS A cross-sectional study design was used to select preoperative patients hospitalized in the pain and spine surgery departments of two tertiary hospitals in Shandong Province, China, between February and August 2022. The Pain Catastrophizing Scale, Toronto Alexithymia Scale, Connor-Davidson Resilience Scale-Short, Somatization Sub-Scale of Symptom Checklist 90, and a sociodemographic questionnaire were used to evaluate participants' pain catastrophizing, alexithymia, psychological resilience, somatization, and relevant sociodemographic variables, respectively. Descriptive statistics, correlation, univariate, and multivariate analyses were employed throughout this process. RESULTS Pain catastrophizing in patients with chronic neuropathic pain was affected by pain severity, disease type, alexithymia, psychological resilience, and somatization (p < .05). The mediating effect values of psychological resilience and somatization between alexithymia and pain catastrophizing were both 0.05, with 95% confidence intervals of (0.02, 0.09) and (0.02, 0.07), respectively. CONCLUSIONS Pain severity, disease type, alexithymia, psychological resilience, and somatization all had a significant effect on pain catastrophizing. Healthcare workers must provide timely and accurate assessments of patients' pain levels to help prevent the onset of pain catastrophizing. Adopting measures to improve alexithymia and somatization symptoms, and focusing on enhancing patients' psychological resilience can also help reduce the level of pain catastrophizing. Cognitive behavioral therapy may be an effective treatment method for pain catastrophizing.
Collapse
Affiliation(s)
- Ruirui Qiu
- Department of Pain Management, The Second Hospital of Shandong University, Jinan, Shandong, PR China; School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, PR China
| | - Xiaoliang Bai
- Department of Pain Management, The Second Hospital of Shandong University, Jinan, Shandong, PR China
| | - Yuli Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, PR China.
| | - Xinhua Shi
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Dongyu Song
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, PR China
| | - Yanyan Zhang
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| |
Collapse
|
3
|
Konsman JP. Expanding the notion of mechanism to further understanding of biopsychosocial disorders? Depression and medically-unexplained pain as cases in point. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2024; 103:123-136. [PMID: 38157672 DOI: 10.1016/j.shpsa.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/24/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
Evidence-Based Medicine has little consideration for mechanisms and philosophers of science and medicine have recently made pleas to increase the place of mechanisms in the medical evidence hierarchy. However, in this debate the notions of mechanisms seem to be limited to 'mechanistic processes' and 'complex-systems mechanisms,' understood as 'componential causal systems'. I believe that this will not do full justice to how mechanisms are used in biological, psychological and social sciences and, consequently, in a more biopsychosocial approach to medicine. Here, I propose, following (Kuorikoski, 2009), to pay more attention to 'abstract forms of interaction' mechanisms. The present work scrutinized review articles on depression and medically unexplained pain, which are considered to be of multifactorial pathogenesis, for their use of mechanisms. In review articles on these disorders there seemed to be a range of uses between more 'abstract forms of interaction' and 'componential causal system' mechanisms. I therefore propose to expand the notions of mechanisms considered in medicine to include that of more 'abstract forms of interaction' to better explain and manage biopsychosocial disorders.
Collapse
Affiliation(s)
- Jan Pieter Konsman
- ImmunoConcEpT, CNRS UMR 5164, University of Bordeaux, 33076, Bordeaux, France.
| |
Collapse
|
4
|
Huang WL, Liao SC, Wu CS, Chiu YT. Clarifying the link between psychopathologies and heart rate variability, and the sex differences: Can neuropsychological features serve as mediators? J Affect Disord 2023; 340:250-257. [PMID: 37562561 DOI: 10.1016/j.jad.2023.08.046] [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: 05/15/2023] [Revised: 06/23/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Patients with common mental disorders (depression, anxiety, and somatic symptoms) often exhibit lower heart rate variability (HRV) than healthy individuals. Under the hypothesis that disorder status affects cognitive function, we examined whether neuropsychological features can be mediators between psychopathologies and HRV and possible sex differences. METHODS We recruited 359 individuals (aged 42.47 ± 12.23) with and without common mental disorders. Questionnaires were used to measure their psychopathologies. Eight tests from the Cambridge Neuropsychological Test Automated Battery were selected to measure neuropsychological functions. Resting-state HRV measurements were obtained for 5 min. The associations among these constructs were analyzed using multiple linear regression analysis and structural equation modelling. RESULTS Among women, Reaction Time (RTI, a task of psychomotor speed) indicator mediated the relationship between depression and low-frequency power (LF); Emotion Recognition Task (ERT, a task of emotional regulation) indicator mediated the relationship between health anxiety and high-frequency power (HF). Among men, Intra-Extra Dimensional Set Shift (IED, a task of shifting) indicator mediated the relationship between depression and LF; Match to Sample Visual Search (MTS, a task of selective attention) indicator mediated the relationship between health cognition and HF. The depression-RTI-LF pathway in women tended to lower HRV; whereas health anxiety-ERT-HF in women, depression-IED-LF and health cognition-MTS-HF in men tended to increase HRV. LIMITATIONS Possible medication effects; not directly measuring brain activity; only gathering resting-state HRV. CONCLUSION Our findings support the notion that neuropsychological features mediate the relationship between psychopathologies and HRV, and that sex differences exist.
Collapse
Affiliation(s)
- Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Cerebellar Research Center, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Shih-Cheng Liao
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu Hospital, Hsinchu, Taiwan
| | - Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
| | - Yi-Ting Chiu
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| |
Collapse
|
5
|
Peiffer C. Puzzled by dysfunctional breathing disorder(s)? Consider the Bayesian brain hypothesis! Front Neurosci 2023; 17:1270556. [PMID: 37877012 PMCID: PMC10593455 DOI: 10.3389/fnins.2023.1270556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 10/26/2023] Open
Abstract
There is currently growing clinical concern regarding dysfunctional breathing disorder(s) (DBD), an umbrella term for a set of multidimensional clinical conditions that are characterized by altered breathing pattern associated with a variety of intermittent or chronic symptoms, notably dyspnea, in the absence or in excess of, organic disease. However, several aspects of DBD remain poorly understood and/or open to debate, especially the inconsistent relationship between the array of experienced symptoms and their supposedly underlying mechanisms. This may be partly due to a more general problem, i.e., the prevailing way we conceptualize symptoms. In the present article, after a brief review of the different aspects of DBD from the current perspective, I submit a call for considering DBD under the innovating perspective of the Bayesian brain hypothesis, i.e., a potent and novel model that fundamentally changes our views on symptom perception.
Collapse
Affiliation(s)
- Claudine Peiffer
- Dyspnea Clinic, Department of Physiology, University Children Hospital Robert Debré (AP-HP), Paris, France
| |
Collapse
|
6
|
Imperiale MN, Lieb R, Meinlschmidt G. Treatment-associated network dynamics in patients with globus sensations: a proof-of-concept study. Sci Rep 2023; 13:15615. [PMID: 37730963 PMCID: PMC10511470 DOI: 10.1038/s41598-023-42186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 09/06/2023] [Indexed: 09/22/2023] Open
Abstract
In this proof-of-concept study, we used a systems perspective to conceptualize and investigate treatment-related dynamics (temporal and cross-sectional associations) of symptoms and elements related to the manifestation of a common functional somatic syndrome (FSS), Globus Sensations (GS). We analyzed data from 100 patients (M = 47.1 years, SD = 14.4 years; 64% female) with GS who received eight sessions of group psychotherapy in the context of a randomized controlled trial (RCT). Symptoms and elements were assessed after each treatment session. We applied a multilevel graphical vector-autoregression (ml GVAR) model approach resulting in three separate, complementary networks (temporal, contemporaneous, and between-subject) for an affective, cognitive, and behavioral dimension, respectively. GS were not temporally associated with any affective, cognitive, and behavioral elements. Temporally, catastrophizing cognitions predicted bodily weakness (r = 0.14, p < 0.01, 95% confidence interval (CI) [0.04-0.23]) and GS predicted somatic distress (r = 0.18, p < 0.05, 95% CI [0.04-0.33]). Potential causal pathways between catastrophizing cognitions and bodily weakness as well as GS and somatic distress may reflect treatment-related temporal change processes in patients with GS. Our study illustrates how dynamic NA can be used in the context of outcome research.
Collapse
Affiliation(s)
- Marina N Imperiale
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland
| | - Roselind Lieb
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland
| | - Gunther Meinlschmidt
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse 62a, 4055, Basel, Switzerland.
- Department of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University (IPU) Berlin, Stromstrasse 1, 10555, Berlin, Germany.
- Department of Digital and Blended Psychosomatics and Psychotherapy, Psychosomatic Medicine, University Hospital Basel and University of Basel, Hebelstrasse 2, 4031, Basel, Switzerland.
| |
Collapse
|
7
|
Sætren SS, Augusti EM, Myhre MC, Hafstad GS. The regulatory role of affective inhibitory control in somatic symptoms among adolescents exposed to child maltreatment: a population-based study. Eur Child Adolesc Psychiatry 2023; 32:1701-1710. [PMID: 35441902 PMCID: PMC10460330 DOI: 10.1007/s00787-022-01988-7] [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: 10/25/2021] [Accepted: 04/06/2022] [Indexed: 11/24/2022]
Abstract
Adolescents exposed to child maltreatment are at increased risk for various somatic symptoms, but which psychological factors that contribute to this relationship need to be further investigated. Emotion dysregulation is suggested to serve as a proximal link between child maltreatment and somatic complaints. The purpose of the present study was to investigate whether individual differences in affective inhibitory control, a central component in implicit emotion regulation, contribute to the risk of somatic symptoms in adolescents exposed to child maltreatment. Data were drawn from the UEVO study, a national population-based survey of adolescents between 12 and 16 years of age (N = 9240). For this study, we included participants who completed the emotional go/no-go task measuring affective inhibitory control (N = 7241; Mage/SD = 14 years/.87; 52% girls, 47% boys), of which N = 3349 reported at least one incident of maltreatment exposure (57% girls, 41% boys). Exposure to psychological abuse and sexual abuse were associated with somatic symptoms. Affective inhibitory control was related to somatic symptoms, both in the total sample and in adolescents exposed to child maltreatment. The strength of relationships between exposure to psychological abuse and somatic symptoms, as well as sexual abuse and somatic symptoms, were moderated by individual differences in affective inhibitory control problems. Our study suggests that psychological abuse and sexual abuse increase the risk for somatic symptoms in adolescence. Affective inhibitory control, a central component in implicit emotion regulation, was related to somatic symptoms and moderated the relationships between psychological abuse and somatic symptoms, and sexual abuse and somatic symptoms. Revealing these associations in a population-based sample indicates that treatment targeting affective inhibitory control may be beneficial and should be explored further in clinical settings.
Collapse
Affiliation(s)
- Sjur Skjørshammer Sætren
- Department for Child and Adolescent Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Jan Johnsens gate 12, 4011, Stavanger, Norway.
| | - Else-Marie Augusti
- Department for Child and Adolescent Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Mia Cathrine Myhre
- Department for Child and Adolescent Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Gertrud Sofie Hafstad
- Department for Child and Adolescent Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| |
Collapse
|
8
|
Wolf J, Limburg K, Sattel H, Lahmann C. Perceived illness consequences predict the long-term course of handicap in patients with vertigo and dizziness beyond vestibular abnormality. J Psychosom Res 2023; 172:111401. [PMID: 37315402 DOI: 10.1016/j.jpsychores.2023.111401] [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: 10/25/2022] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Vertigo and dizziness (VD) affect one third of the population during their lifetime. VD patients are oftentimes severely handicapped. One current study showed that illness perceptions, emotional as well as behavioral responses to illness were associated with VD-related handicap at 3-months follow-up. However, no study has yet investigated this association for a period longer than six months. This study aimed to investigate long-term associations of cognitive, emotional, and behavioral factors with VD-related handicap. METHODS In a naturalistic longitudinal study design, n = 161 patients with VD were examined at baseline, at 6-months follow-up, and at 12-months follow-up. Participants underwent neurological and psychiatric examinations as well as comprehensive psychological assessments using self-report questionnaires. RESULTS During the study period VD-related handicap decreased significantly (Cohen's d = .35, p < .001). Cognitive, emotional, and behavioral factors remained without significant change during the study period. Vestibular testing as well as the type of diagnosis were not associated with changes in VD-related handicap. Changes in perceived illness consequences (ß = .265, p < .001), depression (ß = .257, p < .001), and anxiety (ß = .206, p = .008) significantly predicted the course of VD-related handicap over 12 months, while the presence vs. absence of vestibular abnormality did not. CONCLUSION Our results extend findings that cognitive and emotional factors including perceived illness consequences, depression, and anxiety are associated with the long-term course of VD-related handicap and may provide therapeutic targets to improve long-term outcomes in patients with VD.
Collapse
Affiliation(s)
- Johannes Wolf
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Karina Limburg
- Department of Conservative Orthopedics, Manual Medicine, and Pain Medicine, SANA Hospital, Munich, Germany
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Hospital Rechts der Isar, Technical University Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Albert-Ludwigs-University Freiburg, Germany
| |
Collapse
|
9
|
Moneta ME, Kaechele H. A theoretical and clinical perspective of an embodied view in psychotherapy of somatic symptoms disorders. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:605. [PMID: 37667890 PMCID: PMC10519280 DOI: 10.4081/ripppo.2023.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/26/2023] [Indexed: 09/06/2023]
Abstract
In this paper, we offer some ideas for the treatment of somatoform patients and related pathologies based on the concept of embodiment. Embodiment refers to the interplay between body and mind in behavior. The word refers to giving a body to something, "incarnate". Spinoza wrote extensively about the topic in the 17th century. In the 20th century, picking up on Spinoza's work, Damasio presented extensive and important neuro-scientific evidence that feelings can be direct perceptions of internal body states, substantiating the growing understanding of emotions and feelings as a core component of the embodied experience. Here, we summarize the evidence for the intersection of emotion and cognition in the body, which impinges on the effectiveness of using the body and movement in psychotherapy and the management of somatic symptoms and related disorders. We present evidence indicating that movement would be a way to reach unconscious processes dealing with body-mind interaction and body awareness.
Collapse
|
10
|
Du X, Witthöft M, Zhang T, Shi C, Ren Z. Interpretation bias in health anxiety: a systematic review and meta-analysis. Psychol Med 2023; 53:34-45. [PMID: 36349699 DOI: 10.1017/s0033291722003427] [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] [Indexed: 11/11/2022]
Abstract
Interpretation bias (i.e. the selective negative interpretation of ambiguous stimuli) may contribute to the development and maintenance of health anxiety. However, the strength of the empirical evidence for this association remains a topic of debate. This study aimed to estimate the association between health anxiety and interpretation bias and to identify potential moderators of this association. Chinese-language databases (CNKI, VIP, and Wanfang), English-language databases (Web of Science, PubMed, PsycINFO, and Scopus), and German-language databases (Psyndex and PubPsych) were searched for relevant studies. There were 36 articles (39 studies) identified by this search (N = 8984), of which 32 articles (34 studies) were included in the meta-analysis (N = 8602). Results revealed a medium overall effect size (g = 0.67). Statistically equivalent effect sizes were observed for patients diagnosed with clinical health anxiety (g = 0.58) and subclinical health anxiety (g = 0.72). The effect sizes for threat stimuli that were health related (g = 0.68) and not health related (g = 0.63) did not differ significantly. The effect size for studies using an offline paradigm (g = 0.75) was significantly higher than that for studies using an online paradigm (g = 0.50). It is concluded that health anxiety is significantly and robustly associated with interpretation bias. These findings are of central importance for the advancement of models and treatment of health anxiety.
Collapse
Affiliation(s)
- Xiayu Du
- Key Laboratory of Adolescent Cyberpsychology and Behavior (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
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tao Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behavior (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
| | - Congrong Shi
- Key Laboratory of Adolescent Cyberpsychology and Behavior (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 Behavior (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
| |
Collapse
|
11
|
Peng RX. How online searches fuel health anxiety: Investigating the link between health-related searches, health anxiety, and future intention. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
12
|
Kancherla N, Vanka SC, Pokhrel S, Shahzadi RB, Vijaya Durga Pradeep G. The Development of Illness Anxiety Disorder in a Patient After Partial Thyroidectomy. Cureus 2022; 14:e25416. [PMID: 35769682 PMCID: PMC9233939 DOI: 10.7759/cureus.25416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/12/2022] Open
Abstract
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), characterises illness anxiety disorder (IAD) as the preoccupation with having or acquiring a serious illness in the absence of somatic symptoms (or, if present, symptoms that are only mild in severity). DSM-5 includes illness anxiety disorder in the category called somatic symptom and related disorders, characterised by prominent somatic concerns, distress, and impaired functioning. More often than in psychiatric settings, individuals with illness anxiety disorder are encountered in primary care and specialist medical settings. Despite negative laboratory results, the benign course of the alleged disease over time, and adequate reassurances from specialists, their conviction of being ill persists. Illness anxiety preoccupations are heterogeneous, and the degree of insight is variable. Their illness-related preoccupation interferes with their relationships with family, friends, and coworkers. They are frequently addicted to internet searches about their feared illness, inferring the worst from the information (or false information) they uncover. Patients with illness anxiety disorder often have comorbid psychopathology, especially anxiety and depressive disorders. Typically, illness anxiety disorder is chronic. Physical symptoms are absent or mild and frequently represent a misinterpretation of normal bodily sensations. This case report presents the case of a patient diagnosed with IAD by a psychiatrist. The patient had been seen by his primary care physician and therapist for three years without any improvement in his symptoms before he was referred to a psychiatrist. After undergoing a partial thyroidectomy in 2018, this patient has been experiencing increasing symptoms of recurrent anxiety/fear consistent with IAD, despite extensive medical examinations that have consistently revealed normal results.
Collapse
|
13
|
Mewes R, Feneberg AC, Doerr JM, Nater UM. Psychobiological Mechanisms in Somatic Symptom Disorder and Depressive Disorders: An Ecological Momentary Assessment Approach. Psychosom Med 2022; 84:86-96. [PMID: 34508045 DOI: 10.1097/psy.0000000000001006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Persistent somatic symptoms cause strong impairment in persons with somatic symptom disorder (SSD) and depressive disorders (DDs). Specific negative psychological factors (NPFs), such as catastrophizing, negative affectivity, and behavioral avoidance, are assumed to contribute to this impairment and may maintain symptoms via dysregulations of biological stress systems. We examined the associations between NPF and somatic symptoms in the daily life of women with SSD or DD and investigated the mediating role of psychobiological stress responses. METHODS Twenty-nine women with SSD and 29 women with DD participated in an ecological momentary assessment study. For 14 days, intensity of and impairment by somatic symptoms, NPF, and stress-related biological measures (cortisol, alpha-amylase) were assessed five times per day using an electronic device and saliva samples. Multilevel models were conducted. RESULTS The greater the number of NPF, the higher the concurrent and time-lagged intensity of and impairment by somatic symptoms in both groups (12.0%-38.6% of variance explained; χ2(12) p < .001 for all models). NPFs were associated with higher cortisol levels in women with DD and with lower levels in women with SSD (interaction NPF by group: B = -0.04, p = .042 for concurrent; B = -0.06, p = .019 for time-lagged). In women with SSD, lower cortisol levels were associated with higher intensity at the next measurement time point (group by cortisol: B = -1.71, p = .020). No mediation effects were found. CONCLUSIONS NPFs may be considered as transdiagnostic factors in the development and treatment of impairing somatic symptoms. Our findings will allow the development of new treatment strategies that use ecological momentary intervention approaches focusing on NPF.
Collapse
Affiliation(s)
- Ricarda Mewes
- From the Outpatient Unit for Research, Teaching and Practice (Mewes) and Department of Clinical and Health Psychology (Feneberg, Nater), Faculty of Psychology, University of Vienna, Vienna, Austria; and Department of Neurology (Doerr), University Hospital Gießen and Marburg, Gießen, Germany
| | | | | | | |
Collapse
|
14
|
Elhamiasl M, Dehghani M, Heidari M, Vancleef LMG, Khatibi A. Negative interpretation of ambiguous bodily symptoms among illness-anxious individuals: Exploring the role of developmental and maintenance constructs. Front Psychiatry 2022; 13:985125. [PMID: 36699482 PMCID: PMC9868299 DOI: 10.3389/fpsyt.2022.985125] [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: 07/04/2022] [Accepted: 11/23/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cognitive factors play an essential role in the development and maintenance of anxiety problems. Among individuals with illness anxiety problems, their interpretation of bodily symptoms is a crucial factor in the determination of their ability to regulate their emotions. The catastrophic interpretation of ambiguous bodily symptoms and changes, known as interpretation bias, in line with the failure to reappraise the symptoms in safer ways, is supposed to increase the levels of anxiety in illness-anxious individuals. METHODS This study aimed to address the statistical limitations of the direct (self-report) measure of interpretation bias, using an indirect (online interpretation bias task) measure for assessing biased interpretations of bodily symptoms. In addition, we examined the contribution of self-report anxiety sensitivity (AS), intolerance of uncertainty (IU), interpretation bias, and reappraisal to illness anxiety problems in a subclinical population and compared it with controls with low levels of illness anxiety. FINDINGS Illness-anxious individuals made more negative interpretations of ambiguous, potentially health-threatening information. They used less reappraisal to regulate their emotion. Among the measures, the physical subscale of AS and the reaction time to the safe resolution of ambiguous information were the best factors that could contribute to the differentiation between the illness-anxious individuals and non-anxious individuals. CONCLUSION Our findings provided further support for the biased processing of information related to physical symptoms among individuals with illness anxiety. AS-physical and safe resolutions for ambiguous situations could differentiate the illness-anxious and the control groups better than other factors. These findings suggest that a change of interpretation of ambiguous bodily symptoms among individuals suffering from chronic conditions can be a possible intervention to target anxiety and improve patients' lives.
Collapse
Affiliation(s)
- Mina Elhamiasl
- Psychology Department, Shahid Beheshti University, Tehran, Iran
| | - Mohsen Dehghani
- Psychology Department, Shahid Beheshti University, Tehran, Iran
| | - Mahmood Heidari
- Psychology Department, Shahid Beheshti University, Tehran, Iran
| | - Linda M G Vancleef
- Section Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom.,Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
15
|
Barthels F, Horn S, Pietrowsky R. Orthorexic eating behaviour, illness anxiety and dysfunctional cognitions characteristic of somatic symptom disorders in a non-clinical sample. Eat Weight Disord 2021; 26:2387-2391. [PMID: 33392953 DOI: 10.1007/s40519-020-01091-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To analyse the relation of illness anxiety, dysfunctional cognitions characteristic of somatic symptom disorders and orthorexic eating behaviour in a non-clinical sample. METHODS N = 445 participants (n = 363 females) completed an online survey with the following questionnaires: the Düsseldorf Orthorexia Scale to measure orthorexic eating behaviour, the Attitudes Towards Body and Health Questionnaire to assess dysfunctional cognitions concerning the perception and interpretation of bodily sensations and the Multidimensional Inventory of Hypochondriacal Traits to measure illness anxiety. RESULTS In the total sample, orthorexic eating behaviour was associated with the aforementioned variables to a very low extent. However, individuals with high levels of orthorexic eating behaviour (n = 19) displayed significantly higher levels of health habits and of perceptions of autonomic sensations, as well as higher levels of hypochondriacal worry and absorption than individuals with low levels of orthorexic eating behaviour (n = 19). CONCLUSIONS Orthorexic eating behaviour is associated to some characteristic features of illness anxiety and dysfunctional cognitions characteristic of somatic symptom disorders. Future studies should investigate whether illness anxiety serves as a risk factor for the development of orthorexic eating behaviour. LEVEL OF EVIDENCE III, case-control analytic study.
Collapse
Affiliation(s)
- Friederike Barthels
- Department of Clinical Psychology, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | - Stefanie Horn
- Department of Clinical Psychology, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Reinhard Pietrowsky
- Department of Clinical Psychology, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| |
Collapse
|
16
|
Airoldi S, Kolubinski DC, Nikčević AV, Spada MM. The relative contribution of health cognitions and metacognitions about health anxiety to cyberchondria: A prospective study. J Clin Psychol 2021; 78:809-820. [PMID: 34559886 DOI: 10.1002/jclp.23252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Cyberchondria involves the excessive and compulsive use of the Internet to search for health information. The present study investigated the relative contribution of health cognitions and metacognitions about health anxiety to prospective cyberchondria scores, controlling for health anxiety and hours spent online per day. METHODS A convenience sample of 221 participants was recruited for the purpose of this study with a final sample totaling 125 participants (58.4% females, Mage = 34.51 years) who completed the full survey at baseline (T0 ) and a measure of cyberchondria after 30 days (T1 ). RESULTS The results of the study showed that metacognition about health anxiety relating to beliefs about the uncontrollability of thoughts was the only significant predictor of prospective cyberchondria scores when controlling for health anxiety. CONCLUSIONS These results offer further support to the role of beliefs about the uncontrollability of thoughts in cyberchondria. The implications of the findings are discussed.
Collapse
Affiliation(s)
- Sofia Airoldi
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
| | - Daniel C Kolubinski
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
| | - Ana V Nikčević
- Department of Psychology, Kingston University, Kingston Upon Thames, UK
| | - Marcantonio M Spada
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
| |
Collapse
|
17
|
Svensson SJ, Elntib S. Community cohesion during the first peak of the COVID-19 pandemic: A social antidote to health anxiety and stress. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2021; 51:793-808. [PMID: 34219802 PMCID: PMC8237056 DOI: 10.1111/jasp.12800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/16/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022]
Abstract
Social support gained through community ties has been pivotal in dealing with stressful events. A cross-sectional community sample (N = 2,329) was gathered to assess community cohesion buffering against heath anxiety and perceived stress during the first peak of the pandemic in the UK, using structural equation modeling analyses. Community cohesion acted as a protective mechanism against both health anxiety and stress during the first national lockdown. A strong positive association was also found between health anxiety and stress. Stress and health anxiety scores peaked in the first weeks of the imposed quarantine; as the lockdown was extended, participants reported lower stress, health anxiety and community cohesion scores. The reduction of community cohesion scores was greater for those younger than 45 while the positive association between stress and health anxiety was stronger among males during the lockdown. While community cohesion effects against health anxiety were enhanced for females, community's buffering against stress were greater for males. Strengthening citizens' psychological sense of community through the publicization and support of local initiatives and mutual-aid groups and utilizing methodically green (and blue) spaces to boost neighborhood attraction might be viable strategies within which stress and health anxiety can be suppressed. Conversely, allowing community, regional and national cracks to deepen can exacerbate the impact of stressful events experienced during the COVID-19 pandemic.
Collapse
|
18
|
Latent profile analysis of COVID-19 fear, depression, anxiety, stress, mindfulness, and resilience. CURRENT PSYCHOLOGY 2021; 41:459-469. [PMID: 33821112 PMCID: PMC8012016 DOI: 10.1007/s12144-021-01667-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/16/2022]
Abstract
The purpose of the current study was to identify latent profiles of COVID-19 fear, depression, anxiety, stress, mindfulness, and resilience among university students. A total of 506 university undergraduate and graduate students from various universities were recruited through online platforms in Turkey. Data were collected utilizing self-report scales and were analyzed utilizing latent profile analysis. Results indicated significant relationships among COVID-19 fear, depression, anxiety, stress, resilience, and mindfulness. A three-class solution was adapted to fit the current data. Findings revealed that 46% of the participants were classified into the high COVID-19 fear and medium psychological symptoms profile. Also, 38% of the participants were identified as low psychological symptoms and high mindfulness and resilience. Additionally, 16% of the participants were classified as high COVID-19 fear, psychological symptoms and low mindfulness and resilience. Female gender was positively associated with COVID-19 fear, depression, anxiety, and stress. Life satisfaction and social support were positively associated with the mindfulness and resilience, and were negatively related to COVID-19 fear, depression, anxiety, and stress.
Collapse
|
19
|
Liao SC, Huang WL. Psychometric Properties of the Chinese Version of the Cognitions About Body and Health Questionnaire. Neuropsychiatr Dis Treat 2021; 17:1135-1144. [PMID: 33911863 PMCID: PMC8071698 DOI: 10.2147/ndt.s297584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The Cognitions About Body and Health Questionnaire (CABAH) is a self-rating questionnaire measuring cognitions about health. The psychometric properties of its Chinese version and its performance on evaluating somatic symptom disorder (SSD) were examined in this study. METHODS After translating the CABAH into Chinese, we collected data of the CABAH and another four questionnaires (Patient Health Questionnaire-15, Health Anxiety Questionnaire, Beck Depression Inventory-II, Beck Anxiety Inventory) in 208 SSD patients and 197 healthy individuals. We used exploratory factor analysis (EFA) to explore the structure of the Chinese CABAH. Internal consistency and criterion-related validity were analyzed. An independent t-test and receiver operating characteristic (ROC) curve analysis were used to evaluate the performance of the CABAH for evaluating SSD. RESULTS Six factors were suggested by EFA. Five (bodily weakness, health habits, catastrophizing interpretation of specific bodily complaints, somatosensory amplification, catastrophizing interpretation of general bodily complaints) are conceptually associated with the original CABAH. The sixth factor (reverse, with three items) is different from the original construct. Cronbach's alpha for the CABAH was 0.885. The CABAH score was moderately correlated with scores of the other four questionnaires. Scores for the whole CABAH and scores of the six factors were all significantly higher in SSD patients than in healthy individuals. The results of ROC curve analysis were as follows: area under the curve=0.700; suggested cutoff=58/59; Youden's J=0.295. CONCLUSION The reliability and validity of the Chinese CABAH were fair, although the three items in the reverse factor should be interpreted cautiously.
Collapse
Affiliation(s)
- Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
20
|
Pan X, Ding W, Sun X, Ji C, Zhou Q, Yan C, Zhou Y, Luo Y. Gray Matter Density of the Dorsomedial Prefrontal Cortex Mediates the Relationship Between Catastrophizing and Anxiety in Somatic Symptom Disorder. Neuropsychiatr Dis Treat 2021; 17:757-764. [PMID: 33727819 PMCID: PMC7955750 DOI: 10.2147/ndt.s296462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Catastrophizing is commonly co-occurrence with anxiety in somatic symptom disorder (SSD). However, the quantitative relationship between catastrophizing and anxiety in SSD and its underlying neuropsychopathology remains unclear. METHODS To address the issue, twenty-eight SSD patients and twenty-nine healthy controls (HCs) completed the Hamilton anxiety scale and the catastrophizing subscale of the cognitive emotion regulation questionnaire. Then they underwent structural magnetic resonance imaging and voxel-based morphometry analysis was performed to obtain gray matter density (GMD) of the dorsomedial prefrontal cortex (dmPFC). RESULTS Independent samples t-tests showed no significance between SSD patients and HCs in the scores on the catastrophizing subscale and GMD of the dmPFC. However, correlation analysis found that catastrophizing was significantly positively associated with anxiety in SSD. Further, mediation analyses revealed that GMD of the dmPFC (bilateral medial Brodmann area 8) mediated the relationship between catastrophizing and anxiety in SSD. CONCLUSION These findings support Kirmayer's disease model of SSD that catastrophic interpretations of somatic symptoms resulted in increased anxiety and demonstrate that the dmPFC may be a potential neural site linking catastrophizing and anxiety in SSD.
Collapse
Affiliation(s)
- Xiandi Pan
- Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Weina Ding
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Xia Sun
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Chenfeng Ji
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Qian Zhou
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, People's Republic of China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Yanli Luo
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
21
|
Bailey R, Wells A. The contribution of metacognitive beliefs and dysfunctional illness beliefs in predicting health anxiety: An evaluation of the metacognitive versus the cognitive models. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12078] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robin Bailey
- Department of Clinical Psychology, University of Manchester, Manchester, UK,
- School of Health, University of Central Lancashire, Preston, UK,
| | - Adrian Wells
- Department of Clinical Psychology, University of Manchester, Manchester, UK,
| |
Collapse
|
22
|
Waqas M, Hania A, Hongbo L. Psychological Predictors of Anxious Responses to the COVID-19 Pandemic: Evidence from Pakistan. Psychiatry Investig 2020; 17:1096-1104. [PMID: 33190456 PMCID: PMC7711115 DOI: 10.30773/pi.2020.0167] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/30/2020] [Accepted: 09/20/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE COVID-19 epidemic can be associated with a variety of anxious responses and safety behaviors. The present research explored the psychological implications associated with COVID-19 during the outbreak in 2020 to date. Pakistani media has given particular attention to this outbreak in the region. METHODS Three hundred and forty-seven undergraduate university students from Pakistan completed a battery of questionnaires focusing fear of COVID-19, associated safety behaviors, factual knowledge of COVID-19, and other psychological pointers hypothesized to be as predictors of anxious responses to COVID-19 threat and associated safety behaviors. RESULTS The sample appeared to be fearful of COVID-19 and this fear was related to disgust sensitivity, anxiety sensitivity-related physical concerns, body vigilance, contamination cognitions, and general distress. Results suggested that the tendency of overestimating the severity of contamination and anxiety sensitivity towards physical concerns are significant predictors of COVID-19 related fear and consequent safety behaviors. CONCLUSION It is suggested that people with a greater concern of contamination are likely to respond fearfully to COVID-19 and that people with higher fear of COVID-19 are likely to feel contamination concerns.
Collapse
Affiliation(s)
- Muhammad Waqas
- School of Management, Jiangsu University, Zhenjiang, China
| | - Alishba Hania
- Department of Psychology, Institute of Southern Punjab, Multan, Pakistan
| | - Li Hongbo
- School of Management, Jiangsu University, Zhenjiang, China
| |
Collapse
|
23
|
Medically unexplained symptoms in children and adolescents: Illness-related self-concept and parental symptom evaluations. J Behav Ther Exp Psychiatry 2020; 68:101565. [PMID: 32171996 DOI: 10.1016/j.jbtep.2020.101565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/15/2020] [Accepted: 02/29/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVES According to cognitive-behavioral models, illness-related symptom evaluations and self-concepts play a pivotal role in the development and maintenance of medically unexplained somatic symptoms (MUS). However, illness-related cognitions related to MUS have rarely been studied in children/adolescents and their parents. METHODS Seventy-eight children and adolescents (M = 14.2 years; 59% female) performed two versions of the Implicit Association Test (IAT) to measure the implicit illness-related and the implicit anxiety-related self-concept. Illness-related evaluations of unspecific symptoms were assessed via the Health Norms Sorting Task (HNST), and MUS as well as characteristics of somatic symptom disorder (SSD) via questionnaires. RESULTS MUS were significantly positively associated with the explicit (r = 0.30, p < .01) and implicit illness-related self-concept (r = 0.24, p = .04), but not with the anxiety-related self-concept (r = 0.15, p = .18). The implicit illness-related self-concept explained incremental variance in MUS (ΔR2 = 0.05, p = .04) beyond the explicit illness-related self-concept. Regarding health anxiety, parental illness-related symptom evaluations moderated the relationship between child-reported severity of MUS and health anxiety (B = 0.12, p < .01). LIMITATIONS Some measures have been adapted for childhood and adolescence, but validations on larger samples are still pending. CONCLUSIONS A disorder-specific self-concept of being ill, as well as parental symptom evaluations, seem to play an essential role in MUS and health anxiety in childhood and adolescence. Due to the importance of the top-down processes found here, the findings are in line with current predictive coding models of somatic symptom perception.
Collapse
|
24
|
Lorimer SB, Sansom-Daly UM, Stech EP, Newby JM. Predictors of health anxiety in cancer patients' loved ones: A controlled comparison. Psychooncology 2020; 29:1874-1882. [PMID: 32789932 DOI: 10.1002/pon.5517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive-behavioural models suggest that vicarious illness experiences precipitate health anxiety; however, this assumption is largely untested. This study aimed to (a) compare the severity of health anxiety and rates of clinical health anxiety, Illness Anxiety Disorder (IAD), and Somatic Symptom Disorder (SSD) in participants with and without a loved one with cancer, and (b) determine the predictors of health anxiety severity in participants with vicarious cancer experiences. METHODS Participants with (n = 142) and without (n = 65) vicarious cancer experiences completed an online battery of questionnaires assessing the severity and cognitive, physiological, and behavioural components of health anxiety. Participants reporting clinical levels of health anxiety completed a diagnostic telephone interview to assess for IAD and SSD. RESULTS Severity and rates of clinical health anxiety, IAD, and SSD did not differ between groups. Participants with a vicarious experience of cancer reported elevated fear of cancer recurrence regarding their loved one's illness, however only 15.8% reported clinically significant health anxiety. Hierarchical regression revealed that in participants with vicarious cancer experiences, less relationship closeness and greater perceived risk of cancer, severity of somatic symptoms, bodily hypervigilance, and catastrophic interpretation of symptoms predicted health anxiety. Being a caregiver for or genetically related to the person with cancer, the expectedness of the cancer diagnosis, and whether the loved one died from cancer were not significant predictors. CONCLUSIONS These results suggest that people reporting vicarious cancer experiences do not have elevated rates of health anxiety. However, how these individuals interpret their experiences influences health anxiety severity.
Collapse
Affiliation(s)
| | - Ursula M Sansom-Daly
- School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Sydney Youth Cancer Service, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | | | | |
Collapse
|
25
|
Antognelli SL, Sharrock MJ, Newby JM. A randomised controlled trial of computerised interpretation bias modification for health anxiety. J Behav Ther Exp Psychiatry 2020; 66:101518. [PMID: 31610436 DOI: 10.1016/j.jbtep.2019.101518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/24/2019] [Accepted: 09/29/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Health anxiety is characterised by a tendency to interpret benign bodily sensations as a sign of serious illness. This study aimed to examine whether computerised cognitive bias modification (CBM-I) training to facilitate benign interpretations of bodily symptoms could reduce these negative interpretations of bodily symptoms, health anxiety and comorbid symptoms. METHODS Participants (N = 89) with clinical levels of health anxiety (Short Health Anxiety Inventory [SHAI] scores ≥20) were randomised to receive two internet-delivered 30-min sessions of either CBM-I interpretation training (Intervention) or control CBM-I training over 1-week. Participants were assessed at pre-treatment, post-treatment and 2-weeks follow-up on self-reported health anxiety, cognitions and attributions of bodily symptoms, and comorbid symptoms (e.g., depression). RESULTS Results showed significantly reduced catastrophic attributions, health anxiety and related symptoms at post-treatment in both groups, which were maintained at 2-week follow-up. Although there were no significant group differences at post-treatment or follow-up, we found small non-significant effect sizes in favour of the CBM-I Intervention group on health anxiety and cognitions (Cohen's d's between-group effect sizes of 0.28 at post-treatment and d = 0.35 at follow-up on the 18-item Short Health Anxiety Inventory). LIMITATIONS The study was conducted online, limiting control over the setting in which participants completed training. Additionally, training was not tailored to the specific symptoms or diseases that participants feared. CONCLUSIONS This study is the first to evaluate the effect of internet-delivered CBM-I training targeting benign interpretations of bodily symptoms on health anxiety. Further research is needed before this intervention is disseminated.
Collapse
|
26
|
Abstract
Severe health anxiety (SHA)/hypochondriasis (HY) is often associated with personality pathology; however, studies report inconsistent results. In general populations, 12% have a personality disorder (PD). We assessed physician-referred psychiatric outpatients with SHA enrolled for a treatment study (n = 84) with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) axis II (SCID-II), Personality Inventory for DSM-5 (PID-5), Whiteley Index 7, and Short Health Anxiety Inventory, and the healthy controls (n = 84) with PID-5 only. There were 71.4% of the patients who met criteria for PDs: avoidant (22.6%), obsessive-compulsive (16.7%), depressive (16.7%), dependent (7.1%), paranoid (3.6%), borderline (2.4%), and not otherwise specified (32.1%). Severity of personality pathology was associated with severity of health anxiety. In group comparisons, PID-5 trait domains of negative affectivity, detachment, low antagonism, and low disinhibition, and facets of anxiousness, separation insecurity, and low attention seeking emerged as unique predictors of SHA. Personality pathology is common among individuals with SHA/HY. Further research is needed to understand the nature of the relationship between health anxiety and personality pathology and to determine whether treatments that target both SHA/HY and personality pathology will improve short- and long-term outcomes.
Collapse
|
27
|
Ma YJ, Wang DF, Yuan M, Long J, Chen SB, Wu QX, Wang XY, Liu TQ. The mediating effect of health anxiety in the relationship between functional somatic symptoms and illness behavior in Chinese inpatients with depression. BMC Psychiatry 2019; 19:260. [PMID: 31455294 PMCID: PMC6712795 DOI: 10.1186/s12888-019-2246-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Functional somatic symptoms in depression disorder may cause inappropriate illness behavior hindering the treatment process. Health anxiety may play a role in this relationship, but few studies have examined it. The current study aimed to investigate the role of health anxiety in the relationship between functional somatic symptoms and illness behavior in patients with depression. METHODS The present study recruited 323 hospitalized patients with depression to complete the Patient Health Questionnaire-15, Whiteley-Index-7, and Scale for the Assessment of Illness Behavior, then constructed a structural equation model to examine whether health anxiety mediated the relationship between functional somatic symptoms and illness behavior. RESULTS The results showed significant correlations between any two of the three variables of interest. More importantly, health anxiety played a partially mediating role (42.86%) in the relationship between functional somatic symptoms and illness behavior. Further analysis suggested that elderly patients reached higher health anxiety than younger patients when their functional somatic symptoms were mild. CONCLUSIONS These results highlight that health anxiety may mediate the influence of functional somatic symptoms on illness behavior. The implications of assessing and intervening in health anxiety in patients with depression were discussed.
Collapse
Affiliation(s)
- Yue-Jiao Ma
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Dong-Fang Wang
- 0000 0001 0379 7164grid.216417.7Psychosomatic health institute of the Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan People’s Republic of China
| | - Ming Yuan
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Jiang Long
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China ,0000 0001 2294 713Xgrid.7942.8Laboratory for Experimental Psychopathology, Psychological, Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Shu-Bao Chen
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Qiu-Xia Wu
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Xu-Yi Wang
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Tie-Qiao Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.
| |
Collapse
|
28
|
Abstract
Illness anxiety disorder is a primary disorder of anxiety about having or developing a serious illness. The core feature is the cycle of worry and reassurance seeking regarding health, as opposed to a focus on relief of distress caused by somatic symptoms (as in Somatic Symptom Disorder). Clinically significant health anxiety is common, with estimates ranging up to 13% in the general adult population. There are evidence-based treatments, including psychopharmacology and cognitive behavioral therapy, that can significantly alleviate symptoms. An understanding of the core psychopathology and clinical features of illness anxiety disorder is essential to fostering a working alliance with patients with health anxiety, as is the maintenance of an empathic, curious, and nonjudgmental stance toward their anxiety. Collaboration between medical providers is essential to avoid the pitfalls of excess testing and medical treatment.
Collapse
|
29
|
Oldroyd K, Pasupathi M, Wainryb C. Social Antecedents to the Development of Interoception: Attachment Related Processes Are Associated With Interoception. Front Psychol 2019; 10:712. [PMID: 31068846 PMCID: PMC6491743 DOI: 10.3389/fpsyg.2019.00712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 03/14/2019] [Indexed: 11/24/2022] Open
Abstract
Current empirical work suggests that early social experiences could have a substantial impact on the areas of the brain responsible for representation of the body. In this context, one aspect of functioning that may be particularly susceptible to social experiences is interoception. Interoceptive functioning has been linked to several areas of the brain which show protracted post-natal development, thus leaving a substantial window of opportunity for environmental input to impact the development of the interoceptive network. In this paper we report findings from two existing datasets showing significant relationships between attachment related processes and interoception. In the first study, looking at a sample of healthy young adults (n = 132, 66 males), we assessed self-reported interoceptive awareness as assessed with the Multidimensional Assessment of Interoceptive Awareness (Mehling et al., 2012) and attachment style as assessed with the Experiences in Close Relationships Scale-Short (Wei et al., 2007). We found relationships between aspects of interoception and attachment style such that avoidant individuals reported lower interoceptive functioning across several dimensions [r's(130) = -0.20 to -0.26, p's < 0.05]. More anxious individuals, on the other hand, reported heightened interoceptive across several dimensions [r's(130) = 0.18 to 0.43, p's < 0.05]. In the second study, we examined the congruence between a youth's self-reported negative emotion and a measure of sympathetic nervous system arousal (SCL). The congruence score was positively associated with parental rejection of negative emotion. These results suggest that parenting style, as reported by the mother, are associated with a youth's ability to coordinate their self-reported emotional and physiological responding across a series of independent assessments, r(108) = -0.24, p < 0.05. In other words, the more maternal reported parental rejection of youth negative emotions, the less congruent a youth's self and physiological reports of distress.
Collapse
Affiliation(s)
- Kristina Oldroyd
- Social Development Laboratory, Department of Psychology, The University of Utah, Salt Lake City, UT, United States
| | | | | |
Collapse
|
30
|
A comprehensive study of oxidative stress in patients with somatic symptom disorder. Acta Neuropsychiatr 2019; 31:100-105. [PMID: 30558690 DOI: 10.1017/neu.2018.33] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate oxidative stress parameters [total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), paraoxonase (PON), arylesterase (ARE) and thiol-disulphide homeostasis] in patients who were diagnosed as having somatic symptom disorder in accordance with Diagnostic and Statistical Manual of Mental Disorders-5. METHODS The study included 41 medication-free patients with somatic symptom disorder and 47 age, sex, and sociodemographic-matched healthy individuals. The patients were administered the Patient Health Questionnaire-15, Somatic Symptom Amplification Scale, Beck Depression Inventory, and Beck Anxiety Inventory. TOS, TAS, OSI, PON, ARE thiol, disulphide levels, and routine biochemical parameters were compared between the two groups. RESULTS TOS, OSI, disulphide levels, disulphide/native thiol, and disulphide/total thiol ratios were found significantly higher in the patient group compared with the control group (p < 0.001). There was no significant difference in PON, ARE, and TAS parameters between the two groups (p > 0.05). CONCLUSION This study showed that the level of oxidants increased and oxidative balance was impaired in somatic symptom disorder. Oxidative stress may play a role in the aetiopathogenesis of this disorder. This is the first study to report an association between oxidative stress and somatic symptom disorder.
Collapse
|
31
|
Liao SC, Ma HM, Lin YL, Huang WL. Functioning and quality of life in patients with somatic symptom disorder: The association with comorbid depression. Compr Psychiatry 2019; 90:88-94. [PMID: 30818088 DOI: 10.1016/j.comppsych.2019.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Patients with somatic symptoms often have impaired functioning and reduced quality of life (QOL), but the factors identified as responsible for these impairments vary between studies. We examined functioning and QOL in patients with somatic symptom disorder (SSD), exploring their associations with demographic factors, personality traits and psychological features. METHODS The sample comprised 107 SSD patients and 100 healthy controls. Several types of self-report instrument were administered. Group differences were assessed with independent t-tests. We used multiple linear regression to examine relationships between the independent variables and functioning and QOL. Finally, we used structural equation modeling (SEM) to perform path analysis and examine the fit of a model based on the earlier results. RESULTS Most function scores were lower in SSD patients than in healthy controls. In SSD patients overall WHO Quality of Life-BREF (WHOQOL-BREF) score was correlated with exercise level and Beck Depression Inventory-II (BDI-II) score. There were also associations between Sheehan Disability Scale (SDS) score and age, novelty seeking, Cognitions About Body and Health Questionnaire (CABAH) score and BDI-II score. Family APGAR score was only related to BDI-II score. Path analysis revealed that BDI-II score was related to all three indices of functioning. CONCLUSIONS Depression is associated with functioning and QOL in SSD patients. TRIAL REGISTRATION INFORMATION The Research Ethics Committee of National Taiwan University National Taiwan University Hospital approved this study (approval number: 201507007RINB).
Collapse
Affiliation(s)
- Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, No.7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan, ROC; Department of Psychiatry, College of Medicine, National Taiwan University, No.1, Sec. 1, Ren'ai Rd., Zhongzheng Dist., Taipei City 100, Taiwan, ROC
| | - Huei-Mei Ma
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, Yunlin County 640, Taiwan, ROC
| | - Yi-Ling Lin
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, Yunlin County 640, Taiwan, ROC
| | - Wei-Lieh Huang
- Department of Psychiatry, College of Medicine, National Taiwan University, No.1, Sec. 1, Ren'ai Rd., Zhongzheng Dist., Taipei City 100, Taiwan, ROC; Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, Yunlin County 640, Taiwan, ROC; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No.7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan, ROC.
| |
Collapse
|
32
|
Karlinski M, Jones A, Forster B. Electrophysiological evidence for changes in attentional orienting and selection in functional somatic symptoms. Clin Neurophysiol 2019; 130:85-92. [PMID: 30481650 PMCID: PMC6318479 DOI: 10.1016/j.clinph.2018.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/19/2018] [Accepted: 09/28/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We investigated changes in attention mechanisms in people who report a high number of somatic symptoms which cannot be associated with a physical cause. METHOD Based on scores on the Somatoform Disorder Questionnaire (SDQ-20; Nijenhuis et al., 1996) we compared two non-clinical groups, one with high symptoms on the SDQ-20 and a control group with low or no symptoms. We recorded EEG whilst participants performed an exogenous tactile attention task where they had to discriminate between tactile targets following a tactile cue to the same or opposite hand. RESULTS The neural marker of attentional orienting to the body, the Late Somatosensory Negativity (LSN), was diminished in the high symptoms group and attentional modulation of touch processing was prolonged at mid and enhanced at later latency stages in this group. CONCLUSION These results confirm that attentional processes are altered in people with somatic symptoms, even in a non-clinical group. Furthermore, the observed pattern fits explanations of changes in prior beliefs or expectations leading to diminished amplitudes of the marker of attentional orienting to the body (i.e. the LSN) and enhanced attentional gain of touch processing. SIGNIFICANCE This study shows that high somatic symptoms are associated with neurocognitive attention changes.
Collapse
Affiliation(s)
- Maayan Karlinski
- Cognitive Neuroscience Research Unit, City, University of London, London, UK; Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | | | - Bettina Forster
- Cognitive Neuroscience Research Unit, City, University of London, London, UK.
| |
Collapse
|
33
|
Hennemann S, Böhme K, Baumeister H, Bendig E, Kleinstäuber M, Ebert DD, Witthöft M. Efficacy of a guided internet-based intervention (iSOMA) for somatic symptoms and related distress in university students: study protocol of a randomised controlled trial. BMJ Open 2018; 8:e024929. [PMID: 30598489 PMCID: PMC6318514 DOI: 10.1136/bmjopen-2018-024929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/18/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Persistent and distressing somatic symptoms are common in younger age cohorts such as university students. However, the majority does not receive adequate psychosocial care. Internet-based and mobile-based interventions may represent low threshold and effective extensions to reduce somatic and associated mental symptom severity. The planned study aims to investigate the feasibility and efficacy of an internet-based intervention in reducing somatic and psychological symptoms in an international population of university students with somatic symptom burden. METHODS AND ANALYSIS This parallel two-armed randomised controlled trial evaluates an 8-week guided intervention, including web-based consecutive modules based on cognitive behavioural therapy (CBT) principles against a waitlist control group. Guidance will be provided by trained psychologists with weekly written supportive feedback. As part of the 'Studicare' project, the present study aims to recruit n=154 university students indicating somatic symptom burden at baseline in German-speaking universities. Self-report assessments will take place at baseline and after intervention completion (8, 16 weeks after randomisation). The primary outcome will be the severity of somatic symptoms and associated mental distress. Secondary outcomes include depression, (health) anxiety, disability, intervention satisfaction and adherence. ETHICS AND DISSEMINATION Ethics approval has been granted. Results from this study will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER DRKS00014375; Pre-results.
Collapse
Affiliation(s)
- Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Katja Böhme
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Eileen Bendig
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Maria Kleinstäuber
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - David Daniel Ebert
- Department of Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| |
Collapse
|
34
|
Love S, Sharman R, Kannis-Dymand L. Emotion Regulation and the Specific Associations with Health Anxiety. PSYCHOLOGICAL STUDIES 2018. [DOI: 10.1007/s12646-018-0469-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
35
|
Hüsing P, Bassler M, Löwe B, Koch S, Toussaint A. Validity and sensitivity to change of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in a clinical population. Gen Hosp Psychiatry 2018; 55:20-26. [PMID: 30232051 DOI: 10.1016/j.genhosppsych.2018.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The SSD-12 is a brief self-report questionnaire to measure the psychological criteria of DSM-5 Somatic Symptom Disorder. This study examines its psychometric properties in a German inpatient sample from a psychosomatic rehabilitation setting, and provides evidence to its sensitivity to change. METHOD Patients completed the SSD-12 and the Health49-subscale on somatoform complaints before and after receiving inpatient treatment. Therapists evaluated the psychological improvement of their patients at the end of treatment. Effect sizes (ES) and standardized response means (SRM) of pre- and post-SSD-12 mean changes were calculated for subgroups of patients who did or did not improve. RESULTS SSD-12 scores at discharge were significantly lower compared to scores at admission for subgroups of patients who improved according to clinicians (t=2976, df=103, p=.004), and for patients who improved according to self-report (t=5.059, df=159, p<.001). Effect sizes of change in SSD-12 scores in the improved subgroups were ES=-0.19 and ES=-0.30, and standardized response means were SRM=-0.29 and SRM=-0.40, respectively. CONCLUSION The SSD-12 shows sound psychometric properties and is useful and time-efficient for monitoring psychological burden associated with bothersome somatic symptoms. Its sensitivity to change over time could be documented.
Collapse
Affiliation(s)
- Paul Hüsing
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Markus Bassler
- Psychosomatic Clinic Oberharz, Clausthal-Zellerfeld, Germany; Nordhausen University of Applied Science, Nordhausen, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Stella Koch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| |
Collapse
|
36
|
Zhao J, Su Q, Liu F, Zhang Z, Li R, Zhu F, Wu R, Zhao J, Guo W. Regional white matter volume abnormalities in first-episode somatization disorder. Int J Psychophysiol 2018; 133:12-16. [DOI: 10.1016/j.ijpsycho.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/31/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
|
37
|
Acceptance and Cognitive Reappraisal as Regulation Strategies for Symptom Annoyance in Individuals with Medically Unexplained Physical Symptoms. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9973-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
38
|
Chapman A, Poliakoff E, Chew-Graham CA, Brown RJ. Attending away from the body predicts increased physical symptom reports at six months in primary care patients. J Psychosom Res 2018; 113:81-88. [PMID: 30190054 DOI: 10.1016/j.jpsychores.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE High symptom reporting (HSR) and medically unexplained symptoms (MUS) are associated with considerable distress, disability, healthcare utilization and costs, but are poorly understood, and current treatments are of limited benefit. Most models of HSR and MUS implicate cognitive-perceptual factors, such as increased body-focused attention, reduced perceptual thresholds and a tendency to experience somatic misperception, but little is known about the causal role of these variables. We investigated this issue by studying whether there is a longitudinal relationship between perceptual-attentional variables and later clinical outcomes in primary care patients. METHOD Primary care patients (N = 102) completed clinical (physical symptom reporting, health anxiety and healthcare utilization) and perceptual-attentional (body-focused attention, perceptual threshold, somatic misperception) measures at baseline and then again six months later (N = 72). Hierarchical regression was used to examine cross-lagged relationships between baseline and follow-up scores. RESULTS Contrary to expectation, attending away from the body at baseline predicted increased not decreased symptom reporting six months later. Neither perceptual threshold nor somatic misperception predicted clinical outcomes at six months. CONCLUSIONS These findings suggest that body avoidance, rather than increased body focus, contribute to the development of HSR. Future studies should consider the potential clinical benefits of reducing bodily avoidance, via techniques that promote adaptive engagement with bodily sensations.
Collapse
Affiliation(s)
- Anna Chapman
- Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
| | | | | | - Richard J Brown
- University of Manchester, United Kingdom; University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, United Kingdom.
| |
Collapse
|
39
|
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.
Collapse
Affiliation(s)
| | - Georgia Panayiotou
- Department of Psychology, University of Cyprus, Cyprus; Center of Applied Neuroscience, University of Cyprus, Cyprus
| |
Collapse
|
40
|
Owens AP, Allen M, Ondobaka S, Friston KJ. Interoceptive inference: From computational neuroscience to clinic. Neurosci Biobehav Rev 2018; 90:174-183. [PMID: 29694845 DOI: 10.1016/j.neubiorev.2018.04.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 02/11/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022]
Abstract
The central and autonomic nervous systems can be defined by their anatomical, functional and neurochemical characteristics, but neither functions in isolation. For example, fundamental components of autonomically mediated homeostatic processes are afferent interoceptive signals reporting the internal state of the body and efferent signals acting on interoceptive feedback assimilated by the brain. Recent predictive coding (interoceptive inference) models formulate interoception in terms of embodied predictive processes that support emotion and selfhood. We propose interoception may serve as a way to investigate holistic nervous system function and dysfunction in disorders of brain, body and behaviour. We appeal to predictive coding and (active) interoceptive inference, to describe the homeostatic functions of the central and autonomic nervous systems. We do so by (i) reviewing the active inference formulation of interoceptive and autonomic function, (ii) survey clinical applications of this formulation and (iii) describe how it offers an integrative approach to human physiology; particularly, interactions between the central and peripheral nervous systems in health and disease.
Collapse
Affiliation(s)
- Andrew P Owens
- Lab of Action & Body, Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK; Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, UK; Autonomic Unit, National Hospital Neurology and Neurosurgery, UCL NHS Trust, London, UK.
| | - Micah Allen
- Wellcome Trust Centre for Neuroimaging, University College London, UK; Institute of Cognitive Neuroscience, University College London, UK
| | - Sasha Ondobaka
- Institute of Cognitive Neuroscience, University College London, UK; Sobell Department for Motor Neuroscience and Movement Disorders, University College London, UK
| | - Karl J Friston
- Wellcome Trust Centre for Neuroimaging, University College London, UK
| |
Collapse
|
41
|
Abstract
The threat of a United States (U.S.) Zika virus pandemic during 2015-2016 was associated with public anxiety. Such threats represent opportunities to examine hypotheses about health anxiety. The present study investigated psychological predictors of Zika-related anxiety during the 2015-2016 outbreak. U.S. adults (N = 216) completed a battery of measures assessing Zika-related anxiety as well as psychological variables hypothesized to predict anxious responding to the threat of a domestic Zika outbreak. Contrary to hypotheses, regression analyses indicated that only contamination severity overestimates and greater Zika knowledge significantly predicted Zika-related anxiety. Study limitations and clinical implications are discussed.
Collapse
Affiliation(s)
- Shannon M Blakey
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, CB # 3270, Davie Hall, Chapel Hill, NC, 27599, USA.
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, CB # 3270, Davie Hall, Chapel Hill, NC, 27599, USA
| |
Collapse
|
42
|
Weiss FD, Rief W, Martin A, Rauh E, Kleinstäuber M. The Heterogeneity of Illness Behaviors in Patients with Medically Unexplained Physical Symptoms. Int J Behav Med 2017; 23:319-326. [PMID: 26732093 DOI: 10.1007/s12529-015-9533-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the heterogeneity of illness behavior in patients with medically unexplained physical symptoms (MUPS), we clustered patients in regard to their degree of engaging in different aspects of illness behavior and identified related variables with these behaviors. METHOD A sample of N = 224 patients attending treatment in primary care with a history of MUPS (at least two symptoms) was investigated by analyzing different aspects of illness behavior with the self-reported number of doctor visits during the last 6 months and the Scale for the Assessment of Illness Behavior (SAIB; e.g., expression of symptoms). RESULTS Two distinct clusters were identified by cluster analysis: a low (n = 106) and a high (n = 118) illness behavior clusters. The high illness behavior cluster exhibited a significantly higher rate of health anxiety than the low illness behavior cluster. Regression analysis revealed a particular effect of sex in the high illness behavior cluster: whereas being male was associated with increased illness behavior as measured by the SAIB, being female was linked to a higher number of doctor visits. Increased health anxiety was associated with the SAIB illness behavior in both clusters. Depression and anxiety did not show incremental associations with all aspects of illness behavior. CONCLUSION Knowledge of the pattern of illness behavior in patients with MUPS enables us to improve psychological treatments that directly address specific aspects of illness behavior or health anxiety. Differences between sexes in illness behaviors require more differentiated consideration in future research.
Collapse
Affiliation(s)
- Frauke Dorothee Weiss
- Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Philipps University of Marburg, Gutenbergstrasse 18, 35032, Marburg, Germany.
| | - Winfried Rief
- Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Philipps University of Marburg, Gutenbergstrasse 18, 35032, Marburg, Germany
| | - Alexandra Martin
- Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Bergische University of Wuppertal, Max-Horkheimer-Str. 20, 42097, Wuppertal, Germany
| | - Elisabeth Rauh
- Department of Psychosomatic and Behavioral Medicine, Am Kurpark 11, 96231, Bad Staffelstein, Germany
| | - Maria Kleinstäuber
- Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Philipps University of Marburg, Gutenbergstrasse 18, 35032, Marburg, Germany
| |
Collapse
|
43
|
Richardson LA, Porcerelli JH, Dauphin VB, Morris P, Murdoch W. The Use of the Social Cognition and Object Relations Scale in a Primary Care Setting. J Pers Assess 2017; 100:156-165. [DOI: 10.1080/00223891.2017.1369984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - John H. Porcerelli
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | | | - Pierre Morris
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | - William Murdoch
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| |
Collapse
|
44
|
DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis. J Psychosom Res 2017; 101:31-37. [PMID: 28867421 DOI: 10.1016/j.jpsychores.2017.07.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the reliability, validity and utility of DSM-5 illness anxiety disorder (IAD) and somatic symptom disorder (SSD), and explore their overlap with DSM-IV Hypochondriasis in a health anxious sample. METHODS Treatment-seeking patients with health anxiety (N=118) completed structured diagnostic interviews to assess DSM-IV Hypochondriasis, DSM-5 IAD, SSD, and comorbid mental disorders, and completed self-report measures of health anxiety, comorbid symptoms, cognitions and behaviours, and service utilization. RESULTS IAD and SSD were more reliable diagnoses than Hypochondriasis (kappa estimates: IAD: 0.80, SSD: 0.92, Hypochondriasis: 0.60). 45% of patients were diagnosed with SSD, 47% with IAD, and 8% with comorbid IAD/SSD. Most patients with IAD fluctuated between seeking and avoiding care (61%), whereas care-seeking (25%) and care-avoidant subtypes were less common (14%). Half the sample met criteria for DSM-IV Hypochondriasis; of those, 56% met criteria for SSD criteria, 36% for IAD, and 8% for comorbid IAD/SSD. Compared to IAD, SSD was characterized by more severe health anxiety, somatic symptoms, depression, and higher health service use, and higher rates of major depressive disorder, panic disorder and agoraphobia. CONCLUSIONS DSM-5 IAD and SSD classifications reliably detect more cases of clinically significant health anxiety than DSM-IV Hypochondriasis. The differences between IAD and SSD appear to be due to severity. Future research should explore the generalizability of these findings to other samples, and whether diagnostic status predicts treatment response and long-term outcome.
Collapse
|
45
|
Weck F, Nagel LC, Richtberg S, Neng JMB. Personality Disorders in Hypochondriasis: A Comparison to Panic Disorder and Healthy Controls. J Pers Disord 2017; 31:567-576. [PMID: 27749185 DOI: 10.1521/pedi_2016_30_271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous studies found high prevalence rates of personality disorders (PDs) in patients with hypochondriasis; however, assessment was often based only on questionnaires. In the current study, a sample of 68 patients with hypochondriasis was compared to 31 patients with panic disorder and to 94 healthy controls. Participants were investigated with the Structured Clinical Interview for DSM-IV Personality Disorders questionnaire (SCID-II questionnaire) and the SCID-II interview. Based on the cut-off scores of the SCID-II questionnaire, we found a prevalence rate of 45.6% for PD in patients with hypochondriasis. In comparison to healthy controls, patients with hypochondriasis showed characteristics of paranoid, borderline, avoidant, and dependent PDs in the dimensional assessment significantly more often. However, no significant differences were found between the clinical samples. Based on the SCID-II interview, only 2.9% of the patients with hypochondriasis fulfilled the criteria for a PD. These results suggest that PDs are not a specific characteristic of hypochondriasis.
Collapse
Affiliation(s)
- Florian Weck
- Department of Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
| | - Laura Carlotta Nagel
- Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany
| | - Samantha Richtberg
- Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany
| | - Julia M B Neng
- Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany
| |
Collapse
|
46
|
Limburg K, Sattel H, Dinkel A, Radziej K, Becker-Bense S, Lahmann C. Course and predictors of DSM-5 somatic symptom disorder in patients with vertigo and dizziness symptoms - A longitudinal study. Compr Psychiatry 2017; 77:1-11. [PMID: 28535434 DOI: 10.1016/j.comppsych.2017.05.003] [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] [Received: 01/30/2017] [Revised: 05/01/2017] [Accepted: 05/08/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Somatic symptom disorder (SSD) is a diagnosis that was newly included in DSM-5. Currently, data on the course of SSD are largely lacking. The present study aimed to evaluate the natural course of SSD in a one-year follow-up study in patients with vertigo and dizziness (VD) symptoms. METHODS We investigated n=239 outpatients presenting in a tertiary care neurological setting over a one-year period. Patients had a medical examination at baseline and completed self-report questionnaires, which were re-assessed after 12months. DSM-5 SSD was assigned retrospectively. We evaluated the prevalence of SSD at baseline and 12-month follow-up and investigated predictors of the persistence of SSD during the study period. RESULTS The prevalence rate of SSD was 36% at baseline and 62% at 12-months follow-up. The persistence rate of SSD was 82% and the incidence rate was high, leading to a markedly increased prevalence rate at follow-up. Risk factors for persistent SSD were a self-concept of bodily weakness (OR: 1.52, 95% CI: 1.30-1.78) and an increase of depression during the study period (OR: 1.11, 95% CI: 1.02-1.22). Further, the diagnosis of an anxiety disorder (OR: 7.52, 95% CI: 1.17-48.23) or both anxiety and depressive disorder (OR: 23.14, 95% CI: 2.14-249.91) at baseline were significant predictors. CONCLUSIONS Our findings point out that SSD is highly prevalent in patients with VD symptoms, the incidence of the disorder widely outweighs its remission. Potential predictors of a persistence of SSD are discussed and can be chosen as a focus in therapy.
Collapse
Affiliation(s)
- Karina Limburg
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany.
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Katharina Radziej
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany
| | - Claas Lahmann
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| |
Collapse
|
47
|
Symptoms and the body: Taking the inferential leap. Neurosci Biobehav Rev 2017; 74:185-203. [PMID: 28108416 DOI: 10.1016/j.neubiorev.2017.01.015] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/01/2016] [Accepted: 01/11/2017] [Indexed: 12/19/2022]
Abstract
The relationship between the conscious experience of physical symptoms and indicators of objective physiological dysfunction is highly variable and depends on characteristics of the person, the context and their interaction. This relationship often breaks down entirely in the case of "medically unexplained" or functional somatic symptoms, violating the basic assumption in medicine that physical symptoms have physiological causes. In this paper, we describe the prevailing theoretical approach to this problem and review the evidence pertaining to it. We then use the framework of predictive coding to propose a new and more comprehensive model of the body-symptom relationship that integrates existing concepts within a unifying framework that addresses many of the shortcomings of current theory. We describe the conditions under which a close correspondence between the experience of symptoms and objective physiology might be expected, and when they are likely to diverge. We conclude by exploring some theoretical and clinical implications of this new account.
Collapse
|
48
|
DSM-5 somatic symptom disorder in patients with vertigo and dizziness symptoms. J Psychosom Res 2016; 91:26-32. [PMID: 27894459 DOI: 10.1016/j.jpsychores.2016.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/11/2016] [Accepted: 10/16/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE DSM-5 somatic symptom disorder (SSD) could potentially be a highly relevant diagnosis for patients with vertigo and dizziness. The criteria of SSD, particularly the B-criterion with its three components (cognitive, affective, behavioral), have however not yet been investigated in this patient group. METHODS We evaluated a large sample (n=399) of outpatients presenting in a neurological setting. Physical examinations and a psychometric assessment (SCID-I) were conducted; patients completed self-report questionnaires. The diagnosis of SSD was assigned retrospectively. The prevalence of SSD, its diagnostic criteria, and its overlap with former DSM-IV somatoform disorders were evaluated; comparisons were drawn between (1) patients fulfilling different components of the B-criterion and (2) patients with diagnoses after DSM-IV vs. DSM-5. RESULTS SSD was almost twice as common as DSM-IV somatoform disorders. Patients with all three components of the B-criterion reported the highest impairment levels. Patients with both DSM-IV somatoform disorders and DSM-5 SSD were more impaired compared to groups with one of the diagnoses; patients with DSM-IV somatoform disorders only were more impaired than those with SSD only. CONCLUSIONS Our findings demonstrate that SSD is highly prevalent in patients with vertigo and dizziness. The classification of severity based on the number of psychological symptoms appears valid and may assist in finding suitable treatment options according to clinical practice guidelines. Future studies should investigate the overlap of SSD and other psychiatric disorders, this may assist in better defining the diagnostic criteria of SSD.
Collapse
|
49
|
Newby JM, Mahoney AE, Mason EC, Smith J, Uppal S, Andrews G. Pilot trial of a therapist-supported internet-delivered cognitive behavioural therapy program for health anxiety. Internet Interv 2016; 6:71-79. [PMID: 30135816 PMCID: PMC6096191 DOI: 10.1016/j.invent.2016.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 12/28/2022] Open
Abstract
Cognitive behavioural therapy (CBT) is an effective treatment for health anxiety, but more research is needed to evaluate accessible, low cost ways of delivering CBT. Internet CBT may be effective, but there are no iCBT programs available outside of Sweden. We developed the first English-language clinician-guided iCBT program for health anxiety and conducted an open pilot trial (n = 16) to examine its acceptability, and impact on health anxiety and comorbidity, disability, and the cognitive and behavioural factors thought to maintain the disorder (e.g., catastrophising, hypervigilance). 13/16 participants completed the program (81% adherence). We found large and significant reductions in health anxiety, depression, distress, anxiety and disability (g's > 1.0), dysfunctional cognitions, behaviours and body vigilance between pre- and post-treatment, which were maintained at 3-month follow-up. The results provide preliminary support for the use of iCBT for health anxiety. Randomised controlled efficacy trials are now needed to evaluate this program.
Collapse
Affiliation(s)
- Jill M. Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
- School of Psychology, University of New South Wales, Australia
| | - Alison E.J. Mahoney
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Elizabeth C. Mason
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Jessica Smith
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Shivani Uppal
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| |
Collapse
|
50
|
Fears, Coping Styles, and Health Behaviors: A Comparison of Patients With Hypochondriasis, Panic Disorder, and Depression. J Nerv Ment Dis 2016; 204:778-786. [PMID: 27441462 DOI: 10.1097/nmd.0000000000000566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research into correlates of illness anxiety disorder (formerly hypochondriasis) rarely applies comprehensive assessments of health behavior. Moreover, studies on phenomenological varieties of clinical health anxiety are scarce. We examined health behavior, fear, and acceptance of death and dying, and coping with a hypothetical bodily disease in patients with hypochondriasis, panic disorder, depression, and healthy controls (all groups n = 30) using self-rated questionnaires. ANOVA with Dunnett-T3 post hoc tests revealed no group differences in health behavior. The hypochondriasis and panic disorder groups showed more fear and less acceptance of death and dying than patients with depression and controls. Groups did not differ concerning coping strategies. Patients with hypochondriasis ruminated more when confronted with their most feared rather than another disease. Patients apparently overestimate the danger of a specific disease, but without underestimating their coping abilities. A therapeutic focus on fear of death and dying via cognitive interventions and exposure is recommended.
Collapse
|