Neuropsychological effects of hostility and pain on emotion perception

Psychosocial Underpinnings of Pain and Sleep Disturbance in Safety-Net Primary Care Patients

Objective

The aim of this study was to uncover possible psychosocial underpinnings of pain and sleep disturbance in a safety-net primary care sample.

Methods

Patients (n = 210) awaiting care in a safety-net primary care clinic waiting room completed measures of cynical hostility, social support, mental health, sleep disturbance, and pain. This study was cross-sectional and observational.

Results

A structural equation model suggested that higher cynical hostility was associated with lower social support, which in turn was associated with poorer mental health, which then corresponded with higher pain and sleep disturbance. All possible indirect (mediational) effects within this model were statistically significant, suggesting a possible route through which cynical hostility may shape pain and sleep, two common presenting problems in primary care.

Conclusions

These findings illustrate the interplay of psychosocial factors with chronic pain and sleep disturbance in a sample of low-income, predominantly African-American patients seeking care at a safety-net primary care clinic. The findings support integrated primary care as a way to target not only behavioral health issues but also the psychosocial factors entangled with physical health.

Hostility and cognitive control: Evidence of increased cardiovascular reactivity as a function of exposure to affective stress using a dichotic listening paradigm

Indices of cognitive control were examined in men with high and low levels of trait hostility as a function of exposure to affective and cognitive stress. A dual concurrent task paradigm was used whereby participants intentionally directed focus to the left or right ear under dichotic listening conditions before and after exposure to angry infant vocalizations. Analysis of the behavioral data supports the prediction of reduced right frontal regulatory control in men with high levels of hostility as indicated by diminished capacity to suppress report of phonemes presented to the language dominant left hemisphere (right ear) in the Focus Left condition. This diminishment in the capacity to suppress report of phonemes presented to the right ear in the Focus Left condition is suggestive of reduced cognitive control. With respect to the neurophysiological data, heart rate increased for only men with high levels of hostility in the Focus Left condition, and this was especially evident in the post-affective stress condition. This increase in right hemisphere arousal provides additional evidence of reduced cognitive control and support for the capacity model of hostility by implicating poor right frontal regulatory control over right posterior cerebral regions under dual task conditions. The results are discussed in terms of integrating the construct of cognitive control into the capacity model as well as providing implications regarding reductions in the capacity to suppress predominant aggressive responses in domestic settings.

Relationship of musculoskeletal pain and well-being at work - Does pain matter?

BACKGROUND AND AIMS

Musculoskeletal pain is a common symptom and many people even with chronic pain continue to work. The aim of our study is to analyze how musculoskeletal pain affects work well-being by comparing work engagement in employees with or without pain, and how pain-related risk of disability is associated with work engagement. In a separate analysis, we also studied, how psychosocial factors are related to work engagement.

METHODS

This is a cross-sectional study of Finnish female employees of the city of Pori, Finland (PORi To Aid Against Threats (PORTAAT) study). Data was collected by trained study nurses and self-administrated questionnaires. Work well-being was measured by work engagement using Utrecht Work Engagement Scale (UWES-9) questionnaire and the burden of pain was measured by using the short version of Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). Study population was divided into four groups: those without pain and the groups with low (I), medium (II) or high (III) ÖMPSQ score, reflecting increasing risk of long term disability due to musculoskeletal pain. The study nurse assessed psychosocial risk factors using defined core questions.

RESULTS

We evaluated 702 female employees, 601 (86%) had suffered from musculoskeletal pain over the past 12 months, whereas 101 (14%) reported no pain at all. Pain was chronic (duration at least 3 months) in 465/601 (77%) subjects. Subjects with musculoskeletal pain were older, had higher BMI and were on sick leave more often than subjects without pain. Of the psychosocial risk factors, depression, type D personality, anxiety and hostility were significantly more common among subjects with musculoskeletal pain. Hypertension and the use of non-steroidal anti-inflammatory drugs were significantly more frequent in the musculoskeletal pain group. Quality of sleep and working capability were significantly better among persons without pain. Average weekly working hours were slightly higher among those with musculoskeletal pain. In crude analysis, work engagement (UWES-9) was similar in women without pain and those with musculoskeletal pain (4.96 vs. 4.79; p=0.091). After adjustment for age, education years, BMI, working hours and financial satisfaction, the difference between the groups became statistically significant (p=0.036). Still, there was no difference between the groups of no-pain and low burden of pain (p=0.21, after adjustment). Work engagement was significantly lower in the groups of medium (p=0.024, after adjusted) and high (p<0.001, after adjustment) burden of pain. Linearity across the Linton tertiles was significant (p<0.001). In univariate and multivariate ordered logistic regression analyses relating study variables to the work engagement musculoskeletal pain per se did not enter in the model to explain work engagement. Work and family stress, type D personality and duration of sick leave due to pain reduced work engagement, whereas financial satisfaction, moderate and high leisure time physical activity and higher BMI improved it.

CONCLUSIONS

Among women with musculoskeletal pain psychosocial and lifestyle factors significantly correlate with work engagement, while the pain itself does not.

IMPLICATIONS

Special attention should be paid to the psychosocial aspects in female employees with musculoskeletal pain to improve work well-being and maintain work ability.

Frontal lobe regulation of blood glucose levels: support for the limited capacity model in hostile violence-prone men

Hostile men have reliably displayed an exaggerated sympathetic stress response across multiple experimental settings, with cardiovascular reactivity for blood pressure and heart rate concurrent with lateralized right frontal lobe stress (Trajanoski et al., in Diabetes Care 19(12):1412-1415, 1996; see Heilman et al., in J Neurol Neurosurg Psychiatry 38(1):69-72, 1975). The current experiment examined frontal lobe regulatory control of glucose in high and low hostile men with concurrent left frontal lobe (Control Oral Word Association Test [verbal]) or right frontal lobe (Ruff Figural Fluency Test [nonverbal]) stress. A significant interaction was found for Group × Condition, F (1,22) = 4.16, p ≤ .05 with glucose levels (mg/dl) of high hostile men significantly elevated as a function of the right frontal stressor (M = 101.37, SD = 13.75) when compared to the verbal stressor (M = 95.79, SD = 11.20). Glucose levels in the low hostile group remained stable for both types of stress. High hostile men made significantly more errors on the right frontal but not the left frontal stressor (M = 17.18, SD = 19.88) when compared to the low hostile men (M = 5.81, SD = 4.33). These findings support our existing frontal capacity model of hostility (Iribarren et al., in J Am Med Assoc 17(19):2546-2551, 2000; McCrimmon et al., in Physiol Behav 67(1):35-39, 1999; Brunner et al., in Diabetes Care 21(4):585-590, 1998), extending the role of the right frontal lobe to regulatory control over glucose mobilization.

The dynamic opponent relativity model: an integration and extension of capacity theory and existing theoretical perspectives on the neuropsychology of arousal and emotion

Arousal theory as discussed within the present paper refers to those mechanisms and neural systems involved in central nervous system activation and more specifically the systems involved in cortical activation. Historical progress in the evolution of arousal theory has led to a better understanding of the functional neural systems involved in arousal or activation processes and ultimately contributed much to our current theories of emotion. Despite evidence for the dynamic interplay between the left and right cerebral hemispheres, the concepts of cerebral balance and dynamic activation have been emphasized in the neuropsychological literature. A conceptual model is proposed herein that incorporates the unique contributions from multiple neuropsychological theories of arousal and emotion. It is argued that the cerebral hemispheres may play oppositional roles in emotion partially due to the differences in their functional specializations and in their persistence upon activation. In the presence of a threat or provocation, the right hemisphere may activate survival relevant responses partially derived from hemispheric specializations in arousal and emotional processing, including the mobilization of sympathetic drive to promote heightened blood pressure, heart rate, glucose mobilization and respiratory support necessary for the challenge. Oppositional processes and mechanisms are discussed, which may be relevant to the regulatory control over the survival response; however, the capacity of these systems is necessarily limited. A limited capacity mechanism is proposed, which is familiar within other physiological systems, including that providing for the prevention of muscular damage under exceptional demand. This capacity theory is proposed, wherein a link may be expected between exceptional stress within a neural system and damage to the neural system. These mechanisms are proposed to be relevant to emotion and emotional disorders. Discussion is provided on the possible role of currently applied therapeutic interventions for emotional disorders.

Physiological and behavioural indices of hostility: an extension of the capacity model to include exposure to affective stress and right lateralized motor stress

Right hemisphere functional cerebral systems have reliably been associated with sympathetic nervous system arousal and the perception of negative affective events. The goal of the current research was to provide additional support for the capacity model of hostility by examining changes attributable to functional cerebral systems within the right hemisphere using a dual concurrent task paradigm. To incorporate exposure to negative affective and right-lateralized motor stress using this approach, high and low hostile individuals completed a series of grip-strength tasks before and after hearing a recording of angry infant vocalizations. Results supported the capacity model in that high hostile individuals were unable to maintain regulatory control over right hemisphere activation as indicated through increased motor perseveration in the pre- and post-affective stress conditions, heightened systolic blood pressure (SBP) upon exposure to negative emotional sounds, and increased heart rate (HR) following stress. Conversely, low hostile individuals showed improved regulatory control over these regions as evidenced by reduced motor perseveration in the pre- and post-affective stress conditions, maintenance of SBP and reductions in HR following stress. The current data support the capacity model and extend its scope to include exposure to affective and right-lateralized motor stress.

An extension of the functional cerebral systems approach to hostility: a capacity model utilizing a dual concurrent task paradigm

Regulatory control of emotions and expressive fluency (verbal or design) have historically been associated with the frontal lobes. Moreover, research has demonstrated the importance of cerebral laterality with a prominent role of the right frontal regions in the regulation of negative affect (anger, hostility) and in the fluent production of designs rather than verbal fluency. In the present research, participants identified with high and with low levels of hostility were evaluated on a design fluency test twice in one experimental session. Before the second administration of the fluency test, each participant underwent physiological (cold pressor) stress. It was hypothesized that diminished right frontal capacity in high-hostile men would be evident through lowered performance on this cognitive stressor. Convergent validity of the capacity model was supported wherein high-hostile men evidenced reduced delta magnitude over the right frontal region after exposure to the physiological stressor but failed to maintain consistent levels of right cerebral activation across conditions. The results suggest an inability for high-hostile men to maintain stable levels of cerebral activation after exposure to physiological and cognitive stress. Moreover, low-hostiles showed enhanced cognitive performance on the design task with lower levels of arousal (heightened delta magnitude). In contrast, reduced arousal yielded increased executive deficits in high-hostiles as evidenced through increased perseverative errors on the design fluency task.

The sad, the angry, and the asymmetrical brain: dichotic listening studies of negative affect and depression

Dichotic Listening (DL) is a valuable tool to study emotional brain lateralization. Regarding the perception of sadness and anger through affective prosody, the main finding has been a left ear advantage (LEA) for the sad but contradictory data for the anger prosody. Regarding an induced mood in the laboratory, its consequences upon DL were a diminished right ear advantage (REA) for the induction of sadness and an increased REA for the induction of anger. The global results fit with the approach-withdrawal motivational model of emotional processing, pointing to sadness as a right hemisphere emotion but anger processed bilaterally or even in the left hemisphere, depending on the subject's preferred mode of expression. On the other hand, the study of DL in clinically depressed patients found an abnormally larger REA in verbal DL tasks which was predictive of therapeutic pharmacological response. However, the mobilization of the available left hemisphere resources in these responders (reflected in a higher REA) would indicate a remission of the episode but would not assure the absence of new relapses.