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Mamtani NH, Mamtani HG, Chaturvedi SK. Psychiatric aspects of ophthalmic disorders: A narrative review. Indian J Ophthalmol 2023; 71:1810-1815. [PMID: 37203034 PMCID: PMC10391518 DOI: 10.4103/ijo.ijo_2101_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Ophthalmic disorders have psychiatric aspects associated with them at various levels. Psychological factors have a well-documented role in the causation, aggravation, and maintenance of various ophthalmic conditions, including glaucoma, central serous retinopathy, dry eye disease, and retinitis pigmentosa. Many ophthalmic conditions, including blindness, have psychological manifestations as well, which need to be addressed, in addition to the ophthalmic pathology. There is also significant overlap in the treatment of the two disciplines in many ways. For instance, many ophthalmic drugs have psychiatric side effects. Even ophthalmological surgeries have psychiatric aspects associated with them, which primarily include black patch psychosis and anxiety in the operation theater. This review will be useful for psychiatrists and ophthalmologists, for their clinical practice and research. Future research should focus on this interface to give it its well-deserved attention.
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Affiliation(s)
- Nidhi H Mamtani
- Department of Glaucoma, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Harkishan Gurmukh Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Santosh K Chaturvedi
- Department of Psychiatry, Leicestershire Partnership, NHS Trust, Leicester, United Kingdom
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2
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Gilchrist PT, Provini F. Sleep syncope: a new clinical entity or just a vasovagal syncope during wakefulness after sleep onset? Clin Auton Res 2022; 32:5-6. [PMID: 35015169 DOI: 10.1007/s10286-021-00847-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Philippe T Gilchrist
- School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy. .,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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3
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Botan V, Critchley HD, Ward J. Different psychophysiological and clinical symptoms are linked to affective versus sensory vicarious pain experiences. Psychophysiology 2021; 58:e13826. [PMID: 33942318 DOI: 10.1111/psyp.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
For some people, seeing pain in others triggers a pain-like experience in themselves: these experiences can either be described in sensory terms and localized to specific body parts (sensory-localized, or S/L) or in affective terms and nonlocalized or whole-body experiences (affective-general, or A/G). In two studies, it is shown that these are linked to different clinical and psychophysiological profiles relative to controls. Study 1 shows that the A/G profile is linked to symptoms of Blood-Injection-Injury Phobia whereas the S/L profile shows some tendency toward eating disorders. Study 2 shows that the A/G profile is linked to poor interoceptive accuracy (for heartbeat detection) whereas the S/L profile is linked to higher heart-rate variability (HRV) when observing pain, which is typically regarded as an index of good autonomic emotion regulation. Neither group showed significant differences in overall heart rate, systolic blood pressure (SBP), or skin conductance response (SCR) when observing pain, and no overall differences in state or trait anxiety. Overall, the research points to different underlying mechanisms linked to different manifestations of vicarious pain response. Affective-General pain responders have strong subjective bodily experiences (likely of central origin given the absence of major differences in autonomic responsiveness) coupled with a worse ability to read objective interoceptive signals. Sensory-localized pain responders have differences in their ability to construct a multi-sensory body schema (as evidenced by prior research on the Rubber Hand Illusion) coupled with enhanced cardiovagal (parasympathetic) reactivity often indicative of better stress adaptation.
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Affiliation(s)
- V Botan
- School of Psychology, University of Sussex, East Sussex, UK.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
| | - H D Critchley
- School of Psychology, University of Sussex, East Sussex, UK.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - J Ward
- School of Psychology, University of Sussex, East Sussex, UK.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
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4
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Abado E, Aue T, Okon-Singer H. Cognitive Biases in Blood-Injection-Injury Phobia: A Review. Front Psychiatry 2021; 12:678891. [PMID: 34326784 PMCID: PMC8313757 DOI: 10.3389/fpsyt.2021.678891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022] Open
Abstract
Blood-injection-injury (BII) phobia can lead to avoidance of crucial medical procedures and to detrimental health consequences, even among health workers. Yet unlike other specific phobias, BII phobia has been understudied. Specifically, while cognitive biases have been extensively investigated in other anxiety disorders, little is known about the same biases in BII phobia. The current article reviews cognitive biases in BII phobia and suggest future directions for further study and treatment. The reviewed biases include attention, expectancy, memory, perception, and interpretation biases. The investigation of these biases is highly relevant, as cognitive biases have been found to interact with anxiety symptoms. Results showed that attention, expectancy, and memory biases are involved in BII phobia, while no studies were found on interpretation nor perception biases. Mixed results were found for attention bias, as different studies found different components of attention bias, while others found no attention bias at all. Similarly, some studies found a-priori/a-posteriori expectancy biases, while other studies found only one type of bias. A better understanding of the cognitive particularities of BII phobia may lead to better treatments and ultimately reduce avoidance of needles and blood-related situations, thereby enabling individuals with BII phobia to undergo potentially life-saving medical procedures.
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Affiliation(s)
- Elinor Abado
- School of Psychological Sciences, University of Haifa, Haifa, Israel.,The Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Tatjana Aue
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Hadas Okon-Singer
- School of Psychological Sciences, University of Haifa, Haifa, Israel.,The Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
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5
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Sánchez-Navarro JP, Martínez-Selva JM, Maldonado EF, Carrillo-Verdejo E, Pineda S, Torrente G. Autonomic reactivity in blood-injection-injury and snake phobia. J Psychosom Res 2018; 115:117-124. [PMID: 30470310 DOI: 10.1016/j.jpsychores.2018.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This research aimed to study the salivary flow and other autonomic reactions -heart rate (HR) and skin conductance response (SCR)- in blood-injection-injury (BII) phobia and snake phobia participants, under the assumption that exposure to blood-related pictures in BII phobia will provoke an increase in parasympathetic activity that, in turn, will lead to a greater saliva production than other affective contents. METHODS We selected 18 BII phobia and 14 snake phobia participants along with 22 non-phobia individuals. All participants were exposed to 3 blocks of pictures (12 pictures per block) depicting either mutilations, snakes or neutral, household objects. Saliva samples were taken in the 2-min interval before and after each block. RESULTS In comparison to other contents, blood-related pictures provoked an increase in salivary flow in BII phobia participants, as well as an increase in the number of SCRs. In the snake phobia group, snake pictures provoked HR acceleration, but the SCRs they elicited did not differ from the SCRs provoked by the blood-related pictures. CONCLUSION BII phobia individuals react to their phobic object with a series of physiological changes resulting from a sympathetic-parasympathetic co-activation. This is in contrast with other specific phobias (e.g., small animal phobias) that usually show a sympathetically mediated, defensive reactivity when exposed to their disorder-relevant stimuli. These data support the use of therapeutic interventions in BII phobia that may differ in some respect from those used in other specific phobias.
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Affiliation(s)
- Juan P Sánchez-Navarro
- Department of Human Anatomy and Psychobiology, School of Psychology, University of Murcia, Murcia 30100, Spain; Institute of Biomedical Research of Murcia (IMIB-Arrixaca), Spain.
| | - José M Martínez-Selva
- Department of Human Anatomy and Psychobiology, School of Psychology, University of Murcia, Murcia 30100, Spain; Institute of Biomedical Research of Murcia (IMIB-Arrixaca), Spain
| | | | - Eduvigis Carrillo-Verdejo
- Department of Human Anatomy and Psychobiology, School of Psychology, University of Murcia, Murcia 30100, Spain; Institute of Biomedical Research of Murcia (IMIB-Arrixaca), Spain
| | - Sara Pineda
- Department of Human Anatomy and Psychobiology, School of Psychology, University of Murcia, Murcia 30100, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Ginesa Torrente
- Department of Human Anatomy and Psychobiology, School of Psychology, University of Murcia, Murcia 30100, Spain; Institute of Biomedical Research of Murcia (IMIB-Arrixaca), Spain
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6
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Meuret AE, Simon E, Bhaskara L, Ritz T. Ultra-brief behavioral skills trainings for blood injection injury phobia. Depress Anxiety 2017; 34:1096-1105. [PMID: 28294471 DOI: 10.1002/da.22616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Blood injection injury (BII) phobia is common, with debilitating consequences to the health and well being of many of its sufferers. BII phobia presents with a unique fear response that can involve drops in blood pressure and ultimately fainting. The aim of this study was to provide proof of concept for a line of brief, easy to implement, video-based interventions for reducing phobic avoidance and fears in BII sufferers. One of the interventions was a novel Hypoventilation Respiratory Training (HRT) aimed at reducing the exaggerated ventilation response (hyperventilation) seen in BII phobia. The response has been linked to cerebral vasoconstriction and fainting symptoms. METHOD Sixty BII patients were randomly assigned to one of three 12-min video-guided trainings: Symptom-Associated Tension (SAT) training, Relaxation Skills Training (RST), or HRT. Experiential and cardiorespiratory activity to phobic stimuli was assessed before and after training. RESULTS Both SAT and HRT resulted in overall greater reductions of phobic fears and symptoms than RST. SAT significantly increased heart rate during exposure, and HRT led to significantly reduced ventilation, increases in PCO2 , and elevated blood pressure throughout exposure and recovery. Treatment expectancy was rated equally high across conditions, whereas credibility ratings were highest for HRT. CONCLUSIONS Brief, video-based instructions in muscle tension and normocapnic breathing are effective in reducing BII symptom severity and require minimal time and expertise. HRT may be particularly helpful in reducing fainting caused by cerebral vasoconstriction.
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Erica Simon
- Palo Alto Veterans Institute for Research, Palo Alto, CA, USA.,National Center for PTSD-Dissemination and Training Division, Palo Alto VA Healthcare System, Livermore, CA, USA
| | - Lavanya Bhaskara
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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7
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Simon E, Meuret AE, Ritz T. Sympathetic and parasympathetic cardiac responses to phobia-relevant and disgust-specific emotion provocation in blood-injection-injury phobia with and without fainting history. Psychophysiology 2017; 54:1512-1527. [DOI: 10.1111/psyp.12900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Erica Simon
- Palo Alto Veterans Institute for Research; Palo Alto California USA
- National Center for PTSD-Dissemination and Training Division; Menlo Park California USA
| | - Alicia E. Meuret
- Department of Psychology; Southern Methodist University; Dallas Texas USA
| | - Thomas Ritz
- Department of Psychology; Southern Methodist University; Dallas Texas USA
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8
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Harrison JM, Gilchrist PT, Corovic TS, Bogetti C, Song Y, Bacon SL, Ditto B. Respiratory and hemodynamic contributions to emotion-related pre-syncopal vasovagal symptoms. Biol Psychol 2017; 127:46-52. [PMID: 28456564 DOI: 10.1016/j.biopsycho.2017.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 04/10/2017] [Accepted: 04/22/2017] [Indexed: 02/05/2023]
Abstract
Vasovagal reactions are conventionally understood as resulting from systemic changes in cardiovascular activity; however, there exists a complementary perspective focused on specific changes in cerebral vasoconstriction associated with hyperventilation-induced hypocapnia. The present study investigated the role of cardiovascular and respiratory activity in self-reported pre-syncopal vasovagal reactions to a surgery video in a sample of 49 healthy women. Participants who indicated more previous real-life episodes of dizziness reported experiencing significantly more symptoms in the laboratory consistent with a vasovagal response. They also showed lower total peripheral resistance and higher pre-ejection period in general, suggesting lower sympathetic nervous system activity. Significant decreases in end-tidal carbon dioxide (PETCO2) occurred during the surgery video among susceptible participants, without significant increases in respiration rate. Further, participants who experienced reductions from the neutral video in PETCO2, systolic blood pressure, or both, reported vasovagal symptoms during the surgery video. The results suggest that patterns of respiration associated with decreases in PETCO2 may contribute to vasovagal symptoms reported in non-clinical groups as well as those with blood-injection-injury phobia and are associated with susceptibility to dizziness.
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Affiliation(s)
- Johanna M Harrison
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Ave. Docteur Penfield, Montreal, Quebec, H3A 1B1, Canada.
| | - Philippe T Gilchrist
- Wolfson College, University of Cambridge, Cambridge CB3 9BB, United Kingdom; MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort's Causeway, Cambridge, CB1 8RN, United Kingdom
| | - Tiana S Corovic
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Ave. Docteur Penfield, Montreal, Quebec, H3A 1B1, Canada
| | - Curtis Bogetti
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Ave. Docteur Penfield, Montreal, Quebec, H3A 1B1, Canada
| | - Yuqing Song
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Ave. Docteur Penfield, Montreal, Quebec, H3A 1B1, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec, H4 B 1R6, Canada
| | - Blaine Ditto
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Ave. Docteur Penfield, Montreal, Quebec, H3A 1B1, Canada
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9
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Disgust stimuli reduce heart rate but do not contribute to vasovagal symptoms. J Behav Ther Exp Psychiatry 2016; 51:116-22. [PMID: 26851836 DOI: 10.1016/j.jbtep.2016.01.005] [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: 08/07/2015] [Revised: 12/09/2015] [Accepted: 01/27/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The vasovagal response demonstrates a unique form of stress response, common in medical settings yet provoked by a variety of blood-injury-injection stimuli. This study aimed to better understand the psychophysiological mechanisms of the vasovagal response.. METHODS 16 undergraduates with and 42 without a self-reported history of fainting watched five 3-5 min videos with different emotional content. One documentary clip (Neutral condition) described a campus environmental project while another (Blood/Injury) depicted portions of an open heart surgery. Three additional clips were also used, including Medical, Threat, and Contamination stimuli. Vasovagal symptoms and physiological variables were assessed during each video. RESULTS As predicted, while the disgust-related stimuli (Blood/Injury, Medical, Contamination) were associated with generally lower heart rate, the Blood/Injury video produced the highest symptoms and the only significant difference between previous fainters and non-fainters. The physiological measures also revealed that participants with a fainting history experienced higher stroke volume and lower systolic blood pressure throughout, as well as several main effects of video. LIMITATIONS An additional decrease in systolic blood pressure and respiration produced by watching the Blood/Injury video may have been sufficient to trigger symptoms in some, though results also suggest that systemic variables do not entirely explain susceptibility to symptoms. More careful evaluation of regional blood flow may be required. CONCLUSIONS Participants who had previously experienced strong vasovagal responses displayed what appeared to be an anticipatory response to the Blood/Injury video. Finally, disgust stimuli may reduce heart rate but do not appear to contribute to vasovagal symptoms.
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10
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Gilchrist PT, McGovern GE, Bekkouche N, Bacon SL, Ditto B. The vasovagal response during confrontation with blood-injury-injection stimuli: the role of perceived control. J Anxiety Disord 2015; 31:43-8. [PMID: 25728015 DOI: 10.1016/j.janxdis.2015.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 01/14/2015] [Accepted: 01/29/2015] [Indexed: 11/30/2022]
Abstract
The vasovagal response (VVR) is a common medical problem, complicating and deterring people from various procedures. It is an unusual stress response given the widespread decreases in physiological activity. Nevertheless, VVR involves processes similar to those observed during episodes of strong emotions and pain. We hypothesized that heightened perceived control would reduce symptoms of VVR. Eighty-two young adults were randomly assigned to perceived control or no perceived control conditions during exposure to a stimulus video of a mitral valve surgery, known to trigger VVR in non-medical personnel. Perceived control was manipulated by allowing some participants to specify a break time, though all received equivalent breaks. Outcomes included subjective symptoms of VVR, anxiety, blood pressure, heart rate, and other measures derived from impedance cardiography. Compared to participants with perceived control, participants with no perceived control reported significantly more vasovagal symptoms and anxiety, and experienced lower stroke volume, cardiac output, and diastolic blood pressure. Participants who were more fearful of blood were more likely to benefit from perceived control in several measures. Perceived control appears to reduce vasovagal symptoms. Results are discussed in terms of cognition and emotion in VVR.
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Affiliation(s)
- Philippe T Gilchrist
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Dr Penfield Avenue, Montreal, Quebec H3A 1B1, Canada.
| | - Gillian E McGovern
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Dr Penfield Avenue, Montreal, Quebec H3A 1B1, Canada
| | - Nadine Bekkouche
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Dr Penfield Avenue, Montreal, Quebec H3A 1B1, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre and Research Centre, Hôpital du Sacré-Coeur de Montréal - A University of Montreal Affiliated Hospital, Montreal H4J 1C5, Canada; Department of Exercise Science, Concordia University, 7141 Sherbrooke Street West, Montreal, Quebec H4B 1R6, Canada
| | - Blaine Ditto
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, 1205 Dr Penfield Avenue, Montreal, Quebec H3A 1B1, Canada
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11
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Gilchrist PT, Ditto B. Sense of impending doom: Inhibitory activity in waiting blood donors who subsequently experience vasovagal symptoms. Biol Psychol 2015; 104:28-34. [DOI: 10.1016/j.biopsycho.2014.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 11/26/2022]
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12
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Fang J, Prakash R. Antiseptic phobia in a patient experiencing anesthesia awareness during cleft palate repair surgery: a case report. Gen Hosp Psychiatry 2013; 35:681.e1-3. [PMID: 23725824 DOI: 10.1016/j.genhosppsych.2013.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/18/2013] [Accepted: 04/19/2013] [Indexed: 11/25/2022]
Abstract
Specific phobia is an excessive and irrational fear often triggered by a stressor. Among different types of phobias arising in medical settings, we could not find any case reported for exclusively antiseptic fluids without any medical-surgical intervention. The term "anesthesia awareness" (AA) signifies the specific surgical period of time when an individual, in spite of being under intended general anesthesia, remains aware of the sensory stimuli and the memories of which also remain available for his subsequent explicit recall in the future. According to the "American Society of Anesthesiologists Practice Advisory", it is explicit recall during general anesthesia. Its hallmark is the presence of awareness of the events going on during the surgical procedure while being under a general anesthesia. AA is a distressing condition with immediate and long-term consequences. In spite of an estimated prevalence of 0.1%-0.2% of all the surgeries, our knowledge about this condition is limited. The most commonly reported consequences of AA are acute painful flashbacks of surgical events along with the emotional turmoil and a sense of helplessness followed later by posttraumatic stress disorder. Here, we report a unique case of occurrence of "antiseptic-phobia" in a patient following the experience of anesthesia awareness during cleft palate repair surgery.
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Affiliation(s)
- Jun Fang
- Department of Anesthesiology, ZheJiang Cancer Hospital, China.
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13
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Cardiac Autonomic Function Associated with Treatment Adherence After a Brief Intervention in Patients with Chronic Pain. Appl Psychophysiol Biofeedback 2013; 38:193-201. [DOI: 10.1007/s10484-013-9222-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Ritz T, Meuret AE, Simon E. Cardiovascular activity in blood-injection-injury phobia during exposure: evidence for diphasic response patterns? Behav Res Ther 2013; 51:460-8. [PMID: 23747585 DOI: 10.1016/j.brat.2013.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 02/20/2013] [Accepted: 03/28/2013] [Indexed: 11/19/2022]
Abstract
Exposure to feared stimuli in blood-injection-injury (BII)-phobia is thought to elicit a diphasic response pattern, with an initial fight-flight-like cardiovascular activation followed by a marked deactivation and possible fainting (vasovagal syncope). However, studies have remained equivocal on the importance of such patterns. We therefore sought to determine the prevalence and clinical relevance of diphasic responses using criteria that require a true diphasic response to exceed cardiovascular activation of an emotional episode of a negative valence and to exceed deactivation of an emotionally neutral episode. Sixty BII-phobia participants and 20 healthy controls were exposed to surgery, anger and neutral films while measuring heart rate, blood pressure, respiratory pattern, and end-tidal partial pressure of carbon dioxide (as indicator of hyperventilation). Diphasic response patterns were observed in up to 20% of BII-phobia participants and 26.6% of healthy controls for individual cardiovascular parameters. BII-phobia participants with diphasic patterns across multiple parameters showed more fear of injections and blood draws, reported the strongest physical symptoms during the surgery film, and showed the strongest tendency to hyperventilate. Thus, although only a minority of individuals with BII phobia shows diphasic responses, their occurrence indicates significant distress. Respiratory training may add to the treatment of BII phobia patients that show diphasic response patterns.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA.
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15
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Ritz T, Bosquet Enlow M, Schulz SM, Kitts R, Staudenmayer J, Wright RJ. Respiratory sinus arrhythmia as an index of vagal activity during stress in infants: respiratory influences and their control. PLoS One 2012; 7:e52729. [PMID: 23300753 PMCID: PMC3530477 DOI: 10.1371/journal.pone.0052729] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/21/2012] [Indexed: 11/24/2022] Open
Abstract
Respiratory sinus arrhythmia (RSA) is related to cardiac vagal outflow and the respiratory pattern. Prior infant studies have not systematically examined respiration rate and tidal volume influences on infant RSA or the extent to which infants' breathing is too fast to extract a valid RSA. We therefore monitored cardiac activity, respiration, and physical activity in 23 six-month old infants during a standardized laboratory stressor protocol. On average, 12.6% (range 0–58.2%) of analyzed breaths were too short for RSA extraction. Higher respiration rate was associated with lower RSA amplitude in most infants, and lower tidal volume was associated with lower RSA amplitude in some infants. RSA amplitude corrected for respiration rate and tidal volume influences showed theoretically expected strong reductions during stress, whereas performance of uncorrected RSA was less consistent. We conclude that stress-induced changes of peak-valley RSA and effects of variations in breathing patterns on RSA can be determined for a representative percentage of infant breaths. As expected, breathing substantially affects infant RSA and needs to be considered in studies of infant psychophysiology.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas, United States of America.
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16
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Does disgust increase parasympathetic activation in individuals with a history of fainting? A psychophysiological analysis of disgust stimuli with and without blood-injection-injury association. J Anxiety Disord 2012; 26:849-58. [PMID: 23023164 DOI: 10.1016/j.janxdis.2012.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/07/2012] [Accepted: 07/14/2012] [Indexed: 11/20/2022]
Abstract
People with blood-injection-injury fear can faint when being confronted with blood, injections or injuries. Page (1994) holds that people with blood-injury phobia faint, because they are disgust sensitive and disgust facilitates fainting by eliciting parasympathetic activity. We tested the following two hypotheses: (1) Disgusting pictures elicit more disgust in blood-injection-injury-anxious people with a history of fainting than they do in controls. (2) Disgust causes parasympathetic activation. Subjects were 24 participants with high blood-injection-injury fear and a history of fainting in anxiety relevant situations and 24 subjects with average blood-injection-injury fear and no fainting history. We analyzed self-reported feelings of disgust, anxiety and faintness and reactions in heart rate, skin conductance, blood pressure and respiratory sinus arrhythmia during the confrontation with disgusting pictures with and without blood content. We did not find any evidence that the blood-injection-injury anxious subjects were more disgust sensitive than the control subjects and we also did not find any evidence that disgust elicits parasympathetic activation.
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17
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Airway constriction in asthma during sustained emotional stimulation with films. Biol Psychol 2012; 91:8-16. [PMID: 22490762 DOI: 10.1016/j.biopsycho.2012.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 03/16/2012] [Accepted: 03/26/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND Individuals with asthma have been shown to respond to unpleasant stimuli with bronchoconstriction, but little is known about the time course of responding during sustained emotional stimulation and whether it varies with patients' experience. OBJECTIVE To examine the time course of oscillatory resistance (R(os)) during emotionally evocative films in 15 asthma patients and 14 healthy controls. METHODS Participants viewed unpleasant, surgery, and neutral films, each ranging 3-5min in duration. R(os) and the respiratory pattern (respiration rate, tidal volume, minute ventilation) were monitored continuously. Following each film, participants rated their affective response and symptoms. The time course of R(os) during films was explored using multilevel modeling. RESULTS Compared to neutral film sequences, unpleasant films (including those with surgery scenes) elicited a uniform pattern of initial increases in R(os) with peaks within the first 1-2min, followed by a gradual decline. Increases were more pronounced in asthma and during surgery films. Including additional respiratory parameters as time-varying covariates did not affect the temporal course of R(os) change. The rate of decline in R(os) (after the initial increase) was less in participants who experienced greater arousal and in patients who reported more shortness of breath. Patients more susceptible to psychological triggers in daily life showed slower rates of decline in R(os). CONCLUSION The temporal course of bronchoconstriction to unpleasant stimulation is highly uniform in asthma, with strong constriction in early stages of stimulation. More sustained constriction in emotion-induced asthma could be a risk factor for developing asthma exacerbation in daily life.
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Gilchrist PT, Ditto B. The effects of blood-draw and injection stimuli on the vasovagal response. Psychophysiology 2012; 49:815-20. [PMID: 22416882 DOI: 10.1111/j.1469-8986.2012.01359.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 01/04/2012] [Indexed: 11/30/2022]
Abstract
Vasovagal reactions (VVR) are common, complicating and deterring people from various medical procedures. A recent perspective (R. R. Diehl, ) suggests that VVR developed from the adaptive process of hemorrhagic fainting, perhaps as a means of preparing for anticipated blood loss. The primary goal of this study was to compare vasovagal symptoms during intravenous-injection and blood-draw videos. Sixty-two young adults watched the videos. Vasovagal symptoms were assessed with self-report, blood pressure, and heart rate variability. As predicted, participants reported more vasovagal symptoms and anxiety following the blood-draw video. Sympathetic nervous system activity (low- to high-frequency ratio) decreased during both videos but significantly more during the blood-draw video, although this could be reversed by the Applied Tension technique. Results are discussed in terms of the relevance of specific stimuli and emotions in VVR.
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Affiliation(s)
- Philippe T Gilchrist
- Laboratory for Cardiovascular Psychophysiology, Department of Psychology, McGill University, Montreal, Quebec, Canada.
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Vossbeck-Elsebusch AN, Gerlach AL. The relation between disgust-sensitivity, blood-injection-injury fears and vasovagal symptoms in blood donors: disgust sensitivity cannot explain fainting or blood donation-related symptoms. J Behav Ther Exp Psychiatry 2012; 43:607-13. [PMID: 21906532 DOI: 10.1016/j.jbtep.2011.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/22/2011] [Accepted: 08/15/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Page's (1994) prominent theory for the explanation of fainting in blood-injection-injury situations holds that disgust sensitivity contributes to syncopal reactions. We investigated if blood donation-related vasovagal symptoms (1) or fainting related to blood donations (2) are associated with disgust sensitivity. METHODS In an online sample of 361 blood donors, we assessed blood-injection-injury fears, disgust sensitivity, history of blood donation related fainting and retrospective self-ratings of vasovagal symptoms. For the assessment of blood-injection-injury fears we used the BII-Q which has excellent psychometric properties and does not confound disgust and anxiety sensitivity. Vasovagal symptoms were measured by the Blood Donation Reactions Inventory (BDRI) which captures mild and strong vasovagal symptoms and has been used in previous studies with blood donors. RESULTS Disgust sensitivity did not significantly contribute to the explanation of self-reported vasovagal symptoms in a regression model with gender, blood-injection-injury fear and disgust sensitivity as predictors. We did not find any significant group differences in disgust sensitivity for blood donors with or without a fainting history (statistical power = 0.95) and a Bayesian model selection procedure showed that it is more likely that both groups are equally disgust sensitive than it is that the fainters are more disgust sensitive. LIMITATIONS Further research is required to confirm the findings in prospective studies. CONCLUSION Our results indicate that disgust sensitivity is not relevant for the development of vasovagal syncopes.
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Affiliation(s)
- Anna N Vossbeck-Elsebusch
- Westfälische Wilhelms-Universität Münster, Institut für Klinische Psychologie und Psychotherapie, Fliednerstraße 21, 48149 Münster, Germany.
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Effects of experienced disgust on habituation during repeated exposure to threat-relevant stimuli in blood-injection-injury phobia. Behav Ther 2012; 43:132-41. [PMID: 22304885 DOI: 10.1016/j.beth.2011.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 04/22/2011] [Accepted: 04/27/2011] [Indexed: 11/23/2022]
Abstract
Despite growing evidence implicating disgust in the etiology of blood-injection-injury (BII) phobia, the relevance of disgust for exposure-based treatment of BII phobia remains largely unknown. Individuals with BII phobia were randomly assigned to a disgust (view vomit videos) or neutral activation (view waterfall videos) condition. They were then exposed to 14 videotaped blood draws, during which fear and disgust levels were repeatedly assessed. Participants then engaged in a behavioral avoidance test (BAT) consisting of exposure to threat-relevant stimuli. Examination of outcome comparing the identical first and last blood-draw clips revealed that fear and disgust toward blood draws was significantly reduced in both groups. Disgust levels were also found to be more intense for the video stimuli relative to fear levels whereas the opposite was true for BAT stimuli. Contrary to predictions, the disgust induction did not enhance reductions in negative responses to the target video or reduce behavioral avoidance. Growth curve analyses did show that individuals with BII phobia exposed to the disgust induction showed greater initial fear levels during repeated exposure than those in the neutral condition. However, this effect was not consistently observed across different analytic approaches. Changes in fear during exposure were also found to be independent of changes in disgust but not vice versa, and greater initial fear levels during repeated exposure to threat was associated with fear and disgust levels during the BAT. The implications of these findings for conceptualizing the role of disgust in etiology and treatment of BII phobia are discussed.
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Aue T, Hoeppli ME, Piguet C. The Sensitivity of Physiological Measures to Phobic and Nonphobic Fear Intensity. J PSYCHOPHYSIOL 2012. [DOI: 10.1027/0269-8803/a000078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We investigated whether amygdala activation, autonomic responses, respiratory responses, and facial muscle activity (measured over the brow and cheek [fear grin] regions) are all sensitive to phobic versus nonphobic fear and, more importantly, whether effects in these variables vary as a function of both phobic and nonphobic fear intensity. Spider-phobic and comparably low spider-fearful control participants imagined encountering different animals and rated their subjective fear while their central and peripheral nervous system activity was measured. All measures included in our study were sensitive to variations in subjective fear, but were related to different ranges and positions on the subjective fear level continuum. Left amygdala activation, heart rate, and facial muscle activity over the cheek region captured fear intensity variations even within narrowly described regions on the fear level continuum (here within extremely low levels of fear and within considerable phobic fear). Skin conductance and facial muscle activity over the brow region did not capture fear intensity variations within low levels of fear: skin conductance mirrored only extreme levels of fear, and activity over the brow region distinguished phobic from nonphobic fear but also low-to-moderate and high phobic fear. Finally, respiratory measures distinguished phobic from nonphobic fear with no further differentiation within phobic and nonphobic fear. We conclude that a careful consideration of the measures to be used in an investigation and the population to be examined can be critical in order to obtain significant results.
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Voßbeck-Elsebusch AN, Schroers LK, Gerlach AL. Diagnostik der Blut-Verletzungs-Spritzen-Angst. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2012. [DOI: 10.1026/1616-3443/a000127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Zur Erfassung von Blut-Verletzungs-Spritzen-Ängsten sollte für den deutschen Sprachraum ein valider Fragebogen mit klarer Faktorenstruktur entwickelt werden. Fragestellung: Entwicklung eines neuen Messinstrumentes, welches auf die Erhebung von Blut-Verletzungs-Spritzen-Ängstlichkeit fokussiert. Methode: Entwicklung und Validierung eines Fragebogens an 340 Studenten, 20 Phobikern, 20 Kontrollpersonen und 18 Blutspendern. Ergebnisse: Es ergab sich ein Fragebogen mit 20 Items. Die Retest-Korrelation war hoch (rtt(42) = .78). Die Validitätsanalyse ergab hohe Korrelationen mit konstruktnahen Fragebögen, niedrige Korrelationen mit konstruktfernen Fragebögen und eine gute Differenzierung zwischen Phobikern und Kontrollpersonen. Ab einem Cut-Off von 44 (Range 20 bis 140) sollte das Vorliegen einer Blut-Verletzungs-Spritzen-Phobie geprüft werden. Schlussfolgerungen: Es konnte ein reliabler und valider deutscher Fragebogen mit vier klar definierten Faktoren entwickelt werden.
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Gonçalez TT, Sabino EC, Schlumpf KS, Wright DJ, Leao S, Sampaio D, Takecian PL, Proietti AB, Proitetti AB, Murphy E, Busch M, Custer B. Vasovagal reactions in whole blood donors at three REDS-II blood centers in Brazil. Transfusion 2011; 52:1070-8. [PMID: 22073941 DOI: 10.1111/j.1537-2995.2011.03432.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In Brazil little is known about adverse reactions during donation and the donor characteristics that may be associated with such events. Donors are offered snacks and fluids before donating and are required to consume a light meal after donation. For these reasons the frequency of reactions may be different than those observed in other countries. STUDY DESIGN AND METHODS A cross-sectional study was conducted of eligible whole blood donors at three large blood centers located in Brazil between July 2007 and December 2009. Vasovagal reactions (VVRs) along with donor demographic and biometric data were collected. Reactions were defined as any presyncopal or syncopal event during the donation process. Multivariable logistic regression was performed to identify predictors of VVRs. RESULTS Of 724,861 donor presentations, 16,129 (2.2%) VVRs were recorded. Rates varied substantially between the three centers: 53, 290, and 381 per 10,000 donations in Recife, São Paulo, and Belo Horizonte, respectively. Although the reaction rates varied, the donor characteristics associated with VVRs were similar (younger age [18-29 years], replacement donors, first-time donors, low estimated blood volume [EBV]). In multivariable analysis controlling for differences between the donor populations in each city younger age, first-time donor status, and lower EBV were the factors most associated with reactions. CONCLUSION Factors associated with VVRs in other locations are also evident in Brazil. The difference in VVR rates between the three centers might be due to different procedures for identifying and reporting the reactions. Potential interventions to reduce the risk of reactions in Brazil should be considered.
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Affiliation(s)
- Thelma T Gonçalez
- Blood Systems Research Institute, 270 Masonic Avenue, San Francisco, CA 94118, USA.
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Ritz T, Wilhelm FH, Meuret AE, Gerlach AL, Roth WT. Airway response to emotion- and disease-specific films in asthma, blood phobia, and health. Psychophysiology 2011; 48:121-35. [PMID: 20573055 DOI: 10.1111/j.1469-8986.2010.01044.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Earlier research found autonomic and airway reactivity in asthma patients when they were exposed to blood-injection-injury (BII) stimuli. We studied oscillatory resistance (R(os)) in asthma and BII phobia during emotional and disease-relevant films and examined whether muscle tension counteracts emotion-induced airway constriction. Fifteen asthma patients, 12 BII phobia patients, and 14 healthy controls viewed one set of negative, positive, neutral, BII-related, and asthma-related films with leg muscle tension and a second set without. R(os), ventilation, cardiovascular activity, and skin conductance were measured continuously. R(os) was higher during emotional compared to neutral films, particularly during BII material, and responses increased from healthy over asthmatic to BII phobia participants. Leg muscle tension did not abolish R(os) increases. Thus, the airways are particularly responsive to BII-relevant stimuli, which could become risk factors for asthma patients.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas 75205, USA.
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Viar MA, Etzel EN, Ciesielski BG, Olatunji BO. Disgust, anxiety, and vasovagal syncope sensations: a comparison of injection-fearful and nonfearful blood donors. J Anxiety Disord 2010; 24:941-5. [PMID: 20667690 DOI: 10.1016/j.janxdis.2010.06.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 06/19/2010] [Accepted: 06/21/2010] [Indexed: 10/19/2022]
Abstract
Although research has implicated disgust in the fainting response observed in blood-injection-injury (BII) phobia, this finding has not been consistently observed in the literature. The present study further examines the relationship between disgust and fainting symptoms among injection-fearful (n=108) and nonfearful (n=338) blood donors. Volunteers from community blood drives provided pre-donation levels of anxiety and disgust towards giving blood and completed a standardized measure of vasovagal reactions (fainting) to blood donation after giving blood. As predicted, injection-fearful participants reported significantly more pre-donation anxiety and disgust compared to nonfearful participants. Injection-fearful donors also reported experiencing more fainting symptoms during blood donation and found the donation experience more unpleasant than did nonfearful participants. Although pre-donation disgust and anxiety levels each uniquely predicted fainting symptoms among nonfearful donors, only pre-donation anxiety uniquely predicted fainting symptoms among injection-fearful donors. Implications of these findings for conceptualizing the disgust-faint relationship in BII phobia are discussed.
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Affiliation(s)
- Megan A Viar
- Department of Psychology, Vanderbilt University, 312 Wilson Hall, 111 21st Avenue South, Nashville, TN 37203, USA.
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26
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Ritz T, Meuret AE, Ayala ES. The psychophysiology of blood-injection-injury phobia: looking beyond the diphasic response paradigm. Int J Psychophysiol 2010; 78:50-67. [PMID: 20576505 DOI: 10.1016/j.ijpsycho.2010.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/29/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
Abstract
Blood-injection-injury (BII) phobia is an anxiety disorder that may be accompanied by vasovagal fainting during confrontation with the feared stimuli. The underlying pattern of autonomic regulation has been characterized as a diphasic response, with initial increases in heart rate and blood pressure that are typical of a fight-flight response, and subsequent drops in blood pressure and/or heart rate that may precipitate vasovagal fainting. Tensing skeletal muscles of the arms, legs, and trunk (applied tension) has been proposed as a technique to cope with this dysregulation. This review critically examines the empirical basis for the diphasic response and its treatment by applied tension in BII phobia. An alternative perspective on the psychophysiology of BII phobia and vasovagal fainting is offered by focusing on hypocapnia that leads to cerebral blood flow reductions, a perspective supported by research on neurocardiogenic and orthostatically-induced syncope. The evidence may indicate a role for respiration-focused coping techniques in BII phobia.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA.
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27
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Ayala ES, Meuret AE, Ritz T. Confrontation with blood and disgust stimuli precipitates respiratory dysregulation in blood–injection–injury phobia. Biol Psychol 2010; 84:88-97. [DOI: 10.1016/j.biopsycho.2010.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 01/25/2010] [Accepted: 02/10/2010] [Indexed: 11/26/2022]
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Herbert BM, Pollatos O, Flor H, Enck P, Schandry R. Cardiac awareness and autonomic cardiac reactivity during emotional picture viewing and mental stress. Psychophysiology 2010; 47:342-54. [DOI: 10.1111/j.1469-8986.2009.00931.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Olatunji BO, Cisler J, McKay D, Phillips ML. Is disgust associated with psychopathology? Emerging research in the anxiety disorders. Psychiatry Res 2010; 175:1-10. [PMID: 19969378 DOI: 10.1016/j.psychres.2009.04.007] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 03/25/2009] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
Recent evidence indicates that the propensity towards experiencing disgust may contribute to the development and maintenance of some anxiety disorders. This article summarizes the empirical evidence with emphasis on illuminating potential mediators, moderators, and mechanisms of the disgust-anxiety disorder association that may inform the development of an integrative conceptual model. Early research using neuroimaging methods suggest that disgust processing is associated with activation of the insula. This research has the potential to facilitate progress in developing an empirically informed psychobiological theory on the causal role of disgust in the anxiety disorders.
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Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, Wilson Hall, 111 21st Avenue South, Nashville, TN 37203, USA.
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Schmid M, Wolf RC, Freudenmann RW, Schönfeldt-Lecuona C. Tomophobia, the phobic fear caused by an invasive medical procedure - an emerging anxiety disorder: a case report. J Med Case Rep 2009; 3:131. [PMID: 20062769 PMCID: PMC2803803 DOI: 10.1186/1752-1947-3-131] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 11/18/2009] [Indexed: 11/15/2022] Open
Abstract
Introduction Tomophobia refers to fear or anxiety caused by forthcoming surgical procedures and/or medical interventions. Case presentation We present the case of a 69-year-old Caucasian man who refused urgently indicated medical intervention because of severe tomophobia. Conclusion Due to the rising number of surgical interventions in modern medicine, as well as the high number of unrecognised cases of tomophobia, this common but underdiagnosed anxiety disorder should be highlighted.
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Affiliation(s)
- Markus Schmid
- Department of Psychiatry and Psychotherapy III, University of Ulm, Leimgrubenweg 12, 98075 Ulm, Germany
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31
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Ditto B, Byrne N, Holly C. Physiological Correlates of Applied Tension May Contribute to Reduced Fainting During Medical Procedures. Ann Behav Med 2009; 37:306-14. [DOI: 10.1007/s12160-009-9114-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ritz T, Wilhelm FH, Meuret AE, Gerlach AL, Roth WT. Do blood phobia patients hyperventilate during exposure by breathing faster, deeper, or both? Depress Anxiety 2009; 26:E60-7. [PMID: 19085969 DOI: 10.1002/da.20466] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Recently we found that patients with blood-injection-injury (BII) phobia tend to hyperventilate when exposed to feared stimuli. Hyperventilation results from increases in minute ventilation above levels required by metabolic demand and can result from increases in either frequency or depth of breathing, or a combination of both. METHOD In order to determine which of these factors contributed most to hyperventilation in BII phobia we analyzed breathing patterns of BII phobia patients (N=12) and non-anxious controls (N=14), recorded with respiratory inductance plethysmography. Participants viewed ten film clips of either an emotionally positive, negative, or neutral quality, as well as surgery and asthma-relevant clips. During five film clips (one from each category) they also tensed their leg muscles. RESULTS Minute ventilation was markedly increased in blood phobia patients compared to other groups during surgery films. Also, tidal volume and irregularity of tidal volume showed strong increases, while respiration rate was not affected. Leg muscle tension increased ventilation in general but far below the extent brought about by hyperventilation in BII phobia. Patients who were breathing deeper during exposure reported stronger symptoms of dizziness, light-headedness and faintness. In general, patients showed a higher rate of spontaneous sighs throughout all film presentations, but not at baseline. CONCLUSION Thus, hyperventilation in blood phobia is produced by excessively deep and irregular breathing and may contribute to fainting responses. Behavioral interventions for BII phobia could benefit from attention to this aspect of dysfunctional breathing.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas 75205, USA.
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Cisler JM, Olatunji BO, Lohr JM. Disgust, fear, and the anxiety disorders: a critical review. Clin Psychol Rev 2008; 29:34-46. [PMID: 18977061 DOI: 10.1016/j.cpr.2008.09.007] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Revised: 06/22/2008] [Accepted: 09/19/2008] [Indexed: 11/29/2022]
Abstract
Anxiety disorders have traditionally been conceptualized as reflecting the emotions of fear and anxiety. A developing program of research demonstrates a relation between disgust and three specific anxiety disorders: blood-injection-injury (BII) phobia, spider phobia, and contamination-related obsessive-compulsive disorder (OCD). This review serves three purposes. First, the authors review the response patterns predicted to be observed if the emotional response in these disorders involved disgust versus fear. The review suggests specific response patterns that characterize disgust and fear in the domains of heart rate, facial expression, neural activity, and cognitive processes. Second, the authors review extant research employing measures of these domains in spider phobia, BII phobia, and contamination-related OCD. The evidence suggests that both fear and disgust characterize each of these disorders, but the magnitude at which the emotions characterize the disorders may depend on the response domain measured. For example, disgust may be more involved in spider phobia in appraisals and facial expression, but less involved in neural correlates or heart rate domains. Third, the authors suggest guidelines for future research, including concurrent use of specific measures as well as examining whether the different emotions in different response domains respond to similar interventions (e.g., exposure).
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Affiliation(s)
- Josh M Cisler
- Psychology Department, University of Arkansas, AR 72701, USA.
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Sarlo M, Buodo G, Munafò M, Stegagno L, Palomba D. Cardiovascular dynamics in blood phobia: evidence for a key role of sympathetic activity in vulnerability to syncope. Psychophysiology 2008; 45:1038-45. [PMID: 18823415 DOI: 10.1111/j.1469-8986.2008.00713.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study was aimed at clarifying the mechanism predisposing people with blood phobia to syncope by investigating the complete hemodynamic response pattern and the underlying autonomic control. Blood phobics and controls were shown 3 film-clips: phobia-related, phobia-unrelated, and neutral. Hemodynamic responses were recorded using impedance cardiography and Finapres. Preejection period and respiratory sinus arrhythmia were employed as indices of cardiac sympathetic and parasympathetic activity. Self-ratings of emotion were also collected. Blood phobics displayed global heart rate and cardiac output increases to the phobic film, mediated by augmented cardiac sympathetic activity. Systolic blood pressure and total peripheral resistance markedly declined, with no evidence of diphasic reaction or parasympathetic activation. An impaired vasomotor response under sympathetic control might be the key mechanism underlying the phobic dysfunctional response.
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Affiliation(s)
- Michela Sarlo
- Department of General Psychology, University of Padova, Padova, Italy.
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Hohoff C, Domschke K, Schwarte K, Spellmeyer G, Vögele C, Hetzel G, Deckert J, Gerlach AL. Sympathetic activity relates to adenosine A2A receptor gene variation in blood-injury phobia. J Neural Transm (Vienna) 2008; 116:659-62. [DOI: 10.1007/s00702-008-0089-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 06/19/2008] [Indexed: 10/21/2022]
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36
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Rohrmann S, Hopp H. Cardiovascular indicators of disgust. Int J Psychophysiol 2008; 68:201-8. [DOI: 10.1016/j.ijpsycho.2008.01.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 07/30/2007] [Accepted: 01/22/2008] [Indexed: 11/30/2022]
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Olatunji BO, Connolly KM, David B. Behavioral avoidance and self-reported fainting symptoms in blood/injury fearful individuals: an experimental test of disgust domain specificity. J Anxiety Disord 2008; 22:837-48. [PMID: 17920808 DOI: 10.1016/j.janxdis.2007.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 08/29/2007] [Accepted: 08/29/2007] [Indexed: 11/24/2022]
Abstract
This study examined the specificity of disgust in predicting avoidance in blood/injury (BI) phobia. Participants high (n=38) and low (n=46) in BI fear completed measures of disgust across multiple domains and severity of BI-related fear. They then completed three randomly presented behavioral avoidance tasks (BATs) that consisted of exposure to a 15'' severed deer leg (BI task), a live spider (spider task), and a 'contaminated' cookie (cookie task). Fainting symptoms associated with each BAT were recorded as well. When controlling for gender and BI fear group membership, mutilation disgust contributed unique variance to avoidance on the BI task and animal disgust contributed unique variance to avoidance on the spider task. None of the disgust domains contributed unique variance to avoidance on the cookie task. For the high BI fear group, self-reported fainting symptoms were more pronounced during the BI and spider BAT than during the cookie BAT. Although mutilation disgust was significantly associated with self-reported fainting symptoms on the BI task among the high BI fear group, this relationship became nonsignificant when controlling for BI-related fear severity. Implications of the domain specificity of disgust and its relevance for understanding fainting responses in BI phobia are discussed.
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Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, Nashville, TN 37203, USA.
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Abstract
PURPOSE OF REVIEW Specific phobias are prevalent and often disabling anxiety disorders. The present review examines relevant investigations that have been published during the last 2 years on major aspects of this group of disorders. RECENT FINDINGS Recent studies have come mainly from epidemiology, brain imagery and cognitive-behavioral therapy, including virtual reality exposure therapy. SUMMARY Studies published in the last 2 years confirm the high prevalence of specific phobias in the general population and provide new insights into the mechanisms underlying the fear reaction after exposure to a phobic stimulus.
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