Attentional correlates of illness anxiety in a non-clinical sample

How do illness-anxious individuals process health-threatening information? A systematic review of evidence for the cognitive-behavioral model

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.

Gender differences in body consciousness and substance use among high-risk adolescents

This study explores the association between private and public body consciousness and past 30-day cigarette, alcohol, marijuana, and hard drug use among adolescents. Self-reported data from alterative high school students in California were analyzed (N = 976) using multilevel regression models to account for student clustering within schools. Separate regression analyses were conducted for males and females. Both cross-sectional baseline data and one-year longitudinal prediction models indicated that body consciousness is associated with specific drug use categories differentially by gender. Findings suggest that body consciousness accounts for additional variance in substance use etiology not explained by previously recognized dispositional variables.

Body vigilance in nonclinical and anxiety disorder samples: structure, correlates, and prediction of health concerns

The Body Vigilance Scale (BVS) is a measure developed to assess one's conscious attendance to internal cues. The present report investigated the structure, correlates, and predictive utility of the BVS in nonclinical (N=442) and anxiety (N=135) disorder samples. The findings of Study 1 suggest that the BVS is 1-dimensional in a nonclinical sample, and Study 2 replicated the factor structure of the BVS in an anxiety disorder sample. Correlations between the BVS and related (i.e., anxiety sensitivity) and unrelated (i.e., social anxiety) variables were consistent with predictions in both studies. Study 2 also showed that body vigilance is primarily elevated in patients with panic disorder relative to other anxiety disorders. Relative elevations in body vigilance were also observed for patients with hypochondriasis and generalized anxiety disorder. The BVS also demonstrated a specific association with medical utilization and health-related safety-seeking behaviors after controlling for related variables in nonclinical and anxiety disorder samples. The implications of our findings for the nature and measurement of body vigilance as a predictor of health concerns in anxiety disorders are considered.

Cognitive and perceptual variables in hypochondriasis and health anxiety: A systematic review

This review examined (a) whether hypochondriacal/health-anxious individuals hold distinct assumptions about health and illness, (b) if triggering these assumptions leads to increased hypochondriacal concerns, and (c) whether these individuals perceive their bodily sensations differently from others (i.e., experience greater somatosensory amplification). There was clear evidence that health anxiety is related dysfunctional health-related beliefs. Few studies have examined how hypochondriacal concerns are triggered, and inconsistent results emerged from those that have. Health anxiety is also associated with self-reported higher levels of somatosensory amplification. However, there was little evidence that individuals high in health anxiety are actually more accurate perceivers of the their own autonomic processes. Although the results generally supported the central tenets of the cognitive-behavioral model of hypochondriasis and health anxiety, further research will be necessary to determine whether these beliefs are specific to hypochondriasis and to identify any cognitive processes that may be unique to hypochondriasis.

The effect of psychological stress and relaxation on interoceptive accuracy: Implications for symptom perception

OBJECTIVES

The goals of the current study were to investigate: (i) how the manipulation of psychophysiological state (stress vs. relaxation) would influence heartbeat detection performance in a laboratory environment and (ii) whether interoceptive accuracy had a relationship with symptom reporting.

METHOD

Forty participants (20 males) performed a stressor (a demanding mental arithmetic task) and a relaxation exercise during two counterbalanced sessions, both of which included baseline (control) conditions. Performance of both tasks was interspersed with a heartbeat detection task, i.e., a two-choice Whitehead paradigm. Data were collected from subjective mood scales as well as the electrocardiogram.

RESULTS

Both stress and relaxation conditions had the anticipated influence on subjective mood. There was no effect of stress or relaxation on heartbeat detection accuracy for male participants. However, the heartbeat detection accuracy of female participants showed a significant decline during the stressor condition. There was evidence that lower mean heart rate tended to improve heartbeat detection performance. A regression analysis revealed that two traits from the Body Perception Questionnaire (autonomic reactivity and body awareness) predicted heartbeat detection accuracy but not in the expected direction.

CONCLUSIONS

The study provided evidence of a gender-specific decrement of heartbeat detection accuracy due to a laboratory stressor. However, the relevance of this finding for health psychology may be limited, as interoceptive accuracy had no significant relationship with symptom reporting.

Distinguishing between hypochondriasis and somatization disorder: a review of the existing literature

A valid classification is important for further understanding of the somatoform disorders. The main disorders in this grouping - somatization disorder and hypochondriasis - have lengthy historical traditions and are defined in a contrasting manner. Various authors point to distinguishing demographic and clinical features, but there have been few direct comparisons of patients with these disorders. A review of the literature indicates those domains where differences are most likely to be found. Research assessing these may serve to refine and validate these key somatoform categories and/or dimensions.