Associations between heart rate,perceived heart rate,and anxiety during acute psychological stress

ABSTRACT

Background: Acute psychological stress elicits increases in heart rate (HR) and anxiety. Theories propose associations between HR, perceived HR, and anxiety during stress. However, anxiety is often measured as a unidimensional construct which limits a comprehensive understanding of these relationships.

Objectives: This research explored whether HR reactivity or perceived HR change was more closely associated with cognitive and somatic anxiety during acute psychological stress.

Design: Two laboratory-based studies were conducted.

Methods: In a single laboratory session, healthy male (N?=?71; study 1) and female (N?=?70; study 2) university students completed three laboratory psychological stress tasks (counterbalanced), each with a preceding baseline. Heart rate, perceived HR change, and cognitive and somatic anxiety intensity and interpretation of anxiety symptoms were assessed immediately following each task. Data were aggregated across tasks.

Results: Actual HR change was unrelated to anxiety intensity, but was associated with more debilitative interpretations of anxiety (study 2). Perceptions of HR change were consistently associated with greater intensity of cognitive (study 1) and somatic (study 1 and 2) anxiety.

Conclusions: Perceived HR rather than actual HR is more closely associated with anxiety intensity during psychological stress. The findings have implications for stress management and the clinical treatment of anxiety symptoms.     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

Attentional biases to threat in social anxiety disorder: time to focus our attention elsewhere?

Background: Cognitive models propose that attentional biases to threat contribute to the maintenance of social anxiety disorder (SAD). However, the specific characteristics of such biases are still object to debate.

Objectives: The current study aimed to disentangle effects of trait and state social anxiety on attention allocation towards social stimuli.

Methods: Participants with SAD (n?=?67) and healthy controls (n?=?62) completed three visual search tasks while their eye movements were recorded. Half of the participants in each group were randomly assigned to a state anxiety induction.

Results: Contrary to our predictions, neither trait nor state social anxiety was associated with a facilitated attention to or a delayed disengagement from threat. However, participants with SAD did show reduced fixation durations for threatening stimuli, indicating an avoidance of threat. Induction of state anxiety led to an increased distractibility by threat.

Conclusions: We suggest that attention allocation in SAD is characterized by an avoidant rather than a vigilant attentional bias. Accordingly, our results contradict previous results that associate SAD with facilitated attention to threat and existing approaches to modify attentional biases, that aim to decrease attention towards threatening stimuli.     

Specificity of peer difficulties to social anxiety in early adolescence: categorical and dimensional analyses with clinical and community samples

Background and Objectives: We investigated the specificity of social difficulties to social anxiety by testing associations of social anxiety and other anxiety presentations with peer acceptance and victimization in community and treatment-seeking samples of adolescents aged 12–14 years.

Design: Cross-sectional, quantitative survey.

Methods: Adolescents from the community (n?=?116) and a clinical setting (n?=?154) completed ratings of anxiety symptoms, perceived social acceptance, and peer victimization. Their parents also completed ratings of the adolescents’ anxiety and social acceptance.

Results: Social acceptance was lowest among adolescents with social anxiety disorder (SAD) and lower among adolescents with other anxiety disorders than in the community sample. Anxiety symptoms were negatively correlated with social acceptance, but these associations were not unique to social anxiety symptoms. Girls in the community sample reported more overt victimization than girls with SAD and with other anxiety diagnoses. Relational victimization was associated with social and nonsocial anxiety symptoms only in the community sample.

Conclusions: Our findings supplement recent laboratory-based observational studies on social functioning among adolescents with SAD and other anxiety disorders. Although social anxiety may be associated with unique social skill deficits and impairment, concerns about peer relations should also be considered among adolescents with other anxiety symptoms.     

Are perfectionism dimensions risk factors for anxiety symptoms? A meta-analysis of 11 longitudinal studies

Background: Over 50 years of theory and research implicates perfectionism in anxiety. However, it is unclear which (if any) perfectionism dimensions are risk factors for anxiety.

Objective: To address this, we conducted a meta-analysis testing whether socially prescribed perfectionism, concern over mistakes, doubts about actions, self-oriented perfectionism, and personal standards predict increases in anxiety.

Method: Our literature search yielded 11 relevant studies for inclusion, composed of children, adolescents, undergraduates, community adults, and psychiatric patients.

Results: Meta-analysis using random-effects models revealed concern over mistakes (r^+?=?.11), doubts about actions (r^+?=?.13), and personal standards (r^+?=?.08), but not socially prescribed perfectionism or self-oriented perfectionism, displayed significant small positive relationships with follow-up anxiety, after controlling for baseline anxiety.

Conclusion: Research is needed to understand the conditions under which the connection between perfectionism and anxiety becomes stronger (e.g., stress).     

Cortisol and behavioral reaction of low and high sensation seekers differ in responding to a sport-specific stressor

Background/objectives: Sensation seeking is closely related to practicing high-risk sports. This domain offers individuals an opportunity to achieve an increased level of arousal. Moreover, stress reactivity implies interindividual differences in the capacity to respond to a stressor. The purpose of this study was to examine whether high sensation seekers (HSS) compared to low sensation seekers (LSS) experience lower levels of stress on a physiological and psychological basis. Stress was induced in a sport-specific experimental paradigm with a climbing task through a jump into the rope.

Methods: Two extreme groups (n?=?28 male athletes) were examined in a mixed-factorial design (between: HSS vs. LSS; within: repeated measurements of several variables related to stress reactivity - cortisol, heart rate, anxiety).

Results: In response to the stressor HSS compared to LSS released a significantly lower amount of cortisol and needed less time for the climbing task. Heart rate and anxiety were not significant.

Conclusions: Individuals seem to react physiologically differently to a sport-specific stressor, depending on their level of sensation seeking. HSS seem to be less strained, and seem to perform better. These findings might be relevant not only for the evaluation of (sport-) psychological interventions but also for other contexts (e.g., special forces).     

Deconstructing trait anxiety: a network perspective

Background and objectives: For decades, the dominant paradigm in trait anxiety research has regarded the construct as signifying the underlying cause of the thoughts, feelings, and behaviors that supposedly reflect its presence. Recently, a network theory of personality has appeared. According to this perspective, trait anxiety is a formative construct emerging from interactions among its constitutive features (e.g., thought, feelings, behaviors); it is not a latent cause of these features.

Design: In this study, we characterized trait anxiety as a network system of interacting elements.

Methods: To do so, we estimated a graphical gaussian model via the computation of a regularized partial correlation network in an unselected sample (N?=?611). We also implemented modularity-based community detection analysis to test whether the features of trait anxiety cohere as a single network system.

Results: We find that trait anxiety can indeed be conceptualized as a single, coherent network system of interacting elements.

Conclusions: This radically new approach to visualizing trait anxiety may offer an especially informative view of the interplay between its constitutive features. As prior research has implicated trait anxiety as a risk factor for the development of anxiety-related psychopathology, our findings also set the scene for novel research directions.     

Computerized attention retraining for individuals with elevated health anxiety

Background and Objectives: Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information. Design: This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words. Methods: Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18). Results: Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outperform ACC in reducing HA and other relevant emotional symptoms. However, both AMP and ACC evidenced overall significant symptom reduction in most of the outcome measures, including overall HA, anxiety sensitivity, general depression and anxiety, and somatic complaints. Conclusions: Further research is needed to better understand the effects and mechanisms of AMP as a possible cognitive intervention for HA.     

Anxiety across the transition to parenthood: change trajectories among low-risk parents

Background and Objectives: A number of sources suggest changes in anxiety across the transition to parenthood may be experienced by parents in different ways, yet no studies have examined whether new parents experience changes in anxiety in distinct subgroups. Design: We conducted a longitudinal study of 208 first-time parents (104 couples) from a low-risk population. Parents were interviewed from the third trimester of pregnancy to nine-months postpartum. Methods: The current study utilized latent class growth analysis to explore subgroups of change in symptoms of anxiety. Based on stress and coping theory, we also examined a number of personal and social prenatal predictors of subgroup membership. Results: We identified two distinct change trajectories: (1) moderate and stable and (2) low and declining. We also found prenatal depression, expected parenting efficacy, and relationship satisfaction were significantly associated with subgroup membership. Conclusions: Our results suggest a majority of new parents adjust well to parenthood in terms of anxiety, while a smaller subgroup of parents experience continually higher levels of anxiety months after the baby is born.     

Exams? Why worry? Interpreting anxiety as facilitative and stress appraisals

Background and Objectives: The present study examined why people differ in how they appraise the same stressful situation (an approaching exam). Design: We explored whether interpreting anxiety as a facilitative emotion can affect the type of stress appraisal people make. Method: One hundred and three undergraduate students took part in this study, which lasted for 10 days (leading up to an exam). The students completed a daily self-reported evaluation of anxiety, emotional exhaustion, and stress experienced. Results: The findings suggest a process by which a stressful time can be experienced as motivating rather than threatening or emotionally exhausting. For example, interpreting anxiety as facilitative moderated the relationship between anxiety and stress appraisals. When interpreting their anxiety as facilitative, individuals showed a higher tendency to make challenge stress appraisals and a lower tendency to appraising the stressor as a threat. These differences were especially visible with high levels of anxiety. Furthermore, interpreting anxiety as facilitative was negatively associated with emotional exhaustion, but positively associated with the academic performance. Conclusions: These findings suggest an explanation why people differ in how they appraise the same stressor: how people interpret their anxiety may to a large part affect how they appraise difficult events and situations.     

Attentional control mediates fearful responding to an ecologically valid stressor

Background and Objectives: Attentional control (AC) is defined as the ability to voluntarily shift and disengage attention and is thought to moderate the relationship between preexisting risk factors for fear and the actual experience of fear. Design: This longitudinal study elaborates on current models of AC by examining whether AC moderates or mediates effects of an ecologically valid stressor (a college examination) and also whether AC is predictive of state-like fear over longer timescales than previously reported. Methods: Based on previous findings, we hypothesized that AC would moderate the relationship between trait anxiety and affective distress in response to the examination stressor. We also tested a competing mediational model based on AC theory. These models were tested in two separate samples (sample 1, N = 219; sample 2, N = 129; Total N = 348) at two time points, at the beginning of a college semester in a large undergraduate class and 5 minutes prior to a college examination. Results: Mediation but not moderation of anxiety by AC was supported in both samples using multiple dependent measures. Conclusions: We conclude that AC may be useful in predicting affective distress in naturalistic settings, particularly in cases where anxiety is anticipatory.     

Perfectionistic concerns predict increases in adolescents’ anxiety symptoms: a three-wave longitudinal study

Background and Objectives: Although perfectionism has been proposed to be a risk factor for the development of anxiety, research on perfectionism and anxiety symptoms in adolescents is scarce and inconclusive. The aim of the present study was to investigate whether the two higher-order dimensions of perfectionism – perfectionistic strivings and perfectionistic concerns – predict the development and maintenance of anxiety symptoms. An additional aim of the present study was to examine potential reciprocal effects of anxiety symptoms predicting increases in perfectionism.

Design: The study used a longitudinal design with three waves spaced 4–5 months apart.

Methods: A non-clinical sample of 489 adolescents aged 12–19 years completed a paper-and-pencil questionnaire.

Results: As expected, results showed a positive effect from perfectionistic concerns to anxiety symptoms, but the effect was restricted to middle-to-late adolescents (16–19 years old): Perfectionistic concerns predicted longitudinal increases in adolescents’ anxiety symptoms, whereas perfectionistic strivings did not. Furthermore, anxiety symptoms did not predict increases in perfectionism.

Conclusions: Implications for the understanding of the relationship between perfectionism and anxiety symptoms are discussed.     

Evidence for the effectiveness of holistic process goals for learning and performance under pressure

ObjectivesResearch has suggested that holistic process goals might help avoid the effects associated with conscious processing of task relevant information by skilled but anxious athletes. This experiment compared the efficacy of holistic and part process goal strategies for novices using a learning paradigm.DesignLaboratory-based experimental design incorporating practice, retention and transfer phases.MethodTwenty-four males were randomly assigned to a part process goal, holistic process goal or control condition and performed a simulated race-driving task in practice, retention and transfer tests.ResultsAnalyses of variance revealed that performance during practice was similar in all conditions but that the holistic process goal group outperformed the part process goal group at both retention and transfer.ConclusionsCompared to part process goals, holistic process goals result in more effective motor learning and performance that appears to be more robust under pressure.     

Diminished heart rate complexity in adolescent girls: a sign of vulnerability to anxiety disorders?

Background and Objectives: Diminished heart rate variability has been found to be associated with high anxiety symptomatology. Since adolescence is the period of onset for many anxiety disorders, this study aimed to determine sex- and anxiety-related differences in heart rate variability and complexity in adolescents.

Methods: We created four groups according to sex and anxiety symptomatology: high-anxiety girls (n?=?24) and boys (n?=?25), and low-anxiety girls (n?=?22) and boys (n?=?24) and recorded their cardiac function while they performed regular school activities. A series of two-way (sex and anxiety) MANOVAs were performed on time domain variability, frequency domain variability, and non-linear complexity.

Results: We obtained no multivariate interaction effects between sex and anxiety, but highly anxious participants had lower heart rate variability than the low-anxiety group. Regarding sex, girls showed lower heart rate variability and complexity than boys.

Conclusions: The results suggest that adolescent girls have a less flexible cardiac system that could be a marker of the girls’ vulnerability to developing anxiety disorders.     

Social anxiety and post-event processing among African-American individuals

Background: Social anxiety is among the most prevalent psychiatric conditions, yet little attention has been paid to whether putative cognitive vulnerability factors related to social anxiety in predominantly White samples are related to social anxiety among historically underrepresented groups.

Design: We tested whether one such vulnerability factor, post-event processing (PEP; detailed review of social event that can increase state social anxiety) was related to social anxiety among African-American (AA; n?=?127) persons, who comprise one of the largest underrepresented racial groups in the U.S. Secondarily, we tested whether AA participants differed from non-Hispanic White participants (n?=?127) on PEP and social anxiety and whether race moderated the relation between PEP and social anxiety.

Method: Data were collected online among undergraduates.

Results: PEP was positively correlated with social anxiety among AA participants, even after controlling for depression and income, pr?=?.30, p?=?.001. AA and White participants did not differ on social anxiety or PEP, β?=??1.57, 95% CI: ?5.11, 1.96. The relation of PEP to social anxiety did not vary as a function of race, β?=?0.00, 95% CI: ?0.02, 0.02.

Conclusions: PEP may be an important cognitive vulnerability factor related to social anxiety among AA persons suffering from social anxiety.     

Children with social phobia have lower quality friendships than children with other anxiety disorders

Background and Objective: Whilst shy, socially anxious or socially withdrawn children in nonclinical community samples report lower friendship quality (FQ) than nonanxious children, no study has examined the FQ of clinically anxious children. The aim of the study was to examine the FQ of children with anxiety disorders; and whether it differs for clinical children with or without a diagnosis of social phobia (SP). Design: The study design was cross-sectional self-report. Methods: Clinical children – 39 anxiety-disordered children with SP and 28 anxiety-disordered children without SP (No-SP) – presented for psychological treatment, and 29 nonclinical children were recruited from the community. Same-sex close friends were invited to participate using an unrestricted nomination procedure. All children were aged between 7 and 13 years. Both target child and friend completed the Friendship Quality Questionnaire and the Spence Children's Anxiety Scale. Results: Using multilevel modeling within the framework of the Actor–Partner Interdependence Model, SP dyads were found to report lower overall FQ than No-SP dyads. SP dyads did not report lower overall FQ than nonclinical dyads. Conclusion: Children with SP in their diagnostic profile may be unique in their friendship experiences relative to children with other anxiety disorders.     

Information giving and involvement in treatment decisions: Is more really better? Psychological effects and relation with adherence

Objectives : The aim of this study is to improve our understanding of the ways in which a medical consultation style relates to satisfaction and adherence.

Design : Participants completed questionnaires about preferred and perceived consultation styles; psychological variables such as satisfaction, anxiety and depression; and questions about taking medication. Questionnaires were completed prior to the consultation, immediately after, three months later and one year later. Doctors also completed a scale on completion of the consultation. The decisions in question related to women seeking advice about Hormone Replacement Therapy (HRT) and decisions about pain management.

Results : Patients expressed preferences for information about the treatment options and for active involvement in the decision process. The extent to which patients perceived themselves as having received information about the treatment options was a particularly consistent predictor of satisfaction. The extent to which patients perceived themselves as having been prepared for the side effects of HRT was a consistent predictor of anxiety.

Conclusions : Perceptions of the amount of information received about medical options, including information preparing individuals for potential side effects of medication, appears to be more important to satisfaction and anxiety, than actual involvement in the decision.     

Avoidance temperament and social-evaluative threat in college students' math performance: a mediation model of math and test anxiety

Background and Objectives: Standardized testing has become a common form of student evaluation with high stakes, and limited research exists on understanding the roles of students' personality traits and social-evaluative threat on their academic performance. This study examined the roles of avoidance temperament (i.e., fear and behavioral inhibition) and evaluative threat (i.e., fear of failure and being viewed as unintelligent) in standardized math test and course grades in college students. Design and Methods: Undergraduate students (N = 184) from a large public university were assessed on temperamental fear and behavioral inhibition. They were then given 15 minutes to complete a standardized math test. After the test, students provided data on evaluative threat and their math performance (scores on standardized college entrance exam and average grades in college math courses). Results: Results indicate that avoidance temperament was linked to social-evaluative threat and low standardized math test scores. Furthermore, evaluative threat mediated the influence of avoidance temperament on both types of math performance. Conclusions: Results have educational and clinical implications, particularly for students at risk for test anxiety and underperformance. Interventions targeting emotion regulation and stress management skills may help individuals reduce their math and test anxieties.