Paradoxical breathlessness in asthma

This study tested the hypothesis that breathlessness in asthma relates linearly to airway obstruction when situational, attentional and emotional influences are held constant via random presentation of different intensities of externally applied airflow obstruction. Adolescents with stable asthma and normal controls (n=25+25) with lung functions of approximately 3.5 l forced expiratory volume in 1 s (FEV₁) breathed through a device which obstructed airflow with five stimulus intensities, analogous to a mean reduction in FEV₁ of 8–66%. A session consisted of 10 blocks, each with presentation of five stimulus intensities plus the baseline resistance of the apparatus. Breathlessness was continuously reported by moving a lever along a 10-point scale. The mean breathlessness was computed per stimulus intensity. Lung function and anxiety were measured before and after the test.

Participants with asthma, not controls, manifested a paradoxical response: they reported significantly more breathlessness, but undifferentially. One patient against 12 controls reported consistently more breathlessness from baseline to severe obstruction. The hypothesis was only supported for controls. Breathlessness did not correlate with severity of asthma, lung function, duration of asthma, number of exacerbations over the last six months, age, sex or anxiety.

It was concluded that the meaning of airflow obstruction in patients with asthma has changed and underlies their paradoxical responses, even when situational, attentional and emotional factors are controlled.     

Negative beliefs about breathlessness increases panic for patients with chronic respiratory disease

Breathlessness is a multidimensional symptom of respiratory disease and is associated with the experience of panic. Patients with panic disorder have increased mortality, morbidity and healthcare utilisation that is unrelated to their disease severity. Our qualitative study aimed to appraise respiratory patients' experiences of breathlessness and whether their cognitions were associated with panic aetiology. The self-regulatory theory was utilised to develop the framework for the semi-structured interview schedule. Twelve individuals with respiratory disease at a U.K. cardiothoracic centre participated and their data were analysed using interpretative phenomenological analysis. Perceived control over the disease, symptoms and panic emerged as the core theme with three related belief systems; (1) Perceived consequences of panic and disease; (2) Illness and symptom coherence; and (3) Emotional adaptation. Panic symptoms were most prevalent in participants with low perceived control over symptoms and the disease, negative beliefs about the life-limiting consequences of unpredictable breathless attacks and by those using emotional coping strategies such as denial and avoidance. The experience of panic for respiratory patients can be explained through the cognitive-behavioural model of anxiety, which highlights the contributory role of catastrophic beliefs about the control and consequences of symptoms and disease as a significant contributory factor for the prevalence and maintenance of panic. The mortality and morbidity of respiratory patients is significantly affected by a co-morbid diagnosis of panic disorder and so it is critical to patients' long-term healthcare that their psychological experiences are assessed. Healthcare services must enhance patients' understanding about their disease to improve their confidence to control symptoms. Recent evidence suggests that cognitive-behavioural interventions that increase problem-solving coping will reduce catastrophic misinterpretations about the perceived consequences of breathlessness and improve emotional adaption to respiratory disease.     

Rollercoaster asthma: when positive emotional stress interferes with dyspnea perception

The current study assessed how negative and positive stress is related to dyspnea perception. The participants were 25 young women with a medical diagnosis of severe asthma, and 15 matched controls. Stress was induced during repeated rollercoaster rides. Results showed that negative emotional stress and blood pressure peaked just before, and positive emotional stress and heart beat peaked immediately after rollercoaster rides. Dyspnea in women with asthma was higher just before than immediately after rollercoaster rides, even in women with asthma with a rollercoaster-evoked reduction in lung function. These results suggest that stressed and highly aroused individuals with chronic asthma tend to perceive dyspnea in terms of acquired, familiar associations between dyspnea and positive versus negative feeling states, favoring either underperception or overperception of dyspnea, depending on the emotional valence of a situation.     

Future-Oriented Positive Mental Imagery Reduces Anxiety for Exposure to Public Speaking

Exposure therapy is the recommended treatment for anxiety disorders, but many anxious individuals are unwilling to expose themselves to feared situations. Episodic simulation of future situations contributes to adaptive emotion regulation and motivates behavior. This study investigated whether future-oriented positive mental imagery reduces anticipatory anxiety and distress during exposure, and increases exposure willingness and duration. Forty-three individuals with moderate public speaking anxiety were randomized to a standardized positive mental imagery exercise about future public speaking or no-task. All participants were then asked to present in a virtual reality environment. Anticipatory anxiety reduced in the positive mental imagery group, but not in the control group. Additionally, the positive mental imagery group reported lower distress during exposure than the control group, but groups did not differ in exposure willingness. Due to limited variance, effects on exposure duration could not be tested. Future-oriented positive mental imagery is promising to prepare individuals for exposure to previously avoided situations.     

Self-images play a causal role in social phobia

Patients with social phobia often experience negative self-images in social situations. The current study investigated whether negative self-images have a causal role in maintaining social phobia. Patients with social phobia participated twice in a conversation with a stranger, once whilst holding their usual negative self-image in mind and once whilst holding a less negative (control) self-image in mind, with order counterbalanced across participants. Compared to the control image condition, when participants held the negative image in mind they experienced greater anxiety, rated their anxiety symptoms as being more visible, and rated their performance as poorer. An assessor who did not know which image was being held also rated participants' anxiety as more evident and their behaviour as less positive when the negative image was being held in mind. Finally, when participant and assessor ratings were compared, participants underestimated their performance and overestimated the visibility of their anxiety to a significantly greater extent in the negative imagery condition. Taken together, these results support the hypothesis that negative self-imagery has a causal role in maintaining social phobia.     

Malleability of attentional bias for positive emotional information and anxiety vulnerability

Recent research supports a causal link between attentional bias for negative emotional information and anxiety vulnerability. However, little is known about the role of positive emotional processing in modulating anxiety reactivity to stress. In the current study, we used an attentional training paradigm designed to experimentally manipulate the processing of positive emotional cues. Participants were randomly assigned to complete a computerized probe detection task designed to induce selective processing of positive stimuli or to a sham condition. Following training, participants were exposed to a laboratory stressor (i.e., videotaped speech), and state anxiety and positive affect in response to the stressor were assessed. Results revealed that individual variability in the capacity to develop an attentional bias for positive information following training predicted subsequent emotional responses to the stressor. Moreover, individual differences in social anxiety, but not depression, moderated the effects of the attentional manipulation, such that, higher levels of social anxiety were associated with diminished attentional allocation toward positive cues. The current findings point to the potential value of considering the role of positive emotional processing in anxiety vulnerability.     

Physiological and psychological reactivity in women with asthma: the effects of anxiety and menstrual cycle phase.

The relation between menstrual cycle timing, panic attacks, and diagnosis of asthma was explored in this study. Women with or without asthma and with or without a history of panic attacks engaged in a psychophysiological task during either the intermenstrual or premenstrual cycle phase and completed self-report measures of menstrual symptoms and attitudes, general psychological symptoms, and attitudes toward illness. No significant differences were identified for psychological or psychophysiological measures with menstrual cycle phase as a factor. However, women with both asthma and a history of panic attacks reported more general psychological distress than women in the other groups, and more state anxiety than controls. Women in the asthma, asthma and panic, and panic groups reported higher anxiety sensitivity than the control group. After listening to asthma-related scenes, women with asthma exhibited a decrease in peak expiratory air flow, and women with asthma and panic exhibited increased skin conductance response magnitude. Implications for the role of anxiety in lung function are discussed, as well as directions for future research with asthma and anxiety populations.     

Written threat: Electrophysiological evidence for an attention bias to affective words in social anxiety disorder

Social anxiety disorder (SAD) is associated with heightened sensitivity to threat cues, typically represented by emotional facial expressions. To examine if this bias can be transferred to a general hypersensitivity or whether it is specific to disorder relevant cues, we investigated electrophysiological correlates of emotional word processing (alpha activity and event-related potentials) in 20 healthy participants and 20 participants with SAD. The experimental task was a silent reading of neutral, positive, physically threatening and socially threatening words (the latter were abusive swear words) while responding to a randomly presented dot. Subsequently, all participants were asked to recall as many words as possible during an unexpected recall test. Participants with SAD showed blunted sensory processing followed by a rapid processing of emotional words during early stages (early posterior negativity – EPN). At later stages, all participants showed enhanced processing of negative (physically and socially threatening) compared to neutral and positive words (N400). Moreover, at later processing stages alpha activity was increased specifically for negative words in participants with SAD but not in healthy controls. Recall of emotional words for all subjects was best for socially threatening words, followed by negative and positive words irrespective of social anxiety. The present findings indicate that SAD is associated with abnormalities in emotional word processing characterised by early hypervigilance to emotional cues followed by cognitive avoidance at later processing stages. Most importantly, the specificity of these attentional biases seems to change as a function of time with a general emotional bias at early and a more specific bias at later processing stages.     

Social anxiety and the effects of negative self-imagery on emotion, cognition, and post-event processing

Numerous studies have shown that social phobia patients experience negative self-impressions or images during social situations. Clark and Wells (1995) posited that such negative self-images are involved in the maintenance of social phobia. Thus, the present study investigated the effects of negative self-imagery on cognition and emotion during and following a brief social situation. Specifically, high and low socially anxious participants (N = 77) were instructed to hold either a negative or control self-image as they engaged in a brief speech. Participants then rated their anxiety, performance, cognitions, and focus of attention. Twenty-four hours later, they returned to the laboratory and completed questionnaires assessing the amount of post-event processing (PEP) they engaged in. The results showed that, irrespective of the level of social anxiety or depressive symptoms, participants that held the negative self-image experienced higher levels of anxiety, were more self-focused, experienced more negative thoughts, rated their anxiety as more visible, appraised their performance more negatively, and engaged in more negative and less positive PEP than participants that held the control self-image. Collectively the results indicate that negative imagery is causally involved in the maintenance of social phobia, as well as in the generation of social anxiety among non-anxious individuals.     

The Effects of Social Anxiety and State Anxiety on Visual Attention: Testing the Vigilance–Avoidance Hypothesis

A growing theoretical and research literature suggests that trait and state social anxiety can predict attentional patterns in the presence of emotional stimuli. The current study adds to this literature by examining the effects of state anxiety on visual attention and testing the vigilance–avoidance hypothesis, using a method of continuous visual attentional assessment. Participants were 91 undergraduate college students with high or low trait fear of negative evaluation (FNE), a core aspect of social anxiety, who were randomly assigned to either a high or low state anxiety condition. Participants engaged in a free view task in which pairs of emotional facial stimuli were presented and eye movements were continuously monitored. Overall, participants with high FNE avoided angry stimuli and participants with high state anxiety attended to positive stimuli. Participants with high state anxiety and high FNE were avoidant of angry faces, whereas participants with low state and low FNE exhibited a bias toward angry faces. The study provided partial support for the vigilance–avoidance hypothesis. The findings add to the mixed results in the literature that suggest that both positive and negative emotional stimuli may be important in understanding the complex attention patterns associated with social anxiety. Clinical implications and suggestions for future research are discussed.     

The interaction effect of attentional bias and attentional control on dispositional anxiety among adolescents

Research has shown that children and adolescents with attentional control deficits tend to have high anxiety and exhibit threat‐related selective attentional bias. This study aimed to investigate how positive and negative attentional biases would interact with attentional control on dispositional anxiety. One hundred and twenty participants aged 18 years of age or younger participated in a visual dot‐probe task to measure their attentional bias and completed psychological questionnaires to measure their trait anxiety, and attentional control. Mean reaction times to the probe in milliseconds were used to measure attentional bias. Overall, our participants showed a bigger tendency towards attending to positive emotional stimuli than to negative emotional stimuli. Adolescents with high dispositional anxiety showed poorer attentional control. Regression analyses showed that attentional control interact with negative attentional bias to affect anxiety. For participants with high attentional control, higher negative attentional bias was associated with lower trait anxiety. Trait anxiety was not related to negative attentional bias for participants with low attentional control. Positive attentional bias showed no significant relationship with dispositional anxiety, either alone or in interaction with attentional control. Theoretical and clinical implications of the findings are also discussed.     

情绪障碍及其干预:心理表象的视角

心理表象在多种情绪障碍中均表现出病理性特点。研究者基于心理表象主要对创伤后应激障碍、抑郁心境、双相障碍情绪和社交焦虑进行了心理病理学解释,尤其关注闪回和过度概化记忆等两种典型症状,并且重视心理表象在情绪症状维持中的作用。概括而言,研究者强调记忆形成与提取过程的异常、认知与行为的保护性策略的负强化、对事件及自我的认知偏差等三类因素对情绪障碍的致病作用。目前,针对或运用心理表象的干预与训练方法包括减少消极表象、改变消极表象内容、提高积极表象能力、提高记忆的具体性等四类。未来应注重侵入性表象的功能分析以及相关的心理病理学模型研究,并拓展干预与训练研究。     

Acquired sensitivity to relevant physiological activity in patients with chronic health problems

The hypothesis that biased symptom perception toward excessive symptoms is common when relatively normal chronic patients enter symptom-relating situations, irrespective of emotional variables, was tested in 19 women with severe asthma, 18 with somatization-like characteristics, and 18 controls. Each underwent three experimental conditions: mental stress, resting, and physical exercise. Each condition included three breathing conditions: breathing normally, normal compressed air, and 5.5% CO2-enriched compressed air. Results yielded no group differences in physiological measures, e.g. elevated CO2 in exhaled air (end-tidal partial pressure of CO2, PetCO2), or lung function. Asthma patients experienced more breathlessness, and somatization-like participants more breathlessness, miscellaneous symptoms, and subjective stress than controls. Although these differences suggested acquired biased symptom perception, as it turned out, breathlessness in asthmatics was more influenced by PetCO2 and less by subjective stress compared to controls. Likewise, breathlessness in somatization-like participants was similarly influenced by PetCO2 and subjective stress compared to controls, and miscellaneous symptoms were even more influenced by PetCO2 and less by subjective stress compared to controls. It was concluded that acquired sensitivity to physiological activity associated with habitual symptoms may account for excessive symptoms in patients with chronic health problems.     

SenseCam, imagery and bias in memory for wellbeing

Identifying and modifying the negative interpretation bias that characterises depression is central to successful treatment. While accumulating evidence indicates that mental imagery is particularly effective in the modification of emotional bias, this research typically incorporates static and unrelated ambiguous stimuli. SenseCam technology, and the resulting video-like footage, offers an opportunity to produce training stimuli that are dynamic and self-relevant. Here participants experienced several ambiguous tasks and subsequently viewed SenseCam footage of the same tasks, paired with negative or positive captions. Participants were trained to use mental imagery to inter-relate SenseCam footage and captions. Participants reported increased levels of happy mood, reduced levels of sad mood, and increased task enjoyment following SenseCam review with positive versus negative captions. This shift in emotional bias was also evident at 24-hour follow-up, as participants recollected greater task enjoyment for those tasks previously paired with positive captions. Mental imagery appears to play an important role in this process. These preliminary results indicate that in healthy volunteers, SenseCam can be used within a bias modification paradigm to shift mood and memory for wellbeing associated with performing everyday activities. Further refinements are necessary before similar methods can be applied to individuals suffering from subclinical and clinical depression.     

Test anxiety,emotional responding under guided imagery,and self-talk during an academic examination

Abstract

This investigation examined the assumption that phenomenological responses created by guidedimagery procedures pertinent to test anxiety are topographically similar to emotional responses experienced during an actual examination. Participants were divided on facilitating versus debilitating test anxiety and exposed to subclinical doses of stimulus-response propositions that involved test-taking, fear, and physical activity using the induction technique employed by Lang et al. (1980). Patterns of emotional responses obtained after each induction were compared to the pattern elicited immediately prior to students' final course examination as well as self-talk during the examination. Results indicated that exposure to test-related imagery elicited a pattern of emotional responding that was different than exposure to fear or action imagery but was nearly identical to emotional responses found before examinations. Negative emotional states before the examination also were associated with higher frequencies of negative self-statements during the examination. Treatment implications of these findings were explored.     

Images of the self and self-esteem: do positive self-images improve self-esteem in social anxiety?

Negative self-images play an important role in maintaining social anxiety disorder. We propose that these images represent the working self in a Self-Memory System that regulates retrieval of self-relevant information in particular situations. Self-esteem, one aspect of the working self, comprises explicit (conscious) and implicit (automatic) components. Implicit self-esteem reflects an automatic evaluative bias towards the self that is normally positive, but is reduced in socially anxious individuals. Forty-four high and 44 low socially anxious participants generated either a positive or a negative self-image and then completed measures of implicit and explicit self-esteem. Participants who held a negative self-image in mind reported lower implicit and explicit positive self-esteem, and higher explicit negative self-esteem than participants holding a positive image in mind, irrespective of social anxiety group. We then tested whether positive self-images protected high and low socially anxious individuals equally well against the threat to explicit self-esteem posed by social exclusion in a virtual ball toss game (Cyberball). We failed to find a predicted interaction between social anxiety and image condition. Instead, all participants holding positive self-images reported higher levels of explicit self-esteem after Cyberball than those holding negative self-images. Deliberate retrieval of positive self-images appears to facilitate access to a healthy positive implicit bias, as well as improving explicit self-esteem, whereas deliberate retrieval of negative self-images does the opposite. This is consistent with the idea that negative self-images may have a causal, as well as a maintaining, role in social anxiety disorder.     

Inducing an interpretation bias changes self-imagery: a preliminary investigation

Prior work suggests that variations in self-imagery can influence the emotional interpretations people make about social situations. The current experiment investigated the converse possibility: that inducing an inferential bias can change the content of self-related images. The effects of repeated practice in accessing either negative or positive social outcomes was tested by having participants report on self-images generated during subsequent experience with ambiguous social situations. Participants and independent judges rated the content of participants’ self-images as being more negative after prior practice in accessing negative rather than positive social outcomes. Furthermore, participants who practiced accessing negative outcomes rated their anticipated anxiety in an imagined stressful social situation as being greater, and their expected social performance as poorer than participants in the positive outcome group. Groups did not differ in state anxiety levels when making their ratings, so it is unlikely that any observed differences between groups can be attributed to mood effects. We suggest that this finding is consistent with the hypothesis that inferential biases and content of self-images can interact with each other and may together serve to maintain social anxiety.     

The lateralized emotional stroop task: left visual field interference in women

In a visual hemifield emotional Stroop task, 54 women were asked to name the color of laterally flashed emotional and neutral words while ignoring their semantic content. Vocal reaction times for color naming were recorded. The participants exhibited significant emotional interference effects in the left visual field, which tended to be larger for negative words than for positive words. Participants with higher trait anxiety scores exhibited larger interference for positive words in the left relative to the right visual field. The outcome indicates that, in women, emotional Stroop interference arises in the right rather than in the left hemisphere, with a larger impact of negative than of positive words, and with trait anxiety modulating the lateralized interference for positive words.     

Expanding the topography of social anxiety. An experience-sampling assessment of positive emotions, positive events, and emotion suppression

The relation between social anxiety and hedonic activity remains poorly understood. From a self-regulatory perspective, we hypothesized that socially anxious individuals experience diminished positive experiences and events on days when they are unable to manage socially anxious feelings adequately. In this 21-day experience-sampling study, we constructed daily measures of social anxiety and emotion regulation. Greater dispositional social anxiety was associated with less positive affect and fewer positive events in everyday life. Among individuals defined as socially anxious from their scores on a global self-report measure of social anxiety, the number of positive events was lowest on days when they both were more socially anxious and tended to suppress emotions and highest on days when they were less socially anxious and more accepting of emotional experiences. Irrespective of dispositional social anxiety, participants reported the most intense positive emotions on the days when they were both least socially anxious and most accepting of emotional experiences. Possible clinical implications are discussed.     

Impact of Experimentally Induced Positive and Anxious Mood on Alcohol Expectancy Strength in Internally Motivated Drinkers

The effects of musically‐induced positive and anxious mood on explicit alcohol‐related cognitions (alcohol expectancy strength) in 47 undergraduate students who consume alcohol either to enhance positive mood states (for enhancement motives) or to cope with anxiety (for anxiety‐related coping motives) were investigated. Pre‐ and post‐mood induction, participants completed the emotional reward and emotional relief subscales of the Alcohol Craving Questionnaire – Now. The hypothesis that anxiety‐related coping motivated drinkers in the anxious mood condition (but not those in the positive mood condition) would exhibit increases in strength of explicit emotional relief alcohol expectancies after the mood induction was supported. An additional, unanticipated finding was that enhancement‐motivated drinkers in the anxious condition also showed significant increases in strength of explicit emotional relief (but not emotional reward) alcohol expectancies. The hypothesis that enhancement‐motivated (but not anxiety‐related coping motivated) participants would exhibit increases in explicit emotional reward expectancies following exposure to the positive mood induction procedure was not supported. Taken together with past research findings, the current results highlight the importance of distinguishing between subtypes of negative affect (i.e., anxious and depressed affect) in exploring the affective antecedents of explicit alcohol outcome expectancies.