Perceptual consequences of an illness-concern induction and its relation to hypochondriacal tendencies.

This article examines the perceptual consequences of activating illness concern as a function of hypochondriacal tendencies. In 2 independent samples, hypochondriacal tendencies were associated with slower reaction times on a modified emotional Stroop task when the stimulus words were illness related, but only when illness concern was activated. Moreover, these findings emerged when hypochondriacal tendencies were defined as a sensitivity to bodily sensations. When defined as illness preoccupation and fear, hypochondriacal tendencies were associated with a generalized pattern of perseveration to all stimuli when health concern was activated. Finally, the results persisted even after statistically controlling for state anxiety. Findings are discussed within the context of an activation hypothesis and highlight the importance of the operational definition and assessment of hypochondriacal tendencies when examining perceptual biases.     

Hypochondriacal attitudes may reflect a general cognitive bias that is not limited to illness-related thoughts

Previous findings suggested that hypochondriacal attitudes could originate from a pessimistic trait independent of illness-related thoughts. We hypothesised that hypochondriacal attitudes correlated with a general cognitive tendency towards negative interpretations and reduced familiarisation. Healthy non-patients were invited to participate. The sum score from the Hypochondriacal Beliefs and Disease Phobia scales of the Illness Attitude Scales assessed hypochondriacal attitudes. Participants without any knowledge of the Chinese language were asked to guess whether or not each of eight Chinese characters had a positive meaning and whether the characters appeared familiar. Stimuli without semantic content avoided a reference to illness in order to assess a general cognitive bias. Participants with high hypochondriasis scores rated apparently familiar stimuli as being less positive in comparison to low hypochondriacal participants, F(1,78)?=?9.2, p?=?0.003, η2?=?0.10; correlation of hypochondriasis scores to the differences between ratings of familiar and unfamiliar characters: ρ?=?0.345, p?=?0.002. Positivity and familiarity ratings did not correlate with hypochondriacal attitudes independent of each other. A less positive appraisal of familiar experiences, which is unrelated to illness-related thoughts, may maintain hypochondriacal concerns. A general distrustful attitude towards familiar procedures should be considered in hypochondriasis.     

Interpretive biases for ambiguous stimuli in social anxiety.

A growing body of literature suggests that individuals with high levels of general anxiety form threatening interpretations of ambiguous events. Although theoretical formulations of pathological social anxiety emphasize the importance of a negative interpretive-style in the etiology and maintenance of the disorder, we are unaware of any study that documents this presumed phenomenon. To address this issue, we assessed for possible interpretive biases in a group of high and low socially-anxious students. The results indicated that socially-anxious subjects showed more threatening interpretations of ambiguous, interpersonal events when compared to the low-anxious participants. However, this bias was marked not so much by an outright negative interpretation style, but rather by a failure of the socially-anxious subjects to show a positive interpretation as was evinced by the low-anxious individuals. These group differences in interpretive style appeared to be influenced by trait aspects of social anxiety rather than differences in current mood state. No group differences emerged in interpretations of events that involved non-personal stimuli suggesting there is content specificity in the interpretive biases associated with social-anxiety.     

Beyond words: Sensory properties of depressive thoughts

Verbal thoughts (such as negative cognitions) and sensory phenomena (such as visual mental imagery) are usually conceptualised as distinct mental experiences. The present study examined to what extent depressive thoughts are accompanied by sensory experiences and how this is associated with symptom severity, insight of illness and quality of life. A large sample of mildly to moderately depressed patients (N = 356) was recruited from multiple sources and asked about sensory properties of their depressive thoughts in an online study. Diagnostic status and symptom severity were established over a telephone interview with trained raters. Sensory properties of negative thoughts were reported by 56.5% of the sample (i.e., sensation in at least one sensory modality). The highest prevalence was seen for bodily (39.6%) followed by auditory (30.6%) and visual (27.2%) sensations. Patients reporting sensory properties of thoughts showed more severe psychopathological symptoms than those who did not. The degree of perceptuality was marginally associated with quality of life. The findings support the notion that depressive thoughts are not only verbal but commonly accompanied by sensory experiences. The perceptuality of depressive thoughts and the resulting sense of authenticity may contribute to the emotional impact and pervasiveness of such thoughts, making them difficult to dismiss for their holder.     

Respiratory function, cognitions, and panic in chronic obstructive pulmonary patients.

The present study investigated the relationship between respiratory function, catastrophic thoughts about anxiety, and panic in 48 Chronic Obstructive Pulmonary Disease (COPD) patients. During a routine office visit which included respiratory function tests (Forced Vital Capacity, FVC; Forced Expiratory Volume--first second, FEV1) patients completed a battery of questionnaires which assessed history of panic, days with shortness of breath, general activity level, agoraphobic cognitions, perception of bodily sensations, anxiety and depression. Thirty-seven percent of the sample reported experiencing a panic attack. Subjects showed a significant impairment in respiratory functioning. Patients with a history of panic did not differ from those who had not experienced panic on demographic, physiologic, or activity variables. Patients who experienced panic reported significantly more agoraphobic cognitions and greater concern with bodily sensations than did patients who did not experience panic.     

Interpretation bias and social anxiety: does interpretation bias mediate the relationship between trait social anxiety and state anxiety responses?

Two studies aimed to examine whether high socially anxious individuals are more likely to negatively interpret ambiguous social scenarios and facial expressions compared to low socially anxious individuals. We also examined whether interpretation bias serves as a mediator of the relationship between trait social anxiety and state anxiety responses, in particular current state anxiety, bodily sensations, and perceived probability and cost of negative evaluation pertaining to a speech task. Study 1 used ambiguous social scenarios and Study 2 used ambiguous facial expressions as stimuli to objectively assess interpretation bias. Undergraduate students with high and low social anxiety completed measures of state anxiety responses at three time points: baseline, after the interpretation bias task, and after the preparation for an impromptu speech. Results showed that high socially anxious individuals were more likely to endorse threat interpretations for ambiguous social scenarios and to interpret ambiguous faces as negative than low socially anxious individuals. Furthermore, negative interpretations mediated the relationship between trait social anxiety and perceived probability of negative evaluation pertaining to the speech task in Study 1 but not Study 2. The present studies provide new insight into the role of interpretation bias in social anxiety.     

Individual differences in positive and negative interpretive biases

Student subjects were given the task of writing down the spellings of a series of words (many of them homophones) presented auditorily. Some of the homophones had a negative and neutral interpretation, whereas others had a positive and neutral interpretation. Subjects low in trait anxiety (high extraversion, low neuroticism) produced more positive homophone interpretations than did those low in positive affectivity; this constitutes a positive interpretive bias. Subjects very high in negative affectivity (in terms of trait anxiety) produced more negative homophone interpretations than did those lower in trait anxiety; this constitutes a negative interpretive bias. Theoretical implications of these biases were discussed.     

Waning of panic sensations during prolonged hyperventilation

Recent theories about panic emphasize that a hyperventilatory positive feedback loop is involved in panic: catastrophic misinterpretation of bodily sensations may trigger anxiety, anxiety may stimulate hyperventilation, hyperventilation may promote the salience of feared sensations etc. Such models leave unexplained how and when panics come to an end. It was hypothesised that panic with hyperventilation may end because pronounced hyperventilation becomes, in the course of time, less powerful in generating perceivable bodily sensations. Twenty healthy subjects hyperventilated forcefully and experienced clear panic symptoms as defined by DSM IIIR. When pCO2 was kept 55% below base line for 90 min, panic symptoms waned. The mean intensity of the symptoms declined as did the number of symptoms occurring. No panic symptoms were observed in the control group (n = 20) who ventilated normally. In so far as hyperventilation is involved in the positive feedback loops that characterize panic, panic attacks may be time-limited because sensations induced by hyperventilation become less salient even if massive hyperventilation continues. As to the explanation of the reported phenomenon, it is suggested that, apart from habituation, local physiological changes due to prolonged hyperventilation may produce a decrease in interoceptive input.     

Increased interoceptive awareness in fear of flying: sensitivity to suffocation signals

In flight phobia, particular environmental factors can facilitate a fear response. The current study aimed to explore the relationship between respiratory sensations and fear of flying: individuals with fear of flying may be more sensitive to suffocation signals and could experience more bodily sensations as a consequence of an added resistive respiratory load. The sample included 19 subjects with fear of flying and 19 controls. Each subject wore a mask to which a respiratory load could be added. First, an interference paradigm was used: respiratory loads were presented during a tone detection task. Next, subjects were asked to detect the loads. After each task, subjects reported their somatic sensations. All subjects showed interference of the respiratory loads. However, subjects with fear of flying were more accurate in detecting the loads, thereby indicating higher interoceptive awareness. Moreover, their superior accuracy was related to increased bodily sensations: a higher interoceptive awareness resulted in increased symptom reporting. It follows that treatment interventions for fear of flying should be supplemented with interventions that target internal stimuli.     

Haunted by somatic tendencies: Spirit infestation as psychogenic illness

It has been suggested that haunting and poltergeist episodes are akin to outbreaks of contagious psychogenic illness. Therefore, it might be expected that hypochondriacal and somatic tendencies would significantly predict self-reported experiences of 'spirit infestation' and other paranormal ideations. This prediction was tested on a sample of 314 undergraduate students who completed the Anomalous Experiences Inventory, the Transliminality Scale and three standard questionnaires about hypochondriasis, somatic complaints, and cognitions about body and health. Results from correlational and regression analyses supported predictions, although we found that the type of bodily cognition varied with the specificity of the paranormal experience. For example, indices of spirit infestation coincided with autonomic sensations, perceived paranormal ability was related to catastrophizing cognitions, and general paranormal experiences correlated with somatization traits. Transliminality and paranormal belief contributed positively to nearly all of these associations. These findings are consistent with the idea that some paranormal experiences are partly misattributions of internal experience to external (paranormal) sources - a process that could initiate an episode of contagious (mass) psychogenic illness by encouraging the collective perception of similar 'symptoms' in a group of people due to suggestion and demand characteristics.     

情绪的身体感觉：基于身体感觉地图（BSMs）与主观报告

关于不同情绪是否对应不同的生理反应一直存在争议。Nummenmma等人（2014）使用自创的emBODY工具,发现每种情绪都有其独特的身体感觉地图（BSMs）。本研究以中国大学生为被试,以emBODY为研究工具绘制快乐、爱、恐惧、焦虑四种情绪的BSMs,并要求被试口头报告BSMs所反映的身体感觉。结果发现,四种情绪具有不同的身体感觉,体现为BSMs的差异与主观报告的差异。质性资料分析发现BSMs所反映的身体感觉不仅包括生理反应、也包括认知、感受和行为倾向,这为情绪与身体的关系提供了新的证据。被试对身体部位活动性增强或减弱的理解不一致、只呈现身体的一面等是BSMs作为研究工具的潜在局限,未来研究需要做出改进。     

Treatment of panic attacks using cognitive therapy without exposure or breathing retraining

Cognitive treatment of panic attacks is based on the hypothesis that panic results from the catastrophic misinterpretation of bodily sensations, and that changing such misinterpretations will block the occurrence of panic. The treatment normally involves an integrated set of cognitive and behavioural techniques. In a consecutive series of panic patients, a multiple baseline across subjects design was used to investigate whether a modified form of treatment involving only cognitive procedures could reduce panic attack frequency. The results provide preliminary evidence that cognitive procedures directed at changing misinterpretations of bodily sensations can reduce panic attack frequency, and also that cognitive procedures which do not target misinterpretations may not reduce panic.     

Cognitive processing of emotional information in panic disorder.

Panic-disordered (PD) patients, obsessive-compulsive (OCD) patients, and normal control subjects were exposed to either a high (i.e. exercise) or low arousal manipulation prior to performing a computerized version of the modified Stroop color-naming paradigm. Subjects named the colors of neutral nonlexical stimuli, positive words, and threat words associated with fear, bodily sensations, and catastrophes. After the Stroop task, subjects rated the personal emotional significance of the words. Inconsistent with the emotionality hypothesis of Stroop interference, PD patients rated positive words as more emotional than catastrophe words, but took longer to color-name the latter than the former. Yet consistent with the emotionality hypothesis, PD patients took as long to color-name positive words as to color-name fear and bodily sensation words. Contrary to expectation, OCD patients resembled PD patients in terms of interference, and arousal did not enhance interference for threat words in PD patients.     

Interpretation revealed in the blink of an eye: depressive bias in the resolution of ambiguity

Self-report measures of interpretation have been criticized on methodological grounds. An approach is introduced in this article that enables the assessment of interpretive bias with a greater degree of methodological rigor than previously has been the case. Psychophysiological researchers have established that the magnitude of the human blink reflex is augmented when elicited during negative rather than neutral imagery. The 1st experiment demonstrates that the blink reflex is sensitive to the emotional valence of imagery evoked by interpretations imposed on ambiguous stimuli. In the 2nd experiment, this measure is used to assess interpretations imposed on ambiguous stimuli by individuals who differ in depression levels. The findings are consistent with the hypothesis that depression is associated with a negative interpretive bias.     

The Relationship Between Premenstrual Distress and Anxiety Sensitivity: The Mediating Role of Rumination

Given that premenstrual distress is reported by large numbers of women, research has focused on the identification of biological and psychological factors that influence its severity. Previous research suggests that women who are high in anxiety sensitivity also report greater levels of premenstrual distress and negative affect. According to the menstrual reactivity hypothesis, women who have a tendency to self-focus and catastrophize about physical sensations are more likely to report greater levels of premenstrual distress. Cognitive schemas surrounding the menstrual cycle develop that are influenced by gender roles, cultural stereotypes, and expectations about bodily sensations. Another cognitive process, rumination, may also be linked to increased reports of premenstrual distress. Conceptually, the constructs of anxiety sensitivity and rumination share the tendency to self-focus on internal states. The goal of this study was to investigate how these two constructs relate to the prediction of premenstrual distress in a large sample of healthy undergraduate women (N = 478). Using mediational modeling, support was found for a mediational model; women who reported high levels of rumination and anxiety sensitivity reported the greatest premenstrual distress. These results are discussed within the framework of the menstrual reactivity hypothesis, a diathesis-stress model of premenstrual distress.     

Affective responses to hyperventilation: a test of the cognitive model of panic

A cognitive explanation of the association between acute hyperventilation and panic attacks has been proposed: the extent to which sensations produced by hyperventilation are interpreted in a negative and catastrophic way is said to be a major determinant of panic. Non-clinical subjects were provided with a negative or a positive interpretation of the sensations produced by equivalent amounts of voluntary hyperventilation. As predicted, there was a significant difference between positive and negative interpretation conditions on ratings of positive and negative affect. Subjects in the positive interpretation condition experienced hyperventilation as pleasant, and subjects in the negative interpretation condition experienced hyperventilation as unpleasant, even though both groups experienced similar bodily sensations and did not differ in their prior expectations of the affective consequences of hyperventilation. When the subjects were given a positive interpretation, the number of their sensations correlated with positive affect; when a negative interpretation was given, the number of bodily sensations correlated with negative affect. The results provide support for a cognitive model of panic and are inconsistent with the view that panic is simply a symptom of hyperventilation syndrome.     

Cognitive-emotional sensitization and somatic health complaints

Sensitization is conceptually related to cognitive bias in experimental psychopathology, and they share the basic mechanism of neuronal sensitization. Every strongly relevant individual concern, like fears, can yield cognitive bias or "cognitive-emotional sensitization". It might also be present for bodily and environmental information related to illness, and could be an etiological factor in medically unexplained complaints. Physiological and cognitive sensitization are theoretically compared. There is evidence for cognitive-emotional sensitization in some medically unexplained somatic complaints, and negative affect is suggested as a catalyst. Prolonged cognitive-emotional sensitization ("perseverative negative cognition" or worry, rumination) might even have demonstrable somatic pathological effects. It is concluded that sensitization may be organized at different levels, both in the organism and in the larger living system within which the organism is subsumed. This view might not only help to clarify medically unexplained pain syndromes, but virtually every subjective complaint, both with and without recognized physiopathology.     

Threat is in the eye of the beholder: social anxiety and the interpretation of ambiguous facial expressions

The current study investigated the tendency of individuals with high levels of social anxiety to interpret ambiguous facial expressions in a threatening manner. Results obtained from self-report measures were consistent with previous studies in which highly socially anxious individuals endorsed threatening interpretations for ambiguous social information. More importantly, highly socially anxious participants showed relative facilitation of processing of threatening faces following neutral faces when a priming technique was used to eliminate artifact due to response selection bias. These findings support the hypothesized social anxiety-linked interpretive bias.     

Effects of preparatory information about sensations, threat of pain, and attention on cold pressor distress.

Pain experience is conceptualized as a combination of stimulus sensations (e.g., aching) and emotional distress. In Experiment 1, less distress was reported to cold pressor stimulation by subjects first told about stimulus sensations than by subjects who were uninformed or were told about symptoms of bodily arousal (e.g., tension). Adding a pain warning to sensation information blocked distress reduction, presumably by eliciting an emotional interpretation of the stimulus. In Experiment 2, subjects attending only to hand sensations reported less distress than subjects attending to their bodies. This decrease in the power of the stimulus to provoke emotion is presumably mediated by a schema of hand sensations formed by attention. In Experiment 3, subjects attending to hand sensations early in the immersion and distracting themselves later reported the same low levels of distress as did subjects who attended to hand sensations throughout. Subjects distracted throughout and subjects attending to hand sensations later showed no distress reduction. Therefore, stimulus schematization must precede distress reduction. Implications for distress control are discussed.     

Social anxiety and fear of bodily sensations in panic disorder and agoraphobia: A matched comparison

This study tests the hypothesis that social anxiety and fear of bodily sensations are associated with the development of agoraphobic avoidance behavior in panic disorder patients. Twenty patients with panic disorder were compared to 20 patients with panic disorder with agoraphobia, matched by sex and duration of disorder. The two groups did not differ on measures of fear and frequency of assertive social responses. However, the agoraphobics scored higher on measures of interpersonal sensitivity, depression, feelings of inadequacy, and hostility. They also reported higher fear of bodily sensations. Although definitive conclusions need to be postponed until prospective studies have been conducted, there is evidence suggesting that the development of agoraphobia in panic patients is associated with hypersensitivity to bodily sensations and interpersonal situations.This research was supported by Grant 560-268-009 of the Dutch Organization for Scientific Research.