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Heartbeat awareness and heart rate reactivity in anxiety sensitivity: A further investigation

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Abstract

We examined the effects of anxiety sensitivity (AS) and arousal induction on heartbeat awareness and heart rate reactivity in a nonclinical undergraduate sample. Students were randomly selected from a larger screening sample to fill two groups (high and low AS; n = 15 per group) based on Anxiety Sensitivity Index (ASI) [Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index manual (2nd ed. revised). Worthington, OH: International Diagnostic Systems] scores. Participants completed a mental arithmetic/spelling task to induce arousal. At two phases (i.e., baseline vs. stress), participants estimated their heart rates during specified intervals using a mental tracking paradigm. Actual heart rates were simultaneously measured. Although heart rate did increase significantly from baseline to stress phases, high and low AS groups did not differ in terms of heart rate reactivity to the stressor. As hypothesized, high AS individuals were more accurate in estimating their actual heart rate as compared to low AS individuals. Contrary to hypothesis, the AS group differences in accuracy of heartbeat estimations did not vary across baseline vs. stress phases. Interestingly, only low AS individuals provided heart rate estimates which were significantly lower than their actual heart rate readings. Although high and low AS individuals did not differ in actual heart rate, high AS individuals provided significantly higher heart rate estimates than low AS individuals. These results are consistent with the interoceptive sensitivity hypothesis. Implications of the greater heartbeat awareness of high AS individuals are discussed.

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... In a collaboration with my former graduate student Susan Buffett-Jerrott, we reasoned that the selective attention to physical threat words on the Stroop observed in the Stewart et al.'s (1998) study should translate into selective attention to internal arousal sensations among high AS individuals, and hence greater interoceptive sensitivity (Stewart, Buffett-Jerrott, et al., 2001). We studied this in the lab through a heartrate awareness task with high and low AS individuals selected according to scores on the original ASI (Peterson & Reiss, 1992). ...
... Contrary to our predictions, however, high AS individuals were not more accurate in estimating their heartrate when in an emotionally aroused state than when in a relaxed state at baseline. This suggests that high AS individuals may remain chronically vigilant toward bodily arousal cues (Stewart, Buffett-Jerrott, et al., 2001). ...
... They appeared more likely than OAT clients in the other personality groups to discuss the aversiveness of opioid withdrawal symptoms, suggesting use of substances to relieve withdrawal as a maintenance factor for their opioid misuse and use of other substances. They often discussed health concerns which is not surprising given links of AS with health anxiety and interoceptive sensitivity (Stewart, Buffett-Jerrott, et al., 2001). High AS OAT clients more frequently discussed use of prescription tranquilisers, often to cope with feared anxiety experiences. ...
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Le présent article résume notre programme de recherche sur la sensibilité à l’anxiété (SA) – un facteur dispositionnel cognitif et affectif impliquant des craintes de sensations liées à l’anxiété en raison de croyances selon lesquelles ces sensations entraînent des conséquences catastrophiques. La SA et ses dimensions d’ordre inférieur sont considérées comme des facteurs transdiagnostiques de risque ou de maintien des troubles émotionnels et des troubles addictifs. La compréhension des mécanismes par lesquels la SA exerce ses effets peut révéler des cibles d’intervention clés pour les programmes de prévention et de traitement axés sur la SA. Dans le présent article, je passe en revue les recherches fondamentales que nous avons menées pour comprendre les mécanismes qui relient la SA à ces troubles et à leurs symptômes. Je décris également les interventions transdiagnostiques ciblées sur la SA et j’illustre la manière dont la recherche fondamentale a permis d’orienter le contenu de ces interventions. Enfin, je passe en revue les projets en cours dans mon laboratoire et je souligne les orientations futures importantes dans ce domaine. Bien que des progrès considérables aient été réalisés au cours des trois dernières décennies et que la recherche ait considérablement fait avancer notre compréhension de la SA en tant que facteur transdiagnostique, de nombreuses questions restent en suspens. Les réponses devraient nous aider à affiner les interventions afin d’en faire bénéficier au maximum les personnes qui ont une grande peur d’avoir peur.
... The HR measurement was also used as a gauge to evaluate level of anxiety. Heart rate has been shown to be a valid measure in determining anxiety (2,5,9,19), allowing for performance evaluation as a result of psychological stress (11,17,19,25). ...
... The HR measurement was also used as a gauge to evaluate level of anxiety. Heart rate has been shown to be a valid measure in determining anxiety (2,5,9,19), allowing for performance evaluation as a result of psychological stress (11,17,19,25). ...
... Additionally, NASCAR rules state that if a lug nut is not securely tightened when the race car leaves pit road, then the car is penalized usually by a return to pit road which, at best, results in the loss of multiple positions and, at worst, can result in the loss of multiple laps in the race (3). Therefore, the higher HRs we observed in the changers could be a result of increased anxiety (5,19,25) to tighten the lug nuts properly and prevent a costly-both economically and competitionwise-penalty. ...
... However, it correlates most highly with SAD in children and adolescents (Alkozei et al., 2014;Essau et al., 2010). Although individuals with high and low anxiety sensitivity have similar heart rate reactivity under stress, those with high anxiety sensitivity have been found to be more accurate in their perception of heart rate than those low in anxiety sensitivity who underestimate heart rate elevation (Stewart et al., 2001). Anxiety sensitivity may play a causal role in anxiety disorders by increasing aversion toward already threatening stimuli (Reiss et al., 1986). ...
... We anticipated that higher levels of anxiety sensitivity and effortful control may moderate this effect. In line with Stewart et al. (2001), anxiety sensitivity should elevate perceived heart rate after negative vicarious experience. Higher levels of effortful control should be associated with lower physiological reactivity and perceived heart rate at task after the negative vicarious experience when compared to the neutral one. ...
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Two experiments investigated perceived and physiological changes in anxiety in children (7–11 years; N = 222; 98 female) in a performance situation after they observed another child in a similar situation with a negative or neutral outcome. The sample's London, United Kingdom, school catchment areas ranged from low to high socioeconomic statuses with 31% to 49% of children from ethnic minority backgrounds. In Study 1, participants watched one of two films of a child playing a simple musical instrument (a kazoo). In one film, an audience of peers responds negatively to the performance. In the other film, the audience response was neutral. Participants were then filmed playing the instrument themselves and measures of perceived and actual heart rate were taken along with individual differences in trait social anxiety, anxiety sensitivity, and effortful control. To better understand findings from Study 1, Study 2 replicated Study 1 but added a manipulation check and measures of effortful control and self-reported anxiety. Multiple regression analyses found watching a negative performance film, compared with a neutral one, was associated with a blunted heart rate response for children with low effortful control (Study 1 and 2). These findings suggest that children who are low in effortful control may disengage during performance tasks if the situation's social threat is elevated. Hierarchical regression analyses found that, compared to the neutral film, the negative performance film elevated children's self-report anxiety (Study 2). Overall, the findings indicated that anxiety in performance situations can be elevated after observing peers’ negative experiences.
... PSVT has been associated with anxiety and panic disorders. This association may be due to the sudden onset of tachycardia, causing increased anxiety and stress levels [3][4][5]. However, the symptoms of PSVT appear to mimic anxiety and may offer another etiology for this relationship. ...
... One study reported that anxiety disorder has been present in approximately 25% of patients with PSVT; interestingly, the same study reported that PSVT was unrecognized over 50% of the time [6]. As anxiety levels increase, patients are at an increased risk for further PSVT [5,9]. Therefore, patients can often get caught between anxiety and panic attacks between episodes of PSVT. ...
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Background: Patients with true paroxysmal supraventricular tachycardia (PSVT) are frequently misdiagnosed with panic or anxiety disorders due to similar symptoms of palpitations, light-headedness, dyspnea, or chest discomfort. Unrecognized PSVT can lead to unnecessary management with anxiety medications. Treatment of PSVT with catheter ablation may lead to a reduction in anxiety medications. Methods: A total of 175 patients underwent successful PSVT ablation between January 1, 2010 and December 31, 2020. We examined symptoms at presentation, psychiatric medications prior to PSVT ablation, comorbidities, and psychiatric medications at three months post-ablation. Results: Fifteen percent of patients who underwent successful PSVT ablation were being treated with psychiatric medications and included in the final study population. The most common symptoms were palpitations (80.77%), followed by dizziness (42.31%), and shortness of breath (34.62%). The average number of medications prior to ablation was 1.42 and decreased to 1.08 at three months post-ablation (p = 0.04). The average number of selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other anxiolytics also decreased but was not statistically significant. Conclusion: In patients with anxiety and PSVT, catheter ablation reduced the average number of psychiatric medications.
... PSVT has been associated with anxiety and panic disorders. This association may be due to the sudden onset of tachycardia, causing increased anxiety and stress levels [3][4][5]. However, the symptoms of PSVT appear to mimic anxiety and may offer another etiology for this relationship. ...
... One study reported that anxiety disorder has been present in approximately 25% of patients with PSVT; interestingly, the same study reported that PSVT was unrecognized over 50% of the time [6]. As anxiety levels increase, patients are at an increased risk for further PSVT [5,9]. Therefore, patients can often get caught between anxiety and panic attacks between episodes of PSVT. ...
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Background: Patients with true paroxysmal supraventricular tachycardia (SVT) are frequently misdiagnosed with panic or anxiety disorders due to similar symptoms of palpitations, light-headedness, dyspnea, or chest discomfort. Unrecognized SVT can lead to unnecessary management with anxiety medications. Treatment of SVT with catheter ablation may lead to reduction in anxiety medications. Methods: A total of 175 patients underwent successful SVT ablation between January 1, 2010 and December 31, 2020. We examined symptoms at presentation, psychiatric medications prior to SVT ablation, comorbidities, and psychiatric medications at 3 months post-ablation. Results: 15% of patients who underwent successful SVT ablation were being treated with psychiatric medications and were included in the final study population. The most common symptoms were palpitations (80.77%), followed by dizziness (42.31%), and shortness of breath (34.62%). The average number of medications prior to ablation was 1.42 and decreased down to 1.08 at 3 months post-ablation (p = 0.04). The average number of SSRIs, SNRIs, and other anxiolytics were also decreased but were not statistically significant. Conclusion: In patients with anxiety and paroxysmal supraventricular tachycardia, catheter ablation is associated with reduced average number of psychiatric medications.
... Similarly, those high (vs. low) in anxiety sensitivitythe fear that anxiety-related somatic sensations have harmful consequencesare more accurate in estimating their heart rate (Stewart, Buffet-Jerrott, & Kokaram, 2001). ...
... Neither baseline cardioceptive accuracy nor the standardized measure of alcohol use/abuse (AUDIT) was significantly associated with any other measure. The absence of a significant correlation between baseline cardioceptive accuracy and anxiety sensitivity is inconsistent with results from Stewart et al. (2001). This is possibly due to the greater number of cardiovascular-related items in the ASI-R (6), which was used in the Stewart et al. study, than in the ASI-3 (3), which was used in the present study. ...
Article
Introduction: It is well established that some individuals self-medicate their anxiety with alcohol. Though much evidence exists that alcohol consumption can be negatively reinforcing, there remains uncertainty regarding what mediates the relationship between alcohol and anxiety. An unexplored possibility is that, for some, alcohol impairs interoceptive sensitivity (the ability to accurately perceive one's physiological state), thereby decreasing state anxiety. Consistent with this, highly accurate heartbeat perception is a risk factor both for elevated trait anxiety and anxiety disorders. However, the direct impact of alcohol on cardioceptive accuracy has not to our knowledge been previously examined. Methods: Sixty-one social drinkers came to the lab in groups of 4-6 on two days spaced a week apart. Each participant was randomly assigned to receive alcoholic drinks targeting a BAC of 0.05% on one testing day and placebo drinks on the other, with the order counter-balanced. On both testing days, participants engaged in a Schandry heartbeat perception task on three occasions: at baseline, after an alcohol absorption period, and after physiological arousal was raised via exercise. Results: For men only, alcohol significantly impaired cardioceptive accuracy relative to a placebo at both low and high levels of arousal, with medium to large effect sizes. Conclusions: Though preliminary, this finding is consistent with the proposed hypothesis linking alcohol consumption and anxiety, at least for men. Future studies should directly examine whether, among individuals with anxiety disorders, cardioceptive sensitivity mediates the relationship between alcohol consumption and state anxiety.
... Here, we sought to investigate whether exposure to interoceptive signals influences participant's behavior in an UG. The influence of interoception has been shown on various cognitive or emotional tasks (e.g., attention, (Matthias et al. 2009), decision making (Werner et al. 2009), emotional intelligence (Schneider et al. 2005), empathy (Schneider et al. 2005) and tendency to general anxiety (Stewart et al. 2001). This has usually been assessed by grouping participants into good versus bad perceivers based on a heartbeat tracking task (Schandry and Weitkunat 1990) or heartbeat discrimination task (Critchley et al. 2004) and comparing the groups in a between-group design. ...
... The study thus demonstrates how individual differences in perceiving bodily signals interact with different strategies of emotional responding. While the measurement of individual differences in interoceptive sensitivity has proven to be a useful tool in the study of how this ability correlates with behavior or personality traits (Stewart et al. 2001;Herbert et al. 2007;Matthias et al. 2009;Pollatos et al. 2009;Werner et al. 2009;Dunn et al. 2012), this approach may not always provide the most complete description of the role of interoception in cognition. In fact, several studies found the effects of cardiac interoceptive accuracy to be context dependent or to mediate/or be mediated by other variables (Bogaerts et al. 2005(Bogaerts et al. , 2008Pollatos et al. 2009;Dunn et al. 2012). ...
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The ultimatum game (UG) is commonly used to study the tension between financial self-interest and social equity motives. Here, we investigated whether experimental exposure to interoceptive signals influences participants' behavior in the UG. Participants were presented with various bodily sounds-i.e., their own heart, another person's heart, or the sound of footsteps-while acting both in the role of responder and proposer. We found that listening to one's own heart sound, compared to the other bodily sounds: (1) increased subjective feelings of unfairness, but not rejection behavior, in response to unfair offers and (2) increased the unfair offers while playing in the proposer role. These findings suggest that heightened feedback of one's own visceral processes may increase a self-centered perspective and drive socioeconomic exchanges accordingly. In addition, this study introduces a valuable procedure to manipulate online the access to interoceptive signals and for exploring the interplay between viscero-sensory information and cognition.
... It was also evident in studies that showed that highly sensitive individuals tend to react intensely to emotional stimuli, as was measured by a variety of measurements such as self-reports, records of event-related potentials and monitored heart rate (Herbert et al., 2007;Pollatos et al., 2007aPollatos et al., , b, 2007d. Furthermore, there are indications that high sensitivity to internal signals is related to indicators of somatosensory amplification (Bekker et al., 2002;Spoor et al., 2005), as well as to anxiety (Pollatos et al., 2007a(Pollatos et al., , 2009Stewart et al., 2001), eating disorders (Spoor et al., 2005), interpersonal problems (Bekker et al., 2008) and impaired quality of life (Oh et al., 2010). ...
... Closer examination of the way that sensitivity was measured in the various studies suggests that the reported conflicting finding with regard to the adaptivity of sensitivity to bodily signals cannot be explained by the method of assessment. Most of the studies that assessed sensitivity to bodily signals as the level of accuracy in the heartbeat detection task indicated its maladaptivity (Pollatos et al., 2007b(Pollatos et al., , 2009Stewart et al., 2001). However, some studies provided support for the adaptivity of sensitivity as measured by this procedure (Aronson et al., 2001;Johnston et al., 2012;Mailloux & Brener, 2002). ...
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Sensitivity to bodily signals is the tendency to be aware of bodily states and to identify subtle bodily reactions to internal and environmental conditions. Monitoring these signals is a top-down process, describing individuals' tendency to actively scan their bodies in order to detect cues for their physical condition. Two studies examined the relations between these constructs and their adaptivity among young adults. In Study 1, 180 young adults completed questionnaires assessing sensitivity, monitoring, and hypochondriac tendency. In Study 2, 205 students reported their levels of sensitivity, monitoring, pain catastrophizing, and trait anxiety. Although monitoring and sensitivity were correlated, when controlling for their shared variance, only monitoring was associated with high hypochondriac tendency and anxiety. In addition, the adaptivity of sensitivity to bodily signals was dependent on both level of monitoring of bodily signals and pain catastrophizing. That is, pain catastrophizing moderated the effect of sensitivity and monitoring on anxiety. These findings suggest that the adaptivity of sensitivity is determined by the mode of attention characterizing the individual engaged in this process.
... Methods for assessment can often be quite simple, and in some cases portable. For example, multiple cardiac metrics, such as HR, HRV/vagal tone, and IBI, can be measured with a wristwatch (i.e., HR monitor) that wirelessly connects to a band worn around the torso (e.g., Stewart, Buffett-Jerrott, & Kokaram, 2001). The torso band collects EKG signals from which cardiac metrics may be taken. ...
... Depending on the model, HR monitors may also display "live" readings of HR. In some cases, the wristwatches can be held up to 3 feet away from the adolescent wearing the EKG torso band to facilitate clinician monitoring (Stewart et al., 2001). ...
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How clinicians should assess adolescent patients distressed by physiological experiences of social anxiety is often unclear. Clinicians might hypothesize that this component of social anxiety will resolve with treatment of other components (e.g., negative thoughts or behavioral avoidance) and thus focus assessments on these other components. However, research has indicated that expressions of the different components of social anxiety often do not operate in synchrony. Evidence-based assessment and treatment of social anxiety in adolescence is critical because of its potential impact on psychosocial functioning; if left untreated, social anxiety places an adolescent at greater risk for developing substance use problems in adulthood. Practitioners rarely assess adolescents' physiological experiences, but when they do, they tend to rely on subjective measures (e.g., paper and pencil) rather than on a multimethod approach including objective psychophysiological measures. It is possible that practitioners infrequently utilize objective psychophysiological assessments because they assume that subjective measures comprehensively assess this physiological component of social anxiety. Additionally, practitioners may believe that the use of objective psychophysiological methods is cost-prohibitive. Yet, recent technological innovations have resulted in low-cost, portable instruments to objectively assess psychophysiology in research and practice. In this review, we discuss objective psychophysiological measures of social anxiety in adolescents and provide recommendations for their use in research and practice. We argue that neither subjective nor objective measures alone yield a comprehensive understanding of psychophysiology. Rather, joint use of these measures may greatly improve both the assessment and treatment of adolescent social anxiety.
... Existing research has found that abnormalities in interoception vary across different psychiatric conditions. For instance, individuals with depression exhibit impaired interoceptive accuracy (18), while patients with severe anxiety symptoms report more bodily sensations, showing heightened interoceptive sensitivity (19,20). In schizophrenia, the manifestation of interoception is more complex; some studies have found that individuals with schizophrenia have lower interoceptive accuracy compared to healthy populations (21). ...
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Background Bipolar disorder (BD) with somatic symptoms is prevalent in adolescent patients. Interoception has an important impact on physical and emotional regulation. However, it is unclear the characteristics of interoception and its relationship to somatization and emotional symptoms in adolescents with BD. Methods This study recruited 71 adolescent BD subjects during rehabilitation and 111 age-matched controls. Demographic characteristics, interoception, somatization, depression, and anxiety symptoms were assessed. Mann-Whitney U tests, partial correlation analysis, and multiple linear regression were used to explore the alteration of interoception in BD patients and its association with clinical symptoms. Results After adjusting for differential demographic variables, adolescent BD patients scored lower on several dimensions of interoception and higher on somatization and emotional symptoms than controls. Moreover, there were significant differences on the interoceptive dimensions of not-distracting, not-worrying, and trusting between BD patient groups with and without somatization. Correlational analysis revealed that the interoceptive indicators of BD patients were significantly correlated with emotional and somatic symptoms. The dimension of not-distracting was the only interoceptive predictor of somatization symptoms and emotional problems in adolescents with BD, maintaining its predictive stability even after controlling for emotional symptoms. This indicates that the capacity for focused attention is a key interoceptive element affecting the expression of somatic and emotional issues in BD adolescent patients. Conclusion Adolescents with BD exhibit deficits in interoception, somatization and emotional issues. The not-distracting aspect of interoception significantly correlates with emotional and somatic symptoms in adolescents with BD, offering insights and targeted strategies for managing psychosomatic symptoms in this demographic.
... En consecuencia, varios estudios (Pollatos, Gramann y Schandry, 2007;Füstös et al., 2013) realizados en población general han encontrado que un déficit en la conciencia interoceptiva se asocia con mayores niveles de alexitimia que definida como un déficit en el procesamiento cognitivo de la emoción y la incapacidad de representar mentalmente las emociones, lo que limita la capacidad de regulación emocional a través de los procesos cognitivos (Jakubczyk et al. 2020); junto con una menor diferenciación en las emociones de otros (Terasawa et al., 2014), menos empatía (Grynberg y Pollatos, 2015), entre otros. Además, otro estudios han informado de que las medidas de la precisión de la percepción de los latidos del corazón se correlacionan positivamente con las medidas de los rasgos afectivos, como la tendencia a la ansiedad general (Pollatos et al., 2009, Stewart et al., 2001. La evidencia en su totalidad apoya la noción de que la monitorización y la representación central de las señales corporales desempeñan un papel fundamental en la emoción. ...
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The perception of body changes, defined as interoception, is a key element in current research. The present review article aims to characterize the role of interoception in emotional processing. First, we describe the main interoceptive models and their measurement methods. Then, we delimit in a general way the mechanisms of atypical interoception. The results indicate that research in the area has not been systematic, which has led to the widespread practice of extending the definition of interoceptive as “not exteroceptive”. It has also, in a more restricted way, been described as simply a physiological pathway. This has led to the measurement of interoception having certain limitations that must be resolved wherever possible. Finally, it is concluded that atypical interoceptive mechanisms are a common factor related to the symptomatology present in different emotional disorders such as alexithymia, depression, anxiety, and somatic disorders.
... Roerdink et al. [19] showed that internal monitoring which depends on paying greater attention to somatic sensations is connected with a decrease in postural control automaticity, and increased center of pressure regularity. Individuals with a high level of anxiety sensitivity pay greater attention to somatic sensations and have more detailed interoception than people with low-anxiety sensitivity [20]. Phenomena, being aware of bodily states, may point to less continuous inter-segmental postural coordination patterns, a more reactive pattern of forces to maintain a stance. ...
Article
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Postural control is a term used to describe how the central nervous system regulates sensory information from other systems to produce adequate motor output to maintain a controlled, upright posture. Emotions (fear, anxiety) and thus personality type can affect the strategy of body control. This study aimed to evaluate the impact of personality on postural control. Thirty-three healthy individuals participated in this study. The big-five model was used to examine personality traits. Each participant performed four different standing tasks (one and both legs standing with eyes open (eo) and closed (ec): 2eo, 2ec, 1eo, 1ec). We showed that the dominant personality traits in the study group were extraversion and agreeableness. There were significantly low negative associations between nonlinear parameters and personality traits. A moderate correlation was noted for the 1eo trial between Openness and the Lyapunov exponent. In conclusion, nonlinear measures provide a possible link between personality and postural control. The relationships detected are weak. It shows that factors such as visual control and the size of the support area rather than personality will play a significant role in describing postural control.
... Auf deskriptivem Niveau ist zu bemerken, dass die ASI-3-Mittelwerte in den beiden Hochangstsensitivitäts(HAS)-Gruppen "HAS_Intervention" und "HAS_Warteliste" mit den Mittelwerten von Patientengruppen aus dem neurotischen und affektiven Bereich vergleichbar waren (Kemper, Lutz, Bahr, Rüddel & Hock, 2012;Taylor et al., 2007 Domschke et al., 2010;Ehlers & Breuer, 1992;Ehlers et al., 1995;Stewart, Jerrott, et al., 2001;Van der Does et al., 2000;Van der Does et al., 1997), konnten andere Studien wiederum keinen Zusammenhang zwischen erhöhter AS bzw. der Panikstörung und interozeptiver Sensitivität finden (Antony et al., 1995;Antony et al., 1994;Barsky et al., 1994;Yoris et al., 2015). ...
Thesis
Angsterkrankungen stellen mit einer 12-Monats-Prävalenz von 14% die häufigsten psychischen Erkrankungen in der westlichen Gesellschaft dar. Angesichts der hohen querschnittlichen wie sequentiellen Komorbidität von Angsterkrankungen, der ausgeprägten individuellen Einschränkungen sowie der hohen ökonomischen Belastung für das Gesundheitssystem ist neben therapeutischen Behandlungsansätzen die Entwicklung von kurzzeitigen, kostengünstigen und leicht zugänglichen Präventionsmaßnahmen von großer Bedeutung und steht zunehmend im Fokus des gesundheitspolitischen Interesses, um die Inzidenz von Angsterkrankungen zu reduzieren. Voraussetzung für die Entwicklung von gezielten und damit den effektivsten Präventionsmaßnahmen sind valide Risikofaktoren, die die Entstehung von Angsterkrankungen begünstigen. Ein Konstrukt, das in der Literatur als subklinisches Symptom in Form einer kognitiven Vulnerabilität für Angsterkrankungen und damit als Risikofaktor angesehen wird, ist die sogenannte Angstsensitivität (AS). AS umfasst die individuelle Tendenz, angstbezogene körperliche Symptome generell als bedrohlich einzustufen und mit aversiven Konsequenzen zu assoziieren. Das Ziel der vorliegenden Arbeit war daher die Etablierung und Validierung eines Präventionsprogramms zur Reduktion der AS an einer nicht-klinischen Stichprobe von 100 Probanden (18-30 Jahre) mit einer erhöhten AS (Anxiety Sensitivity Index [ASI-3] ≥17) sowie die Rekrutierung von 100 alters- und geschlechtsangeglichenen Probanden mit niedriger Angstsensitivität (ASI-3 <17). In einem randomisiert-kontrollierten Studiendesign durchliefen die Probanden mit hoher AS entweder das über fünf Wochen angelegte „Kognitive Angstsensitivitätstraining“ (KAST) als erste deutschsprachige Übersetzung des Computer-basierten „Cognitive Anxiety Sensitivity Treatment“ (CAST) von Schmidt et al. (2014) oder wurden der Wartelisten-Kontrollgruppe zugeteilt. Das KAST Training bestand aus einer einmaligen Vermittlung kognitiv-behavioraler Psychoedukation zum Thema Stress und Anspannung sowie deren Auswirkungen auf den Körper und der Anleitung von zwei interozeptiven Expositionsübungen (‚Strohhalm-Atmung‘ und ‚Hyperventilation‘), die über den anschließenden Zeitraum von fünf Wochen in Form von Hausaufgaben wiederholt wurden. Es konnte gezeigt werden, dass die Teilnehmer des KAST-Programms nach Beendigung des Trainings (T1) eine signifikant niedrigere AS-Ausprägung im Vergleich zur Wartelisten-Kontrollgruppe aufwiesen und diese Reduktion auch über den Katamnese-Zeitraum von sechs Monaten (T2) stabil blieb. Ergänzend wurde auch die Targetierbarkeit weiterer intermediärer Risikomarker wie der Trennungsangst (TA), des Index der kardialen Sensitivität sowie der Herzratenvariabilität (HRV) untersucht, die jedoch nicht durch das KAST-Training direkt verändert werden konnten. Im Vergleich der Subgruppen von Probanden mit hoher AS und gleichzeitig hoher TA (Adult Separation Anxiety Questionnaire [ASA-27] ≥22) und Probanden mit hoher AS, aber niedriger TA (ASA-27 <22) zeigte sich, dass die AS-TA-Hochrisikogruppe ebenfalls gut von der KAST-Intervention profitieren und eine signifikante Reduktion der AS erzielen konnte, indem sie sich bei T1 dem Niveau der Gruppe mit niedriger TA anglich. Zudem korrelierte die prozentuale Veränderung der Einstiegswerte der inneren Anspannung während der Strohhalm-Atmungsübung positiv mit der prozentualen Veränderung der dimensionalen TA bei T1. Zusammenfassend weisen die Ergebnisse der vorliegenden Arbeit erstmalig auf die Wirksamkeit der deutschsprachigen Übersetzung des CAST-Programms (Schmidt et al., 2014), eines Computer-basierten, und damit leicht zu implementierenden sowie kostengünstigen Programms, in Bezug auf die Reduktion der AS sowie indirekt der TA hin und können damit zur indizierten und demnach besonders effektiven Prävention von Angsterkrankungen in Hochrisikogruppen beitragen.
... People with high levels of AS have been reported to perform better at heartbeat detection tasks (Stewart et al., 2001;Sturges & Goetsch, 1996). This seems evident because arousal has been related to IAcc, and high anxiety individuals showing elevated arousal levels (Dunn et al., 2010). ...
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Background: The market for energy drinks has grown quickly over the past 20 years. While the physiological and psychological effects of different ingredients have been studied, the influence of energy drinks on interoceptive processes is unclear. Anxiety has been associated with amplified interoceptive functioning, suggesting potentially exaggerated reactions to energy drinks. Aims: Investigate the effect of energy drink consumption and anxiety sensitivity (AS) as well as their possible interactions on cardiorespiratory dimensions of interoception. Method: Thirty-nine healthy students consumed an energy drink via a placebo-controlled, counterbalanced, crossover design. Cardiac and respiratory interoceptive accuracy (IAcc), interoceptive sensibility (IS), and interoceptive evaluation (IE) were assessed. Heartbeat-evoked potentials (HEPs) were analyzed to evaluate neural processing of the heartbeat. Results: Consumption of one energy drink did not influence IAcc, IS, or IE. However, high AS subjects reported reduced interoceptive confidence after energy drink intake. While HEP amplitudes did not differ depending on the type of drink, high AS subjects showed reduced HEPs overall compared to low AS subjects. Heart rate was significantly lower following energy drink consumption as compared to the placebo condition. Limitations: The sample size was small, energy dosages low, and physiological parameters should be assessed in more detail. Conclusion: Energy drink consumption was associated with an interoceptive bias in high AS individuals suggesting possible interaction effects between changes in physical state, interoception, and anxiety.
... Among these, the sensitivity to one's own heartbeat is closely associated with interoceptive awareness (14,15) and the intensity of experienced emotions (16)(17)(18). The accuracy of heartbeat counts has been found to be positively correlated with the sensitivity of emotional traits, such as tendencies for general anxiety (19,20). ...
Article
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The majority of the models of emotional processing attribute subjective emotional feelings to physiological changes in the internal milieu, which are sensed by the interoceptive system. These physiological reactions evoked by emotional phenomena occur via the autonomic nervous system, and give rise to alterations in body-mind interactions that are characterized by heartbeat evoked magnetic fields (HEFs) involving brain regions associated with emotional perception. The current study used magnetoencephalography (MEG) to examine regional cortical activity and connectivity changes in HEFs provoked by the emotion of disgust. MEG results from 39 healthy subjects (22 female) revealed that passively listening to sounds of disgust elicited right insular cortical activity and enhancement of cortical connectivity between the right anterior ventral insular cortex and left ventromedial prefrontal cortex, demonstrated by phase lag indexes in the beta frequency range. Furthermore, inter-trial coherence significantly increased at 19 Hz and 23 Hz, and decreased at 14 Hz, which highlights the involvement of low beta oscillations in emotional processing. As these results were based on spontaneously triggered bioelectrical signals, more indigenous and induced signals were extracted with a block designed experiment. The insular cortices play an important role in emotional regulation and perception as the main cortical target for signals with interoceptive information, providing direct substrates of emotional feelings. The current results provide a novel insight into frequency properties of emotional processing, and suggest that emotional arousal evoked by listening to sounds of disgust partially impact the autonomic nervous system, altering HEFs via connectivity changes in the right anterior ventral insular cortex and left ventromedial prefrontal cortex.
... This might cause greater prediction errors in the allostatic control regions, leading to updating of the internal models in a negative direction, accompanied by hedonically negative affective experiences. In addition, it has been argued that noisy bodily signals to the brain and unstable fluctuation of interoception might cause subjective experiences of anxiety (Farb et al., 2015;Stewart, Buffett-Jerrott, & Kokaram, 2001). In a previous study, the author attempted to simulate this phenomenon by increasing the variance of the noise term 1 (Normal~(0, −1 )) shown in Figure 2, specifically, introducing a large value of −1 . ...
Article
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Emotional intelligence is composed of a set of emotional abilities, including recognition of emotional states in the self and others, the use of emotions to guide thoughts and behaviours, and emotion regulation. Previous studies have demonstrated that emotional intelligence is associated with mental health, social problem solving, interpersonal relationship quality, and academic and job performance. Although emotional intelligence has received much interest both in basic research fields and applied and clinical fields, the mechanisms underlying the functions of emotional intelligence remain unclear. The aim of the present article was to consider the mechanisms of emotional intelligence using a computational approach. Recent theories of emotion in psychology and neuroscience have emphasized the importance of predictive processing. It has been proposed that the brain createsinternal models that can provide predictions for sensation and motor movement, and perception and behaviors emerge from Bayesian computations rooted in these predictions. This theoretical framework has been expanded to include interoceptive perception of the internal body to explain affect and decision-making as phenomena based on interoception. This perspective has implications for understanding issues of emotional intelligence.
... These findings are notable, especially since most individuals, including experienced meditators, show relatively poor interoceptive awareness for cardiac sensation under resting conditions (31,32). Although individuals with high AS do tend to have heightened interoceptive awareness (33,34), it is worth emphasizing that the aforementioned enhancement effects cannot be fully attributed to a global increase in interoceptive awareness in this sample, as these same participants did not report any enhancement during the film condition. Given the heightened AS in this sample and the heightened awareness of cardiorespiratory sensations, it is notable that these sensations were rated as pleasant ( Figure 4C), a finding that surprised a number of participants who were used to associating cardiorespiratory sensations with the feeling of anxiety (see Debriefing Transcriptions in the Supplement). ...
Article
Background Floatation-REST (Reduced Environmental Stimulation Therapy), an intervention which attenuates exteroceptive sensory input to the nervous system, has recently been found to reduce state anxiety across a diverse clinical sample with high levels of anxiety sensitivity (AS). To further examine this anxiolytic effect, the present study investigated the affective and physiological changes induced by Floatation-REST, and assessed whether individuals with high AS experienced any alterations in their awareness for interoceptive sensation while immersed in an environment lacking exteroceptive sensation. Methods Using a within-subject crossover design, 31 participants with high AS were randomized to undergo a 90-minute session of Floatation-REST or an exteroceptive comparison condition. Measures of self-reported affect and interoceptive awareness were collected before and after each session, and blood pressure (BP) was collected during each session. Results Relative to the comparison condition, Floatation-REST generated a significant anxiolytic effect characterized by reductions in state anxiety and muscle tension, and increases in feelings of relaxation and serenity (p<.001 for all variables). Significant BP reductions were evident throughout the float session and reached the lowest point during the diastole phase (average reduction > 12 mmHg). The float environment also significantly enhanced awareness and attention for cardiorespiratory sensations. Conclusions Floatation-REST induced a state of relaxation and heightened interoceptive awareness in a clinical sample with high AS. The paradoxical nature of the anxiolytic effect in this sample is discussed in relation to Wolpe’s theory of reciprocal inhibition and the regulation of distress via sustained attention to present moment visceral sensations such as the breath.
... Studies have shown associations between AS and greater accuracy in estimating physiological reactivity among children (Eley, Stirling, Ehlers, Gregory, & Clark, 2004) and young adults (S. H. Stewart, Buffett-Jerrott, & Kokaram, 2001). Similarly, studies have shown that GAD (vs. ...
Article
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Maladaptive emotional traits (anxiety sensitivity [AS], fear of anxiety-related sensations and consequences) and symptoms (major depressive disorder [MDD] and generalized anxiety disorder [GAD] symptoms) could play a role in altering sensitivity to the subjective effects of drugs of abuse in adolescents. Data were drawn from a longitudinal study of high school students in Los Angeles, CA, USA who completed surveys and reported past six-month use of alcohol (n = 1054), cigarettes (n = 297), or cannabis (n = 706). At each of the four semi-annual waves during mid-adolescence (14–16 years old), students reported positive and negative subjective drug effects experienced in the prior six-months. Controlling for covariates and the simultaneous covariance across the three domains of emotional dysfunction, AS was associated with more positive and negative cannabis effects (βs = 0.09–0.16, ps < 0.05), and MDD symptoms were associated with fewer negative cigarette effects (β = − 0.13, p = 0.04) and more negative cannabis effects (β = 0.10, p = 0.004). The acceleration of positive alcohol and cannabis effects over time was slower among adolescents with higher baseline MDD (MDD × time: β = − 0.04, p = 0.044) and GAD (GAD × time: β = − 0.05, p = 0.03) symptoms, respectively. These findings suggest that emotional dysfunction factors show differential and overlapping effects on subjective drug effects, which may vary across time. Future research should investigate emotional dysfunctions and subjective drug effects in relation to substance use across adolescence and emerging adulthood.
... Typically these include headache, sensibility deficits in chest and abdomen, and increased muscle tension. These somatic symptoms go along with altered awareness of bodily symptoms as well as altered awareness of external stimuli [21,23,24], which has been described as decreased environment focus and increased selffocus in MDD [18,[25][26][27]. At the same time the accuracy of interoceptive heartbeat perception seems to be impaired in MDD [28], which can be seen as a result of impaired cognitive and decision-making functions. ...
Article
Interoceptive awareness is defined as the awareness of stimuli originating inside one’s own body such as the heartbeat. The emergence of new brain imaging techniques like functional magnetic resonance imaging (fMRI) or magnetic resonance spectroscopy (MRS) has increased our knowledge of neural substrates underlying interoceptive awareness. In particular, the bilateral brain structure of the insula has been identified as a key region involved in interoceptive processes in healthy populations. In line with prominent theories of human emotion, the insula has an important function in connecting interoceptive awareness with affective experience. This connection hinging on the insula between interoception and emotional processing is suggestive of an involvement of the insula in mood disorders such as major depressive disorder (MDD). Multilayered deficits in the insula cortex of depressed individuals such as abnormal function, biochemistry, and anatomy support this hypothesis. The aim of the present article is a) to describe the importance of the insula for the interplay between interoception and emotional processing and b) how this might be figured into psychotherapeutic treatment of depressed patients using new imaging techniques like real-time fMRI. The article begins with a brief introduction about neuroanatomical settings of the insula (I. Introduction- Neuroanatomical background of the insula). Afterwards, early behavioral studies to investigate interoceptive awareness are described (II. A step Back-First attempts to investigate interoceptive awareness), followed by a description of more recent imaging studies outlining neural mechanisms underlying interoceptive awareness and emotional processing in the insula (III. The insula as key region involved in functional interoception and emotion.) Throughout, the article addresses the question of why the investigation of individuals suffering from depression might provide novel insights into the neural underpinnings of interoceptive awareness and its link to abnormal behavior (IV. Why study interoceptive awareness in depressed participants?). Following the description of a selected study that combines for the first time functional results of interoception (using fMRI) with biochemical results of the insula (using MRS) (V. Neuroimaging in interoceptive awareness combining fMRI and MRS – A specific study), the article concludes with a perspective outlining the potential for using imaging techniques like real-time fMRI to enhance neural activity in the insula during interoceptive awareness. This approach potentially leads to faster recovery in depressed patients and might be the first therapeutic application of functional imaging in psychiatry (VI. Perspectives: Neurofeedback in major depression using real-time fMRI).
... This argumentation would be in line with the marginal difference in reported arousal levels for neutral and fearful face stimuli. Another explanation might be that after the induction of fear, participants focused on resulting mood and bodily changes like raised heart rate (e.g., Stewart et al., 2001;Wiens et al., 2000). Consequently, fewer resources could be allocated to processing emotional faces, canceling the expected effect. ...
... Heightened interoceptive attention has been suggested to increase the probability to develop anxiety and anxiety disorders (Domschke et al., 2010b). Patients with panic disorder and healthy subjects with high levels of anxiety sensitivity have been found to be extraordinarily accurate at estimating their heartbeat (Ehlers and Breuer, 1992;Stewart et al., 2001;Van der Does et al., 2000) and exhibit abnormal processing of interoceptive information (Pauli et al., 1991b;Pauli et al., 1997;Pauli et al., 2005). Interoceptive accuracy defined as the ability to accurately estimate the own heartbeat (Garfinkel et al., 2015) shows a moderate heritability of about 30% (Eley et al., 2007). ...
Article
Facilitated processing of interoceptive and exteroceptive information in the salience network is suggested to promote the development of anxiety and anxiety disorders. Here, it was investigated whether the adenosine 2 A receptor gene (ADORA2A) 1976T/C (rs5751876) variant - previously associated with anxiety disorders and anxiety-related phenotypes as well as general attentional efficiency -was involved in the regulation of this network. In detail, fMRI recordings of 65 healthy participants (female=35) were analyzed regarding ADORA2A genotype effects on brain connectivity related to (1) interoceptive processing in terms of functional connectivity resting-state fMRI, and (2) exteroceptive processing using dynamic causal modeling in task-based fMRI. In a subsample, cardiac interoceptive accuracy was furthermore measured via the Mental Tracking Task. ADORA2A genotype was found to modulate a fronto-insular network at rest (interoceptive processing) and while performing an executive control task (exteroceptive processing). Across both modalities, the ADORA2A TT risk genotype was associated with increased connectivity between the insula and the prefrontal cortex. The strength in connectivity correlated with interoceptive accuracy. It is concluded that alterations in fronto-insular connectivity are modulated by both the adenosinergic system and interoceptive accuracy. Thus, fronto-insular connectivity in synopsis with ADORA2A genotypic information could serve as combined biomarkers for personalized treatment approaches in anxiety disorders targeting exteroceptive and interoceptive dysfunction.
... This argumentation would be in line with the marginal difference in reported arousal levels for neutral and fearful face stimuli. Another explanation might be that after the induction of fear, participants focused on resulting mood and bodily changes like raised heart rate (e.g., Stewart et al., 2001;Wiens et al., 2000). Consequently, fewer resources could be allocated to processing emotional faces, canceling the expected effect. ...
... This argumentation would be in line with the marginal difference in reported arousal levels for neutral and fearful face stimuli. Another explanation might be that after the induction of fear, participants focused on resulting mood and bodily changes like raised heart rate (e.g., Stewart et al., 2001;Wiens et al., 2000). Consequently, fewer resources could be allocated to processing emotional faces, canceling the expected effect. ...
Article
Previous research showed that fearful faces produce longer temporal estimates than neutral faces. This study probed whether fearful mood enhances this effect. In two experiments, participants viewed neutral and threatening film excerpts and subsequently evaluated the duration of neutral and fearful faces in a bisection task. In Experiment 1, where neutral mood was induced before fearful mood, skin conductance levels (SCLs) and subjective emotion ratings indicated successful mood induction. Compared to neutral mood, fearful mood lengthened subjective duration estimates irrespective of stimulus quality. Additionally, stimuli of fearful faces were temporally overestimated relative to neutral faces; but only in neutral, not in fearful mood. In Experiment 2, where fearful mood was induced before neutral mood, subjective emotion ratings, but not SCLs, indicated successful mood induction. Moreover, neither mood nor facial expressions influenced duration estimation. Taken together, the results show that fearful mood may accelerate an internal pacemaker but does not enhance temporal perception differences between fearful and neutral faces. Additionally, this study highlights the importance of dissociating stimulus, state, and trait emotionality for our understanding of emotional influences on temporal perception.
... Patients with panic attacks and chest pain fear illness and death so much (Katerndahl 2004) that they easily request medical assistance. Indeed, patients with higher anxiety sensitivity pay more attention to their heartbeats and heart rate (Stewart et al. 2001) and to the electrocardiogram, relating their symptoms to an ischemic heart disease (Katerndahl 2004). Chest pain during a panic attack is thus related with hospitalization (Fleet et al. 2005) and to the fruition of the assistance of family doctors, psychiatrists and cardiologists. ...
Article
Different data indicate that psychological and/or emotional disorders may play an important role in the natural history of heart diseases. Although the major evidence is that related to depression, epidemiological data would indicate that anxiety and panic disorders are highly represented in cardiac patient, thus influencing mortality and morbidity.
... Her heart rate will rise if she is stressed or certain emotions occur. On the other hand, her heart rate will fall if she is relaxed [24,25]. Consequently, there is a neutral heart rate and a deviation of this neutral heart rate depending on the situation. ...
... Her heart rate will rise if she is stressed or certain emotions occur. On the other hand, her heart rate will fall if she is relaxed [24,25]. Consequently, there is a neutral heart rate and a deviation of this neutral heart rate depending on the situation. ...
Conference Paper
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We conducted an experiment to investigate the influence of objective and subjective methods to capture affective aspects. We used a sensor to measure participants' heart rate and a mood map where participants could report their emotional state. Results showed that the display of the heart rate had more influence on the self-reported valence dimension than on the arousal dimension. In this paper, we discuss several ideas why people might act this way and raise those ideas for discussion. The discussed reasons may change the way how people feel when they see their heart rate. If some of the reasons apply in reality, this could change the way we use objective methods to capture and make affective aspects aware in TEL.
... The current study demonstrated that cardiac perception is related to a more negative stress experience. Former studies have shown that cardiac perception is positively related to anxiety sensitivity (Stewart, Buffett-Jerrott, & Kokaram, 2001;Sturges & Goetsch, 1996) and clinical emotional states like social anxiety (Stevens et al., 2011) or panic disorders (e.g., Ehlers, 1993;Ehlers & Breuer, 1992). Therefore, we assume that individuals high in cardiac perception are at higher risk of perceiving situations as more stressful (e.g., threatening) and are consequently especially vulnerable to psychosomatic diseases like anxiety disorders. ...
Article
Full-text available
In the present study we aimed to investigate the impact of the ability to perceive bodily changes as indexed by the perception of one’s heartbeat (cardiac perception) on emotional experience when being confronted with a mental stressor. To induce stress, participants high and low in cardiac perception performed a computerized mental arithmetic test while listening to a white noise increasing in volume. Emotional experience and heart rate were assessed as indices of stress response. Our results show that participants high in cardiac perception reported more negative emotions during the stress period compared to participants low in cardiac perception, though heart rate did not differ between the groups. Our findings suggest that cardiac perception moderates the stress experience by enhancing the perceived emotion. Thus we were able to demonstrate that cardiac perception contributes as a factor explaining the variance in individuals’ emotional response to a stressor.
... The findings consists with the previous studies that cognitive anxiety has negative effects on human performance, physical anxiety is concerned with perception of physiological to psychological response as racing heartbeats and rapid breathing (Pougatchev and Pougatchev, 2008). Anxiety sensitivity is the fear of anxiety related sensation such as increased heart rate and breathlessness (Stewart et al., 1999). Another judgment support the findings if breathing is the basic handling of anxiety due to physiological arousal (Lehrer and Woolfolk, 2007). ...
Article
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The Catastrophe model in which the theory attempts to explain the interaction of physiological arousal cognitive anxiety affect on sport's performance. The model is important to understand the influence of anxiety upon performance. This research proposes a model to understand the effect of anxiety upon academic performance. The research consists with finding on the Catastrophe model of anxiety upon sport's performance. A total 135 students were participated in this study conducted during 2(nd) semester. The physiological arousal was measured using heart rate sensor and respiration sensor. Meanwhile, cognitive anxiety was measure using State Trait Anxiety Inventory (STAI) and Study Anxiety Scale (SAS). Furthermore, Grade Point Average (GPA) is employed to predict students' academic performance. For assessment, the Pearson correlation was used to assess the physiological arousal and cognitive anxiety toward academic performance. The finding shows that high level of physiological arousal and cognitive anxiety is a significant factor that creates low academic performance. Based on the finding, it is concluded that the model can be use to comprehend of relationship between anxiety toward academic performance. (C) 2011 Published by Elsevier Ltd. Selection and/or peer-review under responsibility of the 2nd World Conference on Psychology, Counselling and guidance.
... Somatic awareness is also described as a cognitive attitude characterized by exaggerated attention to body cues, rumination, and negative beliefs about the effects of body signals (Cioffi, 1991). Heightened awareness of somatic signals can be distressing and maladaptive, as shown by several studies that indicate a link between somatic awareness and medicalization (Hansell et al., 1991), high level of anxiety (Schmidt & Telch, 1997), hypertension and cardiovascular activity (Koroboki et al., 2010;Pollatos, Traut-Mattausch, Scroeder, & Schandry, 2007;Stewart, Buffett-Jerrott, & Kokaram, 2001), intense reaction to some stimuli associated with a major neuronal activation (Herbert, Pollatos, & Schandry, 2007;Pollatos, Gramann, & Schandry, 2007), and somatosensory amplification (Bekker, Croon, & Vermaas, 2002;Spoor, Bekker, Van Heck, & Croon, 2005). ...
Article
Full-text available
Health and illness are complex constructs for which a biomedical approach alone is insufficient. The purpose of the present study was to explore how personal attitudes toward health and illness affect health experience. By adopting a constructivist perspective, we carried out individual semistructured interviews with 15 persons enrolled in a yoga class in northern Italy. We analyzed the interview data using interpretative phenomenological analysis and found that participants' attitudes toward health and wellness were linked to their experiences and perceptions of health and illness, their somatic awareness, and their constructions of themselves and of their relations. The findings point toward the importance of people taking responsibility for their health. In addition, they suggest that health care should be personalized: approaching people as a complex unity and health and illness as inextricable parts of their lives.
... Similar findings have resulted from lab-based stressor research. Indeed, empirical investigations have correlated elevated AS to heightened stress reactivity across experimental stressors, including mental arithmetic, cold pressor task, and the TSST (Gómez-Pérez, López-Martínez, & Asmundson, 2013; Lee, Watson, & Law, 2010; Messenger & Shean, 1998; Rosa Esteve & Camacho, 2008; Shostak & Peterson, 1990; Stewart, Buffett-Jerrott, & Kokaram, 2001; Thompson, Keogh, French, & Davis, 2008; Zvolensky et al., 2002). Furthermore, the link between AS and stress reactivity is of the upmost importance since stressful life events may trigger one's AS to increase, thereby aggravating vulnerability to numerous psychological disorders (Schmidt et al., 1997; Taylor, Koch, & McNally, 1992; Wheaton, Mahaffey, Timpano, Berman, & Abramowitz, 2012 ). ...
Article
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Stress pervades daily society, often with deleterious consequences for those prone to react intensely to it. Intervention techniques to attenuate stress reactivity are thus paramount. With that goal in mind, researchers have sought to identify and alter malleable psychological dispositional variables that influence stress reactivity. Trait emotional intelligence (TEI), anxiety sensitivity (AS), and experiential avoidance (EA) are increasingly receiving attention in these research efforts. The self-reported emotional component of stress reactivity has been emphasized in investigations and is our focus. Specifically, this paper overviews the role of TEI, AS, and EA in self-reported stress responses. We also discuss empirically supported psychological methods to adjust suboptimal levels of these variables in normal populations. Both psycho-educational (information, skills) and mindfulness-based interventions (specific mindfulness therapies or components) are covered. Findings include that (1) TEI, AS, and EA are each correlated with the emotional component of stress reactivity to both naturalistic and lab-based stressors; (2) preliminary support currently exists for psycho-educational intervention of TEI and AS but is lacking for EA; (3) adequate evidence supports mindfulness-based interventions to target EA, with very limited but encouraging findings suggesting mindfulness methods improve TEI and AS; and (4) although more research is needed, stress management approaches based on mindfulness may well target all three of these psychological variables and thus appear particularly promising. Encouragingly, some methods to modify dispositional variables (e.g., a mindfulness-based format of guided self-help) are easily disseminated and potentially applicable to the general public.
... This approach was deemed to be impractical for conducting studies on trading floors and at conferences as there was too much distraction from the stimulus. We therefore developed a tool that implements the second approach, heartbeat tracking, which evaluates how accurate the participant is at determining their heart rate (Schandry, 1981;Stewart et al., 2001). The tool developed is well-suited for use in field settings as well as in the laboratory. ...
... This approach was deemed to be impractical for conducting studies on trading floors and at conferences as there was too much distraction from the stimulus. We therefore developed a tool that implements the second approach, heartbeat tracking, which evaluates how accurate the participant is at determining their heart rate (Schandry, 1981;Stewart et al., 2001). The tool developed is well-suited for use in field settings as well as in the laboratory. ...
... Such internal monitoring and a decrease in postural control automaticity have been linked to increased COP regularity [29]. In general, individuals with high levels of anxiety sensitivity pay greater attention to somatic sensations [30] and have more accurate interoception [31] than people with low-anxiety sensitivity. Such increased awareness about bodily states may lead to less smooth inter-segmental postural coordination patterns resulting in a more reactive pattern of force injections to maintain stance as opposed to a more proactive, smooth control strategy that relies on multiple smaller corrections during more automatic stance. ...
Article
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Objective: We investigated whether young adults with asthma have impaired balance and whether this impairment is related to altered musculoskeletal function and/or psychological characteristics. Methods: 21 participants with a self-reported asthma diagnosis but no known postural instability or history of falls, and 18 control participants were recruited from undergraduate psychology courses. Participants performed a postural control task of maintaining the center of pressure (COP) in a fixed position with visual feedback (feedback condition) and while standing as still as possible without visual feedback (no-feedback condition). COP variability, regularity and task performance were used to characterize the quality of balance. To document group differences in musculoskeletal function, we measured neck and lower back angles as well as range of motion (ROM) of the neck in the frontal and sagittal planes. To document group differences in psychological state, we administered self-report questionnaires to assess symptoms of anxiety and depression, anxiety sensitivity and negative effect. Results: COP variability and task performance were similar between the groups, but participants with asthma exhibited more regular anterior-posterior COP dynamics. Participants with asthma had smaller ROM of neck extension, a more forwardly bent neck, greater thoracic spine angle, and they reported greater levels of the physical concerns facet of anxiety sensitivity. These musculoskeletal and affective variables moderated COP differences between the groups. Conclusions: Young adults with asthma showed a different postural control strategy in the absence of any obvious balance impairment. This change in strategy is related to musculoskeletal and affective characteristics of individuals with asthma.
... Typically these include headache, sensibility deficits in chest and abdomen, and increased muscle tension. These somatic symptoms go along with altered awareness of bodily symptoms as well as altered awareness of external stimuli [21,23,24], which has been described as decreased environment focus and increased selffocus in MDD [18,[25][26][27]. At the same time the accuracy of interoceptive heartbeat perception seems to be impaired in MDD [28], which can be seen as a result of impaired cognitive and decision-making functions. ...
Article
Full-text available
Interoceptive awareness is defined as the awareness of stimuli originating inside one’s own body such as the heartbeat. The emergence of new brain imaging techniques like functional magnetic resonance imaging (fMRI) or magnetic resonance spectroscopy (MRS) has increased our knowledge of neural substrates underlying interoceptive awareness. In particular, the bilateral brain structure of the insula has been identified as a key region involved in interoceptive processes in healthy populations. In line with prominent theories of human emotion, the insula has an important function in connecting interoceptive awareness with affective experience. This connection hinging on the insula between interoception and emotional processing is suggestive of an involvement of the insula in mood disorders such as major depressive disorder (MDD). Multilayered deficits in the insula cortex of depressed individuals such as abnormal function, biochemistry, and anatomy support this hypothesis. The aim of the present article is a) to describe the importance of the insula for the interplay between interoception and emotional processing and b) how this might be figured into psychotherapeutic treatment of depressed patients using new imaging techniques like real-time fMRI. The article begins with a brief introduction about neuroanatomical settings of the insula (I. Introduction–Neuroanatomical background of the insula). Afterwards, early behavioral studies to investigate interoceptive awareness are described (II. A step Back–First attempts to investigate interoceptive awareness), followed by a description of more recent imaging studies outlining neural mechanisms underlying interoceptive awareness and emotional processing in the insula (III. The insula as key region involved in functional interoception and emotion.) Throughout, the article addresses the question of why the investigation of individuals suffering from depression might provide novel insights into the neural underpinnings of interoceptive awareness and its link to abnormal behavior (IV. Why study interoceptive awareness in depressed participants?). Following the description of a selected study that combines for the first time functional results of interoception (using fMRI) with biochemical results of the insula (using MRS) (V. Neuroimaging in interoceptive awareness combining fMRI and MRS – A specific study), the article concludes with a perspective outlining the potential for using imaging techniques like real-time fMRI to enhance neural activity in the insula during interoceptive awareness. This approach potentially leads to faster recovery in depressed patients and might be the first therapeutic application of functional imaging in psychiatry (VI. Perspectives: Neurofeedback in major depression using real-time fMRI).
... HRMs have been used in research settings to reliably measure heart rate. [18][19][20] HRMs are discrete (consisting of a chest strap worn beneath clothing and a wrist watch receiver), as inexpensive as $30-$50, and readily available at sporting goods stores or online retailers. ...
Article
Rural patients with anxiety often lack access to traditional biofeedback modalities. Exercise heart rate monitors (HRMs) are tools used in the fitness industry to provide athletes with feedback on heart rate and regulatory breathing strategies. HRMs are inexpensive, discrete, and publicly accessible. This randomized controlled pilot study explored whether use of HRMs for biofeedback during guided mindfulness, diaphragmatic breathing, and progressive muscle relaxation techniques could facilitate anxiety reduction as compared to these techniques alone. Fifty-three rural anxiety patients were randomized to HRM or control groups for four weekly 20-minute, scripted sessions with a non-behaviorist wherein they practiced these techniques; the HRM group received feedback on their heart rate response. The HRM group had significantly greater improvement in state anxiety (State-Trait Anxiety Inventory) and self-efficacy (General Self Efficacy Scale), and a greater percentage of the group indicated that they "felt in control of their anxiety." This pilot study demonstrates that this novel, inexpensive, and accessible tool may be a useful clinical intervention for anxiety and can be easily incorporated by both behaviorists and non-behaviorist primary care clinicians into individual or group biofeedback treatment for patients with anxiety. This tool has additional potential for patients to use for anxiety self-management. Further study with a larger sample and blinded design is warranted.
... It is an emotional state consisting of feeling tension, apprehension, and nervousness ). Anxiety sensitivity is the fear of anxiety related to sensations such as an increased heart rate and breathlessness (Stewart et al. 1999). Wilkinson and Campbell (1997) defined anxiety as a threat which made an individual anxious, nervous, and disturbed; the causes of anxiety are unknown or unclear. ...
Article
Full-text available
The main purpose of this research is to explore the relationships among learning attitude and learning anxiety in accounting courses. The subjects were students from the department of hospitality management in southern Taiwan. The sample for this study consisted of 422 hospitality management students studying at various universities. The results have been analyzed by descriptive statistics, item analysis, factor analysis, reliability analysis, and canonical correlation analysis. The conclusions of this research were summarized as follows: there was a significant relationship between learning desire of learning attitude, and the physiology and psychology of learning anxiety; there was also a significant relationship between learning habits and the physiology of learning anxiety; finally, significant relationships also existed between learning and exam method, and test anxiety of learning anxiety of hospitality management in southern Taiwan universities. Based on the evidence results, the current study proposes a few suggestions for educational institutions and future research.
... Lastly, negative affect was the only self-reported measure associated with physiological indices. This null finding is not necessarily a limitation and converges with other research on physiological arousal and state anxiety and anxiety traits (Mauss et al., 2004; Stewart et al., 2001; Thibodeau et al., 2012 ); however, researchers may benefit from further examining the relationship between IU and physiological arousal using various physiological indices (e.g., breathing rate, muscle tension) and in different experimental paradigms (e.g., startle experiments , public speaking). ...
Article
Intolerance of uncertainty (IU) has been posited as ubiquitous across experiences of anxiety; however, studies testing how IU impacts behavior remain scant. The current study examined the impact of IU on performance during a keyboard typing task, a relatively complex and common behavior. A total of 40 members of the university community completed the task and measures of IU, trait anxiety, negative affect, and state anxiety. Heart rate and skin conductance were also assessed during the task as indices of state anxiety. IU was independently and substantially associated with slower typing speed (part r = -0.68) beyond other measured psychological and physiological variables but was not associated with typing errors. Prospective and inhibitory IU, as manifestations of IU, did not seemingly differ in their relationship with performance. IU may negatively impact day-to-day behaviors and contribute to undesired consequences. Further research is needed to explore whether this relationship warrants consideration in models of anxiety disorders.
... Anxiety disorders are common in PSVT. PSVT and AD can occur comorbidly in a chronological sequence, with PSVT possibly precipitating and maintaining AD via interoceptive processes or, alternatively, with AD increasing the risk for PSVT by elevating stress levels 20,21 . Previous studies showed that in patients with PSVT, radiofrequency ablation offers a curative therapy and can reduce anxiety symptoms dramatically 22 . ...
Article
Full-text available
Paroxysmal supraventricular tachycardia (PSVT) has been shown to be associated with poor outcome in psychological status and quality of life. This study aimed to assess the quality-of-life and anxiety in patients with PSVT and to investigate the influence of radiofrequency ablation (RFA) treatment on these parameters. Fifty patients with newly diagnosed PSVT with electrophysiologic study and treated with RFA, were enrolled in the study and 50 healthy age-and sex-matched individuals. The brief version of World Health Organization Quality of Life Scale and the state-trait anxiety inventory were administered to controls and all patients before and three months after the RFA procedure. At baseline, in comparison with the control group, the patients with PSVT exhibited greater anxiety average scores (p < 0.05). After RFA procedure, the patients with PSVT exhibited significant improvement in anxiety, quality of life and health satisfaction scores. Statistically significant difference between the controls and the patients in respect to state and trait anxiety average scores disappeared after treatment (p > 0.05). In this study, normalization of anxiety and quality of life is associated with RFA treatment for patients with PSVT. This finding need to be confirmed by larger scale clinical trials with long-term quality of life follow-up in higher number of patients.
Chapter
Panic attacks are prevalent; almost one in three people will experience a panic attack in their lifetime. The occurrence of a panic attack is not sufficient for panic disorder diagnosis and can be added as a specifier to other disorders. DSM-5 separated the diagnoses panic disorder and agoraphobia. Various comorbidities with panic disorder and/or agoraphobia are summarized. Genes implicated in the etiology of PD are discussed including genes related to COMT, adenosine, MAO, GABA, and CRHR. Epigenetic factors such as methylation across different genes and G × E interactions are considered. Learning theory’s account of how panic disorder/agoraphobia develop is reviewed. The chapter offers a detailed explanation of the involvement of anxiety sensitivity trait in the development and maintenance of the disorder. Various cognitive models including Barlow’s, Clark’s, and Reiss’ expectancy model and integrative attempts are discussed. Gorman’s seminal neuroanatomical model of the disorder and its updates are examined considering functional connectivity, structural, and functional MRI studies. Finally, neurochemical hypotheses related to serotonergic and opioidergic deficits are explained.
Article
Introduction: Despite the high rate of somatic symptom disorder (TSS) in the pediatric population, etiological mechanisms remain poorly understood. Previous studies conducted in youths with anxiety, eating disorder, or autistic disorder support a relation between difficulties in the perception of sensory signals (i.e., interoception) and difficulties in identifying emotions. Method: A cross-sectional study was carried out at the University Hospital of Amiens-Picardie in 19 young people aged 9 to 17 hospitalized in the pediatric ward for TSS. A mental heartbeat tracking task was used to assess interoceptive accuracy, awareness and sensibility. The Porges Body Perception Questionnaire (PBPQ) was used to assess interoceptive attention. Other questionnaires were used to assess associated clinical dimensions such as depression, anxiety, emotional dysregulation and alexithymia. Results: The mean interoceptive accuracy score was lower in TSS subjects compared to expected scores in the general population (33% error vs. 20%). A statistically significant correlation was found between, on the one hand, interoceptive sensibility and the "avoidance" subscore of the ECAP (r=0.51) and, on the other hand, between interoceptive awareness and the total score of the Child Depression Inventory (r=0.51). A significant relationship was found between the PBPQ scale total score and the Children-Toronto Alexithymia Scale total score (r=0.42), in particular with the "difficulty expressing emotions" subscore (r=0.62). Conclusion: This study confirms that interoceptive difficulties occur in young patients with severe TSS. Our finding adds empirical evidence supporting the relations between interoceptive difficulties, alexithymia and somatic symptoms in children and adolescents.
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Anxiety is often conceptualised as the prototypical disorder of interoception (one’s perception of bodily states). Whilst theoretical models predict an association between interoceptive accuracy and anxiety, empirical work has produced mixed results. This manuscript presents a pre-registered systematic review (https://osf.io/2h5xz) and meta-analysis of 55 studies, obtained via a Pubmed search on 9th November 2020, examining the relationship between state and trait anxiety and objectively measured cardiac interoceptive accuracy as assessed by heartbeat counting and discrimination tasks. Potential moderators of this relationship - the age, gender and clinical diagnoses of participants, the anxiety measures used and the study design - were also explored. Overall, we found no evidence for an association between cardiac interoceptive accuracy and anxiety, with none of the factors examined moderating this finding. We discuss the implications these findings have for future research, with a particular focus on the need for further investigation of the relationship between anxiety and other facets of interoception.
Article
Adequately recognizing one’s own emotion is an important ability for a healthy emotional life and appropriate behavior. This review article features interoception—the sensation of the internal and physiological bodily state—as a crucial factor in emotional experience. This review discusses a possible mechanism of emotion recognition through interoception, arguing several conditions for a healthy or unhealthy relationship between the body and the mind. First, a brief introduction to interoception is provided. It is proposed that the concept of interoception should be organized into two levels of process. The lower level is the process of individual internal organs (e.g., heart, gut, etc.), which corresponds to the interoception in a narrow sense. The higher level is the integrative process of these individual sensations, which is the interoception in a broad sense. The second section then reviews theories on the relation between the body and emotion, suggesting that interoception directly contributes to the subjective experience of arousal level. In addition, depending on the precision of arousal recognition, interoception may also indirectly underpin the identification of emotion. The third section of this paper discusses the clinical aspects of interoception. With regard to the pros and cons of interoceptive sensitivity, it seems to benefit the regulation of emotions, but it is also associated with certain clinical conditions such as high anxiety. It is important to examine the condition of alexithymia (i.e., affective agnosia), which usually involves the phenomena of alexisomia (i.e., difficulty in recognizing one’s physical condition) and somatosensory amplification (i.e., negative hypersensitivity). By reviewing the condition of autism spectrum disorders, which frequently accompany alexithymia and anxiety, the last section discusses several factors for body-mind interaction such as the difference between the accuracy of sensation and hypersensitivity, the balance between bottom-up and top-down process, and particularly the pivotal role of the sensory integration process.
Thesis
Hintergrund: Eine Panikattacke beginnt typischerweise mit der Wahrnehmung einer physiologischen oder psychischen Veränderung, die von der Person als bedrohlich eingestuft wird. Während in klassischen neuroanatomischen Modellen der Panikstörung die Amygdala in der sich anschließenden aufschaukelnden Symptomatik in den Mittelpunkt gestellt wurde, erweitern aktuelle Studien dieses amygdalozentrische Bild und lenken die Aufmerksamkeit auf extratemporale neuronale Netzwerke. Dysfunktionen im neuronalen Aufmerksamkeitsnetzwerk, relevant für die Wahrnehmung und Regulierung exterozeptiver und interozeptiver Prozesse, könnten zur Entstehung einer Panikstörung beitragen. Weiterhin scheinen bestimmte Risikogenotypen für die Panikstörung wie z.B. im Adenosin Rezeptor 2A (ADORA2A) oder dem Neuropeptid S Rezeptor (NPSR1) Gen und die entsprechenden Neurotransmittersysteme in der Regulierung der Aufmerksamkeitsnetzwerke involviert zu sein. Fragestellung: Dysfunktionen im noradrenergen bottom-up Alertingnetzwerk und in der dopaminergen exekutiven top-down Aufmerksamkeitskontrolle könnten in einem neurokognitiven Entstehungsmodell der Panikstörung eine wichtige Rolle spielen. Mit Hilfe funktioneller Bildgebung soll die Funktion des neuronalen Aufmerksamkeitsnetzwerkes in einer nichtklinischen Stichprobe abhängig von genetischen Risikofaktoren und einer klinischen Stichprobe von und nach einer kognitiven Verhaltenstherapie untersucht werden. Methoden: Im nichtklinischen Teil der Untersuchung wurden in Studie 1 47 gesunde Versuchspersonen für die NPSR1 rs324981 Variante stratifiziert rekrutiert. Mittels fMRT wurde die Aktivität des Alertingnetzwerks und des Executive Control Netzwerks auf neuronaler Ebene mit dem Attentional Networt Test (ANT) untersucht. In Studie 2 wurde bei N=65 Versuchspersonen stratifiziert für die ADORA2A rs5751876 Variante als zusätzliches Verhaltensmaß die Fähigkeit zur interozeptiven Wahrnehmung in Bezug zur Konnektivität im insulären Ruhenetzwerk untersucht. Im klinischen Teil der Untersuchung (Studie 3) wurden 44 Patienten mit Panikstörung sowie eine entsprechend große und gematchte Kontrollgruppe rekrutiert. Es wurden fMRT Ruhemessungen vor und nach Abschluss einer kognitiven Verhaltenstherapie erhoben. Als zusätzliches Verhaltensmaß wurde die selbstberichtete Aufmerksamkeitskontrolle zwischen der Patienten- und der Kontrollgruppe verglichen. Ergebnisse: Träger des NPSR1 TT und des ADORA2A TT Risikogenotyps für Angst und Angsterkrankungen zeigten eine erhöhte Aktivität in Teilen des Alertingnetzwerks. Die Aktivität im Executive Control Netzwerk war arealabhängig teilweise erhöht, teilweise reduziert. Innerhalb eines interozeptiven Netzwerks zeigten Träger des ADORA2A TT Genotyps Hinweise auf eine dysfunktionale fronto-striatale-insuläre Interaktion. Im klinischen Teil der Studie zeigten Patienten mit Panikstörung eine reduzierte Konnektivität des dorsolateralen Präfrontalkortex (dlPFC) im fronto-parietalen Aufmerksamkeitsnetzwerk. Die Konnektivität innerhalb dieses Netzwerks korrelierte mit Defiziten in selbstberichteter Aufmerksamkeitskontrolle bei Patienten mit Panikstörung. Nach Abschluss der Therapie zeigte sich bei Patienten, die von der Therapie profitiert hatten, wieder eine Zunahme oder Verbesserung der Konnektivität mit dem dlPFC. Schlussfolgerung: Die Ergebnisse dieser Untersuchung betonen die Rolle dysfunktionaler interozeptiver und exterozeptiver Aufmerksamkeitsnetzwerke in der Entstehung von Angsterkrankungen. Bei Patienten mit Panikstörung sowie gesunden Versuchspersonen mit bestimmten prädisponierenden genetischen Variationen scheint eine Dysbalance des neuronalen Aufmerksamkeitsnetzwerks bzgl. der Abstimmung von bottom-up und top-down Netzwerken vorzuliegen.
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The Multidimensional Inventory of Hypochondriacal Traits (MIHT; Longley, Watson, & Noyes, 2005) appears to address shortcomings of other common measures of health anxiety, but further research is required prior to using this measure in treatment planning and outcome assessment. This study was designed to explore the hierarchical structure of this health anxiety measure and relations of the various MIHT health anxiety components to anxiety sensitivity. A sample of 535 university students (362 women) was administered the 31-item MIHT and the 16-item Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986). Confirma-tory factor analyses of participants' responses on the MIHT showed that this measure may be conceptualized either as involving four correlated factors (i.e., Affective, Cognitive, Behavioral, and Perceptual) or as being hierarchical in nature, with the four lower-order factors loading on a single higher-order global health anxiety factor. Correlational analyses revealed significant relations of anxiety sensitivity to each of the four MIHT subscales and to the MIHT total score. Of the three established anxiety sensitivity components, ASI Physical Concerns were most strongly and consistently related to the various dimensions of health anxiety on the MIHT. Additional analyses revealed that the ASI and MIHT are better represented as two correlated but independent traits as opposed to common manifestations of a single underlying trait.
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The Multidimensional Inventory of Hypochondriacal Traits (MIHT; Longley, Watson, & Noyes, 2005) appears to address shortcomings of other common measures of health anxiety, but further research is required prior to using this measure in treatment planning and outcome assessment. This study was designed to explore the hierarchical structure of this health anxiety measure and relations of the various MIHT health anxiety components to anxiety sensitivity. A sample of 535 university students (362 women) was administered the 31-item MIHT and the 16-item Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986). Confirma-tory factor analyses of participants' responses on the MIHT showed that this measure may be conceptualized either as involving four correlated factors (i.e., Affective, Cognitive, Behavioral, and Perceptual) or as being hierarchical in nature, with the four lower-order factors loading on a single higher-order global health anxiety factor. Correlational analyses revealed significant relations of anxiety sensitivity to each of the four MIHT subscales and to the MIHT total score. Of the three established anxiety sensitivity components, ASI Physical Concerns were most strongly and consistently related to the various dimensions of health anxiety on the MIHT. Additional analyses revealed that the ASI and MIHT are better represented as two correlated but independent traits as opposed to common manifestations of a single underlying trait. The
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Anxiety and somatic symptoms have a high prevalence in the general population. A mechanistic understanding of how different factors contribute to the development and maintenance of these symptoms, which are highly associated with anxiety disorders, is crucial to optimize treatments. In this article, we review recent literature on this topic and present a redefined model of mind-body interaction in anxiety and somatic symptoms, with an emphasis on both bottom-up and top-down processes. Consideration is given to the role played in this interaction by predisposing physiological and psychological traits (e.g., interoception, anxiety sensitivity, and trait anxiety) and to the levels at which mindfulness approaches may exert a therapeutic benefit. The proposed model of mind-body interaction in anxiety and somatic symptoms is appraised in the context of joint hypermobility syndrome, a constitutional variant associated with autonomic abnormalities and vulnerability to anxiety disorders.
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Cognitive behavioral models of panic disorder (PD) stress the importance of an increased attentional focus towards bodily symptoms in the onset and maintenance of this debilitating anxiety disorder. In this fMRI mental tracking paradigm, we looked at the effects of focusing one's attention internally (interoception) vs. externally (exteroception) in a well-studied group at risk for PD-that is anxiety-sensitive females (AS-high). We hypothesized that AS-high subjects compared to control subjects will present higher arousal and decreased valence scores during interoception and parallel higher activity in brain areas which are associated with fear and interoception. 24 healthy female students with high levels of anxiety sensitivity and 24 healthy female students with normal levels of anxiety sensitivity serving as control group were investigated by 3 T fMRI. Subjects either focused their attention on their heartbeats (internal condition) or on neutral tones (external condition). Task performance was monitored by reporting the number of heartbeats or tones after each block. State of arousal and emotional valence were also assessed. The high anxiety-sensitive group reported higher arousal scores compared to controls during the course of the experiment. Simultaneously, fMRI results indicated higher activation in anxiety-sensitive participants than in controls during interoception in a network of cortical and subcortical brain regions (thalamus, amygdala, parahippocampus) that overlaps with known fear circuitry structures. In particular, the activity of the right amygdala was up-regulated. Future prospective-longitudinal studies are needed to validate the role of the amygdala for transition to disorder. Attention to internal body functions up-regulates the activity of interoceptive and fear-relevant brain regions in anxiety-sensitive females, a high-risk group for the development of anxiety disorders.
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This theoretical work examines the question of how dance/movement therapy (DMT) might be applied to support the development of emotion regulation in maltreated children, specifically in the context of residential treatment centers. As foundation for this discussion, literature pertaining to the ontogenesis of adaptive emotion regulation and the consequences of early maltreatment on its development is reviewed. Also included is a summary of therapeutic approaches and residential treatment models that address emotion regulation in children. A theoretical framework for promoting emotion regulation in maltreated children based on DMT principles and an accompanying residential treatment application is proposed.
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Describes the development of the Agoraphobic Cognitions Questionnaire and the Body Sensations Questionnaire, companion measures for assessing aspects of fear of fear (panic attacks) in agoraphobics. The instruments were administered to 175 agoraphobics (mean age 37.64 yrs) and 43 controls (mean age 36.13 yrs) who were similar in sex and marital status to experimental Ss. Results show that the instruments were reliable and fared well on tests of discriminant and construct validity. It is concluded that these questionnaires are useful, inexpensive, and easily scored measures for clinical and research applications and fill a need for valid assessment of this dimension of agoraphobia. (22 ref)
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Reviews existing model of panic attacks and panic disorder and proposes a new cognitive psychophysiological model to explain panic attacks.
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Two studies were designed to establish whether high anxiety sensitive (AS) university students selectively process threat cues pertaining to their feared catastrophic consequences of anxiety, and to examine potential gender differences in the selective processing of such threat cues among high versus low AS subjects. Forty students (20 M; 20 F) participated in Study 1. Half were high AS and half low AS, according to scores on the Anxiety Sensitivity Index (ASI). Subjects completed a computerised Stroop colournaming task involving social/psychological threat (e.g. EMBARRASS; CRAZY), physical threat (e.g. CORONARY; SUFFOCATED), and neutral (e.g. MOTEL; TOWEL) target words. High AS subjects demonstrated more threat-related interference in colour-naming than did low AS subjects, overall. High AS menevidencedgreater interference relative to low AS men only for the social/psychological threat stimuli; highAS women evidencedgreater interference relative to low AS women only for the physical threat stimuli. Study 2 was designed to replicate and extend the novel Study 1 finding of a cognitive bias favouring the processing of social/psychological threat cues among high AS men. Participants were 20 male university students (10 high AS; 10 low AS). In addition to social/psychological threat, physical threat, and neutral words, a category of positive emotional words (e.g. HAPPINESS; CELEBRATION) was included as a supplementary control on the Stroop. Consistent with Study 1, high AS males evidenced greater Stroop interference than did low AS males, but only for social/psychological threat words. No AS group differences in Stroop interference were revealed for the physical threat or positive words. Clinical implications, and potential theoretical explanations for the gender differences, are discussed.
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Examined the effects of anxiety-sensitivity (AS) levels, and 1.00 ml/kg alcohol, on autonomic and subjective-emotional responses to aversive stimulation (i.e., noise bursts). Ss were 30 university women divided into 3 AS groups (high, moderate, and low), on the basis of Anxiety Sensitivity Index (ASI) scores. When sober, high-AS women provided higher emotional arousal ratings while anticipating the noise bursts than did low-AS women. Alcohol dampened the noise burst-anticipation ratings, particularly in the high-AS group. ASI scores were positively correlated with degree of sober skin conductance level (SCL) reactivity and with degree of alcohol dampening of SCL reactivity. Thus, high-AS women may use alcohol to normalize their anticipatory emotional and electrodermal overreactivity to threat. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Although there is little direct evidence available, there is a pervasive assumption that HR is easily detected during periods of physical stress or exertion. It has also been suggested that distance runners are keenly aware of their cardiac functioning. The present study assessed cardiac awareness while at rest and again following vigorous exercise for groups of subjects differing in physical fitness. Thirty-six subjects were solicited and composed groups of Sedentary, Tennis, and Distance Running groups. Each group was composed of equal numbers of male and female subjects. HR awareness was assessed using 35 10-sec discrimination trials. Veridical feedback was composed of light flashes triggered by EKG R-spikes whereas false feedback was composed of flashes at rates 10, 20, or 30 percent above or below their actual rate. At the end of each trial, subjects indicated the degree of certainty of their choice. Discrimination accuracy was measured at rest and again following exercise which raised HR level by 75 percent. Analyses of variance indicated that male runners were significantly more accurate discriminators at rest than any other group. Similar superiority was not shown by the female runners. After exercise, the tennis and sedentary groups showed significant overall increases in awareness during augmented cardiac functioning. Exercise did not produce additional increments in awareness for the male runners. A battery of post experimental questionnaires largely failed to discriminate experimental groups.
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The main assumption of the present study is that emotional experience is coupled to perception of bodily processes. From this it is deduced that individuals who show good perception of heart activity tend to exhibit higher levels of a momentarily experienced emotion (in this case anxiety) and to score higher on the personality trait “Emotional Lability.” The aspect of cardiac awareness considered here is perception of heart beats. Subjects were instructed to count heart beats (only by concentrating on their body but not by taking their pulse) during a signalled time interval and the reported number of beats was then compared to the actual number of beats as extracted from the EKG. Additionally, skin conductance and respiration were recorded. During the experimental task (i.e., counting heart beats) increases in heart rate, respiration rate and number of spontaneous fluctuations in skin conductance were recorded. Groups of good and poor perceivers were formed on the basis of accuracy on the perception task. The two groups did not differ in heart rate; however, in State Anxiety and Emotional Lability, the group of good perceivers had significantly higher scores. The importance of visceroception for emotional experience is pointed out and the relevance for clinical psychology is discussed.
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The present study examined the effects of naturalistic benzodiazepine (BZ) use on selective attention to threat cues in 50 patients diagnosed with anxiety disorders, according to DSM-IV (APA, 1994) criteria. Patients provided information on their BZ use histories, demographics, and severity of anxiety symptomatology, and completed a computerized Stroop task involving color naming of social threat, physical threat, and matched no-threat control words. Patients were selected to fill two age-, gender-, and diagnosis-matched groups based on self-reported BZ use histories: 25 current BZ users versus 25 medication nonusing controls. Planned comparisons were conducted to determine whether BZ use groups differed in degree of selective attention to either the physical and/or social threat stimuli, or overall. Even with BZ use group differences in anxiety severity covaried out, the BZ users demonstrated significantly greater selective attention to threat than the medication nonusers, particularly in the case of physical threat stimuli. These findings are consistent with Westra and Stewart's (1998) suggestion that BZ use may increase preferential attention to physical threat cues, since BZs are often taken on an as needed (prn) basis. This prn enhancement interpretation was further supported through the finding of a significant positive correlation between frequency of prn use of BZs and degree of physical threat-related interference on the Stroop among the BZ users group. Theoretical explanations and clinical implications of these findings are discussed.
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Relationships between affect intensity and basal, evoked, and perceived cardiac arousal were investigated in 3 experiments. Affect intensity was assessed using Larsen and Diener's (1987) Affect Intensity Measure (AIM). Cardiac arousal was evoked with exercise in the 1st study and with mental arithmetic in the 2nd and 3rd. Perceived cardiac arousal was measured under optimal conditions using a standard heartbeat discrimination procedure. Women as a group scored higher on the AIM. Affect intensity was unrelated to basal or evoked cardiac arousal and was negatively related to perceived cardiac arousal in all 3 studies. Data suggest that affect intensity, although unrelated to actual physiological arousal, is negatively related to the accuracy with which individuals perceive their own arousal. Results are discussed within the context of an expanded arousal-regulation model (Blascovich, 1990).
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One hundred forty-five consecutive patients referred for ambulatory electrocardiographic monitoring for the evaluation of palpitations were studied just before monitoring. They were compared with 75 asymptomatic, nonpatient volunteers. The research battery included a structured diagnostic interview, self-report questionnaires, and perceptual tasks measuring awareness of cardiac activity. After monitoring, symptom reports were compared with concurrent electrocardiographic recordings to determine their accuracy. Forty palpitation patients (27.6%) had DSM-III-R lifetime panic disorder, and 27 (18.6%) had current (1-month) panic disorder. Panic patients were significantly more likely to describe their palpitations as "racing" or "pounding" and to have been awakened from sleep by them. They did not have more cardiac arrhythmias during 24-hour, electrocardiographic monitoring, and their symptom reports were significantly less likely to be due to demonstrable cardiac irregularities. They were not more accurately aware of resting heartbeat than nonpanic palpitation patients. They did score higher on self-report measures of somatization, hypochondriasis, and bodily amplification.
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Body vigilance, consciously attending to internal cues, is a normal adaptive process. The present report investigated whether body vigilance is exaggerated among those with panic disorder, a condition characterized by intense fear and worry regarding bodily sensations. The Body Vigilance Scale is validated in nonclinical and anxiety disorder samples. Study 1 suggests that body vigilance is normally distributed in a nonclinical sample (n = 472) but vigilance is related to a history of spontaneous panic attacks, anxiety symptomatology, and anxiety sensitivity. Study 2 suggests that body vigilance is elevated in panic disorder patients (n = 48) relative to social phobia patients (n = 18) and nonclinical controls (n = 71). During cognitive-behavioral treatment, panic disorder patients show substantial reductions in body vigilance associated with reductions in anxiety symptomatology. Anxiety sensitivity was found to be related to body vigilance and to predict changes in body vigilance during treatment.
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Twenty-eight non-clinical subjects, scoring either high or low on a variety of anxiety measures, were asked to match their perceived heart rate to a series of tones produced by a metronomal device, both at rest and during a period of mild exercise. Actual heart rate was measured concurrently with an electrocardiogram. No differences were found between groups in the accuracy with which they were able to monitor their heart rates and, in fact, all subjects markedly underestimated their heart rate. Also, no significant correlations were found between heart rate awareness and any of the measures of anxiety, except for a negative relationship between awareness and scores on the Anxiety Sensitivity Index. Theories of anxiety, and methodological considerations, are discussed.
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Examined the effects of anxiety-sensitivity (AS) levels, and 1.00 ml/kg alcohol, on autonomic and subjective-emotional responses to aversive stimulation (i.e., noise bursts). Ss were 30 university women divided into 3 AS groups (high, moderate, and low), on the basis of Anxiety Sensitivity Index (ASI) scores. When sober, high-AS women provided higher emotional arousal ratings while anticipating the noise bursts than did low-AS women. Alcohol dampened the noise burst-anticipation ratings, particularly in the high-AS group. ASI scores were positively correlated with degree of sober skin conductance level (SCL) reactivity and with degree of alcohol dampening of SCL reactivity. Thus, high-AS women may use alcohol to normalize their anticipatory emotional and electrodermal overreactivity to threat.
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Anxiety sensitivity (AS) is the fear of anxiety-related sensations. According to Reiss’s (e.g., Reiss, 1991) expectancy theory, AS amplifies fear and anxiety reactions, and plays an important role in the etiology and maintenance of anxiety disorders, particularly panic disorder. Recent evidence suggests that AS has a hierarchical structure, consisting of multiple lower order factors, loading on a single higher order factor. If each factor corresponds to a discrete mechanism (Cattell, 1978), then the results suggest that AS arises from a hierarchic arrangement of mechanisms. A problem with previous studies is that they were based on the 16-item Anxiety Sensitivity Index, which may not contain enough items to reveal the type and number of lower order factors. Also, some of the original ASI items are too general to assess specific, lower order factors. Accordingly, we developed an expanded measure of AS—the ASI-R—which consists of 36 items with subscales assessing each of the major domains of AS suggested by previous studies. The ASI-R was completed by 155 psychiatric outpatients. Factor analyses indicated a four-factor hierarchical solution, consisting of four lower order factors, loading on a single higher factor. The lower order factors were: (1) fear of respiratory symptoms, (2) fear of publicly observable anxiety reactions, (3) fear of cardiovascular symptoms, and (4) fear of cognitive dyscontrol. Each factor was correlated with measures of anxiety and depression, and fear of cognitive dyscontrol was most highly correlated with depression, which is broadly consistent with previous research. At pretreatment, patients with panic disorder tended to scored highest on each of the factors, compared to patients with other anxiety disorders and those with nonanxiety disorders. These findings offer further evidence that Reiss’s expectancy theory would benefit from revision, to incorporate the notion of a hierarchic structure of AS.
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Reviewed 23 studies with 18,627 Ss to explore 5 areas of the literature on nonclinical panickers (NCPs): (1) prevalence of panic attacks (PATs) and factors affecting prevalence rates, (2) panic symptom profile, (3) measures of psychopathology, (4) family history of PATs, and (5) psychophysiological responses to challenge tasks. Results suggest that (1) reported prevalence of PATs depends on the way PATs are defined and measured; (2) the symptom profile of nonclinical panic is consistent; (3) levels of associated depressed and anxious mood are consistent and show that the scores of NCPs fall between those of nonpanickers and clinical panickers; (4) NCPs, compared with nonpanickers, report a higher prevalence of family members experiencing PATs; and (5) psychophysiological responses to challenge tasks show both similarities and differences to those of nonpanickers and clinical patients. The requirement that nonclinical panic be spontaneous in nature is not valid. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Anxiety sensitivity refers to the degree to which an individual fears symptoms of anxiety because of beliefs about anxiety's aversive consequences. Heart-rate reactivity and sensitivity to physiology were investigated in 59 female undergraduate participants. It was predicted that compared to women with low anxiety sensitivity, women with high anxiety sensitivity would exhibit higher heart rates and greater cardiac awareness during a mental arithmetic and caffeine manipulation. Women high on anxiety sensitivity were significantly more accurate at counting heartbeats during arithmetic than women low on anxiety sensitivity, although absolute heart rate did not differ across groups. Self-report data for caffeine-induced physical sensations support the use of caffeine challenge tasks in future research on anxiety sensitivity.
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Recent research on psychosocial models of panic disorder has demonstrated that panic patients become anxious about, and tend to focus on, the physical sensations of panic (e.g., palpitations, dizziness, and breathlessness). To assess whether patients' hypervigilance for panic sensations is associated with heightened awareness of internal sensations, subjects with panic disorder, social phobia, and no mental disorder were asked to count heartbeats at rest and following a period of exercise, while actual heartbeats were recorded using a polygraph. The groups did not differ in heartbeat awareness at rest. Following exercise, all groups became more aware of cardiac sensations, again with no between-group differences. Despite a lack of group differences, several variables were positively related to accuracy of heartbeat perception, including self-reported anxiety over relevant sensations and subjects' confidence in their estimations. In addition, actual heart rate was negatively related to accuracy of heartbeat tracking. The implications of these results are discussed.
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Recent cognitive-behavioral theories of panic disorder (PD) suggest that PD patients experience heightened anxiety over, and hypervigilance for, specific physical sensations. Researchers have recently begun to examine whether PD patients evidence heightened interoceptive awareness, relative to normals, with inconclusive results. The present study examined changes in cardiac awareness in 15 PD patients following cognitive-behavioral treatment. Before and after treatment, cardiac awareness was evaluated by having patients count heart beats during specified intervals while actual heart rate was monitored. Despite significant reductions in panic attacks and related symptomatology, cardiac awareness did not change on average, although some individual subjects showed dramatic changes in either direction. As was the case with the entire sample, a subgroup of patients who showed the greatest reduction in anxiety over panic sensations did not evidence significant changes in heart beat awareness. The implications of these results are discussed.
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Considerable controversy exists regarding the practice of combining Cognitive Behavioural Therapy (CBT) with Pharmacotherapy (PT) in the management of anxiety. This paper considers whether these two forms of treating anxiety disorders can be effectively combined to enhance treatment outcome. Despite the theoretical appeal of a combined approach, a critical review of treatment outcome findings across CBT and various anxiolytic medications and their combination, suggests a failure of these treatments to operate in a complementary fashion. A detrimental impact of anxiolytic medication on CBT outcome is particularly salient for high potency benzodiazepines. Low potency benzodiazepines and antidepressants generally have a negligible impact with no clear evidence of treatment enhancement and some negative combined treatment effects on medication withdrawal and at long-term follow-up. Thus, we address potential mechanisms that may explain this treatment noncomplementarity and in some cases, treatment incompatibility. Cognitive factors influencing treatment outcome (catastrophic beliefs, self-efficacy, selective attention, and memory) are highlighted in view of the empirically supported mediating role of these variables in accounting for treatment responsiveness. Potential effects of anxiolytic medication on cognitive change in CBT are postulated. A number of suggestions for future research and clinical practice are proposed on the basis of this review.
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Anxiety sensitivity (AS) is the fear of anxiety-related sensations arising from beliefs that these sensations have harmful physical, psychological, or social consequences. AS is measured using the Anxiety Sensitivity Index (ASI), a 16-item self-report questionnaire. Little is known about the origins of AS, although social learning experiences (including sex-role socialization experiences) may be important. The present study examined whether there were gender differences in: (a) the lower- or higher-order factor structure of the ASI; and/or (b) pattern of ASI factor scores. The ASI was completed by 818 university students (290 males; 528 females). Separate principal components analyses on the ASI items of the total sample, males, and females revealed nearly identical lower-order three-factor structures for all groups, with factors pertaining to fears about the anticipated (a) physical, (b) psychological, and (c) social consequences of anxiety. Separate principal components analyses on the lower-order factor scores of the three samples revealed similar unidimensional higher-order solutions for all groups. Gender × AS dimension analyses on ASI lower-order factor scores showed that: females scored higher than males only on the physical concerns factor; females scored higher on the physical concerns factor relative to their scores on the social and psychological concerns factors; and males scored higher on the social and psychological concerns factors relative to their scores on the physical concerns factor. Finally, females scored higher than males on the higher-order factor representing the global AS construct. The present study provides further support for the empirical distinction of the three lower-order dimensions of AS, and additional evidence for the theoretical hierarchical structure of the ASI. Results also suggest that males and females differ on these various AS dimensions in ways consistent with sex role socialization practices.
Article
The purposes of this article are to summarize the author's expectancy model of fear, review the recent studies evaluating this model, and suggest directions for future research. Reiss' expectancy model holds that there are three fundamental fears (called sensitivities): the fear of injury, the fear of anxiety, and the fear of negative evaluation. Thus far, research on this model has focused on the fear of anxiety (anxiety sensitivity). The major research findings are as follows: simple phobias sometimes are motivated by expectations of panic attacks; the Anxiety Sensitivity Index (ASI) is a valid and unique measure of individual differences in the fear of anxiety sensations; the ASI is superior to measures of trait anxiety in the assessment of panic disorder; anxiety sensitivity is associated with agoraphobia, simple phobia, panic disorder, and substance abuse; and anxiety sensitivity is strongly associated with fearfulness. There is some preliminary support for the hypothesis that anxiety sensitivity is a risk factor for panic disorder. It is suggested that future researchers evaluate the hypotheses that anxiety and fear are distinct phenomena; that panic attacks are intense states of fear (not intense states of anxiety); and that anxiety sensitivity is a risk factor for both fearfulness and panic disorder.
Article
Somatic sensations are not only a core symptom of panic attacks, but they are also considered the primary trigger of the attacks according to recent psychological models. Studying interoception in panic disorder may help to specify situational factors of panic attacks and to explain why some people are more prone to panic attacks than others. Our research program identified three characteristics of panic disorder patients which may contribute to why they notice more bodily symptoms, tend to respond with anxiety when they experience such symptoms and tend to avoid situations in which such symptoms occur. Panic patients demonstrated an enhanced ability to perceive their heart rate, they tended to shift their attention towards physically threatening cues and they rated bodily symptoms associated with anxiety or panic as more dangerous. These factors may be involved in the development and maintenance of panic disorder.
Article
We investigated relationships between anxiety sensitivity and perceptions of facial emotions following relaxation and hyperventilation. The Anxiety Sensitivity Index was administered to 606 female college undergraduates and samples of high (n = 30) and low (n = 25) scorers were obtained from the top and bottom 15% of the distribution. Following exposure to randomly counterbalanced 5-minute relaxation and hyperventilation instructions, participants rated the intensity of seven basic emotions in photographs of faces using a standardized test of affect-receiving ability. High ASI scorers perceived significantly more intense fear and anger than did low ASI respondents and reported relatively larger increases in ratings of sadness and fear following hyperventilation. ASI was significantly correlated with heightened state anxiety and vigilance prior to beginning the experiment, and these affects mediated interpersonal perceptions. Results suggest that high ASI scorers may manifest a chronic state of vigilance that triggers heightened anxiety in ambiguous situations. The combination of high anxiety sensitivity and state anxiety appears to foster greater sensitivity to interpersonal stimuli.
Article
We investigated cardiac perception in panic disorder with both self-report and objective measures. In Study 1, 120 patients with panic disorder, 86 infrequent panickers, and 38 patients with other anxiety disorders reported greater cardiac and gastrointestinal awareness than 62 normal control subjects. Subjects with panic attacks reported greater cardiac awareness, but not gastrointestinal awareness, than those with other anxiety disorders. Studies 2 and 3 included a test of heart rate perception in which subjects silently counted their heart-beats without taking their pulse. In Study 2, 65 panic disorder patients showed better performance than 50 infrequent panickers, 27 patients with simple phobias, and 46 normal control subjects. No group differences were found in ability to estimate time intervals. In Study 3, 13 patients with panic disorder and 15 with generalized anxiety disorder showed better heart rate perception than 16 depressed patients.
Article
The purpose of this investigation was to further define the role of anxiety sensitivity, in relation to physiological arousal and the cognitive perception of anxiousness, as a determinant of anxiety. One hundred and thirty-two undergraduates at an urban university served as subjects. Two physiological measures of arousal and two cognitive measures of anxiety were used following an anxiety inducing task (mental arithmetic). The general expectation, which was supported, was that individual differences in anxiety sensitivity levels are more closely related to subjects' reported anxiousness in stressful conditions than are the actual physiological changes. Additionally, anxiety sensitivity was related to poststress levels of anxiety whereas trait anxiety was only related to pre- and postrelaxation levels of anxiety. Implications of the findings are addressed.
Article
The psychophysiological model of panic attacks postulates a positive feedback loop between anxiety symptoms and the patient's anxious reaction to these symptoms. We tested the underlying assumption that the appraisal of bodily change can induce anxiety in this patient group. Twenty-five patients with panic disorder or agoraphobia with panic attacks (DSM-III) and 25 matched normal controls were given false feedback of an abrupt heart rate increase. Self-ratings of anxiety and excitement, heart rate, skin conductance level, and systolic and diastolic blood pressure were taken. On all measures, patients who believed that the feedback was accurate (N = 19) responded differently to the false feedback than controls (N = 16). Patients showed increases in anxiety and physiological arousal. The preceding true heart rate feedback did not induce changes in anxiety. Patients and controls did not differ in their accuracy of heart rate perception. The results underline the role of appraisal processes and the fear of anxiety symptoms in panic disorder.
Article
Biological models have had major consequences for the therapy and theory of panic disorder and agoraphobia. Authors such as Klein and Sheehan propose a qualitative biological distinction between panic attacks and other types of anxiety. Central arguments for their models include drug specificity, panic induction, family data, spontaneity of panic attacks and separation anxiety. A look at the evidence, however, shows surprisingly little empirical support for these arguments. In spite of the great heuristic value of Klein's and Sheehan's models, alternative approaches focusing on an interaction of physiological and psychological factors seem more capable of integrating the relevant findings.
Article
A distinction is proposed between anxiety (frequency of symptom occurrence) and anxiety sensitivity (beliefs that anxiety experiences have negative implications). In Study 1, a newly-constructed Anxiety Sensitivity Index (ASI) was shown to have sound psychometric properties for each of two samples of college students. The important finding was that people who tend to endorse one negative implication for anxiety also tend to endorse other negative implications. In Study 2, the ASI was found to be especially associated with agoraphobia and generally associated with anxiety disorders. In Study 3, the ASI explained variance on the Fear Survey Schedule—II that was not explained by either the Taylor Manifest Anxiety Scale or a reliable Anxiety Frequency Checklist. In predicting the development of fears, and possibly other anxiety disorders, it may be more important to know what the person thinks will happen as a result of becoming anxious than how often the person actually experiences anxiety. Implications are discussed for competing views of the ‘fear of fear’.
Article
Describes the development of the Agoraphobic Cognitions Questionnaire and the Body Sensations Questionnaire, companion measures for assessing aspects of fear of fear (panic attacks) in agoraphobics. The instruments were administered to 175 agoraphobics (mean age 37.64 yrs) and 43 controls (mean age 36.13 yrs) who were similar in sex and marital status to experimental Ss. Results show that the instruments were reliable and fared well on tests of discriminant and construct validity. It is concluded that these questionnaires are useful, inexpensive, and easily scored measures for clinical and research applications and fill a need for valid assessment of this dimension of agoraphobia. (22 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
SYNOPSIS Awareness of pulse rate was tested in 60 psychiatric out-patients with anxiety, phobic or hypochondriacal neuroses by asking them to record how fast their hearts were beating during exposure to short film sequences. Correlations between subjective and objective heart rate (ECG) were significantly higher in anxious and hypochondriacal patients than in phobic ones. The results suggest that somatic symptoms in hypochondriacal and anxiety neurosis reflect increased awareness of bodily function.
Article
Twenty-four panic disorder patients and 25 nonclinical subjects underwent double-breath inhalations of 5, 10, and 20% carbon dioxide (CO2) or room air. All subjects were blind to inhalation content and were required to guess if the inhalation contained CO2. There was no significant difference between groups in the accuracy with which they were able to detect CO2 at any concentration. Similarly, the number of somatic symptoms reported to each inhalation did not differ between groups. The findings question suggestions that individuals with panic disorder are more accurate at detecting changes in physiology than other individuals.
Article
Cognitive models maintain that panic attacks may be initiated by fear resulting from the interpretation of somatic sensations as personally threatening or harmful. Similarly, several researchers have proposed that the enhanced response of panickers to biological challenge may result from the fear of induced anxiety sensations rather than from direct stimulation of aberrant biochemical systems. The present study examined the effects of both panic history and fear of anxiety sensations on subjective and cardiac responses to biological challenge. Eighty nonclinical subjects were chosen on the basis of level of anxiety sensitivity and history of previous panic attacks. High and low anxiety-sensitive panickers and nonpanickers (four groups of 20 subjects) were subjected to a 90 sec period of voluntary hyperventilation, during which heart rate was assessed. Regardless of panic history, total symptom scores did not differ between high and low anxiety-sensitive subjects at baseline or pre-hyperventilation, but did differ at post-hyperventilation. There were, however, no significant differences in post-hyperventilation measures of heart rate. The apparent mismatch of subjective and physiological responsivity to the challenge in high anxiety-sensitive individuals (i.e. more severe symptom self-reports in the absence of increased cardiac activation) provides support for the hypothesis that high anxiety sensitivity is associated with an enhanced tendency to panic in response to biological challenge.
Article
It has been suggested that perception of visceral changes, and cognitive reactions to such changes, may be important for triggering panic attacks. It remains to be determined, however, whether people with panic attacks are actually characterized by enhanced perceptual acuity for interoceptive stimuli. The purpose of this study was to explore the relationship between panic attacks and awareness for cardiac sensations using an objective heartbeat discrimination procedure. Twenty panickers and 20 nonpanickers were given 60 trials of the Whitehead heartbeat discrimination procedure. Thirty trials were given during rest and 30 following hyperventilation. Results indicated that panic attacks were not related to enhanced interoceptive acuity for cardiac sensations, either at rest or following hyperventilation. These results are discussed in terms of their relevance to cognitive models of panic.
Article
Anxiety sensitivity (AS) is the fear of anxiety-related sensations. According to Reiss's (e.g., Reiss, 1991) expectancy theory, AS amplifies fear and anxiety reactions, and plays an important role in the etiology and maintenance of anxiety disorders, particularly panic disorder. Recent evidence suggests that AS has a hierarchical structure, consisting of multiple lower order factors, loading on a single higher order factor. If each factor corresponds to a discrete mechanism (Cattell, 1978), then the results suggest that AS arises from a hierarchic arrangement of mechanisms. A problem with previous studies is that they were based on the 16-item Anxiety Sensitivity Index, which may not contain enough items to reveal the type and number of lower order factors. Also, some of the original ASI items are too general to assess specific, lower order factors. Accordingly, we developed an expanded measure of AS--the ASI-R--which consists of 36 items with subscales assessing each of the major domains of AS suggested by previous studies. The ASI-R was completed by 155 psychiatric outpatients. Factor analyses indicated a four-factor hierarchical solution, consisting of four lower order factors, loading on a single higher factor. The lower order factors were: (1) fear of respiratory symptoms, (2) fear of publicly observable anxiety reactions, (3) fear of cardiovascular symptoms, and (4) fear of cognitive dyscontrol. Each factor was correlated with measures of anxiety and depression, and fear of cognitive dyscontrol was most highly correlated with depression, which is broadly consistent with previous research. At pretreatment, patients with panic disorder tended to scored highest on each of the factors, compared to patients with other anxiety disorders and those with nonanxiety disorders. These findings offer further evidence that Reiss's expectancy theory would benefit from revision, to incorporate the notion of a hierarchic structure of AS.
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