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Daily worrying and somatic health complaints: Testing the effectiveness of a simple worry reduction intervention
Psychology & Health
Abstract
This study examines whether worry is prospectively associated with somatic complaints and whether a worry reduction intervention can decrease these complaints. One hundred and seventy-one high school students (16–17 years old) kept a log of their worry duration and frequency for 6 days, of whom half were instructed to try to postpone worrying to a special 30-min worry period each day (‘postponers’). Somatic symptoms during ‘the last 3 days’ were assessed before and after the 6 days. At follow-up, postponers reported fewer complaints than controls, controlled for baseline. This reduction appeared to be mediated by worry duration, and pertained to, amongst others, lower back pain, neck pain, coughing/bronchitis, breathing difficulties and stomach pains. Thus, daily worry appears to be prospectively related to a broad set of somatic complaints, and its effect might be reversed by a simple intervention. Possible underlying mechanisms include prolonged physiological activity and illness-related perseverative cognition.
... The associations between worry/rumination and poorer subjective physical health are in-keeping with previous studies which found that higher levels of rumination and/or worry were associated with an increased number of health complaints in the general population (Rector and Roger, 1996;Lok and Bishop, 1999;Brosschot and van der Doef, 2006;Verkuil et al., 2010) and that higher levels of rumination were associated with poorer self-reported physical health in older adults (Thomsen et al., 2004b). We build on these findings by Frontiers in Psychology 06 frontiersin.org ...
... As such, our results showing a lack of a relationship between worry/rumination and the FRS and blood pressure may be due to our evaluation of long-term rather than transient relationships between these measures. In relation to the physical comorbidities, there is limited empirical evidence linking worry or rumination with long-term health conditions as assessed in the CCI; however, worry/rumination have been associated with the immune, cardiovascular, and endocrine systems in the general population (Brosschot and van der Doef, 2006;Verkuil et al., 2010;Ottaviani et al., 2016). More specifically, the CCI includes several cardiovascular conditions (e.g., myocardial infarction; Charlson et al., 1987), and worry/rumination have been associated with increased cardiovascular risk factors (Brosschot and van der Doef, 2006;Verkuil et al., 2010;Ottaviani et al., 2016). ...
... In relation to the physical comorbidities, there is limited empirical evidence linking worry or rumination with long-term health conditions as assessed in the CCI; however, worry/rumination have been associated with the immune, cardiovascular, and endocrine systems in the general population (Brosschot and van der Doef, 2006;Verkuil et al., 2010;Ottaviani et al., 2016). More specifically, the CCI includes several cardiovascular conditions (e.g., myocardial infarction; Charlson et al., 1987), and worry/rumination have been associated with increased cardiovascular risk factors (Brosschot and van der Doef, 2006;Verkuil et al., 2010;Ottaviani et al., 2016). However, as discussed above, the measures of cardiovascular health may only be associated with worry/rumination in experimental settings. ...
Introduction
Mental health conditions are associated with cognition and physical function in older adults. We examined whether worry and ruminative brooding, key symptoms of certain mental health conditions, are related to subjective and/or objective measures of cognitive and physical (cardiovascular) health.
Methods
We used baseline data from 282 participants from the SCD-Well and Age-Well trials (178 female; agemean = 71.1 years). We measured worry and ruminative brooding using the Penn State Worry Questionnaire and the Ruminative Response Scale-brooding subscale. We assessed subjective physical health using the WHOQOL-Bref physical subscale, and objective physical health via blood pressure and modified versions of the Framingham Risk Score and Charlson Comorbidity Index. With subjective and objective cognition, we utilized the Cognitive Difficulties Scale and a global composite (modified Preclinical Alzheimer’s Cognitive Composite, PACC5, with the Wechsler Adult Intelligence Scale-IV, category fluency, Mattis Dementia Rating Scale-2, and either the California Verbal Learning Test or the Rey Auditory Verbal Learning Test). We conducted linear regressions, adjusted for education, age, sex and cohort.
Results
Worry and ruminative brooding were negatively associated with subjective physical health (worry: β = −0.245, 95%CI −0.357 to −0.133, p < 0.001; ruminative brooding: β = −0.224, 95%CI −0.334 to −0.113, p < 0.001) and subjective cognitive difficulties (worry: β = 0.196, 95%CI 0.091 to 0.302, p < 0.001; ruminative brooding: β = 0.239, 95%CI 0.133 to 0.346, p < 0.001). We did not observe associations between worry or ruminative brooding and any measure of objective health.
Discussion
Worry and ruminative brooding may be common mechanisms associated with subjective but not objective health. Alternatively, cognitively unimpaired older adults may become aware of subtle changes not captured by objective measures used in this study. Interventions reducing worry and ruminative brooding may promote subjective physical and cognitive health; however, more research is needed to determine causality of the relationships.
... In 2006, Brosschot, Gerin and Thayer proposed the 'perseverative cognition hypothesis' indicating that worry prolongs the bodily response to stress which results in additional negative health consequences. In this line, several studies found that worry can predict the number of somatic complaints that people report (Aasa Brulin et al.,2005;Brosschot & van der Doef, 2006;Jellesma et al., 2009;Verkuil et al.,2012;Versluis et al., 2016;Eggli et al., 2021). It was furthermore found that worry is associated with fatigue and lower back pain (Freeston et al., 1996;Verkuil et al., 2012), cardiovascular disease (Kubzansky et al., 1997), neck pain (Borkovec, 1994) as well as insomnia (Harvey & Greenall, 2003). ...
... Further instructions regarding the content of that worry window were not given. Three studies used these basic instructions adapted from Brosschot and Van Der Doef (2006). Jellesma et al. (2009) adapted these main instructions for children. ...
... Thus, results cannot clearly indicate whether the reduction of worry can be attributed to one, several or a combination of instructions of worry postponement. For example, Verkuil et al. (2011) used the most basic instructions of worry postponement (Brosschot & van der Doef, 2006) and added instructions for disengagement for the intervention group. It cannot be clearly indicated whether worry postponement, disengagement or the combination of both led to the reduction of worry. ...
Worry postponement, also called stimulus control, is a simple and easy to administer intervention that often forms part of cognitive-behavioural treatments for worry. We conducted a meta-analysis to test if worry postponement is effective in reducing daily worry. Data from 7 randomized trials were included providing a total of 999 participants, of which 250 experienced worry as a burden and of which the majority was women. When comparing worry postponement to the mere registration of worries small effect sizes were observed for worry duration (d = 0.313) and for worry frequency (d = 0.189). Moderation analyses showed that the intervention yielded larger effect sizes in studies including more women. However, long-term follow-up studies are still lacking. Worry postponement, practiced between a week or a maximum of a month, was found to effectively reduce the frequency and duration of worry in daily life. This suggests that a simple intervention is available for people whose worries (temporarily) spiral out of control.
... According to the perseverative cognition hypothesis , perseverative cognition prolongs the psychophysiological stress response, by prolonging the mental representation of stressful events beyond their actual presence. This prolonged stress response has been suggested to lead to somatic as well as psychological stress related pathology, including health complaints (Brosschot & Van Der Doef, 2006), cardiovascular disease (Kubzansky et al., 1997) and mood and anxiety disorders. A recent meta-analysis showed that perseverative cognition was related to a range of physiological concomitants including increased heart rate, blood pressure, cortisol, and lower heart rate variability (Ottaviani et al., 2016). ...
... Worry Log. The worry log is a one-page A4 form validated in previous studies by Brosschot and Van Der Doef (2006), Verkuil et al. (2007) and Versluis et al. (2016). On this form an adapted version of Borkovec et al.'s (1983) working definition of worry is given. ...
... The mean scores on the PSWQ (M = 44.11, SD = 12.76) and the STAI-T (M = 37.31, SD = 8.95) are within the normal range for healthy subjects and are comparable with mean scores found in other studies (Brosschot & Van Der Doef, 2006;Tallis et al., 1994). On average, participants worried 144 min, which means 24 min on average per day, which is comparable to previous studies using momentary assessments of worry (Verkuil et al., 2007;Brosschot & Van Der Doef, 2006). ...
Worry is a central process in a wide range of psychopathological and somatic conditions. Three studies (N = 856) were used to test whether a subscale composed of five items of the most commonly used trait anxiety questionnaire, Spielberger’s State Trait Anxiety Inventory-Trait version (STAI-T), is appropriate to measure worry. Results showed that the subscale, named the Brief Worry Scale (BWS), had excellent internal consistency and temporal stability. Convergent and divergent validity were supported by correlation analyses using worry questionnaires and measures of anxious arousal and depression. The BWS was a particularly good predictor of the pathogenic aspects of worry, including worry perseveration in daily life (study 1), measures of clinical worry (study 2) and the uncontrollability of experimentally induced worry (study 3). Taken together, these studies demonstrate that the BWS might be a valuable scale for pathological worry, for which many researchers already have data.
... Systematic review evidence suggests that, in patient samples, mindfulness-based stress reduction techniques are associated with better sleep by reducing worry [55] and it is possible that these effects may extend to other behaviors, including exercise. Likewise, a brief postpone worry intervention has been shown to significantly reduce daily worry [56,57], writing about life goals has been shown to reduce ruminative thinking [58], and a self-compassion intervention has been found to improve sleep quality via reduced rumination [59]. It is recommended that future research tests the effectiveness of such interventions within the context of physical activity promotion. ...
... Second, Brosschot and van der Doef [56] found that the duration but not the frequency of worry was predictive of somatic symptoms. Here, only the frequency of daily worry and brooding was captured as it was thought that it would be too difficult for participants to recall the number of minutes each day they were worrying and brooding. ...
... A measure of duration is more feasible when multiple daily measurements are taken. In the study by Brosschot and van der Doef [56], a daily pen and paper tally was made of worry episodes which may have made estimating duration at the end of the day easier. In future studies, it is suggested that multiple daily measurements of perseverative cognition and health behaviors are taken and that this includes assessment of the duration of daily perseverative cognition. ...
Background
Meta-analyses have reported associations between perseverative cognition (both worry and brooding) and increased engagement in health-risk behaviors, poorer sleep, and poorer physiological health outcomes.Method
Using a daily diary design, this study investigated the within- and between-person relationships between state and trait perseverative cognition and health behaviors (eating behavior, physical activity, alcohol consumption, and sleep) both cross-sectionally and prospectively. Participants (n = 273, 93% students, Mage = 20.2, SD = 4.11, 93% female) completed morning and evening diaries across 7 consecutive days.ResultsMultilevel modeling analyses revealed that, cross-sectionally, higher levels of state worry were associated with more time spent sitting and higher levels of state brooding predicted less daily walking.Conclusion
Worry and brooding may represent useful intervention targets for improving inactivity and walking levels, respectively.
... According to the perseverative cognition hypothesis , perseverative cognition prolongs the psychophysiological stress response, by prolonging the mental representation of stressful events beyond their actual presence. This prolonged stress response has been suggested to lead to somatic as well as psychological stress related pathology, including health complaints (Brosschot & Van Der Doef, 2006), cardiovascular disease (Kubzansky et al., 1997) and mood and anxiety disorders. A recent meta-analysis showed that perseverative cognition was related to a range of physiological concomitants including increased heart rate, blood pressure, cortisol, and lower heart rate variability (Ottaviani et al., 2016). ...
... Worry Log. The worry log is a one-page A4 form validated in previous studies by Brosschot and Van Der Doef (2006), Verkuil et al. (2007) and Versluis et al. (2016). On this form an adapted version of Borkovec et al.'s (1983) working definition of worry is given. ...
... The mean scores on the PSWQ (M = 44.11, SD = 12.76) and the STAI-T (M = 37.31, SD = 8.95) are within the normal range for healthy subjects and are comparable with mean scores found in other studies (Brosschot & Van Der Doef, 2006;Tallis et al., 1994). On average, participants worried 144 min, which means 24 min on average per day, which is comparable to previous studies using momentary assessments of worry (Verkuil et al., 2007;Brosschot & Van Der Doef, 2006). ...
Worry is a central process in a wide range of psychopathological and somatic conditions. Three studies (N = 856) were used to test whether a subscale composed of five items of the most commonly used trait anxiety questionnaire, Spielberger’s State Trait Anxiety Inventory-Trait version (STAI-T), is appropriate to measure worry. Results showed that the subscale, named the Brief Worry Scale (BWS), had excellent internal consistency and temporal stability. Convergent and divergent validity were supported by correlation analyses using worry questionnaires and measures of anxious arousal and depression. The BWS was a particularly good predictor of the pathogenic aspects of worry, including worry perseveration in daily life (study 1), measures of clinical worry (study 2) and the uncontrollability of experimentally induced worry (study 3). Taken together, these studies demonstrate that the BWS might be a valuable scale for pathological worry, for which many researchers already have data.
... The worry reduction intervention was implemented as described by Brosschot and van der Doef (2006). The participants in the intervention group were instructed to post- pone their worrying every time they realised they were worrying during the day, to a self-chosen 30-minute period late in the evening that they would reserve for worrying (i.e. ...
... Brosschot and van der Doef (2006) modified this instruction for the purpose of their study, with the difference being that participants in their study did not receive an instruction on the exact time of their worry-window. The current study followed the procedure by Brosschot and van der Doef (2006) by letting partici- pants choose the time of their worry window individually. In the case, participants received an ESM notification in the worry-window or immediately after, they were instructed to fill in the questions with regard to the half hour before the worry-window. ...
... Fifth, a manipulation check for the effect of the intervention on worry frequency and worry duration was performed (in line with former research [e.g. Brosschot & van der Doef, 2006]) using t- tests for independent samples. These preparatory steps were conducted using SPSS, version 21.0 (IBM Corp, 2012). ...
Objective:
Worry is an important perpetuating factor of Medically Unexplained Symptoms (MUS). Former research has shown that a worry postponement instruction is effective in reducing Subjective Health Complaints (SHC) in non-clinical samples. This study aimed to (1) replicate these findings in a MUS-analogue student-sample and (2) assess alexithymia as a moderator.
Design:
The current study had an experimental design with two waves of data collection: pre- and post-intervention.
Main outcome measures:
A MUS-analogue student-sample consisting of 114 undergraduate students with high self-reported health worry and a minimum of two doctor visits in the previous year with no current diagnosis for a (chronic or acute) disease were instructed to register their worry frequency and duration eight times per day via an experience sampling-application on their smartphones. The intervention group additionally postponed their worries to a 30-minute period in the evening. SHC were assessed pre- and post-intervention.
Results:
The intervention did not have an effect on worry or SHC. Alexithymia did not moderate this effect (p's > .05).
Conclusion:
Our study did not find evidence for the effectiveness of the worry reduction intervention on SHC in a MUS-analogue student-sample. This finding contributes to several previous studies that have found mixed evidence for the effectiveness of the worry reduction intervention on SHC and suggests that the worry intervention may not be effective in all cases.
... More specifically, evidence suggests that somatic problems may be more strongly linked with metacognitive executive skills as opposed to other sets of executive skills, such as behavior regulation skills. 18,19 Metacognitive executive skills are theorized to capture cognitive regulatory skills needed to plan, coordinate activity, and engage in active problem-solving, whereas behavior regulation executive skills index capability to implement behavioral actions toward goals. Bailey and Wells 18 provide compelling evidence to suggest dysfunctional metacognitive processes, such as worrying, rumination, and perseverative thinking-that is, heightened attentional focus on threatening stimuli-may help to explain the relation between metacognitive impairments and somatic problems. ...
... Moreover, some evidence supports that interventions bolstering metacognitive skills (eg, worry postponement) lessen somatic problems. 19 Given that adolescents with type 1 diabetes are a population at risk for somatic problems 4,5 and somatic problems are associated with high utilization of and high expenditures for medical services, it may be especially important to understand if perceived somatic problems are uniquely linked with executive function impairments over and above disease severity and poor adherence. ...
... Multiple studies have shown support for this proposed pathway, providing evidence to imply that problems with metacognition, specifically perseveration and worrying, represent pathogenic factors of somatic problems. 19,21 These findings should be interpreted in the context of some limitations. White adolescents made up the majority of this sample. ...
Adolescents with type 1 diabetes may be at elevated risk for somatic problems. This study used cross‐sectional, baseline data from an intervention to examine if problems with executive function (EF) were associated with greater somatic problems independent of poor adherence and disease severity in adolescents with type 1 diabetes and above target glycemic control. In addition, it examined whether certain types of EF skills, i.e., metacognitive and behavior regulation, accounted for variance in somatic problems. Ninety‐three adolescents completed a glycated hemoglobin (HbA1c) blood test and parents completed adherence, somatic problems, and EF questionnaires, which measured metacognitive, behavior regulation, and global EF. Greater somatic problems had significant bivariate associations with greater global (r = .42, p < .01), metacognitive (r = .43, p < .01), and behavior regulation EF problems (r = .31, p < .01), worse adherence (r = ‐.39, p < .01), and poorer metabolic control (r = .26, p < .05). However, when adherence, metabolic control, and EF subscales were examined together in the same model, only greater global EF problems (b = .15, p < .01) and metacognitive EF problems (b = .16, p < .01) were independently associated with greater somatic problems; behavior regulation EF problems were not independently associated with greater somatic problems when controlling for adherence. Metacognitive EF problems may predict somatic problems in adolescents with above target glycemic control above and beyond physical symptoms related to disease management, underscoring the importance of proper assessment and treatment of these distinct somatic problems.
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... We therefore attempted to replicate the findings of the worry postponement intervention and tested whether it can reduce worry and SHC in the larger general population. In contrast to the previous studies that delivered this intervention on paper (Brosschot & van der Doef, 2006;Jellesma et al., 2009;Verkuil et al., 2011), the present intervention will be delivered over the Internet. Internet-based interventions are increasingly being used for treating various psychological disorders and health problems, and its use carries several advantages like being easily accessible and cost-effective (Griffiths, Lindenmeyer, Powell, Lowe, & Thorogood, 2006). ...
... If the intervention is capable of reducing worry, it may in turn also decrease the level of negative affect. Furthermore, it is important to confirm earlier findings that effects of worry on SHC are independent of negative affect (Brosschot & van der Doef, 2006). Based on earlier findings with the 'regular' offline version of the intervention, it was expected that the online intervention would reduce the number of SHC and the level of daily worrying (both frequency and duration). ...
... Instead of asking about complaints during the past 30 days, we asked about the presence of these problems during the past 3 days (cf. Brosschot & van der Doef, 2006). Moreover, in line with Verkuil et al. (2012) two items regarding anxiety and depression were removed, because these do not represent physical complaints. ...
Ruminative thinking about negative feelings has been prospectively associated with increases in depressive symptoms and heightened risk for new onsets of major depression. One putative pathophysiological mechanism underlying this link might be represented by autonomic nervous system dysfunction. The objective of this longitudinal study was to evaluate the interplay between rumination, autonomic function (as revealed by heart rate variability (HRV) analysis), and depressive symptoms in healthy young subjects, over a three-year period. Rumination and depressive symptoms were evaluated in twenty-two women and twenty men at three assessment points (Time 0, 1 and 2) by the score on the Ruminative Response Scale, and the Center for Epidemiological Studies Depression Scale, respectively. Vagally-mediated HRV was assessed in a laboratory session (Time 0) and in two ambulatory sessions at Time 1 and Time 2 (~13 and 34months after Time 0, respectively). Ruminative thinking was found to be (i) a stable trait characteristic, (ii) more prevalent in women than men, and (iii) positively correlated with depressive symptoms. Moreover, resting HRV was negatively correlated with both rumination and depressive symptoms. Finally, HRV at Time 1 mediated the relationship between rumination at Time 0 and depressive symptoms at Time 2. We conclude that autonomic dysfunction, specifically low vagal tone, may be prospectively implicated in the generation of depressive symptoms in a non-clinical setting.
... Yet, more benign views recognize worry as quite common and as motivating constructive action. Adolescents typically report multiple worries per day [4,5], and the worries often wax and wane with everyday environmental pressures from school, peers, and family. Thus, to better articulate connections between worry and health, the present study investigates if ups and downs in adolescents' daily worries are associated with shifts in diurnal cortisol patterns via the daily cortisol awakening response (CAR). ...
... Thus, the second overall objective of this study was to investigate separate and combined effects of worry and CAR on either short-term or long-term health symptoms. To our knowledge, only one study has investigated direct effects between adolescents' worry and health: Global worry and duration of worry across 6 days correlated with concurrent health complaints in 171 predominantly female adolescents [5]. Our goal here was to test whether CAR strengthens associations between worry and adolescents' experience of health concerns. ...
... Investigating connections between worry, stress physiology, and health is particularly important during adolescence, which is considered a critical period when effects of perceived stress become biologically embedded [20,21]. Although chronic health concerns are somewhat infrequent during adolescence, contagious diseases (e.g., cold and sore throat) are common, and headaches, sleep difficulties, and musculoskeletal problems also increase [5,22,23]. ...
Purpose:
To assess short-term effects of daily worries on hypothalamic-pituitary-adrenal axis activity and later implications for adolescents' health symptoms. We hypothesized that heightened worry would be associated with stronger next-morning cortisol awakening response (CAR) to prepare the body for the demands of the upcoming day. Guided by biological adaptation to stress theories, we also hypothesized that dysregulated CAR would heighten associations between worries and later health symptoms, while also testing direct associations between worries and dysregulated CAR and health.
Methods:
Ninety-nine late adolescents during waves 5 and 6 of a longitudinal study reported on 26 worries for 10 days. On 3 of the 10 days, participants also provided morning saliva samples that were assayed for cortisol to capture the CAR. At both waves, participants reported on 22 common health symptoms.
Results:
Multilevel models showed significant within-person associations between high daily worries and next-morning heightened CAR for females. Contrary to expectation, worries were inversely related to concurrent health symptoms. For the whole sample, CAR moderated the effect of worries on later health symptoms: Worries were positively associated with health symptoms in adolescents with high CAR and inversely associated with health symptoms for those with low CAR.
Conclusions:
In this sample of typically developing adolescents, worries alone do not increase the risk for common health complaints and may be somewhat protective in the short run. However, high worries in the context of high CAR appear to increase the risk for health symptoms.
... Another topic not covered by prior social work research is the consideration of physical symptoms (e.g., headaches) as an alternative marker to the commonly applied well-being indicators (e.g., burnout) 16) . Considering physical problems is vital, as such health issues are closely linked to job stressors 8,17) and often remain clinically undiagnosed, while producing immense organizational costs due to sick leaves and productivity loss 18) . ...
... Furthermore, the driving force behind the relationship between daily social stressors and daily physical health was uncovered, namely rumination as a daily within-person mediator. Since physical symptoms often remain undiagnosed 18) , social work practice needs to be sensitized for these complaints and be able to identify their sources. As for prevention measures, social workers should be given alternative coping mechanisms, assisting recovery processes immediately after stressful incidences, rather than fostering ill-health through daily rumination. ...
The present study focuses on social stressors at work and the development of physical symptoms in social workers on a daily basis. In a seven-day diary study it was anticipated that daily rumination functions as a mediator, linked to additional daily physical symptoms in individuals. Before and after work, 81 social workers completed daily questions on social stressors, rumination, and physical symptoms. Multilevel analyses of up to 391 daily measurements revealed that more intense social stressors predicted more rumination, as well as physical symptoms. Rumination anteceded higher physical symptoms. A test of the indirect effects showed a significant indirect path from social stressors at work via rumination to physical symptoms. Hence, it was found that social stressors and rumination contribute to the ongoing health crisis in the social work profession. These findings advance our understanding of the stress mechanisms in social work, as well as point to individual and organizational aspects that occupational health prevention programs should consider.
... To better understand this relation is important because the costs associated with decreases in workers' well-being are very high when the resultant medical actions, sick leave compensation and loss of productivity are taken into account (Brosschot & Van Der Doef, 2006). Weiss and Cropanzano (1996) presented the affective events theory (AET) as a framework for studying affect and wellbeing at work. ...
... For example, Dudenhöffer and Dormann (2013) showed that customer mistreatment within a working day can accumulate and persist, and in turn influence employees' health symptoms, such as headaches, or stomachaches. Brosschot and Van Der Doef (2006) also demonstrated that worries resulting from agressive and unfriendly customer behaviors were related to somatic health complaints. It is utterly important to advance knowledge in this area, because the impact of exposure to customers misbehavior also affects organizations. ...
This study examined the indirect effect and moderators that may explain the link between unfriendly customer behaviors and workers’ psychological capital with a sample of 380 employees. We hypothesized that perceived health symptoms would have an indirect effect on the link between unfriendly customer behaviors and psychological capital. We also hypothesized a moderated mediation model, in which positive humor events would moderate the indirect effect. Results show that the negative association between unfriendly customer behaviors with psychological capital was due to an increased level of perceived health symptoms. Moreover, positive humor events moderated the link between unfriendly customer behaviors and perceived health symptoms, such that the link was stronger when the frequency of positive humor events was low to moderate. This study addresses a major gap in the positive psychology literature by attempting to examine why unfriendly customer behaviors relate to decreased psychological capital and what factors influence in this relation. Practical implications are further discussed.
... Worry is associated with various somatic complaints, including pain (Borkovec, 1994). Brosschot and van der Doef (2006) found worry to be associated prospectively with general somatic complaints (pain, dizziness, headache, etc.). ...
... Furthermore, a lack of research has examined links between worry and general somatic complaints (Brosschot & van der Doef, 2006), and assessed rumination and worry as potential mediators between neuroticism and somatic complaints. An assessment of indirect effects in this relationship is important for healthcare implications because worry and rumination represent cognitive processes that are to an extent malleable (Danielsson, Harvey, MacDonald, Jansson-Fröjmark, & Linton, 2013;Jacobs et al., 2016). ...
Background:
Neuroticism is associated with inflated somatic symptom reporting. Worry and rumination are a cognitive concomitant of neuroticism and potentially mediate the neuroticism-somatic complaint relationship.
Aims:
The present study examined the degree to which worry and rumination mediated the relationship between neuroticism and somatic complaints.
Method:
A sample of 170 volunteers, recruited via convenience sampling, took part. Participants completed a series of self-report measures: the Eysenck Personality Questionnaire Revised-Short Form, Penn State Worry Questionnaire, the Ruminative Response Scale and the Somatic Symptom Scale-8.
Results:
Analysis revealed significant positive correlations between neuroticism, rumination and worry. Neuroticism, rumination and worry also correlated positively with somatic complaints. Using structural equation modelling, a mediational model indicated that rumination fully mediated the relationship between neuroticism and somatic complaints.
Conclusions:
Findings are consistent with the symptom perception hypothesis and have implications for healthcare in terms of managing individuals who present with multiple somatic complaints. Future research would benefit from adopting a longitudinal approach to test how rumination interacts with neuroticism and somatic complaints over time.
... Striving to reduce stimulus generalization and uncontrollable worry, patients are asked to postpone their worry to a predefined worry period at the same time and location every day. This approach has shown promis ing results with effects particularly on worry duration in kids and psychology students (Borkovec et al., 1983;Brosschot & van der Doef, 2006;Jellesma et al., 2009;McGowan & Behar, 2013;Verkuil et al., 2011). However, in a study with GAD patients (Tallon, 2019), WP showed no effect on worry or metacognitions compared to control conditions. ...
Background
Pathological worry is associated with appraisals of worrying as uncontrollable. Worry postponement (WP) with a stimulus control rationale appears to be effective in non-clinical samples. However, preliminary research in participants with generalized anxiety disorder (GAD) does not support its efficacy in reducing negative metacognitions or worry. The aim of this study was to investigate the efficacy of WP with a metacognitive rationale.
Method
Participants with GAD (n = 47) or hypochondriasis (HYP; n = 35) were randomly assigned to either an intervention group (IG) or waitlist (WL). The IG received a two-session long WP intervention aiming at mainly reducing negative metacognitions concerning uncontrollability of worrying. Participants were instructed to postpone their worry process to a predetermined later time during the six days between the two sessions. Participants completed questionnaires of negative metacognitions and worry at pre-assessment, post-assessment, and follow-up.
Results
We observed a significant Time*Group interaction for negative metacognitions and worry. Post-hoc analyses on the total sample and separately for GAD and HYP revealed significantly lower worry scores in the treated GAD sample compared to the WL, representing the only significant effect. In the GAD group, pre-post-effect sizes were small for negative metacognitions and large for worry. Effects persisted to a four-week follow-up.
Conclusion
WP with a metacognitive rationale seems to be effective in reducing worry in participants with GAD. The effectiveness for HYP seems limited, possibly due to the small sample size.
... The existing literature has found that this concern is understood as an apprehensive expectation about real-life concerns such as health (Barlow, 2002), which plays a fundamental role at such a critical moment as a global health alert; it is the central characteristic of generalized anxiety disorder (GAD) (American Psychiatric Association, 2013) and is associated with psychopathology such as depressive rumination (Watkins et al., 2005) and obsessive-compulsive disorder (Goodwin et al., 2017). As a subjective trait without reaching clinical levels, excessive concern is associated with somatic health problems (Brosschot and van der Doef, 2006), contributing significantly to the severity of psychological responses to traumatic events and stressors (Spinhoven et al., 2015), and should be considered as a relevant variable for a clinical intervention designed to mitigate the psychological effects of the pandemic. ...
Background
The health crisis caused by the COVID-19 pandemic has led to a considerable increase in the psychopathology of COVID-19 patients and among the general population. This study aims to conduct the psychometric analysis of the scale of concern about COVID-19 in the Spanish population and to estimate the level of concern and dysfunctional anxiety present one year after the lockdown measures in Spain aimed at resisting the spread of the viral disease among the population.
Methods
The factorial structure of the instrument, its reliability for the general population and for COVID patients, and its construct validity have been analyzed, and measurements of dysfunctional concern have been obtained from a sample of 502 adults.
Results
The scale of concern about COVID-19 showed optimal results of reliability and validity for the Spanish population, confirming that it is an ideal instrument for estimating the concern regarding coronavirus contagion.
Limitations
This study used a cross-sectional design and thus, could not compare the changes in the incidence of anxiety symptoms before and after the COVID-19 outbreak. Furthermore, the use of mental health services prior to the COVID-19 restrictions was not assessed in this study, and therefore, no comparisons between the two time points could be made.
Conclusions
After a year of the confinement measures that was instilled to avoid further spread of the disease, the Spanish population presented levels of concern and anxiety that may require clinical attention, with a significant percentage of participants meeting the requirements to be diagnosed with generalized anxiety disorders.
... Stress increases the risk for various health issues (Andrews & Borkovec, 1988;Borkovec et al., 1983;Brosschot & Van Der Doef, 2006), and it also has negative effects on a person's overall well-being (Ganster & Rosen, 2013;Lazarus & Folkman, 1984). ...
The present study examined the relationships between emotional well‐being (positive and negative affect), sleep‐related variables (sleep quality, sleep duration, and change in sleep quality and duration compared to weeks before lockdown), and worrying about coronavirus disease (COVID‐19) challenges during the beginning of the outbreak in Europe. In addition, four different coping strategies were investigated. The study was conducted in Germany with data from 665 participants (53.8% female; 18–73 years), who completed an online questionnaire in April 2020. The results revealed that COVID‐19 worry was associated with impaired well‐being and sleep. Meaning‐ and problem‐focused coping were the most frequently used coping strategies, and showed positive associations with well‐being and sleep. Social and avoidance coping were associated with decreased well‐being and worse sleep outcomes. Three coping strategies showed moderating effects. People who worried more showed higher levels of positive affect when they used problem‐focused coping compared to those who did not. Similarly, highly worried participants showed lower levels of negative affect when they reported using meaning‐focused coping more often. In contrast, social coping increased the risk of high negative affect levels in worried participants. In conclusion, problem‐focused and meaning‐focused coping strategies seemed to be most effective in coping with COVID‐19 challenges.
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... Another recent meta-analysis, specifically seeking to examine mental health outcomes from psychotherapy for IBS, found small-to-medium effects for trait anxiety (Cohen's d = 0.37) and depression (d = 0.29;Laird, Tanner-Smith, Russell, Hollon, & Walker, 2017). Brosschot and Van Der Doef (2006) also found that a worry reduction intervention significantly reduced somatic complaints in a sample of high school students, especially in terms of neck and lower back pain. These syntheses of the literature are promising, showing that the effect of psychological interventions is not only realized in the psychological but also the physical domain. ...
Objective
Generalized anxiety disorder (GAD) is characterized, in part, by physical symptoms such as muscle tension and gastrointestinal (GI) distress. To date, little research has examined how changes in psychological symptoms associated with GAD may impact physical symptoms. This study investigated if reductions in worry, anxiety, and depression precede changes in muscle tension and GI distress throughout psychotherapy.
Methods
Participants with GAD (N = 85) completed 20 weeks of emotion regulation therapy (ERT) in addition to assessments pre, mid, and post treatment. They completed a physical symptom questionnaire, evaluating muscle tension and GI distress. Participants also completed psychological symptoms questionnaires, including the State Trait Anxiety Inventory (STAI-7), Penn State Worry Questionnaire (PSWQ), and Beck Depression Inventory (BDI-II). Control participants (N = 44) completed these measures at baseline.
Results
Participants with GAD had significantly greater muscle tension (p < .001) and GI distress (p < .001) compared to control participants without GAD. Reductions in worry, depression, and trait anxiety did not precede changes in muscle tension (range of effect size (r): .05 to .12). Reductions in both depression (p = .04) and trait anxiety (p < .01) preceded reductions in GI distress. Reductions in worry did not precede reductions in GI distress (p = .25).
Conclusion
These data provide preliminary evidence for the temporal effect of reductions in psychological symptoms on reductions in GI distress in GAD, highlighting the potential of psychotherapy to improve physical outcomes.
... First, strategies to self-regulate high physical fatigue and low vigor are physical relaxation techniques relaxation such as progressive muscle relaxation (PMR), biofeedback, systematic breathing, and stretching, as well as mental relaxation techniques such as meditation and mindfulness, autogenic training, and hypnosis (Kudlackova et al., 2013;Pelka et al., 2016). Second, strategies to self-regulate sport-related worry include expressive writing and worry postponement (Brosschot & Van Der Doef, 2006;Hudson & Day, 2012). Furthermore, achieving a state of both physical and mental relaxation could lead to a stop in perseverative cognitions, and may benefit an individual's ability to self-regulate one's own physical and mental state (Kellmann et al., 2018). ...
Mental detachment, which includes both cognitive and emotional detachment, refers to an athlete’s sense of being away from the cognitive and emotional demands of sport and is considered an important recovery experience for athletes. However, mental detachment appears to be impaired by high levels of physical fatigue following training or competition, suggesting that self-regulating post-performance cognitions and emotions may depend on available energetic resources. The purpose of this daily diary study was therefore to investigate whether daily sport-related rumination and worry can explain the relation between daily post-training physical fatigue and vigor on the one hand, and subsequent cognitive and emotional detachment on the other hand. Thirty-nine Dutch elite athletes completed a daily survey after training (T1) and at bedtime (T2) across 3–9 days. Multilevel structural equation modeling showed that daily physical fatigue was positively associated with sport-related rumination and worry during recovery, whereas daily vigor was negatively associated with sport-related worry during recovery. In turn, worry, but not rumination, was negatively associated with both cognitive detachment and emotional detachment. Results also revealed a significant indirect effect of worry between physical fatigue and cognitive detachment. These findings are in line with the view that recovery is a self-regulation process that may be dependent on available energetic resources. Moreover, this study underscores the practical importance of regulating postperformance physical fatigue, vigor, and sport-related worry to optimize the recovery process.
... With higher levels of perseverative thoughts being associated with poorer emotional well-being for most individuals in the sample, preventing these thoughts from occurring may constitute a beneficial intervention approach to disable the potential underlying mechanism that prolongs the detrimental effects of stressor anticipation. Hence, interventions keeping perseverative cognitions in check (or mindfulness interventions, e.g., Hilt & Pollak, 2012; such as worry reduction training, e.g., Borkovec, Wilkinson, Folensbee, & Lerman, 1983;Brosschot & van der Doef, 2006) might aid in ameliorating the potentially detrimental effects of stressor forecasting on subsequent affective well-being. Furthermore, these findings also underline the need for individualized or tailored interventions: For some persons anticipating a stressor was not as consistently linked to lower levels of perseverative cognitions indicating that the mediating mechanism proposed by the perseverative cognition hypothesis may not equally apply to all individuals. ...
Anticipatory stress can prospectively and negatively influence diverse outcomes, including cognitive performance and emotional well-being. It has been suggested that perseverative cognitions (e.g., worry, rumination) during the anticipation period constitute a key mechanism driving these effects. The present study investigated the temporal dynamics among stressor anticipation, perseverative cognitions and affective well-being. To accurately test the suggested mechanism, we focused on how these dynamics unfold within individuals over time. To that end, we analyzed data from an ecological momentary assessment study in an ethnically diverse sample (N = 243, 25-65 year olds, 68.7% Hispanic or non-Hispanic Black; 14 days, 5 measurement occasions per day) using dynamic structural equation modeling. Anticipating an upcoming stressor was linked to higher levels of perseverative cognitions approximately three hours later. At times when individuals reported higher levels of recent perseverative cognitions than typical for them, they also reported higher levels of negative affect and lower levels of positive affect. Mediational modeling indicated that perseverative cognitions accounted for the persistent effects of previous stressor anticipation on negative as well as positive affect several hours later. These findings suggest that perseverative cognitions may play an important role in explaining the detrimental effects of anticipatory stress on subsequent emotional well-being.
... Psychological therapies targeting RNT in the form of rumination focused cognitive behavioural therapy have been found to be beneficial in the treatment of depression and anxiety [30,33]. Brosschot and van der Doef [34] found that limiting RNT time reduced functional somatic symptoms such as lower back pain, coughing and breathing difficulties suggesting possible translatability for RNT focused therapy in functional disorders such as PNES. ...
Purpose
Previous research suggests that catastrophisation and perseverative, or repetitive negative thinking (RNT) could play an important role in the aetiology of Psychogenic Nonepileptic Seizures (PNES). This study was designed to explore whether these cognitive tendencies are more prevalent in patients with PNES than those with epilepsy and to examine the relationship between these cognitions, depression, anxiety, seizure frequency and diagnosis.
Methods
26 patients with PNES (PWPNES) and 29 with epilepsy (PWE) self-reported RNT (Perseverative Thinking Questionnaire), catastrophisation tendencies (modified Safety Behaviors and Catastrophizing Scale), symptoms of anxiety (Generalised Anxiety Disorder Assessment 7) and depression (Primary Health Questionnaire 9) as well as seizure frequency.
Results
RNT and catastrophic thinking were highly correlated with each other and more prevalent in PWPNES than PWE. Positive correlations were also found between all other self-report measures and seizure frequency. The PNES diagnosis predicted RNT (perseverative thinking) independently of catastrophic thinking, anxiety, depression and seizure frequency.
Conclusion
PWPNES exhibit greater negative perseverative and catastrophising cognitive tendencies than PWE. PNES as a diagnosis independently predicted RNT. Hence, RNT and catastrophisation should be considered as possible specific targets for psychological interventions in patients with PNES.
... Worry is the central feature of generalized anxiety disorder [10], but it is also frequently associated with depressive rumination [11] and with psychopathological conditions such as panic disorder and obsessive-compulsive disorder [12]. However, worry can also be understood as a non-clinical subjective trait [13], with high levels of trait worry being associated with negative health outcomes and somatic health complaints [14]. Furthermore, high trait worry relevantly contributes to severity of psychological responses to traumatic events and stressors [15]. ...
Background:
We tested whether the tendency to worry could affect psychological responses to quarantine by capitalizing on the opportunity of having collected data before the COVID-19 outbreak on measures of worry, anxiety, and trait mindfulness in a group of university students.
Methods:
Twenty-five participants completed self-report measures assessing worry (Penn State Worry Questionnaire, PSWQ), anxiety (Anxiety Sensitivity Index, ASI-3), and trait mindfulness (Mindful Attention Awareness Scale, MAAS) at T0 (pre-lockdown, 4 November 2019-17 February 2020) and T1 (at the end of lockdown, 26 April-30 April 2020). We compared assessments at the two time points in the whole sample and in high and low worriers (defined at T0 by scores on PSWQ respectively above and below 1.5 SD from mean of the Italian normative sample).
Outcomes:
High worriers showed at T1 a significant increase of anxiety sensitivity and fear of mental health in comparison to low worriers. Moreover, in the whole sample, at T1 trait mindfulness was inversely related to worry and fear of mental health.
Interpretation:
A valuable approach to support individuals experiencing anxiety related to the COVID-19 outbreak could be represented by mindfulness-based interventions improving the ability to focus attention and awareness on the present moment.
... Work-related rumination (hereafter, rumination) is characterized by repetitively thinking about work-related issues, particularly work stress, during off-job time (cf., Martin & Tesser, 1996). Thinking about negative work aspects prolongs negative activation in one's body and mind as work stressors remain more salient in employees' cognition and continue to confront them, thereby depleting their energetic and cognitive resources (cf., perseverative cognition model of stress; Brosschot & Van der Doef, 2006). The prolonged negative activation associated with job stressors makes it more difficult for employees to calm down and find restful sleep (Sonnentag, 2018). ...
This diary study investigated nurses’ recovery after transitioning to morning shift work (i.e., their short-term adaptation to shift work) by examining the change trajectory of sleep quality over the course of five consecutive morning shifts. Results of latent growth analyses ( N = 132) showed that nurses’ sleep quality started at low levels and increased rapidly in the beginning until it stabilized toward the end of the shift work period. Moreover, work-related rumination moderated the sleep quality trajectory. When rumination was low, nurses’ sleep quality showed a quadratic trajectory, whereas when rumination was high, sleep quality showed a flatter and linear trajectory, suggesting that rumination impedes recovery after the transition and adaptation to morning shift work.
... Rumination is giving attention to the symptoms/stressors, focusing on the possible reasons and outcomes of these symptoms / stressors. Previous studies indicated that rumination was related to several psychological problem such as depression (Lyubomirsky, Caldwall, & Nolen-Hoeksema, 1998;Thomsen, Mehlsen, Christensen & Zachariae, 2003), anxiety (Mellings & Alden, 2000), anger (Hogan & Linden, 2004), poor sleep quality (Thomsen et al., 2003), and somatic symptoms (Brosschot & Van Der Doef, 2006). ...
The aim of the present study was to investigate the validity and reliability of the Turkish version of Work-Related Rumination Scale (T-WRRS). The study was conducted sampling 582 white-collar workers from various fields. In order to determine the construct validity, confirmatory factor analysis was conducted. Additionally, Cronbach Alpha values as an indicator of internal consistency and item-total correlations were utilized for reliability analysis. The results yielded that the Turkish version of WRRS is a reliable scale with three-factor, and it can be used to measure work-related rumination among Turkish workers.
... In line with this reasoning, cross-sectional research showed that negatively valenced repetitive thoughts are associated with higher fatigue levels (Querstret & Cropley, 2012), and meta-analytic results showed that worry is associated with various physiological stress indicators (Ottaviani et al., 2016). For instance, daily worry duration was associated with lower heart rate variability (Brosschot, Van Dijk, & Thayer, 2007) as well as more somatic complaints (Brosschot & Van Der Doef, 2006). Taken together, we expect that employees feel more exhausted in the morning on days when they worried more about their next workday during the evening: ...
In this diary study, we focused on the anticipatory phase of the stress process. We investigated how work‐related worry and planning during the evening relate to next‐morning exhaustion and vigour, respectively. Moreover, we examined how afternoon workload anticipation is related to next‐morning exhaustion versus next‐morning vigour, depending on worry and planning in the evening. A sample of 112 employees took part in a daily diary study with three daily measurement occasions over two consecutive workweeks. Results of multilevel regression analyses showed that work‐related worry during the evening was positively related to next‐morning exhaustion. Moreover, worry interacted with workload anticipation in predicting next‐morning exhaustion: On days when worry was high, workload anticipation was positively related to next‐morning exhaustion. Work‐related planning was not related to next‐morning vigour and did not interact with workload anticipation in predicting next‐morning vigour. Our study suggests that work‐related worry is an important factor in the anticipatory phase of the stress process.
Practitioner points
On days when employees worry about their next workday during the evening, high workload may already be associated with employees’ well‐being even before employees are facing it.
Worry about one’s next workday is associated with lower well‐being in the next morning, while planning one’s next workday is not associated with next‐morning well‐being.
In anticipation of high workload, employees should refrain from worry about work during leisure time, for instance by engaging in absorbing leisure activities.
... Worry is often defined as negative thinking about future events that might occur (Brosschot & van der Doef, 2006). Worry, like rumination, is assessed in myriad ways (e.g., Likert-type measures, lists of worries; Arbel, Shapiro, Timmons, Moss, & Margolin, 2017;Zoccola et al., 2011). ...
This study examined how rumination and worry experienced within varying contexts of everyday life are associated with current‐moment and cross‐moment indicators of subjective well‐being. We also investigated if, in the context of social interaction, distracted communication uniquely predicts subjective well‐being and mediates the link between perseverative cognition and well‐being. Using experience sampling, we found that the effects of rumination and worry on subjective well‐being were social‐context dependent. Rumination experienced alone, relative to during interaction, was a stronger positive predictor of current and later‐in‐the‐day loneliness. In contrast, worry experienced alone, but not during interaction, negatively predicted later loneliness. Distracted communication accounted for unique variance in current affective well‐being and current and later loneliness, but its role as a mediator was uncertain.
... On average, our participants reported 25 min of PC per day. This is in the same range as reported by Brosschot and van der Doef (2006) and Verkuil et al. (2015) who found average PCs between 24 and 37 min per day in healthy individuals over 6-and 14-day periods, respectively. Furthermore, whereas we assessed general daytime PC as a state measure to predict sleep quality of the following night, van Laethem et al. (2015) assessed exclusively work-relevant PC as a trait measure to predict self-reported sleep quality over a 4-week period 13 months later in a sample of 877 employees. ...
Objective: Subjective health complaints (SHC) are frequent in musicians. These complaints may be particularly distressing in this population because they are performance relevant. This paper aims at testing a model positing that (a) perseverative cognition (PC) predicts sleep duration/quality, (b) sleep duration/quality predicts SHC and (c) mood is a mediator of these associations.
Design: Participants were 72 music students (mean age (SD): 22.7 (3.0) years), and the assessment period consisted of seven consecutive days, with a solo performance on the fifth day.
Main outcome measures: Self-reported total sleep time (TST) and sleep quality were assessed 30 min after wake-up, and objective TST/sleep quality were assessed with an actigraphy watch. PC and mood were measured five times a day. Daily SHC were assessed at 9 p.m.
Results: PC did not significantly predict sleep duration/quality. Self-reported and objective TST and sleep quality were all significantly associated with SHC. Mood played a mediating role in each of these relationships with the exception of objective sleep quality.
Conclusion: The tested model on the association among PC, sleep and SHC and the mediating role of mood received partial support, highlighting the importance of sleep and mood in the emergence of SHC among university music students.
... Moreover, some studies have found a nearly identical frequency and intensity of worry among patients with GAD and those with depression (Starcevic, 1995). Similarly, worry duration has been linked to the somatic symptoms of stress and anxiety, such that reducing the duration of worries may reduce such somatic symptoms (Brosschot and van der Doef, 2006). However, the duration of worry, specifically, has not been examined in relation to depression and suicidality. ...
Background: Pathological worry is defined as worry that is excessive, pervasive, and uncontrollable. Although pathological worry is related to depression, anxiety, and suicidal ideation, less is understood about what specific features of worry confer risk for these mental health conditions. The current study examined associations between four characteristics of worry—frequency, duration, controllability, and content—and self-reported symptoms of depression, anxiety, suicidal ideation, and lifetime suicide attempts. Methods: A sample of 548 community participants (53.6% female, 45.4% male, 0.5% transgender male, 0.2% transgender female, and 0.2% gender non-binary), aged 19–98 years (M = 36.54, SD = 12.33), was recruited via Amazon's MTurk and completed a battery of self-report questionnaires online. Results: Results indicated that controllability of worry was uniquely associated with depression, anxiety, and suicidal ideation above and beyond other characteristics of worry, demographic variables, negative affect, and future-oriented repetitive thinking. Lifetime suicide attempts were found non-significant to these mental health outcomes. Frequency of worry was also positively related to depression. Limitations: This study utilized a cross-sectional design with exclusive self-report measures. Conclusions: Overall, these findings suggest that controllability of one's thoughts may be a key transdiagnostic factor that confers risk for a variety of psychopathology-related concerns. Clinical relevance includes identifying potential risk factors for varying psychopathology. Future research should examine relationships between worry controllability and anxiety, depression, suicidal ideation, and attempts, within clinical samples and utilizing a variety of methodologies.
... One intervention on dealing with injustice has shown that writing down the thoughts and emotions associated with the injustice helps recovering quicker from it (Barclay and Skarlicki 2009). There is also one intervention that uses simple stop instructions in order to stop worrying about stressors during the day (Brosschot and Van Der Doef 2006). Moreover, Shepherd (2004) discussed his approach to teaching students about grief and recovery from business failure 2 . ...
In this paper, we build on the allostatic load model, developed in stress research, to explore the impact of entrepreneurs’ overall justice perceptions on emotional exhaustion and firm performance. Results revealed that the relationship between overall justice and emotional exhaustion was mediated by rumination about work. Further, building on recent work by Baron et al. (Journal of Management, 42(3), 742–768, 2016), which highlighted that company founders have more resources to deal with stress, we hypothesized that the relationship between rumination about work and emotional exhaustion was moderated by whether the entrepreneur was the founder of the venture or not. Results revealed that indeed founders appeared to be immune to the consequences of rumination about work elicited by injustice at work, while non-founders suffered from it. Moreover, emotional exhaustion was related to the monthly firm performance. Implications for research and practice are discussed.
... Given that presurgical worry is significantly predicted by trait anxiety, it is likely to be higher in individuals who have a dispositional tendency to worry in general (Maes et al., 2014). More generally, daily worry appears to be prospectively related to a broad set of somatic complaints, such as lower back pain, neck pain, coughing/bronchitis, breathing difficulties, and stomach pains (Brosschot & van der Doef, 2006;Verkuil et al., 2012). Finally, whereas the pathogenic effects of rumination can be partially explained by its capacity to trigger unhealthy or risky behaviors (such as substance use, unhealthy eating, and smoking), this does not appear to be true for worry (Clancy, Prestwich, Caperon, & O'Connor, 2016). ...
The move from the concept of homeostasis to that of allostasis has led reactivity stress research to widen the object of its investigation: From the brief physiological response that occurs when one is facing a stressor to what happens when one is anticipating or recover from a stressor. A paradigmatic example is represented by perseverative cognition, during which human beings react “as if” they were constantly facing a concrete stressor. The core idea behind this review is that the cognitive inflexibility that characterizes perseverative cognition is reflected in both our body (by increased autonomic nervous system rigidity assessed by heart rate variability; HRV) and our brain (by reduced prefrontal-amygdala functional connectivity). This is a review of studies conducted in different settings (laboratory, daily life), populations (healthy, major depression, generalized anxiety), location (USA, Europe), and age groups (children, adults) that consistently replicated the association between autonomic, subjective, and behavioral measures of cognitive inflexibility during perseverative cognition. Moreover, compelling neuroimaging data suggests that HRV reduction from pre- to post induction of perseverative cognition is associated with both structural and functional brain abnormalities reflecting impaired prefrontal inhibitory control over subcortical structures (e.g. diminished prefrontal-amygdala functional connectivity). The integration of neuroscience techniques with clinical autonomic research has advanced our understanding of the neurobiology of brain-heart interaction during perseverative cognition, potentially yielding to more effective treatment packages. This is clinically relevant if one considers that perseverative cognition is a pervasive transdiagnostic factor that carries prognostic risk for both psychological and somatic health.
... A few studies have suggested a link between perseverative cognition and health outcomes. Prospective studies have found that rumination and worry are related to somatic complaints (Brosschot & van der Doef, 2006) and self-reported physical health problems (Thomsen et al., 2004). Importantly, these physiological changes may be driven by the emotional upset that results from dwelling on negative emotional experiences (Gruber, Harvey, & Johnson, 2009;Kross, Ayduk, & Mischel, 2005). ...
The way we respond to life’s daily stressors has strong implications for our physical health. Researchers have documented the detrimental effects of initial emotional reactivity to daily stressors on future physical health outcomes but have yet to examine the effects of emotions that linger after a stressor occurs. The current study investigated how negative affect that lingers the day after a minor stressor occurs is associated with health-related outcomes. Participants (N = 1,155) in a community-based, nationwide study answered questions about daily stressors and affect across 8 consecutive days and about their physical health almost 10 years later. Multilevel models indicated that people experience heightened levels of negative affect the day after a stressor occurs. Furthermore, higher levels of lingering negative affect are associated with greater numbers of chronic conditions and worse functional limitations 10 years later. Findings suggest that affective recovery from daily stressors has unique importance for long-term physical health.
... The concern also may affect the performance of adolescents by creating mind preoccupation in them [25], leading to behavioral consequences such as poor social and scientific skills [26], [27], different physical and psychological consequences such as backache, neck pain, stomach ache [28], depression, anxiety [29], and even trigger of risky behaviors [14]. In Iran according to Shoja'ei-Zadeh and Rassafiani [30], the majority of depression is in students who are highly concerned about the success in Konkoor. ...
Background
The university entrance exam or Konkoor is a determining event for the Iranian adolescents and their families. It is considered as the most important opportunity for adolescents for creating their ideal futures. Hence, regarding the importance of this exam and its accompanying pressures during the critical and stressful adolescence period, this study describes adolescents’ perspective about what make them worried about the university entrance exam.
Methods
This study is based on responses of 500 high school female students to an open-ended question completed in their class. In total 482 adolescents wrote down their answers. Using quantitative content analysis, these statements were analyzed.
Results
The findings showed that three categories including “individual” category (87.90%) with three subcategories; Konkoor’s outcome, readiness for Konkoor, self-blame, and “family” category (7.12%) with three subcategories; consequences of failure, family expectations, family conflicts, and “religious- socioeconomic” category (4.98%) with three subcategories; religion, financial status, educational policies as the main adolescents concern sources about the university entrance exam.
Conclusion
Considering the high concerns of female adolescents about the university entrance exam and the pressures that they receive from their families, society, and even themselves, modifying the educational policies, applying some measures to promote knowledge, and gaining required skills to deal with different aspects of such concerns are necessary for adolescents and their parents.
... Mindfulness-based stress-reduction (MBSR;Kabat-Zinn, 2003) is a technique with positive effects on mental and physical health (Grossman, Niemann, Schmidt, & Walach, 2004).Klatt et al. (2008)implemented a short version of MBSR at the workplace and report effects on mindfulness, perceived stress, and several subjective sleep indicators. In an investigation by Brosschot and van derDoef (2006), a very simple intervention from cognitive behavioral therapy (postponement of worries to a daily worry period of 30 minutes) decreased worry duration as well as psychosomatic complaints in adolescents over the course of one week. Although the two constructs are distinct, worries and psychological detachment overlap to some extent (Sonnentag & Fritz, 2014). ...
Vacations offer opportunities for recovery from work-related stress. However, little is known about the impact of job stressors on recovery experiences during vacation, such as psychological detachment and relaxation. This study investigated detachment and relaxation to mediate the influence of job stressors prior to vacation on recovery during vacation. A total of 136 employees from various occupations completed a questionnaire on their ability to relax and mentally detach from work during a recent vacation. Participants rated perceived time pressure and social exclusion at work prior to their vacation as well as any psychosomatic health complaints or sleep problems during vacation. The results of bootstrap mediation analysis confirmed the mediating role of recovery experiences. The association between job stressors and sleep problems was fully mediated by detachment and relaxation, whereas the association between social exclusion and psychosomatic complaints was fully mediated by relaxation. Furthermore, relaxation partially mediated the association between time pressure and psychosomatic complaints. Not only should the ability of employees to relax and mentally detach be fostered, but job stressors should be reduced in order to allow employees to reach optimal recovery during vacation.
... We find the recent publication a satisfying reparation. Many studies have shown that excessive worrying can increase the risk of illness in the long term (Broadbent, Petrie, Alley, & Booth, 2003;Brosschot & van der Doef, 2006;Fortune et al., 2003;Gerin et al., 2012;Holman et al., 2008;Jellesma, Verkuil, & Brosschot, 2009;Radstaak, Geurts, Beckers, Brosschot, & Kompier, 2014;Tully, Cosh, & Baune, 2013;Van Laethem et al., 2015;Verhoeven et al., 2009;Verkuil et al., 2011;Verkuil, Brosschot, Gebhardt, & Korrelboom, 2015;Verkuil, Brosschot, Gebhardt, & Thayer, 2010;Verkuil, Brosschot, Meerman, & Thayer, 2012). ...
Stress, whether daily stress, work stress or traumatic stress, is unhealthy. This lecture covers three recent theoretical approaches in explaining the mechanisms underlying the influence of psychological stress on somatic health. It is argued that stress research should focus less on stressors themselves and put more emphasis on prolonged stress responses. Three mechanisms are identified that cause this unhealthy prolonged stress response: first, the partly-proven mechanism of perseverative cognition; second, the mechanism of unconscious stress, which is currently being explored; and third, the notion of the stress response being a default response that is inhibited only when safety is perceived. All three mechanisms are deeply rooted in millions of years of our evolution. Although the dangers of the past have virtually disappeared, many of us remain ever at the ready for events that never happen.
... Consequently, recovery can prevent an accumulation of stress and reduce the risk of health issues. Empirical studies support these theoretical considerations, suggesting that adequate recovery processes in leisure time lead to a more positive affective state, an increase in well-being, and a reduction in perceived work strain and need of recovery[31][32][33][34][35][36][37]. An essential recovery process is detachment, defined by Geurts and Sonnentag[26]as a basic recovery process not linked to a specific behavior but rather as a process of physically and psychologically distancing from work strains during leisure time. ...
Objectives:
Recovery processes in leisure time influence the effect of psychosocial work factors on health issues. However, this function of recovery has been neglected in research regarding the influence of work-related risk factors on low back pain (LBP) development. The aim of this prospective study was to examine the function of psychological detachment - a relevant recovery experience - concerning the influence of psychosocial work factors on LBP development. A moderating function of detachment for the interplay of work factors and LBP was assumed.
Material and methods:
Sixty pain-free administrative employees of German universities completed an online survey 3 times during a 6-month period. Generalized estimating equations were used to estimate risk-factors of LBP.
Results:
Analyses revealed an increased chance of LBP development for smokers and a decreasing chance when work resources were high. Detachment had no direct influence on LBP development, although it moderated the influence of work stressors and work resources on LBP. On the one hand, high detachment values seem to protect against an increased chance of LBP development when employees were confronted with high work stressors, while on the other hand high detachment values enhance the protective effect of high work resources.
Conclusions:
The results indicated a moderating role of detachment concerning the influence of psychosocial work factors on LBP development. Therefore, it is necessary to include recovery processes in future research regarding LBP development and consequently in LBP prevention concepts. Int J Occup Med Environ Health 2017;30(2):313-327.
... Worry may be associated with poorer cardiovascular health, as well as other somatic complaints and conditions Brosschot and van der Doef 2006;Pieper et al. 2007). In older adults, GAD has a higher prevalence among individuals with cardiovascular health problems, and higher levels of worry may be associated with a higher risk for incident coronary heart disease (Grenier et al. 2011a;Kubzansky et al. 1997). ...
... Nevertheless, future studies should evaluate the association between SCT and somatic complaints in more detail, in part by including measures that directly assess rumination and worry. Findings stemming from such studies may be especially informative because there is some evidence that worry reduction interventions may reduce somatic complaints in youth (Brosschot & van der Doef, 2006). ...
Objective: This study evaluated whether sluggish cognitive tempo (SCT) is separable from ADHD–inattention (IN) and uniquely associated with internalizing dimensions in preschool children in South Korea. Method: Mothers of 172 preschool children (ages 4-6 years; 52% girls) rated children’s SCT, ADHD-IN, ADHD–hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), aggression, emotional reactivity, anxiety/depression, somatic complaints, withdrawal, and sleep problems. Results: Eight of 10 SCT symptoms showed convergent and discriminant validity with ADHD-IN. ADHD-IN remained significantly positively associated with ADHD-HI, ODD, and aggressive behavior after controlling for SCT, whereas SCT was no longer positively associated with these externalizing behaviors after controlling for ADHD-IN. Both SCT and ADHD-IN were uniquely associated with greater emotionally reactivity, anxiety/depression, and withdrawal. Only SCT was uniquely associated with somatic complaints, and only ADHD-IN was uniquely associated with sleep problems. Conclusion: Findings replicate results with children and adolescents, thus expanding evidence for the validity of SCT in early development.
Introduction
Accumulating research suggests both eating disorders (EDs) and internalizing disorders (e.g., anxiety, depression) are associated with gastrointestinal disease (e.g., irritable bowel syndrome, inflammatory bowel disease). However, the mechanisms underlying comorbidity with gastrointestinal disease—and whether they may differ for eating and internalizing disorders—remain poorly understood. Addressing these gaps is a critical first step to refining etiologic models of comorbidity and identifying potential targets for intervention.
Method
Participants included female and male twins ages 18–65 from the population‐based MSU Twin Registry ( N = 5883). Lifetime history of EDs, internalizing disorders, and gastrointestinal disease was assessed via questionnaire. We first examined whether EDs and internalizing disorders were independently associated with gastrointestinal disease phenotypically. We then used trivariate Cholesky decomposition twin models to investigate whether EDs and internalizing disorders were related to gastrointestinal disease through overlapping or distinct genetic/environmental pathways.
Results
Eating (OR = 2.54, p = 0.009) and internalizing (OR = 2.14, p < 0.001) disorders were independently associated with gastrointestinal disease. Conclusions were unchanged after adjusting for important covariates (e.g., body mass index, age) and did not significantly differ across sex. Twin models suggested genetic influences shared by all three conditions explained their co‐occurrence, with 31% of the variance in EDs and 12% of the variance in gastrointestinal disease attributable to genetic influences shared with internalizing disorders.
Conclusion
Shared genetic mechanisms may contribute to comorbidity between EDs, internalizing disorders, and gastrointestinal disease. Identifying overlapping molecular pathways could potentially lead to novel interventions that simultaneously address all three conditions.
Employment quality is a social determinant of employee health. However, little is known about the psychological mechanisms underlying this relationship. In this study, we investigated whether work engagement and affective job insecurity mediated the relationship between three employment quality indicators: type of contract (0. temporary vs. 1. permanent), employment relationship (0. part-time vs. 1. full-time), and salary, on the one hand, and employee health complaints, on the other. We implemented a time-lagged design with three time points. Our sample was composed of 247 employees. The data analysis using Structural Equation Modelling methods showed statistically significant negative indirect effects of the job contract type and salary on employee health complaints via the two mediators investigated in the case of salary and via affective job insecurity in the case of job contract type. Our study contributes to understanding why some employment quality indicators are related to employee health complaints. It also highlights that promoting high quality employment arrangements is not only a way to create engaging and secure jobs, but also an avenue leading towards employees’ health.
Background:
This study tested a hypothesised model of the effects of adverse life events on the mental health of middle-aged and older adults living alone, as mediated by thought suppression and help-seeking behaviours, considering gender differences.
Methods:
A questionnaire survey was conducted on a sample of 1202 (622 men; 580 women) individuals from 247445 residents aged 50-79 in District A of Tokyo. The questionnaire items covered parameters on adverse life events, help-seeking behaviour, thought suppression, and mental health status.
Results:
Multiple group structural equation-modelling analysis revealed that the seriousness of adverse life events, help-seeking behaviours, and mental health scores were higher in women than in men. No significant gender differences were observed in thought suppression. The findings support all three proposed hypotheses: severe adverse life events will: (a) give rise to help-seeking behaviours, which will have a positive effect on mental health; (b) intensify thought suppression, which will harm mental health; and (c) inhibit help-seeking behaviour, especially in single middle-aged and older adult men.
Conclusion:
There is a need to develop interventional programs based on the theory of replacement thinking to encourage help-seeking behaviours in middle-aged and older adults.
This study examined the longitudinal relationship of anxiety, depression, and perseverative cognition with headache frequency, severity, and disability among non-clinical students in two waves. The interval between the two self-reported measurements was one month for Sample 1 (n = 426) and one week for Sample 2 (n = 92). The results showed that anxiety and repetitive negative thinking predicted the onset of migraine after one month. Depression was related to higher headache parameters after one month. Among probable migraine sufferers, repetitive negative thinking predicted higher headache impact after one month. Contrarily, metacognitions related to repetitive negative thinking indicated both positive and negative prospective relations to headache a month later, according to initial migraine status.
Objective
Generalized anxiety disorder (GAD) is a prevalent mental health disorder that often goes untreated. A core aspect of GAD is worry, which is associated with negative health outcomes, accentuating a need for simple treatments for worry. The present study leveraged pretreatment individual differences to predict personalized treatment response to a digital intervention.
Methods
Linear mixed-effect models were used to model changes in daytime and nighttime worry duration and frequency for 163 participants who completed a six-day worry postponement intervention. Ensemble-based machine learning regression and classification models were implemented to predict changes in worry across the intervention. Model feature importance was derived using SHapley Additive exPlanation (SHAP).
Results
Moderate predictive performance was obtained for predicting changes in daytime worry duration (test r² = 0.221, AUC = 0.77) and nighttime worry frequency (test r² = 0.164, AUC = 0.72), while poor predictive performance was obtained for nighttime worry duration and daytime worry frequency. Baseline levels of worry and subjective health complaints were most important in driving model predictions.
Limitations
A complete-case analysis was leveraged to analyze the present data, which was collected from participants that were Dutch and majority female.
Conclusions
This study suggests that treatment response to a digital intervention for GAD can be accurately predicted using baseline characteristics. Particularly, this worry postponement intervention may be most beneficial for individuals with high baseline worry but fewer subjective health complaints. The present findings highlight the complexities of and need for further research into daily worry dynamics and the personalizable utility of digital interventions.
Vacations offer opportunities for recovery from work-related stress. However, little is known about the impact of job stressors on recovery experiences during vacation, such as psychological detachment and relaxation. This study investigated detachment and relaxation to mediate the influence of job stressors prior to vacation on recovery during vacation. A total of 136 employees from various occupations completed a questionnaire on their ability to relax and mentally detach from work during a recent vacation. Participants rated perceived time pressure and social exclusion at work prior to their vacation as well as any psychosomatic health complaints or sleep problems during vacation. The results of bootstrap mediation analysis confirmed the mediating role of recovery experiences. The association between job stressors and sleep problems was fully mediated by detachment and relaxation, whereas the association between social exclusion and psychosomatic complaints was fully mediated by relaxation. Furthermore, relaxation partially mediated the association between time pressure and psychosomatic complaints. Not only should the ability of employees to relax and mentally detach be fostered, but job stressors should be reduced in order to allow employees to reach optimal recovery during vacation.
Objective:
Evidence suggests that perseverative cognition (PC), the cognitive representation of past stressful events (rumination) or feared future events (worry), mediates the relationship between stress and physical disease. However, the experimental evidence testing methods to influence PC and the subsequent relationship with health outcomes has not been synthesized. Therefore, the current review addressed these gaps.
Method:
Studies randomly assigning participants to treatment and control groups, measuring PC and a physical and/or behavioral health outcome after exposure to a nonpharmacological intervention, were included in a systematic review. Key terms were searched in Medline, PsycINFO and CINAHL databases. Of the screened studies (k = 10,703), 36 met the eligibility criteria.
Results:
Random-effects meta-analyses revealed the interventions, relative to comparison groups, on average produced medium-sized effects on rumination (g = -.58), small-to-medium sized effects on worry (g = -.41) and health behaviors (g = .31), and small-sized effects on physical health outcomes (g = .23). Effect sizes for PC were negatively associated with effect sizes for health behaviors. (following outlier removal). Effect sizes for PC were significantly larger when interventions were delivered by health care professionals than when delivered via all other methods. No specific intervention type (when directly compared against other types) was associated with larger effect sizes for PC.
Conclusions:
Psychological interventions can influence PC. Medium-sized (negative) effect sizes for PC correspond with small (but positive) health behavior effect sizes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Objectives:
This study investigated how COVID-19-related media exposure during the COVID-19 crisis was related to same-day and next-day COVID-19-related worries.
Design:
A 21-day diary study was conducted between late March and late April 2020 in Germany.
Main outcome measures:
Hypotheses were tested in a sample of 561 participants (Mage = 42.79, SDage = 6.12). Every evening, participants indicated their exposure to COVID-19-related media (e.g., TV, print, online) and their COVID-19-related worries.
Results:
Same-day analyses showed that participants reported more COVID-19-related worries on days with higher exposure to COVID-19-related media. Dynamical structural equation models provided evidence for a reciprocal cycle across days: Higher media exposure at one day predicted higher worries the next day, and higher worries at one day also predicted higher media exposure the next day. Individuals with high trait anxiety reported an enhanced general level of media exposure during the 21 days of assessment, and individuals high in neuroticism and anxiety reported an enhanced level of worries.
Conclusion:
These findings suggest a self-reinforcing cycle whereby consuming crisis-related media and worrying reciprocally influence each other across days, possibly amplifying adverse effects of the COVID-19 crisis and other crises alike on mental and physical health.
School stress can be significant for adolescents. Improving stress-related coping skills and stress management can be very helpful. In this chapter brief strategies for reducing school stress are addressed. Emotion-focused coping can be taught. The avoidance that students with anxiety may use to cope can be decreased with brief interventions. Some of the more traditional approaches to stress reduction may not work as well as more current approaches such as stress reappraisal and a stress-is-enhancing mindset. The data to support the more current approaches is discussed. In addition, a personality can change mindset works in the same way as intelligence can change mindsets. Exciting interventions such as values affirmation have been demonstrated to reduce the racial/ethnic achievement gap, but they can be tricky to implement. If educators keep the information in mind that allows values affirmation to work, they will find the interventions very valuable.
A growing body of literature has documented the negative outcomes
associated with worry. To extend this line of research, we examined why
some bereaved college students with the tendency to worry experience
intense grief by focusing on psychosomatic symptoms that follow a
wave of emotions episode. The results demonstrated that tonic
immobility is not only responsible for grief outcomes beyond
somatisation, but it also explains some of the bereaved worriers’ grief related pain and dysfunction. Clinical implications and limitations of
these results are discussed.
The transdiagnostic approach to psychopathologies was introduced as a solution to high comorbidity and weak differentiation of psychological disorders. Factor analytic studies have revealed a hierarchical structure with the highest single p-factor (i.e., psychopathology), which parallels the results in the personality studies of general factor of personality over the Big 5 dimensions. The etiology of the single super-factor is considered in the life history strategy in evolutionary psychology. Two strategies to clinically utilize the p-factor are discussed, as follows: (1) setting the p-factor as a predictor to probe the relevant mediators (i.e., endophenotype) of symptoms and (2) moving across the levels of hierarchy to enhance flexible responding. The final topic discussed is the cybernetic principle with goal hierarchy, which will enhance studies on personality, psychopathology, and well-being.
Our aim was to investigate the presence of experiential avoidance and rumination in children, and its potential connections to internalizing and externalizing symptoms. We hypothesized that emotion regulation deficits would relate to both internalizing and exernalizing problems.
Among anxious populations, attention has been demonstrated to be preferentially biased to threatening material compared to neutral or other valenced material. Individuals who have high levels of trait worry, such as those with Generalized Anxiety Disorder (GAD), may be biased to threat but research has produced equivocal findings. This review aimed to systematically review the extant experimental literature to establish the current evidence of attentional bias to threat among trait worriers compared to healthy controls and other clinical populations. Twenty-nine published articles were included in the final review. There was strong evidence of a bias to threat among GAD patients compared to other groups and this was found across most experimental paradigms. Few studies had investigated this bias in non-clinical trait worriers. Among GAD patients this bias to threat was most strongly evidenced when visual threat material was in a verbal-linguistic format (i.e., words) rather than when in pictorial form (i.e., images or faces). The bias was also found across several domains of negative material, supporting the general nature of worry. Further research should look to examine the specific components of the threat bias in GAD, as well as investigating the bias to threat in trait worriers.
Background: Subjectively reported health complaints account for approximately 50% of all long-term sickness compensation and permanent disability in Northern European countries. The prevalence of these complaints in the population at large was examined. Methods: Data from national surveys conducted in 1993 of 2,030 men and 2,016 women above 15 years of age in Denmark, Finland, Norway, and Sweden were analysed. Results: As many as 75% of our sample had at least some subjective health complaints for the previous 30 days. More than 50% had experienced tiredness, 42% headache, 37% worry, 35% low back pain and 33% pain in their arms or shoulders. The prevalence was higher in women than in men. In general, substantial muscle pain was more common in older subjects, but tiredness, headache, worry and depressive mood were more common in young subjects. Conclusion: The very high prevalence of these complaints in the general population should be taken into account whenever these complaints are reported to be due to any new environmental factor or disease.
This study examines physical symptoms related to worry in a nonclinical sample (N = 583). According to the Generalized Anxiety Disorder Questionnaire, physical symptoms for DSM-III-R GAD criteria were frequently experienced by nonclinical subjects who met cognitive criteria for GAD. Factor analysis, item endorsement rates, and concurrent validity of individual items identified eight symptoms that were frequently endorsed, had good concurrent validity, and were factorially separate from a panic-like factor. Seven of these items are retained for DSM-IV. Furthermore, these items form a brief scale that does not overlap with other well-established scales for measuring anxious symptoms. The reliability and convergent/divergent validity of the scale were satisfactory. In conclusion, this study indicates that nonclinical populations experience physical symptoms that are similar to those associated with GAD and that DSM-IV retains items that are frequently endorsed, distinguish worriers from nonworriers, and are factorially separate from a panic-like factor.
Research on worry during the past 15 years has revealed a remarkable amount of knowledge about this pervasive human phenomenon. Worry involves a predominance of verbal thought activity, functions as atype of cognitive avoidance, and inhibits emotional processing. Worry also produces not only anxious experience but depressive affect as well. Recent evidence suggests that the very private experience of worry is developmentally connected to enmeshed childhood relationships with the primary caregiver and is currently associated with significant interpersonal problems, especially those involving tendency to be overly nurturing to others. At the physiological level, worry is characterized peripherally by parasympathetic deficiency and autonomic rigidity and centrally by left-frontal activation.
The aim of this study was to assess whether Subjective Health Complaints (SHC), demands and coping are associated with health-related quality of life in a population of health care workers. One hundred and nineteen employees in two nursing homes for the elderly filled in a questionnaire on health, exercise, psychological factors, and work conditions. Main outcome measures were SHC and quality of life measured by SF-36. High level of SHC was associated to low health-related quality of life. Low coping and high demands were related to low scores (low quality of life), and high coping and low demands to high scores on mental health. Pseudoneurological complaints (e.g. tiredness, sadness), high demands and low coping were associated with low mental health. The expected negative association between SHC and health-related quality of life was found. There was a positive association between coping and quality of life.
review some of the empirically determined characteristics of worry / suggest theoretical perspectives that may account for the functions and origins of this ubiquitous process
nature of worry [conceptual and imaginal cognitive activity, affective experience of worry, attentional activity and memory retrieval, behavioral responding, physiological activity] / functions of worry [cognitive avoidance of threat, inhibition of emotional processing] / origins of chronic worry and [generalized anxiety disorder] GAD [history of trauma, insecure attachment in childhood] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Understanding generalized anxiety disorder (GAD) and developing interventions for its amelioration could contribute significantly to the understanding and treatment of all adult emotional disorders. GAD has a fairly high prevalence rate, is often associated with multiple additional Axis I diagnoses, and is a frequent comorbid condition for other anxiety and mood disorders. Moreover, worry is pervasive across all anxiety and depression problems. Learning about worry could teach us a considerable amount about human ways of being. We have been attempting to acquire basic knowledge about GAD and worry, and to develop effective forms of psychological intervention for over two decades. We have added several key components to traditional cognitive-behavioral therapy (CBT) approaches over the years, including teaching clients to focus on the present moment, to value tasks based on their intrinsic value rather than solely their eventual outcomes, and to deepen interpersonal and emotional contact with events. This chapter describes some of our specific interventions. We begin with general comments about the nature of human anxiety, which provide a context relevant to our development of GAD interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A modification of the Bonferroni procedure for testing multiple hypotheses is presented. The method, based on the ordered p-values of the individual tests, is less conservative than the classical Bonferroni procedure but is still simple to apply. A simulation study shows that the probability of a type I error of the procedure does not exceed the nominal significance level, α, for a variety of multivariate normal and multivariate gamma test statistics. For independent tests the procedure has type I error probability equal to α. The method appears particularly advantageous over the classical Bonferroni procedure when several highly-correlated test statistics are involved.
This study investigated the relationship between emotional rumination and cortisol secretion during stress. Subjects were 51 student nurses undergoing a written examination as part of their training and urinary-free cortisol was assayed from samples taken immediately after the examination and again three weeks later. Cortisol difference scores were obtained, expressed as a function of creatinine, assayed simultaneously, and baseline cortisol levels. Subjects completed the Eysenck Personality Inventory (EPI) and the Emotion Control Questionnaire (ECQ) and results showed that cortisol differences were associated with the rehearsal (or rumination) scale from the ECQ and to a lesser extent ECQ emotional inhibition and EPI neuroticism.
We examine the growing number of studies of survey respondents' global self-ratings of health as predictors of mortality in longitudinal studies of representative community samples. Twenty-seven studies in U.S. and international journals show impressively consistent findings. Global self-rated health is an independent predictor of mortality in nearly all of the studies, despite the inclusion of numerous specific health status indicators and other relevant covariates known to predict mortality. We summarize and review these studies, consider various interpretations which could account for the association, and suggest several approaches to the next stage of research in this field.
Stressful experiences may influence neuroendocrine, immune and cytokine functioning, as well as physical and psychological well being. The present prospective investigation assessed physiological and behavioral variations in anticipation of a critical oral academic examination among graduate students (i.e. related to a dissertation or comprehensive defense). Relative to matched control subjects, plasma cortisol levels were elevated among graduate students, especially females, 1 h prior to the oral examination, but not 6-8 weeks earlier (at about the time of the submission of the written document). In contrast, mitogen-stimulated (Con-A) lymphocyte proliferation was only reduced 6-8 weeks before the examination. Neither adrenocorticotrophic hormone (ACTH), prolactin, serum interleukin-1beta (IL-1beta) nor mitogen stimulated IL-1beta production was influenced at any time. Although, graduate students did not differ from controls with respect to perceived stress and feelings of mastery, they reported more frequent malaise (e.g. headaches, sore throat, fatigue) than did controls. The present findings suggest that during the course of lengthy anticipatory periods preceding a scheduled stressor, different stress-sensitive, situation-dependent biological processes may be engendered. It is further suggested that cortisol release is most closely aligned with immediate threats, while the immune alterations are sensitive to more distal events, or are subject to adaptation in response to a protracted stressor.
The aim of this study is to present a complete scoring system for subjective health complaints (SHC) as they are experienced by the lay population. The scoring system records the complaints, and does not map attributions or medical diagnoses. In all, 1,219 subjects (323 men, 896 women) from various occupations were tested with a scoring system, the SHC inventory, previously referred to as the Ursin Health Inventory (UHI). The SHC consists of 29 questions concerning severity and duration of subjective somatic and psychological complaints. The SHC inventory yields scores on single items and a total number of health complaints categorized into five factors: musculoskeletal pain (alpha=0.74), pseudoneurology (alpha=0.73), gastrointestinal problems (alpha=0.62), allergy (alpha=0.58) and flu (alpha=0.67). The SHC inventory is a systematic, easy, and reliable way to score subjective health complaints. The prevalence of these complaints is high, and should be considered before conclusions are reached about new diseases and new attributions of environmental hazards.
The purpose of this work was to study the prevalence and dimensionality of subjective health complaints in a cross-national population of adolescents.
The analyses were based on data from a WHO cross-national survey, Health Behaviour in School-aged Children (HBSC). The study included a representative sample of 11, 13 and 15-year-old adolescents from Finland, Norway, Poland and Scotland. Data were collected in 1993-1994 and the total sample included 20,324 adolescents. Subjective health complaints were measured by the HBSC Symptom Checklist (HBSC-SCL), including headaches, abdominal pain, backache, feeling low, irritability, nervousness, sleeping difficulties and dizziness. Descriptive analyses, MANOVA and structural equation modelling (EQS) were conducted.
Patterns of reporting were consistent for all four countries. A large number of students reported a high level of symptoms. The reporting of most symptoms increased with age. Girls reported significantly more symptoms than boys and the gender differences also increased with age. Structural equation modelling suggests a model of two correlated factors, which can be labelled psychological and somatic.
The findings of this study indicate that students report a high level of subjective health complaints already at the age of 11 years. The reporting of most symptoms increases with age and more so for girls than for boys. The finding of two dimensions that differ qualitatively, suggests that these dimensions may have different etiologies.
Sensitization is conceptually related to cognitive bias in experimental psychopathology, and they share the basic mechanism of neuronal sensitization. Every strongly relevant individual concern, like fears, can yield cognitive bias or "cognitive-emotional sensitization". It might also be present for bodily and environmental information related to illness, and could be an etiological factor in medically unexplained complaints. Physiological and cognitive sensitization are theoretically compared. There is evidence for cognitive-emotional sensitization in some medically unexplained somatic complaints, and negative affect is suggested as a catalyst. Prolonged cognitive-emotional sensitization ("perseverative negative cognition" or worry, rumination) might even have demonstrable somatic pathological effects. It is concluded that sensitization may be organized at different levels, both in the organism and in the larger living system within which the organism is subsumed. This view might not only help to clarify medically unexplained pain syndromes, but virtually every subjective complaint, both with and without recognized physiopathology.
Low back pain (LBP) in schoolchildren with no apparent clinical cause is known to be a common problem, but considerably less is understood regarding the aetiology of such pain. Aim: To assess the role of both mechanical and psychosocial factors (including emotional and behavioural problems and other somatic pain complaints) in childhood LBP.
A cross sectional study was carried out in a population of 1446 schoolchildren aged 11-14 years. Information on these potential risk factors for LBP was sought using a self complete questionnaire and a five day bag weight diary.
Mechanical factors such as physical activity and school bag weight were not associated with LBP. However, strong associations with LBP were observed for emotional problems, conduct problems, troublesome headaches, abdominal pain, sore throats, and daytime tiredness.
Results suggest that psychosocial factors rather than mechanical factors are more important in LBP occurring in young populations and could possibly be a reflection of distress in schoolchildren.
To examine gender, age, and country variations in adolescents' self-reported medicine use.
Cross-sectional school surveys of representative samples of 11- to 15-year-old girls and boys were used. The 1997/1998 Health Behaviour in School-aged Children study was referenced. A standardized questionnaire was completed during school hours.
Canada, US, Greenland, Israel, and 24 European countries.
123 227 participants equally distributed by gender and by 3 age groups (mean 11.7, 13.6, 15.6 y).
Self-reported medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness during the past month.
The magnitude of the adolescents' medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness varied substantially across countries. In each of the 28 countries, more girls than boys used medicine for pain. Use of medicine for headache increased by age; use of medicine for stomachache increased by age among girls, but decreased among boys; and use of medicine for difficulties in getting to sleep and nervousness decreased from the age of 11 to 15 years. There was an increase in the crude girl versus boy ratios for medicine use by age for all 4 symptoms. Multivariate logistic regression analyses, adjusting for age group and country, revealed the following odds ratios (95% CI) for girls' versus boys' medicine use: headache 1.56 (1.53 to 1.60), stomachache 2.16 (2.10 to 2.22), difficulties in getting to sleep 0.96 (0.91 to 1.00), and nervousness 1.04 (0.99 to 1.08).
Substantial proportions of adolescents used medicine for common health problems. The prevalence of use differed between type of symptom for which the medicine was used, between countries, and between gender and age groups. We suggest that young people's medicine use should be addressed in public health policy.
The aim of the study was to determine if heart rate (HR) and skin conductance increase as a result of worrying and if the increase is greater in worriers than in non-worriers. Ten self-labelled worriers and 10 self-labelled non-worriers were individually interviewed, and a worrying event and a pleasant event were determined for each. The HR and skin resistance were then measured for all subjects when they were calm and quiet, when they imagined a worrying event, and when they imagined a pleasant event. There was no difference in the HR and skin conductance of worriers and non-worriers across the three conditions, namely, baseline, imagination of a worrying event and imagination of a pleasant event. Heart rate increased only as a result of worrying whereas the skin conductance increased both due to worrying and due to the imagination of the pleasant event. The results suggest that HR may be used as a measure of worrying.
Background: Subjectively reported health complaints account for approximately 50% of all long-term sickness compensation and permanent disability in Northern European countries. The prevalence of these complaints in the population at large was examined. Methods: Data from national surveys conducted in 1993 of 2,030 men and 2,016 women above 15 years of age in Denmark, Finland, Norway, and Sweden were analysed. Results: As many as 75% of our sample had at least some subjective health complaints for the previous 30 days. More than 50% had experienced tiredness, 42% headache, 37% worry, 35% low back pain and 33% pain in their arms or shoulders. The prevalence was higher in women than in men. In general, substantial muscle pain was more common in older subjects, but tiredness, headache, worry and depressive mood were more common in young subjects. Conclusion: The very high prevalence of these complaints in the general population should be taken into account whenever these complaints are reported to be due to any new environmental factor or disease.
Objective: There is now greater public concern about how features of modern life pose threats to personal health. In two studies, we investigated the relationship between individuals' worries about modernity affecting health to symptom reports, perceptions of health and health care utilization. Methods: In the first study, 526 University students completed a questionnaire measuring modern health worries (MHW), symptom reports and health perceptions. A second study utilized an existing national survey database of 7869 New Zealanders. Part of the survey examined people's concerns of modernity affecting their health in the past 12 months, as well as the use of conventional medical and alternative health care. Results: We found concerns about modernity affecting health were made up of four major components: environmental pollution, toxic interventions, tainted food and radiation. MHW were significantly associated with somatic complaints and ratings of the importance of health to the individual. We also found individuals with high levels of MHW had a higher rate of food intolerance and chronic fatigue syndrome (CFS). In the second study, we found MHW to be associated with medical care utilization, particularly of alternative health practitioners. Conclusions: The results of these studies suggest concerns about modernity do cause changes in the way individuals interpret somatic information and may play a role in undermining perceptions of health. The area of MHW is worthy of study and may hold importance for understanding aspects of functional disorders.
The experience and function of worry is described in considerable detail, and its aetiology and maintenance are explained from a broad range of theoretical perspectives. Because it includes self-report measures together with the most recent normative data and information on their psychometric properties, this book will not only be of considerable value to researchers but will also be essential reading for practising clinicians. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The tendency to "catastrophize" during painful stimulation contributes to more intense pain experience and increased emotional distress. Catastrophizing has been broadly conceived as an exaggerated negative "mental set" brought to bear during painful experiences. Although findings have been consistent in showing a relation between catastrophizing and pain, research in this area has proceeded in the relative absence of a guiding theoretical framework. This article reviews the literature on the relation between catastrophizing and pain and examines the relative strengths and limitations of different theoretical models that could be advanced to account for the pattern of available findings. The article evaluates the explanatory power of a schema activation model, an appraisal model, an attention model, and a communal coping model of pain perception. It is suggested that catastrophizing might best be viewed from the perspective of hierarchical levels of analysis, where social factors and social goals may play a role in the development and maintenance of catastrophizing, whereas appraisal-related processes may point to the mechanisms that link catastrophizing to pain experience. Directions for future research are suggested.
In this study the psychometric properties of the PSWQ and the WDQ were investigated in a community sample. The PSWQ proved to be unidimensional although the results indicated that the negatively keyed items contributed less to the general factor. Internal reliability of the PSWQ was satisfactory. Confirmatory analysis of the WDQ indicated that some alternations with regard to the content of the different domains had to be made. Furthermore, an additional health worry domain was included in the scale. This resulted in a revised revision of the WDQ. Internal reliability of the WDQ-R was satisfactory, as well as consistencies of the different domains, with the exception of the Work Incompetence domain. High to moderate correlations were found between the two worry scales and measures of trait anxiety, depression and obsessive compulsive behaviour. In studying the relative impact of these constructs on worry it was found that the predictors accounted for 62 and 61% of the variance in the PSWQ and the WDQ-R respectively, providing further evidence for the separate construct of worry. Copyright © 1999 John Wiley & Sons, Ltd.
Potential Physiological Mechanisms Underlying Depressive RuminationMethods for Detecting Physiological Manifestations of RuminationNeuroimaging of Relationships Between Brain Activity and RuminationPeripheral Physiological Detection of RuminationCautions on Interpretation of Physiological MeasuresSome Implications for TreatmentFuture DirectionsSummary—tying Rumination and Sustained Processing TogetherReferences
Worry, the cognitive enumeration and anticipation of potential future negative events, is associated with autonomic dysregulation, which may in turn have implications for the immune system. People endorsing high (n = 7) and normal levels of trait worry (n = 8) were briefly exposed to a phobic stimulus and the autonomic and immune responses and recovery were assessed. A time-matched control group (n = 6) was not exposed to any stimulus. Both worry groups showed increased heart rate and skin conductance in response to phobic fear. However, only the normal worry group showed a concomitant increase in natural killer cells in peripheral blood. Patterns of change during the follow-up period suggested that phobic fear had disrupted a normal circadian increase in natural killer cells. Adrenergic and hypothalamus–pituitary–adrenal mechanisms may be responsible for the differences between high and normal worry groups in their natural killer cell response to and recovery from phobic fear.
With the advent of DSM-III-R, the diagnostic criteria for generalized anxiety disorder (GAD) shifted in emphasis from the autonomic arousal to the cognitive component of the disorder, namely worry. The Penn State Worry Questionnaire was developed to assess the trait of worry and has proven to be a reliable and valid measure in a series of studies largely based on college student samples. The purpose of the present study was to assess the psychometric properties and utility of the PSWQ in a clinical sample of 436 anxiety disorder patients and 32 normal controls. Factor analysis indicated that the PSWQ assesses a unidimensional construct. Furthermore, the PSWQ evidenced quite favorable internal consistency using GAD patients and each of the other anxiety disorder groups and normal controls. The validity of the PSWQ was supported by an analysis indicating that the measure distinguished. GADs from each of the other anxiety disorder groups including those with obsessive-compulsive disorder. Moreover, correlations between the PSWQ and measures of anxiety, depression, and emotional control supported the convergent and discriminant validity of the measure. Collectively, the findings speak favorably to the use of the PSWQ in research examining the nature and treatment of GAD and the processes of normal and pathological worry.
The present report describes the development of the Penn State Worry Questionnaire to measure the trait of worry. The 16-item instrument emerged from factor analysis of a large number of items and was found to possess high internal consistency and good test-retest reliability. The questionnaire correlates predictably with several psychological measures reasonably related to worry, and does not correlate with other measures more remote to the construct. Responses to the questionnaire are not influenced by social desirability. The measure was found to significantly discriminate college samples (a) who met all, some, or none of the DSM-III-R diagnostic criteria for generalized anxiety disorder and (b) who met criteria for GAD vs posttraumatic stress disorder. Among 34 GAD-diagnosed clinical subjects, the worry questionnaire was found not to correlate with other measures of anxiety or depression, indicating that it is tapping an independent construct with severely anxious individuals, and coping desensitization plus cognitive therapy was found to produce significantly greater reductions in the measure than did a nondirective therapy condition.
To study the prevalence of dyspepsia in the community a postal questionnaire was sent to 2697 patients who were selected at random from the lists of patients registered in two health centres in Hampshire. A total of 2066 returned questionnaires were suitable for analysis (response rate 77%). It was found that the six month prevalence of dyspepsia was 38%. There was considerable overlap between symptoms of heartburn and upper abdominal pain, with over half of patients with dyspepsia experiencing both. One in four of these patients had consulted their general practitioner during that time. The proportion of patients with dyspepsia who consulted their general practitioner varied widely among the eight doctors who participated in the study, from 17% to 45%. Frequency of symptoms tended to fall with age, particularly in men, while the proportion of patients with dyspepsia who sought medical advice increased with age. Almost one in five of the 2066 patients had been investigated with radiology or endoscopy at some time, and 143 (7%) of them claimed to have had a diagnosis of peptic ulcer.
Many symptoms in outpatient practice are poorly understood. To determine the incidence, diagnostic findings, and outcome of 14 common symptoms, we reviewed the records of 1,000 patients followed by house staff in an internal medicine clinic over a three-year period. The following data were abstracted for each symptom: patient characteristics, symptom duration, evaluation, suspected etiology of the symptom, treatment prescribed, and outcome of the symptom. Cost estimates for diagnostic evaluation were calculated by means of the schedule of prevailing rates for Texas employed by the Civilian Health and Medical Program of the Uniformed Services for physician reimbursement.
A total of 567 new complaints of chest pain, fatigue, dizziness, headache, edema, back pain, dyspnea, insomnia, abdominal pain, numbness, impotence, weight loss, cough, and constipation were noted, with 38 percent of the patients reporting at least one symptom. Although diagnostic testing was performed in more than two thirds of the cases, an organic etiology was demonstrated in only 16 percent. The cost of discovering an organic diagnosis was high, particularly for certain symptoms, such as headache (7,263). Treatment was provided for only 55 percent of the symptoms and was often ineffective. Where outcome was documented, 164 (53 percent) of 307 symptoms improved. Three favorable prognostic factors were an organic etiology (p = 0.006), a symptom duration of less than four months (p = 0.009), and a history of two or fewer symptoms (p = 0.001).
The classification, evaluation, and management of common symptoms need to be refined. Diagnostic strategies emphasizing organic causes may be inadequate.
The endocrine, genital, and cognitive--affective responses of sexually functional men were compared under sexually arousing and non-arousing conditions. Sexually aroused subjects showed significantly higher serum luteinizing hormone concentrations than non-aroused subjects. Testosterone concentration was correlated with higher levels of penile response, but it did not prime further sexual arousal. Cortisol and prolactin concentrations decreased in both groups, more in the non-aroused group, and appeared to both inhibit and facilitate sexual response, depending on the level of anxiety reported by the subjects. Cortisol was correlated with self-reported worry, and testosterone with relaxation. These results support a multidimensional approach to the endocrine study of sexual arousal that includes both cognitive and genital response components.
As an internal, self-generated event, worrisome cognitive activity can occur under a wide variety of environmental conditions. The contiguity of the activity and diverse cues would suggest that poor discriminative control is established, and, conversely, that subject-initiated restriction of the temporal and environmental cues for the occurrence of the activity may reduce its frequency during the day. Two experiments are reported wherein self-labeled worriers received either no-treatment or a 4-week trial of stimulus control instructions designed to effect such a restriction. Daily worry reports were found to decline significantly among treated subjects relative to controls.
The present paper reports two questionnaire studies and an experimental investigation of worrying. Worry correlated more highly than general tension reports with a variety of affect scales and was characterized by: (a) feelings of anxiety, tension and apprehension; (b) moderate awareness of somatic cues including muscle tension and upset stomach; and (c) concerns over future rather than past or present situations. Self-labeled worriers were most distinguished from non-worriers by their reported uncontrollability of cognitive intrusions once worrying was initiated. In the experimental study, worriers and non-worriers were assessed for their ability to focus their attention on a monotonous (breathing) stimulus before and after 0, 15 or 30 min of worrying. Worriers reported significantly higher anxiety. depression and hostility, a lower frequency of focused attention and a greater frequency of negative thought intrusions than did non-worriers prior to the worry period. For both worriers and non-worriers. 15 min of worry resulted in an apparent incubation of negative cognitive intrusions on the subsequent attention-focusing task.
To review the empirical literature on somatization in the pediatric age group, emphasizing prevalence, influence on health care utilization, issues in the development of somatization, comorbidity with other psychiatric disorders, assessment, and treatment.
One hundred nineteen studies and reports addressing medically unexplained somatic symptoms in children and adolescents were compiled via MEDLINE search and extensive cross-referencing. All available controlled studies were included, as were selected case reports and collections of cases. Selected citations from the adult literature were chosen for relevance to pediatric somatization.
Recurrent, medically unexplained physical symptoms are common in the pediatric age group, are often associated with other psychiatric symptoms, and may represent a common presentation of psychiatric disorder in the primary care setting. DSM-III-R-defined somatization disorder is rare, and pseudoneurological symptoms are unusual. Patients may be at risk for potentially dangerous, costly, and unnecessary medical investigations and treatments, and they may excessively utilize health care services.
Our current understanding of pediatric somatization and its consequences is limited. Collaboration between mental health professionals and primary health care providers is essential. Consistent terminology, developmentally appropriate classification, and systematic future research will be necessary for the development of successful prevention and treatment strategies.
This study investigated the effects of self-reported life stress and locus of control on reactivity of several immune parameters to a mild and short-lasting interpersonal stressor. Subjects were 86 male teachers aged 24 to 55 years. Immune reactivity was defined as changes in numbers of monocytes. T-lymphocytes and subsets, HLA-DR+ cells, and NK cells as well as changes in (in vitro) proliferative responses of peripheral blood lymphocytes to the antigens PHA and PWM. Multiple regression analysis was used to study the interaction effects of life stress and locus of control by experimental condition on immune reactivity. Life stress, but not locus of control, influences reactivity of the immunological parameters to the stressor. In particular, high numbers of daily hassles were associated with stressor-induced decreases in numbers of T cells and NK cells in peripheral blood. On the other hand, numbers of HLA-DR+ cells in high life stress scorers decreased only slightly during the stressor, whereas they increased in the control condition. The findings suggest that accumulated life stress is related to reactivity of immunological parameters to subsequent experimental stress. Possible physiological explanations and implications of these effects are discussed.
The value of self-rated health in predicting mortality and the incidence of chronic diseases was studied in a cohort of 783 elderly Dutch men in the Zutphen Study. In 1985, 48% of the men felt "healthy," while 12% felt "moderately healthy" or "not healthy." As of 1990, 23% of the 783 men had died. Survival analysis showed that self-rated health was highly predictive of subsequent 5-year mortality from all causes (p < 0.001). When adjusted for the presence of major chronic diseases, age, medication use, smoking, alcohol consumption, physical activity, body mass index, systolic blood pressure, serum cholesterol, education, marital status, and family history of chronic diseases, the relative risk for "moderately healthy" or "not healthy" men compared with "healthy" men was 2.7 (95% confidence interval (CI) 1.8-4.3). Analysis of cause-specific mortality revealed that self-rated health was associated with cardiovascular mortality (crude relative risk (RR) = 2.7), but this finding resulted mainly from confounding by baseline prevalence of cardiovascular diseases (adjusted RR = 1.9, 95% CI 0.9-3.8). However, self-rated health was an independent risk factor for cancer mortality (adjusted RR = 4.2, 95% CI 1.9-9.4) and mortality due to other causes (adjusted RR = 3.0, 95% CI 1.2-7.8). Self-rated health did not independently predict the incidence of chronic diseases. This suggests that self-rated health especially affects fatality from chronic diseases rather than their onset, and this issue should be pursued further.
A secondary school population of 805 11-16-year-olds reported lifetime prevalence of 31 physical symptoms and illness attitudes. Girls had a median of six symptoms (range 0-22) and boys five (range 0-22); 67 (8.3%) had 13 or more. Older girls reported more symptoms than younger ones. The excess of symptoms in older girls was related to reporting painful periods rather than simply to age or the menarche. High symptom scorers of both sexes had significantly higher scores on seven Illness Attitude Sub-Scales (Kellner, 1987), with more distress about illness and more treatment experience. The implications of these findings are discussed.
Worry is an important component of anxiety, which recent work suggests is related to increased incidence of coronary heart disease (CHD). Chronic worry has also been associated with decreased heart rate variability. We hypothesized that high levels of worry may increase CHD risk.
We examined prospectively the relationship of worry with CHD incidence in the Normative Aging Study, an ongoing cohort of older men. In 1975, 1759 men free of diagnosed CHD completed a Worries Scale, indicating the extent to which they worried about each of five worry domains: social conditions, health, financial, self-definition, and aging. During 20 years of follow-up, 323 cases of incident CHD occurred: 113 cases of nonfatal myocardial infarction (MI); 86 cases of fatal CHD; and 124 cases of angina pectoris. Worry about social conditions was the domain most strongly associated with incident CHD. Compared with men reporting the lowest levels of social conditions worry, men reporting the highest levels had multivariate adjusted relative risks of 2.41 (95% CI, 1.40 to 4.13) for nonfatal MI and 1.48 (95% CI, 0.99 to 2.20) for total CHD (nonfatal MI and fatal CHD). A dose-response relation was found between level of worry and both nonfatal MI (P for trend, .002) and total CHD (P for trend, .04).
These results suggest that high levels of worry in specific domains may increase the risk of CHD in older men.
Although stressor uncontrollability has been shown to suppress immune responses in animals and for human subjects, the results have been inconsistent. We reanalyzed results of our previous study regarding stress-related immune deviation in man, to establish whether perceived uncontrollability of an acute stressor acts as a co-determinant in the observed changes in immunological parameters.
Three types of cognitive reactions to an acute interpersonal stressor were assessed: "motivation," "uncontrollability," and "guiltiness." Stress-induced changes in the number of several types of immune cells in peripheral blood and proliferative responses of lymphocytes to antigens and mitogens were assessed.
In comparison with control subjects and with subjects perceiving high control over the experimental stress situation, the subject perceiving low control showed a stressor-induced decrease in the number of T helper cells. Reversely, subjects perceiving high control showed an increase in the number of B cells as opposed to the other two groups. The effects of perceived uncontrollability could not be accounted for by mood changes, but they were related to previously experienced life stress.
Perceived uncontrollability of an acute stressor can have immuno-modulating effects over and above those of the stressor per se.
To examine the associations of somatic complaints with DSM-III-R-defined depression, anxiety disorders, conduct disorder, oppositional defiant disorder, and attention-deficit hyperactivity disorder in a population-based sample of children and adolescents.
Data from 4 annual waves of interviews with 9- to 16-year-olds from the Great Smoky Mountains Study were analyzed.
Overall, somatic complaints were strongly associated with emotional disorders in girls and with disruptive behavior disorders in boys. For girls, stomach aches and headaches together and musculoskeletal pains alone were associated with anxiety disorders. For boys, stomach aches were associated with oppositional defiant disorder and attention-deficit hyperactivity disorder. Musculoskeletal pains were associated with depression in both girls and boys.
There were gender-, illness- and complaint-specific associations between somatic complaints and psychopathology. It appears likely that there are differences in the psychobiological processes underlying these associations in boys and girls. Clinical recommendations include screening children and adolescents with persistent complaints of headaches, stomach aches, or musculoskeletal pains for psychiatric disorders with an awareness that gender may affect the type of psychopathology associated with the somatic complaints.
The aim of the current study was to examine the relation between catastrophizing and pain intensity, pain-related disability, and psychological distress in a group of patients with chronic pain, controlling for the level of physical impairment. Furthermore, it was examined whether these relations are the same for three subgroups of chronic pain patients: those with chronic low back pain, those with chronic musculoskeletal pain other than low back pain, and those with miscellaneous chronic pain complaints, low back pain and musculoskeletal pain excluded.
Correlational, cross-sectional.
Participants in this study were 211 consecutive referrals presenting to a university hospital pain management and research center, all of whom had a chronic pain problem.
Overall, chronic pain patients who catastrophize reported more pain intensity, felt more disabled by their pain problem, and experienced more psychological distress. Regression analyses revealed that catastrophizing was a potent predictor of pain intensity, disability, and psychological distress, even when controlled for physical impairment. No fundamental differences between the three subgroups were found in this respect. Finally, it was demonstrated that there was no relation between physical impairment and catastrophizing.
It was concluded that for different subgroups of chronic pain patients, catastrophizing plays a crucial role in the chronic pain experience, significantly contributing to the variance of pain intensity, pain-related disability, and psychological distress. These relations are not confounded by the level of physical impairment. Some clinical implications of the results are discussed. Finally, the authors concluded that these results support the validity of a cognitive-behavioral conceptualization of chronic pain-related disability.
There is now greater public concern about how features of modern life pose threats to personal health. In two studies, we investigated the relationship between individuals' worries about modernity affecting health to symptom reports, perceptions of health and health care utilization.
In the first study, 526 University students completed a questionnaire measuring modern health worries (MHW), symptom reports and health perceptions. A second study utilized an existing national survey database of 7869 New Zealanders. Part of the survey examined people's concerns of modernity affecting their health in the past 12 months, as well as the use of conventional medical and alternative health care.
We found concerns about modernity affecting health were made up of four major components: environmental pollution, toxic interventions, tainted food and radiation. MHW were significantly associated with somatic complaints and ratings of the importance of health to the individual. We also found individuals with high levels of MHW had a higher rate of food intolerance and chronic fatigue syndrome (CFS). In the second study, we found MHW to be associated with medical care utilization, particularly of alternative health practitioners.
The results of these studies suggest concerns about modernity do cause changes in the way individuals interpret somatic information and may play a role in undermining perceptions of health. The area of MHW is worthy of study and may hold importance for understanding aspects of functional disorders.
A variety of subjective illnesses with few or no objective findings have appeared at regular intervals as epidemics in our society under different labels. There are few or no objective findings that might explain the "disease" or the complaints go beyond what is regarded as "reasonable" by the physician. Muscle pain and other types of subjective health complaints are among the most frequent reason for encounters with general practitioners, and one of the major causes for sickness absence. The prevalence of subjective health complaints is very high, with at least 75% of the population reporting one or more subjective health complaints the past 30 days. From a statistical point of view, it is "normal" to have complaints. It is when they become intolerable that assistance is required. The difficult thing is that this threshold is individual and subjective. The psychiatric definitions of these complaints, therefore, refer only to the tip of an iceberg.
While most investigations of the link between blood pressure responses and later disease have focused on acute reactivity during stressful tasks, there is some theoretical and empirical reason to believe that examining recovery and later re-creations of BP responses may also be useful. Two experiments explored situational determinants of sustained BP elevations, examining whether the extent of recovery and the ability to later mentally recreate the response are influenced by the magnitude or emotionality of the initial task and also whether preventing rumination after a stressor has ended speeds recovery.
Experiment 1, with 72 normotensive male and female undergraduates, examined BP and heart rate before, during, and after a task and also before, during, and after the mental re-creation of that task. Four tasks were used, designed to produce high initial reactivity with an emotional component (mental arithmetic with harassment), low reactivity with emotion (shock avoidance), high reactivity without emotion (physical exercise), or low reactivity without emotion (cold pressor). Experiment 2, with 20 normotensive male and female undergraduates, compared the cardiovascular recovery of persons who were either given a distractor task or just sat quietly immediately after a mental arithmetic task.
Study 1 revealed that only the emotional tasks were associated with delayed BP recovery and elevations during later rumination. Blood pressure during recovery and later rumination was independent of the original reactivity. Experiment 2 found that participants with the distractor, who presumably could not ruminate, showed better BP recovery.
Situations that put people at risk may include not just those that cause large BP elevations, but also emotion-producing situations that lead to sustained and recurring elevations.
The objective of this paper was to present estimates on the prevalence of musculoskeletal pain of five different anatomical areas and ten anatomical sites, and their consequences and risk groups in the general Dutch population. Cross-sectional data from a population-based study of a sex-age stratified sample of Dutch inhabitants of 25 years and older were used. With a postal questionnaire data was assessed on musculoskeletal pain, additional pain characteristics (location, duration, course), its consequences (utilization of health care, sick leave and limitation in daily life) and general socio-demographic characteristics. The top three of self-reported musculoskeletal pain (point prevalence (P(p)) with 95% confidence interval (CI)) was: (1). low back pain, P(p)=26.9% (95% CI 25.5-28.3); (2). shoulder pain, P(p)=20.9% (95% CI 19.6-22.2); and (3). neck pain, P(p)=20.6% (95% CI 19.3-21.9). In most cases the pain was described as continuous or recurrent and mild. In every three out of ten cases the complaints about pain were accompanied by limitations in daily living. Between 33 and 42% of those with complaints consulted their general practitioner about their pain. With the exception of persons who are work disabled, general sociodemographic characteristics cannot be used to identify high risk groups. Musculoskeletal pain is common in all subgroups of the population and has far-reaching consequences for health, work and the use of health care.
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