Search

A dysregulated autonomic stress physiology is hypothesized to play an important role in the etiology and perpetuation of somatic symptoms that cannot be (fully) explained by an organic disease. The aim of this study was to focus on the role of the respiratory system. We examined end-tidal CO2 concentration (PetCO2) in healthy controls (n = 30), patients with panic disorder (n = 36), and patients with stress-related (overstrain; n = 35, burnout; n = 44) or functional syndromes [fibromyalgia (FM) and/or chronic fatigue syndrome (CFS); n = 36]. Participants went through a rest period and a respiratory challenge with recovery, whilst PetCO2 was continuously monitored by a capnograph. Taken together, our results suggest: (1) an overactive respiratory system to be a possible transdiagnostic underlying factor of overstrain, burnout, and panic disorder, and (2) the presence of a less active respiratory fight-flight response in the more chronic and severe functional syndromes (FM/CFS). ispartof: Applied Psychophysiology And Biofeedback vol:48 issue:2 ispartof: location:Germany status: Published online

OBJECTIVE: This study aimed to validate the Interoceptive Sensitivity and Attention Questionnaire (ISAQ), a 17-item self-report measure assessing sensitivity and attention to interoceptive signals. METHODS: In study 1, exploratory and confirmatory factor analysis was performed in a student convenience sample (n = 1868). In study 2, ISAQ data of a healthy sample (n = 144) and various patient groups experiencing stress-related syndromes (overstrain, n = 63; burnout, n = 37; panic disorder [PD]. n = 60) and/or persistent somatic symptoms in daily life (irritable bowel syndrome, n = 38; fibromyalgia and/or chronic fatigue syndrome, n = 151; medically unexplained dyspnea [MUD], n = 29) were compared. RESULTS: Three subscales were revealed: (F1) sensitivity to neutral bodily sensations, (F2) attention to unpleasant bodily sensations, and (F3) difficulty disengaging from unpleasant bodily sensations. Overall, patients with fibromyalgia and/or chronic fatigue syndrome and patients with MUD scored significantly higher on F1 (p = .009 and p = .027, respectively) and F2 (p = .002 and p < .001, respectively) than healthy controls. Patients with PD had higher scores on subscales F2 (p < .001) and F3 (p < .001) compared with healthy controls, as well as higher scores on F2 compared with all other patient groups (pPD versus MUD = .008; all other p values < .001). CONCLUSIONS: Interoceptive sensibility-the self-reported aspect of interoception-is not a homogeneous or unitary construct. The subscales of the ISAQ differentiate healthy controls from patients with persistent somatic and/or stress-related complaints in daily life and distinguish different patient groups. The ISAQ can be used as a concise, reliable, and clinically relevant research tool to further disentangle adaptive and maladaptive aspects of interoceptive ability. ispartof: Psychosomatic Medicine vol:84 issue:2 pages:1-35 ispartof: location:United States status: Published online

A dysregulated autonomic stress physiology is hypothesized to play an important role in the etiology and perpetuation of somatic symptoms that cannot be (fully) explained by an organic disease. The aim of this study was to focus on the role of the respiratory system. We examined end-tidal CO

The Heartbeat Counting Task (HCT) was designed and is intended to measure the objective ability to detect cardiac signals (also called cardiac interoceptive accuracy). Because interoceptive accuracy is thought to play a key role in biological (e.g., body mass index) and psychological (e.g., trait anxiety) risk factors and indicators of mental health, HCT scores should be associated with these outcomes. In order to examine this question, we performed a meta-analysis on these associations among adult participants. The final data set comprised 133 studies with 11,524 participants. We focused here on the seven most studied outcomes (i.e., outcomes that were studied in at least ten published studies). HCT performance was not significantly associated with trait anxiety, depression, and alexithymia. It was weakly and negatively associated with age after correction for publication bias, sex (male > female), heart rate, and body mass index. In addition, the quality assessment indicates that only a few studies reported sample size justification (6%), pre-registration (0.8%), and data in free access (6.8%). Theoretically expected associations between HCT performance and psychological indicators of mental health were not meta-analytically found. We discuss the implications of these findings for practice and theory.

Interoception, or the sense of the internal state of the body, is hypothesized to be essential for a wide range of psychobiological processes and the development and perpetuation of several (mental) health problems. However, the study of interoceptive accuracy, the objectively measured capacity to detect or discriminate conscious bodily signals, has been hampered by the use of tasks with questionable construct validity and is often limited to studying interoception solely in the cardiac domain. We developed a novel task to measure interoceptive accuracy in the respiratory domain, the respiratory occlusion discrimination (ROD) task. In this task, interoceptive accuracy is defined as an individual's ability to detect small differences in lengths of short respiratory occlusions, assessed by means of an adaptive staircase procedure. This article describes a validation study (N = 97) aimed at investigating the internal consistency, test-retest reliability, and discriminant validity of the ROD task. The average just noticeable difference of lengths of respiratory occlusion was 74.22 ms, with large inter-individual variability (SD = 37.1 ms). The results of the validation study indicate acceptable internal consistency (Cronbach's alpha = 0.70), 1-week test-retest reliability (r = 0.53), and discriminant validity, as indicated by a lack of correlation between the ROD task and an auditory discrimination task with identical design (r = 0.18), and a weak correlation with breathing behavior (r = -0.27). The ROD task is a promising novel paradigm to study interoceptive accuracy and its role in various psychobiological processes and disorders. ispartof: PSYCHOPHYSIOLOGY vol:58 issue:4 ispartof: location:United States status: published

Interoceptive accuracy is thought to play a key role in mental health. However, the validity of its most frequently used measure (i.e., the Heartbeat Counting Task; HCT) has been questioned. This calls for a meta-analytic examination of associations between HCT performance and mental health. To this end, we performed a systematic review and meta-analysis on associations between HCT performance and mental disorders, symptoms, and their risk factors among adult participants. The final data set comprised 133 studies with 11 524 participants. The quality assessment indicates that research practice should be improved as, e.g., only a few studies reported sample size justification (6%), pre-registration (0.8%), and data in free access (6.8%). HCT performance was not significantly associated with trait measures of anxiety (r = 0.03), depression (r = -0.04), and alexithymia (r = -0.01). It was weakly and negatively associated with age (r = -0.11) after correction for publication bias, sex (male > female; r = -0.14), heart rate (r = -0.17), and body mass index (r = -0.11). That theoretically assumed associations between interoceptive accuracy and mental health indicators are not meta-analytically found raises further doubts about the validity, and even the very pragmatic value, of the HCT.

Impaired selective fear learning has been advanced as a core mechanism involved in excessive spreading of protective responses such as pain-related fear and avoidance leading to disability in chronic pain conditions. Using the litmus test for selective learning effects, the blocking procedure, we tested the hypothesis that patients with fibromyalgia (FM) show less selective threat learning than healthy controls (HCs). We introduce a novel selective learning task based around a clinical diary scenario. On a trial-by-trial basis, participants rated whether they expected certain situations (A, B, Z, and X) in the diary of a fictive FM patient would trigger pain in that patient. The procedure did not involve any experimental pain induction because the verbal outcomes "pain" or "no pain" were used. During the elemental acquisition phase, one situation was followed by "pain" (A+, eg, "Kim slept badly, and reports pain"), whereas another situation was followed by "no pain" (Z-, eg, "Kim was stressed, and reports no pain"). During the compound acquisition phase, another situation (X), referred to as the blocked stimulus, was presented in compound with a previously pain-eliciting situation and also paired with "pain" (AX+, eg, Kim slept badly" and "Kim has vacuumed," and reports pain). Simultaneously, a novel situation was introduced and also followed by "pain" (B+). Within-group comparisons showed blocking (ie, significant difference between B and X) in the HCs, but not in the patients with FM. This study is the first in directly assessing differences in selective learning between patients with FM and HCs using a blocking procedure. ispartof: Pain vol:159 issue:7 pages:1268-1276 ispartof: location:United States status: published

Objective Patients with functional somatic syndromes show reduced correspondence between induced physiological changes and self-reported symptoms in a rebreathing paradigm, as well as elevated symptoms unrelated to physiological changes after induction of negative affective states in an affective picture-viewing paradigm. Detailed results of both paradigms separately were published elsewhere. The main goal of the current report is to describe the relationship between the responses to these two paradigms measuring distortions in symptom perception in a well-described sample of patients with fibromyalgia and/or chronic fatigue syndrome. Methods Patients (N = 81) with fibromyalgia and/or chronic fatigue syndrome participated in a test session comprising four well-validated paradigms, including the picture-viewing and rebreathing paradigm. Using mixed model analyses, we tested whether the amount of affective modulation of symptom reporting was related to distorted perception of induced dyspnea. In an exploratory way, we assessed the role of several individual difference variables as moderators. Results There was no relationship between patients' amount of affective modulation of symptom reporting, as assessed with the picture paradigm, and level of distortion in dyspnea perception, as assessed with the rebreathing paradigm (effect of affective modulation in the subjective recovery from induced dyspnea: F-1,F-70 = 0.16, p = .70; time by affective modulation interaction effect: F-4,F-70 = 0.14, p = .97). Conclusions Biased symptom reporting in one paradigm is unrelated to biased symptom reporting in the other paradigm, indicating that distortions in symptom perception in patients with functional somatic syndromes are not a trait-like, cross-situationally stable condition, but a versatile dysfunction that is context dependent. This study was funded by the Center for Excellence on Generalization Research (GRIP*TT; University of Leuven grant PF/10/005) and by Asthenes, a long-term structural funding-Methusalem grant by the FWO-Vlaanderen, Flemish Government, Belgium. The study was further supported by infrastructure grants from the Herculesstichting, Belgium (AKUL/13/07 and AKUL/11/08). The authors report no conflicts of interest.

Objective: Dyspnea perception is distorted in patients with medically unexplained dyspnea. The goals of this study were 1) to replicate these results in patients with fibromyalgia and/or chronic fatigue syndrome (CFS), and 2) to investigate predictors of distorted symptom perception within the patient group, with a focus on negative affectivity (NA), psychiatric comorbidity and somatic symptom severity. Methods: Seventy-three patients diagnosed with fibromyalgia and/or CFS and 38 healthy controls (HC) completed a rebreathing paradigm, consisting of a baseline (60s of room air), a rebreathing phase (150s, gradually increasing ventilation, partial pressure of CO2 in the blood, and self-reported dyspnea), and a recovery phase (150s of room air). Dyspnea, respiratory flow and FetCO2 levels were measured continuously. Results: Patients reported more dyspnea than HC in the recovery phase (p = 0.039), but no differences between patients and HC were found in the baseline (p = 0.07) or rebreathing phase (p = 0.17). No significant differences between patients and HC were found in physiological reactivity. Within the patient group, the effect in the recovery phase was predicted by somatic symptom severity (p = 0.046), but not by negative affectivity or by the number of psychiatric comorbidities. Conclusion: This study extended earlier findings in patients with medically unexplained dyspnea to patients with fibromyalgia and CFS. This suggests that altered symptom perception is a non-symptom-specific mechanism underlying functional somatic syndromes in general, particularly in patients with high levels of somatic symptom severity . The results are discussed in a predictive coding framework of symptom perception. The authors would like to thank the physicians and psychologists at the Psychiatry Departments of UZ Gasthuisberg, ZOL Genk, and at the Rheumatology Center in Genk for their help with the recruitment of patients; Mathijs Franssen for his help with data processing; and Katrien Coremans, Lotte Ceuterick, and Celine Samaey for their help with data collection. This research was funded by the Center for Excellence on Generalization Research (GRIP*TT; University of Leuven grant PF/10/005) and by Asthenes, a long-term structural funding-Methusalem grant (METH/15/011) by the FWO-Vlaanderen, Flemish Government, Belgium. The study was further supported by infrastructure grants from the Herculesstichting, Belgium (AKUL/13/07 and AKUL/11/08).

OBJECTIVE: Induction of negative affective states can enhance bodily symptoms in high habitual symptom reporters among healthy persons and in patients with irritable bowel syndrome. The aims of this study were to replicate this effect in patients with fibromyalgia and chronic fatigue syndrome and to investigate the role of moderators, focusing on alexithymia, negative affectivity, and absorption. METHODS: Patients with fibromyalgia and/or chronic fatigue syndrome (n = 81) and HCs (n = 41) viewed series of neutral, positive, and negative affective pictures. After every picture series, participants filled out a somatic symptom checklist and rated emotions experienced during the picture series on valence, arousal, and perceived control. RESULTS: Patients reported more somatic symptoms after viewing negative pictures (least square mean [LSM] = 19.40, standard error (SE) = 0.50) compared with neutral (LSM = 17.59, SE = 0.42, p < .001) or positive (LSM = 17.04, SE = 0.41, p < .001) pictures, whereas somatic symptom ratings of HCs after viewing negative picture series (LSM = 12.07, SE = 0.71) did not differ from ratings after viewing neutral (LSM = 11.07, SE = 0.59, p = .065) or positive (LSM = 11.10, SE = 0.58, p = .93) pictures. Negative affectivity did not moderate the symptom-enhancing effect of negative affective pictures, whereas the alexithymia factor "difficulty identifying feelings" and absorption did (p = .016 and p = .006, respectively). CONCLUSION: Negative affective states elicit elevated somatic symptom reports in patients experiencing fibromyalgia and/or chronic fatigue syndrome. This symptom-enhancing effect is greater in patients having higher difficulty to identify feelings and higher absorption scores. The results are discussed in a predictive coding framework of symptom perception. This study was supported by the Center for Excellence on Generalization Research (GRIP*TT; University of Leuven Grant PF/10/005) and by Asthenes, a long-term structural funding-Methusalem grant by the FWO-Vlaanderen, Flemish Government, Belgium. The study was further supported by infrastructure grants from the Herculesstichting, Belgium (AKUL/13/07 and AKUL/11/08). The authors report no conflicts of interest.

Processing unpleasant affective cues induces elevated momentary symptom reports, especially in persons with high levels of symptom reporting in daily life. The present study aimed to examine whether applying an emotion regulation strategy, i.e. affect labeling, can inhibit these emotion influences on symptom reporting. Student participants (N = 61) with varying levels of habitual symptom reporting completed six picture viewing trials of homogeneous valence (three pleasant, three unpleasant) under three conditions: merely viewing, emotional labeling, or content (non-emotional) labeling. Affect ratings and symptom reports were collected after each trial. Participants completed a motor inhibition task and self-control questionnaires as indices of their inhibitory capacities. Heart rate variability was also measured. Labeling, either emotional or non-emotional, significantly reduced experienced affect, as well as the elevated symptoms reports observed after unpleasant picture viewing. These labeling effects became more pronounced with increasing levels of habitual symptom reporting, suggesting a moderating role of the latter variable, but did not correlate with any index of general inhibitory capacity. Our findings suggest that using an emotion regulation strategy, such as labeling emotional stimuli, can reverse the effects of unpleasant stimuli on symptom reporting and that such strategies can be especially beneficial for individuals suffering from medically unexplained physical symptoms.