Omer Van den Bergh Research Group on Health Psychology University of - - PowerPoint PPT Presentation

Omer Van den Bergh

Research Group on Health Psychology

University of Leuven, Belgium

SOME BACKGROUND

Correlation: r = .42671 NA Total Symptom Score (without anxiety symptoms) 30 50 70 90 110 130 5 15 25 35 45 55

Symptoms and Negative Affectivity (NA)

Van Diest et al., SS&M, 2005

Controlled for content overlap

PANAS

Healthy students

N=1.549; no disease, no medication

Secondary care Primary care Normal population

Negative Affectivity Symptoms

Symptoms – Negative Affectivity: Pervasive relation

high NA anxious/ depressive psychiatric co-morbidity nonconsulting frequent consulters functional syndromes

Trait negative affectivity (NA)

• Genetic basis
• Distinct brain circuit function
• Distinct neurotransmitter activity
• Over-reactive evaluative system
• Poor emotion regulation

– Less reappraisal, more suppression

• Attentional and interpretational

biases towards threatening stimuli

• Cognitive facets like worrying,

rumination, catastrophizing,..

Broad, stable disposition to appraise situations as more threatening and to experience negative mood states and emotions (Watson & Clark, 1984)

Hariri, 2009; Posner & Rothbart, 2000. Davidson, 2000;Yiend, 2010; Moberly & Watkins, 2008; De Peuter et al., 2008; Gross & John, 2003…

CREATING MUS IN THE LAB

Medically unexplained symptoms (MUS)

Creating MUS in the lab

Predictive cues

• dors
• mental images

Odor-CO2 inhalation paradigm

CO2 inhalation trials

• fast breathing
• smothering sensations
• chest tightness
• feelings of choking
• pounding heart
• sweating
• hot flushes
• lump in throat
• headache
• tension, anxious feelings

Methods

Odors air

CO 2 Subject valve

CS+ Odor 1+ 7.5 % CO2 CS- Odor 2+ room air

2 min breathing trials

• Ventilation (f, VT, VE)
• FETCO2
• HR
• Subjective symptoms

CS+ Odor 1+ room air CS- Odor 2+ room air

• Ventilation (f, VT, VE)
• FETCO2
• HR
• Subjective symptoms

ACQUISITION TEST

Odor CSs

Acquired symptoms to harmless

• dors

17 18 19 20 21 22 23 24 Ammon CS+ Niaouli CS+ CS+ CS-

• Symptom learning to unpleasant odor only!
• No difference in contingency awareness

symptoms

Van den Bergh et al., 1995, 1997, 1999

More elevated in high NA and in clinical MUS patients

16 18 20 22 High NA Low NA CS+ CS-

symptoms Van den Bergh et al., 1998, 1999

20 22 24 26 28 Normals Patients CS+ CS-

symptoms

Generalizes to new odors

17 18 19 20 21 22 23 Butyric Acid Acetic Acid Citric Aroma

• Condit. Ss

Not cond. Ss

• Generalization follows gradient of unpleasantness

symptoms Devriese et al., 2000

Can be “extinguished”

16 16.5 17 17.5 18 18.5 19 19.5 20 20.5 21 CS+1 E1 E2 E3 E4 E5 CS+7 Extinct Wait

Symptoms

Repeated presentations of odor only Test trial after learning Test trial after extinction

20% CO2 hampers extinction

1 2 3 4 5 6 Ext1 Ext2 Ext3 CS+ CS-

Meulders et al., 2009

Thoughts as CSs: imagery scripts

FEAR (example 1)

You are alone in an elevator. It is very small and has no ventilation. You start feeling short of breath. It slowly becomes unbearable. You want to leave this place as soon as possible, but when the elevator stops the door is stuck. You are sweating and your heart pounds wildly. In despair, you start pushing all the buttons, but nothing helps. You perspire heavily and gasp for breath. It appears that there is almost no air available anymore in this little place. Your heart leaps into your mouth, while you pull on the door with all your strength. It remains jammed shut. Everything becomes black. Neutral (example 1) You are sitting in your living room reading on a Sunday afternoon. Sitting back, relaxed, you look out of the window. It's a sunny autumn day outside. Red and brown leaves drift slowly down from the trees and several cars and a truck go by in the street. Wind from the cars blows leaves which are lying in the street. They scatter onto the pavement and the thick green lawn. (Based on Lang, Kozak, Miller, Levin & McLean, 1980).

CS+ Imag 1 5.5 % CO2 CS- Imag 2 room air

2 min breathing trials

• Ventilation (f, VT, VE)
• FETCO2
• HR
• Subjective symptoms

CS+ Imag 1 room air CS- Imag 2 room air

• Ventilation (f, VT, VE)
• FETCO2
• HR
• Subjective symptoms

ACQUISITION TEST

Thoughts as CSs

Thoughts as CSs

22 23 24 25 26 27 28 Fear CS+ CS- 18 19 20 21 22 23 24 Neutral CS+ CS-

• symptoms are learned only with fearful thoughts
• knowing the CS-US relationship is necessary but not sufficient

symptoms symptoms

• J. Abnorm. Psychol., 1999

What is the basis for acquired MUS?

What is learned?

• Interoceptive hypervigilance for actual

physiological arousal?

• Cognitive interpretation biases towards actual

physiological arousal?

• Automatic activation of somatic memories of

acquisition experiences?

Automatic memory activation

15.5 16 16.5 17 17.5 18 18.5 19 19.5 20 20.5

• Amm. CS+

Nia CS+ CS+ CS- 15.5 16.5 17.5 18.5 19.5 20.5 Amm CS+ Nia CS+ CS+ CS-

• No diff in physiological responses at test
• Pattern of learned symptoms reflect acquisition symptoms
• RT : memory activation is automatic (nonconscious) process

Symptoms

Symptoms

No Distraction at Acquisition Distraction at Acquisition

Van den Bergh et al., 1998

What needed to produce MUS…

• Take a high NA person
• Have this person experience symptom episodes
• Induce expectancy
• By unpleasant cues reliably associated with the symptom

episodes

• Some characteristics
• MUS generalize to other cues following an unpleasantness

gradient

• Can be “extinguished” but hampered by intense aversive

experiences

• Engage the same central neurobiological structures as the

sensations resulting from peripheral physiological stimulation

Electrosensitivity and sham radiation

Subjects

• Patients with

electrosensitivity

• healthy controls

Exposure

• heat
• sham radiation

from mobile phones

Landgrebe et al., 2008

Anterior cingulate cortex

Landgrebe et al., 2008

ACC

Left and right insular cortex

ACC

Landgrebe et al., 2008

PLAYING “HIDE AND SEEK” WITH MUS

Role of unpleasant cues in persons with MUS?

Interoception and emotion

• Intricate relationship

between interoception and emotion

• Specific brain regions

serve as an interface → How do affective cues influence “interoceptive accuracy” ?

Bechara & Naqvi, 2004

“Fusing”

Affect “invades” the perception of bodily states

• Viewing fearful faces enhances sensations of
• esophageal distention
• Viewing negative IAPS-pictures enhances

unpleasantness of dyspnea

• Negative emotional states increase perceived

dyspnea and pain

Phillips et al., 2003 von Leupoldt et al., 2008 Leeuw et al., 2007 von Leupoldt and Dahme, 2007

Critical role of insula

Craig, 2009

Body – symptom correspondence

• within-subject correlation between a specific subjective

report and a specific physiological response across a number of breathing trials

• Minute ventilation
• PCO2
• Faster/deeper breathing
• Breathlessness

Role of affective context

Negative frame Unpleasant odor

“breathing this air may make you

feel tensed like when being anxious or expecting something terrible to occur”

Positive frame Pleasant odor

“breathing this air may make you feel tensed like when being in love or looking out for something really nice to happen”

High and low NA normals

“Test of quality of air on subjective well-being”

Role of affective context

5 7 9 11 13 15 17 19

Positive Negative

Low NA High NA

Correspondence Symptom Level

Van den Bergh et al., P&H, 2004

Semantic cues

• within-subject correlation between a specific subjective

report and a specific physiological response across a number of breathing trials

• Minute ventilation
• PCO2
• Faster/deeper breathing
• Breathlessness

neutral

Semantic cues

• within-subject correlation between a specific subjective

report and a specific physiological response across a number of breathing trials

• Minute ventilation
• PCO2
• Faster/deeper breathing
• Breathlessness

symptom

Semantic cues : Neutral vs Symptom rating

0,4 0,5 0,6 0,7 0,8 0,9 1

Neutral Symptom Transformed correlation Low MUS High MUS

p < .01

Bogaerts et al., JPR, 2008 High and low symptom reporters (normals)

Pictorial cues (IAPS)

State NA

5 10 15 20 25 POSITIVE NEUTRAL NEGATIVE SYMPTOM Low MUS High MUS

Total symptom score

30 35 40 45 50 55 60 POSITIVE NEUTRAL NEGATIVE SYMPTOM Low MUS High MUS

Bogaerts et al., 2010

Series of 20 pics, 8 sec/pic

• NA acts as a moderator, not as a mediator

Chronic Fatigue Patients

18 20 22 24 10 14 18 22 Bogaerts et al., 2007

Typical CFS Symptoms Negative affect (state)

Brief induction of negative affective state Imagery scripts (2 min)

Somatovisceral illusions

Negative affective cue ?

More speculations ??

• Deficient prefrontal inhibitory control leading to

somatovisceral illusions?

More speculations ??

MUS; LS Means Current effect: F(2, 72)=20,178, p=,00000 Effective hypothesis decomposition Vertical bars denote 0,95 confidence intervals 1 2 3 MUS 12 14 16 18 20 22 24 26 28 ABS-totaal

High NA High MUS Low NA Low MUS High NA Low MUS

• Tellegen Absorption Scale

unpublished

Prefrontal inhibitory control

Go-NoGo Task

Level 2, F(1,58) = 4.69, p < .05, ηp² = .07, Level 3, F(1,58) = 5.14, p < .05, ηp² = .08. Level 2, F(1,58) = 4.69, p < .05, ηp² = .07, Level 3, F(1,58) = 5.14, p < .05, ηp² = .08.

Conclusions

• Relationship between peripheral physiology and

interoceptive processes in the brain is quite “plastic”

• Basic learning mechanisms can shape interoceptive

processes

– Automatic activation of somatic memories

• High trait NA/MUS more prone to “somatovisceral

illusions”

– More fusing of affect with somatic information? – Relevance for somatisation disorders, “functional syndromes”

• Role of deficient inhibitory control from rightVMPFC in high

NA/MUS?

Critchley et al., 2004; Davidson et al., 2000

Thank you

www.ppw.kuleuven.be/ogp