Omer Van den Bergh Research Group on Health Psychology University of Leuven, Belgium

Transcription

1 Omer Van den Bergh Research Group on Health Psychology University of Leuven, Belgium

2 SOME BACKGROUND

3 Healthy students N=1.549; no disease, no medication Symptoms and Negative Affectivity (NA) 130 Correlation: r = Total Symptom Score (without anxiety symptoms) NA PANAS Controlled for content overlap Van Diest et al., SS&M, 2005

4 Symptoms Negative Affectivity: Pervasive relation psychiatric co-morbidity Secondary care functional syndromes Negative Affectivity anxious/ depressive Primary care frequent consulters Symptoms high NA Normal population nonconsulting

5 Trait negative affectivity (NA) Broad, stable disposition to appraise situations as more threatening and to experience negative mood states and emotions (Watson & Clark, 1984) 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,.. Hariri, 2009; Posner & Rothbart, Davidson, 2000;Yiend, 2010; Moberly & Watkins, 2008; De Peuter et al., 2008; Gross & John, 2003

6 Medically unexplained symptoms (MUS) CREATING MUS IN THE LAB

7 Creating MUS in the lab Odor-CO2 inhalation paradigm CO2 inhalation trials Predictive cues fast breathing smothering sensations chest tightness feelings of choking pounding heart sweating hot flushes lump in throat headache tension, anxious feelings odors mental images

8 Methods valve air Odors Subject CO 2

9 Odor CSs ACQUISITION CS+ CS- 2 min breathing trials Odor % CO2 Odor 2+ room air Ventilation (f, VT, VE) FETCO2 HR Subjective symptoms TEST CS+ CS- Odor 1+ room air Odor 2+ room air Ventilation (f, VT, VE) FETCO2 HR Subjective symptoms

10 Acquired symptoms to harmless odors symptoms Ammon CS+ CS+ CS- Niaouli CS+ Symptom learning to unpleasant odor only! No difference in contingency awareness Van den Bergh et al., 1995, 1997, 1999

11 More elevated in high NA and in clinical MUS patients symptoms 22 symptoms CS+ CS CS+ CS High NA Low NA 20 Normals Patients Van den Bergh et al., 1998, 1999

12 Generalizes to new odors symptoms Condit. Ss Not cond. Ss Butyric Acid Acetic Acid Citric Aroma Generalization follows gradient of unpleasantness Devriese et al., 2000

13 Can be extinguished Repeated presentations of odor only Symptoms Extinct Wait CS+1 E1 E2 E3 E4 E5 CS+7 Test trial after learning Test trial after extinction

14 20% CO2 hampers extinction CS+ CS Ext1 Ext2 Ext3 Meulders et al., 2009

15 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).

16 Thoughts as CSs ACQUISITION 2 min breathing trials CS+ Imag % CO2 CS- Imag 2 room air Ventilation (f, VT, VE) FETCO2 HR Subjective symptoms TEST CS+ Imag 1 room air CS- Imag 2 room air Ventilation (f, VT, VE) FETCO2 HR Subjective symptoms

17 Thoughts as CSs symptoms CS+ CS symptoms CS+ CS Fear 18 Neutral symptoms are learned only with fearful thoughts knowing the CS-US relationship is necessary but not sufficient J. Abnorm. Psychol., 1999

18 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?

19 Automatic memory activation No Distraction at Acquisition Symptoms Distraction at Acquisition Symptoms Amm. CS+ CS+ CS- Nia CS Amm CS+ CS+ CS- Nia CS+ No diff in physiological responses at test Pattern of learned symptoms reflect acquisition symptoms RT : memory activation is automatic (nonconscious) process Van den Bergh et al., 1998

20 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

21 Electrosensitivity and sham radiation Subjects Patients with electrosensitivity healthy controls Exposure heat sham radiation from mobile phones Landgrebe et al., 2008

22 Anterior cingulate cortex ACC Landgrebe et al., 2008

23 Left and right insular cortex ACC Landgrebe et al., 2008

24 Role of unpleasant cues in persons with MUS? PLAYING HIDE AND SEEK WITH MUS

25 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

26 Fusing Affect invades the perception of bodily states Viewing fearful faces enhances sensations of oesophageal 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

27 Critical role of insula Craig, 2009

28 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

29 Role of affective context Test of quality of air on subjective well-being High and low NA normals 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

30 Role of affective context Correspondence Symptom Level Positive Negative Low NA High NA Van den Bergh et al., P&H, 2004

31 Semantic cues within-subject correlation between a specific subjective report and a specific physiological response across a number of breathing trials neutral - Minute ventilation - PCO2 - Faster/deeper breathing - Breathlessness

32 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

33 Semantic cues : Neutral vs Symptom rating High and low symptom reporters (normals) Transformed correlation 1 0,9 0,8 0,7 0,6 0,5 0,4 Neutral Symptom Low MUS High MUS p <.01 Bogaerts et al., JPR, 2008

34 Pictorial cues (IAPS) Series of 20 pics, 8 sec/pic Total symptom score State NA POSITIVE NEUTRAL Low MUS NEGATIVE High MUS SYMPTOM POSITIVE NEUTRAL Low MUS NA acts as a moderator, not as a mediator NEGATIVE SYMPTOM High MUS Bogaerts et al., 2010

35 Chronic Fatigue Patients Brief induction of negative affective state Imagery scripts (2 min) 24 Negative affect (state) 22 Typical CFS Symptoms Bogaerts et al., 2007

36 Negative affective cue? Somatovisceral illusions

37 More speculations?? Deficient prefrontal inhibitory control leading to somatovisceral illusions?

38 More speculations?? Tellegen Absorption Scale 28 MUS; LS Means Current effect: F(2, 72)=20,178, p=,00000 Effective hypothesis decomposition Vertical bars denote 0,95 confidence intervals ABS-totaal High NA 3 Low MUS MUS Low NA Low MUS High NA High MUS unpublished

39 Prefrontal inhibitory control Go-NoGo Task Level 2, F(1,58) = 4.69, p <.05, η p ² =.07, Level 3, F(1,58) = 5.14, p <.05, η p ² =.08. Level 2, F(1,58) = 4.69, p <.05, η p ² =.07, Level 3, F(1,58) = 5.14, p <.05, η p ² =.08.

40 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

41 Thank you