Brian M. Hughes

Clinical anxiety, cortisol and interleukin-6: evidence for specificity in emotion-biology relationships.

Anxiety confers increased risk for inflammatory diseases, and elevated inflammatory activity in anxious individuals may contribute to this increased risk. One complication, however, is that anxiety could be associated with inflammatory activity either through a specific anxiety pathway or through a more general negative emotionality pathway. To investigate, we measured levels of the stress hormone cortisol, the pro-inflammatory cytokine interleukin-6 (IL-6), and the systemic inflammatory marker C-reactive protein (CRP), as well as depression and neuroticism, in clinically anxious and non-anxious adults. Compared with non-anxious participants, clinically anxious participants exhibited significantly lower levels of morning cortisol and significantly higher levels of IL-6, independent of age, sex, and depressive symptoms. These group differences were robust when controlling for neuroticism. Conversely, the groups had equivalent levels of CRP in all analyses. Results are indicative of anxiety-specific effects on inflammatory activity, and highlight a pathway by which anxiety may increase risk for inflammatory diseases.

A Taxometric Analysis of Type-D Personality

Objective: To test the dimensionality of Type-D personality, using taxometric procedures, to assess if Type-D personality is taxonic or dimensional. Type-D personality is treated as a categorical variable and caseness has been shown to be a risk factor for poor prognosis in coronary heart disease. However, at present, there is no direct evidence to support the assumption that Type D is categorical and able to differentiate true cases from noncases. Methods: In total, 1012 healthy young adults from across the United Kingdom and Ireland completed the DS14, the standard index of Type D, and scores were submitted to two taxometric procedures MAMBAC and MAXCOV. Results: Graphical representations (comparing actual with simulated data) and fit indices indicated that Type D is more accurately represented as a dimensional rather than categorical construct. Conclusion: Type D is better represented as a dimensional construct. Implications for theory development and clinical practice with respect to Type D are examined as well as the wider use of taxometrics within psychosomatic medicine (e.g., to investigate if there are medically unexplained syndrome taxons, such as a Gulf War Syndrome taxon). NA = negative affectivity; SI = social inhibition; MAMBAC = mean above minus below a cut; MAXCOV = maximum covariance; MAXEIG = maximum Eigenvalue; L-MODE = L-mode factor analysis; CCFI = curve comparison fit index.

The other side of the coin: Blunted cardiovascular and cortisol reactivity are associated with negative health outcomes

A cornerstone for research into the link between stress and health has been the reactivity hypothesis; cardiovascular reactivity to psychological stressors, if prolonged or exaggerated, can promote the development of cardiovascular disease. However, it has recently been argued that low or blunted reactivity is also associated with negative health outcomes. As such, in this special issue we present further evidence implicating that cardiovascular and stress hormone responses to acute stress at the other end of the response spectrum can also be considered a pathway to ill health. In this introductory article, we explore and review the origins of and potential mechanisms underlying blunted responses to acute stress. In so doing, we aim to highlight: what is currently known regarding this new conceptualization of the reactivity hypothesis; the potential explanations for blunted reactivity; the pathways underlying associations with health outcomes; and where this field is headed in terms of developing our understanding of the link between reactivity and health.

Comparison of Behavioral Intervention and Sensory-Integration Therapy in the Treatment of Challenging Behavior

The objective of the current study was to compare the effects of sensory-integration therapy (SIT) and a behavioral intervention on rates of challenging behavior (including self-injurious behavior) in four children diagnosed with Autism Spectrum Disorder. For each of the participants a functional assessment was conducted to identify the variables maintaining challenging behavior. Results of these assessments were used to design function-based behavioral interventions for each participant. Recommendations for the sensory-integration treatment were designed by an Occupational Therapist, trained in the use of sensory-integration theory and techniques. The sensory-integration techniques were not dependent on the results of the functional assessments. The study was conducted within an alternating treatments design, with initial baseline and final best treatment phase. For each participant, results demonstrated that the behavioral intervention was more effective than the sensory integration therapy in the treatment of challenging behavior. In the best treatment phase, the behavioral intervention alone was implemented and further reduction was observed in the rate of challenging behavior. Analysis of saliva samples revealed relatively low levels of cortisol and very little stress-responsivity across the SIT condition and the behavioral intervention condition, which may be related to the participants’ capacity to perceive stress in terms of its social significance.

Illness perceptions about asthma are determinants of outcome

This article reviews an emerging area of research on patients with asthma: namely, illness perceptions and their relationships with various aspects of outcome. The article briefly introduces the Common Sense Model, outlining the relevance of how “lay” patients conceptualize symptoms, illness, and treatment. On the basis of a comprehensive literature search, nine empirical studies illustrating the relationships between illness perceptions and outcomes are discussed. It is concluded that further research should focus on assessing asthma-specific illness and treatment beliefs. Also, given the effects of intervention studies in illness perceptions in other patient categories, it is recommended that serious consideration be given to intervention studies focusing on eliciting and changing illness perceptions in asthma patients, especially in those whose self-management seems to be inadequate.

Construct, concurrent and discriminant validity of Type D personality in the general population: Associations with anxiety, depression, stress and cardiac output

The Type D personality, identified by high negative affectivity paired with high social inhibition, has been associated with a number of health-related outcomes in (mainly) cardiac populations. However, despite its prevalence in the health-related literature, how this personality construct fits within existing personality theory has not been directly tested. Using a sample of 134 healthy university students, this study examined the Type D personality in terms of two well-established personality traits; introversion and neuroticism. Construct, concurrent and discriminant validity of this personality type was established through examination of the associations between the Type D personality and psychometrically assessed anxiety, depression and stress, as well as measurement of resting cardiovascular function. Results showed that while the Type D personality was easily represented using alternative measures of both introversion and neuroticism, associations with anxiety, depression and stress were mainly accounted for by neuroticism. Conversely, however, associations with resting cardiac output were attributable to the negative affectivity–social inhibition synergy, explicit within the Type D construct. Consequently, both the construct and concurrent validity of this personality type were confirmed, with discriminant validity evident on examination of physiological indices of well-being.

Individual differences in adaptation of cardiovascular responses to stress

Previous research has described patterns of adaptation of cardiovascular responses across prolonged or recurring stress. However, despite important implications for the study of reactivity, relatively little research has directly examined the antecedents or consequences of this adaptation. We present data showing that neuroticism, a personality trait associated with dispositional appraisals of stress, is associated with reductions in HR, CO, and TPR responses across stress exposures. Comparisons of reactivity curves suggest blunted initial stress responses among persons with high neuroticism, and higher initial responses followed by greater decreases among persons with low neuroticism. The data also suggest an association between adaptation of cardiovascular responses and myocardial hemodynamic responding. Such findings shed new light on previous studies detecting healthful correlates of short-term stress responding, and highlight the relevance of adaptation to future cardiovascular reactivity research.

Study, Examinations, and Stress: Blood Pressure Assessments in College Students.

The issue of stress associated with higher education and its impact on markers of student health is explored in three experiments looking at blood pressure levels in college students. All participants were full‐time undergraduate students of psychology. In Experiment 1, academic fear of failure, assessed using psychometric testing, was found to be associated with depressed blood pressure responses among students who performed a stressful task on a computer. In Experiment 2, students were found to exhibit higher blood pressure before end‐of‐semester examinations than afterwards. In Experiment 3, students of relatively high academic ability were found to have demonstrated increased levels of pre‐examination blood pressure responses to stress. Overall, the three experiments suggest ways in which the stressfulness of student life may have adverse consequences for student health and, moreover, ways in which the stressfulness of student life can be further explored. Factors such as fear of failure, impending ex...The issue of stress associated with higher education and its impact on markers of student health is explored in three experiments looking at blood pressure levels in college students. All participants were full‐time undergraduate students of psychology. In Experiment 1, academic fear of failure, assessed using psychometric testing, was found to be associated with depressed blood pressure responses among students who performed a stressful task on a computer. In Experiment 2, students were found to exhibit higher blood pressure before end‐of‐semester examinations than afterwards. In Experiment 3, students of relatively high academic ability were found to have demonstrated increased levels of pre‐examination blood pressure responses to stress. Overall, the three experiments suggest ways in which the stressfulness of student life may have adverse consequences for student health and, moreover, ways in which the stressfulness of student life can be further explored. Factors such as fear of failure, impending examinations and academic ability must be taken into account when considering stress‐related health consequences on campus.

50 Years of psychological research on patients with COPD - Road to ruin or highway to heaven?

OBJECTIVE To review the topic of behavioural research on patients with COPD over the past 50 years in order to help inform clinical management and future research on psychosocial aspects of COPD. METHOD Narrative literature review. RESULTS Nine orientations in behavioural research on COPD patients are identified and concisely examined: psychoanalytic approach, psychosomatics, neuropsychology, quality of life, psychomaintenance, patient education, coping and illness cognitions, self-management, and collaborative care. These approaches form a historical sequence of psychosocial perspectives on COPD, of successively increasing utility in COPD research and care. DISCUSSION AND CONCLUSION In the past 50 years behavioural research on COPD patients has evolved considerably. Over time, a trend for the patient to become the central actor in the management of the illness is discernable. Evidence-based reviews indicate that self-management offers COPD patients effective options for managing their illness, leading to positive outcomes such as reduced frequency of hospitalization, greater exercise tolerance, and enhanced quality of life. Future research should focus on how self-management skills can be incorporated formally into medical care. In addition to offering suggestions on how clinicians may be instrumental in improving self-management behaviour in COPD patients, and thereby improve care outcomes, we highlight the importance of gaining insight into the perceptions of patients of their own situation, and incorporating a respect for patient perspectives into the philosophy of care.

Social support in ordinary life and laboratory measures of cardiovascular reactivity: gender differences in habituation-sensitization.

Background: Gender differences in coronary heart disease are mirrored by gender differences both in cardiovascular reactivity to stress and in the nature and content of social support networks. However, little research has examined the association between cardiovascular reactivity in the laboratory and social support outside; and none has established whether gender differences in such associations can elucidate relevant psychosomatic mechanisms. In addition, in general, studies of cardiovascular reactivity fail to take adequate account of cardiovascular response habituation.Purpose: The present study sought to examine gender differences in associations between psychometrically assessed social support and cardiovascular reactivity and, in particular, response habituation patterns.Method: Ninety-two undergraduate men and women underwent two consecutive cardiovascular reactivity assessments, after having provided psychometric assessments of quantity and quality of social support in ordinary life.Results: Inverse associations between social support and cardiovascular reactivity during the second assessment suggested that highly-supported women exhibited cardiovascular response habituation. For men, the opposite trend—that of support-related cardiovascular sensitization—was found. Results were unaffected by performance of the task used to elicit reactivity or by participant ratings of task dimensions.Conclusions: These findings suggest that men and women differ in the degree to which social support in ordinary life moderates cardiovascular stress responses in laboratories. This difference is highlighted when looking at how cardiovascular responses fluctuate over repeated testing. Habituation-sensitization patterns suggest that, when dealing with difficult tasks, women may derive benefit from background social relationships whereas men may find that such background relationships bring additional pressures.