Marcel A. van den Hout

Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment.

ObjectiveThe 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. DesignCorrelational, cross-sectional. Patients and SettingParticipants 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. ResultsOverall, 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. ConclusionsIt 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.

Correlations among Salivary Testosterone, Mood, and Selective Attention to Threat in Humans

An experiment was designed to investigate the relation among salivary testosterone, mood, and selective attention to threat. The participant group consisted of 32 nonclinical subjects (16 men and 16 women). Individuals completed the Profile Of Mood States (POMS) and performed a pictorial emotional Stroop task measuring selective attention to angry faces. Anticipating a time lag between testosterone (as measured in saliva) and cognitive emotional behavior, multiple time-coursed saliva samples were taken preceding the assessment of questionnaire and task for every subject. In both sexes, salivary testosterone was significantly related to mood (i.e., anger and tension) and selective attention to angry faces when saliva samples were taken 6 h before questionnaire and task assessment. Research on the relation between testosterone and human behavior might benefit by taking into account time lags between the behavioral manifestations and the continuously changing levels of testosterone.

Autobiographical memories become less vivid and emotional after eye movements.

OBJECTIVES To test (1) whether eye movements during retrieval of emotional memories are followed by less vividness and less emotionality of future recollections, (2) whether this effect, if present, is stronger than the effects of a control activity (finger tapping), (3) whether the alleged effects of tapping and eye movements are stronger than a no-movement, control condition (mere imagery), (4) whether reductions in vividness and emotionality after eye movements (and finger tapping) are specific to negative memories or also occur in the case of positive memories. METHOD Sixty healthy volunteers recalled either positive or negative memories and scored the vividness and emotionality of the recollections. Next, memories were recalled whilst the participant was performing rapid eye movements, finger tapping, or not performing a dual task. Then participants were asked to recall the event again and to rate its vividness and emotionality. RESULTS Compared to finger tapping and the no-dual-task condition, recollections after eye movements made future recollections less vivid. After eye movements, but not after the other interventions, negative memories became less negative, and positive memories became less positive. CONCLUSION The findings show that eye movements not only reduce vividness and emotionality of memories during the eye moving, but also affect future recollections, during which no eye movements are made. Some theoretical explanations are discussed. As to clinical implications, it is suggested that if there is a role for eye-movement-based treatments, it is very limited.

CO2 vulnerability in panic disorder.

The immediate effects of a single inhalation of a 35% CO2 mixture in oxygen were examined in 12 patients with panic disorders and 11 normal control subjects. Compared to a placebo air inhalation, the CO2 inhalation provoked short-lived autonomic panic symptoms in both patients and normals; it also elicited high subjective anxiety in patients with panic disorders. The latter rated the overall CO2-induced state as very similar to a real-life panic attack.

Attentional bias and spider phobia: Conceptual and clinical issues

Experimental evidence indicates that anxious subjects show an attentional bias for threat-relevant information. Foa and McNally (1986) (Cognitive Therapy and Research, 10, 477-485) and Watts et al. (1986) (British Journal of Psychology, 77, 97-108) reported that behaviour therapy can eliminate this attentional bias. A replication study was carried out in order to increase the evidence for exposure being the crucial component in reducing attentional bias. Moreover, in this study some conceptual and clinical issues are explored. The theoretical and clinical implications of the results are discussed.

Thought suppression induces intrusions

An experiment was conducted to investigate whether deliberate attempts to avoid a thought content have paradoxical effects. Twenty-four Ss received thought suppression instructions, 16 neutral instructions. Thought suppression resulted in an increased number of occurrences of the thought to be suppressed. The contribution of the results to the theory of obsessions is discussed.

Posttraumatic stress disorder after pregnancy loss

This prospective longitudinal study investigated the prevalence of posttraumatic stress disorder (PTSD) in response to pregnancy loss. About 1,370 women were recruited in the early stages of pregnancy and 113 of them had a subsequent pregnancy loss. One and four months after pregnancy loss, they were assessed for PTSD with the Posttraumatic Symptom Scale. Depression was also assessed. The majority had an early loss, i.e., within 20 weeks. At one month, the prevalence of PTSD was 25%, and the symptom-severity was similar to other traumatized populations. Women with PTSD had increased risk of depression: 34% of PTSD cases and 5% of non-cases reported depression. At four months, 7% met the criteria for PTSD, of which half were chronic. In contrast, rates for depression had not declined. The results indicate that pregnancy loss is potentially traumatic, putting women at risk of developing PTSD. In most cases, the disorder is immediate and persists for several months.

Conscious and preconscious selective attention to social threat: different neuroendocrine response patterns

This study was designed to investigate the relationship between selective attention to social threat and neuroendocrine activity. Selective attention to social threat was measured using a supraliminal (unmasked) and a subliminal (masked) version of a pictorial emotional Stroop task, comparing color-naming latencies of neutral and angry faces. Neuroendocrine activity was assessed as (pre-task to post-task) increases in salivary cortisol and testosterone. Forty subjects were randomly assigned to the unmasked or masked version of the task. Analyses for the unmasked task revealed that post-task cortisol levels were significantly increased in subjects showing selective attention to angry faces. Results for the masked task indicated that post-task cortisol and testosterone levels were significantly increased in subjects showing preconscious selective attention to angry faces. The difference in neuroendocrine activity between tasks is suggested to depend on cortical (i.e. prefrontal) control in the unmasked task. Thus, psychological affective regulatory processes were involved in the unmasked task, whereas the neuroendocrine response patterns in the masked task indicates a biologically prepared mechanism.

Selective processing of emotional information in obsessive compulsive disorder.

Three possible explanations for attentional bias effects in anxious subjects have been formulated: the threat-relatedness hypothesis, the emotionality hypothesis and the concern-relatedness hypothesis. In order to investigate these three hypotheses, an experiment was carried out with 33 obsessive compulsive (OC) patients and 29 normal controls. Both groups colour-named a Stroop card with 5 word sets: neutral words and 4 emotional word sets (a 2 x 2 matrix of words, related/unrelated to obsessive compulsive disorder and positively/negatively valenced). In line with previous studies, OC patients selectively attended to negative OC-related cues; this supports the threat-relatedness hypothesis. Although the set-up of the experiment was similar to the Mathews and Klug (1993, Behaviour Research and Therapy, 31, 57-62) study, no evidence was found for the concern-relatedness hypothesis, i.e. the OC patients did not show an attentional bias for positive OC-related words. Two possible reasons for these contradicting findings are discussed.

UPDATED META-ANALYSIS OF CLASSICAL FEAR CONDITIONING IN THE ANXIETY DISORDERS

The aim of the current study was twofold: (1) to systematically examine differences in fear conditioning between anxiety patients and healthy controls using meta‐analytic methods, and (2) to examine the extent to which study characteristics may account for the variability in findings across studies. Forty‐four studies (published between 1920 and 2013) with data on 963 anxiety disordered patients and 1,222 control subjects were obtained through PubMed and PsycINFO, as well as from a previous meta‐analysis on fear conditioning (Lissek et al. ). Results demonstrated robustly increased fear responses to conditioned safety cues (CS−) in anxiety patients compared to controls during acquisition. This effect may represent an impaired ability to inhibit fear in the presence of safety cues (CS−) and/or may signify an increased tendency in anxiety disordered patients to generalize fear responses to safe stimuli resembling the conditioned danger cue (CS+). In contrast, during extinction, patients show stronger fear responses to the CS+ and a trend toward increased discrimination learning (differentiation between the CS+ and CS−) compared to controls, indicating delayed and/or reduced extinction of fear in anxiety patients. Finally, none of the included study characteristics, such as the type of fear measure (subjective vs. psychophysiological index of fear), could account significantly for the variance in effect sizes across studies. Further research is needed to investigate the predictive value of fear extinction on treatment outcome, as extinction processes are thought to underlie the beneficial effects of exposure treatment in anxiety disorders.