Marianna Munafò

Cardiovascular dynamics in blood phobia: Evidence for a key role of sympathetic activity in vulnerability to syncope

This study was aimed at clarifying the mechanism predisposing people with blood phobia to syncope by investigating the complete hemodynamic response pattern and the underlying autonomic control. Blood phobics and controls were shown 3 film-clips: phobia-related, phobia-unrelated, and neutral. Hemodynamic responses were recorded using impedance cardiography and Finapres. Preejection period and respiratory sinus arrhythmia were employed as indices of cardiac sympathetic and parasympathetic activity. Self-ratings of emotion were also collected. Blood phobics displayed global heart rate and cardiac output increases to the phobic film, mediated by augmented cardiac sympathetic activity. Systolic blood pressure and total peripheral resistance markedly declined, with no evidence of diphasic reaction or parasympathetic activation. An impaired vasomotor response under sympathetic control might be the key mechanism underlying the phobic dysfunctional response.

Health risk factors in caregivers of terminal cancer patients: a pilot study.

Background: A large body of literature sustains the association between long-lasting caregiving for impaired significant others and increased health risk. Depression, elevated heart rate, and blood pressure at rest are key measures of health risk, mostly cardiovascular, which have been generally studied in caregivers of patients affected by dementia or chronic illness. Limited research has been conducted on emotional and cardiovascular impact of family caregiving for terminally ill cancer patients. Objective:The aim of the present study was to examine psychological and cardiovascular responses in terminal cancer caregivers. Methods:Twenty relative caregivers who provided in-home or hospice care to terminally ill cancer patients and 20 age- and gender-matched controls were interviewed and assessed for emotional distress. Measures of cardiovascular risk, blood pressure, and heart rate were recorded at rest in 4 separate sessions. Results:Caregivers reported higher levels of depression, state anxiety, and more sleep dysfunctions than controls. They also revealed heightened systolic and diastolic blood pressure in some measurements. Moreover, elevation of heart rate was associated with caregiving length. Conclusions:The caregiving stressor is associated with considerable psychological vulnerability, sleep disorders, and risk of alterations in the cardiovascular system, which seem to be modulated by caregiving characteristics. Implications for Practice:This study shows the importance of screening caregivers for psychological as well as physical symptoms and disorders. An awareness of burden of terminal cancer caregivers could lead to timely proactive preventive interventions on their physical and mental health, to decrease negative outcomes.

The neural correlates of attentional bias in blood phobia as revealed by the N2pc

In the literature, a lack of attentional bias in blood phobia has been reported, using both behavioral and ERP measures. However, in the tasks employed so far, attentional resources to single stimuli, rather than attentional selection, were evaluated. The present study investigated whether in blood phobics disorder-relevant pictures can capture visuo-spatial attention when paired with neutral or non-specific unpleasant pictures (attack), and participants have to focus on a visual detection task. The N2pc component of the ERPs was measured as an index of spatial attentional selection. Results showed that in blood phobics, but not in controls, injuries elicited a larger early N2pc than attack pictures when paired with neutral material. Moreover, only in blood phobics a reliable N2pc to injury-attack pairs was found. The late N2pc reversal to injury pictures suggests that early orienting to phobic cues was followed by cognitive avoidance.

Reorienting of spatial attention in gaze cuing is reflected in N2pc

Research has shown that gaze cuing of attention is reflected in the modulation of P1 and N1 components of ERPs time-locked to target onset. Studies focusing on cue-locked analyses have produced mixed results. The present study examined ERP reflections of gaze cuing in further detail by recording electric brain activity from the scalp of participants engaged in a spatial cuing paradigm with noninformative gaze cues embedded in fearful, disgusted, or neutral faces. Unlike previous work, we focused on N2pc, a recent ERP index of attention shifting over space. Behavioral data showed that gaze-driven orienting was not influenced by facial expression. Importantly, electrophysiological data showed a significant amplitude modulation of the N2pc time-locked to target onset as a function of cue–target spatial congruence. This pattern, however, was independent of facial expression. The results are interpreted as evidence that N2pc can be used as a marker of reorienting of attention in spatially incongruent trials due to gaze cuing. The overall findings support the idea that the effects of facial expression on gaze cuing are weak and likely context-dependent.

Emotional sensitization highlights the attentional bias in blood-injection-injury phobics: an ERP study.

The presence of an attentional bias towards disorder-related stimuli has not been consistently demonstrated in blood phobics. The present study was aimed at investigating whether or not an attentional bias, as measured by event-related potentials (ERPs), could be highlighted in blood phobics by inducing cognitive-emotional sensitization through the repetitive presentation of different disorder-related pictures. The mean amplitudes of the N100, P200, P300 and late positive potentials to picture onset were assessed along with subjective ratings of valence and arousal in 13 blood phobics and 12 healthy controls. Blood phobics, but not controls, showed a linear increase of subjective arousal over time, suggesting that cognitive-emotional sensitization did occur. The analysis of cortical responses showed larger N100 and smaller late positive potentials in phobics than in controls in response to mutilations. These findings suggest that cognitive-emotional sensitization induced an attentional bias in blood phobics during picture viewing, involving early selective encoding and late cognitive avoidance of disorder-related stimuli depicting mutilations.

When faces signal danger: event-related potentials to emotional facial expressions in animal phobics.

Attentional bias research indicates that specific phobics prioritize the processing of disorder-relevant stimuli, although the time course of attentional allocation to the phobic threat remains unclear. The present study employed event-related potentials (ERPs) to investigate whether a processing bias also exists towards specific facial expressions that are able to signal potential phobic cues in the environment. Fifteen women with snake phobia and 15 healthy controls performed an attention-shifting task in which angry, fearful, disgusted and neutral faces were presented as emotional cues. ERP to facial expressions and reaction times to target stimuli were collected during the task. The P200 amplitude was significantly lower in phobics than in controls, specifically in response to facial expressions of fear and disgust. Such reduction in cortical activity may reflect reduced processing associated with rapid cognitive avoidance. Such an avoidance response would not be determined by the threat value of the face stimuli per se, but rather by the ability of fearful and disgusted faces to avert attention by signaling a possible phobic threat in the surrounding area. In addition, phobics showed relatively greater positivity to negative than neutral facial expressions in the later processing stages, indicating a general hypervigilant processing mode.

Contents Vol. 62, 2010

A. Drago, Naples G. Erdmann, Berlin A. Fischer, Göttingen J.M. Ford, San Francisco, Calif. S. Galderisi, Naples M. Hatzinger, Solothurn U. Hegerl, Leipzig K. Hirata, Mibu M. Kato, Osaka J. Kornhuber, Erlangen D. Lehmann, Zürich P. Monteleone, Naples G. Okugawa, Osaka G.N. Papadimitriou, Athens M. Popoli, Milano M. Reuter, Bonn F. Rösler, Marburg G. Ruigt, Oss J.K. Rybakowski, Poznan F. Schneider, Aachen R. Schwarting, Marburg M. Shigeta, Tokyo D. Souery, Brussels A. Steiger, Munich P. Willner, Swansea Associate Editors