Biobehavioral Perspective Research Articles

Biobehavioral approach to distinguishing panic symptoms from medical illness.

Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.

The evolutionary meaning of migraine.

Migraine's astonishing prevalence and preserved genetic background contrast with the definition of a disease and the biological meaning of experiencing recurrent, severe headache attacks is still puzzling. To provide a comprehensive explanation of the migraine evolutionary meaning, we review (i) the putative role of the autonomic nervous system in migraine attacks, (ii) the inter-ictal autonomic, functional, and metabolic signature of migraine patients, (iii) the bio-behavioral perspective of pain, and (iv) the allostatic perception of migraine chronification. Migraineurs have inter-ictal cortical hyperexcitability and metabolic dysfunction that predisposes to brain energetic imbalance. Multiple precipitating factors may lead to brain energy consumption over the migraine attack generation threshold. In response, the brain engenders adaptive, evolutionary conserved, autonomic-behavior responses through the antidromic activation of the trigeminovascular system. The sickness behavior and severe pain experienced during migraine attacks result in avoiding mental and physical activity, allowing brain energy restoration. Chronic exposure to stressors may result in an allostatic overload, leading to maladaptive chronic activation of these responses. In this bio-behavioral perspective, the chronification of migraine should be envisioned as a pathological process, whereas the migraine itself should not. Migraine has an evolutionary (Darwinian) meaning.

Clinical and biobehavioral perspectives: Is medication overuse headache a behavior of dependence?

Medication overuse headache (MOH), previously known as analgesic abuse headache or medication misuse headaches, is a common form of chronic headache disorder that has a detrimental impact on health and society. Although it has been widely accepted that overusing abortive medications is paradoxically the cause of MOH and drug discontinuation is the treatment of choice, ongoing debates exist as to whether drug consumption per se is the cause or consequence of headache chronification. Certain features in MOH such as their compulsive drug-seeking behavior, withdrawal headaches and high relapse rates share similarities with drug dependence, suggesting that there might be common underlying biological and psychobehavioral mechanisms. In this regard, this article will discuss the updated evidence and current debates on the possible biobehavioral overlap between MOH and drug dependence. To begin with, we will discuss whether MOH has characteristics of substance dependence based on standard psychiatry diagnostic criteria and other widely used dependence scales. Recent epidemiological studies underscoring common psychiatric comorbidities between the two disorders will also be presented. Although both demonstrate seemingly distinct personality traits, recent studies revealed similar decision-making impairment from a cognitive perspective, indicating the presence of a maladaptive reward system in both disorders. In addition, emerging imaging studies also support this notion by showing reversible morphological and functional brain changes related to the mesocorticolimbic reward circuitry in MOH, with a strong resemblance to those in addiction. Finally, an increased familial risk for drug dependence and genetic association with dopaminergic and drug dependence molecular pathways in MOH also support a possible link between MOH and addiction. Understanding the role of dependence in MOH will have a great impact on disease management as this will provide the missing piece of the puzzle in current therapeutic strategies.

How negative social interactions at work seep into the home: A prosocial and an antisocial pathway

SummaryWe combined Bakker and Demerouti's spillover–crossover model with Taylor's biobehavioral perspective, tested the comprehensive model, and pursued a set of gender‐related research questions. Negative work interactions were expected to entail two strain responses, high‐ and low‐arousal negative affect. Both should be related to cortisol secretion but transmitted via different social pathways, a positive and a negative one. During a 7‐day ambulatory assessment with 56 couples, we assessed daily variations in the severity of negative social interactions at work and at home along with participants' affect and cortisol levels. Using multilevel structural equation modeling, we found evidence for the three hypothesized processes: strain at work as a consequence of social stress, spillover of strain into the home, and crossover to the partner. On socially more stressful days, participants showed increased high‐ and low‐arousal negative affect at work. Low‐arousal negative affect spilled over into the home. Only for men, high‐arousal negative affect spilled over, and only women showed a tendency for slowed decline of cortisol levels on more socially stressful days (i.e., slower recovery). Surprisingly, high‐arousal negative affect at work tended to be negatively related to partners' high‐arousal negative affect. Commonalities predominated differences between men and women. Copyright © 2016 John Wiley & Sons, Ltd.

Effects of Exercise on Select Biomarkers and Associated Outcomes in Chronic Pain Conditions

Chronic pain is highly prevalent. Current management is challenged by lack of validated objective measures like biological markers. Clinical pain studies employing exercise interventions have evaluated biomarkers; however, it is unclear how exercise impacts biomarkers involved in pain pathways and whether these markers are associated with relevant pain-related outcomes. This systematic review evaluates data from clinical studies employing exercise interventions in chronic musculoskeletal nonmalignant pain conditions in which biomarkers in pain pathways were measured. Published research studies from several databases were examined using the Jadad Scale for assessing the quality of clinical studies. Twelve research studies were reviewed. Jadad scores ranged from 5 to 11 out of 13 points. Inflammatory markers were most commonly measured followed by neurotransmitter-related genes and metabolite-detecting genes. After exercise interventions, changes in biomarkers involved in neurotransmission and inflammation suggest a hypoalgesic exercise effect. Significant biomarker associations were found with pain intensity, fatigue, depression, anxiety, and quality of life. However, there were varying methodologies in the studies reviewed. It remains a question whether biomarkers can be used as objective measures for risk assessment, diagnosis, or evaluation or as surrogate endpoints in chronic pain. Adequate sample sizes, optimal exercise dose determination, study replications, and longitudinal research studies with consistent methodologies are warranted. Regardless, the potential translational value of biomarkers in chronic pain is evident. Advancing nursing research in biomarkers is vital for moving the nursing discipline and clinical chronic pain practice forward. Developing a biobehavioral perspective in chronic pain is also necessary for comprehensive management.

Strengthening bonds and connecting with followers.

The smiles and affiliative expressions of presidential candidates are important for political success, allowing contenders to nonverbally connect with potential supporters and bond with followers. Smiles, however, are not unitary displays; they are multifaceted in composition and signaling intent due to variations in performance. With this in mind, we examine the composition and perception of smiling behavior by Republican presidential candidates during the 2012 preprimary period. In this paper we review literature concerning different smile types and the muscular movements that compose them from a biobehavioral perspective. We then analyze smiles expressed by Republican presidential candidates early in the 2012 primary season by coding facial muscle activity at the microlevel using the Facial Action Coding System (FACS) to produce an inventory of politically relevant smile types. To validate the subtle observed differences between smile types, we show viewers a series of short video clips to differentiate displays on the basis of their perceived reassurance, or social signaling. The discussion considers the implications of our findings in relation to political evaluation and communication efficacy.

Variability in children's eating response to portion size. A biobehavioral perspective

The portion size of foods and beverages offered at meals has been shown to significantly affect human food intake. While portion size effects appear to be fairly robust across studies in adults, findings from studies in children are generally more variable and do not reliably predict a significant portion size effect. Eating behaviors are still forming at a young age and individual differences in children's response to portion size will depend upon genetic predisposition interacting with the child's environment. The aim of this review is to present and discuss evidence that innate controls of appetite and eating, which involve genes that encode key hormones and neuropeptides implicated in processes of satiety and satiation, may differentially affect meal size. We also present evidence that children's response to portion size is learned and this is in turn shaped by upbringing, the early family and home environment. The review will conclude with a conceptual model that illustrates how biological and environmental factors may interact to shape child eating traits including a behavioral susceptibility to overeating when large portion sizes are available.

Keith E. Whitfield (ed.). Focus on Biobehavioral Perspectives on Health in Late Life (Annual Review of Gerontology and Geriatrics, vol. 30). New York, NY: Springer Publishing Company, 2010

Keith E. Whitfield (ed.). Focus on Biobehavioral Perspectives on Health in Late Life (Annual Review of Gerontology and Geriatrics, vol. 30). New York, NY: Springer Publishing Company, 2010 - Volume 31 Issue 3

Verhaltenspädiatrie chronischer Kopfschmerzen im Kindes- und Jugendalter: State of the art

Pediatric headaches, namely migraine and tension type headache, belong to the most common health problems in children and adolescents. The behavioural medicine approach to chronic headache in childhood and adolescence is based on the etiopathogenesis and empirical research. The biobehavioral perspective has the concept of migraine as an information processing deficit disorder, characterized by a central hypersensitivity (informationprocessing dysfunction) and dishabituation. We assume that hereditary and psychosocial (parental education) mechanisms both play an important role in migraine. Behavioural medicine interventions are highly effective and encompass information-processing-training, stress-management training, relaxation training, pain-coping techniques and biofeedback treatment.

A biobehavioral perspective on depressive symptoms in patients with cerebral astrocytoma.

More than 51,000 individuals are diagnosed with a primary brain tumor in the United States each year, and for those with the most common type of malignant tumor, an astrocytoma, almost 75% will die within 5 years of diagnosis. Although surgery, radiation, and chemotherapy have improved length of survival, mortality remains high, which underscores the need to understand how other factors affect the disease trajectory. Several recent studies have shown that depressive symptoms are independently associated with reduced quality of life and survival time after controlling for other variables in patients with an astrocytoma. Thus, depressive symptoms represent a significant risk factor for adverse outcomes in this patient population. A growing body of evidence indicates that depressive symptoms are linked to underlying biological phenomena, particularly inflammatory activation modulated through increased peripheral levels of proinflammatory cytokines. Recent research has shown that neoplastic astrocytes respond to elevated proinflammatory cytokine levels by secreting immune mediators within the central nervous system, including cytokines and glial fibrillary acidic protein that promote astrogliosis and angiogenesis and may increase tumor growth and metastasis. However, because these biological factors have not as yet been measured in conjunction with depressive symptoms in these patients, little is known about the interactions that potentially influence the treatment trajectory. To guide future research and to provide a deeper understanding of the factors that may influence depressive symptoms and length of survival in patients with an astrocytoma, a review of the literature was undertaken. Publications over the past 10 years were analyzed to examine the theoretical models and measures of depressive symptoms used in previous research. Although numerous studies have documented the relationship between depression and reduced length of survival, there were several methodological concerns identified, and there were no studies that included biological variables. Yet, research in the basic sciences provides compelling evidence of specific neuroendocrine-immune interactions orchestrated by astrocytes that can cause depressive symptoms and alter the tumor microenvironment so that standard treatments are not as effective. These findings support the need for clinically based research so that we can begin to understand the potentially modifiable biobehavioral mechanisms underlying depressive symptoms in patients with an astrocytoma. Grounded in the biobehavioral research paradigm of psychoneuroimmunology, a novel research program is presented that may provide a new level of understanding regarding the high prevalence of depressive symptoms in patients with an astrocytoma and lead to new treatment strategies, with possible implications for improved symptom management and quality of life in patients with brain tumors.

Biobehavioral Perspectives on Health in Late Life

Biobehavioral Perspectives on Health in Late Life

Nurses transforming health care using genetics and genomics

Nurses are well positioned to incorporate genetic and genomic information across all aspects of the United States (U.S.) health care system. Nurses, the most trusted health professionals [1], make unique contributions to the field of human genetics and genomics and complement the work of other health care providers to improve the health of the public. Health care benefits greatly from the unprecedented and ongoing work elucidating the genetic/genomic basis of health, illness, disease risk, and treatment response. The progress in genetics and genomics is applicable to the entire spectrum of health care and all health professionals and as such to the entire nursing profession (2.9 million) [2] in the United States regardless of role, clinical specialty, or academic preparation. The majority of disease risk, health conditions and the therapies used to treat those conditions have a genetic and/or genomic element influenced by environmental, lifestyle, and other factors therefore impacting the entire nursing profession [3]. Nurses have intimate knowledge of the patient’s, family’s, and community’s perspectives; an understanding of biologic underpinnings; experience with genetic/genomic technologies and information; skills in communication and building coalitions; and most importantly, the public’s trust. Across the lifespan, nursing focuses on health promotion and disease prevention, which is an integral component of genetic/genomic health care practices. Awareness of nurses’ strengths and skills, together with the recognition that prevention is the hallmark of genetic/genomic health care, will inform public policymaking groups as they address issues that affect heath care practice in the area of genetics/genomics. Policy making process will be informed with new insights will be gained with inclusion of nurses and professional nursing organizations. These policies can facilitate the ability of U.S. health care systems to use genetic/genomic knowledge to promote health and manage disease.

The Interaction Between Chronic Stress and Pregnancy: Preterm Birth from A Biobehavioral Perspective

Women's health care providers are increasingly aware that chronic stressors--such as poverty, ongoing perceived stress and anxiety, intimate partner violence, and experiences of racism--are associated with an increased incidence of preterm birth in the United States. It is important to increase our understanding of the explanatory pathways involved in these associations. This article discusses the concepts of stress, chronic stress response, allostatic load, the physiology of labor initiation, and the pathophysiologic interactions that may contribute to the occurrence of chronic stress-related preterm birth. Implications for future research and interventions are explored.

Predictors of Depression and Anxiety in Patients with Intracranial Neoplasms

Predictors of Depression and Anxiety in Patients with Intracranial Neoplasms

Neurobiological perspectives on the nature of visual and verbal processes

Wyer and colleagues in this issue summarize an array of studies that demonstrate varied and significant effects of a series of antecedents on the relative accessibility of visual and verbal strategies in memory and the ease with which these strategies can be employed to affect comprehension and judgments. We review the studies in light of findings and perspectives from psychophysiological and neuroimaging research. We discuss how measurement of event-related potentials (ERP) can illuminate automatic versus reflective forms of processes. Then the revelation of brain regions involved in the visual processing of pictures and words under different tasks and processes by functional brain imaging (e.g. functional MRI). We close by considering these bio-behavioral perspectives and the interactions among modality, task, and affect on visual and verbal encoding strategies among individuals differing in visual and verbal processing orientations.

Behavioral treatment for nocturnal enuresis.

Nocturnal enuresis is one of the most prevalent and distressing of all childhood problems. The treatment of nocturnal enuresis has shifted in the past few decades from a strictly psychopathological perspective to a biobehavioral perspective. Although the primary clinical features of this disorder are medical/organic, there is currently strong evidence for a behavioral treatment package consisting of the urine alarm and various skillsoriented components. Alternative devices, methods, and adjunctive components are reviewed and presented in the context of an optimal treatment plan.

Advancing biobehavioral research in childhood cancer.

Research on individual and family responses to a child's or adolescent's cancer diagnosis and treatment is important because of significant advances in the field of pediatric oncology. To date, the majority of research has been behavioral or psychosocial in nature. It could be argued that a more holistic perspective that includes psychological, sociocultural, and biological dimensions would advance knowledge about individual and family responses to the experience of childhood cancer. Biobehavioral research refers to investigations that link behavioral and biological underpinnings in specific areas of science. The purpose of this article is to review research in two broad areas that could benefit from a biobehavioral perspective-psychosocial functioning/behavioral adjustment, and CNS treatment outcomes. Studies that include biological measures are highlighted. Advantages, challenges, and strategies for advancing biobehavioral research in childhood cancer are proposed.

Disambiguating the components of emotion regulation.

Affective neuroscience and cognitive science approaches are useful for understanding the components of emotion regulation; several examples from current research are provided. Individual differences in emotion regulation and a focus on the context of emotion experience and expression provide additional tools to study emotion regulation, and its development, from a biobehavioral perspective.

Nausea and emesis: evidence for a biobehavioral perspective.

Abstract. For most people, nausea and vomiting (NV) are simply unfortunate consequences of overindulgent college days or overenthusiastic amusement rides. Yet for most cancer patients, nausea and vomiting (also referred to as emesis) remain among the most frequent side effects of cancer chemotherapy. Patients typically view control of nausea as more important than control of emesis, while physicians and nurses judge emesis control to be more important to antiemetic efficacy than nausea control. The 5-HT3 receptor antagonists have been shown to be clinically more effective in controlling emesis, particularly that caused by regimens containing high-dose cisplatin, than previously available agents. Disappointingly, however, these drugs do not appear to be more effective than previous antiemetics in reducing nausea. In addition, the 5-HT3 receptor antagonists may become less effective over repeated chemotherapy administrations, and they remain expensive. An impediment to research progress has been an insularity that has prompted two parallel research efforts: one searching for biological understanding to enhance pharmacological intervention(s) and the other searching for psychological understanding to aid in developing more effective behavioral intervention(s). While both approaches have been successful, it is time to have the two views merge into a biobehavioral framework that combines them both. This paper draws on both physiological and psychological origins of NV to begin the development of a biobehavioral model of development that integrates features of both approaches.

Influence of adjuvant chemotherapy on skeletal muscle and fatigue in women with breast cancer.

The purpose of this pilot study was to investigate the changes in skeletal muscle size and strength and perception of fatigue in women undergoing adjuvant chemotherapy for breast cancer. The findings of this pilot study suggest that changes in muscle size and strength can occur during chemotherapy. Quadricep muscle size increased for two subjects. These subjects also experienced an increase in muscle strength. This is the first known study to address change in muscle size and fatigue in women during adjuvant chemotherapy for breast cancer from an integrated biobehavioral perspective. Our findings may indicate that muscle size can increase during chemotherapy, but this may not diminish the subjective experiences of fatigue. As the potential for causing serious damage to striated muscle exists, further research into muscle changes and activity during chemotherapy and its role in fatigue is crucial.