Health-related Stimuli Research Articles

Resting-state connectivity and neural response to emotional images in patients with severe health anxiety: An fMRI study

BackgroundSevere health anxiety is a disorder characterized by a persistent preoccupation with one's health. In behavioral studies, biases in the processing of health-related stimuli (e.g., pictures, words) are consistently associated with health anxiety symptoms. The neural correlates of the observed behavioral abnormalities remain however poorly understood. MethodsIn this functional magnetic resonance imaging study, 22 treatment-seeking patients with severe health anxiety and 22 control participants performed a resting-state and a picture matching task. Immediately after the resting-state, participants completed a questionnaire quantifying their thoughts and feelings during rest along several dimensions. The picture task included images of health-related and neutral scenes and of disgusted and neutral faces. ResultsCompared to controls, patients with health anxiety showed increased functional connectivity in the dorsolateral prefrontal cortex within the left fronto-parietal resting-state network, which correlated positively with the self-reported thought dimensions of Self, Health Concern, and Thought Suppression. In the picture matching task, no significant group differences were found in the hypothesised regions (amygdala and insula) or at a whole-brain level in response to either health-related versus neural scenes or disgust versus neutral faces contrasts. LimitationsA relatively small sample size and that no information about patients declining to participate was obtained. ConclusionsOur findings suggest that behavioral biases in health anxiety may be related to aberrant left dorsolateral prefrontal cortex functional connectivity at rest. In contrast, the health anxiety patients did not show significant hyperactivations of amygdala and insula during processing of emotional stimuli, contrasting findings in other anxiety disorders.

"Health Comes First": Action Tendencies to Health-Related Stimuli in People with Health-Anxiety as Revealed by an Emotional Go/No-Go Task.

The processing of health-related stimuli can be biased by health anxiety and anxiety sensitivity but, at the moment, it is far from clear whether health-related stimuli can affect motor readiness or the ability to inhibit action. In this preliminary study, we assessed whether different levels of health anxiety and anxiety sensitivity affect disposition to action in response to positive and negative health-related stimuli in non-clinical individuals. An emotional go/no-go task was devised to test action disposition in response to positive (wellness-related), and negative (disease-related) stimuli in non-clinical participants who also underwent well-validated self-report measures of health anxiety and anxiety sensitivity. The main results showed that both health anxiety and anxiety sensitivity biased participants’ responses. Importantly, safety-seeking and avoidance behaviors differently affected action disposition in response to positive and negative stimuli. These preliminary results support the idea that health anxiety and anxiety sensitivity could determine a hypervigilance for health-related information with a different perturbation of response control depending on the valence of the stimuli. Health anxiety and health anxiety disorder do form a continuum; thus, capturing different action tendencies to health-related stimuli could represent a valuable complementary tool to detect processing biases in persons who might develop a clinical condition.

Risk-Aversion for Negative Health Outcomes May Promote Individual Compliance to Containment Measures in Covid-19 Pandemic.

First-person experience of stressful life events can change individuals' risk attitudes, driving to increased or decreased risk perception. This shift to more risk-averse or risk-loving behaviors may find a correlate in the individual psycho-socio-emotional profile. To this purpose, we aimed to estimate the relationship between differences in risk-taking attitudes toward possible negative health outcomes and psycho-socio-emotional dimensions modulating the experience of life-threatening situations, in the context of the Covid-19 pandemic. In March 2020, we launched the PsyCovid Study (https://wprn.org/item/428452) to assess psycho-socio-emotional changes due to Covid-19 pandemic in the Italian population. Additionally, we distributed to 130 participants the Covid-19 Risk Task, including monetary and health-related stimuli, estimating a measure of risk-aversion toward health and classifying participants on the basis of their risk-attitude profiles. The set of psycho-socio-emotional variables was reduced to three PCA components: Proactivity, Isolation, Inactivity. The individual degree of risk-aversion toward negative health outcomes was directly related to Proactivity, encasing empathic, social support and positive coping strategies, which may prompt individuals to put in place self-protection strategies toward possible negative health consequences. These findings indicate that a risk-averse profile toward possible negative health outcomes may be associated to higher levels of individual prosocial and proactive dispositions, possibly making individuals' more compliant with the social and hygienic guidelines and, thus, reducing their exposure to the SARS-CoV-2 infection.

Health Profiling Using Event-Related Potential (ERP) Brain Signals and Spiking Neural Network (SNN)

Unhealthy lifestyles, especially on nutritional factors have become a major problem causing many diseases in Malaysians in recent years. Identification of lifestyle profiles such as preventive for individuals who adopt healthy and curative for individuals who do not maintain their lifestyle is needed to increase their awareness regarding their lifestyle. Because self-assessment is known to be vulnerable to produce response biases that lead to misclassification, identification of profiles based on brain responses needs to be done. An Event-related potential (ERP) is the main tools of cognitive neurologists and make ideal techniques for studying perception and attention. This research captured brain activity using electroencephalography (EEG) during receiving images of healthy and unhealthy foods that act as health-related stimuli. These EEG signals converted mathematically into the ERP signals and entered into the classification interface as input. In terms of classification, the methodology used is a dynamic developing Spiking Neural Network (deSSN) based on the Neucube architecture. ERP analysis results shown the mean amplitude of the LPP component in the Parietal and Occipital lobes is higher for healthy food in the preventive group. Whereas in the curative group it has been shown to be higher for unhealthy foods. This result is thought to reflect their preference in choosing food in their daily lifestyle. However, the results of the classification have shown that unhealthy food stimulation in the LPP wave showed superior results compared to data analysis in other conditions. Classification with ERP data is believed to support the results of self-assessment and build methods of making profiles that are more accurate and reliable.

Encoding and retrieval biases for health-related scenes in patients with severe health anxiety

ABSTRACTSevere health anxiety is a disorder characterised by excessive worries about harbouring or having a serious illness. The present study examines cognitive biases in evaluation and memory for health-related scenes in severe health anxiety in order to provide insights into the effect of these biases and the formation of illness intrusions in severe health anxiety. Twenty patients with severe health anxiety and 20 healthy participants completed a computerised task consisting of encoding, involuntary retrieval, voluntary retrieval and recognition of health-related, negative and neutral scenes. The results demonstrated that patients with severe health anxiety reported more negative emotional valence and greater physiological arousal to health-related scenes, both during encoding (ps < .031, > .09) and retrieval (ps < .044, ds > 0.18). Furthermore, in contrast to the comparison group, patients with severe health anxiety did not show shorter retrieval time for health-related scenes during involuntary compared with voluntary retrieval (p = .789, d = 0.08), possibly due to greater demands on emotion regulation during involuntary retrieval. The results suggest an important role for negative emotional valence and physiological arousal to health-related stimuli in severe health anxiety, and highlight how cognitive biases in evaluation and memory might be at play in this disorder.

Cognitive Biases Toward Pain: Implications for a Neurocognitive Processing Perspective in Chronic Pain and its Interaction With Depression.

Information-processing biases such as attentional, interpretation, and memory biases are supposed to play a role in the exacerbation and maintenance of chronic pain. Current research in the area of cognitive biases shows that all these biases seem to have an influence on attention to, interpretation of, and recall of pain and can lead to maladaptive strategies and the exacerbation of pain. We conducted a narrative literature review, considering evidence extracted from various databases including PubMed, MEDLINE, Science Direct, and ProQuest. Search terms included cognitive biases, neurocognitive processing, chronic pain, and depression. The literature on attentional, interpretative, and memory biases in experimental and chronic pain, as well as their neuronal underpinnings, suggests that the depression of chronic pain patients may differ from the depression of patients without pain. Depressed pain patients show a recall bias for illness-related and health-related stimuli, whereas depressed patients without pain show a bias for depression-related stimuli. In addition, research has shown that catastrophizing, helplessness/hopelessness, and thought suppression as psychological responses to pain are mediators of the relationship between chronic pain and depression. Current research supports the importance of individual diagnosis of chronic pain patients and their response patterns of pain, psychological processing, and information processing. This leads to the conclusion that depressed pain patients need other clinical interventions when compared with depressed patients without pain. Previous research showed that a combination of a cognitive-behavioral therapy with mindfulness meditation seems to be a promising approach.

Interpretation bias in the face of pain: a discriminatory fear conditioning approach.

Background and aims Interpreting pain- and illness-related stimuli as health-threatening is common among chronic pain patients but also occurs in the general population. As interpretation bias (IB) may affect pain perception and might even play part in the development and maintenance of chronic pain, it is important to improve our understanding of this concept. Several studies suggest an association between IB and pain-related anxiety. However, those studies often rely on verbal and pictorial IB tasks that do not entail a threat of actual pain, therefore lacking personal relevance for healthy participants. The current study investigated whether healthy individuals show an IB towards ambiguous health-related stimuli in a context of actual pain threat, and explored whether this bias is associated to pain anxiety constructs. Methods Thirty-six healthy participants were conditioned to expect painful electrocutaneous shocks (unconditioned stimulus - US) after health-threat words (CS+) but not after neutral (non-health-threat) words (CS-) in order to establish fear of pain. Subsequently, they completed a verbal interpretation task that contained new CS+ and CS- stimuli as well as ambiguous non-reinforced health-threat and non-health-threat words. IB was assessed through shock expectancy ratings and startle responses to ambiguous and evident health threatening or neutral word stimuli. Pain-related anxiety was measured with validated questionnaires. Results The results show a general IB towards ambiguous health-related words on pain expectancies but not on startle response. An exploratory analysis suggests that this effect exists irrespective of pain-related anxiety levels which however may be due to a lack of power. Conclusion We present a novel experimental paradigm employing actual health threat that captures IB towards health-related stimuli in healthy individuals. Taken together, results provide evidence for the further consideration of IB as a latent vulnerability factor in the onset and maintenance of pain chronicity. In contrast to previous studies employing a safe, pain-free context, we found that healthy participants show an IB towards ambiguous health-related stimuli, when confronted with pain threat. Implications Like chronic pain patients, healthy individuals display an IB towards health-threat stimuli when these stimuli become personally relevant by carrying information about pending health threat. Therefore, the presented paradigm could be valuable for pain-related cognitive bias research in healthy participants as it may have a higher ecological validity than previous study designs. Future studies will have to elucidate the influence of anxiety constructs on IB in larger samples.

Effects of Dispositional Coping Strategy and Level of Health Anxiety on Attentional Bias

We examined the influence of dispositional coping strategy and level of health anxiety (HA) on attentional bias in regard to health-related stimuli. In a dot-probe task participants were exposed to health and nonhealth-related words for 1,250 ms. The high HA group showed significantly greater attentional bias in regard to health stimuli compared to the low HA group. In addition, in the low HA group there was no difference in attentional bias toward health-related words according to whether they were blunters (cognitively avoidant) or monitors (vigilant for information), but in the group with high HA blunters showed stronger attentional bias for health stimuli compared to monitors. Our results in this study confirmed that not only did individuals with HA show a bias toward selective attention to health-related information, but also that this bias was affected by their dispositional coping strategy.

Diagnostic uncertainty and recall bias in chronic low back pain

Patients’ beliefs about the origin of their pain and their cognitive processing of pain-related information have both been shown to be associated with poorer prognosis in low back pain (LBP), but the relationship between specific beliefs and specific cognitive processes is not known. The aim of this study was to examine the relationship between diagnostic uncertainty and recall bias in 2 groups of chronic LBP patients, those who were certain about their diagnosis and those who believed that their pain was due to an undiagnosed problem. Patients (N=68) endorsed and subsequently recalled pain, illness, depression, and neutral stimuli. They also provided measures of pain, diagnostic status, mood, and disability. Both groups exhibited a recall bias for pain stimuli, but only the group with diagnostic uncertainty also displayed a recall bias for illness-related stimuli. This bias remained after controlling for depression and disability. Sensitivity analyses using grouping by diagnosis/explanation received supported these findings. Higher levels of depression and disability were found in the group with diagnostic uncertainty, but levels of pain intensity did not differ between the groups. Although the methodology does not provide information on causality, the results provide evidence for a relationship between diagnostic uncertainty and recall bias for negative health-related stimuli in chronic LBP patients.

Health threat increases attentional bias for negative stimuli

Background and objectivesAlthough there is some evidence that health anxiety is associated with attentional bias, relatively little research has examined the role of situational threat on bias. This study examined the effect of health threat on attentional bias for negative health words. MethodsParticipants completed questionnaires and were then randomized to receive either threatening or reassuring health-related feedback. Following randomization, participants completed the emotional Stroop and dot-probe tasks in a counter-balanced order. ResultsOn the emotional Stroop task, all participants took longer to name the colour of negative words, as compared to positive and neutral words. However on the dot probe task, differences in attentional bias emerged based on feedback condition. Those receiving reassuring feedback displayed a bias away from negative words while those receiving threatening feedback did not display a bias either towards or away from negative words. Following reassuring feedback only, metacognitions were negatively correlated with attention towards positive health-related stimuli, suggesting another avenue for future research. ConclusionsHealth threats lead to an increase in the processing of negative information, and the effect of metacognitions on processing appears to be apparent only in the absence of health threat.

The Health Literacy Skills Framework

Although there are a variety of models and frameworks that describe factors that are associated with health literacy skills, few illustrate the full pathway from development and moderators of health literacy skills, their application, and the outcomes that result all in one framework or model. This article introduces the Health Literacy Skills conceptual framework that does encompass this full continuum. To develop the framework, the authors reviewed and built upon existing health literacy frameworks. The Health Literacy Skills framework hypothesizes the relations between health literacy and health-related outcomes and depicts how health literacy functions at the level of the individual. The framework also reflects how factors external to the individual (e.g., family, setting, community, culture, and media) influence the constructs and relations represented in the framework. The framework is organized into 4 primary components: (a) factors that influence the development and use of health literacy skills; (b) health-related stimuli; (c) health literacy skills needed to comprehend the stimulus and perform the task; and (d) mediators between health literacy and health outcomes. Previous theoretical frameworks lend support to the proposed causal pathways it illustrates. The authors hope this conceptual framework can serve as a springboard for further discussion and advancement in operationalizing this complex construct. The Health Literacy Skills framework could also be used to guide the development of interventions to improve health literacy. Future research should be conducted to fully test the relations in the framework.

Measuring Health Literacy: A Pilot Study of a New Skills-Based Instrument

Although a number of instruments have been used to measure health literacy, a key limitation of the leading instruments is that they only measure reading ability or print literacy and, to a limited extent, numeracy. Consequently, the present study aimed to develop a new instrument to measure an individual's health literacy using a more comprehensive and skills-based approach. First, we identified a set of skills to demonstrate and tasks to perform. Next, we selected real-world health-related stimuli to enable measurement of these skills, and then we developed survey items. After a series of cognitive interviews, the survey items were revised, developed into a 38-item instrument, and pilot tested using a Web-based panel. Based on the psychometric properties, we removed items that did not perform as well, resulting in a 25-item instrument named the Health Literacy Skills Instrument. Based on confirmatory factor analysis, the items were grouped into five subscales representing prose, document, quantitative, oral, and Internet-based information seeking skills. Construct validity was supported by correlations with the short form of the Test of Functional Health Literacy in Adults and self-reported skills. The overall instrument demonstrated good internal consistency, with a Cronbach's alpha of 0.86. Additional analyses are planned, with the goal of creating a short form of the instrument.

A sensitive body or a sensitive mind? Associations among somatic sensitization, cognitive sensitization, health worry, and subjective health complaints

Objectives Psychobiological sensitization and health worry appear to be involved in the etiology of clinical manifestations of subjective health complaints (SHCs) via amplified processing of health-related information. However, it is not clear whether sensitization and health worry are also associated with common SHCs, which are extremely prevalent and are responsible for a large part of both human suffering and health care costs. In this study, we investigated whether SHCs are associated with health worry and two types of sensitization: cognitive health-related sensitization and somatic sensitization. We also examined whether health worry mediates the relationship between cognitive sensitization and SHCs and whether both levels of sensitization interact. Methods A nonclinical sample of 47 female students completed questionnaires about their recent subjective health as well as health worry and underwent tests for cognitive sensitization, operationalized as Stroop interference and free recall performance, and somatic sensitization, operationalized as pain tolerance and pain threshold in a cold pressor task. Results Severity of health complaints was positively related with recall of health-related stimuli, but not with Stroop interference, and with worrying about health complaints. In addition, worry mediated the relationship between recall bias and severity of health complaints. Both the number and severity of recent health complaints were associated with pain tolerance. Pain threshold was associated with Stroop interference for health-related information. Conclusions The results suggest that specific types of cognitive sensitization and somatic sensitization are associated with common health complaints and that worrying about one's complaints might play a role by enhancing biased memory of health-related information.

An experimental analysis of hypochondriasis

Hypochondriasis (HC) involves preoccupation with fears of having a serious medical illness based on the misinterpretation of benign bodily perturbations. Individuals with HC also perform behaviors such as checking and reassurance-seeking presumably to reduce health-related fears. Experimental behavioral analyses of HC symptoms, however, are lacking. In the present study, 27 patients with HC were exposed to personally relevant health-related stimuli under one of two conditions: (a) subsequently performing safety-seeking behaviors (e.g., checking) (n=14) or (b) subsequently being instructed not to perform such behaviors (n=13). In both groups, subjective anxiety and urges to perform safety behaviors were monitored for 1h. Results indicated that exposure to the personally relevant health trigger provoked anxiety and urges to perform safety behaviors. For patients who performed such behaviors, these feelings were reduced. For patients who did not, a more gradual reduction of anxiety and urges was observed. Findings are discussed in terms of the conceptualization and treatment of HC behavior, and are relevant to HC's possible relationship to panic and obsessive–compulsive disorder.

Conscious and Preconscious Uses of Memory in Patients with Depressive and Somatoform Disorders

This study investigated whether conscious and preconscious memory features contribute to discrimination between depressive and somatoform disorders. Thirty-one participants fulfilling the diagnostic criteria for a somatoform disorder and 28 participants fulfilling the criteria for depression were examined within the framework of the process–dissociation paradigm using neutral, health-threatening, and general threatening words in a lexical decision task. Parameters of conscious memory, preconscious memory, and chance were used to compare memory features of both the groups. There was an inverse relationship between conscious and preconscious memory effects for health-threatening stimuli in the group of patients with somatoform disorders but not in the group of depressive patients. Patients with somatoform disorders showed a significantly lower level of conscious memory for health-threatening stimuli than depressive participants. Compared to depressive patients, a more dynamic relationship between decreased conscious and increased preconscious memory for health-related stimuli seems to be characteristic for patients with somatoform disorders.