RESUMEN
Patients diagnosed with somatization disorder have high rates of disability and often prove refractory to treatment. This preliminary investigation examines the effect of a 10-session cognitive behavior therapy (CBT) protocol on the physical discomfort and disability of severely impaired somatizers. The severity of patients' physical discomfort and disability was assessed at baseline, post-treatment, and eight months following treatment. Patients reported significant improvement in symptomatology and physical functioning between baseline and post-treatment as well as between baseline and follow-up. The findings suggest that CBT might benefit patients diagnosed with somatization disorder and should be subjected to a controlled treatment trial.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastornos Somatomorfos/terapia , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Heart rate and blood pressure, as well as other physiological systems, among healthy people, show a complex pattern of variability, characterized by multifrequency oscillations. There is evidence that these oscillations reflect the activity of homeostatic reflexes. Biofeedback training to increase the amplitude of respiratory sinus arrhythmia (RSA) maximally increases the amplitude of heart rate oscillations only at approximately 0.1 Hz. To perform this task people slow their breathing to this rate to a point where resonance occurs between respiratory-induced oscillations (RSA) and oscillations that naturally occur at this rate, probably triggered in part by baroreflex activity. We hypothesize that this type of biofeedback exercises the baroreflexes, and renders them more efficient. A manual is presented for carrying out this method. Supporting data are provided in Lehrer, Smetankin, and Potapova (2000) in this issue.
Asunto(s)
Arritmia Sinusal/fisiopatología , Biorretroalimentación Psicológica , Presión Sanguínea , Frecuencia Cardíaca , Barorreflejo/fisiología , Humanos , RespiraciónRESUMEN
Idiopathic environmental intolerance (IEI) is a poorly understood condition that may involve disturbances in immunologic, neurologic, endocrine, behavioral, emotional, and cognitive processes. This chapter reviews theories and evidence that behavioral conditioning processes, including pharmacologic sensitization, conditioned immunomodulation, and conditioned odor and taste aversions, may play a role in the development and maintenance of IEI. It also reviews the psychophysiologic concepts of individual response specificity and situational response stereotypy as potential explanations for the individual differences observed in specific responses to environmental stimuli in patients with IEI. Finally, the treatment implications of a conditioning account of IEI are discussed as part of a more comprehensive treatment approach that incorporates other behavioral and nonbehavioral strategies.
Asunto(s)
Condicionamiento Clásico , Enfermedades Ambientales/psicología , Sensibilidad Química Múltiple/psicología , Enfermedades Profesionales/psicología , Animales , Desensibilización Psicológica , Exposición a Riesgos Ambientales/efectos adversos , Enfermedades Ambientales/terapia , Generalización Psicológica , Humanos , Sensibilidad Química Múltiple/terapia , Enfermedades Profesionales/terapia , Factores de RiesgoRESUMEN
Asthma is a common disease whose morbidity and mortality are rapidly increasing. Panic disorder is common in asthma. Panic, other negative emotions, and a passive coping orientation may affect asthma by producing hyperventilation, increased general autonomic lability, a specific pattern of autonomic arousal that may cause bronchoconstriction, and/or detrimental effects on health care behaviors. Generalized panic is a risk factor for increased asthma morbidity. A repressive coping style also appears to be a risk factor for asthma morbidity because it is accompanied by an impaired ability to perceive symptoms, a necessary prerequisite for taking appropriate remediation. Several self-regulation strategies are hypothesized to be useful adjuncts to asthma treatment. Preliminary research has been done on relaxation therapy, EMG biofeedback, biofeedback for improved sensitivity in perceiving respiratory sensations, and biofeedback training for increasing respiratory sinus arrhythmia. It is hypothesized that finger temperature biofeedback also may be a promising treatment method, and that relaxation-oriented methods will have their greatest effect among asthmatics who experience panic symptoms, while improved perceptual sensitivity will be helpful both for patients who panic and those with repressive coping styles.
Asunto(s)
Asma/etiología , Pánico , Terapia por Relajación , Estrés Fisiológico , Asma/terapia , HumanosRESUMEN
This paper proposes several hypotheses and research strategies for exploring possible psychological factors contributing to multiple chemical sensitivity (MCS). The hypotheses are based on concepts of individual response stereotypy, situational response specificity, classical conditioning of chemical-induced responses, and psychophysiological reactions to active and passive coping orientations. Hypotheses regarding hypersensitivity to perception and/or aversiveness of chemical stimulation also are presented. Strategies for evaluating these hypotheses are described based on experimental literature on psychophysiology and psychophysics.
Asunto(s)
Sensibilidad Química Múltiple/etiología , Sensibilidad Química Múltiple/psicología , Cognición , Salud Ambiental , Humanos , Hiperventilación/complicaciones , Modelos Biológicos , Modelos Psicológicos , Sensibilidad Química Múltiple/fisiopatología , Percepción , Trastornos Psicofisiológicos/etiología , Psicofisiología , Olfato , Estrés Psicológico/fisiopatologíaRESUMEN
This paper reports the relationships among changes in cardiovagal activity, surface EMG, and measures of pulmonary function in a study of relaxation therapy for asthma. Changes in FEV1/FVC were negatively correlated with those in cardiac interbeat interval, consistent with the hypothesis that relaxation-induced changes in airway function are mediated autonomically, with increased vagal tone and/or decreased sympathetic arousal producing bronchoconstriction. Contrary to Kotses's theory of a vagal-trigeminal reflex as mediator for relaxation-induced improvement in asthma, decreases in pulmonary function occurred during relaxation sessions, accompanied by increases in cardiovagal activity, and within-session changes in frontal EMG in the first session of training were positively associated with changes in a measure of pulmonary function (FEV1/FVC). However, consistent with this hypothesis, first-session frontalis EMG changes were positively associated with changes in respiratory sinus arrhythmia, and last-session changes in cardiac interbeat interval were positively associated with changes in FEV1/FVC. The results suggest that the immediate effects of generalized relaxation instruction can be associated with a parasympathetic rebound, which, in tum, may induce countertherapeutic changes in asthma. However, the effects of specific facial muscle relaxation remain unclear.
Asunto(s)
Asma/terapia , Terapia por Relajación , Adulto , Anciano , Electrocardiografía , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Función RespiratoriaRESUMEN
This study investigated pulmonary and autonomic reactions to active and passive behavioral laboratory tasks among asthmatic subjects. It also examined the relationship between airway irritability, as measured by the methacholine challenge test (MCT), and autonomic activity and reactivity to these tasks. Fifty-one asthmatic and 37 nonasthmatic subjects were exposed to psychological laboratory tasks involving either active (mental arithmetic and reaction time) or passive (films depicting shop accidents and thoracic surgery) response. The MCT was given to asthmatics in a separate session. Active tasks reduced respiratory impedance, as measured by forced oscillation pneumography. They also increased heart rate and appeared to block vagal activity, as measured by respiratory sinus arrhythmia (RSA). Airway irritability as assessed by the MCT was positively related to amplitude of RSA and to skin conductance levels. Our data suggest that active and passive behavioral tasks may produce different pulmonary effects among both asthmatic and nonasthmatic individuals. Engaging in tasks requiring active responses may produce temporary improvements in pulmonary function. No autonomic differences were obtained between asthmatics and nonasthmatics in physiological response to stress, but greater cholinergic receptor sensitivity was suggested among high responders to methacholine.
Asunto(s)
Asma/psicología , Procesos Mentales/fisiología , Psicofisiología , Pruebas de Función Respiratoria/psicología , Estrés Psicológico/fisiopatología , Adolescente , Adulto , Análisis de Varianza , Asma/fisiopatología , Estudios de Casos y Controles , Estudios Cruzados , Humanos , Masculino , Cloruro de Metacolina/farmacología , Parasimpaticomiméticos/farmacología , Análisis de Regresión , Respiración/fisiología , MuestreoRESUMEN
This study examined the psychophysiological effects of slow-paced breathing while subjects breathed through external respiratory resistive loads. Twenty-four normal volunteers completed four 5-min trials of paced breathing (.125 Hz) through an inspiratory resistive wire mesh screen (0 to 25 cm H2O/L/s). Each trial was followed by a 5-min rest trial. There was evidence for hyperventilation and/or fatigue during paced breathing. Also, respiratory sinus arrhythmia (RSA) was elevated in the first minute of paced breathing, and then declined toward baseline. Heart period decreased during paced breathing trials, and fell significantly below baseline during rest periods. These data suggest decreased vagus nerve activity and/or sympathetic activation, following an initial increase in parasympathetic activity during paced breathing. They are not consistent with the use of .125-Hz paced breathing as a relaxation technique, particularly during respiratory resistive stress. Finally, although RSA and average heart period changed synchronously within paced breathing and rest conditions, they diverged in comparisons between pacing and rest. This dissociation suggests that different mechanisms mediate these two cardiac parameters. These data are consistent with Porges' theory that vagal influences on tonic heart rate are mediated by the combined effect of vagal projections from both the nucleus ambiguus and the dorsal motor nucleus, while RSA is mediated only through the nucleus ambiguus alone.
Asunto(s)
Arritmia Sinusal/fisiopatología , Corazón/fisiología , Respiración/fisiología , Nervio Vago/fisiología , Adolescente , Adulto , Femenino , Humanos , MasculinoRESUMEN
The authors assessed airway impedance responses to psychological stressors among 113 individuals: 61 with asthma only (AS), 10 with asthma and panic disorder (ASPD), 24 with panic disorder only (PD), and 18 controls with neither condition (CON). Individuals with either AS or PD were affected by psychological stressors as measured by the forced oscillation technique. Individuals with PD (with or without AS) displayed lower airway impedance than those without PD. These data suggest that the airways of individuals with PD are in a chronic state of preparedness, which may promote hyperventilation.
Asunto(s)
Resistencia de las Vías Respiratorias/fisiología , Nivel de Alerta/fisiología , Asma/fisiopatología , Trastorno de Pánico/fisiopatología , Estrés Psicológico/complicaciones , Adolescente , Adulto , Asma/psicología , Femenino , Humanos , Hiperventilación/fisiopatología , Hiperventilación/psicología , Masculino , Trastorno de Pánico/psicología , Ventilación Pulmonar/fisiologíaRESUMEN
Eighty-six asthmatics completed measures of illness-specific panic-fear (i.e., panic-fear in response to symptoms of asthma) and of generalized panic-fear, dyspnea frequency, and catastrophic cognitions about bodily symptoms (the Anxiety Sensitivity Index [ASI] and Agoraphobic Cognitions Questionnaire [ACQ]). Asthma variables (self-report and pulmonary function tests) and cognitive variables (ASI and ACQ) were independently related to illness-specific panic-fear. Regression analyses showed that the cognitive variables predicted significant variance in both panic-fear scales after controlling for the effects of demographic and asthma variables. By contrast, the asthma variables were not associated with generalized panic-fear when the cognitive measures were controlled. In light of the adverse effects of panic-fear on asthma, the authors' results suggest that researchers may fruitfully explore the use of cognitive techniques as an adjunctive treatment for improving asthma outcome.
Asunto(s)
Asma/psicología , Miedo , Pánico , Trastornos Psicofisiológicos/psicología , Rol del Enfermo , Trastornos Somatomorfos/psicología , Adolescente , Adulto , Asma/rehabilitación , Terapia Cognitivo-Conductual , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Inventario de Personalidad/estadística & datos numéricos , Psicometría , Trastornos Psicofisiológicos/diagnóstico , Trastornos Psicofisiológicos/rehabilitación , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/rehabilitación , Capacidad VitalRESUMEN
This article evaluates the hypothesis that various stress management techniques have specific effects. Studies comparing various techniques are reviewed, as well as previous literature reviews evaluating the effects of individual techniques. There is evidence that cognitively oriented methods have specific cognitive effects, that specific autonomic effects result from autonomically oriented methods, and that specific muscular effects are produced by muscularly oriented methods. Muscle relaxation and/or EMG biofeedback have greater muscular effects and smaller autonomic effects than finger temperature biofeedback and/or autogenic training. EMG biofeedback produces greater effects on particular muscular groups than progressive relaxation, and thermal biofeedback has greater finger temperature effects than autogenic training. Disorders with a predominant muscular component (e.g., tension headaches) are treated more effectively by muscularly oriented methods, while disorders in which autonomic dysfunction predominates (e.g., hypertension, migraine headaches) are more effectively treated by techniques with a strong autonomic component. Anxiety and phobias tend to be most effectively treated by methods with both strong cognitive and behavioral components.
Asunto(s)
Estrés Fisiológico/terapia , Entrenamiento Autogénico/métodos , Biorretroalimentación Psicológica/métodos , Estudios de Evaluación como Asunto , Humanos , Terapia por RelajaciónRESUMEN
Thirty-one adult asthmatic subjects, aged 18 to 40 years, were administered both ipratropium bromide and placebo, in two sessions, held at least 2 days apart, in balanced order. Pulmonary function, heart period (milliseconds between heart beats), and respiratory sinus arrhythmia (a measure of cardiac vagal tone) were assessed before drug administration and 45 min thereafter. Ipratropium bromide had no significant effect on cardiac vagal tone, while it did produce improvement in pulmonary function.
Asunto(s)
Asma/fisiopatología , Frecuencia Cardíaca/efectos de los fármacos , Ipratropio/farmacología , Respiración/efectos de los fármacos , Nervio Vago/efectos de los fármacos , Administración por Inhalación , Adulto , Aerosoles , Pruebas de Provocación Bronquial , Femenino , Humanos , Ipratropio/administración & dosificación , Masculino , Contracción Miocárdica/efectos de los fármacos , Espirometría , Factores de Tiempo , Nervio Vago/fisiologíaRESUMEN
The purpose of this study was to examine the relationship among anxiety sensitivity, the experience of frequent, spontaneous panic attacks, and pulmonary function in individuals with asthma. Ninety-three asthmatics participated by completing a battery of questionnaires and a spirometric assessment. Twenty-three percent of the asthmatics reported a history of spontaneous panic attacks with 9.7% reporting attacks that were severe and frequent enough to meet the DSM-IIIR criteria for panic disorder (PD). Anxiety sensitivity (ASI) scores, but not pulmonary function, was significantly related to PD. In addition, we compared the asthmatics (with and without PD) to 10 clinically diagnosed PD Ss without asthma and to 32 nonanxious, nonasthmatic controls on the ASI, the Body Sensations Questionnaire, and the Agoraphobic Cognitions Questionnaire. Whereas Ss with PD (asthmatic and nonasthmatic) displayed significant elevations on these measures compared to those without PD, the presence of asthma alone had no effect. The present study concurs with that of Porzelius et al. [Behaviour Research and Therapy, 30, 75-77 (1992)] in extending the validity of the cognitive model of PD to individuals with pulmonary disease.
Asunto(s)
Ansiedad/psicología , Asma/psicología , Pánico , Adulto , Ansiedad/complicaciones , Ansiedad/terapia , Nivel de Alerta , Comorbilidad , Femenino , Humanos , Masculino , Inventario de PersonalidadRESUMEN
Heart rate is rhythmically related to respiratory rate, in a phenomenon known as respiratory sinus arrhythmia (RSA). Amplitude of RSA has been found to be an accurate noninvasive measure of vagal tone in the normal population. The purpose of this study was to examine the relationship between RSA and cardiac vagal tone among asthmatics, a group which has been described as having elevated RSA. This was accomplished by examining the effects of atropine on RSA in asthmatics, and comparing the results to those obtained elsewhere among normal subjects. Atropine at a dose of 1 mg/75 kg body weight was administered to 18 asthmatics, and produced decreases in RSA, equivalent to those previously found among normal subjects. The results suggest that the relationship between cardiac vagal tone and RSA is unaffected by the presence of asthma.
Asunto(s)
Asma/fisiopatología , Atropina/farmacología , Frecuencia Cardíaca/efectos de los fármacos , Mecánica Respiratoria/efectos de los fármacos , Nervio Vago/efectos de los fármacos , Adolescente , Adulto , Método Doble Ciego , Electrocardiografía/efectos de los fármacos , Femenino , Flujo Espiratorio Forzado/efectos de los fármacos , Volumen Espiratorio Forzado/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Respiración/fisiología , Capacidad Vital/efectos de los fármacosRESUMEN
One hundred six asthmatic subjects were medically prestabilized, then assigned to eight sessions of progressive relaxation, music, or a waiting-list. Seventy-two subjects completed treatment, of which 37 were evaluated in the laboratory with measures of forced expiratory flow. Relaxation-group subjects reported feeling the most deeply relaxed and produced the greatest improvement in forced expiratory flow during the last presession assessment period. All groups evidenced decreases in asthma symptoms. All groups showed decreases in pulmonary function immediately after relaxation sessions. None of the changes in pulmonary function reached levels that are accepted in drug trials to be of clinical significance, and the therapeutic changes occurred only in the situation where training was rendered. Listening to music produced greater decreases in peaks of tension than progressive relaxation, and it produced greater compliance with relaxation practice, but it did not produce any specific therapeutic effects on asthma.
Asunto(s)
Asma/terapia , Música , Terapia por Relajación , Adolescente , Adulto , Anciano , Asma/diagnóstico , Humanos , Cloruro de Metacolina , Persona de Mediana Edad , Ventilación Pulmonar , Pruebas de Función Respiratoria , Autoevaluación (Psicología) , Espirometría , Resultado del TratamientoRESUMEN
In a critique of the study by Carr, Lehrer and Hochron (1992), Ley (Behaviour Research and Therapy, 32, 109-111, 1994) attributes the lack of confirmation for his dyspneic-fear theory among panic disorder patients to a basic flaw of that study: Ss were selected according to DSM-IIIR criteria. Ley argues that dyspneic-fear theory pertains exclusively to hyperventilatory (characterized by intense dyspnea) panic attacks not to all attacks that come under the classification of DSM-IIIR. We address the premise concerning the selection of Ss and argue that cognitive theory continues to offer a more convincing explanation of our study and of more recent findings by others.
Asunto(s)
Disnea/etiología , Miedo , Hiperventilación/psicología , Trastorno de Pánico/psicología , Femenino , Humanos , MasculinoRESUMEN
The Asthma Symptom Profile (ASP) assesses phasic changes in three dimensions of asthma symptoms: intensity, unpleasantness, and quality of sensations. Quantification data on verbal descriptors were gathered from 46 adult asthmatics for each of these scales, using bimodality scaling: i.e., with numerical estimates and drawing lines varying length. Close agreement was obtained between these two modalities. The ASP was analyzed before and after a bronchodilator in 44 asthmatics using ipratropium bromide (IB). Forty of these subjects were also tested in a placebo condition. Although ASP changes produced by IB were no greater than those produced by the placebo, correlations with changes in spirometry variables were significant. There were no significant differences in correlations with line drawings vs. numerical ratings. The ASP appears to be useful measure of phasic changes in asthma symptoms. Asthmatics with mild airway obstruction do not appear to be able to discriminate small changes in airway function.
Asunto(s)
Asma/psicología , Índice de Severidad de la Enfermedad , Rol del Enfermo , Adolescente , Adulto , Asma/clasificación , Asma/tratamiento farmacológico , Método Doble Ciego , Femenino , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Ipratropio/uso terapéutico , MasculinoRESUMEN
This review of the empirical literature on the relationship between asthma and emotion presents an explanatory model of the connection between them. Asthmatics tend to report and display a high level of negative emotion, and asthma exacerbations have been linked temporally to periods of heightened emotionality. Causality may be bidirectional. Hypothesized mediators for the relationship between asthma and emotionality include vagal and alpha-sympathetic hyperreactivity, predominant obstruction in the larger airways, individual response stereotypy, direct effects of emotion-related facial muscle tension on the airways, the emotional effects of asthma medications, heightened respiratory drive, and hyperventilation. Predictions are presented for research on this model of asthma and emotion, and for the psychological treatment of asthma.
Asunto(s)
Asma/psicología , Emociones , Estrés Psicológico/complicaciones , Conductas Relacionadas con la Salud , Humanos , Modelos PsicológicosRESUMEN
Thirty-three asthmatic subjects were told they were receiving, alternately, an inhaled bronchoconstrictor and inhaled bronchodilator, although they actually were only breathing room air. No subjects showed suggestion-produced effects on FEV1, although two (of the 19 on whom FEF50 was measured) showed effects of greater than 20% on measures of maximal midexpiratory flow. The incidence of the effect is smaller than reported previously, possibly because some subjects in previous studies inhaled saline, a mild bronchoconstrictor, and reversal of effect was not required for classification as a reactor. Higher percentages of subjects in this study showed decreased MMEF in response to the 'bronchoconstrictor', but this appeared to reflect fatigue rather than suggestion effects. However, the fact that the effect occurred in a relatively non-effort-dependent measure suggests that real changes occurred in bronchial caliber, not just in test effort. Suggestion had a significant effect on perception of bronchial changes, but the correlation between actual and perceived changes was minimal. There was an increase in FVC prior to administration of the 'bronchoconstrictor', possibly reflecting a preparatory response to the expected drug. Correlations among self-report variables suggested the existence of three personality dimensions among our population related to suggestion and asthma: cognitive susceptibility to suggestion of bronchial change; feeling of physical vulnerability; and anxiety. However, there was no significant relationship between airway response to suggested changes and hypnotic susceptibility, as measured by the Harvard Group Scale of Hypnotic Susceptibility.
Asunto(s)
Resistencia de las Vías Respiratorias/fisiología , Asma/psicología , Trastornos Psicofisiológicos/psicología , Sugestión , Asma/fisiopatología , Pruebas de Provocación Bronquial/psicología , Niño , Femenino , Volumen Espiratorio Forzado/fisiología , Humanos , Hipnosis , Masculino , Trastornos Psicofisiológicos/fisiopatología , Psicofisiología , Disposición en Psicología , Capacidad Vital/fisiologíaRESUMEN
Outcome literature on psychological treatment for asthma covers psychoeducational self-management programs, relaxation therapy, biofeedback, and family therapy. Psychoeducational approaches now being standardized in a national program are cost-effective. They produce improved adjustment, increased medication compliance, greater perceived self-competence in managing symptoms, and decreased use of medical services. Significant effects have been found for relaxation therapy, although it is not clear whether the effectiveness depends on whole-body relaxation or specifically facial- or respiratory-muscle relaxation. Family therapy is helpful to some asthmatics. Active components in these methods remain to be identified as do the populations whom they can best serve. Biofeedback for respiratory resistance, trachea sounds, and vagal tone shows promise but has not been given adequate clinical testing.