The Association of Emotion Regulation and Somatic Symptoms.

OBJECTIVE: People with functional somatic symptoms have difficulties in various stages of the emotion regulation (ER) process (1). As an adaptive and flexible use of ER strategies is a core tenet of emotional health, having difficulties in this area is often assumed to be the key mechanism behind functional somatic symptoms. Following a dimensional population-based sampling approach, we investigated emotion regulation abilities across a broad range of people and tested possible associations with somatic symptom reporting, habitual ER use as well as various subclinical constructs (such as alexithymia and anxiety). METHODS: In a sample of N = 254 persons, somatic symptom distress (PHQ-15, HiTOP somatoform spectrum), trait emotion regulation facets (ERQ, ERS) as well as the emotion regulation abilities (suppression and reappraisal) were assessed. Correlations (frequentist and Bayesian), ANOVAs, and Structural Equation Models were used to analyze the data. RESULTS: Correlational and SEM analyses revealed that general symptom severity (both on the somatoform HiTOP and PHQ-15) was not significantly associated with emotion regulation effectiveness, general arousal, or general valence. The sensory component of pain symptoms (r = - .708, p = .023), as well as health anxiety (r = - .443, p = .028) were significantly negatively associated with effective emotion regulation. CONCLUSIONS: Emotion regulation effectiveness appears independent of general somatic symptom distress. We make recommendations for clinical interventions in light of these complex findings.

Somatic symptom distress is not related to cardioceptive accuracy.

OBJECTIVE: (Cardiac) interoception was long considered a key mechanism behind symptom perception in persistent somatic symptoms (PSS). In this study, we aimed to extend earlier findings to clarify this potential interoceptive mechanisms of PSS. METHODS: A cross-sectional sample of 251 participants (23.1% with self-reported functional somatic syndrome) completed a laboratory study with two cardioceptive accuracy tasks (Schandry task and a new cardiac signal detection task) and multiple questionnaires. Somatic symptom distress and associated constructs were assessed with the PHQ-15, as well as with a novel multidimensional questionnaire measure (HiTOP-SF1) derived from the somatoform spectrum of the Hierarchical Taxonomy of Psychopathology (HiTOP). Correlations (frequentist and Bayesian) and structural equation modelling (SEM) helped further investigate the interplay between these variables. RESULTS: There were no significant correlations between measures of interoception and somatic symptom distress. Self-report and behavioral cardioceptive accuracy measures did not correlate significantly. No significant covariances emerged between diagnostic tools and cardioceptive accuracy; Bayesian analyses supported the lack of association between interoception and symptom perception. CONCLUSIONS: Cardiac interoception (specifically cardioceptive accuracy) unlikely represents a key mechanism in PSS etiology. We recommend investigating other factors in PSS.

"And how did that make you feel?" - Repeated symptom queries enhance symptom reports elicited by negative affect.

OBJECTIVE: Negative affect, alexithymia, and other predisposing traits (such as health anxiety) can influence an individual's symptom perception. In this study, we used the affective picture paradigm (APP, Bogaerts et al., 2010) to induce symptoms using affective picture stimuli. We aimed to cross-sectionally test the effect of high vs low-frequency symptom queries and analyze the time course of the APP, including interactions with health anxiety and somatic symptom distress. METHODS: Participants (N = 124) completed a modified APP and filled out various questionnaires. In the APP, participants were randomized to either a highly-frequent-query condition (18 symptom checklists) or a less-frequent-query condition (6 checklists). Data were analyzed using ANOVAs, cross-lagged panel models, moderation models, and multilevel models. RESULTS: Both groups had comparable symptom baseline values, but people in the highly frequent as opposed to less frequent condition reported significantly higher symptom levels once the experiment started (F (1,120) = 14.319, p < .001, η2=.107). Symptom levels stayed stable over the course of the experiment and were best predicted by symptom levels at earlier timepoints in the experiment (ß = 0.43 and ß = 0.68, both p < .001). Health anxiety levels significantly predicted symptom levels (F(1,121) = 10.054, p = .002, η2=.077) and moderated the relation between condition and symptom levels (F(2,121) = 16.253, p < .001, η2=.212). CONCLUSION: In terms of the predictive processing model (e.g.,[1]), repeated symptom queries following negative affective cues may activate prior beliefs about symptoms, resulting in elevated levels of symptom reports in interaction with health anxiety.

He Who Seeks Finds (Bodily Signals): German Validation of the Interoceptive Attention Scale (IATS) and its Relationship with Subclinical Psychopathology.

Alterations in interoception have been linked to psychopathology. Recent findings suggest that both the attention to and the accuracy of, interoceptive perceptions may be oppositely related to subclinical symptomatology. Thus, providing well-validated tools that tap into these interoceptive processes is crucial for understanding the relation between interoceptive processing and subclinical psychopathology. In the current study (N = 642), we aimed to (1) validate the German version of the Interoceptive Attention Scale (IATS; Gabriele et al., 2022), and (2) test the differential association of self-reported interoceptive attention and accuracy with subclinical symptomatology, including alexithymia, depressive, and anxious symptomatology. We observed that a one-factor solution is a well-fitting model for the IATS. Further, the IATS showed good internal consistency, convergent, and divergent validity, but poor test-retest reliability. Self-reported interoceptive attention and accuracy were unrelated to each other. However, IATS scores were positively related to all measures of psychopathology (except depressive symptomatology), whereas self-reported interoceptive accuracy scores showed negative or nonsignificant relations with these. Our data suggest that the IATS is a good instrument to measure self-report interoceptive attention in the German population. Further, we highlight the need to distinguish between constructs of interoception to better understand the relation between interoception and psychopathology.

Illustrating the pathway from affect to somatic symptom: the Affective Picture Paradigm.

High levels of somatic symptom distress represent a core component of both mental and physical illness. The exact aetiology and pathogenesis of this transdiagnostic phenomenon remain largely unknown. The Affective Picture Paradigm (APP) represents an innovative experimental paradigm to study somatic symptom distress. Based on the HiTOP framework and a population-based sampling approach, associations between facets of somatic symptom distress and symptoms induced by the APP were explored in two studies (N1 = 201; N2 = 254) using structural equation bi-factor models. Results showed that the APP effect was significantly positively correlated with general somatic symptom distress (PHQ-15, HiTOP), cardio-respiratory symptoms (PHQ-15), as well as difficulties identifying feelings. In conclusion, negative affective cues in the APP can elicit somatic symptoms, particularly in people with higher levels of somatic symptom distress. Difficulties identifying feelings might contribute to this phenomenon. Results are compatible with a predictive processing account of somatic symptom perception.

The Hold me Tight Program for Couples Facing Huntington's Disease.

BACKGROUND: A positive predictive genetic test for Huntington's disease (HD) can be a life-changing event for both carriers and their partners, leading to lower wellbeing and increasing the risk for separation and divorce. The 'Hold me Tight' program (HmT), based on emotionally focused couples' therapy, aims at strengthening the couple bond by targeting attachment needs. OBJECTIVE: This study investigates whether the HmT program helps couples strengthen their relationship, as an investment in a future where the disease will affect life in many ways. METHODS: In a multiple baseline design using three baselines of varying length, 15 couples of presymptomatic HD-carriers and their partners were included. In three consecutive groups, couples underwent the intervention (an adapted version of the 8-session HmT program) in four weekly sessions and completed self-report questionnaires throughout the study period of 19 weeks (17 measurements). Attachment style was assessed at baseline, resilience at baseline and at the end of the follow-up, while relationship satisfaction and wellbeing were measured weekly. A multi-level model was applied to the data. RESULTS: Over the course of the study, wellbeing and relationship satisfaction significantly improved; resilience, however, did not. Furthermore, all three outcome measures were moderated by attachment style, with more securely attached individuals showing better outcomes. CONCLUSION: HmT improved wellbeing and relationship satisfaction of couples facing HD. Due to these improvements and high patient acceptability rates, this program could become a standardized procedure in HD care. The program could be adapted for other populations, e.g., couples facing other genetic neurological disorders.

A bias toward the unknown: individual and environmental factors influencing exploratory behavior.

With limited resources, exploring new opportunities is crucial for survival. Exploring novel options, however, comes at the cost of uncertainty. Therefore, there is a trade-off between exploiting options with a known beneficial outcome and exploring novel options with a potentially higher gain. Computational models have suggested that novelty may promote exploratory behavior by inducing a so-called novelty bonus through reward-related processes. So far, few studies have provided behavioral evidence for such a novelty bonus. In this study, we aimed to investigate whether spatial novelty can stimulate exploratory behavior (Experiment 1), and whether age, novelty-seeking, and reduced action radius or social interactions due to COVID-19 restrictions influenced the exploration-exploitation trade-off (Experiment 2). In both experiments, we employed a novel paradigm in which participants made binary decisions between food items, while on rare trials, a surprise option was presented. Results from Experiment 1 are in line with a novelty bonus, with spatial novelty promoting exploratory behavior. In Experiment 2, we found that exploratory behavior declined with age, high novelty seekers made more exploratory choices than low novelty seekers, and participants with a smaller action radius made fewer exploratory choices. These findings are consistent with previous findings in animals and predictions from computational models.