Risk perception as a motivational resource during the COVID-19 pandemic: the role of vaccination status and emerging variants.

BACKGROUND: People's perceived risk of being infected and having severe illness was conceived as a motivational source of adherence to behavioral measures during the COVID-19 crisis. METHODS: We used online self-reported data, spanning 20 months of the COVID-19 crisis in Belgium (n = 221,791; 34.4% vaccinated; July 2020 - March 2022) to study the association between risk perception and motivation. RESULTS: Both perceived infection probability and severity fluctuated across time as a function of the characteristics of emerging variants, with unvaccinated persons perceiving decreasingly less risk compared to vaccinated ones. Perceived severity (and not perceived probability) was the most critical predictor of autonomous motivation for adherence to health-protective measures, a pattern observed at both the between-day and between-person level among both vaccinated and unvaccinated individuals. An integrated process model further indicated that on days with higher hospitalization load, participants reported being more adherent because risk severity and autonomous motivation for adherence were more elevated on these days. CONCLUSIONS: These findings suggest that risk severity served as a critical and dynamic resource for adherence to behavioral measures because it fostered greater autonomous regulation.

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.

Impact of comorbidity on symptomatology in various types of environmental intolerance in a general Swedish and Finnish adult population.

Comorbidity with various health conditions is common in environmental intolerances (EIs), which restricts understanding for what symptoms that are associated with the intolerance per se. The present objectives were to study (i) prevalence of a broad range of specific symptoms in chemical, building-related, electromagnetic field- (EMF) related, and sound EI, irrespective of comorbidity, (ii) prevalence of symptoms in body systems in exclusive EIs, and (iii) increased risk of symptoms in body systems in exclusive EIs that cannot be referred to functional somatic syndromes, inflammatory diseases or mental disorders. Cross-sectional data (n = 4941) were used from two combined population-based surveys, the Västerbotten (Sweden) and Österbotten (Finland) Environmental Health Studies. Categorization of EI cases and controls were based on self-reports. Symptoms were assessed with the Environmental Hypersensitivity Symptom Inventory, and these were converted to 27 symptoms of the International Classification of Primary Care, 2nd edition, in eight chapters of body systems. The results showed, with few exceptions, that all assessed specific symptoms were significantly more prevalent in all four EIs than in referents. Although a large overlap between EIs, characteristic body system symptoms were eye and respiratory symptoms in chemical and building-related intolerance, skin symptoms in EMF-related intolerance, and general and unspecified, digestive, eye, cardiovascular, neurological, and psychological symptoms in sound intolerance. After controlling for various comorbidities, all studied body system symptoms were positively associated with chemical intolerance, fewer with sound intolerance, only one with building-related intolerance, and none with EMF-related EI. In conclusion, a broad range of symptoms are reported in all four EIs implying common mechanisms, but symptoms of certain body systems are more likely to be reported in a certain EI that cannot be explained by comorbidity.

The Role of Communication Style and External Motivators in Predicting Vaccination Experiences and Intentions: An Experimental Vignette Study.

This vignette-based study examined in a sample of unvaccinated Belgian citizens (N = 1918; Mage = 45.99) how health care workers could foster reflection about and intentions to get vaccinated against COVID-19 by experimentally varying their communication style (i.e., autonomy-supportive vs. controlling) and the reference to external motivators (i.e., use of a monetary voucher or corona pass vs. the lack thereof). Each participant was randomly assigned to one of six conditions and rated a vignette in terms of anticipated autonomy satisfaction, perceived effectiveness, reflection, and vaccination intention. An autonomy-supportive, relative to a controlling, communication style predicted greater autonomy need satisfaction, which in turn related positively to perceived effectiveness, reflection, and vaccination intention. External motivators failed to generate positive effects compared to the control condition. The findings highlight the critical role of autonomy support in promoting a self-endorsed decision to get vaccinated.

End-Tidal CO2 in Patients with Panic Disorder, Stress-Related or Functional Syndromes, Versus Healthy Controls.

A dysregulated autonomic stress physiology is hypothesized to play an important role in the etiology and perpetuation of somatic symptoms that cannot be (fully) explained by an organic disease. The aim of this study was to focus on the role of the respiratory system. We examined end-tidal CO2 concentration (PetCO2) in healthy controls (n = 30), patients with panic disorder (n = 36), and patients with stress-related (overstrain; n = 35, burnout; n = 44) or functional syndromes [fibromyalgia (FM) and/or chronic fatigue syndrome (CFS); n = 36]. Participants went through a rest period and a respiratory challenge with recovery, whilst PetCO2 was continuously monitored by a capnograph. Taken together, our results suggest: (1) an overactive respiratory system to be a possible transdiagnostic underlying factor of overstrain, burnout, and panic disorder, and (2) the presence of a less active respiratory fight-flight response in the more chronic and severe functional syndromes (FM/CFS).

The Interoceptive Sensitivity and Attention Questionnaire: Evaluating Aspects of Self-Reported Interoception in Patients With Persistent Somatic Symptoms, Stress-Related Syndromes, and Healthy Controls.

OBJECTIVE: This study aimed to validate the Interoceptive Sensitivity and Attention Questionnaire (ISAQ), a 17-item self-report measure assessing sensitivity and attention to interoceptive signals. METHODS: In study 1, exploratory and confirmatory factor analysis was performed in a student convenience sample (n = 1868). In study 2, ISAQ data of a healthy sample (n = 144) and various patient groups experiencing stress-related syndromes (overstrain, n = 63; burnout, n = 37; panic disorder [PD]. n = 60) and/or persistent somatic symptoms in daily life (irritable bowel syndrome, n = 38; fibromyalgia and/or chronic fatigue syndrome, n = 151; medically unexplained dyspnea [MUD], n = 29) were compared. RESULTS: Three subscales were revealed: (F1) sensitivity to neutral bodily sensations, (F2) attention to unpleasant bodily sensations, and (F3) difficulty disengaging from unpleasant bodily sensations. Overall, patients with fibromyalgia and/or chronic fatigue syndrome and patients with MUD scored significantly higher on F1 (p = .009 and p = .027, respectively) and F2 (p = .002 and p < .001, respectively) than healthy controls. Patients with PD had higher scores on subscales F2 (p < .001) and F3 (p < .001) compared with healthy controls, as well as higher scores on F2 compared with all other patient groups (pPD versus MUD = .008; all other p values < .001). CONCLUSIONS: Interoceptive sensibility-the self-reported aspect of interoception-is not a homogeneous or unitary construct. The subscales of the ISAQ differentiate healthy controls from patients with persistent somatic and/or stress-related complaints in daily life and distinguish different patient groups. The ISAQ can be used as a concise, reliable, and clinically relevant research tool to further disentangle adaptive and maladaptive aspects of interoceptive ability.

Somatic Symptom Perception From a Predictive Processing Perspective: An Empirical Test Using the Thermal Grill Illusion.

OBJECTIVE: In a predictive processing perspective, symptom perceptions result from an integration of preexisting information in memory with sensory input. Physical symptoms can therefore reflect the relative predominance of either sensory input or preexisting information. In this study, we used the thermal grill illusion (TGI), which applies interlaced warm and cool temperatures to the skin to create a paradoxical heat-pain experience. Assuming that the TGI compared with single-temperature stimulation relies more importantly on an active integration process of the brain to create this paradoxical sensation, we tested the hypothesis whether a manipulation of the expectations during TGI would have more impact than during single-temperature stimulation. METHODS: Sixty-four participants received different temperature combinations (16/16°C, 40/40°C, 16/40°C) with neutral, positive ("placebo"), and negative ("nocebo") instructions. Subjective stimulus intensity was rated, and neuroticism and absorption (openness to absorbing and self-altering experiences) served as potential moderating factors. RESULTS: The TGI condition was rated highest. Overall, negative instructions increased (p < .001, d = 0.58), whereas positive instructions did not significantly change the TGI intensity perception (versus neutral; p = .144, d = 0.19). In the TGI condition, increased modulation of pain was observed with higher neuroticism (ß = 0.33, p = .005) and absorption (ß = 0.30, p = .010). CONCLUSIONS: Whereas negative instructions induced a nocebo effect, no placebo effect emerged after positive instructions. The findings are in line with the predictive processing model of symptom perception for participants with higher levels of neuroticism and absorption.

Placebo Effects in the Neuroendocrine System: Conditioning of the Oxytocin Responses.

OBJECTIVE: There is evidence that placebo effects may influence hormone secretion. However, few studies have examined placebo effects in the endocrine system, including oxytocin placebo effects. We studied whether it is possible to trigger oxytocin placebo effects using a classical conditioning paradigm. METHODS: Ninety-nine women were assigned to a conditioned, control, or drug control group. In the two-phase conditioning paradigm, participants in the conditioned and drug control groups received an oxytocin nasal spray combined with a distinctive smell (conditioned stimulus [CS]) for three acquisition days, whereas the control group received placebo spray. Subsequently, the conditioned and control groups received placebo spray with the CS and the drug control group received oxytocin spray for three evocation days. Salivary oxytocin was measured several times during each day. Pain sensitivity and facial evaluation tests previously used in oxytocin research were also administered. RESULTS: On evocation day 1, in the conditioned group, oxytocin significantly increased from baseline to 5 minutes after CS (B[slope] = 19.55, SE = 5.88, p < .001) and remained increased from 5 to 20 (B = -10.42, SE = 5.81, p = .071) and 50 minutes (B = -0.70, SE = 3.37, p = .84). On evocation day 2, a trend for increase in oxytocin was found at 5 minutes (B = 15.22, SE = 8.14, p = .062). No placebo effect was found on evocation day 3 (B = 3.57, SE = 3.26, p = .28). Neither exogenous nor conditioned oxytocin affected pain or facial tasks. CONCLUSIONS: Results indicate that oxytocin release can be conditioned and that this response extinguishes over time. Triggering hormonal release by placebo manipulation offers various clinical possibilities, such as enhancing effects of pharmacological treatments or reducing dosages of medications. TRIAL REGISTRATION: The study was registered as a clinical trial on www.trialregister.nl (number NTR5596).

Prospective study of nocebo effects related to symptoms of idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF).

The exact causes of Idiopathic Environmental Intolerance Attributed to Electromagnetic Fields (IEI-EMF, i.e., experience of somatic symptoms attributed to low-level electromagnetic fields) are still unknown. Psychological causation such as nocebo effects seem plausible. This study aimed to experimentally induce a nocebo effect for somatic symptom perception and examined whether it was reproducible after one week. We also examined whether these effects were associated with increased sympathetic activity and whether interoceptive accuracy (IAcc) moderated these relationships. Participants were recruited from the general population and instructed that electromagnetic exposure can enhance somatosensory perception. They participated twice in a cued exposure experiment with tactile stimulation and sham WiFi exposure in 50% of trials. The two sessions were scheduled one week apart (session 1: N = 65, session 2: N = 63). Before session 1, participants watched either a 6-min film on adverse health effects of EMF or a neutral film on trade of mobile phones. IAcc was assessed with the heartbeat detection paradigm. Electrodermal activity served as a measure of sympathetic activation. Evidence for a nocebo effect (i.e., increased self-reported intensity and aversiveness and electrodermal activity) during sham WiFi exposure was observed in both sessions. IAcc moderated the nocebo effect, depending on stimulus intensity. Contrary to previous findings, no difference emerged between the health-related EMF and the neutral films. Based on negative instructions, somatic perception and physiological responding can be altered. This is consistent with the assumption that IEI-EMF could be due to nocebo effects, suggesting an important role for psychological interventions.

Causal perception is central in electromagnetic hypersensitivity - a commentary on "Electromagnetic hypersensitivity: a critical review of explanatory hypotheses''.

We highly welcome and appreciate the paper of Dieudonné, 2020 ( https://doi.org/10.1186/s12940-020-00602-0 ) on the important but frequently neglected topic of hypersensitivity towards electromagnetic fields (EHS). We agree with the author that the electromagnetic hypothesis (that EHS is caused by exposure to electromagnetic fields) appears scientifically largely unfounded and that other theoretical approaches focussing on psychological processes are more plausible and promising. In the view of the author, two such approaches exist, namely a "cognitive hypothesis" (derived from the comprehensive model by Van den Bergh et al., 2017) and an "attributive hypothesis" as suggested by the author. In this commentary, we want to argue (a) that the distinction between the cognitive and the attributive hypothesis is inaccurate at the conceptual level; (b) that the distinction is also misleading at the mechanistic level, due to an incorrect interpretation of the evidence related to the cognitive hypothesis; and (c) that, by using the term "cognitive hypothesis", the existing comprehensive model is inappropriately narrowed down without fully appreciating its explanatory power for the phenomena subsumed under both the cognitive and attributive hypothesis. Therefore, the original term "comprehensive model" should be used rather than the label "cognitive hypothesis".

Acquisition and generalization of cough trigger beliefs in allergic rhinitis.

In allergic conditions, trigger identification is often inaccurate, and may be influenced by pre-existing beliefs. In this study, we investigated the acquisition and generalization of symptom trigger beliefs in individuals with allergic rhinitis (n = 24) and control participants (n = 24). In a lab-based trigger acquisition task, unique exemplars of two trigger categories were either paired with saline inhalation (CS- category) or citric acid inhalation (CS+ category). The next day, we tested recognition and symptom expectancy for CS category exemplars and exemplars of novel trigger categories. Participants acquired differential symptom expectancies for CS+ compared to CS- exemplars, with faster acquisition in participants with rhinitis. Differential symptom expectancies persisted the next day, and generalized to novel trigger categories, with stronger generalization in rhinitis vs. control participants. These patterns of acquisition and generalization suggest that overgeneralization of trigger beliefs may complicate trigger identification in participants with allergic conditions.

Relationship Between Different Experimental Measures of Distorted Symptom Perception in Functional Syndrome Patients.

OBJECTIVE: Patients with functional somatic syndromes show reduced correspondence between induced physiological changes and self-reported symptoms in a rebreathing paradigm, as well as elevated symptoms unrelated to physiological changes after induction of negative affective states in an affective picture-viewing paradigm. Detailed results of both paradigms separately were published elsewhere. The main goal of the current report is to describe the relationship between the responses to these two paradigms measuring distortions in symptom perception in a well-described sample of patients with fibromyalgia and/or chronic fatigue syndrome. METHODS: Patients (N = 81) with fibromyalgia and/or chronic fatigue syndrome participated in a test session comprising four well-validated paradigms, including the picture-viewing and rebreathing paradigm. Using mixed model analyses, we tested whether the amount of affective modulation of symptom reporting was related to distorted perception of induced dyspnea. In an exploratory way, we assessed the role of several individual difference variables as moderators. RESULTS: There was no relationship between patients' amount of affective modulation of symptom reporting, as assessed with the picture paradigm, and level of distortion in dyspnea perception, as assessed with the rebreathing paradigm (effect of affective modulation in the subjective recovery from induced dyspnea: F1,70 = 0.16, p = .70; time by affective modulation interaction effect: F4,70 = 0.14, p = .97). CONCLUSIONS: Biased symptom reporting in one paradigm is unrelated to biased symptom reporting in the other paradigm, indicating that distortions in symptom perception in patients with functional somatic syndromes are not a trait-like, cross-situationally stable condition, but a versatile dysfunction that is context dependent.

The error-related negativity for error processing in interoception.

The error-related negativity (ERN) is an event-related potential in the electroencephalogram (EEG) observed within the first 100 ms after commission of an error. Increased ERN amplitudes have been observed in several psychological disorders characterized by high negative affect. While the ERN has extensively been studied in tasks using exteroceptive stimuli, its relation to interoceptive stimuli is unknown. Since errors related to interoception might be particularly relevant for survival and negative affect, this study aimed to explore the ERN for errors related to interoceptive, respiratory sensations (intERN). Moreover, we compared the intERN with a commonly observed ERN related to exteroceptive, visual stimuli (extERN) and examined their associations with interoception-related negative affect. We studied the ERN using a respiratory occlusion task (intERN) and a visual flanker task (extERN) in 40 healthy volunteers during continuous 129 channel EEG recordings. In the occlusion task, participants received inspiratory occlusions of two different durations and indicated whether each occlusion was short or long. In the Flanker task, participants indicated the direction of arrowheads. Interoception-related negative affect was assessed with the Anxiety Sensitivity Index. Comparable with the extERN, the intERN was observed at fronto-central scalp positions after error commission in the occlusion task, but it peaked significantly earlier than the extERN. Mean amplitudes of the intERN and extERN showed no significant difference and were not correlated. Moreover, higher levels of anxiety sensitivity were correlated with significantly greater amplitudes of the intERN, but with lower amplitudes of the extERN. The present results firstly demonstrate an error-related negativity EEG-potential that is related to interoceptive sensations (intERN). This intERN is not associated with a commonly observed ERN elicited by exteroceptive stimuli and is distinctly linked to higher levels of interoception-related negative affect. The intERN might be a promising neural marker for future studies on interoception, negative affect and error processing.

Observing dyspnoea in others elicits dyspnoea, negative affect and brain responses.

Dyspnoea is usually caused by diagnosable cardiorespiratory mechanisms. However, frequently dyspnoea relates only weakly or not at all to cardiorespiratory functioning, suggesting that additional neuropsychosocial processes contribute to its experience. We tested whether the mere observation of dyspnoea in others constitutes such a process and would elicit dyspnoea, negative affect and increased brain responses in the observer.In three studies, series of pictures and videos were presented, which either depicted persons suffering from dyspnoea or nondyspnoeic control stimuli. Self-reports of dyspnoea and affective state were obtained in all studies. Additionally, respiratory variables and brain responses during picture viewing (late positive potentials in electroencephalograms) were measured in one study.In all studies, dyspnoea-related pictures and videos elicited mild-to-moderate dyspnoea and increased negative affect compared to control stimuli. This was paralleled by increased late positive potentials for dyspnoea-related pictures while respiratory variables did not change. Moreover, increased dyspnoea correlated modestly with higher levels of empathy in observers.The present results demonstrate that observing dyspnoea in others elicits mild-to-moderate dyspnoea, negative affect, and increased brain responses in the absence of respiratory changes. This vicarious dyspnoea has clinical relevance, as it might increase suffering in the family and medical caregivers of dyspnoeic patients.

Enhancing Placebo Effects in Somatic Symptoms Through Oxytocin.

OBJECTIVE: Placebo effects relieve various somatic symptoms, but it is unclear how they can be enhanced to maximize positive treatment outcomes. Oxytocin administration may potentially enhance placebo effects, but few studies have been performed, and they have had conflicting findings. The study aim was to investigate the influence of positive verbal suggestions and oxytocin on treatment expectations and placebo effects for pain and itch. METHODS: One hundred eight female participants were allocated to one of the following four groups: (1) oxytocin with positive verbal suggestions, (2) placebo with positive verbal suggestions, (3) oxytocin without suggestions, and (4) placebo without suggestions. The administration of 24 IU oxytocin or a placebo spray was preceded by positive verbal suggestions regarding the pain- and itch-relieving properties of the spray or no suggestions, depending on group allocation. Pain was assessed with a cold pressor test, and itch was assessed with histamine iontophoresis. RESULTS: Positive verbal suggestions induced expectations of lower pain (F = 4.77, p = .031) and itch (F = 5.38, p = .022). Moreover, positive verbal suggestions elicited placebo analgesia (F = 5.48, p = .021) but did not decrease itch. No effect of oxytocin on the placebo effect or on expectations was found. CONCLUSIONS: Positive suggestions induced placebo analgesia but oxytocin did not enhance the placebo effect. Study limitations are that we only included a female sample and a failure to induce placebo effect for itch. Future studies should focus on how oxytocin might influence placebo effects, taken into account the role of sex, dose-dependent effects, and various expectation manipulations. TRIAL REGISTRATION: The study was registered as a clinical trial on www.trialregister.nl (number 6376).

Persistent Physical Symptoms as Perceptual Dysregulation: A Neuropsychobehavioral Model and Its Clinical Implications.

OBJECTIVE: The mechanisms underlying the perception and experience of persistent physical symptoms are not well understood, and in the models, the specific relevance of peripheral input versus central processing, or of neurobiological versus psychosocial factors in general, is not clear. In this article, we proposed a model for this clinical phenomenon that is designed to be coherent with an underlying, relatively new model of the normal brain functions involved in the experience of bodily signals. METHODS: Based on a review of recent literature, we describe central elements of this model and its clinical implications. RESULTS: In the model, the brain is seen as an active predictive processing or inferential device rather than one that is passively waiting for sensory input. A central aspect of the model is the attempt of the brain to minimize prediction errors that result from constant comparisons of predictions and sensory input. Two possibilities exist: adaptation of the generative model underlying the predictions or alteration of the sensory input via autonomic nervous activation (in the case of interoception). Following this model, persistent physical symptoms can be described as "failures of inference" and clinically well-known factors such as expectation are assigned a role, not only in the later amplification of bodily signals but also in the very basis of symptom perception. CONCLUSIONS: We discuss therapeutic implications of such a model including new interpretations for established treatments as well as new options such as virtual reality techniques combining exteroceptive and interoceptive information.

Endogenous Pain Modulation: Association with Resting Heart Rate Variability and Negative Affectivity.

Objectives: Several chronic pain syndromes are characterized by deficient endogenous pain modulation as well as elevated negative affectivity and reduced resting heart rate variability. In order to elucidate the relationships between these characteristics, we investigated whether negative affectivity and heart rate variability are associated with endogenous pain modulation in a healthy population. Design, Subjects, and Methods: An offset analgesia paradigm with noxious thermal stimulation calibrated to the individual's pain threshold was used to measure endogenous pain modulation magnitude in 63 healthy individuals. Pain ratings during constant noxious heat stimulation to the arm (15 seconds) were compared with ratings during noxious stimulation comprising a 1 °C rise and return of temperature to the initial level (offset trials, 15 seconds). Offset analgesia was defined as the reduction in pain following the 1 °C decrease relative to pain at the same time point during continuous heat stimulation. Results: Evidence for an offset analgesia effect could only be found when noxious stimulation intensity (and, hence, the individual's pain threshold) was intermediate (46 °C or 47 °C). Offset analgesia magnitude was also moderated by resting heart rate variability: a small but significant offset effect was found in participants with high but not low heart rate variability. Negative affectivity was not related to offset analgesia magnitude. Conclusions: These results indicate that resting heart rate variability (HRV) is related to endogenous pain modulation (EPM) in a healthy population. Future research should focus on clarifying the causal relationship between HRV and EPM and chronic pain by using longitudinal study designs.

The Broken Achilles Heel of Behavior Therapy: A Couple of Reflections on the Function Analysis.

This manuscript is part of a special issue to commemorate professor Paul Eelen, who passed away on August 21, 2016. Paul was a clinically oriented scientist, for whom learning principles (Pavlovian or operant) were more than salivary responses and lever presses. His expertise in learning psychology and his enthusiasm to translate this knowledge to clinical practice inspired many inside and outside academia. Several of his original writings were in the Dutch language. Instead of editing a special issue with contributions of colleagues and friends, we decided to translate a selection of his manuscripts to English to allow wide access to his original insights and opinions. Even though the manuscripts were written more than two decades ago, their content is surprisingly contemporary. This manuscript was originally published in 1992 and discusses functional analysis as the Achilles heel of cognitive-behavioural therapy (CBT). Functional analysis is that part of CBT where insight in learning principles feeds into clinical case conceptualisation. Even though functional analysis was self-evident for first generation behaviour therapists, its importance has been overlooked since long. It is striking to see how modern CBT-approaches again incorporate functional assessment. First published as: Eelen, P., & Van den Bergh, O. (1992). De gebroken achillespees van de gedragstherapie: enkele bedenkingen bij de functieanalyse. Psychotherapeutisch Paspoort, 2, 25-34.