Psychosocial stress impairs working memory at high loads: an association with cortisol levels and memory retrieval.

Stress and cortisol are known to impair memory retrieval of well-consolidated declarative material. The effects of cortisol on memory retrieval may in particular be due to glucocorticoid (GC) receptors in the hippocampus and prefrontal cortex (PFC). Therefore, effects of stress and cortisol should be observable on both hippocampal-dependent declarative memory retrieval and PFC-dependent working memory (WM). In the present study, it was tested whether psychosocial stress would impair both WM and memory retrieval in 20 young healthy men. In addition, the association between cortisol levels and cognitive performance was assessed. It was found that stress impaired WM at high loads, but not at low loads in a Sternberg paradigm. High cortisol levels at the time of testing were associated with slow WM performance at high loads, and with impaired recall of moderately emotional, but not of highly emotional paragraphs. Furthermore, performance at high WM loads was associated with memory retrieval. These data extend previous results of pharmacological studies in finding WM impairments after acute stress at high workloads and cortisol-related retrieval impairments.

[Report from the Health Council of the Netherlands on disputed memories]. / Advies van de Gezondheidsraad over hervonden herinneringen.

The Health Council of the Netherlands recently has published an advisory report to the Minister of Health, Welfare and Sport on 'Disputed Memories'. The committee, which was established to formulate the report, has answered questions about the accessibility of memories of traumatic events, about the circumstances that might make memories accessible again, and about the possibility of recalling memories of events that were never experienced. The role of psychotherapy in retrieving traumatic memories is discussed extensively, leading to specific recommendations. In contacts with patients and law enforcement agency therapists are expected to refrain from judgments about the historical truth of recovered memories.

Sexual outcomes following treatment for early-stage gynecological cancer: a prospective and cross-sectional multi-center study.

This study evaluates the impact of early-stage gynecological cancer and its treatment on sexuality and assessed needs for care regarding sexual rehabilitation. Data from 58 women from a prospective, longitudinal study were compared to data from 220 women from a cross-sectional study. Patients in the prospective study completed questionnaires prior to treatment and then 6 and 12 months post-treatment. A single assessment was obtained from patients in the cross-sectional study. All women had a partner. Both groups were comparable on important independent variables. Both samples had an equal level of sexual contact, but participants in the cross-sectional study (mean time 46 months post-treatment) reported a higher frequency of sexual problems, were more troubled by those problems and reported a lower sexual satisfaction. However, in both groups the level of the reported dysfunctions was relatively low. Around 80% of the patients were satisfied with the information provided on sexual rehabilitation. Little need for extra care on sexual rehabilitation was reported. In conclusion, women with early-stage gynecological cancer were not especially prone to severe sexual problems and seemed to cope well with the consequences of cancer and its treatment on their sexual lives. It was suggested that this relatively positive outcome is a result of the improved patient care and education on sexual aspects in the last decade.

Vaginismus, a component of a general defensive reaction. an investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus.

This study investigates the mechanism underlying vaginismus, which may be part of a general defense mechanism. Exposure to a threatening situation will evoke an increase in muscle activity. This muscle reaction will not be restricted to the pelvic floor but will also occur in postural muscles, such as in the trapezius region. Women with and without vaginismus were exposed to four stimuli: excerpts from threatening, erotic, neutral and sexual-threatening films. Subjects were 45 physician- or self-referred patients with vaginismus and 32 controls with no sexual or pelvic floor complaints. The activity of the pelvic floor muscles and of the muscles in the trapezius region was recorded with surface electrodes. There were no differences between women with and without vaginistic reactions. EMG measurement of both the pelvic floor muscles and the trapezius muscle showed an increase in muscle activity during the threatening and sexual-threatening excerpts in women with and without vaginismus. This increase of involuntary pelvic floor muscle activity is part of a general defense mechanism that occurs during exposure to threatening situations. This reaction is not restricted to a situation with a sexual content. The results of this study shed new light on the concept of vaginismus as a primarily sexual dysfunction.

The effects of tibolone on vaginal blood flow, sexual desire and arousability in postmenopausal women.

AIMS: To compare the effects of 3 months' tibolone treatment with the effects of placebo on sexual function (in particular, vaginal blood flow, and sexual desire and arousability) and climacteric symptoms in postmenopausal women. METHODS: A randomized, double-blind, cross-over study was conducted in 38 postmenopausal women who received tibolone 2.5 mg/day and placebo. Vaginal blood flow during erotic stimulation by fantasy and film was measured using a vaginal photoplethysmograph and subjects completed sexual function questionnaires and daily diaries. RESULTS: Tibolone significantly increased baseline vaginal pulse amplitude (VPA) levels compared with placebo. There were significant treatment differences in VPA in favor of tibolone during fantasy periods but not during erotic film stimulation. Tibolone was associated with significant increases in sexual desire, and the frequency of arousability and of sexual fantasies compared with those with placebo. Vaginal lubrication was significantly improved on tibolone. Twenty-five of 38 (66%) subjects correctly guessed when they were on active treatment. Tibolone was well tolerated. CONCLUSIONS: Tibolone was associated with significant improvements in sexual function in postmenopausal women, reflecting both its estrogenic and androgenic properties. There were significantly greater increases in vaginal blood flow with tibolone in response to erotic fantasy but not film, suggesting two possible pathways of female sexual response.

The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus.

This study assessed the relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Information about this relationship may help understand the mechanism of vaginismus. Twenty-two women with vaginismus and seven control women participated in the study. Women were exposed to four emotion-inducing film excerpts. Vaginal electromyography was recorded. Experienced threat was continuously monitored with the use of a lever. Women responded with increased pelvic floor muscle activity to the threatening and sexually-threatening film excerpt. No changes occurred during the neutral and erotic excerpt. The subjective experienced threat as indicated with the lever showed the same response pattern. However, awareness of changes in muscle activity showed a slightly different pattern. Individual data were inspected. In general, agreement was found between recorded changes in muscle activity and experienced threat. The results of the erotic excerpt showed that awareness of changes in muscle activity is not only determined by information from the pelvic floor muscles, but also by other factors like situational information and the expectations of the women. The data support the idea of a general defense reaction as a mechanism of involuntary pelvic floor muscle activity.

Excessive breathlessness through emotional imagery in asthma.

Breathlessness and negative emotions during asthma attacks interact in complex patterns. This study tested the influence of emotional imagery on breathlessness during voluntary breath holding. Adolescents with and without asthma (n = 36 + 36) were assigned to positive imagery, negative imagery, or no imagery. There were four trials with close to thresholds for breath holding combined with imagery. Breathlessness and quality of imagery were measured by the end of breath holding. Additional measures were lung function and anxiety. The results showed that positive and negative imagery were only influencing breathlessness in participants with asthma. Although threshold duration for the groups were not significantly different, participants with asthma reported more breathlessness. The intensity of imagery enhanced breathlessness but diminished the accuracy of symptom perception. Positive imagery diminished breathlessness in participants with asthma, but also the difference in breathlessness between 75% and 95% of threshold duration. Breathlessness did not correlate with lung function, anxiety or other variables. It was concluded that emotional imagery during asthma attacks distracts from accurate introspection or enhances breathlessness, irrespective of anxiety.

Psychological confounds in medical research: the example of excessive cough in asthma.

This experiment tested the hypothesis that the setting in which research is conducted may dominate symptom magnitude. Cough was induced with inhaled citric acid and its magnitude was influenced by changing the setting in 30 adolescents with asthma. Cough thresholds for citric acid were determined. The participants were assigned to a condition emphasising asthma, or a control condition, described as estimation of lemon flavors. All participants inhaled (in different order) thresholds for citric acid, 50% of these thresholds, or placebo. Results showed that both cough frequency and subjective 'cough tendency' were significantly higher in the asthma condition. State anxiety was higher in the asthma condition, but correlated only moderately with cough. Lung function, severity of asthma, trait anxiety, age or sex did not correlate with cough. It was concluded that patients with asthma cough more often in a situation which they have learned to associate with asthma.

Perceptions of asthma by adolescents at home.

OBJECTIVES: To test symptom perception in asthma under natural circumstances and to establish relationships between changes in airway obstruction as indicated by wheeze, dyspnea, general sensations, and emotional state. DESIGN: Continuous in vivo monitoring. METHOD: Symptom perception was tested in 30 adolescents with severe, unstable asthma. They were continuously monitored in their homes for 72 h. Symptom perception was defined as the relation between self-reported dyspnea and airway obstruction as evident from audible wheeze. Tracheal sounds were continuously recorded with wireless telemetry for wheeze assessment. Dyspnea was assessed four times per day on a Likert-type 10-point scale, as well as four times randomly after pager remote command. The subjects kept records of use of medication, daily activities, general symptoms, and mood state in a diary. RESULTS: There were nine subjects with one or two wheeze episodes, another three subjects with three or four episodes, and one subject with almost continuous wheeze. The presence of wheeze in general related significantly to a rise (from individual baseline) in dyspnea of > 2.5 scale points. Acute wheeze was the best predictor of a rise in dyspnea, but prolonged wheeze correlated significantly with negative mood and general symptoms. CONCLUSION: Patients with prolonged airway obstruction perceived symptoms less well and were more vulnerable to negative effects of asthma than patients with acute onset airway obstruction.

Sexual aggression against women by men acquaintances: attitudes and experiences among Spanish University students.

Extensive prior research has indicated that sexual assault is highly prevalent among American college students. The purpose of this study was to assess Spanish students' attitudes about forced sex and actual experiences with male-against-female sexual aggression (SA) at a major university campus. A date-rape story was presented whereupon students (N = 412) indicated the extent to which they thought forced sex was acceptable or unacceptable in ten hypothetical situations (Giarusso, Johnson, Goodchilds, & Zellman, 1979). A second section examined whether a female or male Spanish student had experienced or engaged in a broad range of coercive sexual activities (Koss & Oros, 1982). A third section elicited help-seeking behavior in those cases where a female student had experienced unwanted sexual activity (Ogletree, 1993). It was hypothesized that students would differ in their acceptance of forced sex as a function of sex, branch and year of study, and actual experience with SA. Results showed that acceptance of forced sex was significantly related to sex, year of study and experience with SA. Results also revealed that 17.5% of all male students (n = 189) accepted forced sex and 33.2% of all female students (n = 223) had experienced some form of unwanted sexual activity; 7.7% of the women had experienced attempted or completed rape. Only 39% of those women victimized sought any form of help. The implications of these findings for rape-prevention programs are discussed.

Voluntary control over pelvic floor muscles in women with and without vaginistic reactions.

The ability to voluntarily contract and relax the pelvic floor muscles may differentiate between women with and without vaginistic reactions. This was investigated using intravaginal surface electromyographic (EMG) recordings of the pelvic floor muscles and EMG measurements of the surrounding muscle groups, during muscle exercises. Sixty-seven physician-or self-referred women with vaginismus and 43 control subjects participated. They performed six short flick contractions and three 10-second holding contractions. No difference in baseline was found between groups, indicating a comparable level of relaxation. There was no difference between groups in the performance of the exercises. As the women with vaginistic reactions do not have less voluntary control, treatment should not be based solely on an increase in control.

Characteristics of couples applying for bibliotherapy via different recruitment strategies: a multivariate comparison.

This study compared characteristics of couples with different sexual dysfunctions who were recruited for participation in a bibliotherapy program via two routes: in response to media advertisements and through their presence on a waiting list for therapist-administered treatment in an outpatient sexology clinic. Data were collected from 492 subjects (246 couples). Male sexology patients were younger than media-recruited males. However, type of sexual dysfunction accounted for a substantially larger proportion of variance in the demographic and psychometric data. An interaction effect of recruitment strategy and sexual dysfunction type was found with respect to female anorgasmia. We conclude from the absence of differences between the two study groups that the Wills and DePaulo (1991) model of help-seeking behavior for mental problems does not apply to couples with sexual dysfunctions joining a bibliotherapy program who either primarily requested professional treatment or who responded to media advertising.

Can biased symptom perception explain false-alarm choking sensations?

BACKGROUND: Breathlessness in asthma often cannot be explained with objective variables indicating airways obstruction. The hypothesis that unrealistic breathlessness results from false interpretation of sensations was tested. METHODS: Sixty-four children and adolescents with asthma, aged 9-18 years, were randomly assigned to; (1) standardized physical exercise for induction of general symptoms; (2) equipment causing itching through skin irritation; or (3) physical exercise combined with equipment causing itching through skin irritation. Pre-test and post-test measures were: lung function; breathlessness; general symptoms; itching; state anxiety; and worry. RESULTS: Lung function decreased within normal parameters (3.8%, 1.1%, 2.6%, respectively) and did not differ significantly between conditions. Breathlessness increased significantly after exercise, particularly in condition 3. Breathlessness correlated with general symptoms and worrying, but not with changes in lung function, age, or asthma severity. CONCLUSION: Biased symptom perception can explain unrealistic breathlessness. Prerequisites are situational cues triggering selective perception and ambiguous sensations associated with the anticipated (feared) physical state. Excessive breathlessness may often warrant objective confirmation by means of lung-function testing.

Sexual outcomes following treatment for early stage gynecological cancer: a prospective multicenter study.

Data are presented of a prospective, longitudinal study on the impact of early stage gynecological cancer on sexuality. Women with a partner (n = 58) completed self-report questionnaires following diagnosis but prior to treatment and then at 6 and 12 months post-treatment. A single assessment was also obtained from a healthy comparison group (n = 103). Pre-treatment cancer patients reported fewer and less trouble with sexual problems compared to healthy controls. Neither sexual satisfaction nor sexual activity changed from pre- to post-treatment and was comparable to that of healthy controls. Post-treatment, relatively minor sexual difficulties were shown; a notable difficulty for cancer patients concerned lubrication. At 12 months post-treatment, the sexual functioning of cancer patients was comparable to healthy controls.

Stress-induced breathlessness in asthma.

BACKGROUND: A majority of patients with asthma believe that psychological factors (particularly stress) can induce asthma attacks, but empirical support for actual stress-induced airways obstruction is controversial. This study tested the hypothesis that stress induces breathlessness and not airways obstruction. METHODS: Stress was induced by a frustrating computer task in 30 adolescents with asthma and 20 normal controls, aged 14-19 years. Stress measures were self-reported emotions, heart rate, blood pressure. Respiratory measures were respiratory rate (RR), end tidal CO2, deep inspirations and sighs. Asthma measures were lung function, wheeze, cough, breathlessness. RESULTS: All measures confirmed high levels of negative emotions and stress. None of the participants developed airways obstruction; they had no reduction in lung function, wheeze was absent and cough negligible. However, breathlessness increased in all participants with asthma and excessively in many. The mean breathlessness was higher than during induction of actual airways obstruction with provocative agents in previous studies. End tidal CO2 showed that breathlessness could not be explained by hypocapnia. CONCLUSION: Stress can be sufficient to induce breathlessness in patients with asthma.

Memory for emotional events: differential effects of centrally versus peripherally acting beta-blocking agents.

Substantial evidence from animal research indicates that enhanced memory associated with emotional experiences involves activation of the beta-adrenergic system. This hypothesis is further supported by the finding in human subjects that blockade of beta-adrenergic receptors with propranolol selectively reduced memory for emotional events. In the present study, we compared the effects of propranolol, a lipid soluble drug which crosses the blood-brain barrier easily, with those of nadolol, a water soluble drug which crosses the blood-brain barrier to a considerably lesser extent, to determine whether the effect involved peripheral or central beta-adrenergic receptors. The effects of these drugs, taken before subjects watched a slide show that was either emotionally arousing or relatively neutral in content, were tested 1 week later with a surprise memory test. Consistent with previous results, propranolol impaired memory (recall and recognition) in the subjects who saw the emotional version of the slide show. In contrast, nadolol did not impair memory of the emotional slide show. These results indicate that the blockade of central beta-adrenergic receptors is responsible for the reduction in storage of emotional events. The results support the view that memory of a mild emotional event involves activation of central, but not necessarily peripheral beta-adrenergic receptors.

Physiological measures of vaginal vasocongestion.

This paper reviews reliability, specificity, and practical applicability of the two most promising and widely used methods for measuring blood flow within the vagina: the oxygenation-temperature method and vaginal photoplethysmography. It was concluded that the oxygenation-temperature method and vaginal pulse amplitude as measured by the photoplethysmograph are both specific indicators of physiological sexual arousal. Although vaginal pulse amplitude seems to be the method of choice for measuring vaginal vasocongestion up to orgasm, and the oxygenation-temperature method for measuring orgasm, these measures should not be used in isolation. It is argued that women's sexual function should be evaluated using vaginal vasocongestion measures in conjunction with subjective indices. Finally, the field is in need of studies comparing physiological and subjective sexual responses in clinical and non-clinical groups.

An in vivo comparison of two circumferential penile strain gauges: the introduction of a new calibration method.

This study assessed the comparability of two types of penile strain gauges using both a circular and a newly developed oval calibration device. A group of 25 sexually functional participants placed both an electromechanical and an indium/gallium-in-rubber strain gauge on the penis and viewed an erotic film. The electromechanical gauge as calibrated on the circular device resulted in greater penile circumference changes than the indium/gallium-in-rubber gauge. Mean circumference changes were not different for the two strain gauges when the oval calibration device was used. The use of an oval calibration device improves ecological validity of calibration of penile strain gauges. Standard inclusion of this method in studies on male sexual response will increase comparability of research findings.