Traumatic Stress, Attachment Style, and Health Outcomes in Cardiac Rehabilitation Patients.

OBJECTIVE: Research on psychosocial risk factors in cardiovascular disease (CVD) has identified traumatic stress and attachment style as independent risk factors for the development of CVD and poor prognosis for those with established CVD. Exploring the interrelationships between these variables will inform psychosocial risk factor modeling and potential avenues for intervention. Therefore, the hypothesis that attachment style is related to health outcomes among CR patients and that traumatic stress mediates this relationship was tested. METHODS: Patients in a cardiac rehabilitation program (n = 201) completed validated self-report measures of traumatic stress and attachment style at baseline (program intake). Health outcomes were assessed at baseline and 3 months, including anxiety, depression, quality of life, fasting blood glucose, glycated hemoglobin (HbA1c), and cholesterol (HDL ratio). Multivariate structural equation modeling was used to fit the data. RESULTS: Of the 201 participants, 42 (21%) had trauma scores indicating the probable presence of posttraumatic stress disorder. Via greater levels of traumatic stress, greater attachment anxiety at baseline was indirectly related to greater anxiety, depression, fasting blood glucose, and HbA1c, and poorer physical and mental quality of life. There were no significant indirect effects on HDL ratios. CONCLUSION: Greater attachment anxiety predicted greater traumatic stress; this, in turn, predicted poorer health outcomes. Screening and treatment for these constructs in CVD patients is warranted.

Depressive symptoms, perceived stress, self-efficacy, and outcome expectations: Predict fitness among adolescents with obesity.

The objective of the present study was to test if outcome expectancy mediated the relationship between fitness and self-efficacy, perceived stress, and depressive symptoms.Adolescents with obesity (n = 228) completed measures of perceived stress and depressive symptoms at baseline, self-efficacy and outcome expectancy at baseline and 3 months, and fitness at baseline and 6 months. Structural equation modeling was used to analyze the data. Results showed that self-efficacy was positively associated with fitness via outcome expectancies. For females, fewer depressive symptoms were linked to fitness via self-efficacy and outcome expectancies. Exercise interventions that enhance exercise self-efficacy, outcome expectancy, and reduce depressive symptoms may increase fitness.

Cognitive-Behavioral Therapy for Insomnia Tailored to Patients With Cardiovascular Disease: A Pre-Post Study.

Objective: There is little research assessing the use of cognitive-behavioral therapy for insomnia (CBT-I) among patients with cardiovascular disease (CVD), even less on the effects of CBT-I on CVD risk factors such as anxiety and depression, and to our knowledge, only limited studies of the efficacy of CBT-I protocols with cardiac disease-specific modifications. The objective of this study is to evaluate a group-based CBT-I intervention tailored to patients with CVD on sleep quality, duration, and mental health. Participants: A sample of 47 participants (25 men) diagnosed with primary insomnia were included in this study. Methods: This study used a pre-post design comparing outcomes before and after a group intervention. Clinicians in a cardiac center referred CVD patients with self-reported sleep disturbance to the intervention group. Following screening and confirmation of insomnia disorder, participants completed a six-week CBT-I group-based intervention tailored for patients with CVD. Participants completed sleep diaries and questionnaires, including the Insomnia Severity Index, Beck Depression Inventory-II, and Beck Anxiety Inventory, pre- and postintervention. Results: Participants' sleep outcomes (sleep duration, maintenance, efficiency, latency, and quality) were significantly improved and patients reported significantly fewer symptoms of anxiety, depression, and insomnia following the CBT-I intervention (p values < .05). Conclusions: After participating in a CBT-I group intervention tailored for cardiac patients, patients reported improved sleep and significantly lower levels of anxiety and depression. Randomized trials of this intervention are warranted.

Depression and Anxiety Screening and Triage Protocol for Cardiac Rehabilitation Programs.

PURPOSE: Best practice guidelines for cardiac rehabilitation (CR) suggest routine screening for anxiety and depression, yet many patients are not screened nor do they receive mental health treatment. Protocols are required to identify those in need of care and to ensure that appropriate assistance is provided. METHODS: Consecutive patients entering CR in our setting from May 4, 2012, to May 3, 2013, completed the Hospital Anxiety and Depression Scale (HADS). As per our Screening and Triage protocol for Anxiety and Depression (STAD), patients with high scores (≥16) were referred to a clinical psychologist; those with low scores (<8 for depression and <11 for anxiety) received information about community resources. Patients with moderate scores were reassessed 4 weeks later before triaging to psychosocial services. High, moderate, and low scores were triaged to a clinical psychologist, social worker, or were guided to community resources, respectively. RESULTS: A total of 1504 patients (76% men) completed the HADS at intake; 287 (19%) had elevated depression and/or anxiety scores. Of these, 43 (15%) were referred to psychology services and 244 (85%) patients were referred for HADS readministration at 4 weeks. Scores following reassessment resulted in 6 referrals to psychology services (3%) and 62 to social work (36%), whereas 78 (45%) no longer needed care. CONCLUSION: Many cardiac patients experience symptoms of depression and anxiety. The STAD protocol using the HADS was an efficient method to screen for anxiety and depression and appropriately utilize psychosocial treatment resources in the cardiac rehabilitation setting.

Self-perceived burden, perceived burdensomeness, and suicidal ideation in patients with chronic pain.

Background: Self-perceived burden and perceived burdensomeness are two apparently related constructs that have arisen independently from research in physical and mental health, respectively. Although both are associated with suicidal ideation in individuals with chronic pain, they have yet to be examined concurrently in the same group of patients. Aims: The aim of this study was to investigate the relationship between the two constructs and their differential prediction of suicidal ideation. Methods: Participants were 260 outpatients of an interdisciplinary chronic pain treatment program. Each participant completed the Self-Perceived Burden Scale (SPBS), the Interpersonal Needs Questionnaire Perceived Burdensomeness Scale (INQPBS), the Beck Scale for Suicide Ideation, and the thoughts of self-harm item of the Patient Health Questionnaire-9. Results: The SPBS and the INQPBS were both unifactorial measures with good internal consistency. They correlated significantly with one another (r = 0.50, P < 0.001), as well as with scores on the two measures of suicidal ideation (rs ranging from 0.29 to 0.62, Ps < 0.001). However, the INQPBS correlated more highly with suicidal ideation than did the SPBS. In regression analyses, the INQPBS predicted unique variance in suicidal ideation after adjusting for the SPBS. Conversely, the SPBS did not contribute uniquely when the INQPBS was entered first. Conclusions: Patients with chronic pain who believe that they have become "a burden to others" are at increased risk for suicidal ideation. The conceptual similarities and differences between the constructs of self-perceived burden and perceived burdensomeness are reviewed to explain why perceived burdensomeness is the stronger predictor of this increased risk.

Contexte: La perception de soi comme un fardeau et le fardeau perçu sont deux construits connexes qui ont respectivement émergé de travaux de recherche en santé physique et en santé mentale, de manière indépendante. Bien qu'ils soient tous deux associés à l'idéation suicidaire chez les individus souffrant de douleur chronique, ils n'ont jamais été évalués simultanément au sein du même groupe de patients. Objectifs: Examiner le lien entre les deux construits et leur prédiction différentielle de l'idéation suicidaire. Méthodes: Le groupe de participants était composé de 260 patients externes d'un programme interdisciplinaire de gestion de la douleur chronique. Chaque participant a rempli le Self-Perceived Burden Scale (SPBS), l'Interpersonal Needs Questionnaire Perceived Burdensomeness Scale (INQPBS), l'Échelle d'idéation suicidaire de Beck et l'énoncé portant sur les pensées d'automutilation du Questionnaire sur la santé des patients-9.Résultats: Tant les mesures du SPBS que celles de l'INQPBS étaient monofactorielles et présentaient une bonne cohérence interne. Elles présentaient une corrélation significative l'une avec l'autre (r = 0,50, p < 0,001) et avec les scores obtenus pour les deux mesures de l'idéation suicidaire (r = de 0,29 à 0,62, p < 0,001), Toutefois, l'INQPBS présentait une plus grande corrélation avec l'idéation suicidaire que le SPBS. Dans les analyses de régression, l'INQPS était un prédicteur de variance unique dans l'idéation suicidaire après rajustement en fonction du SPBS. Inversement, le SPBS ne contribuait pas de manière unique lorsque l'INQPBS était inscrit en premier.Conclusions: Les patients souffrant de douleur chronique qui croient qu'ils sont devenus « un fardeau pour les autres ¼ sont à plus grand risque d'idéation suicidaire. Les similarités et les différences conceptuelles entre les construits de perception de soi comme un fardeau et de fardeau perçu sont examinées afin d'expliquer pourquoi le fardeau perçu est le meilleur prédicteur de ce risque accru.

Testing the Interpersonal Theory of Suicide in Chronic Pain.

OBJECTIVE: The interpersonal theory of suicide offers a conceptual framework for understanding suicidal ideation (SI) that may be applicable to individuals with chronic pain. The theory emphasizes the importance of 2 interpersonal constructs as precursors to SI: perceived burdensomeness (the belief that one has become a burden to others) and thwarted belongingness (a lack of social integration or connection). Our objective was to test the interpersonal theory of suicide in people with chronic pain. METHODS: Hierarchical regression analysis was used in a cross-sectional study of 282 patients of an interdisciplinary pain clinic. The Beck Scale for Suicide Ideation was the criterion measure of SI, and independent variables included both general and pain-specific predictors. RESULTS: After adjusting for other known or putative risk factors related to pain and mental health, perceived burdensomeness significantly predicted SI, whereas thwarted belongingness did not. As expected according to theory, the interaction between perceived burdensomeness and thwarted belongingness was also significant; perceived burdensomeness was a strong predictor of SI at high levels of thwarted belongingness, but only marginally at low levels. Other independent predictors were male sex, number of prior suicide attempts, and hopelessness. DISCUSSION: These findings are in line with some, but not all, of the major predictions of the interpersonal theory of suicide. In general, however, they support the relevance of the theory for individuals with chronic pain.

Event-related potential signatures of perceived and imagined emotional and food real-life photos.

Although food and affective pictures share similar emotional and motivational characteristics, the relationship between the neuronal responses to these stimuli is unclear. Particularly, it is not known whether perceiving and imagining food and affective stimuli elicit similar event-related potential (ERP) patterns. In this study, two ERP correlates, the early posterior negativity (EPN) and the late positive potential (LPP) for perceived and imagined emotional and food photographs were investigated. Thirteen healthy volunteers were exposed to a set of food photos, as well as unpleasant, pleasant, and neutral photos from the International Affective Picture System. In each trial, participants were first asked to view a photo (perception condition), and then to create a visual mental image of it and to rate its vividness (imagery condition). The results showed that during perception, brain regions corresponding to sensorimotor and parietal motivational (defensive and appetitive) systems were activated to different extents, producing a graded pattern of EPN and LPP responses specific to the photo content - more prominent for unpleasant than pleasant and food content. Also, an EPN signature occurred in both conditions for unpleasant content, suggesting that, compared to food or pleasant content, unpleasant content may be attended to more intensely during perception and may be represented more distinctly during imagery. Finally, compared to LLP activation during perception, as well as imagery and perception of all other content, LPP activation was significantly reduced during imagery of unpleasant photos, suggesting inhibition of unwanted memories. Results are framed within a neurocognitive working model of embodied emotions.

The relationship between social anxiety and the perception of depth-ambiguous biological motion stimuli is mediated by inhibitory ability.

Orthographically projected biological motion stimuli are depth-ambiguous. Consequently, their projection when oriented towards the viewer is the same as when oriented away. Despite this, observers tend to interpret such stimuli as facing the viewer more often. Some have speculated that this facing-the-viewer bias may exist for sociobiological reasons: Mistaking another human as retreating when they are actually approaching could have more severe consequences than the opposite error. An implication of this theory is that the facing-towards percept may be perceived as more threatening than the facing-away percept. Given this, as well as the finding that anxious individuals have been found to display an attentional bias towards threatening stimuli, we reasoned that more anxious individuals might have stronger facing-the-viewer biases. Furthermore, since anxious individuals have been found to perform poorer on inhibition tasks, we hypothesized that inhibitory ability would mediate the relationship between anxiety and the facing-the-viewer bias (i.e., difficulty inhibiting the threatening percept). Exploring individual differences, we asked participants to complete anxiety questionnaires, to perform a Go/No-Go task, and then to complete a perceptual task that allowed us to assess their facing-the-viewer biases. As hypothesized, we found that both greater anxiety and weaker inhibitory ability were associated with greater facing-the-viewer biases. In addition, we found that inhibitory ability significantly mediated the relationship between anxiety and facing-the-viewer biases. Our results provide further support that the facing-the-viewer bias is sensitive to the sociobiological relevance of biological motion stimuli, and that the threat bias for ambiguous visual stimuli is mediated by inhibitory ability.

Effects of conversation on situation awareness and working memory in simulated driving.

OBJECTIVE: In the present research, we investigated the hypothesis that working memory mediates conversation-induced impairment of situation awareness (SA) while driving. BACKGROUND: Although there is empirical evidence that conversation impairs driving performance, the cognitive mechanisms that mediate this relationship remain underspecified. Researchers have reported that a phonological working memory task decreased drivers' SA for vehicles located behind them whereas a visuospatial working memory task impaired SA for vehicles ahead. Conversation, therefore, might impair SA for vehicles behind the driver by preferentially taxing the phonological loop. METHOD: A 20-questions task was used as a proxy for natural conversation. In Experiment I, driving performance was measured across three within-subjects conversation conditions (i.e., no conversation, driver asks questions, driver answers questions) with the use of a driving simulator. In Experiment 2, participants drove in the same simulator while either conversing (20-questions task) or not Participants estimated the positions of other vehicles after the screens were blanked at the end of each trial. RESULTS: Speed monitoring and responses to visual probes were impaired by the 20-questions conversation task (Experiment 1). As predicted, conversation impaired SA for the location of other vehicles more for vehicles located behind the driver than for those in front (Experiment 2). CONCLUSION: Conversation impairs drivers' SA of vehicles behind them by taxing working memory's phonological loop and impairs SA generally by taxing working memory's central executive. APPLICATION: Provides a theoretical framework that links driver SA to working memory and a mechanism for understanding why conversation impairs driving performance.

Assessing threat responses towards the symptoms and diagnosis of schizophrenia using visual perceptual biases.

Stigma towards individuals diagnosed with schizophrenia continues despite increasing public knowledge about the disorder. Questionnaires are used almost exclusively to assess stigma despite self-report biases affecting their validity. The purpose of this experiment was to implicitly assess stigma towards individuals with schizophrenia by measuring visual perceptual biases immediately after participants conversed with a confederate. We manipulated both the diagnostic label attributed to the confederate (peer vs. schizophrenia) and the presence of behavioural symptoms (present vs. absent). Immediately before and after conversing with the confederate, we measured participants' facing-the-viewer (FTV) biases (the preference to perceive depth-ambiguous stick-figure walkers as facing towards them). As studies have suggested that the FTV bias is sensitive to the perception of threat, we hypothesized that FTV biases would be greater after participants conversed with someone that they believed had schizophrenia, and also after they conversed with someone who presented symptoms of schizophrenia. We found partial support for these hypotheses. Participants had significantly greater FTV biases in the Peer Label/Symptoms Present condition. Interestingly, while FTV biases were lowest in the Schizophrenia Label/Symptoms Present condition, participants in this condition were most likely to believe that people with schizophrenia should face social restrictions. Our findings support that both implicit and explicit beliefs help develop and sustain stigma.

Both physical exercise and progressive muscle relaxation reduce the facing-the-viewer bias in biological motion perception.

Biological motion stimuli, such as orthographically projected stick figure walkers, are ambiguous about their orientation in depth. The projection of a stick figure walker oriented towards the viewer, therefore, is the same as its projection when oriented away. Even though such figures are depth-ambiguous, however, observers tend to interpret them as facing towards them more often than facing away. Some have speculated that this facing-the-viewer bias may exist for sociobiological reasons: Mistaking another human as retreating when they are actually approaching could have more severe consequences than the opposite error. Implied in this hypothesis is that the facing-towards percept of biological motion stimuli is potentially more threatening. Measures of anxiety and the facing-the-viewer bias should therefore be related, as researchers have consistently found that anxious individuals display an attentional bias towards more threatening stimuli. The goal of this study was to assess whether physical exercise (Experiment 1) or an anxiety induction/reduction task (Experiment 2) would significantly affect facing-the-viewer biases. We hypothesized that both physical exercise and progressive muscle relaxation would decrease facing-the-viewer biases for full stick figure walkers, but not for bottom- or top-half-only human stimuli, as these carry less sociobiological relevance. On the other hand, we expected that the anxiety induction task (Experiment 2) would increase facing-the-viewer biases for full stick figure walkers only. In both experiments, participants completed anxiety questionnaires, exercised on a treadmill (Experiment 1) or performed an anxiety induction/reduction task (Experiment 2), and then immediately completed a perceptual task that allowed us to assess their facing-the-viewer bias. As hypothesized, we found that physical exercise and progressive muscle relaxation reduced facing-the-viewer biases for full stick figure walkers only. Our results provide further support that the facing-the-viewer bias for biological motion stimuli is related to the sociobiological relevance of such stimuli.

Electrophysiological evidence of nicotine's distracter-filtering properties in non-smokers.

Nicotine-enhanced attentional functions are purported to underlie improvements in behavioral performance in cognitive tasks but it is unclear as to whether these effects involve selective attention or attentional control under conditions of distraction. Behavioral and event-related potential measures were used to examine the effects of nicotine on distractibility in 21 non-smokers who were instructed to ignore task-irrelevant auditory stimuli while they performed a visual discrimination task. In a randomized, double-blind, placebo-controlled cross-over design, nicotine gum (6 mg) shortened overall reaction times but failed to prevent increased response slowing and errors caused by deviant sounds. Relative to placebo, nicotine did not modulate the early pre-attentive detection of deviants as reflected in the mismatch negativity but it attenuated the amplitude of the deviant-elicited P3a, an event-related potential component indexing the involuntary shifting of attention. Nicotine also enhanced attentional re-focusing back on to task-relevant stimuli following distraction as evidenced by an increased amplitude of the re-orienting negativity. These findings and the behavioral-electrophysiological dissociation seen with nicotine are discussed in relation to theories of attention and smoking motivation.

Effects of acute nicotine on event-related potential and performance indices of auditory distraction in nonsmokers.

INTRODUCTION: Although nicotine has been purported to enhance attentional processes, this has been evidenced mostly in tasks of sustained attention, and its effects on selective attention and attentional control under conditions of distraction are less convincing. METHODS: This study investigated the effects of nicotine on distractibility in 21 (11 males) nonsmokers with event-related potentials (ERPs) and behavioral performance measures extracted from an auditory discrimination task requiring a choice reaction time response to short- and long-duration tones, with and without imbedded deviants. Administered in a randomized, double-blind, placebo-controlled crossover design, nicotine gum (6 mg) failed to counter deviant-elicited behavioral distraction characterized by longer reaction times and increased response errors. RESULTS: Of the deviant-elicited ERP components, nicotine did not alter the P3a-indexed attentional switching to the deviant, but in females, it tended to diminish the automatic processing of the deviant as shown by a smaller mismatch negativity component, and it attenuated attentional reorienting following deviant-elicited distraction, as reflected by a reduced reorienting negativity ERP component. DISCUSSION: Results are discussed in relation to attentional models of nicotine and with respect to future research directions.