Negative affectivity predicts decreased pain tolerance during low-grade inflammation in healthy women.

INTRODUCTION: Experimental animal studies provided evidence for a synergistic effect of immunological and psychological stressors on subsequent sickness behaviours. Up to now, little corroborating evidence for such synergy exists for humans, in whom it may provide a mechanism leading to the expression of functional somatic symptoms. The aim of the present study was to determine an interaction between stress(-vulnerability) and an immunological activation on experimental pain sensitivity, i.e., pressure pain threshold and tolerance in healthy humans. METHODS: In healthy female participants (n=25, mean age 22.3 years), negative affectivity (NA) and experienced stress were assessed by questionnaire before receiving a Salmonella typhi vaccine or saline control in a randomized blinded cross-over design. Pressure pain threshold was assessed at the lower back and calves and pain tolerance was assessed at the thumbnail, before and six hours after each injection. RESULTS: Vaccination induced leukocytosis (+100%) and increased serum IL-6 (+670%). NA predicted decreased pain tolerance after vaccination (ß=-.57, p=.007), but not after placebo (ß=.25, p=.26). Post-hoc analyses also demonstrated an association with administration order. DISCUSSION: NA moderated the effects of inflammation on pain tolerance. This finding is consistent with a synergistic model whereby inflammation may lower the threshold for pain reporting in individuals with increased vulnerability for somatic symptom reporting.

Young adults' reactions to infant crying.

An infant's optimal development is determined to a great extent by the adequate and sensitive responses of the caregiver. The adequacy and sensitivity of a reaction to an infant in distress (i.e. crying) will partly depend on the causal attributions of the crying and on the individual's sympathy for the infant. Being female, prior caring experiences, and multiparity have shown to be linked to more sympathetic, tolerant and less hostile emotional responses to crying. However, little is known about other factors explaining inexperienced future caregivers' reactions to infant crying. The present paper's goal is to shed more light on the subject by looking at how personality factors, caregiving interest, sex, promptness of the reaction, and gender identity are related to emotional reactions and causal attributions to crying in a population of young adults without children. One hundred and ninety-one childless university students participated (126 females; ages 18-35 years). The participants completed questionnaires on personality, gender identity and caregiving interest, and listened to an audio sample of an infant crying, reporting their emotions and their causal attributions to the crying. The results showed that experiencing anger was associated with more child-blaming attributions to the crying, while quickness of response and feelings of sympathy predicted more child-oriented attributions. The latter was stronger in males. Explicit care interest decreased child-blaming causal attributions more for men than for the women. Interestingly, solely in the females' personality factors neuroticism and conscientiousness played a role in child blaming attributions together with anger. These findings suggest that the motives that young adults attribute to a crying infant depend in males on the emotions triggered by the crying, responsiveness and care interest. While in females, emotions, responsiveness and personality affect the causal attribution to the crying. Future research is needed in order to determine whether these attributions are also linked to young adults' actual behaviour towards a crying infant.

[Questioning the mechanism behind slow breathing and heart coherence training]. / Vraagtekens bij het werkingsmechanisme van slow-breathing en hartcoherentietraining.

BACKGROUND: Slow breathing and heart coherence training are being offered increasingly as treatments for anxiety, depression and stress-related mental and somatic complaints. Both of these interventions are aimed at influencing (i.e. increasing or optimising) heart rate variability and the mechanism involved is described in terms such as heart coherence, resonance breathing and heart-brain communication. AIM: To find out whether treatment effects are indeed based on the optimisation of heart rate variability. METHOD: Our literature search focused on 1) the assumption that poor mental health is definitely linked to deviant heart rate variability, and 2) the assumption that optimising heart rate variability leads specifically to a reduction of complaints and symptoms. RESULTS: There is insufficient evidence to support these two assumptions. CONCLUSION: Slow breathing and heart coherence training probably achieve their effects as a result of non-specific psychological mechanisms.

[Work-stress and cortisol; measurements and results]. / Werkstress en cortisol; meetfilosofie en bevindingen.

Physiological measurements of stress are believed to help with the 'objectivation' of the rather subjective phenomenon called 'stress'. Because there are only moderate interpersonal correlations between the subjective experience of work-stress and physiological stress measurements, the latter are useful mainly for comparing groups with high stress and groups with low stress and not as a diagnostic tool at individual level. Physiological measurements have added value because they quantify the strain that stress exerts on the body, which ultimately determines what effect stress has on health. In addition, physiological measurements on persons with stress-related symptoms such as burn-out can help us understand the nature of the dysregulation of the stress-regulatory system which occurs in the persons with these types of symptoms. The comparison of high-stress groups and low-stress groups on the basis of various cortisol parameters has produced rather inconsistent results. This seems to be due not only to the unreliability of the measurements but also to the fact that cortisol is apparently a rather inaccurate reflection of the stress-regulatory system in the brain. Research into the changes that occur over time in the cortisol-regulatory system resulting from chronic work-stress and into the health-relevance of various cortisol parameters is essential if progress is to be achieved in this area.

Migraine patients as trainers of their fellow patients in non-pharmacological preventive attack management: short-term effects of a randomized controlled trial.

In conformity with current views on patient empowerment, we designed and evaluated the effects of home-based behavioural training (BT) provided by lay trainers with migraine to small groups of fellow patients. The primary aims of BT were to reduce attack frequency and increase perceived control over and self-confidence in attack prevention. In a randomized controlled trial the BT group (n = 51) was compared with a waitlist-control group (WLC), receiving usual care (n = 57). BT produced a minor (-21%) short-term effect on attack frequency and clinically significant improvement in 35% of the participants. Covariance analysis showed a non-significant trend (P = 0.07) compared with WLC. However, patients' perceived control over migraine attacks and self-confidence in attack prevention increased significantly with large effect sizes. Patients with high baseline attack frequency might benefit more from BT than those with low attack frequency. In conclusion, lay trainers with migraine strengthened fellow patients' perceived control, but did not induce a significant immediate improvement in attack frequency.

Emotion regulation predicts change of perceived health in patients with rheumatoid arthritis.

OBJECTIVES: To examine whether emotion regulation predicts change of perceived health in patients with rheumatoid arthritis (RA). METHODS: Sixty six patients (44 female, 22 male; mean (SD) age 57.7 (11.6) years) participated in a prospective study. Hierarchical regression analysis was used to predict change of perceived health between study entry and follow up (1(1/2) years later) from the emotion regulation styles ambiguity, control, orientation, and expression at study entry. RESULTS: Valuing and intensely experiencing emotions (emotional orientation) predicted a decrease of positive affect. Difficulty recognising and expressing emotions (ambiguity) predicted an increase of perceived disease activity. Emotion regulation showed no associations with change of negative affect and social and physical functioning. CONCLUSIONS: Two styles of emotion regulation were shown to have a significant though modest role in the prediction of perceived health change in patients with RA. This suggests that the monitoring of emotion regulation may help to identify patients who are at risk for a reduction of perceived health. If our findings were confirmed by experimental research, improving emotion regulation skills might favourably affect perceived health.

Neuroendocrine-immune relationships between emotion regulation and health in patients with rheumatoid arthritis.

OBJECTIVES: Emotion regulation is hypothesized to be related to health through neuroendocrine-immune changes. This study examined the role of the neuroendocrine variables 24-h urinary cortisol and noradrenaline, and the immune variable serum interleukin 6 as mediators between emotion regulation styles and health (perceived health and disease activity: erythrocyte sedimentation rate (ESR) and Thompson joint score). METHODS: Sixty patients with rheumatoid arthritis (mean age 59.0+/-11.2 yr; 38 female) participated. RESULTS: Emotion regulation was not associated with immune functioning or disease activity, but it was somewhat related to neuroendocrine functioning: one of the emotion regulation styles, ambiguity, was related to noradrenaline in women (r = 0.39) but not in men. The indicators of neuroendocrine functioning (cortisol and noradrenaline) were correlated (r = 0.40), as were indicators of immune functioning (interleukin 6) and inflammatory activity (ESR; r = 0.53), but analyses did not indicate a role of these physiological variables in mediating between emotion regulation and health: neuroendocrine variables were not related to interleukin 6 or ESR, and none of the physiological parameters was correlated with joint score or perceived health. CONCLUSIONS: To examine whether the proposed mediational processes apply to individual patients, a longitudinal within-subjects design is needed. In our cross-sectional study, emotion regulation was somewhat related to neuroendocrine functioning, but our study did not uncover a potential mediational role of cortisol, noradrenaline or interleukin 6 in the relationship between emotion regulation and health in rheumatoid arthritis.

Perioperative microembolism is not associated with cognitive outcome three months after carotid endarterectomy.

OBJECTIVE: To investigate the association between perioperative microembolism and cognitive outcome 3 months after carotid endarterectomy (CEA). DESIGN: Prospective study. MATERIALS AND METHODS: Patients were tested 1 day before and 3 months after surgery with neuropsychological tests measuring a wide range of cognitive functions. Number of microemboli was monitored with transcranial Doppler ultrasonography in 58 patients during the operation and in a random subgroup of 27 patients directly following the procedure. RESULTS: Forty patients (69%) had intraoperative embolism, varying from 1 to 33 isolated microemboli and/or 1 to 11 embolic showers. Postoperative emboli were present in 22 of the 27 patients (81%), ranging from 1 to 142 isolated microemboli. More than 10 microemboli (including showers) were detected in 13 patients (22%) intraoperatively and in 6 patients (22%) postoperatively. Twenty-two patients (38%) showed deterioration in three or more cognitive function variables at 3 months. There were no significant associations between any cognitive change or deterioration score and presence or number of intraoperative and/or postoperative emboli. CONCLUSIONS: The degree of microembolism during and immediately following CEA is generally small and seems to be of no significance with respect to postoperative cognitive functioning. Future research should include a larger group of patients to allow reliable subgroup analysis.