"The mere imagination scares me"-evidence for fear responses during mental imagery of pain-associated interoceptive sensations in adolescents with chronic pain.

ABSTRACT: According to the bio-informational theory of emotion by Lang, mental imagery of fearful stimuli activates physiological and behavioural response systems, even in the absence of sensory input. We investigated whether instructed mental imagery of pain-associated (not painful) interoceptive sensations entails a threat value and elicits increased startle response, skin conductance level (SCL), and heart rate (HR) indicative of defensive mobilization in adolescents with chronic pain. Additionally, self-reported measures (fear, fear of pain, desire to avoid) were assessed. Adolescents (11-18 years) with chronic headache (CH, n = 46) or chronic abdominal pain (CAP, n = 29) and a control group (n = 28) were asked to imagine individualized pain-associated, neutral and standardized fear scripts. During pain-associated compared with neutral imagery, both pain groups showed higher mean HR, with CH also showing higher HR reactivity, while HR acceleration was not observed within control group. In contrast, during pain-associated compared with neutral imagery, startle response magnitude and SCL remained unchanged in all groups. Additionally, overall levels in self-reports were higher during pain-associated compared with neutral imagery, but significantly more pronounced in the pain groups compared with the control group. Results suggest that the mere imagination of pain-associated sensations elicits specific autonomic fear responses accompanied by increased self-reported fear in adolescents with chronic pain. The specific modulation of heart rate shed new light on our understanding of multimodal fear responses in adolescents with chronic pain and may help to refine paradigms to decrease fear of interoceptive sensations in chronic pain.

Close(d) to you? Avoidant attachment is associated with attenuated pupil responsivity to social stimuli.

Insecure attachment is thought to impair romantic relationships, presumably also contributing to mental health problems. Previous research has suggested a link to biased automatic processing of social information, potentially reflected in pupil dilation responses. To address this hypothesis, 37 adults were presented with attachment-related, emotional pictures of erotic couples, everyday couples, or interpersonal violence after assessment with the Experiences in Close Relationships Scale. Considerable variation in self-reported attachment behaviors regarding both attachment anxiety and avoidance was observed in our sample. Overall, pupil dilation was most pronounced during viewing of erotica and violence-related pictures. Relative to nature pictures as control, attachment avoidance was associated with attenuated pupillary responses to social content. However, this was not significant with erotica. For pictures of violence, this avoidant bias was also evident in reduced subjective arousal. In contrast, attachment anxiety was unrelated to differential pupil dilation. Our findings, although preliminary, suggest that previous attachment-related experiences may bias the processing of social stimuli, which in turn may be reflected in altered patterns of pupillary responses.

Interoception in preschoolers: New insights into its assessment and relations to emotion regulation and stress.

Interoception may play an important role for emotion regulation and stress, thereby affecting mental health in children and adults. Yet, little is known on interoception in preschool children. Therefore, we investigated interoceptive accuracy using the adapted Jumping Jack Paradigm (JJP) and its relationship with emotion regulation and stress. In Study I, 40 preschoolers completed the JJP and an emotion regulation task, demonstrating a positive relationship between interoceptive accuracy and emotion regulation at trend level (R² = 0.231, p = .023; ß = .278, p = .073). In Study II, 31 preschoolers completed the adapted JJP before and after an acute laboratory stress test. Higher total cortisol output following acute stress induction was associated with reduced interoceptive accuracy (r = -0.670, p = .017). Extending earlier findings in adults and school-children, the relationship of interoceptive accuracy with emotion regulation and stress highlights the importance to investigate interoception in early childhood.