Biomedical subjects

Ilse Van Diest

Publications and source records attributed to Ilse Van Diest.

15 recordsLinked to original sources

PubMed2006

Differentiation between the sensory and affective aspects of histamine-induced bronchoconstriction in asthma.

Respiratory symptom perception research has focused mainly on respiratory sensations. Because dyspnea is multidimensional, affective aspects should be investigated. Patients with asthma (N=25) underwent a histamine provocation until a 20% fall in forced expiratory volume in 1s (FEV(1)). After each dose level, 6 symptoms of dyspnea intensity and 6 symptoms of dyspnea affectivity were rated. Individual perceptual sensitivity was determined by calculating the linear slope between the fall in FEV(1) and the increase in the total symptom score, and for affective and sensory symptoms separately [Bijl-Hofland, Folgering, van den Hoogen, et al. Perception of bronchoconstriction in asthma patients measured during histamine challenge test. Eur Respir J 1999;14:1049-54]. Trait anxiety, baseline state anxiety, daily asthma symptoms and catastrophizing during an asthma exacerbation were also assessed. Sensitivity was unrelated to physiological indices of disease severity (i.e., baseline FEV(1) and histamine dose level at 20% fall in FEV(1)), whereas it was positively related to trait anxiety, state anxiety, daily asthma symptoms and catastrophic thinking during an asthma exacerbation in daily life. These relationships were overall much stronger for affective than for sensory symptom slopes. In stepwise multiple regressions, state anxiety was the best predictor of the affective symptom slopes, whereas catastrophic thinking during an asthma exacerbation was the best predictor for the sensory symptom slopes. The differentiation between sensory and affective components of dyspnea adds to the understanding of respiratory symptom perception in asthma.

Adolescent↗

PubMed2006

Anxiety and respiratory variability.

Associations of inter- and intra-individual differences in anxiety and fear with within subject variability in breathing parameters were explored. Timing and volume components of respiration and FETCO(2) were measured non-intrusively before and during anxious and fearful imagery in 98 young women. Trait anxiety was associated with less variability in several breathing parameters during baseline preceding imagery. Significant decreases in the variability of expiratory time and inspiratory drive were also observed during anxious imagery. During fearful imagery, however, the variability of FETCO(2) increased compared to baseline. Results on anxiety are largely in agreement with models that posit that healthy systems are characterized by variability and flexibility. The paradoxical findings for fearful imagery enhance the importance of a distinction between fearful and anxious affects.

Adaptation, Physiological↗

PubMed2006

US-inflation in a differential odor-conditioning paradigm is not robust: relevance for medically unexplained symptoms.

Reported somatic symptoms without clear relation to physiological processes are studied. A learning paradigm was used with two odors (CSs) and the inhalation of CO(2)-enriched air (US), while measuring symptom levels and respiratory behavior. After paring one odor with the CO(2)-enriched air and the other odor with air, half of the participants received a US-inflation manipulation (information manipulation and enhanced US). Subsequently, all participants received both odors with air (test). A difference between the odor previously paired with CO(2)-enriched air and the odor previously paired with air was found for the symptom measure, US-expectancy ratings, and, to a lesser extent, for respiratory volume. No differences, however, were found between the group receiving the US-inflation manipulation and a group not receiving this manipulation. The results indicate that, despite a successful learning of reported symptoms, US-inflation does not seem to be robust.

Acetic Acid↗

PubMed2006

Air hunger and ventilation in response to hypercapnia: effects of repetition and anxiety.

We investigated the effects of anxiety on the intensity of air hunger during gradually increasing levels of CO2 until the end-tidal fractional concentration of CO2 was 7.9% or air hunger was intolerable. Normal high and low (trait) anxious participants (N=23) went through three rebreathing trials (15 min interval). Breathing behaviour was continuously monitored and air hunger was rated every 12 s. The threshold for responding to the increased CO2 was always lower for the subjective rating than for the ventilatory response. Habituation across trials was observed for both the ventilatory response and the air hunger rating regardless of anxiety. However, beyond the threshold, the slope in air hunger ratings decreased across trials in low anxious persons and tended to increase in high anxious persons (interaction P<0.05). No differences occurred in the slopes of the breathing responses. The findings documented uncoupling of the physiological and subjective responses during CO2-induced air hunger.

Adolescent↗

PubMed2005

Negative affectivity and enhanced symptom reports: differentiating between symptoms in men and women.

This study aimed to characterize individual bodily symptoms as regards their differential relationship with negative affectivity (NA). In a first step, 73 symptoms were rated by independent groups of raters (psychologists, medical doctors, healthy students) on the following characteristics: the extent to which a symptom (1) refers to a specific location in the body (vagueness), (2) may refer to both a physical condition and a negative emotional state (overlap), and (3) is likely to be a physiological manifestation of anxiety (anxiety). Each symptom was also rated on (4) the probability that it is caused by a clearly defined somatic pathology (somatic pathology), (5) how life-threatening or (6) compromising for the quality of life a symptom is, and (7) how worried one would be if the symptom were to be experienced in daily life (worrying). Two factors, severity and somatic versus psychic, explained 75% of the variance in the ratings on the symptom characteristics. Next, based on the data of 1017 university students (858 women), correlations of each individual symptom with NA were calculated for each gender. The pattern of correlation was highly variable and differed in important ways for men and women. Whereas the correlation of an individual symptom with NA could be predicted by both symptom factors in women (R(2)=52%), only the somatic versus psychic factor was a significant predictor in men (R(2)=11%). These results suggest that (1) NA should not be considered a general complaining factor, and (2) important gender differences exist regarding the type of symptoms that relate most strongly to NA.

Adolescent↗

PubMed2005

Accuracy of respiratory symptom perception in different affective contexts.

OBJECTIVE: The accuracy of respiratory symptom perception was investigated in different affective contexts in participants (N=48) scoring high or low for negative affectivity (NA). METHODS: Within-subject correlations were calculated between two subjective ratings and their respective physiological referent (the rating of "deeper breathing" and respiratory volume, and rating of "faster breathing" and breathing frequency) across nine consecutive breathing trials. Three different air mixtures were used: room air, air enriched with 7.5% CO(2), and with 10% CO(2). For half the participants, the trials were framed in a pleasant context, created by adding a pleasant odour to the air mixture in addition to information announcing pleasant feelings as a result of breathing the air mixtures. The other half received the trials in a distressing context: A foul smelling odour was added and the information announced unpleasant feelings. RESULTS: High-NA persons were overall less accurate than were low-NA persons in the perception of respiratory volume. For breathing frequency, high-NA persons were significantly less accurate in the distressing condition than in the pleasant one, whereas for low-NA persons, the information frame did not matter. CONCLUSION: The study shows that the accuracy of respiratory symptom reports is reduced in high-NA persons, especially in a distressing context.

Adolescent↗

PubMed2004

Perceived relation between odors and a negative event determines learning of symptoms in response to chemicals.

BACKGROUND: We investigated the effects of worrying information about chemical pollution on subjective symptoms in response to an odor that was previously associated with symptom episodes. METHODS: Ammonia and butyric acid in harmless concentrations were used as odor cues, and 10% CO2-enriched air was used to induce symptoms. One of two odors was consistently mixed with CO2-enriched air while the other odor was presented in room air during 80 s breathing trials (three trials of each). Next, information framing the experiment in the context of possible health-damaging effects of chemical pollution of our environment was presented to half the participants, whereas no information was given to the other half. Finally, both odor cues were presented with room air. Symptom scores were used as the dependent variable. RESULTS: Unexpectedly, participants reported more symptoms in response to the odor previously presented with air than to the odor previously presented with CO2-enriched air. Post-hoc analyses suggested a crucial role for perceived rather than actual contingencies between odor and symptom episodes. Information manipulation had no effect. CONCLUSIONS: Believing that a specific odor cue was associated with a symptom episode was more important than the actual association in order to provoke symptoms in response to harmless odor cues.

Adolescent↗

PubMed2004

Contingency awareness in a symptom learning paradigm: necessary but not sufficient?

In previous studies, we found that bodily symptoms can be learned in a differential conditioning paradigm, using odors as conditioned stimuli (CSs) and CO2-enriched air as unconditioned stimulus (US). However, this only occurred when the odor CS had a negative valence (a selective conditioning effect), and tended to be more pronounced in persons scoring high for Negative Affectivity (NA). This paper considers the necessity and/or sufficiency of awareness of the CS-US contingency in three studies using this paradigm. The relation between contingency awareness and the selective conditioning effect, and between contingency awareness and NA was also considered. Both self reported symptoms and respiratory physiology served as dependent variables. A learning effect on symptoms was found only for participants aware of the CS-US contingency, but not all participants reporting contingency awareness showed a learning effect. No conditioning effects appeared on the physiological measures. Also contingency awareness did not account for the selective conditioning effect, and did not interact with NA. Overall, the necessity but insufficiency hypotheses can only be withhold for group data and not for individual data.

Adolescent↗

PubMed2004

Dyspnea: the role of psychological processes.

Breathlessness or dyspnea-the subjective experience of breathing discomfort-is a symptom in many pulmonary, cardiovascular, and neuromuscular diseases. It occurs in normals as well during intense emotional states and heavy labor or exercise. In clinical cases, it generally causes severe suffering. Dyspnea has multifactorial causes and the explanation for the symptom may differ largely among patients. Explanatory models imply the involvement of mechanisms at several levels of functioning, such as afferent signals from the respiratory muscles or blood gas levels related to hypercapnia and hypoxia. Depending on the relative involvement of specific mechanisms and their interactions, dyspnea may be experienced differently and subtypes can be distinguished. More recently, perceptual-cognitive and emotional processes related to symptom perception and interpretation have been investigated in the context of dyspnea. In this review, we focus on the psychological processes that play part in the perception of dyspnea and formulate some practical guidelines for those who are confronted with dyspnea.

Arousal↗

PubMed2002

Learning subjective health complaints.

Symptom episodes often show a spatio-temporal structure, that is, they occur in a specific context for a certain duration. Repeated experiences may therefore be construed as associative learning trials, in which context elements are turned into predictive cues, triggering anticipatory processes conducive to subjective health complaints. A series of experiments, using inhalations of air enriched with CO2 and external (odors) or internal (mental images) stimuli as cues, is discussed to show that subjective health complaints may occur upon presenting the cue alone. Learned symptoms may be unrelated to bodily responses and easily generalize to new related cues. Better learning occurs to cues with a negative affective valence and in participants scoring high for negative affectivity. Our findings are relevant to the understanding of medically unexplained ("functional") syndromes and the poor relationship between objective and subjective health indicators in general.

Humans↗

PubMedDate not supplied

Media warnings about environmental pollution facilitate the acquisition of symptoms in response to chemical substances.

OBJECTIVE: Previous studies showed that somatic symptoms can be acquired in response to chemical substances using an associative learning paradigm, but only when the substance was foul smelling and not when it smelled pleasant. In this study, we investigated whether warnings about environmental pollution would facilitate acquiring symptoms, regardless of the pleasantness of the smell. METHOD: One group received prior information framing the study in the context of the rapidly increasing chemical pollution of our environment. Another group received no prior information. Conditional odor stimuli (CS) were diluted ammonia (foul-smelling) and niaouli (neutral-positive smelling); the unconditional stimulus (UCS) was 10% CO2-enriched air. Each subject breathed one odor mixed with CO2 and a control odor mixed with air in 80-sec breathing trials. The type of odor mixed with CO2 was counterbalanced across participants. Next, the same breathing trials were administered without CO2. Breathing behavior was measured during each trial; subjective symptoms were assessed after each trial. RESULTS: Only participants who had been given warnings about environmental pollution reported more symptoms to the odor that had previously been associated with CO2, compared with the control odor. This was so for both the foul- and the pleasant-smelling odor. Symptom learning did not occur in the group that did not receive warnings. The elevated symptom level could not be accounted for by altered respiratory behavior, nor by experimental demand effects. CONCLUSIONS: Raising environmental awareness through warnings about chemical pollution facilitates learning of subjective health symptoms in response to chemical substances.

Administration, Inhalation↗

PubMedDate not supplied

Resting end-tidal CO2 and negative affectivity.

OBJECTIVE: Dhokalia, Parsons, and Anderson (Psychosom Med 1998;60:33-37) found a positive correlation between a trait measure of negative affectivity (NA; neuroticism) and resting end-tidal fractional concentration of CO2 (FetCO2) (fractional-concentration of end-tidal carbon dioxide) in a nonclinical sample. This contrasts sharply with studies reporting a negative association of FetCO2 with state measures of NA and with studies reporting no or a negative relationship between FetCO2 and trait NA. In two studies we aimed to clarify this paradox. MATERIALS AND METHODS: In the first study, 110 participants (83 women) completed the PANAS and a Checklist for Psychosomatic Symptoms in daily life. FetCO2 was measured noninvasively during 5 minutes via a nose cannula connected to a capnograph. In the second study, FetCO2 of high (N= 20, 10 men) and low (N= 20, 10 men) NA participants was sampled once with a nasal cannula and once while breathing through a mouthpiece for 6 minutes each during rest, completion of the NEO-PI-R questionnaire, and completion of a verbal knowledge test. RESULTS: The first study found no association between trait NA and resting FetCO2 after partialling out the effects of gender, menstrual phase, and use of oral contraceptives. The second study showed that FetCO2 increased significantly in the high NA group only when the particpants filled out the questionnaires, regardless of its type. CONCLUSIONS: Overall, no association between dispositional NA and cross-situational FetCO2 was observed. Apparently inconsistent findings may be caused by lack of control for hormonal status and mental load during testing.

Adolescent↗

PubMedDate not supplied

Can subjective asthma symptoms be learned?

OBJECTIVE: We investigated whether perception of subjective asthma symptoms can be brought under control of biomedically irrelevant cues in the environment, i.e., whether subjective asthma symptoms can be learned in response to harmless stimuli. METHODS: Twenty patients with asthma and 20 healthy participants were presented with two placebo-inhalers presented as new chemicals for diagnosing asthma. One inhaler was coupled three times with rebreathing 5% CO2 in oxygen, the other inhaler was coupled three times with rebreathing oxygen. In the subsequent test phase, both inhalers were coupled once with oxygen. We assessed airway resistance and subjective symptoms throughout the study. RESULTS: Both groups expected and reported more symptoms with the inhaler that was previously associated with the CO2 trials compared with trials with the inhaler that was used on trials without CO2 without concomitant effects on respiratory resistance. The learning effects were most pronounced in a subgroup of patients reporting symptoms of hyperventilation during asthma exacerbations in daily life. CONCLUSIONS: Subjective respiratory symptoms can be learned in response to harmless stimuli and a substantial proportion of patients with asthma might be especially vulnerable to this phenomenon. Because asthma patients rely mainly on perceived symptoms for their medication use, it is likely that they will take reliever medication based on expected symptoms instead of real exacerbations of respiratory dysfunction.

Adolescent↗

PubMedDate not supplied

Imagined risk of suffocation as a trigger for hyperventilation.

OBJECTIVE: Although hyperventilation has been hypothesized to play a role in many pathologies, its critical triggers remain poorly understood. The present experiment aimed to test whether stronger hyperventilation responses occur in response to suggested risk of suffocation compared with other fearful situations in high- and low-trait anxious women. METHODS: Fractional end-tidal CO2-concentration (FetCO2), respiratory frequency, and inspiratory volume were measured nonintrusively in high- (n = 24) and low- (n = 24) trait anxious women during imagery of 3 fear, 1 tension, 1 depressive, and 3 relaxation scripts. The fear scripts were equal in ratings of unpleasantness and arousal but differed regarding the inclusion of suggested risk of suffocation and entrapment. After each imagery trial, participants rated the emotional dimensions of pleasantness, arousal, and dominance and the vividness of their imagery. RESULTS: Decreases in FetCO2 occurred in all fear scripts. High-trait anxious women showed a stronger reduction in FetCO2 compared with low-trait anxious women during the fear script suggesting risk of suffocation but not during the other fear scripts. This effect was unrelated to any of the self-reported fear ratings. Self-reported fear of entrapment was associated with an overall lower FetCO2 but not with enhanced reactivity to imagined entrapment. CONCLUSION: High-trait anxiety is associated with stronger respiratory responsivity to imagined risk of suffocation and may constitute a specific vulnerability factor for the development of panic disorder and claustrophobia.

Adolescent↗

PubMedDate not supplied

Acquired lightheadedness in response to odors after hyperventilation.

OBJECTIVE: This study aimed to investigate whether lightheadedness in response to odors could be acquired through previous associations with hyperventilation-induced hypocapnia. METHODS: Diluted ammonia and acetic acid served as conditional odor cues (CSs) in a differential associative learning paradigm. Hyperventilation-induced hypocapnia (unconditional stimulus [US]) was used to induce lightheadedness. In a training phase, participants (n = 28) performed three hypocapnic and three normocapnic overbreathing trials of 60 seconds each. One odor was consistently paired with the hypocapnic overbreathing (CS+); the other (control) odor was paired with normocapnic overbreathing (CS-). In the test phase, each odor was presented once during spontaneous breathing and once during normocapnic overventilation. Lightheadedness was assessed online during each breathing trial, which was followed by an extensive hyperventilation symptom checklist. Fractional end-tidal CO2, breathing frequency, and inspiratory volume were measured throughout the experiment. RESULTS: In the test phase, participants experienced lightheadedness more quickly in response to the odor that had been paired with hypocapnic overbreathing compared with the control odor. They also scored higher on the symptom "feeling unreal." CONCLUSION: Lightheadedness in response to odors can be acquired easily. The present results may help to elucidate the paradox that both avoidance and exposure to chemicals seem to be effective in reducing symptoms in idiopathic environmental illness.

Adult↗