Electromagnetic indication of hypervigilant responses to emotional stimuli in blood-injection-injury fear

Blood phobia differs from other phobias and anxiety disorders in that no attentional bias for blood-related stimuli has been consistently observed. The present study aimed at clarifying this characteristic by investigating electromagnetic brain activity to blood-related and -unrelated pictures in high blood-fearful and non-fearful individuals. Relative to non-fearful controls, high blood-fearful subjects displayed more intense occipito-parietal activation 190–250 ms after picture onset, which was interpreted as non-specifically enhanced sensory encoding of visual stimuli. Blood-related stimuli did not elicit different activity patterns in high blood-fearful subjects and controls, supporting the hypothesis that non-specific hypervigilance does not provide a basis for subsequent, specifically enhanced processing of fear-related contents.     

Disgust, fear, and the anxiety disorders: a critical review

Anxiety disorders have traditionally been conceptualized as reflecting the emotions of fear and anxiety. A developing program of research demonstrates a relation between disgust and three specific anxiety disorders: blood-injection-injury (BII) phobia, spider phobia, and contamination-related obsessive-compulsive disorder (OCD). This review serves three purposes. First, the authors review the response patterns predicted to be observed if the emotional response in these disorders involved disgust versus fear. The review suggests specific response patterns that characterize disgust and fear in the domains of heart rate, facial expression, neural activity, and cognitive processes. Second, the authors review extant research employing measures of these domains in spider phobia, BII phobia, and contamination-related OCD. The evidence suggests that both fear and disgust characterize each of these disorders, but the magnitude at which the emotions characterize the disorders may depend on the response domain measured. For example, disgust may be more involved in spider phobia in appraisals and facial expression, but less involved in neural correlates or heart rate domains. Third, the authors suggest guidelines for future research, including concurrent use of specific measures as well as examining whether the different emotions in different response domains respond to similar interventions (e.g., exposure).     

Confrontation with blood and disgust stimuli precipitates respiratory dysregulation in blood-injection-injury phobia

Blood-injection-injury (BII) phobia patients sometimes faint during exposure to relevant stimuli. However, mechanisms and timing of physiological adjustments in BII phobia remain poorly understood. In a larger sample of 60 patients and 20 controls, we sought to replicate findings of a prior study demonstrating the role of hyperventilation in the phobic response. We also investigated the timing of respiratory adjustment across an extended exposure recovery period. In addition, because intense disgust is commonly reported by patients, responses to surgery films were compared to a pure disgust film. End-tidal PCO₂ dropped significantly while volume and flow increased during the surgery film in patients compared to controls and to other emotional films except disgust. Patients recovered quickly following the disgust film but not the surgery film. PCO₂, volume, and flow parameters showed robust associations with anxiety, disgust, and physical symptoms. Findings suggest that respiratory adjustments during and after phobic exposure may provide a critical missing link in the understanding of the psychophysiology of this singular disorder, including why fainting often occurs after the stimulus is removed.     

Sympathetic and parasympathetic responses to a core disgust video clip as a function of disgust propensity and disgust sensitivity

It is generally assumed that disgust is accompanied by increased activation of the parasympathetic nervous system (PNS). However, empirical support for the role of PNS in disgust is scarce. This study tested whether (i) activation of the PNS is indeed involved in disgust and (ii) disgust-induced autonomic activation is especially pronounced in individuals with high disgust propensity or enhanced disgust sensitivity. Participants (N=60) viewed a 5 min disgust-inducing video clip. Participants showed increased parasympathetic activity of both the cardiac and the digestive components of the autonomic nervous system (ANS), together with increased sympathetic activation of the cardiac system. ANS responses were independent of subjective disgust and individuals' habitual disgust propensity or sensitivity. Results support the hypothesis that PNS activation is involved in disgust. The absence of a relationship between subjective and physiological indices of disgust indicates that both types of responses reflect independent phenomena.     

The effect of disgust-related side-effects on symptoms of depression and anxiety in people treated for cancer: a moderated mediation model

As maladaptive disgust responses are linked to mental health problems, and cancer patients may experience heightened disgust as a result of treatments they receive, we explored the associations between disgust-related side-effects and symptoms of depression and anxiety in people treated for cancer. One hundred and thirty two (83 women, M _age = 57.48 years) participants answered questions about their treatments, side-effects, disgust responding, and mental health. Experiencing bowel and/or bladder problems, sickness and/or nausea (referred to here as “core” disgust-related side-effects) was significantly related to greater symptoms of depression and borderline increased anxiety. Further, these links were explained by a moderated mediation model, whereby the effects of core disgust side-effects on depression and anxiety were mediated by (physical and behavioural) self-directed disgust, and disgust propensity moderated the effect of core disgust side-effects on self-disgust. These findings stress the importance of emotional responses, like disgust, in psychological adaptation to the side-effects of cancer treatments.     

Bradygastric activity of the stomach predicts disgust sensitivity and perceived disgust intensity

The aim of this study was to investigate gastric and non-gastric autonomic responses to disgusting pictures and to assess the relationship between autonomic changes, disgust sensitivity, and perceived disgust intensity. Healthy participants viewed pictures with affectively neutral or disgusting content of either a high or moderate arousal level. Electrogastrogram, electrocardiogram, and electrodermal activity were recorded, and participants’ disgust sensitivity and disgust intensity were assessed. No main effect of condition on gastric myoelectrical activity was found. However, stepwise regression analyses indicated that the percentage of bradygastria predicted disgust ratings in case of the highly arousing disgust pictures. When moderately arousing pictures were shown, disgust ratings were predicted by disgust sensitivity, which in turn was predicted by the percentage of bradygastria. Heart periods and respiratory sinus arrhythmia increased to a similar extent during both the highly arousing and moderately arousing picture blocks, while a tendency for larger skin conductance responses during the highly arousing picture block was shown. The results suggest that feelings of disgust may be specifically related to increased bradygastria, which may represent a prodromal sign of vomiting.     

Disgust and fear‐related UCS‐expectancy bias in blood‐fearful individuals

People with specific fears tend to overestimate the occurrence of unpleasant consequences in situations involving their feared objects. Such expectancy bias logically acts in a way to confirm phobic fear and avoidance. Increasing evidence suggests that blood phobia is qualitatively different from other specific phobias. Confrontation with phobic stimuli gives rise to disgust and repulsion rather than (threat‐induced) fear. Therefore, this study examined the role of disgust‐related UCS expectancies following confrontation with blood phobia‐relevant stimuli. Using a thought‐experiment procedure, high (n = 30) and low (n = 30) blood‐fearful individuals estimated the probability that the presentation of slides showing a bloody wound and a series of filler slides would be followed by a sip of nauseating juice, a threat‐related electrical shock or nothing. Although participants generally expected shock and juice following blood, UCS expectancies for both aversive outcomes for blood were significantly more pronounced in high blood‐fearful participants. This implicates that UCS‐expectancy biases may be involved in the development and maintenance of blood phobia. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner's Message This paper is relevant to clinical practitioners: ? To learn whether disgust and fear could both be important factors in blood phobia; ? To examine the role of UCS expectancies in the maintenance of phobic complaints; and ? To learn whether cognitive biases towards disgust are relevant to psychopathology (in particular, blood phobia) and to learn about the relevance of addressing disgust‐related UCS expectancies for blood in future treatments.     

Stress-related changes in financial risk taking: Considering joint effects of cortisol and affect

Many decisions under risk and uncertainty are made under physical or emotional stress. A recent meta-analysis suggested that stress reliably influences risk taking but did not find a relation between single measures of stress such as cortisol and risk taking. One reason for the conflicting findings could be that the influence of stress on risk taking depends not only on physiological but also on psychological stress responses, in particular affective valence. We tested this hypothesis in an exploratory empirical study: Seventy participants worked on a financial risk-taking task. In half of the participants acute stress was induced with a cold pressor task. For all participants we measured cortisol and α-amylase levels, blood pressure, subjective arousal, and affective valence before and after the task. The stress induction increased participants' levels of cortisol, subjective arousal, and systolic blood pressure but did not directly influence negative affect or risky decision making. Examining the interplay between physiological and psychological stress responses, a moderation analysis revealed an interaction between stress induction and affect valence: Negative affect predicted an increase in risk-seeking decision making in the stress condition, but not in the control group. A similar moderation was found with cortisol reactivity, that is, negative affect predicted an increase in risk-seeking decision making in participants with high cortisol reactivity but not in participants with low cortisol reactivity. These results suggest that the effect of stress on risky decision making depends on the interplay of affective valence and cortisol reactivity.     

Diminished medial prefrontal cortex activity in blood-injection-injury phobia

We examined the effects of symptom induction on neural activation in blood-injection-injury (BII) phobia. Nine phobic and 10 non-phobic subjects participated in an fMRI study in which they were presented with disorder-relevant, generally disgust-inducing, generally fear-evoking and neutral pictures. We observed diminished medial prefrontal cortex (MPFC) activity in patients compared to controls for phobia-relevant and disgust-inducing pictures. The MPFC has been shown to be critically involved in the automatic and effortful cognitive regulation of emotions. Therefore, the results might reflect reduced cognitive control of emotions in BII phobics during the experience of phobic symptoms as well as during states of disgust. The latter response component might be a result of the elevated disgust sensitivity of BII phobics.     

Sympathetic and parasympathetic responses to a core disgust video clip as a function of disgust propensity and disgust sensitivity

It is generally assumed that disgust is accompanied by increased activation of the parasympathetic nervous system (PNS). However, empirical support for the role of PNS in disgust is scarce. This study tested whether (i) activation of the PNS is indeed involved in disgust and (ii) disgust-induced autonomic activation is especially pronounced in individuals with high disgust propensity or enhanced disgust sensitivity. Participants (N = 60) viewed a 5 min disgust-inducing video clip. Participants showed increased parasympathetic activity of both the cardiac and the digestive components of the autonomic nervous system (ANS), together with increased sympathetic activation of the cardiac system. ANS responses were independent of subjective disgust and individuals’ habitual disgust propensity or sensitivity. Results support the hypothesis that PNS activation is involved in disgust. The absence of a relationship between subjective and physiological indices of disgust indicates that both types of responses reflect independent phenomena.     

Core disgust and moral disgust are related to distinct spatiotemporal patterns of neural processing: An event-related potential study

Core disgust is thought to rely more on sensory and perceptual processes, whereas moral disgust is thought to rely more on social evaluation processes. However, little is known about the neurocognitive mechanisms underlying these two types of disgust. We recorded event-related potentials (ERPs) from participants while they performed a lexical decision task in which core- and moral-disgust words were intermixed with neutral words and pseudowords. Lexical judgment was faster for coredisgust words and slower for moral-disgust words, relative to the neutral words. Core-disgust words, relative to neutral words, elicited a larger early posterior negative (EPN), a larger N320, a smaller N400, and a larger late positive component (LPC), whereas moral disgust words elicited a smaller N320 and a larger N400 than neutral words. These results suggest that the N320 and N400 components are particularly sensitive to the neurocognitive processes that overlap in processing both core and moral disgust, whereas the EPN and LPC may reflect process that are particularly sensitive to core disgust.     

Airway response to emotion‐ and disease‐specific films in asthma,blood phobia,and health

Earlier research found autonomic and airway reactivity in asthma patients when they were exposed to blood‐injection‐injury (BII) stimuli. We studied oscillatory resistance (R_os) in asthma and BII phobia during emotional and disease‐relevant films and examined whether muscle tension counteracts emotion‐induced airway constriction. Fifteen asthma patients, 12 BII phobia patients, and 14 healthy controls viewed one set of negative, positive, neutral, BII‐related, and asthma‐related films with leg muscle tension and a second set without. R_os, ventilation, cardiovascular activity, and skin conductance were measured continuously. R_os was higher during emotional compared to neutral films, particularly during BII material, and responses increased from healthy over asthmatic to BII phobia participants. Leg muscle tension did not abolish R_os increases. Thus, the airways are particularly responsive to BII‐relevant stimuli, which could become risk factors for asthma patients.     

Disgust sensitivity,blood–injection–injury fear,and dental anxiety

The present studies evaluated whether high disgust sensitivity is associated with high levels of blood–injection–injury (BII) fear. The first study found no evidence for a connection between disgust sensitivity and BII fear in a sample of undergraduate students (N=166). In contrast, the second study did find a significant correlation between disgust sensitivity and BII fear in a mixed sample of dental anxious patients and undergraduate students (N=96), but the magnitude of this correlation was rather modest. The third study relied on a sample of patients with clinical dental phobia (N=36). Although these patients displayed heightened disgust sensitivity scores, no significant associations were found between disgust sensitivity and BII fear or fainting. Taken together, the present data indicate that disgust sensitivity plays only a minor role in BII‐related fears such as dental anxiety. Copyright © 1999 John Wiley & Sons, Ltd.     

特质应对方式与夜班护士身心健康问题关系探讨

目的　了解夜班护士不同特质应对方式与身心健康的关系。方法　采用特质应对方式问卷 (TCSQ)和康奈尔医学指数 (CM1 )调查 62名夜班护士 ,按消极应对 (NC)高 /低分和积极应对 (PC)高 /低分进行分组比较 ,其身心 (A-RR)及心理健康问题 (M-R)得分。结果　 NC高分组 A-R、M-R得分均高于 NC低分组 ,PC高 /低分组之间 A-R、M-R得分无明显差异。结论　消极应对态度对身心健康影响较明显 ,尤其对心理健康影响更突出     

Danger and disease: Electrocortical responses to threat- and disgust-eliciting images

Previous research suggests facilitated processing of evolutionarily significant stimuli (e.g., depictions of erotica, mutilation, threat), as reflected by augmented event-related potentials (ERPs), including the early posterior negativity (EPN) and late positive potential (LPP). Evolutionary models suggest that images that evoke disgust should be high in motivational salience, but evidence that the EPN and LPP are enhanced by disgusting images is lacking. Prior studies have employed only a small number of disgusting images that were limited in the types of content depicted. In the current study, participants viewed larger sets of disgusting, threatening, and neutral images with more varied content while electroencephalography (EEG) was recorded. Results showed that disgusting and threatening images elicited equivalent LPPs, which were both significantly increased relative to LPPs elicited by neutral images. EPN amplitudes were augmented for both disgusting and threatening relative to neutral images, though significantly more for disgust. These findings offer initial evidence that the EPN and the LPP are sensitive to disgust-eliciting pictures and that these pictures may receive processing that is at least on par with that of threatening images. Limitations of the current study and implications for future research are discussed.