Expectations affect psychological and neurophysiological benefits even after a single bout of exercise

The study investigated whether typical psychological, physiological, and neurophysiological changes from a single exercise are affected by one’s beliefs and expectations. Seventy-six participants were randomly assigned to four groups and saw different multimedia presentations suggesting that the subsequent exercise (moderate 30 min cycling) would result in more or less health benefits (induced expectations). Additionally, we assessed habitual expectations reflecting previous experience and beliefs regarding exercise benefits. Participants with more positive habitual expectations consistently demonstrated both greater psychological benefits (more enjoyment, mood increase, and anxiety reduction) and greater increase of alpha-2 power, assessed with electroencephalography. Manipulating participants’ expectations also resulted in largely greater increases of alpha-2 power, but not in more psychological exercise benefits. On the physiological level, participants decreased their blood pressure after exercising, but this was independent of their expectations. These results indicate that habitual expectations in particular affect exercise-induced psychological and neurophysiological changes in a self-fulfilling manner.     

Physical and psychological correlates of severe heart disease in men

Seventy eight men were assessed one month before coronary artery bypass graft surgery using standardized measures of psychiatric morbidity and personality as well as a measure of emotional expression (the CECS). All patients had at least one coronary vessel occluded by 75% or more of its diameter, and functional capacity was assessed by calculating the exercise treadmill time (in seconds) for each patient. Most of the variance in exercise treadmill time was accounted for by the following variables: young age, short duration of symptoms, and less severe angina. Only one of five men was designated a psychiatric 'case'. The only psychological measure significantly associated with atherosclerosis was expression of fear (on the CECS). A measure of Type A behaviour (Bortner score) was related to exercise treadmill time, but not to any of the angiographic or clinical indices of coronary heart disease (CHD). Like other measures of Type A behaviour, the Bortner scale is psychometrically impure and has doubtful validity. More valid behavioural variables (such as those measured by the CECS) require further investigation. Future studies on the relation between psychological factors and the extent of CHD should take account of not only sex differences but also patients without significant CHD: high rates of psychiatric morbidity in such patients confound the relation between psychological trait measures and atherosclerosis.     

The Effects of Menstrual Cycle Phase on Cardiovascular and Pulmonary Responses to Behavioral and Exercise Stress

The present study was designed to compare the differential cardiopulmonary and hemodynamic responses of Type A and B women to an exercise and a psychological stressor. In addition, the effects of menstrual cycle phase on the resting and response levels of a wide range of physiological variables were explored. Thirty-two women participated in a progressive exercise stress test and a threat of shock video game during both the luteal and follicular phases of the menstrual cycle. Half of these subjects expressed the coronary-prone behavior pattern referred to as Type A, as assessed by the Jenkins Activity Survey. The remaining women were relatively free of these behaviors (Type B). Heart rate, oxygen consumption, carbon dioxide production, minute ventilation, and end-tidal carbon dioxide were monitored and recorded on a breath-by-breath basis. Systolic and diastolic blood pressure measures were taken at 2-min intervals. Results indicated similar baseline, exercise, and behavioral stress responses among Type A and B women. The stress responses were also the same between the follicular and luteal phases for all measured physiological variables. However, resting levels of heart rate, metabolism, and ventilation were all elevated at rest during the luteal phase. A regression analysis based on the exercise heart rate and oxygen consumption data demonstrated that a majority of subjects exhibited heart rate responses in excess of that expected during the psychological stressor. These data are discussed with special reference to possible mechanisms of the pathophysiology of cardiovascular disease.     

Medical visits and psychological disturbance in chronic low back pain. A study of a back education class.

Associations between the frequency of medical visits and psychological disturbance were explored using chronic low back pain patients from a back education class. Psychometric measures included the illness Behaviour Questionnaire (IBQ), somatic problems, and current mood. Males and females responded similarly on all psychological measures. Pain duration and IBQ disease affirmation significantly predicted visits to both general practitioners and specialists. Additional predictors for specialist visits included a self-rated pain/mood association, sex, age, and IBQ denial. Patients' expectations and attitudes about illness and treatment appeared most central to medical visits and several different forms of psychological disturbance accompanied increased visits.     

Autonomic Correlates of Illness Imagery

Psychophysiological responses to imagery of self-relevant illness threats were examined for high and low extreme groups of hypervigilants and health care utilizers. Heart rate, skin conductance, and respiration were the physiological measures recorded; self-reports of perceived illness vulnerability, negative affect, image clarity, and image realness were the psychological measures obtained. Responses to neutral, exercise, and illness threat scenes were compared. Hypervigilants showed an increased heart rate response to imagery of illness scenes, whereas all other groups returned more quickly to baseline levels. The results are similar to those reported by Lang for snake phobics. They also lend some support to Horowitz's theory of intrusive imagery, in which self-relevant, anxiety-provoking events tend to continuously intrude upon one's thoughts, and this intrusive imagery was reflected cardiovascularly. There could be several possible underlying mechanisms for these findings.     

Newly identified psychiatric illness in one general practice: 12-month outcome and the influence of patients'' personality.

BACKGROUND. Relatively little is known about the natural history and outcome of psychological problems in patients who present to general practitioners. Only a small proportion of such patients are seen by specialists. Clinical experience suggests that patient personality is one of the factors influencing outcome in patients diagnosed as having psychiatric illness. AIM. This study set out to examine prospectively the progress and 12-month outcome of patients with newly identified psychiatric illness, and the association of patients' personality with outcome. METHOD. One hundred and seventy one patients with clinically significant psychiatric illness attending one practice in a Scottish new town were followed up prospectively (96 presented with psychological symptoms and 75 with somatic symptoms), and were compared with a group of 127 patients with chronic physical illness. Patients were assessed in terms of psychiatric state, social problems and personality using both computer-based and pencil and paper tests in addition to clinical assessments at each consultation during the follow-up year and structured interview one year after recruitment. RESULTS. Most of the improvement in psychiatric state scores on the 28-item general health questionnaire occurred in the first six months of the illness. Of the 171 patients with psychiatric illness 34% improved quickly and remained well, 54% had an intermittent course but had improved at 12-month follow up while 12% pursued a chronic course without improvement. The mean number of consultations in the follow-up year was 8.4 for patients presenting with psychological symptoms, 7.2 for those presenting with somatic symptoms and 6.6 for patients with chronic physical illness. The Eysenck N score proved a strong predictor of the outcome of new psychiatric illness. CONCLUSION. Only one in three patients with newly identified psychiatric illness improved quickly and and remained well, reflecting the importance of continuing care of patients with psychological problems. This study has confirmed the feasibility of simple personality testing in everyday practice and shown a link between Eysenck N score and the outcome of new psychiatric illness. The predictive value of the Eysenck N score in general practice requires further research.     

Psychological and physiological predictors of lipids in black males

The association between lipids and both psychological and physiological measures were examined in this study of healthy black males. The results revealed that certain psychological measures, namely, State and Trait Curiosity and Trait Anger, explained a significant proportion of the variance in high-density lipoproteins (HDL), low-density lipoproteins (LDL), and triglycerides. Although psychological factors accounted for a significant proportion of the variance in lipids (29% for HDL, 25% for LDL, 64% for LDL/HDL, 29% for triglyceride), the amount of explained variance was significantly increased by the inclusion of both psychological and physiological variables in the regression equation. However, neither of the psychological variables explained any of the variance for total cholesterol when physiological variables were included in the regression analysis. The overall pattern of the findings suggests that black males who are at increased risk for elevated lipid levels may be identified by their level of mental vigilance, the frequency at which their anger is experienced, and the presence of other traditional risk factors.This work was supported by NHLBI Grant RO1-HL38424 to Dr. Johnson, who completed this study at the Division of Hypertension at the University of Michigan Medical Center.     

Changing the coronary-prone (Type A) behavior pattern in a nonclinical population

This report presents the design and initial findings of an attempt to reduce the risk of coronary heart disease in healthy men by modifying their type A behavior pattern. A group of 27 professional and executive volunteers, aged 39–59, who had been medically assessed as free from coronary heart disease, were randomly assigned to brief psychotherapy and behavior therapy groups. Each treatment group met for 14 sessions over a period of 5 months. Pre- and postmeasures of physiological (serum cholesterol, serum triglycerides, blood pressure) and psychological (anxiety, psychological symptoms, satisfaction) variables were taken. Results indicate that both treatment groups changed in the desired direction on most of the psychological and physiological variables without apparent change in habits of diet, exercise, smoking, or work load. The findings are provocative, but only tentative, leaving questions of clinical validity, durability, and generalizability unresolved. Nevertheless, they indicate that this approach to modifying type A behavior may reduce coronary risk and therefore warrants further exploration.     

A pilot study of some associations between behavioural stressors and physiological processes in healthy men

Summary A study was made of the physiological effects of smoking, psychological stressors, heat, exercise, and fat ingestion on 12 healthy men. Repeated measurements were made of cardiovascular, neuroendocrine, enzyme, lipid, and other variables in all stressor situations. The main findings were that psychological stressors and exercise were associated with more and larger physiological changes than the other stressors, and widespread response differences in addition to those in lipids were identified between subgroups of seven normolipidaemic men and five hypertriglyceridaemic men.     

Prognostic Factors and Treatment-Related Changes Associated with Return to Work in the Multimodal Treatment of Chronic Back Pain

The goals of the current study were to determine those preprogram (=prognostic) variables and treatment-related changes that predict return to work in the multimodal management of chronic back pain. The outcome measures for 143 patients at 6-month follow-up were analyzed. The program had a duration of 4 weeks, was based largely on the functional restoration approach (Mayer and Gatchel, 1998), and occurred within a workers' compensation framework. Some 87% of the patients successfully returned to work. Three sets of predictor variables were considered: demographic/socioeconomic data, physical measures, and psychological measures. Three prognostic variables proved to be significant negative predictors of return to work: time off work, previous spinal surgery, and a clinically elevated (preprogram) score on the MMPI-2 scale Lassitude-Malaise (Hy3). A repeated-measures MANOVA showed an incomplete return to work to be associated with only limited improvement in self-reported disability and pain report. However, patients who failed to return to work did not differ with regard to improvement in objective physical functioning or psychological distress. It is therefore hypothesized that a change in the perceived disability status is the key element necessary to return patients with chronic back pain to work, although ongoing reinforcement schemes operative in the home work environment may lead to a relapse in the post treatment phase.     

Predicting self‐efficacy using illness perception components: A patient survey

Objectives. To assess the measures of illness representation components in predicting measures of self‐efficacy in patients with coronary heart disease. Design. A longitudinal design was adopted with predictor variables and dependent variables (general self‐efficacy, diet self‐efficacy and exercise self‐efficacy) measured twice while participants were in hospital and 9 months following discharge. Change scores of the predictor variables can be calculated and dependent variables at baseline can be controlled. Method. A cohort sample of 300 patients admitted to hospital with coronary heart disease were given the questionnaire measuring their illness perception (illness representation components: identity, consequences, timeline and control/cure and outcome expectation for diet and exercise); self‐efficacy (general, diet and exercise self‐efficacy measures), demographic and illness characteristics and attendance on a cardiac rehabilitation programme. The patients were asked to complete the questionnaire in hospital before discharge following their cardiac diagnosis, and again, 9 months later, when participants were expected to be functioning independently of any rehabilitation programme. Results. Demographic and illness characteristics were found to have a more significant relationship with illness representation components than with specific self‐efficacy. The relationship between illness representation components and specific self‐efficacy changes overtime, consequence and timeline were significantly related to self‐efficacy measures initially; however, symptom and control/cure were the variables that were significantly related to self‐efficacy measures 9 months later. After statistically controlling individuals' baseline self‐efficacy measures, demographic and illness characteristic effects, symptom and control/cure were found to make significant contributions to exercise and diet self‐efficacy, respectively, 9 months later. Conclusion. A significant relationship exists between illness representation and self‐efficacy. There is potential to integrate both approaches to the assessment of psychosocial factors to provide effective individualized care in cardiac rehabilitation.     

Work strain, health, and absenteeism: a meta-analysis

Work strain has been argued to be a significant cause of absenteeism in the popular and academic press. However, definitive evidence for associations between absenteeism and strain is currently lacking. A theory focused meta-analysis of 275 effects from 153 studies revealed positive but small associations between absenteeism and work strain, psychological illness, and physical illness. Structural equation modeling results suggested that the strain-absence connection may be mediated by psychological and physical symptoms. Little support was received for the purported volitional distinction between absence frequency and time lost absence measures on the basis of illness. Among the moderators examined, common measurement, midterm and stable sources of variance, and publication year received support.     

The relationship between psychological and physiological measures of anxiety

The responses of 6 representative physiological parameters frequently assumed to be measures of anxiety along with a set of 4 psychological tests for measuring anxiety were obtained under naturalistic conditions from 25 patients hospitalized with a first myocardial infarction. A canonical correlational analysis failed to show any relationship between anxiety as assessed by the Taylor Manifest Anxiety Scale, Mood Adjective Check List, State-Trait Anxiety Inventory and Multiple Affect Adjective Check List psychological tests, and anxiety as assessed by the physiological indices of heart rate, systolic and diastolic blood pressures, epinephrine, norepinephrine and VMA. The intercorrelation matrix revealed a significant positive pattern of relationships among all 4 psychological tests, a non-significant, positive pattern of relationships among the physiological indices, and a non-significant, negative pattern of relationships between the psychological and physiological measures. The absence of mood-specific physiological measures for anxiety, as measured by the psychological tests, supports previous theory and investigation and points to the inadvisability of assuming that studies on anxiety that use diverse physiological and psychological measures yield results that may be compared as though they were assessing a common mood.     

Emotional stress,psychosocial variables and coping associated with hepatitis C virus and human immunodeficiency virus infections in intravenous drug users

BACKGROUND: The increasing health problem of hepatitis C virus (HCV) infection has only recently attracted the attention of psychosocial research, especially among subjects at higher risk (e.g. intravenous drug users; IDUs). The aim of the present study was to compare emotional stress symptoms, psychosocial variables (i.e. social support, external locus of control and emotional repression) and coping strategies in HCV-seropositive, human immunodeficiency virus (HIV)-seropositive and HCV/HIV-noninfected IDUs. METHODS: IDUs followed by the Infectious Diseases Outpatient clinic were enrolled in the study over a period of 1 year. HCV-positive (n = 62) and HIV-positive (n = 76) IDUs and HCV/HIV-seronegative IDUs (n = 152) completed the Brief Symptom Inventory, the Social Provision Scale, the Locus of Control scale and the affective inhibition scale of the Illness Behavior Questionnaire. Coping with illness among HCV-positive and HIV-positive subjects was assessed through a modified version of the Mental Adjustment to Cancer Scale. RESULTS: No significant differences were found between the samples with respect to individual and interpersonal variables. HCV-positive subjects showed higher scores on several psychological stress dimensions (i.e. obsessive-compulsive, phobic anxiety, paranoid ideation, psychoticism) and lower scores on fighting spirit, hopelessness and anxious preoccupation towards illness than HIV-positive patients. HCV-positive and HCV/HIV-seronegative IDUs reported comparable scores on most of the psychological measures. CONCLUSIONS: The findings indicate that routine assessment of psychosocial variables and coping mechanisms should be integrated into all HCV and HIV services, especially those dedicated to treatment of patients with substance abuse, as a vulnerable segment of the population at risk for life-threatening physical illness such as HCV and HIV infections.     

Health change in air traffic controllers: a prospective study. I. Background and description

The background, rationale, and design of a 3-year prospective study of health change in 416 air traffic controllers is described. This study was designed to assess the relevant variables that might predict future physical and psychological health change. This report describes the major variables that were assessed in all participants, which included endocrine, cardiovascular, and behavioral differences in response to work, the occurrence of significant life events, work attitude and morale, availability and usefulness of psychosocial supports, and job commitment and performance. Future reports will describe the contribution, both individually and interactively, of these various factors to the risk for future illness. A major hypothesis to be tested by this study is that health change among air traffic controllers can be predicted by differential responsivity to work.     

The differentiation of individual-specific, stimulus-specific, and motivation-specific response patterns in activation processes: an inquiry investigating their stability and possible importance in psychophysiology

The role of specific response patterns obtained by means of psychophysiological activation and their temporal stability are meeting with an increasing interest in the literature because of a low correlation between psychophysiological variables and of possible implications with regard to pathogenetic mechanisms in psychosomatic disease. Two empirical studies are presented that were conducted under similar stress conditions (mental arithmetic, free speech, cold-pressor test, blood-taking) and have been monitoring similar activation variables (seven physiological and four or five psychological variables) - one of which using a large sample of 125 students, the other one consisting of 47 students, who were tested three times week- by-week. Findings reveal that substantial proportions of variance in the three-factorial ANOVA (subjects, situations, variables) may be considered on the basis of individual-specific (23-29% for physiological variables, 6-11% for psychological variables), stimulus-specific (5-19% for physiological variables, 1-11% for psychological variables), and motivation-specific (21% for physiological variables, 10% for psychological variables) response patterns. Five evaluation procedures on nominal, ordinal, and interval data levels as well as various definitions of similarity found in the reaction patterns are used in a comprehensive approach to the analysis of specificities. Estimation of variance components, global tests, and individual tests are applied. The results prove to be reliable and rather stable, at least over a period of several weeks. In total, about one fourth of the subjects show a stable individual-specific response pattern on physiological variables. The results are discussed with respect to data and sampling problems as well as to various methods of data analysis.     

Sex differences in emotional and psychophysiological responses to musical stimuli.

Although it is known that men and women differ in their music preferences and emotional reactions to music, little is known about sex differences in physiological reactions to music. In our study, we therefore set out to examine the differential reactivity to two musical stimuli that elicit distinct psychological and physiological reaction patterns. Fifty-three healthy subjects (mean age: 26.13, SD: 3.97; 26 males, 27 females) were examined. Heart rate, electrodermal activity, skin temperature, salivary cortisol, salivary alpha-amylase, and psychological variables were assessed during the course of the whole study. Following baseline assessment, two musical stimuli, which were carefully selected and rated in a pre-study as relaxing and pleasant (renaissance music) and arousing and unpleasant (heavy metal), respectively, were introduced. They were presented on two different days in a randomized order. Whereas psychological variables did not differ between men and women, results of electrophysiological measures indicate significantly different reactivity patterns between men and women. Women displayed elevated response curves to the arousing and unpleasant stimulus, whereas men did not. However, no differences were found with regards to endocrine measures in saliva. Our results demonstrate sex differences in reactivity patterns to musical stimuli in psychophysiological measures. In our study, we were able to show that women tend to show hypersensitivity to aversive musical stimuli. This finding is in accordance with previous literature on sex differences in emotion research. Furthermore, our study indicates that the confounding effects of sex differences have to be considered when using musical stimuli for emotion induction.     

The effects of psychological factors and physical trauma on recovery from oral surgery

This study evaluated the effects of several psychological factors on postsurgical recovery while controlling for and also evaluating the effects of the physical trauma induced by the surgery. Subjects were 38 patients (18 males and 20 females) who were scheduled to have four third molars surgically removed. The psychological factors measured included anxiety and expectations about recovery, trait anxiety, coping behaviors, and health locus of control. Surgical trauma was rated after surgery, and the following aspects of recovery were monitored: postoperative pain, interference with normal function, swelling, and healing. Poorer postoperative recovery was significantly predicted by each of the psychological variables and by higher levels of surgical trauma. In addition, the effects of the psychological variables on recovery were shown to be largely independent of the trauma effects. The data suggest that (a) future studies which give patients more positive expectations and reduce their anxiety about recovery may improve their recovery and (b) the types of patients most in need of preoperative psychological support would be those who have higher trait anxiety, vigilant coping behaviors, or an internal locus of control.This research was supported by NIH Research Grants DE-02668 and RR-05333 and by a Pfeiffer Foundation Fellowship.     

The natural history of sexual dysfunction in diabetic women. A 6-year follow-up study

The natural history of sexual dysfunction in diabetic women was evaluated in a 6-year prospective study. Fifty type I, insulin-treated diabetic women, aged 26-45 years, were assessed and re-evaluated 6 years later. Measures included psychological, physiological and social parameters. The frequency of sexual dysfunction was similar in 1977 and 1983. Diabetic women did not differ in sexual function from their healthy controls. None of the physiologic measures studied were predictive of sexual function. Six out of 14 women who were sexually dysfunctional in 1977 recovered normal function, some of them in spite of objective evidence of neuropathy. None of the women had been on psychotherapy for their sexual problem. The most important factor in the spontaneous remission rate seemed to be improvement in the overall marital and social situation. The women's acceptance of illness, as judged by the interviewer, and data from the questionnaires concerning psychological distress, were strong predictors of sexual function. Sexual dysfunction in diabetic women is thus an index of psychological adjustment to chronic illness. Family and marital counseling should be routinely offered as part of the medical care of the diabetic patient.