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Biomedical subjects

A Arntz

Publications and source records attributed to A Arntz.

At least 37 records · Page 2Linked to original sources
PubMed1997

Cued UCS rehearsal and the impact of painful conditioned stimuli: UCS rehearsal increases SCRs but reduces experienced pain.

The effects of cued UCS rehearsal on responses to a mildly painful CS previously paired with a highly painful UCS were investigated. Following CS pretest and CS-UCS pairings, subjects either mentally rehearsed the UCS (condition 1), received the real UCS (condition 2), mentally rehearsed an unrelated painful experience (condition 3), or waited (condition 4). In a fifth condition, subjects received CS and UCS unpaired before engaging in UCS rehearsal. During a posttest, subjects received CS-alone presentations and rated experienced pain and anxiety, while electrodermal responses were assessed. These responses were compared to pretest and acquisition responses. UCS rehearsal led to pain reduction of the CS comparable to the habituation effect of real UCS confrontation. In line with an associative basis for this effect, UCS rehearsal did not influence the pain experience of an unpaired CS. Yet, rehearsal of a memory of an unrelated painful experience also reduced the pain experience of the CS. Electrodermal responses showed delayed extinction and incubation after UCS rehearsal, but there were no significant effects on subjective anxiety. Incubation of electrodermal responses was related to low self-consciousness and the combination of low self-consciousness and high trait anxiety. Trait anxiety and worry proneness per se did not relate to incubation. The findings suggest that worry-like processes can have functional values like reducing pain impact, and cast doubt upon the contention that UCS rehearsal leads to an overall incubation of fear.

Adult↗
PubMed1997

No evidence for opioid-mediated analgesia induced by phobic fear.

The influence of anxiety on acute pain sensation was investigated, studying the relative contribution of endogenous opioids and attentional mechanisms. Thirty-six spider phobics received mildly painful electrical stimulation, while anxiety and focus of attention were manipulated within subjects. The opioid antagonist naloxone or placebo was administered between subjects to examine an analgesia owing to anxiety-induced endorphinergic activity. In contrast to earlier findings, attention towards pain failed to increase pain as opposed to distraction from pain, probably owing to a less effective attention manipulation. Furthermore, despite high levels of anxiety, subjective pain ratings were not influenced by anxiety, although heart rate responses were slightly inhibited. Accordingly, there was no increase in subjective or physiological pain responses as a result of naloxone, nor did beta-endorphin plasma levels rise during anxiety. The results suggest that phobic anxiety does not induce an opioid-mediated analgesia. Curiously, naloxone itself effected a dose-dependent analgesia compared to placebo during both high and low anxiety, which is compatible with the assumption of agonist properties of naloxone in the absence of opioid activity.

Adolescent↗
PubMed1996

Psychological treatments of panic disorder without agoraphobia: cognitive therapy versus applied relaxation.

This study compared two psychological treatments of panic disorder and tested whether cognitive therapy (CT) was superior to applied relaxation (AR); and whether treatment was superior to waiting. Thirty-six outpatients of the community mental health center with the DSM-III-R diagnosis of panic disorder with no or mild agoraphobia were randomly assigned to CT or AR. Eighteen similar patients who were referred after the treatment conditions were complete constituted a waiting-list group. Treatment consisted of 12 weekly sessions. Patients self-monitored panic attacks during the whole treatment period, and the following 4 weeks, and during 1 week at a half-year follow-up. Questionnaires were filled out before and after treatment, and at 4-week and half-year follow-ups. After the first follow-up additional treatment was provided if clinically indicated. One patient dropped out of AR and was replaced. Treatment was superior to waiting in reducing panic and questionnaire scores. CT was clearly superior to AR in reducing panic frequency, and somewhat less strongly superior to AR in reducing the questionnaire scores. Depending on the assessment point, 77.8-83.3% of the CT patients was panic-free after treatment, compared to 50% of the AR and 27.7% of the waiting-list patients. In conclusion, cognitive therapy for panic is especially effective in reducing the incidence of panic attacks.

Adult↗
PubMed1996

Why do people tend to overpredict pain? On the asymmetries between underpredictions and overpredictions of pain.

After an underpredicted painful experience people tend to expect increased pain levels for a considerable time, despite disconfirmatory experiences. Underpredictions also tend to raise long-lasting fear and increased physiological responding. Overpredicted pain does not have such dramatic effects. What are the reasons for this asymmetry? Evidence for and against the hypothesis that underpredicted pain hurts more than correctly predicted pain, and that overpredictions result from a tendency to avoid the extra aversiveness of underpredictions, is reviewed. Based on recent experiments this explanation is rejected, and alternative explanations are discussed. It is reasoned that the most plausible explanation is that the organism automatically infers danger from an underprediction, because of the loss of predictability into the dangerous direction (i.e. more pain). Elevated expectancy and fear levels are the result of this. A modified stimulus-comparator model that accounts for the differential effects of both types of incorrect predictions is suggested. In contrast to previous models, such a model hypothesizes: (i) differential processing of under- and overpredictions; and (ii) different processes involved in the influence of expectations on subjective and non-subjective pain responses.

Fear↗
PubMed1996

Anxiety and pain: attentional and endorphinergic influences.

The role of attentional mechanisms and endogenous opioids in the influence of anxiety on acute pain sensation was investigated. Forty-five spider phobics received mildly painful electrical stimulation. The opioid antagonist naltrexone or placebo was administered between subjects to examine an analgesia due to anxiety-induced endorphinergic activity, while anxiety and focus of attention were manipulated within subjects. In accordance with previous research, pain ratings and skin conductance responses (SCRs) were not influenced by anxiety when focus of attention was controlled for. Attention towards pain led to an increase in subjective pain as opposed to distraction from pain. SCRs, however, were increased in the distraction conditions, probably due to heightened unexpectedness. Further, both high and low anxiety resulted in an analgesia compared to the pretest in the placebo condition, which was reversed by a low dose of naltrexone, but not by a high dose. Apart from possible agonist properties of high doses of naltrexone, this effect suggests an opioid-induced analgesia. It remains to be demonstrated whether this was due to endogenous opioids released during high anxiety.

Adolescent↗
PubMed1996

The placebo effect in pain reduction: the influence of conditioning experiences and response expectancies.

We investigated the role of conditioning experiences and response expectancies in the generation of placebo effects. On 3 sequential days (Test 1, Experimental Session, Test 2), 66 female undergraduates were presented with a series of pain stimuli. For the experimental group, placebo administration (analgesic cream) was paired with a decrease in the painful stimulus. Two control groups were used to explore the relative contributions of verbally induced expectancies and contingent unconditional stimulus experiences per se. The results show that placebo-induced pain reduction can he obtained as a result or a conditioning procedure, independent of verbally induced expectancies. Mere verbal persuasion was not sufficient to elicit placebo-induced pain reduction. Irrespective of the experimental manipulations, the placebo effect was related to both reduced pain expectations and reduced fear of pain. Although conditioned placebo responses were evident at the subjective level, no placebo effects emerged at the physiological level.

Journal Article↗
PubMed1995

Chronic low back pain and inaccurate predictions of pain: is being too tough a risk factor for the development and maintenance of chronic pain?

The present study tests whether chronic low back pain (CLBP) patients show a tendency to overpredict or to underpredict pain. Twenty CLBP patients and 20 healthy controls underwent 6 trials of laboratory induced pressure pain. Ratings of predicted and experienced pain intensity were obtained. In contradiction with the hypothesis that CLBP patients show a generalized tendency to overpredict pain, CLBP patients showed a tendency to underpredict the laboratory pain, whereas controls appeared to be more accurate. This finding replicates a previous finding, that there may be a substantial group of CLBP patients who underestimate pain. The tendency to underpredict pain may constitute a risk factor for the development and maintenance of CLBP.

Adaptation, Psychological↗
PubMed1995

"If I feel anxious, there must be danger": ex-consequentia reasoning in inferring danger in anxiety disorders.

It has been suggested that neurotic patients engage in 'emotional reasoning', i.e. draw invalid conclusions about a situation on the basis of their subjective emotional response. The present experiment investigated whether anxiety patients infer danger on the basis of their anxious response, whereas normals infer danger only on the basis of objective information. Four groups of anxiety patients (52 spider phobics, 41 panic patients, 38 social phobics, and 31 other anxiety patients) and 24 normal controls made ratings of the danger they perceived in scripts in which information about objective safety vs objective danger, and anxiety response vs non-anxiety response information were systematically varied. As hypothesized, anxiety patients were not only influenced by objective danger information, but also by anxiety response information, whereas normal controls were not. The effect was neither situation-specific, nor specific for panic patients. This tendency to infer danger on the basis of subjective anxiety ('ex-consequentia reasoning') may play a role in the development and maintenance of anxiety disorders.

Adult↗
PubMed1995

Covariation bias in phobic women: the relationship between a priori expectancy, on-line expectancy, autonomic responding, and a posteriori contingency judgment.

Thirty-eight people with spider phobias (19 untreated and 19 treated) were exposed to a series of 72 slides of pictures of spiders, weapons, and flowers that were randomly paired with either a shock, a siren, or nothing. A posteriori, untreated participants reported an illusory correlation (IC) between spiders and shock. Although the IC was not significantly smaller in treated as compared to untreated participants, no significant IC could be shown in treated participants. For untreated people enhanced shock expectancies were already present on the first spider trials. The IC was paralleled by heightened skin conductance responses (UCRs) on shocks that were preceded by spider slides compared to shocks preceded by other slides. There were positive correlations between IC, on-line expectancies, and UCRs.

Adolescent↗
PubMed1995

Efficacy of a self-control therapy program in a psychiatric day-treatment center.

A 12-week self-control therapy program based on the self-control model proposed by Rehm was added to the routine program for depressed patients in a psychiatric day-treatment center. It was hypothesized that addition of the self-control therapy would accelerate the recovery of depressed patients. Twenty-five depressed patients were randomly assigned to either standard treatment or standard treatment plus the self-control therapy program. At post-test, patients in the self-control condition showed significant improvement with regard to self-control, self-esteem, depression, depressed mood and frequency and potential enjoyability of pleasant events, whereas the control patients did not. On 5 of 6 measures the differences between the groups were significant in the hypothesized direction. Although at the 13-week follow-up the positive effects of the self-control therapy were maintained, between-group differences were no longer significant, except for self-control.

Adult↗
PubMed1994

Treatment of borderline personality disorder: a challenge for cognitive-behavioural therapy.

Patients with so-called Borderline Personality Disorder are generally considered as extremely difficult to treat. Until recently, conceptualizations of this severe disorder on which cognitive-behavioural therapy could be based were underdeveloped. The present paper presents a cognitive formulation based on previous cognitive and behavioural conceptualizations, and on empirical evidence pertaining to the relationship between childhood traumas and Borderline Personality Disorder. It is assumed that chronic traumatic abuse or neglect in childhood has led to the development of almost unshakeable fundamental assumptions about others (dangerous and malignant), about one's own capabilities (powerless and vulnerable) and upon one's value as a person (bad and unacceptable). These are assumed to underlie the complex symptomatic presentation of borderline patients. A treatment protocol is described, which takes 1.5-4 years, and consists of 5 stages: (1) construction of a working relationship; (2) symptom-management (gaining more control over symptoms); (3) correction of thinking errors; (4) emotional processing and cognitive re-evaluation of the childhood trauma and schema changes; and (5) termination. A case example is presented, and a call for research into the efficacy of this approach is made.

Adult↗
PubMed1994

Exposure reduced agoraphobia but not panic, and cognitive therapy reduced panic but not agoraphobia.

Earlier studies showed that cognitive therapy has anti-panic effects and exposure has anti-agoraphobic effects while other studies suggest that agoraphobia is a secondary complication of panic disorder. It was therefore hypothesized that cognitive therapy not only reduces panic but also agoraphobia and that it potentiates the effects of exposure in vivo. Two groups of 12 severe agoraphobics were treated with 4 sessions of cognitive therapy followed by 8 sessions of cognitive therapy combined with in vivo exposure. The other 12 received 4 sessions of 'associative therapy', a presumably inert treatment that controls for therapist attention, followed by 8 sessions of in vivo exposure that was framed in common behavioral terms. The initial cognitive therapy produced a significant reduction in panic frequency, while associative therapy did not affect panic. Neither cognitive therapy alone, nor associate therapy alone significantly reduced depression, state or trait anxiety, self-rated agoraphobia or behavioral avoidance. After adding exposure however, these parameters were clearly and significantly reduced. Cognitive therapy did not potentiate exposure effects. The results are discussed.

Adult↗
PubMed1994

Overprediction of anxiety, and disconfirmatory processes, in anxiety disorders.

The overprediction of anxiety phenomenon and its relationships with fear, dysfunctional and functional beliefs, and emotional experiences during confrontations with feared stimuli were investigated in two studies. Study 1 investigated exposure in vivo exercises executed by anxiety patients during treatment (n = 37). Study 2 investigated behavioural experiments executed by anxiety patients (n = 11) during cognitive treatment. In both studies patients rated various variables just before and immediately after their exercises. The results indicate that anxiety patients tend to overpredict the level of anxiety they are going to experience. There is no evidence that this phenomenon is a statistical artefact, caused for instance by a pre-test response style. There is also no evidence that the observed adjustment of incorrect anxiety predictions is a statistical artefact. A global negative emotional evaluation of the experience appears to have an adverse influence on the reduction of anxiety predictions and on the reduction of fear. Fear, and its reduction after exposure in vivo or after behavioural tests, appears to be influenced by both anxiety predictions and dysfunctional beliefs. Positive emotions and functional beliefs did not appear to play an important role. The interrelationships between these factors are comprised in a path-model which describes how emotional and cognitive information yielded by disconfirmatory experiences influences changes in anxiety predictions and changes in fear. Unexpectedly, change in dysfunctional belief did not relate directly to change in fear, but only indirectly, via change in anxiety predictions. Theoretical and therapeutical implications are discussed.

Adult↗
PubMed1994

Cognitive therapy for obsessive-compulsive disorder.

This paper discusses three cognitive models for the obsessive-compulsive disorder (OCD). Further, a cognitive formulation of OCD while stresses the importance of the perception of danger and responsibility is described. Several specific cognitive interventions, which address the estimation of catastrophes and the perception of personal responsibility, are presented and illustrated with patient material. Furthermore, problems with cognitive therapy with OCD patients are described and some solutions for these pitfalls are discussed. Finally, the findings of controlled studies into cognitive therapy with OCD are given.

Cognitive Behavioral Therapy↗
PubMed1994

Personality disorders and features in social phobia and panic disorder.

The hypothesis that there is a specific relationship between social phobia (SP) and avoidant personality disorder (APD) was investigated. Using the Structured Clinical Interview for DSM-III-R Personality Disorders, we screened 32 patients with SP and 85 patients with panic disorder (PD) for the presence of personality disorders. Avoidant features were found significantly more often in SP than in PD, although the diagnosis of APD could not be established significantly more often. On the item level, APD Criterion 6 (fears being embarrassed) discriminated the strongest. Social phobics appeared to be more disturbed on Axis II than PD patients.

Adult↗
PubMed1993

Effects of endorphin blocking on conditioned SCR in humans.

In order to test the hypothesis that low levels of endogenous opioids (endorphins) predispose to strong conditioning effects, female Ss (N = 36) were assigned to a placebo group, a low-dose naltrexone group, or a high-dose naltrexone group and then underwent a classical conditioning procedure. This procedure consisted of an acquisition phase in which all Ss received 5 pairings of a CS+ (neutral picture) and a UCS (100 dB white noise). The CS- (neutral picture) was never followed by a UCS. During extinction, Ss received 4 unreinforced presentations of CS+ and CS-. Throughout the experiment, skin conductance responses (SCRs) to the CSs and UCSs were recorded. Acquisition was successful in that CS+ slides elicited stronger SCRs than CS- slides. However, during acquisition, there was no interaction between drug and differential response (CS+ vs CS-). During extinction, there was no overall remaining effect of conditioning. Again, no evidence was found to suggest that (remaining) effects of conditioning were stronger in the naltrexone treated Ss than in the placebo Ss. If anything, the opposite seemed to be true with especially high-dose naltrexone Ss showing relatively weak conditioning effects.

Acoustic Stimulation↗
PubMed1993

Attentional bias and spider phobia: conceptual and clinical issues.

Experimental evidence indicates that anxious subjects show an attentional bias for threat-relevant information. Foa and McNally (1986) (Cognitive Therapy and Research, 10, 477-485) and Watts et al. (1986) (British Journal of Psychology, 77, 97-108) reported that behaviour therapy can eliminate this attentional bias. A replication study was carried out in order to increase the evidence for exposure being the crucial component in reducing attentional bias. Moreover, in this study some conceptual and clinical issues are explored. The theoretical and clinical implications of the results are discussed.

Adult↗