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PubMed2002

The intralaminar and midline nuclei of the thalamus. Anatomical and functional evidence for participation in processes of arousal and awareness.

The thalamic midline and intralaminar nuclei, long thought to be a non-specific arousing system in the brain, have been shown to be involved in separate and specific brain functions, such as specific cognitive, sensory and motor functions. Fundamental to the participation of the midline and intralaminar nuclei in such diverse functions seems to be a role in awareness. It is unknown whether the midline and intralaminar nuclei, together often referred to as the 'non-specific' nuclei of the thalamus, act together or whether each nucleus is involved idiosyncratically in separate circuits underlying cortical processes. Detailed knowledge of the connectivity of each of these nuclei is needed to judge the nature of their contribution to cortical functioning. The present account provides an overview of the results of neuroanatomical tracing studies on the connections of the individual intralaminar and midline thalamic nuclei in the rat, that have been performed over the past decade in our laboratory. The results are discussed together with those reported by other laboratories, and with those obtained in other species. On the basis of the patterns of the afferent and efferent projections, we conclude that the midline and intralaminar thalamic nuclei can be clustered into four groups. Each of the groups can be shown to have its own set of target and input structures, both cortically and subcortically. These anatomical relationships, in combination with functional studies in animals and in humans, lead us to propose that the midline and intralaminar nuclei as a whole play a role in awareness, with each of the groups subserving a role in a different aspect of awareness. The following groups can be discerned: (1) a dorsal group, consisting of the paraventricular, parataenial and intermediodorsal nuclei, involved in viscero-limbic functions; (2) a lateral group, comprising the central lateral and paracentral nuclei and the anterior part of the central medial nucleus, involved in cognitive functions; (3) a ventral group, made up of the reuniens and rhomboid nucleus and the posterior part of the central medial nucleus, involved in multimodal sensory processing; (4) a posterior group, consisting of the centre médian and parafascicular nuclei, involved in limbic motor functions.

Animals↗
PubMed2003

Affective associative learning modifies the sensory perception of nociceptive stimuli without participant's awareness.

The present experiment examined the possibility to change the sensory and/or the affective perception of thermal stimuli by an emotional associative learning procedure known to operate without participants' awareness (evaluative conditioning). In a mixed design, an aversive conditioning procedure was compared between subjects to an appetitive conditioning procedure. Both groups were also compared within-subject to a control condition (neutral conditioning). The aversive conditioning was induced by associating non-painful and painful thermal stimuli - delivered on the right forearm - with unpleasant slides. The appetitive conditioning consisted in an association between thermal stimuli - also delivered on the right forearm - and pleasant slides. The control condition consisted in an association between thermal stimuli - delivered for all participants on the left forearm - and neutral slides. The effects of the conditioning procedures on the sensory and affective dimensions were evaluated with visual analogue scale (VAS)-intensity and VAS-unpleasantness. Startle reflex was used as a physiological index of emotional valence disposition. Results confirmed that no participants were aware of the conditioning procedure. After unpleasant slides (aversive conditioning), non-painful and painful thermal stimuli were judged more intense and more unpleasant than when preceded by neutral slides (control condition) or pleasant slides (appetitive conditioning). Despite a strong correlation between the intensity and the unpleasantness scales, effects were weaker for the affective scale and, became statistically non-significant when VAS-intensity was used as covariate. This experiment shows that it is possible to modify the perception of intensity of thermal stimuli by a non-conscious learning procedure based on the transfer of the valence of the unconditioned stimuli (pleasant or unpleasant slides) towards the conditioned stimuli (non-painful and painful thermal stimuli). These results plead for a conception of pain as a conscious output of complex informational processes all of which are not accessible to participants' awareness. Mechanisms by which affective input may influence sensory experience and clinical implications of the present study are discussed.

Adolescent↗
PubMed1997

Attention and somatic awareness in chronic pain.

Empirical methods are used to explore the relationship between chronic pain, somatic awareness and attention. Using a primary task paradigm, 46 chronic pain patients performed an attentionally demanding task. Patients were classified according to self reported pain intensity and the extent of their reporting of the perception of bodily sensations (somatic awareness). Results showed that, as predicted, disruption of attentional performance was most pronounced in those who reported high pain intensity and high somatic awareness. Further analysis revealed that these patients also reported high negative affect. These findings are discussed in terms of their theoretical implications for the concept of hypervigilance and their clinical implications for chronic pain control.

Adult↗
PubMed2000

Factors affecting environmental awareness among Head Start families in Mississippi.

BACKGROUND: Socioeconomic and racial/ethnic disparities in health status in the United States may be attributed in part to environmental injustice and differential exposure to environmental hazards among low-income and/or minority populations. However, the environmental justice movement has historically focused on equity in the siting of point-source polluting facilities, giving little attention to environmental hazards and environmental awareness at the level of the individual household. METHODS: Heads of 763 low-income households participating in Head Start programs in 20 counties of the Mississippi Delta region were surveyed regarding their education, the physical environment of their home and workplace, sources of food and water, awareness of local polluting sites/facilities, knowledge of government agencies, and behaviors that may affect their health or impact their local environment. Survey results were compared to demographic, socioeconomic, and environmental quality indicators. RESULTS: Significant associations existed between both education and race/ethnicity and the responses of survey participants. Being African American was more commonly associated with poor quality-of-life indicators such as renting substandard older homes and living in close proximity to areas of unfavorable watershed quality. Higher education was more commonly and positively associated with indicators of heightened environmental awareness and increased political empowerment. No association was observed between race/ethnicity and the prevalence of polluting facilities. However, a significant association existed between race/ethnicity and indicators of environmental quality/integrity. CONCLUSIONS: Environmental health education interventions that target individual households may be a useful mechanism for increasing the access of low-income communities to government health resources and reducing adverse health effects from the environment. However, racial/ethnic disparities in education and health remain an important consideration.

Awareness↗
PubMed2002

Awareness during anesthesia.

The number of patients who have preoperative anxiety over possibly "waking up" in the middle of surgery has increased dramatically over the last decade. McCleane and Cooper found that more than 50% of 247 patients were concerned that they would not be asleep during their surgery. Even after having an adequate anesthetic, 25% were still worried about being asleep with future anesthetics. With increased media coverage, these anxieties are not likely to go away anytime soon. For the patient, awareness or recall while under general anesthesia is a frightening experience that can lead to debilitating emotional injury and even post-traumatic stress disorder. For anesthesiologists, awareness under anesthesia ranks second only to death as a "dreaded" complication. This chapter reviews the incidence, etiology, psychological sequelae, medicolegal consequences, and prevention of awareness during anesthesia.

Anesthesia↗
PubMed2003

Prefrontal cortex: procedural sequence learning and awareness.

Activation of the prefrontal cortex has been linked to awareness during sequence-learning tasks. A recent study, however, finds activation of the prefrontal cortex during such tasks regardless of awareness. So what is the neurophysiological basis of awareness, and what is the role of the prefrontal cortex in sequence learning?

Awareness↗
PubMed2003

Developmental aspects of consciousness: how much theory of mind do you need to be consciously aware?

When do children become consciously aware of events in the world? Five possible strategies are considered for their usefulness in determining the age in question. Three of these strategies ask when children show signs of engaging in activities for which conscious awareness seems necessary in adults (verbal communication, executive control, explicit memory), and two of the strategies consider when children have the ability to have the minimal form of higher-order thought necessary for access consciousness and phenomenal consciousness, respectively. The tentative answer to the guiding question is that children become consciously aware between 12 and 15 months (+/-3 months).

Awareness↗
PubMed1997

Unexpected awareness and memory in the perianesthesia setting.

Unexpected awareness and memory with general anesthesia are phenomena that can occur in the intriguing interface between consciousness and unconsciousness. Studies suggest that, for some patients, cognitive processing remains active even during deep anesthesia; that is, an apparently unconscious patient still may be registering information. Although explicit memory is usually eliminated by general anesthesia, implicit or subconscious memory may remain. There is no monitor to tell where the patient lies on the continuum between consciousness and unconsciousness. "Sleeping" patients are vulnerable to overhearing inappropriate conversation that may have negative consequences. Post-traumatic stress disorder as well as medical malpractice litigation may result from awareness or memory during anesthesia. Implications for the use of opioids, benzodiazepines, and muscle relaxants in the perianesthesia setting as well as nursing interventions addressing unexpected awareness or memory are discussed.

Anesthesia, General↗
PubMed2002

Visual perception without awareness in a patient with posterior cortical atrophy: impaired explicit but not implicit processing of global information.

A patient with progressive posterior cortical atrophy (PCA) was examined on several tests of visual cognition. The patient displayed multiple visual cognitive deficits, which included problems identifying degraded stimuli, attending to two or more stimuli simultaneously, recognizing faces, tracing simple visual stimuli, matching simple shapes, and copying objects. The patient was also impaired in identifying visual targets contained at the global level within global-local stimuli (i.e., smaller letters that compose a larger letter). Although the patient denied any conscious awareness of the global form, he nevertheless displayed a normal pattern of global interference when asked to identify local level targets. Thus, the patient processed the global information despite not being consciously aware of such information. These results suggest that global-local processing can take place in the absence of awareness. Possible neurocognitive mechanisms explaining this dissociation are discussed.

Aged↗
PubMed1998

Health status in sickle cell disease: examining the roles of pain coping strategies, somatic awareness, and negative affectivity.

People with sickle cell disease (SCD) vary in their pain, activity levels, and medical care. We examined how coping (Coping Strategies Questionnaire), somatic awareness, and illness worry were related to these health indices in 70 African-American adults with SCD. Negative Thinking/Passive Adherence and/or somatic awareness was positively correlated with pain episode frequency, duration, or severity, after controlling for demographics and disease severity and positively correlated with activity reduction or hospitalization frequency after also controlling for pain. Self-reported negative affectivity was correlated with both psychological and SCD measures; and controlling for negative affectivity eliminated several, but not all, relationships. Examination of the Negative Thinking/Passive Adherence factor suggested a distinction between Negative Thinking and Passive Adherence, which was partially supported by their different relationships. We conclude that negative thinking, passive coping, and somatic awareness are related to several measures of poor health in SCD but that some relationships are better accounted for by general measures of negative affectivity.

Activities of Daily Living↗
PubMed2004

Increasing awareness and perception of heart failure in Europe and improving care--rationale and design of the SHAPE Study.

UNLABELLED: In the last decennia heart failure has become one of the most important diseases worldwide in terms of prevalence, morbidity, life expectancy, and in health care management and costs. Despite significant improvements in prevention and treatment, heart failure remains a frequently occurring disorder with increasing incidence and a high hospitalisation and death rate. As major health care problem it deserves full attention of health care authorities. Unfortunately, the seriousness of heart failure and the therapeutic possibilities are often not recognised by those directly involved, i.e. the doctor, the patient or his relatives, let alone that they are known to the general public and health care authorities. The SHAPE study aims at improving heart failure care by increasing awareness and perception of the disease in Europe. Firstly, awareness and perception of heart failure will be documented in the general public, primary care physicians and specialists (cardiologists, internists and geriatricians) in 9 European countries: France, Germany, Italy, the Netherlands, Poland, Romania, Spain, Sweden and the UK. Subsequently, the results will be used to design and carry out suitable awareness and educational programmes in these groups, aimed at improving heart failure care and research. Finally, the results of these programmes will be tested in a second documentation phase and adaptations made where needed. This manuscript describes the rationale and design of the first phase, the Documentation Phase.During the first documentation phase, 800 participants per country selected based on sex, two age groups and urban vs. rural location (100/cell) will be surveyed using a 32-question interview. Questions for the general public focus on recognition, incidence and prevalence, severity and prognosis of the disease in comparison to other disease areas, like cancer, on quality of life, therapeutic possibilities and availability of care. The primary care physician (PCP) survey aims at receiving a minimum of 300 responses. A questionnaire with 33 closed questions will be used covering the PCP's knowledge of heart failure, including prevalence, aetiology, new diagnostic and therapeutic developments and health care costs. Questions concerning diagnostic procedures and various treatments carried out by the PCP in his own practice, as well as referral patterns for diagnostic procedures and for specialist care. Questions relating to the type of practice and number of patients in each PCP's clinical practice. A minimum of 150 cardiologists and 150 internists + geriatricians will be surveyed per country. The specialist's questionnaire contains 31 questions focusing on identification of heart failure patients, patients at risk, use and availability of diagnostic tools, importance of therapies and order of treatment, perceived risks of treatment, relevance of counselling and advice, use of paramedical personnel, and questions concerning practice size, type of practice and number of patients with heart failure. CONCLUSION: This first part of the SHAPE study will provide important information about the level of knowledge and understanding of heart failure of the general public, as well as the perception of the relevance of heart failure and appropriate diagnostic and therapeutic approaches by both the primary care physician and the medical specialist. This knowledge will be extremely valuable when it comes to defining optimal educational programmes in the different target groups studied in SHAPE necessary to implement appropriate heart failure care in Europe and to obtain the means to do so.

Adult↗
PubMed2005

Negative priming with masked distractor-only prime trials: awareness moderates negative priming.

The literature yields inconsistent evidence for negative priming (NP) following masked distractor-only prime trials. We contrast two different hypotheses on the inconsistent findings: one - which is most compatible with the temporal discrimination theory - that relates the sign of priming effects to the absence vs. presence of prime awareness and one -which is most compatible with the inhibition and episodic retrieval accounts - that relates the sign of priming effects to the prime event being categorized as a to-be-attended vs. to-be-ignored event. In two experiments, it turned out that participants' awareness of the masked stimuli caused the different results (with participants being not aware of the primes showing NP), whereas the factor prime color = probe target color vs. prime color = probe distractor color (i.e., the prime contains the to-be-attended vs. the to-be-ignored signal) did not moderate NP. These findings are discussed with regard to theories of negative priming and the debate on conscious vs. unconscious perception.

Adult↗
PubMed1992

Increased cardiac awareness in panic disorder.

We investigated cardiac perception in panic disorder with both self-report and objective measures. In Study 1, 120 patients with panic disorder, 86 infrequent panickers, and 38 patients with other anxiety disorders reported greater cardiac and gastrointestinal awareness than 62 normal control subjects. Subjects with panic attacks reported greater cardiac awareness, but not gastrointestinal awareness, than those with other anxiety disorders. Studies 2 and 3 included a test of heart rate perception in which subjects silently counted their heart-beats without taking their pulse. In Study 2, 65 panic disorder patients showed better performance than 50 infrequent panickers, 27 patients with simple phobias, and 46 normal control subjects. No group differences were found in ability to estimate time intervals. In Study 3, 13 patients with panic disorder and 15 with generalized anxiety disorder showed better heart rate perception than 16 depressed patients.

Adult↗
PubMed2002

Metacognitive awareness and prevention of relapse in depression: empirical evidence.

Metacognitive awareness is a cognitive set in which negative thoughts/feelings are experienced as mental events, rather than as the self. The authors hypothesized that (a) reduced metacognitive awareness would be associated with vulnerability to depression and (b) cognitive therapy (CT) and mindfulness-based CT (MBCT) would reduce depressive relapse by increasing metacognitive awareness. They found (a) accessibility of metacognitive sets to depressive cues was less in a vulnerable group (residually depressed patients) than in nondepressed controls; (b) accessibility of metacognitive sets predicted relapse in residually depressed patients; (c) where CT reduced relapse in residually depressed patients, it increased accessibility of metacognitive sets; and (d) where MBCT reduced relapse in recovered depressed patients, it increased accessibility of metacognitive sets. CT and MBCT may reduce relapse by changing relationships to negative thoughts rather than by changing belief in thought content.

Adult↗
PubMed1981

A rapprochement of the operant-conditioning and awareness views of biofeedback training: the role of discrimination in voluntary control.

In order to adequately evaluate Cott, Pavloski and Black's claim that the discrimination of a physiological response is not necessary for the voluntary control of that response, this commentary presents a set of formal articulations and clarifications of intentional action, voluntary control, discrimination, awareness, and physiological response. It is concluded on logical grounds that Cott et al. are necessarily mistaken and that the conceptual foundations of the issue have not been clearly articulated heretofore. Based upon this discussion, a rapprochement is offered of the operant conditioning and awareness views of biofeedback training, demonstrating that the awareness view is essentially a tautology that aids us in understanding what is meant by "voluntary control of the physiological response." Finally, the issue of mediation in biofeedback-augmented self-regulation is reconceptualized and it is argued that the search for a "neurophysiological mechanism" of voluntary control is meaningless, reflecting a misappropriation of the concept of voluntary control.

Alpha Rhythm↗
PubMed1984

Awareness of the response after feedback training for changes in heart rate and sudomotor laterality.

What is the relation between the ability to control visceral responding on a biofeedback task and the ability to report behaviors actually contributing to this performance? Subjects received biofeedback training for unidentified visceral responses and then gave written reports about what they had done to control the feedback displays. Independent judges were given these reports and, on the basis of knowledge about activities known to contribute to visceral activity, were asked to determine the visceral responses for which the subjects had been trained. The reports of subjects who succeeded at bidirectional control of heart rate (Experiment 1) or sudomotor laterality (Experiment 2) showed awareness of behaviors related to feedback as assessed by this procedure, whereas the reports of subjects who failed at bidirectional control did not. Subsequent experiments indicated that these results did not depend on a learning strategy that might have been specific to the initial studies. These findings call into question the view that people are unaware of what they have done to produce the response after training on biofeedback tasks. Earlier studies reporting lack of awareness in biofeedback are discussed in light of factors that affect the measurement of biofeedback learning and response awareness.

Adolescent↗
PubMed2002

Cognitive components of deficit awareness in Alzheimer's disease.

Awareness of deficit was examined in 24 patients with Alzheimer's disease (AD) and their spouses (for a total of 48 participants) using performance prediction-postdiction and questionnaire discrepancy (QD) paradigms. Participants estimated their own memory performances as well the performances of spouses and of a fictional, memory-disordered patient observed on videotape. Patients overpredicted self-performances, but the extent of overestimation decreased for postdictions. Patients and caregivers accurately estimated caregiver performances but overestimated performances of the fictional patient. QD data revealed that patients underestimated their difficulties performing daily functioning tasks as compared with caregiver reports. Awareness of deficit is a complex ability, involving dissociable cognitive processes. AD patients may display intact immediate awareness of memory dysfunction but fail to incorporate incidents of memory failure into generalized self-belief systems.

Aged↗
PubMed2003

The development of phonological awareness in preschool children.

A short-term longitudinal study was carried out on a group of 67 preschool children. At three points in time over a 12-month period, the children were given tests measuring their syllable, rime, and phoneme awareness, speech and language skills, and letter knowledge. In general, children's rime skills developed earlier than their phoneme skills. Structural equation models showed that articulatory skills and syllable and rime awareness predicted later phoneme awareness.

Attention↗