Attentional distraction reduces the affective but not the sensory dimension of perceived dyspnea

Abstract

The perception of dyspnea shows many similarities to the perception of pain. Both are multidimensional processes, which are not only influenced by sensory input but also by nonsensory factors like attention. Recent research has suggested that attentional distraction might reduce the perception of dyspnea but results are conflicting. Furthermore, the specific impact of attentional distraction on the distinct dimensions of perceived dyspnea has not been studied yet. Therefore, the present study examined the specific impact of changes in the attentional focus on the sensory and affective dimension of perceived dyspnea. Dyspnea was induced in forty-four healthy volunteers (mean age: 27.7 years, range: 18-47 years) by breathing through an inspiratory resistive load (3.57 kPa/L/s), while attention was directed either to breathing or distracted by reading texts. Inspiratory time (T(i)) and breathing frequency (f) were measured continuously. After each condition the experienced intensity (i.e., sensory dimension) and unpleasantness (i.e., affective dimension) of dyspnea were rated on separate visual analog scales (VAS), presented in randomized order. ANOVAs showed that attentional distraction during loaded breathing reduced the perceived unpleasantness of dyspnea (P<0.05), while the perceived intensity of dyspnea as well as T(i) and f remained unchanged. The results show that attentional distraction reduces the affective, but not the sensory dimension of induced dyspnea in healthy volunteers. Future studies are needed to clarify whether attentional distraction can effectively be used as intervention technique for reducing the unpleasant aspects of dyspnea in different patients groups.

The Affective Dimension of Laboratory Dyspnea

“…We calculated an A/SI ratio using published mean data; statistical testing was not possible without paired individual data. More recent studies have measured SI and unpleasantness (A 1 ) while attempting to alter their relationship by acutely altering psychological state (33,34). These studies were performed on healthy subjects in whom moderate respiratory discomfort was produced with inspiratory resistive loads.…”

Psychophysiological responses to inspiratory resistive loads

“…Since the detection of an IRL largely depends on interoceptors located in the lung-and chest wall (Killian et al, 1980) it can be considered as an 'interoceptive' stimulus following the some common conceptions and definitions of 'interoception' (Cameron, 2001;Dworkin, 1993;Craig, 2003). The literature shows that IRLs can induce dyspnea (von Leupoldt and Dahme, 2005;von Leupoldt et al, 2006) and considerable subjective distress, both in healthy persons and in patients suffering from PD, COPD or asthma (Livermore et al, 2008;Lavietes et al, 2000;Smoller et al, 1998;Simon et al, 2006;von Leupoldt et al, 2007). Pappens et al (2010) tried to validate the use of IRLs for psychophysiological fear research by systematically measuring skin conductance responses (SCR), startle eye blink (EMG) and subjective fear responses to IRLs of two different intensities and by comparing these reactions with those evoked by fear pictures from the IAPSdatabase (IAPS; Center for the Study of Emotion and Attention, 1999).…”

Dyspnea related to reversibly-binding P2Y12 inhibitors: A review of the pathophysiology, clinical presentation and diagnostics

“…It has been shown that, following conditioning, even harmless cues per se may trigger dyspnea with varying susceptibilities in different groups of individuals [54]. This reference is subject to changes at the conscious level using cognitive processes such as experience, learning, and interpretation [16,39,51]. A forward mechanism in the perception of dyspnea has also been hypothesized: current breathing may meet the current demands but may be considered insufficient for the anticipated effort of the task to come [51].…”

“…This definition emphasizes the subjectivity of the sensation where the affective domain with the emotional (angst, anxiety, hopelessness) and physical components (effort, rapid, shallow, work) play important roles [14][15][16][17]. Although physicians may settle with the obvious when interpreting dyspnea as physiologic breathlessness occurring at the end of exhaustive exercise in healthy individuals, they may miss either enhanced bronchial hyper-responsiveness in 5% to 70% of the cases [18][19][20][21][22] or vocal cord dysfunction [23], possibly resulting in a missed treatment opportunity.…”