Enhanced Early Emotional Intrusion Effects and Proportional Habituation of Threat Response for Symptom and Illness Words in College Students with Elevated Health Anxiety

Abstract

Studies evaluating attentional biases in health anxiety have produced equivocal results. Little is known about the details and potential moderators of prioritized processing of illness related information. We compared individuals with health anxiety (HAG; N = 54) to not health anxious participants (CG; N = 53) in a blocked emotional Stroop paradigm. Analyses focused on differences between categories of health threatening information (words referring to symptoms and illnesses), on the time course of the emotional intrusion effect, and on test order effects. When symptom words were presented first in the experiment (i.e., before the illness words), the HAG showed a stronger emotional intrusion effect to symptom words in the first test half (trials 1-20) compared to the CG. A similar pattern of results with a smaller effect size was apparent for the illness words, when they were presented first in the experiment. The results contribute to a more fine-grained understanding of attentional processes towards external sources of threat in health anxiety. In particular, they emphasize the importance of taking into account the time course when analyzing data from an emotional Stroop paradigm.

Neuronal and Behavioral Correlates of Health Anxiety: Results of an Illness-Related Emotional Stroop Task

“…a neurodegenerative disease) represent key processes in maintaining HA [for a review, see [7]. Since biased information processing was also found in persons with subclinical HA not fulfilling strict criteria of hypochondriasis [8,9,10,11], alterations in attention allocation to health threat stimuli are proposed as a risk factor for the development of hypochondriasis [12]. …”

“…[9], [12]] or the dot-probe task [e.g. [13], [14]] to investigate preferred attention allocation towards illness-related stimuli in HA.…”

“…body symptom words and illness words) shown to be effective in inducing emotional interference in HA on the behavioral level [9] were presented during fMRI. Since body symptoms (e.g.…”

“…tumor, stroke) seem to represent different aspects of HA (i.e. body symptoms operate as HA triggers, whereas illness words correspond to elaborative catastrophic thoughts [9,37]), these two word categories were considered separately. In line with the finding of a previous study in non-clinical participants with varying degrees of HA [9], we expected even stronger effects for body symptom words (due to their stronger idiosyncratic relevance) compared to illness words.…”

“…body symptoms operate as HA triggers, whereas illness words correspond to elaborative catastrophic thoughts [9,37]), these two word categories were considered separately. In line with the finding of a previous study in non-clinical participants with varying degrees of HA [9], we expected even stronger effects for body symptom words (due to their stronger idiosyncratic relevance) compared to illness words. This hypothesis is also in line with cognitive models of HA proposing selective attention toward body signals as the primary triggering process that elicits rumination about severe illnesses as a later more elaborative process.…”