"Psychophysiologic Reactivity" in Asthmatic Children: A New Perspective on Emotionally Triggered Asthma

Abstract

This article offers a reconceptualization of the influence of emotional arousal on asthma. We propose that the degree to which an asthmatic child is generally psychophysiologically re¬ active will influence the degree to which emotional arousal affects airways reactivity and pulmonary function. This psychophysiologic reactivity may be genetically (temperamentally) based, or acquired through emotional trauma. Controlled laboratory studies are cited that demonstrate an emotional link in asthma process. A focused and more detailed review is presented of new research support for psychophysiologic reactivity in asthmatic children as a continuum of risk for emotional stimulation of airways constriction mediated by cholin¬ ergic mechanisms. Treatment implications are drawn with case illustrations.

Pilot study of effect of emotional stimuli on tic severity in children with Tourette's syndrome

“…Our work involving children with asthma demonstrated that emotional stimuli can produce potent physiological reactions via the autonomic nervous system. For example, we have found that sadness and despair may produce cholinergically mediated airway constriction in this population 3–6. Preliminary evidence indicates that autonomic processes may also influence tic severity.…”

“…The reliability of selected movie scenes as stimuli for emotional and physiologic responsivity has been supported by correlating physiological responses to the scenes viewed during the context of the movie with the same scenes re‐viewed after the movie. The interclass correlation ranged from 0.81 to 0.93 ( P < 0.0001) and there was nearly perfect agreement as to the types of emotions evoked by the target scenes 4–6. Each subject sat on a comfortable chair in front of a television monitor to watch a videotape of the movie.…”

“…Beginning at 8:30 AM, each subject watched the movie ET : The Extraterrestrial (ET) while simultaneously being monitored for respiratory rate (RR) and heartbeat (HB) and being videotaped (to assess motor tics; vocal tics were not assessed). The movie ET was chosen because it elicits emotional responses relevant to normal childhood events (family stress, separation, loss) and events specific to chronically ill children (illness, death, and survival) 4–6. Eight preselected scenes from the movie served as emotional stimuli: opening credits, fear scene, anger scene, dead (sad) scene, alive (happy) scene, separation scene, family scene and post‐movie closing credits.…”

Evolving the Biobehavioral Family Model: The Fit of Attachment*

“…Thus, these mechanisms of airway constriction in asthma point to two possible biobehavioral pathways by which emotions may influence airway function: 1) psychoneuroimmunological, and 2) psychophysiological (vagal). Previous research on children with asthma has linked hopelessness or despair to airway constriction and poor course of illness through the psychophysiological mechanism of vagal activation (Miller, 1987; Miller & Strunk, 1989; Miller & Wood, 1995, 1997). Thus the proposed BBFM pathway under investigation will be particular patterns of family process (parental conflict, triangulation of the child, and insecure parent‐child attachment) which evoke states of hopelessness with concomitant vagal activation in children with asthma.…”

“…Mental illnesses, such as schizophrenia or bipolar disorder may also be susceptible to high sympathetic arousal (Tarrier, Vaughn, Lader, & Leff, 1979). For other illnesses, such as asthma or gastrointestinal disorders, different psychophysiological processes, such as emotionally induced parasympathetic (vagal) activation, may be more problematic (Lehrer, 1998; Lehrer, Isenberg, & Hochron, 1993; Miller, 1987; Miller & Wood, 1994, 1997). Biobehavioral reactivity thus encompasses a variety of emotional and physiological processes.…”