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

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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.

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Notes

  1. We refer to health anxiety as a continuous construct ranging from low to severe with hypochondriasis representing only the right end of this continuum. Marcus et al. (2007) recently offered a similar distinction between health anxiety and hypochondriasis with the former referring to the “full range of dysfunctional health concerns” (footnote 1) and the latter to the clinical syndrome. Since, categorical definitions of hypochondriasis are still under debate, as outlined above, we consider the use of continuous constructs like health anxiety (or hypochondriacal concerns as a synonym) as informative to gain a better understanding of processes also relevant for the syndrome of hypochondriasis.

  2. Recently, carry-over effects (Waters et al. 2003, 2005) or slow emotional Stroop effects (McKenna and Sharma 2004) from preceding critical word trials (e.g., threat or negative words) to the following neutral trial have been detected in random order emotional Stroop experiments. However, these carry-over effects have been demonstrated to be relatively short-lived, lasting only one trial (Waters et al. 2005; study 1). Analyses focusing on trial-to-trial carry-over effects mostly consider long-term changes of the emotional intrusion effect as error variance and therefore do not allow for the detection of an emotional habituation or sensitization effect, which we consider as more relevant in our current context.

  3. We thank an anonymous reviewer for this suggestion regarding possible differences in the processing of symptoms and illness words.

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  1. Division of Clinical Psychology, Central Institute of Mental Health, Square J 5, 68159, Mannheim, Germany

    Michael Witthöft & Josef Bailer

  2. University of Münster, Munster, Germany

    Fred Rist

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  1. Michael Witthöft
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Witthöft, M., Rist, F. & Bailer, J. Enhanced Early Emotional Intrusion Effects and Proportional Habituation of Threat Response for Symptom and Illness Words in College Students with Elevated Health Anxiety. Cogn Ther Res 32, 818–842 (2008). https://doi.org/10.1007/s10608-007-9159-5

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