Physiological Hyperarousal (PHY)
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Bodily manifestations of autonomic arousal (Clark and Watson 1991).
Physiological hyperarousal is an aspect of human experience relating to emotion and anxiety. It has been thought of as transient and as an individual difference characteristic relating to the way people experience emotion. Its history, measurement, and relationship to other constructs are examined.
Physiological hyperarousal (PH) has been longed discussed within psychology. Wilhelm Wundt postulated that emotions and physiological arousal precede cognition and behavior, and Sigmund Freud conceptualized anxiety as an unpleasant state characterized by worry, apprehension, and physiological arousal. Thayer and colleagues considered arousal to be a basic element of mood and behavior, with distinctions between energetic and tense arousal. Numerous types of arousal (e.g., calm-energy, calm-tiredness, tense-energy, and tense-tiredness) have been posited in terms of emotional experience (Thayer et al. 1994).
Another line of research examining the role of arousal in emotional experience comes from circumplex models, which arrange emotions onto a Cartesian coordinate system whose based on their intercorrelations. Russell (1980) showed support for a circumplex model in which affective concepts are mapped onto a vertical arousal-sleep dimension (i.e., y axis) and a horizontal positive-negative valence dimension (i.e., x-axis). Yik et al. (2011) showed support for a 12-point circumplex structure of core affect, which includes an arousal dimension. They explain that arousal refers to the level of activation one is experiencing and can be considered either negative or positive. For example, excitement can be characterized by positive valence and high activation, whereas agitation can be characterized by negative valence and high activation. Similarly, feeling sluggish can be characterized by negative valence and deactivation, whereas feeling placid can be considered positive valence and deactivation. It is unclear whether the arousal within the circumplex model is necessarily physiological.
Expanding on Raymond Cattell’s earlier differentiation between traits and states, Charles Spielberger described a model of state and trait anxiety resulting from internal and external stimuli in which stressors or internal cues (such as visceral activity) initiate anxious states characterized by cognitions (such as impending doom) and physiological arousal. As anxious states become more frequent, individuals become more sensitive to future state anxiety, resulting in trait anxiety; trait anxiety is considered to be the individual’s susceptibility to frequent state anxiety experiences. Thus, Spielberger postulated that the disposition to experience anxiety is trait-like. Physiological hyperarousal as a trait may be a stable individual difference, should be measurable, and should change little over time. Spielberger and colleagues created the State-Trait Anxiety Inventory, a measure used to distinguish between trait and state anxiety.
PH in Anxiety and Depression
First proposed by Clark and Watson (1991), the tripartite model of anxiety and depression implicates PH as a way to distinguish between anxiety and depression. Clark and Watson reviewed psychometric properties of depression and anxiety measures and concluded that anxiety and depression can be differentiated on the basis of specific factors. In their proposal of the tripartite model, they identify a general distress/negative affect (NA) factor common to both anxiety and depression, anhedonia/low positive affect factor specific to depression, and a PH factor specific to anxiety.
Watson, Clark, and colleagues used three collegiate samples, an adult sample, and a patient sample to show support for the Mood and Anxiety Symptom Questionnaire (MASQ). They also showed that the Anxious Arousal subscale and the Anhedonic Depression subscale could differentiate between anxiety and depression, providing support for the tripartite model and its elements. Furthermore, Watson and colleagues used factor analytic methods to show that the anxious arousal items from the MASQ loaded onto the same somatic anxiety factor.
Joiner et al. (1999) assessed the construct validity of PH by using self-report measures and clinician diagnoses from a psychotherapy outpatient sample, an undergraduate sample, and a sample of air force cadets. The PH items selected from the Beck Anxiety Inventory included items 2 (feeling hot), 3 (wobbliness in the legs), 6 (dizzy or lightheaded), 7 (heart pounding or racing), 15 (difficulty breathing), and 20 (face flushed). Their analyses showed that the two-factor model (PH and subjective anxiety) fits the data significantly better than a one-factor model (general anxiety), providing support for the idea that PH is discernable from but correlated with other aspects of anxiety. Joiner et al.’s (1999) decision to include somatic anxiety symptoms was guided by the original formulation of the tripartite model (Clark and Watson 1991). However, it should be noted that Joiner et al.’s (1999) analysis was somewhat inconsistent with Watson and Clark’s earlier work in which PH items and somatic arousal items all loaded onto the same anxious arousal factor.
PH has also been studied and measured in various youth samples and with many instruments (e.g., the Children’s Manifest Anxiety Scale (CMAS), the Revised Children’s Manifest Anxiety Scale (RCMAS), and its further revision, the RCMAS-2) including items assessing physiological anxiety. Laurent et al. (2004) developed the Physiological Hyperarousal Scale for Children (PH-C), in order to measure somatic arousal associated with anxiety. Psychometric properties and initial scale validation indicate that the PH-C is a useful and meaningful measure of PH in youth (Laurent et al. 2004). In the context of their cross-cultural examination of the tripartite model within youth samples, Kiernan et al. (2001) translated the Positive and Negative Affect Scale for Children (PANAS-C) and the PH-C into several languages including German, Hungarian, Spanish, Polish, Swedish, and Russian. Although some items were eliminated from the translated versions, the measures were shown to be useful tools for examining the tripartite model and the PH construct.
Similarly, Chorpita et al. (2000) provided preliminary support for reliability and validity of the Affect and Arousal Scale (AFARS), which includes a PH subscale. They conceptualized PH as an autonomic activity including items such as “I have trouble breathing,” “I feel shaky,” “my hands get shaky,” and “my mouth gets dry.” Translated versions of their PH measure exist and show similar reliability, correlations, and validity to the English language versions.
Miller (2006) provided support for the temporal and internal consistency reliability of PH and demonstrated the psychometric value of his instrument for measuring trait PH in adults. The instrument demonstrated acceptable test-retest reliability across two time points, indicating the potentially stable nature of PH. Factor analytic methods revealed facets of PH which map onto a higher order general factor. The unitary construct of PH was most readily able to predict Anxious Arousal and General Distress: Anxiety, as measured by the MASQ, demonstrating that PH indeed can predict anxiety.
Catanzaro et al. (2014) investigated individual differences in affective traits and negative mood regulation expectancies (NMRE) as predictors of symptom patterns relating to anxiety and depression. Trait physiological hyperarousal (TPH), trait negative affect (TNA), and trait positive affect (TPA) were conceptualized as predictors of emotional distress symptoms. Their analysis showed that TPH was correlated with TPA, but even more strongly correlated with TNA, and that each trait was associated with different distress symptoms. More specifically, TPH was most strongly associated with anxious arousal, somewhat associated with general distress, but not associated with anhedonic depression.
The Nomological Network of Physiological Hyperarousal
McNally (2015) explained that PH is also a central symptom in posttraumatic stress disorder (PTSD) and is frequently discussed within research on PTSD symptom clusters (i.e., (1) intrusion and (2) alterations in arousal and reactivity). The intrusion cluster includes symptoms such as physiological reactivity to reminders of traumatic experiences. The alterations in arousal and reactivity cluster include symptoms such as exaggerated startle, aggression, reckless behavior, and hypervigilance. Individuals with PTSD have higher physiological resting states (heart rate, skin conductance, and blood pressure) as compared to individuals who have been exposed to trauma but are not experiencing PTSD. Furthermore, PTSD subjects exhibit higher diastolic blood pressure, heart rate, and EMG responses to script-driven imagery compared to controls. Studies with Vietnam veterans diagnosed with PTSD showed higher heart rate responses to slides and sounds of combat, compared to Vietnam veterans without PTSD. Similarly, studies with Vietnam veteran twins showed that the twin with combat exposure and PTSD had a greater heart rate response to startle sounds when compared with the noncombat exposed twin, as well as combat veterans without PTSD and their twins. This shows strong support for the idea that the increased reactivity to startle sounds is a result of the PTSD, rather than a risk factor. Interestingly, it appears that the PH becomes consistent and stable over time, making it unclear whether PH should be considered a symptom or a dispositional trait.
Recently, PH has also been examined in relation to violence and aggressive personalities. A meta-analysis revealed that exposure to violent video games (VVGs) is positively associated with aggressive cognition, which may become stably activated in a person (Anderson et al. 2010). They showed an association between VVGs and PH, as measured by systolic blood pressure, diastolic blood pressure, and heart rate. Anderson et al. (2010) point out that both violent and nonviolent games have the potential to increase arousal but that the PH elicited by VVGs is less likely to leave long-term traces in the brain compared to learning and rehearsing of aggression-related schemata. Unfortunately, there are no long-term studies of PH to support or refute this idea. PH continues to be a widely studied variable associated with exposure to VVGs.
Researchers have examined whether PH and NA are best conceptualized as one construct. Chorpita et al. (2000) posited that they may be the same while examining a sample from an anxiety clinic. However, this may be due to range restriction for the sample he examined. Chorpita argued that it is difficult to imagine states of nausea, trembling, etc. that do not relate to some negative affect. Miller (2006) examined a college sample and compared factor models; treating the two constructs as separate but correlated fits the data better. Laurent et al. (2011) noted correlation between NA and PH was high but that distinct factors emerged. Further research that attempts to examine PH without NA is needed.
Despite the body of research and literature surrounding PH, there remain numerous unanswered questions and unexplored avenues. For instance, there is a lack of longitudinal studies that incorporate PH. Anderson et al. (2010) pointed out the lack of longitudinal studies of PH and its relation to violent video games and aggression. Watson (2009) proposed the quadripartite model to differentiate mood and anxiety disorders. He suggests supplementing disorder-based analyses by examining specific symptom dimensions and their relationships within diagnostic classes. There are no studies specifically examining PH in the context of the quadripartite model, though recent work indicates it is a specific factor related to internalizing distress components (e.g., Kotov et al. 2017). PH continues to be a promising dimension for further examination in terms of personality, emotion, and anxiety.
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