A Szomatoszenzoros Amplifikáció Skála (SSAS) magyar változatának validálása = Validation of the Hungarian version of the Somatosensory Amplification Scale (SSAS)

A Szomatoszenzoros Amplifikáció Skála (SSAS) magyar verziójának pszichometriai értékelését és kérdőíves validálását egyetemi hallgatók (N = 184; átlag életkor = 21,43 év, SD = 4,124; 38,1% férfi) és háziorvosi rendelőben várakozó betegek (N = 562; átlag életkor = 46,54 év, SD = 17,248; 40,4% férfi) mintáján végeztük el. A skála jó belső konzisztenciát mutatott (Cronbach-alfa = 0,70 és 0,77 az egyetemista és a betegmintán), és a konfirmátoros faktoroanalízis eredményei alapján kifejezetten jól illeszkedett az elméletileg feltételezett egydimenziós struktúrához (CMIN/df = 3,088; CFI = 0,989; NFI = 0,984; RMSEA = 0,053). A kérdőíves validáláshoz négy pszichológiai skálát (Életszemlélet Teszt átdolgozott verzió - LOT-R; Beck Depresszió Kérdőív rövidített változat - BDI-R; Spielberger Vonásszorongás Kérdőív - STAI-T; Szubjektív Testi Tünet Skála - PHQ-15) használtunk. Az egyetemista mintán az SSAS pontszámok szignifikánsan korreláltak a nemmel, valamint a PHQ-15, a STAI-T és a BDI-R pontszámokkal. A többváltozós regressziós elemzés során a nem (p = 0,044) és a STAI-T pontszám (p = 0,053) bizonyult jó prediktornak. A betegmintán szignifikáns együttjárást találtunk a nemmel, az iskolai végzettséggel és mind a négy validáló skálával (az együttjárás az iskolai végzettség és a LOT-R esetében negatív irányú volt). A regressziós elemzésben az SSAS pontszámot a PHQ-15 és a STAI-T pontszám jelezte előre (mindkét esetben p < 0,001). Az eredmények alapján elmondható az, hogy a magyar verzió jó pszichometriai jellemzőkkel bír, és jól megőrizte az eredeti skála által megragadott pszichológiai konstruktumot. | The Hungarian version of the Somatosensory Amplification Scale (SSAS) has been psychometrically evaluated and validated with questionnaires on the samples of university students (N = 184; mean age = 21.43 yrs, SD = 4.124; 38.1% male) and patients visiting their GPs (N = 562; mean age = 46.54 yrs, SD = 17.248; 40.4% male). The scale showed good internal consistency (Cronbach-alfa = 0.70 and 0.77 in the student and the patient samples, respectively). According to the results of the confirmatory factor analysis (CFA), data from the two samples fitted very well to the hypothesized one-dimensional structure of the scale (CMIN/df = 3.088; CFI = 0.989; NFI = 0.984; RMSEA = 0.053). Four psychological scales (Life Orientation Test revisited — LOT-R; Beck Depression Inventory short version — BDI-R; State-Trait Anxiety Inventory — STAI-T; Subjective Somatic Symptoms — PHQ-15) were used for the validation. On the student sample, SSAS scores significantly correlated with gender, PHQ-15, STAI-T and BDI-R scores. In the multiple linear regression analysis, good predictors of the SSAS scores were gender (p = 0.044) and STAI scores (p = 0.053). On the patient sample, significant correlations with gender, education level, and all four validating scales were found (the correlations were negative in the cases of education level and LOT-R). Significant predictors in the regression equation were PHQ-15 and STAI-T scores (p < 0.001 in both cases). According to the results, the Hungarian version of the SSAS is psychometrically sound and it seems to assess the same psychological construct as the original scale

Predictors of course and outcome in hypochondriasis after cognitive-behavioral treatment

Background. Predictors of treatment outcome were evaluated in a clinical sample suffering from hypochondriasis. Methods: The sample consisted of 96 patients with hypochondriacal disorder according to DSM-IV or high syndrome scores on the Illness Attitude Scales (IAS) or Whiteley Index (WI). After intense inpatient cognitive-behavioral treatment (CBT), 60% of the patients were classified as responders because of substantial improvements or recovery from hypochondriacal symptomatology. Results: Non-responders were characterized by a higher degree of pre-treatment hypochondriasis, more somatization symptoms and general psychopathology (SCL-90R), more dysfunctional cognitions related to bodily functioning, higher levels of psychosocial impairments, and more utilization of the health care system as indicated by the number of hospital days and costs for inpatient treatments and medication. No predictive value was found for sociodemographic variables, comorbidity with other mental disorders and chronicity. Multiple linear regression showed that pre-treatment variables significantly predicted IAS scores at post-treatment (R-2 = 0.59), changes during treatment (0.10), IAS scores at follow-up two years later (0.41) and changes between baseline and follow-up (0.25). Conclusions: The results demonstrate the relevance of various psychopathological variables and health care utilization as important indicators for outcome and further course of clinical hypochondriasis. Copyright (C) 2002 S. Karger AG, Basel

Sources of somatization: Exploring the roles of insecurity in relationships and styles of anger experience and expression

Research has shown strong connections between insecure attachment in close relationships and somatization. In addition, studies have demonstrated connections between somatic symptoms and anger experience and expression. In this study, we integrate perspectives from these two literatures by testing the hypothesis that proneness to anger and suppression of anger mediate the link between insecurity in relationships and somatization. Between 2000 and 2003, a community-based sample of 101 couples in a large U.S. city completed self-report measures, including the Somatic Symptom Inventory, the Relationship Scales Questionnaire, the Multidimensional Anger Inventory, the Revised Conflict Tactics Scale, and the Beck Depression Inventory. Controlling for age, income, and recent intimate partner violence, analyses showed that the link between insecure attachment and somatization was partially mediated by anger proneness for men and by anger suppression for women. Findings are consistent with the hypothesis that men who are insecurely attached are more prone to experience anger that in turn fosters somatization. For women, findings suggest that insecure attachment may influence adult levels of somatization by fostering suppression of anger expression. Specific clinical interventions that help patients manage and express angry feelings more adaptively may reduce insecurely attached individuals’ vulnerability to medically unexplained somatic symptoms

Clinical application of somatosensory amplification in psychosomatic medicine

Many patients with somatoform disorders are frequently encountered in psychosomatic clinics as well as in primary care clinics. To assess such patients objectively, the concept of somatosensory amplification may be useful. Somatosensory amplification refers to the tendency to experience a somatic sensation as intense, noxious, and disturbing. It may have a role in a variety of medical conditions characterized by somatic symptoms that are disproportionate to demonstrable organ pathology. It may also explain some of the variability in somatic symptomatology found among different patients with the same serious medical disorder. It has been assessed with a self-report questionnaire, the Somatosensory Amplification Scale. This instrument was developed in a clinical setting in the U.S., and the reliability and validity of the Japanese and Turkish versions have been confirmed as well

Clinical Application of Somatosensory Amplification in Psychosomatic Medicine

Many patients with somatoform disorders are frequently encountered in psychosomatic clinics as well as in primary care clinics. To assess such patients objectively, the concept of somatosensory amplification may be useful. Somatosensory amplification refers to the tendency to experience a somatic sensation as intense, noxious, and disturbing. It may have a role in a variety of medical conditions characterized by somatic symptoms that are disproportionate to demonstrable organ pathology. It may also explain some of the variability in somatic symptomatology found among different patients with the same serious medical disorder. It has been assessed with a self-report questionnaire, the Somatosensory Amplification Scale. This instrument was developed in a clinical setting in the U.S., and the reliability and validity of the Japanese and Turkish versions have been confirmed as well. Many studies have attempted to clarify the specific role of somatosensory amplification as a pathogenic mechanism in somatization. It has been reported that somatosensory amplification does not correlate with heightened sensitivity to bodily sensations and that emotional reactivity exerts its influence on somatization via a negatively biased reporting style. According to our recent electroencephalographic study, somatosensory amplification appears to reflect some aspects of long-latency cognitive processing rather than short-latency interoceptive sensitivity. The concept of somatosensory amplification can be useful as an indicator of somatization in the therapy of a broad range of disorders, from impaired self-awareness to various psychiatric disorders. It also provides useful information for choosing appropriate pharmacological or psychological therapy. While somatosensory amplification has a role in the presentation of somatic symptoms, it is closely associated with other factors, namely, anxiety, depression, and alexithymia that may also influence the same. The specific role of somatosensory amplification with regard to both neurological and psychological function should be clarified in future studies. In this paper, we will explain the concept of amplification and describe its role in psychosomatic illness

A Rövidített Egészségszorongás-kérdőív (SHAI) magyar verziójának kérdőíves validálása és pszichometriai értékelése = Validation and psychometric evaluation of the Hungarian version of the Short Health Anxiety Inventory (SHAI)

Elméleti háttér és célkitűzés: Jelen kutatás célja a Rövidített Egészségszorongás-kérdőív (Short Health Anxiety Inventory — SHAI; Salkovskis, Rimes, Warwick, &amp; Clark, 2002) magyar verziójának elkészítése, pszichometriai értékelése és kérdőíves validálása volt. Módszerek: A vizsgálatban 441 alsóéves egyetemista (37% férfi; átlagéletkor: 20,5±1,33 év) vett részt, összesen 5 kérdőív kitöltésével (SHAI; Szomatoszenzoros Amplifikáció — SSAS; Vonásszorongás — STAI-T; Szubjektív Testi Tünetek — PHQ-15; WHO Jól-lét — WBI-5). Eredmények: A megerősítő faktorelemzés mind a két-, mind a háromfaktoros verzió esetében jó illeszkedési mutatókat eredményezett, ezért az irodalomban inkább elfogadott két alskálás (Beteggé válás észlelt valószínűsége; Betegség észlelt következménye) megoldás használatát javasoljuk. A kérdőív magyar verziója jó belső konzisztenciával (Cronbach-alfa = 0,83) bírt, a STAI-T, az SSAS és a PHQ-15 skálákkal közepes erősségű (Pearson-r: 0,33—0,44; p<0,001) korrelációt mutatott, míg a WBI-5 esetében az együttjárás gyengébbnek és negatív irányúnak mutatkozott (—0,26; p<0,001). Következtetések: Az eredmények alapján a kérdőív pszichometriai szempontból megfelelőnek tűnik, ugyanakkor a végső értékeléshez a vizsgálatot érdemes volna más mintákon is megismételni. | Aim: The study aimed at the preparation, psychometric evaluation and questionnaire-based validation of the Hungarian version of the Short Health Anxiety Inventory (SHAI; Salkovskis et al. 2002). Methods: 441 undergraduate students (37% male; mean age: 20.5±1.33 yrs) completed five questionnaires (SHAI; Somatosensory Amplification — SSAS; Trait Anxiety — STAI-T; Subjective Somatic Symptoms — PHQ-15; Well-being — WHO-WB). Results: The confirmatory factor analysis indicated equally good fit between the empirical data and the two- and three-factor-models described in the literature. In the light of the international findings, the use of two subscales (Illness Likelihood and Illness Severity) seems to be preferable. The Hungarian version of the questionnaire has shown good internal consistency (Cronbach’s alfa = 0.83) and medium level correlations (Pearson’s coefficients between 0.33 and 0.44; p<0,001) with the STAI-T, SSAS and PHQ-15 scales. The association with the WBI-5 was weaker and negative (r = —0.26; p<0.001). Conclusion: According to the results, the Hungarian version of the SHAI has good psychometric properties. To come to a final conclusion, replication of the study in different samples would be necessary

Sources of somatization: Exploring the roles of insecurity in relationships and styles of anger experience and expression

Research has shown strong connections between insecure attachment in close relationships and somatization. In addition, studies have demonstrated connections between somatic symptoms and anger experience and expression. In this study, we integrate perspectives from these two literatures by testing the hypothesis that proneness to anger and suppression of anger mediate the link between insecurity in relationships and somatization. Between 2000 and 2003, a community-based sample of 101 couples in a large U.S. city completed self-report measures, including the Somatic Symptom Inventory, the Relationship Scales Questionnaire, the Multidimensional Anger Inventory, the Revised Conflict Tactics Scale, and the Beck Depression Inventory. Controlling for age, income, and recent intimate partner violence, analyses showed that the link between insecure attachment and somatization was partially mediated by anger proneness for men and by anger suppression for women. Findings are consistent with the hypothesis that men who are insecurely attached are more prone to experience anger that in turn fosters somatization. For women, findings suggest that insecure attachment may influence adult levels of somatization by fostering suppression of anger expression. Specific clinical interventions that help patients manage and express angry feelings more adaptively may reduce insecurely attached individuals’ vulnerability to medically unexplained somatic symptoms

Is metacognition a causal moderator of the relationship between catastrophic misinterpretation and health anxiety? A prospective study

Psychological theories have identified a range of variables contributing to health anxiety, including, dysfunctional illness beliefs, catastrophic misinterpretation, somatosensoryamplification and neuroticism. More recently, metacognitive beliefs have been proposed as important in health anxiety. This study aimed to test the potential causal role of metacognitive beliefs in health anxiety. A prospective design was employed and participants (n=105) completed a battery of questionnaire at two time points (6 months apart). Results demonstrated that cognitive, personality and metacognitive variables were bi-variate prospective correlates of health anxiety. Hierarchical regression analysis revealed that only metacognitive beliefs emerged as independent and significant prospective predictors of health anxiety. Moderation analysis demonstrated that metacognitive beliefs prospectively moderated the relationship between catastrophic misinterpretation and health anxiety. Follow-up regression analysis incorporating the interaction term (metacognition x misinterpretation) showed that the term explained additional variance in health anxiety. The results confirm that metacognition is a predictor of health anxiety and it is more substantive than misinterpretations of symptoms, somatosensory amplification, neuroticism, and illness beliefs. These results may have major implications for current cognitive models and for the treatment of health anxiety

MS

thesisHypochondriasis is a complex disorder that has considerable impact on healthcare utilization and costs. Recent conceptualizations of hypochondriasis posit that it is a multicomponent construct, which varies along a continuum of severity. Cognitivebehavioral theory is the predominant conceptualization of hypochondriasis, but recent theoretical developments posit important interpersonal factors in the development and maintenance of the disorder resulting in an interpersonal model of hypochondriasis. The purpose of the current study was to replicate and extend the interpersonal model. One hundred twenty-two undergraduate students were asked to complete selfreport measures assessing demographic information, hypochondriacal tendencies, interpersonal traits and problems, interpersonal correlates, attachment, and personality. The multicomponent aspect of hypochondriasis was confirmed in which distinct patterns of correlations emerged among the various components and interpersonal correlates. The conviction component of hypochondriasis-the belief that one is really sick along with the frustration that others do not recognize this-was associated with the predicted hostile-submissive interpersonal style. Hypochondriacal tendencies were also associated with insecure, anxious attachment, interpersonal problems, increased loneliness and interpersonal stress, and decreased social support. The findings indicate that the interpersonal model of hypochondriasis might be refined by considering its multiple components, particularly the conviction component

Hypochondriasis : the relationship between self-verification and confirmatory biases along a continuum of illness beliefs

The present study examines how the role of illness fear activation affects the attentional biases of individuals varying in hypochondriacal tendencies. Participants were assigned to either a health protective condition or a health fear induction condition.Participants in the health fear induction condition were told that the presence of the enzyme PKR increases their susceptibility to meningitis. This feedback was intended to activate illness fears. In the health protective condition, the presence of the enzyme served as a preventative factor for meningitis, thus decreasing susceptibility and presumably minimizing illness fears. Participants then took part in a computer task in which they had the opportunity to choose from a series of confirming and disconfirming statements regarding the presence of a serious illness. Each set of information served as a makeshift doctor’s feedback. Following the completion of the computer task, all participants completed questionnaires assessing hypochondriacal tendencies and the presence and severity of meningitis symptoms. The results indicated a positive correlation between the two measures of hypochondriasis as well as a positive correlation between one of those measures and the selection of illness confirming information. As this study was intended to be an analog for the interaction between physicians and their hypochondriacal patients, implications for facilitating such interactions are discussed