Effect of the INTER-ACT lifestyle intervention on maternal mental health during the first year after childbirth:A randomized controlled trial

We assess whether the INTER-ACT postpartum lifestyle intervention influences symptoms of depression and anxiety, sense of coherence and quality of life during the first year after childbirth. A total of 1047 women of the INTER-ACT RCT were randomized into the intervention (n = 542) or control arm (n = 505). The lifestyle intervention consisted of 4 face-to-face coaching sessions, supported by an e-health app. Anthropometric and mental health data were collected at baseline, end of intervention and 6-months follow-up. We applied mixed models to assess whether the evolution over time of depressive symptoms, anxiety, sense of coherence and quality of life differed between the intervention and control arm, taking into account the women's pre-pregnancy BMI. There was no statistical evidence for a difference in evolution in anxiety or quality of life between intervention and control arm. But an improvement in symptoms of depression and sense of coherence was observed in women who received the intervention, depending on the mother's pre-pregnancy BMI. Women with normal/overweight pre-pregnancy BMI, reported a decrease in EPDS between baseline and end of intervention, and the decrease was larger in the intervention arm (control arm: -0.42 (95% CI, -0.76 to -0.08); intervention arm: -0.71 (95% CI, -1.07 to -0.35)). Women with pre-pregnancy obesity showed an increase in EPDS between baseline and end of intervention, but the increase was less pronounced in the intervention arm (control arm: +0.71 (95% CI, -0.12 to 1.54); intervention arm: +0.42 (95% CI -0.42 to 1.25)). Women with a normal or obese pre-pregnancy BMI in the intervention arm showed a decrease in sense of coherence between baseline and end of intervention (-0.36) (95% CI, -1.60 to 0.88), while women with overweight pre-pregnancy showed an increase in sense of coherence (+1.53) (95% CI, -0.08 to 3.15) between baseline and end of intervention. Receiving the INTER-ACT postpartum lifestyle intervention showed improvement in depressive symptoms, in normal weight or overweight women on the short run, as well as improvement in sense of coherence in women with pre-pregnancy overweight only

Startle responding in the context of visceral pain

This study aimed to investigate affective modulation of eye blink startle by aversive visceral stimulation. Startle blink EMG responses were measured in 31 healthy participants receiving painful, intermittent balloon distentions in the distal esophagus during 4 blocks (positive, negative, neutral or no pictures), and compared with startles during 3 ‘safe’ blocks without esophageal stimulations (positive, negative or neutral emotional pictures). Women showed enhanced startle during blocks with distentions (as compared with ‘safe’ blocks), both when the balloon was in inflated and deflated states, suggesting that fear and/or expectations may have played a role. Men's startle did not differ between distention and non-distention blocks. In this particular study context affective picture viewing did not further impose any effect on startle eye blink responses. The current results may contribute to a better understanding of emotional reactions to aversive interoceptive stimulation

Interoceptive accuracy and medically unexplained symptoms

Medically Unexplained Symptoms (MUS) are commonly met and are often seen as a burden on the health care system. Physicians rely to a large extent on subjective symptom reports to infer underlying disease processes, often implicitly assuming accurate interoception. We would like to challenge this traditional view of a one-on- one relationship between physiology and subjective experiences. In some conditions, there may be no direct mapping between sensory stimulation and the subjective experience. The assessment of interoceptive accuracy (IA) involves some index of the within-subject correspondence between a self-reported sensation and a clear, objective physiological referent. As such, interoceptive accuracy research can be an important aid towards a better understanding and treatment of MUS. Based on the theoretical backgrounds of Pennebaker and Watson (1989), Mogg and Bradley (1998), and Critchley et al. (2001; 2004) we derived basic assumptions about symptom perception in high (as opposed to low) MUS: (1) There is partial overlap between brain areas responsible for negative affective and somatic interoception; (2) It is likely that often negative affective cues are used to interpret somatic states; (3) Conditions may differ as to the extent that either somatic or affective cues are used to interpret somatic states; (4) At any moment, a person may rely on a specific combination of somatic and negative affective cues to determine somatic state; (5) Several variables determine the relative likelihood that affective rather than somatic cues are used to determine somatic states. These variables can be related to the stimuli themselves (type and intensity); the processing mode of the person (as influenced by instructions etc.), such as automatic vs controlled processing mode of affective states; to relatively stable characteristics of the person, such as learning history linking somatic and affective experiences, propensity to experience negative moods and negative affective states (high NA); interactions among these variables. This set of assumptions may have implications for the effect of distraction (which leaves little attentional resources for controlled processing of somatic state and may make persons more vulnerable for the role of negative affective cues) and interoceptive exposure (controlled processing of sensory information promotes habituation of anxiety responses to somatic cues). Previously, preliminary evidence was found for lower IA of respiratory symptom perception in high NA persons (Van den Bergh et al., 2004). This evidence was based on a post-hoc analysis of data collected for another purpose. Our first research study intended to replicate and extend this finding using an improved methodology. The results confirmed the preliminary findings (Bogaerts et al., 2005). Given problems inherent in our first paradigm, we changed to a rebreathing paradigm (Mohan and Duffin, 1997). This new paradigm allowed to obtain a more stable within-subject correlation and to inspect IA within one and the same trial. In addition, it offered a better operationalization of an immediate measure of accuracy (online rating). We investigated the effect of neutral versus symptom information frames on the accuracy of respiratory symptom perception and on retrospective symptom reporting in non-clinical high and low reporters of MUS, using the rebreathing paradigm. In a next study, we examined the clinical relevance of this new paradigm by comparing IA in a MUS patient population vs a matched control group. Since we also wanted to shed more light on processes of interest in retrospective symptom reporting, we used our paradigm to test the peak-end effect (Kahneman, 1993). Most researchers to date could not distinguish between selectivity at encoding and selectivity at recall because they relied solely on retrospective (i.e. recall) measures. Our design (using online and retrospective measures) allows to distinguish both information processing effects. As a clinical application, using emotional imagery, we wanted to test the assumption that in patients with Chronic Fatigue Syndrome (CFS), affective state plays an important role in symptom reporting (Bogaerts et al., submitted). In planned research, we will investigate whether elevated reportings of MUS also occur without symptom inductions through CO2-inhalation, just by inducing negatively valent cues, and even when negative emotional cues have no relation to symptom related or medical issues. In addition, by use of the rebreathing paradigm, we will investigate the effect of distraction and (type of) interoceptive exposure on IA in high MUS persons.status: publishe

Psychological treatment for irritable bowel syndrome

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Virtual reality distraction induces analgesia in chronic low back pain: a randomised controlled trial

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Virtual reality distraction induces hypoalgesia in patients with chronic low back pain : a randomized controlled trial

Background Attentional distraction from pain has been shown to be largely ineffective for obtaining a hypoalgesic effect in patients with chronic pain when compared to a control condition. It has been hypothesized that this may be due to the non-engaging types of distraction that have been used so far. Moreover, it is suggested that the hypoalgesic effects of distraction may be attenuated by pain-related cognitions and emotions, as they may increase the attention to pain. Methods In this randomized controlled trial, patients with chronic nonspecific low back pain in the intervention group (n = 42) performed a single exercise session with nonimmersive VR games, while those in the control group (n = 42) performed the same exercises without VR games. We investigated whether VR distraction had a hypoalgesic effect during and immediately after the exercises, and whether it reduced the time spent thinking of pain during the exercises. We further explored whether pain-related fear, pain catastrophizing and baseline pain intensity moderated the effects of VR distraction. Results VR distraction had a hypoalgesic effect during (Cohen's d = 1.29) and immediately after (Cohen's d = 0.85) the exercises, and it also reduced the time spent thinking of pain (Cohen's d = 1.31). Preliminary exploratory analyses showed that pain-related fear, pain catastrophizing and baseline pain intensity did not moderate the effects of VR distraction. Conclusions Large effect sizes of VR distraction induced hypoalgesia were observed. This suggests that nonimmersive VR games can be used when it is deemed important to reduce the pain during exercises in patients with chronic nonspecific low back pain

Lumbar range of motion in chronic low back pain is predicted by task-specific, but not by general measures of pain-related fear

Background Most studies fail to show an association between higher levels of pain-related fear and protective movement behaviour in patients with chronic low back pain (CLBP). This may be explained by the fact that only general measures of pain-related fear have been used to examine the association with movement patterns. This study explored whether task-specific, instead of general measures of pain-related fear can predict movement behaviour. Methods Fifty-five patients with CLBP and 54 healthy persons performed a lifting task while kinematic measurements were obtained to assess lumbar range of motion (ROM). Scores on the Photograph Daily Activities Series-Short Electronic Version (PHODA-SeV), Tampa Scale for Kinesiophobia and its Activity Avoidance and Somatic Focus subscales were used as general measures of pain-related fear. The score on a picture of the PHODA-SeV, showing a person lifting a heavy object with a bent back, was used as task-specific measure of pain-related fear. Results Lumbar ROM was predicted by task-specific, but not by general measures of pain-related fear. Only the scores on one other picture of the PHODA-SeV, similar to the task-specific picture regarding threat value and movement characteristics, predicted the lumbar ROM. Compared to healthy persons, patients with CLBP used significantly less ROM, except the subgroup with a low score on the task-specific measure of pain-related fear, who used a similar ROM. Conclusions Our results suggest to use task-specific measures of pain-related fear when assessing the relationship with movement. It would be of interest to investigate whether reducing task-specific fear changes protective movement behaviour. Significance This study shows that lumbar range of motion in CLBP is predicted by task-specific, but not by general measures of pain-related fear. This suggests that both in clinical practice and for research purposes, it might be recommended to use task-specific measures of pain-related fear when assessing the relationship with movement behaviour. This may help to disentangle the complex interactions between pain-related fear, movement and disability in patients with CLBP