SEMINAR PRESENTATION

Presented By : Amna MaqsoodRoll No : 16

Presented To : Ma’m Umm e Rubab

RESEARCH ARTICLE

EMOTIONS AND STRESS INCREASE RESPIRATORY RESISTANCE IN ASTHMA

THOMAS RITZ , ANDREW STEPTOE ,STEPHEN DEWILDE AND MARCO COSTA

Abstract

Objectives: Clinical reports suggest that

various emotions and types of stress can precipitate asthmatic symptoms,but there is little experimental evidence to substantiate this claim.

We studied the impact of different emotional states and stress on respiratory resistance in asthmatic and nonasthmatic individuals.

T Abstract Cont…

completed two stressful tasks

Participants (24 asthmatic and 24 nonasthmatic) viewed

short film sequences selected to induce seven emotions

mental arithmetic Methods

medical slides

AsthmaAsthma is a disease affecting the

airways that carry air to and from your lungs.

EmotionAny strong feelings of love,

hate ,fear etc accompanied by certain physiological changes, as increased heartbeat or respiration

etc

StressWe generally use the word "stress" when we feel that everything seems to have become too much - we are

overloaded and wonder whether we really can cope with the pressures placed upon us.

Key Words

Respiratory resistance

It is also called airway resistance. It describes the resistance of therespiratory tract to airflow during

respiration and expiration.

Literature Review• The study of psychological influences on pulmonary function has

been a pervasive topic in asthma research throughout the years and a considerable body of experimental work has been published on it.

• It has also been suggested that distinctive emotional states, such as sadness or depression, are particularly linked to an aggravation of symptoms in persons with asthma.

• Similarly, experimental studies have shown that different emotionalstates, such as anxiety, anger, and joy, are equally capable of eliciting increases in airway resistance in asthmatics.

• However, no systematic comparison of a broader range of emotional states has yet been attempted, and comparisons between states of positive and negative valence are rare.

Literature Review Cont..

Lehrer (1993) proposed that the active vs. passive coping demand of the task could be a useful distinction in explaining airwayresponse to stress.

Active taskssuch as mental arithmetic or a reaction time task, should lead to decreases in airway resistance whereas

Passive taskssuch as viewing distressing films or noise stimulation, should lead to increases in airway resistance.

.

Literature Review Cont..

• Increases in airway resistance can more readily be explained in stressful situations that are unavoidable or inescapable for the individual, demanding a passive coping response.

• A number of studies have confirmed this idea, with stressful filmsor noise stimulation leading to elevated airway resistance levels.

• Studies comparing nonasthmatic and asthmatic groups in theirresponse to aversive films are not fully consistent,with some showing a stronger response in asthmatics and others showing no differences.

Mathe´ and Knapp reported evidence of a blunted response of the hypothalamic-medullary axis during stress in

asthmatics

Literature Review Cont..

. Baroreftex Sensitivity•BRS has been studied as an

index of vagal system functioning in the cardiac system

With respect to asthma,stronger BRS was

observed in a subgroup of asthmatics patients

In addition,sympathetic effects contribute to BRS to only a limited degree ,particularly during the “up sequences of the BR action,when cardiac slowing is triggered by blood pressure increases

Literature Review Cont..

Given these conflicting results and uncertaintyabout the mechanisms of airway responses to stress,additional investigation of active vs. passive coping

tasks is indicated. In this study, we investigated sympatheticmechanisms and BR regulation as potential

mediators of airway response to stress, particularlytheir contribution to a potentially stronger responsiveness

of asthmatics to stressful tasks.

Literature Review Cont..Important abbreviations in Research

Methodology

ParticipantsAsthmatic patients

Non Asthmatic participantsEach (N=24)

.

Mean Age Range 20-48 Years

Gender

16 Women 8 Men

.

All participants were non -smokers

Free of psychiatric illnesses

Free of Cardiovasculardiseases

No family history of CVD

No family history of respiratory diseases other than Asthma

Non asthmatic group had no respiratory

diseases

Nonasthmatic patients were selected at random with appropriate categories of age and genderTheir clinical notes indicated no serious illnesses

In asthmatic patients degree of severity was Mild to Moderate

Mean duration of Asthma was 16.9 years

Mean age of onset was 11.4 years (0-29 years) all but three reported onset before the age of 18 years

Patients continued to take their prescribed asthma medication, which consisted mainly of b-adrenergic bronchodilators or inhalers

Asthmatic patients were tested during symptom free periods and were instructed to take the last dose of their b-adrenergic bronchodilators (if necessary) at least 8 hours before arriving at the laboratory.

Methods Cont…..

• Experimental Films and Tasks Participants viewed seven film sequences that were pre

evaluated

for eliciting certain emotional states, such as

AnxietyAnger Sadness

Happiness

Elation

ContentmentNeutral states

Experimental Films and Tasks Cont…..

After a pilot test was conducted, two sketches of a British comedian were chosen for induction of happiness and elation to match cultural preferences

The duration of the film clips ranged from 90 to 290 seconds (mean = 224 seconds).

The order of the films was randomizedbetween participants x2 tests revealed no significant order effects for individual clips (p .>.68 –.99).

Experimental Films and Tasks Cont…..

Participants were instructed to calculate“in their mind” and not to move their lips, whisper, or “speak

silently” during calculating.

Participants were instructed to add up as many numbers as possible in 3 minutes. They were informed

that the correctness of their results would be checked.

A mental arithmetic task was presented to elicit active coping behavior.

A colored slide with seven lines of 14 one- and two-digit numbers was projected onto a screen. Participants were instructed to add up as many numbers as possible in 3 minutes. They wereinformed that the correctness of their results would be checked

Experimental Films and Tasks Cont…..

For passive coping behavior, nine medical slides depicting injuries, mutilation, and corpses were presented

in a continuous series for 3 minutes (20 seconds per slide).

Participants were instructed to watch the screen and keep their eyes open

during the whole presentation.

.

Skin resistance level was measured with Ag-AgCl electrodes

Beat-to-beat HR, SBP, and DBP were monitored continuouslywith a Finapres ( Biomedical Instrumentation.)

For each individual sequence, a correlation coefficientwas computed, and sensitivity was expressed as the

change in pulse interval per change in SBP

Equipment and Measures Cont . . .

.

2-Psychological Measures

Self-reports of shortness of breath andemotion were given using visual analog scales

Self-reports were given for list of seven emotions

Nine-point Self Assessment Manikins of pleasure andarousal were administered.

For ease 1 was assigned to” Displeasure”And 9 was assigned to “Pleasure”

To compare both groups in terms of habitual affectivity and defensiveness, the Toronto Alexithymia Scale

and Social Desirability Scale were administered before theexperiment

.

The lights were dimmed, and participants wereinstructed to keep their eyes open during all stages of the experiment

Procedure

All laboratory sessions were scheduled individually in the afternoonor early evening.

Participants were then trained in the useof the mouthpiece and nose clip for the respiration measurements..

.

Statistical Analysis

Hypothesis

1) Increases in Ros would be found inasthmatics during negative emotional states compared with the neutralstate

2) increases in Ros would be found in both groupsduring positive and negative emotional states as compared with theneutral state.

Results

Film Effects

Self-

reported Measures

Physiological Measures

Baseline Difference

s

Task Effects

Self-

reportedMeasures

Physiological

Measure

s

1-Baseline DifferencesNo group differences in baseline physiological measures

or ratings were found

2-Film Effects

a) Self-Reported Measures

Results Cont..

Each negative film reliably elicitedthe respective target emotion but

positivefilms were not fully successful

b) Physiological Measures

Ros was increased during all emotional andnegative films compared with neutral

films in asthmatics(F(1,46)=39.66

Non asthmatics F(1,46)=32.89

3-Task Effects

a) Self-Reported Measures

Results Cont..

Task administration had astrong impact on emotion and

shortness of breath ratings in asthmatics,as revealed by

MANOVA (F(20,21) 5 120.4, p , .001). Post hoc test revealed higher ratings

of anxiety in asthmatics

b) Physiological Measures

Substantial increases were found in Ros,HR, SBP, DBP, and SCL during

Tasks and films in asthmatics

Graphic RepresentationGraphical Presentation

Line Chart

Line Chart

Research Research

Discussion

Effects of emotional films on AirwaysAll emotional conditions showed increases in Ros compared with the

neutral condition.

Effects of Stress Tasks on the Airways We found significant increasesin Ros in both groups for the active coping task and inasthmatic patients for the passive coping task.

SBP and DBP both increased in response tomental arithmetic, and an even stronger response wasseen in asthmatics during viewing of the medicalslides.

Conclusion

Uniform increases in oscillatory resistancewere found in all emotional states compared with the neutral state and during

mental arithmetic in both groups.

Asthmatic patients showed stronger reactions to the medical slides than healthy control subjects, with significant increases in oscillatory resistance, blood pressure,

skin conductance level, and minute volume, as well as higherlevels of self-reported depression, arousal, and shortness of breath.

Various emotional states and stress increaseoscillatory resistance largely independently of

concurrent increases in autonomic or ventilatory activity.

SuggestionAdditional research is needed to elucidate

the psychological importance and autonomic dynamics associated with passive coping, particularly with

blood and injury-related stimuli, in asthma.

Critical Evaluation

Positive Evaluation

In abstract ,every point is written in headings

Abbreviations are explained precisely

Two-way ANOVA is clearly explained

Measured emotion list is mentioned Results are graphically

presented very well in bar and line chart

Further research is suggested in future

Researchers have published their thanks to advisors and supporters

Negative Evaluation

• In start ,no specific heading of Abstract is given

• X2 and Correlation are also used for statistical analysis but they are not clearly mentioned

• No study design is mentioned

• Gender ratio is not equal• Key words are not

defined• No reliability method is

mentioned

Critical Evaluation

Negative Evaluation• Sampling method is

different for both participants

Positive Evaluation Literature review is

relevant Terms used in

research are written separately with abbreviations

Hypothesis is mentioned

Result tables are precisely explained

Thank You