High symptom reporters are less interoceptively accurate in a symptom-related context Katleen Bogaerts, An Millen, Wan Li, Steven De Peuter, Ilse Van Diest, Elke Vlemincx, Stien Fannes, Omer Van den Bergh ⁎ Department of Psychology, University of Leuven, Leuven, Belgium Received 20 November 2007; received in revised form 11 March 2008; accepted 18 March 2008 Abstract Objective: We investigated the role of a symptom interpreta- tion frame on the accuracy of interoception and on retrospective symptom reporting in nonclinical high and low reporters of medically unexplained symptoms. Methods: All participants (N=74) went through two subsequent trials of the Rebreathing Test, inducing altered respiration and other physical sensations as a result of a gradually increasing pCO 2 level in the blood. Each trial consisted of a baseline (60 s), a rebreathing phase (150 s), and a recovery phase (150 s). In one trial, the sensations were framed in a neutral way (“the gas mixture might alter breathing behavior and induce respiratory sensations”). In the other trial, a symptom frame was induced (“the gas mixture might alter breathing behavior and induce respiratory symptoms”). Breathing behavior was continuously monitored, subjective sensations were rated every 10 s, and after each trial, participants filled out a symptom checklist. Within-subject correlations between the subjective rating and its physiological referent were calculated for the rebreathing phase and recovery phase of each trial separately. Results: High symptom reporters had more (retro- spective) complaints than low symptom reporters, especially in the symptom trial. Only in the symptom frame were high symptom reporters less accurate than low symptom reporters. The reduction in interoceptive accuracy (IA) in high symptom reporters was most striking in the recovery phase of the symptom frame trial. Conclusion: A contextual cue, such as a reference to symptoms, reduced IA in high symptom reporters and this was more so during recovery from the symptom induction. © 2008 Elsevier Inc. All rights reserved. Keywords: Medically unexplained symptoms; Interoception; Accuracy; Symptom reporting; Rebreathing test; Contextual cues Introduction Medically unexplained symptoms (MUS) are widespread in modern society, implying considerable direct and indirect costs [1]. A consistent finding across a wide variety of measurements and populations, both nonclinical and clinical, is a firm relationship between negative mood and negative affect (NA) and elevated self-reports of somatic symptoms [2–8]. Experimental manipulations inducing an aversive stimulus context (creating state NA) have been shown to increase self-reports of pain [9–12]. Recent findings suggest that elevated self-report of symptoms may occur in the absence of corresponding elevated peripheral physiological activity. Houtveen et al. [13,14] have shown in nonclinical high symptom reporters that their self-rated somatic symptoms during mental stress, CO 2 rebreathing, or in daily life using a diary method were unrelated to a wide variety of autonomic, ventilatory, and cardiovascular measures. When exposed to a stressor, anxious patients with gastroesophageal reflux report an increased perception of reflux symptoms, despite the lack of heightened acid reflux [15,16]. In a study with chronic fatigue patients, imagery-induced NA was associated with a strong increase in hyperventilation symptoms without Journal of Psychosomatic Research 65 (2008) 417 – 424 ⁎ Corresponding author. Department of Psychology, University of Leuven, Tiensestraat 102, B-3000 Leuven, Belgium. Tel.: +32 16 32 60 58; fax: +32 16 32 59 23. E-mail address: omer.vandenbergh@psy.kuleuven.be (O. Van den Bergh). 0022-3999/08/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2008.03.019 brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Lirias