Salivary cortisol response after a medical interview: The impact of physician communication behaviour, depressed affect and alexithymia

Finset, Arnstein; Graugaard, Peter Kjær; Holgersen, Kjersti

doi:10.1016/j.pec.2005.03.005

Cited by 30 publications

(17 citation statements)

References 32 publications

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“…On the other hand, it is of interest that in recent research [44,45] , there have been indications that alexithymia might be associated with decreased basal activity of the hypothalamic-pituitary-adrenal axis. In contrast, in a recent study [46] , a positive relationship between alexithymia and high cortisol levels was found. Other authors [47][48][49] even discussed hypocortisolism as a biological marker of stress-related disorders such as chronic fatigue syndrome or other idiopathic syndromes, like SFD.…”

Section: Discussioncontrasting

confidence: 66%

Alexithymia and Interleukin Variations in Somatoform Disorder

Gil

Nickel

Ridout

et al. 2007

Neuroimmunomodulation

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Objective: The aim of the present study was to investigate if somatoform disorders (SFD) are associated with changes in the normal serum levels of important interleukins, and further, to establish if these changes are related to the presence and severity of alexithymia in patients with SFD. Methods: Twenty-four unmedicated patients who met the International Classification of Diseases (ICD-10) diagnostic criteria for SFD completed the psychological questionnaire to assess alexithymia (Toronto Alexithymia Scale), symptom reporting (SCL-90-R) and diagnostic criteria for SFD (Screening for Somatoform Symptoms scale). Serum concentrations of soluble interleukin 2 receptor α (sIL-2 Rα), IL-4, IL-6, IL-10 and IL-12 were determined in patients with SFD and in 9 healthy subjects. Results: In patients with SFD, serum levels of IL-6 (p < 0.001), IL-10 (p = 0.047) and immunoglobulin E (p = 0.045) were significantly increased in comparison with healthy controls. Additionally, a negative correlation was observed between the level of alexithymia (‘total’ Toronto Alexithymia Scale score) and the serum levels of sIL-2 Rα (r = –0.538) in SFD. Conclusions: Taken together, these results suggest that SFD, with clinically significant alexithymia, are associated with a reduction in Th1-mediated immune function and an increase in the activation of the Th2 immune function, indicated by the augmented serum levels of IL-6 and IL-10 and elevated immunoglobulin E.

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Section: Discussioncontrasting

confidence: 66%

Alexithymia and Interleukin Variations in Somatoform Disorder

Gil

Nickel

Ridout

et al. 2007

Neuroimmunomodulation

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“…However, the underlying mechanisms for these inflammatory changes may differ and should be explored in future studies. These findings widen the concept of a connection between stress and alexithymia [31,36,37]. …”

Section: Discussionmentioning

confidence: 76%

“…Finset et al [31] tested the cortisol levels of female fibromyalgia patients during and after consultations with physicians and observed that high cortisol levels (after 24 h) were associated with an increase in depressed affect, but only in patients with alexithymia. A recent study examined nonclinical subjects after critical incidents [32], and found that alexithymia predicted numbing and physiological hyperarousal but not avoidance or reexperiencing symptoms.…”

Section: Discussionmentioning

confidence: 99%

Alexithymia and Tissue Inflammation

Honkalampi

Lehto²,

Koivumaa‐Honkanen³

et al. 2011

Psychother Psychosom

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Background: Altered immune responses are seen in depression, and recent data suggest that similar changes could also be observable in alexithymia. We examined whether the inflammatory markers high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL)-6 are independently related to alexithymia or its factors in a population-based sample. Methods: This study formed a clinical part of the Kuopio Depression (KUDEP) general population study focusing on the mental health of a general population of adults aged 25–64 years (n = 308). Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20), and depressive symptoms were assessed using the Beck Depression Inventory (BDI-21). Results: The levels of IL-6 (in picograms per milliliter) and hs-CRP (in milligrams per liter) were significantly higher in alexithymic than in nonalexithymic subjects (IL-6 effect size, ES: 0.50; hs-CRP ES: 0.27). The BDI scores, hs-CRP and IL-6 explained 33.5% of the variation in TAS scores in the whole study population. According to logistic regression analysis, hs-CRP but not IL-6 increased the likelihood of belonging to the alexithymic group. This observation remained unaltered after additional adjustments for chronic inflammation-related disorders, the use of inflammation-modulating medications and depressive symptoms. Conclusions: Our findings suggest that the association between hs-CRP and alexithymia resembles that observed in depressed patients. It is, however, independent of depressive symptoms. These findings widen our view on the stress-alexithymia concept.

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“…It would have been better to control for effects of breathing on SCL by means of a respiratory belt (Dawson et al, 2007), although this might have been too invasive for our sample. It is encouraging that measurement of skin conductance did not seem to interfere with the communication in the interview: use of psychophysiological measures for assessing patient-healthcare provider is still relatively rare (Ellington et al, 2008;Finset et al, 2006), but as known from other fields, it can be a valuable addition in outcome measures (Cacioppo et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

Is pain patients' psychophysiological arousal while watching their videotaped medical interview similar to their arousal during participation in this medical interview?

Verheul

Finset

Holt

et al. 2011

International Journal of Psychophysiology

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Showing videos of medical consultation as a proxy for participation is being increasingly applied in research in order to let patients (re-)experience social interaction in medical settings. If subjects do indeed experience the interaction process when watching this on video, then they should show similar patterns in physiological arousal as when actually participating. We assessed whether watching one's own interaction in a medical setting on video lead to the same skin conductance activity (SC) as when participating in that interaction. Fifteen women with fibromyalgia participated in a medical interview and, after a break, watched the video of this interview. Skin conductance activity was measured throughout the medical interview and, again, while the participants watched their own video. Coherence in SC between these two conditions was assessed. In eleven subjects (73%) a significant positive coherence between the two measurements was found, indicating that watching your own videotaped consultations evokes comparable psychophysiological arousal in most but not all participants. This physiological coherence might be an indication that people are capable of re-experiencing their interaction process by watching replays of these situations, although further research is needed. The positive coherence also supports skin conductance as a reliable moment-to-moment measure for physiological arousal throughout the doctor-patient interaction process. The next step should be linking the changes in physiological arousal to what exactly is happening at that moment in the interaction between doctor and patient. This could provide support for the validity of experimental designs in which standardized videotaped medical visits are shown to patients. More research is needed on predictors of (non-)coherence in certain subjects.

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Salivary cortisol response after a medical interview: The impact of physician communication behaviour, depressed affect and alexithymia

Cited by 30 publications

References 32 publications

Alexithymia and Interleukin Variations in Somatoform Disorder

Alexithymia and Interleukin Variations in Somatoform Disorder

Alexithymia and Tissue Inflammation

Is pain patients' psychophysiological arousal while watching their videotaped medical interview similar to their arousal during participation in this medical interview?

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