Is it all top-down? Influence of cognition and categorization on interoceptive sensitivity and bias in health anxiety

病理性健康焦虑与高昂的个人和社会成本有关。病因学模型假设了负面的健康相关思想的影响，对身体感觉的高度敏感性(内感敏感性)，以及对健康相关刺激的注意偏差。注意力偏向和消极的灾难性想法对身体感觉的影响得到了经验上的支持。内感敏感性的影响还在争论中，很少有人研究这些因素之间的相互作用。我们的目的是探索认知、知觉和内感因素之间的相互作用，这些因素可能有助于维持病理性健康焦虑。我们将使用两个适应版本的躯体信号检测任务(SSDT)和两个实验，其中呼吸受到两类呼吸努力增加负荷的影响。研究1：我们将健康参与者暴露在虚假电磁场中，这将激活与疾病相关的认知图式。我们假设，当假电磁场被打开时，参与者将报告SSDT中的幻觉触觉。研究2和3：病理性健康焦虑患者将接受SSDT的第二次适应。这里，与疾病相关的词汇将被用来激活与疾病相关的认知图式。假设触觉错觉增加。在研究中，3名患者进行了分类实验。参与者必须记住第一组中低强度(A)和高强度(B)的分类负荷，并在第二组中标记刺激。我们假设，高度的健康焦虑与类别边界上的自由主义反应偏见有关。换句话说，与健康参与者相比，患者将更多的低强度类别的负荷识别为高强度类别。研究4：我们将考察任意分类(A、B)和与疾病(感觉、疾病相关症状)语义相关的分类对呼吸刺激评估的影响。我们假设属于同一类别的两个相邻刺激将比类别之间的相邻刺激被更相似地评级。此外，有意义的语义分类的影响应该高于任意分类的影响。通过这个项目，我们将有助于更好地理解病理性健康焦虑。改进的病因学模型将有助于加强治疗，减轻个人和社会负担。

Pathological health anxiety is associated with high personal and social costs. Etiological models postulate an influence of negative health-related thoughts, high sensitivity for body sensations (interoceptive sensitivity) and an attentional bias concerning health-related stimuli. The influence of the attentional bias and negative, catastrophizing thoughts on bodily sensations is empirically supported. The impact of interoceptive sensitivity is under debate, the interplay of factors rarely examined. We aim at exploring the interplay of cognitive, perceptual and interoceptive factors that may contribute to the maintainance of pathological health anxiety. We will use two adapted versions of the somatic signal detection task (SSDT) and two experiments, in which breathing is influenced by two categories of breathing effort increasing loads.Study 1: We expose healthy participants to a sham electromagnetic field, which will activate illness-relevant cognitive schemata. We assume that participants will report illusory tactile sensations in the SSDT, when sham electromagnetic field is switched ‘on’. Study 2 and 3: Patients with pathological health anxiety will undergo the second adaptation of the SSDT. Here, illness-relevant words will be used to activate disease-related cognitive schemata. An increase of tactile illusions is assumed. In study 3 patients undergo a categorization experiment. Participants have to memorize categorized loads of low (A) and high (B) intensity in a first block and label stimuli in a second block. We assume that high health anxiety is associated with a liberal response bias at the border of categories. In other words, patients will identify more loads of the low intensity category as belonging to high intensity category than healthy participants. Study 4: We will examine the influence of an arbitrary categorization (A, B) and with categorizations semantically related to illness (sensation, disease-related symptom) on evaluation of respiratory stimuli. We hypothesize that two neighboring stimuli belonging to the same category will be rated more similarly than neighboring stimuli between categories. Furthermore, the influence of a meaningful semantic categorization should be higher than the influence of an arbitrary categorization.With this project, we will contribute to a better understanding of pathological health anxiety. Improved etiological models will enable the enhancement of treatment and reduce individual and social burden.