Virginia Commonwealth University VCU Scholars Compass Theses and Dissertations Graduate School 1991 Perceptual and Cognitive Abnormality Model of Hypochondriasis: Psychological Correlates of Amplification and Misinterpretation James R. Craft Follow this and additional works at: https://scholarscompass.vcu.edu/etd Part of the Psychology Commons © The Author Downloaded from https://scholarscompass.vcu.edu/etd/4506 This Thesis is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, please contact [email protected]. College of Humanities and Sciences Virginia Commonwealth University This is to certify that the thesis prepared by James R. Craft entitled "Perceptual and Cognitive Abnormality Model of Hypochondriasis: Psychophysiological Correlates of Amplification and Misinterpretation" has been approved by his committee as satisfactory completion of the thesis requirement for the degree of Master of Science. or of Thesis Timothy R. Elliott, Ph.D., Committee Member Director of Graduate Studies Elske v.P. Smith, Ph.D., Dean, College of Humanities and Sciences Date Perceptual and Cognitive Abnormality Model of Hypochondriasis: Psychophysiological Correlates of Amplification and Misinterpretation A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University By James Randolph Craft Bachelor of Science Virginia Commonwealth University 1978 Director: Sandra E. Gramling, Ph.D. Assistant Professor of Psychology Virginia Commonwealth University Richmond, Virginia August, 1990 ii Acknowledgements I would first like to extend my deepest gratitude to my advisor and committee chairperson, Dr. Sandra E. Gramling. Her ceaseless efforts and generosity on my behalf have made this project come to fruition. It is very much appreciated. I would also like to thank Dr. Steve Harkins for his generous donation of time, equipment, space to run this study, as well as all his help with graphs and suggestions. Thanks go as well to Dr. Tim Elliott for serving on my committee. There were many people who helped with this study who also deserve thanks. First, my project coordinator, Lori Howell, who had a thankless task and did a first-rate job with it. Thank you for all your help keeping everything in order and running smoothly. I would also like to thank my three research assistants, Betsy Rogan, Hiliary Guess, and Christine Case, for all those late Friday afternoons and early Saturday mornings when it was so nice outside, Thanks as well for scoring all those forms. Also to Monte Thomas and Tineka Archer thanks for checking the data QD& more time. I would also like to thank Ben Holland and Spotland Productions of Nashville, Tennessee for their invaluable assistance in producing the pre-recorded audiotape instructions for this project. Thanks as well Ben for being my friend for over twenty years. I would like to thank all those professors who let me come into their class and make my pitch. Thanks to Kristen Knoebber for iii commiserating and to Chiara Nuzzo for being that last data point. Finally, thanks to all those women who participated in the study and put their foot in that cold water. I really appreciate that. iv Dedication This project is dedicated to my lovely wife Debbie. You have worked just as hard on this project as I have. Thank you for all your help typing, scoring, entering, organizing, retyping, listening, staying up late, waiting, caring, pushing, not pushing, being there. Without your MRS I would never have gotten my MS. Thank you for being who you are and for being my wife. One day I hope to come through for you the way you have for me. v TABLE OF CONTENTS LIST OF TABLES................................................ ix LIST OF FIGURES................................................ x LIST OF ABBREVIATIONS......................................... xi ABSTRACT..... ................................................xii Page 1 INTRODUCTION .................................................... 2 Conceptualization and Diagnosis of Hypochondriasis ......... 3 Psychiatric Model of Hypochondriasis ............. ..... 4 Psychodynamic Model of Hypochondriasis ................ 5 Social Learning Model of Hypochondriasis .............. Perceptual and Cognitive Abnormality Model 6 of Hypochondriasis. ..... ........... .... ... .... ....... 7 Amplification .......................... .......... 9 Misinterpretation ... ... .... .... .... .............. 10 Summary of Conceptual Models .... ..... ..... .... .... ........ 11 Pain and Hypochondriasis ........... ....................... 12 Pain Measurement . .... ..... ... ...· ........... ... ....... 13 McGill-Melzack Pain Questionnaire ............... 14 Visual Analogue Scales ...... ....... ............. 17 Pain as a Measurable Stressor... .... ... .... .... ..... .... vi 18 Physiological Reactivity and Hypochondriasis .............. 18 Physiological Reactivity to Stressors ........... 19 Two Views of Cardiovascular Reactivity .......... 19 Lacey Theory ............................... 22 Obrist Theory .............................. 23 Heart Rate ...................................... 24 Rationale for the Present Experiment ...................... 29 METHODS ........................................................ 29 Subjects .................................................. 29 Environment ............................................... 30 Equipment ................................................. 30 Dependent Measures ........................................ 30 Heart Rate ........................................... 31 Pain Tolerance ....................................... 31 Visual Analogue Scales ............................... 32 Procedures ....................... .......................... 32 Phase I .............................................. 32 Phase II ............................................. 34 Phase III ............................................ 35 Cold Pressor Task ............................... 35 Heat Stimulator Task ............................ 36 Visualization Stressor Task ..................... 37 Phase IV ............................................. 37 Post Questionnaires and Debriefing ........................ vii . .................... ............. ......40 Hypotheses ........ 41 RESULTS ........................................................ ............. ...................41 Subject Variables ...... ............. .........41 Hypochondriasis Scores ........ .. ...... .............41 Mood and Personality Variables .. ...................... ...... ...............42 Order Effects . .... .... ... ....44 Hypothesis 1 ............................ ............ ...... ......... ..44 Hypothesis 2 .............. Hypothesis 3 ..............................................50 .. .... ................................60 DISCUSSION ............... .....................................60 Hypothesis 1 ........ Hypothesis 2 ..............................................61 Hypothesis 3 ..............................................68 70 Methodological Considerations ............................. ............... ..... ..... ......70 Instrumentation.. .. .. .... , ......................... 73 Subject Selection ... .. ...... ............. ..74 Measurement ................... ....... .......74 Stressors ............................. .............75 Problems with the Model. .................... ............. ..................... ......76 Conclusion.. ..... .. ....... ....... ................ ... ........... 78 REFERENCES .... viii APPENDICES .....................................................87 Appendix A: Consent Forms, Medical Checklist, and Screening Questionnaire .................87 Appendix B: Personality & Mood Questionnaires ............93 Appendix C: Visual Analogue Scales ......................113 Appendix D: Script for Explaining VASs ..................117 Appendix E: Publication Version .........................122 VITA ..........................................................178 ix LIST OF TABLES 1. Stressor presentation order .......................................39 2. Mood and personality variable scores ...................... ... ..... 43 3. Heart rate measurement for all stressors by group................. 46 4. Visual analogue scale ratings for cold pressor task by group ......51 5. Visual analogue scale ratings for heat stimulator task............ 55 6. Visual analogue scale ratings for heat stimulator task by group ...56 X LIST OF FIGURES 1. Mean heart rate for the heat stimulator task by group ...........47 2. Mean heart rate for the cold pressor task by group ..............49 3. Mean VAS ratings for sensory intensity and unpleasantness for the cold pressor task for entire sample..................... 52 4. Mean VAS ratings for sensory intensity and unpleasantness for the cold pressor task for entire sample .....................53 5. Mean VAS ratings for sensory intensity and unpleasantness for the heat stimulator task for entire sample ..................57 6. Mean VAS ratings for sensory intensity for the heat stimulator task by group ...................................................58 7. Mean VAS ratings for unpleasantness for the heat stimulator task by group................................................... 59 xi LIST OF ABBREVIATIONS HR Heart Rate MMPI Minnesota Multiphasic Personality Inventory MPD Myofascial Pain Dysfunction