The role of emotional imagery and somatosensory amplification in atypical chest pain in patients with angina pectoris: a single-case experimental design

Abstract

Background: Atypical chest pain is a common condition that has poor symptomatic, functional, and psychological outcomes. Individuals with abnormal coronary anatomy who experience chest pain present a particular challenge to medical services as they frequently report other chest sensations that are atypical of their condition. Cognitive-behavioral therapy has been found to be effective in the treatment of atypical chest pain, suggesting that anxiety may have a significant etiological role. Normal or minor physical sensations may be interpreted as evidence of serious medical problems, resulting in a vicious circle of anxiety, physiological arousal, and hypervigilance.

Methods: The present study evaluated the role of emotional imagery and somatosensory amplification in the experience of atypical chest pain in a patient with diagnosed angina pectoris. Using an experimental ABACA reversal design, the patient was assisted to engage in 3 types of imagery via the presentation of 3 prerecorded scripts: (A) neutral, (B) angina pectoris, and (C) idiosyncratic emotional imagery. Subjective measures of atypical chest sensation intensity were collected at 5 points during each script presentation.

Results: It was found that the patient experienced more intense chest sensations while engaged in the first angina pectoris imagery condition compared to the second presentation of the neutral script. This difference was found to be statistically significant, using an interrupted time series analysis.

Conclusions: The findings of this study support the view that anxiety processes can exacerbate and intensify the experience of atypical chest sensations in patients who have abnormal coronary anatomy.