Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders

Abstract

We investigated body vigilance, cardiac anxiety, and the mediating role of interoceptive fear on pain in patients with non-cardiac chest pain (NCCP; a syndrome of chest pain in the absence of identifiable organic etiology). Patients were more attentive to cardiac-congruent sensations than cardiac-incongruent sensations (e.g., gastrointestinal, cognitive dyscontrol; p's < .001). Patients with a DSM-IV Axis I anxiety or mood disorder were more body vigilant compared to patients who did not have a disorder (p's < .05). Patients with anxiety disorders were particularly vigilant to and fearful of cardiac sensations relative to patients without anxiety disorders. Latent variable path models examined the extent that interoceptive fear mediated the association between body vigilance and cardiac anxiety on chest pain. Within each model, diagnostic status, body vigilance, and cardiac anxiety were exogenous and predicted interoceptive fear that in turn predicted pain. Separate models examined body vigilance and cardiac anxiety, and both models fit the data well. Findings showed partial mediation for the body vigilance factor, and full mediation for the cardiac anxiety factor. Interoceptive fear played a mediating role in both models. The syndrome of NCCP may persist partly due to conscious hypervigilance to and fear of cardiac-congruent body sensations, particularly among anxious patients.

Figure 1

Initial Measurement model representing relations between observed variables and latent factors. Rectangles represent observed variables, ovals represent latent factors, and solid lines with arrows represent relations among the observed variables and latent factors. Inspection of the item-scale content and factor loadings, the items reflecting attention to heart-related sensations were evident on two scales (i.e., CAQ-Attention, BVS-Attention). To ensure that the theoretical construct of cardiac anxiety represented concerns reflected cardiac anxiety and related behaviors and not attentional processes, the Cardiac Anxiety Factor was represented by cardiac worry and avoidance.

Figure 2

Combined cross-sectional latent variable path model representing hypothesized relations among body vigilance, interoceptive fear, and chest pain. The rectangle represents an observed variable, the ovals represent latent factors, and the solid lines with arrows represent relations among the observed variables and latent factors. To decrease the complexity of the figure, the figure does not show indicator variables for latent factors, paths that were not significant, disturbance terms, or relations between observed variables and latent variables.