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We examined the influence of dispositional coping strategy and level of health anxiety (HA)
on attentional bias in regard to health-related stimuli. In a dot-probe task participants were
exposed to health and nonhealth-related words for 1,250 ms. The high HA group showed
significantly greater attentional bias in regard to health stimuli compared to the low HA
group. In addition, in the low HA group there was no difference in attentional bias toward
health-related words according to whether they were blunters (cognitively avoidant) or
monitors (vigilant for information), but in the group with high HA blunters showed stronger
attentional bias for health stimuli compared to monitors. Our results in this study confirmed
that not only did individuals with HA show a bias toward selective attention to health-related
information, but also that this bias was affected by their dispositional coping strategy.
Sujin Kim, Kiho Kim, and Jang-Han Lee, Department of Psychology, Chung-Ang University.
Correspondence concerning this article should be addressed to: Jang-Han Lee, Department of
Psychology, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 156-756, Republic of
Korea. Email: clipsy@cau.ac.kr
1183
1184 HEALTH ANXIETY AND COPING STRATEGY
Method
Procedure
Study participants initially signed a consent form, and were asked to fill out
both the Trait and State forms of the State-Trait Anxiety Inventory (STAI-T and
STAI-S) in which responses are rated on a 4-point Likert scale ranging from
1 = not at all to 4 = very much so (Spielberger, Gorsuch, & Lushene, 1970).
They were then seated in front of a computer screen to perform the dot-probe
task. The task consisted of 90 trials: 10 practice trials and 80 tests. Each trial
of the dot-probe task began with a central fixation point that was presented at
the center of the screen for 500 ms. Following this fixation point, a randomly
selected stimulus pair of words was presented on the screen for 1,250 ms. The
location of each word was counterbalanced. Participants then indicated where the
probe had appeared by pressing the two buttons labeled L (left, Z key) and R
(right, / key) on the keyboard as soon as possible. Bias scores were obtained by
subtracting the mean reaction time (RT) when the health-related words and probe
were in the same position, from the mean RT when the health-related words and
probe were in different positions.
We obtained the stimuli word pairs from previous studies (Brown, Kosslyn,
Delamater, Fama, & Barsky, 1999; Owens, Asmundson, Hadjistavropoulos,
& Owens, 2004) and from a survey of frequency use of words in the Korean
language (Kim, 2005). To select the words, 50 people assessed the relationship
to health and the emotional valence of 151 words on a 5-point scale ranging from
1 = not at all to 5 = very much so for each dimension. In the end, we selected 20
pairs of health-related and neutral words (see Table 1).
At the end of the task, participants were asked to rate the valence of the
health-related words using a 9-point Likert scale where 1 = very positive, 5 =
neutral, 9 = very negative. The entire experiment lasted approximately 15 minutes.
1186 HEALTH ANXIETY AND COPING STRATEGY
Results
To test the level of anxiety of the groups, we conducted a 2 (HA: HHA, LHA)
2 (coping strategy: blunter, monitor) analysis of variance (ANOVA) for STAI-T
and STAI-S scores, separately. There were main effects of HA in scores for both
STAI-T F(1, 63) = 22.02, p < .01, 2 = .26, and STAI-S, F(1, 63) = 9.68, p <
.01, 2 = .13. These results indicated that the HHA group was more likely than
the other groups to report anxiety. Details of the results for the four groups are
reported in Table 2.
30
blunter
25
monitor
30
15
Bias score (ms)
10
5
0
-5
-10
-15
High Low
Health anxiety
Figure 1. Differences in attentional bias according to level of health anxiety (HHA vs. LHA)
and coping strategy (blunter vs. monitor).
The rating scores of health-related words were entered into a 2 (HA: HHA,
LHA) 2 (coping: blunter, monitor) ANOVA. The results showed a significant
main effect of HA, F(1, 63) = 4.36, p < .05, 2 = .07. There was no significant
interaction between HA and coping strategy. These results indicated that the
HHA group rated negative health-related words as more negative than did the
LHA group.
1188 HEALTH ANXIETY AND COPING STRATEGY
Discussion
There are two main findings in this study: (a) individuals with HHA showed
stronger attentional bias for health-related stimuli than did those with LHA; (b)
individuals with HHA who used a blunting coping strategy showed stronger
attentional bias for health-related stimuli than did HHA who used a monitoring
strategy. There was no difference in attentional bias for health-related stimuli
between the two coping strategies among individuals with LHA.
These results indicated that a higher level of HA was associated with a greater
attentional bias for health-related stimuli. In the cognitive behavioral model it is
suggested that cognitive variables (e.g., cognitive processing of information) are
involved in the development and maintenance of HA (Salkovskis & Warwick,
2001). Individuals with HA pay attention to physical sensations and stimuli
selectively; thus, they may misinterpret the inner stimuli and sensations as
indicators of illness. In this model, it is posited that not only internal stimuli,
but also external stimuli (e.g., images, information about illness), act to trigger
events in a vicious circle of body sensations, their catastrophic interpretation,
and affective, attentional, behavioral, and physiological consequences that foster
the detection of more body sensations (Warwick, 1989). Our results provide
empirical support for this model: in our study individuals with HHA showed
greater attentional bias for information about health than did those with LHA.
In addition, we found that not only was level of HA related to attentional
bias for health-related stimuli, but also that this attentional bias was affected by
dispositional coping strategy. Specifically, blunters with HHA showed stronger
attentional bias toward health-related stimuli than did monitors with HHA, but
there was no difference in attentional bias between the two coping strategies
in individuals with LHA. Contrary to our prediction, the stimuli exposure
duration time (1,250 ms) used in our study might be insufficient to examine
the late attentional process that reflects shift of an individuals attention from
health-related words. In light of this view, the results we have reported for
monitors with HHA may be explained by Eysencks (1992) hypervigilance
hypothesis of anxiety. At the initial stage of attentional processing, in detecting
potential threat, monitors with HHA would scan the other location, whereas
blunters with HHA might be autonomically susceptible and sensitive to
health-related information.
A notable limitation in our study is that the findings cannot provide information
regarding the late attentional process, but only provide information on the initial
attention pattern of HA based on coping strategy. Although previous researchers
have found significant associations between anxiety sensitivity and attentional
bias toward illness stimuli (Keogh, Dillon, Georgiou, & Hunt, 2001; Lees,
Mogg, & Bradley, 2005), it is, as yet, unclear whether individuals maintain their
HEALTH ANXIETY AND COPING STRATEGY 1189
attention on, or shift their attention from, such stimuli (Jasper & Witthft, 2011).
To address the difference between early and later attention processes of HA,
distinctions between the early, largely autonomic, process in the detection of the
threat, and the later, controlled thinking processes in reaction to the threat may
need to be tested in future studies using more diverse exposure time(s).
Despite the limitations we have noted, in the present study we have revealed
that different cognitive mechanisms in HA may differ according to the coping
strategy used by the individual. Thus, our findings in this study may provide
empirical support for the idea that the coping strategy, in addition to the
attentional process, plays a specific role in the cognitive mechanisms of an
individuals HA. In addition, this idea implies that, because the attention process
differs based on individual coping strategy, it may be more beneficial to provide
a differentiated approach for each individuals coping strategy.
Overall, in this study we presented the investigation of the relationship
between HA and coping strategy in terms of attentional bias. Individuals showed
a different attentional bias toward health-related stimuli according to the level
of their HA and whether they used a blunting or a monitoring coping strategy.
Therefore, our findings add to the extant literature through suggesting the
significance of the effect of coping strategy in the field of HA.
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