Lugar de acompañamiento de los padres según nota de comportamiento

S ection 5.1.4 exam ined Schacter & S in g e r’s (1962) approach to the role of autonomic arousal in the creation o f emotion. This approach, and later cognitive approaches, em phasise the role of attribution and interpretation of arousal or physiological sensation (the exam ple o f panic d iso rd er again) in determ ining subse q u en t em otional response.

K oeske (1977) suggests a similar model for PMS, in that the perception and attribution o f physiological change may play an im portant part in how that

c h a n g e is e x p e rie n c e d and in te rp re te d . T h is is c o m m e n s u r a te w ith the exam ination o f panic disorder as a parallel to PMS earlier in this chapter. In panic disorder, specific physiological changes are m onitored m ore closely, and responded to in a more catastrophic manner, than in non-panic patients.

The parallel does not end there. One notable non-cognitive aspect o f panic disorder is that a panic attack may be induced by a sodium lactate infusion, suggesting some direct neurological or physiological aetiologic com ponent (see Endelmann, 1992). Facchinetti et al (1992) performed a sodium lactate test on 35 women with prospectively confirmed PMS, and 16 normal controls. This was done in order to determine whether women with PMS were sensitive to this test, and w hether this sensitivity was accounted for by the existence of a concurrent panic disorder. The PMS sample were also administered a structured clinical interview to asses comorbid anxiety and / or mood disorders. It was found that only 31% of the PMS sample were free from any affective disorder of this nature (unfortunately, the control sample were not given the same interview, so there is no comparison data). Nine o f these women met the criteria for panic disorder, and it was found that a sodium lactate infusion induced a panic attack in 22 (62.9%) o f the PMS sample, and two controls (12.5%). The authors conclude that in this study, the PMS sample display a heightened sensitivity to lactate, which is not accounted for by the presence of co-morbid panic disorder.

H arrison et al (1989) compared the anxiogenic (anxiety producing) effects of d o u b le b reath in h a latio n o f carb o n j dioxide mixture in 14 w om en seeking treatm ent for PMS (with no co-morbid panic disorder) and 14 normal controls. The authors report that 9 of the PMS sample experienced panic attack symptoms (sev ere s u b jectiv e anxiety, with autonom ic sy m ptom s) a fte r C 0 2 exposure, compared to mild non-panic anxiety symptoms experienced by the control group. It is concluded that this study provides evidence for an abnormal sensitivity of the locus coeruleus to this p a rticu la r type o f C 0 2 ex p o su re, a p h ysiologic characteristic shared by patients with panic disorder.

M any authors suggest draw ing a distinction betw een central and autonom ic nervous system arousal (Asso, 1983). Some studies have found lower levels of CNS activity premenstrually, compared to intermenstrually, and higher levels o f ANS activity at the same discrete points (see Asso & Brier, 1982; Asso & Beech, 1975).

C om bined with specific cognitive traits, changes in u n d e rly in g physiological system s may be seen to produce abnormal em otional responses (e.g. panic disorder, PMS).

There are a number o f measures taken as indicators o f ANS activity. Heart rate, temperature, skin conductance, blood pressure and self report have all been used as indices, often with am biguous results. T here is some evidence for a prem e n stru al increase in ANS activity, com pared to interm en stru a l m easures (Asso & Beech, 1975; Asso & Brier, 1980; Vila & Beech, 1977; Williams et al, 1980). These studies have predominantly used combined m easures o f autonomic activity. Studies using single measures of ANS activity have tended to find no difference in activation levels (e.g. Doty et al, 1981; Slade & Jenner, 1979; Parlee, 1980), although U ssh er & W i ld in g ’s (1992) study showed a g e n e ra l in c re a s e in arousal premenstrually in PMS and non-PMS women, using a single measure. Dissociation between measures used as indices of ANS activity may also be partly accountable for this discrepancy (Asso, 1978).

K uczmierczyk et al (1986) conducted a cyele-phase specific study o f 11 women with PMS and 10 normal controls, to investigate differences in autonomic arousal. M easures o f heart rate and skin conduetance were taken prem enstrually and interm enstrually, as indices of ANS activity. M easures were monitored during baseline and after completion of a stressful laboratory task. Heart rate was found to be g e n e ra lly lo w er in the PMS g ro u p than in the c o n tro l group interm enstrually, but higher in the prem enstrual phase. Pain intensity ratings were found to be higher overall in the PMS sample. This study provides some support for cognitive factors in the acquisition and maintenance o f PMS, in the role o f u n derlying physiological activity and in the c o g n itiv e appraisal of s y m p to m s .

Palmero & Choliz (1991) took measures of resting heart rate in a group of women with prospectively confirmed PMS, and a non-PMS control group. Measures were taken throughout prem enstrual, menstrual, post m enstrual and ovulatory cycle p hases. PMS p a rtic ip a n ts showed h igher rating h e a rt rate levels in the prem enstrual phase than controls.

electromymogram measures in 16 women attending a PMS clinic and 8 controls. M easures were taken at rest, relaxation, an em o tionally upsettin g film, and p erfo rm a n ce o f stressful tasks. G enerally, skin c o n d u c ta n c e was show n to decrease to a greater extent in the premenstrual than the post menstrual phase, w h ilst the neck e le c tro m y m o g ra m show ed the rev erse p attern . Heart rate reaction to stressful tasks were larger in the prem enstrual than in the post menstrual phase for the PMS group, but not in the controls or the clinic attendees who showed only modest premenstrual symptoms.

Kirsch & Geer (1988) investigated the effect o f cycle phase on aspects of ANS arousal and perform ance. M easures of heart rate and skin conductance were taken pre and post menstrually from 16 retrospectively assessed PMS sufferers, and 16 controls, whilst hearing 10 audio tones and completing 2 stressful tasks. The PMS group were found to experience more stress premenstrually, and to show higher spontaneous skin conductance rate during a task, and higher SCR whilst hearing tones, prior to menses.

Girdler et al (1993) tested 15 women with prospectively confirmed PMS and 15 controls at two points in the menstrual cycle (fo llic u la r and luteal) for cardio v ascu lar stress reactivity and behavioural perform ance. Blood pressure and heart rate responses to stress were not found to differ across the menstrual cycle in either group of women, but differences in haem odynamic response was observed in the non-PMS group across the two cycle phases. Interestingly, the PMS group show ed s ig n ifican tly attenuated blood p re s s u re and heart rate responses compared with non-PMS women, irrespective of cycle phase.

The attribution of perceived state change can have a sign ifican t effect on menstrual distress. Koeske (1977) reports that negative m oods, behaviours and sym ptom s o ccurring p rem enstrually are likely to be attributed to biological factors, w hereas positive m oods, behaviours and sym ptom s are likely to be attributed to external or personality factors. Koeske goes on to suggest that women experience an increase in general arousability prem e n stru ally , w hich will be attributed as eith er positive or negative, depending upon environm ental cues. This fits in with the notion o f a premenstrual ‘state c h an g e’, and the role of cognition in d eterm ining prem enstrual experience.

Rodin (1976) manipulated the attributions of aroused participants, and found that those women who had a ‘p ill’ attribution (i.e. who attributed their arousal to the fact that they took a contraceptive pill) , or who were warned o f the effects of their arousal, performed better than subjects with no attribution provided. Parlee (1981) suggested that positive moods reported premenstrually are the result of the in t e r p r e ta tio n o f n o n -s p e c ific a ro u sal, due to s a ti s f a c to r y o r fa v o u ra b le environm ental circumstances. She proposed that women who have had a more problem atic or stressful life may have learned to label premenstrual feelings as d e p r e s s i o n .

5.2.3

Conc lusio n.

The literature reviewed in the preceding sections of this chapter is intended to provide support for a cognitive approach to PMS. Some cognitive psychological approaches to certain emotional disorders have been introduced and reviewed, with the intention o f providing support for a cognitive approach to PMS, in u n d erstanding self-diagnosis o f prem enstrual problem s.

Little evidence exists for cognitive performance differences (see this chapter; see chapter two; see chapter three) between women with and w ithout PMS, however it is diagnosed, and theoretical accounts of PMS are, on the whole, weak. However, because o f parallels that may be drawn with research into emotional disorders, and some research studies, this section concludes that there is some support for the role of cognitive processes in the experience and interpretation o f menstrual symptomology, that may lead some women to self-diagnose PMS. Furthermore, these cognitive processes may be focused around the interpretation, or misinterpretation, of some underlying arousal change. The rem ainder of this c h a p te r presents a pilot study, designed as a p relim in ary in v e stig atio n of attentional bias and self-reported PMS, and an experimental study to investigate changes in attentional bias, stress, arousal and heart rate activity across the m enstrual cycle.

5.3 The pilot study