Journalof Psychosomatic Research,Vol. 19,pp. 113to 121.PergamonPress,1975.Printedin Great Britain
SITUATIONAL STEREOTYPY IN ESSENTIAL HYPERTENSION PATIENTS* V.
HODAPPt,
G. WEYERt and J.
(Received
1 I September
BECKER~
1974)
investigations with patients suffering from essential hypertension are based mainly on experiments on stress. The major interest of these investigators is testing the hypothesis that hypertensives react to stressful stimuli by larger increases in blood pressure than normals. Reaction patterns of this type interpreted as specificity of symptoms were observed by several authors [l-6] while others were not able to reproduce these results [7-91. With respect to Lacey’s concept of situational stereotypy [lo] a comparison between hypertensives and normotensives in non-stressful situations seems interesting. Lacey’s concept differs from the concept of stimulus specificity of physiological reactions in that it does not primarily refer to specificity of emotional behaviour stereotypes but rather to situational specificity of behaviour that might be interpreted in terms of perception theory. According to Lacey, situations with the impact of orienting behaviour, involving environmental intake of the organism are likely to produce deactivation of the cardiovascular system (decrease in heart rate and blood pressure) whereas situations dominated by cognitive activities with selective rejection of stimuli are characterized by activation of cardiovascular parameters. Comparability between the concept of situational stereotypy and psychological constructs of perception theory is mediated by the concept of the orienting reflex. Graham and Clifton [II] stressed that both Lacey’s theory and the concept of the orienting reflex are based on the concept of autonomic feed-back able to reinforce or diminish stimulus effects. Furthermore, strong evidence for comparability of the two constructs is provided by authors who found either simple decreases in heart rate or decreases as a component of a biphasic reaction after simple sensory stimulation
PSYCHOPHYSIOLOGICAL
[ill. The investigations of reaction patterns as described by Lacey in hypertensives seemed rewarding with respect to the following considerations: Hypertensives suffer from disturbances of circulatory regulations evidently associated with ‘high level of reactivity’ in emotionally stressful situations. Thus for instance the possibility of inefficient regulation of ‘alarm-defence-reactions’, described by Charvat et al. [ 121, is discussed by Brod [6]. According to Lacey stressful situations of this type represent part of a continuum of stimulus situations likely to produce different activities and attitudes toward the situations in the subject. It seems rewarding to learn something about circulatory regulations of hypertensives in stimulus conditions which, according to Lacey, are likely to produce decrease in heart rate and blood pressure in healthy persons. * The study was supported by ‘Deutsche Forschungsgemeinschaft, Sonderforschungsbereich 36’. i_Department of Medical Statistics and Documentation, University of Mainz, West Germany. $ Department of Psychology, University of Mainz, Section General Experimental Psychology, West Germany. Present address: Department of Psychology, University of Dusseldorf. 113
114
V. HODAPP, G. WEYERand J. BECKER
Such stimulus induced variations in cardiovascular parameters without any special emotional involvement of the subject could contribute additional information to earlier experiments on circulation. According to Richter-Heinrich, hypertensives should differ from normals in their reaction patterns in situations of ‘environmental intake’ (Lacey). She was able to demonstrate by her experiments that hypertensives with increased sympathetic autonomous activation not only react to emotionally stressful stimuli, but also to emotionally neutral weak acoustic stimuli [5]. If an overall increased level of activation may be suspected in hypertensives, Lacey’s concept seems to provide a suitable approach for testing the hypothesis of a deficient regulation of complex reaction patterns like orienting- defence-reaction according to Sokolow [13], or alarm- defencereactions according to Charvat et al. [12]. METHOD* Experimental
design
andprocedure
The two respective experimental situations were watching coloured slides of landscapes and forming sentences of words with a given initial. The first situation was taken from an experiment of Obrist’s [14]. The second, forming sentences, seemed primarily suitable because it did not require talking of the subject. Thus disturbing stimuli upon heart rate can be avoided. The subjects were placed in a sound proof cubicle (Phonax company, 2.24 x 2.24 m”) on a comfortable chair with an adjustable back. After some general initial instructions, that ‘measurements of their bodily reactions’ were going to be taken, electrodes were attached followed by a 10 min initial period of rest. During this period several measurements of blood pressure were taken in order to habituate the subject to the inflation of the manometer cuff. Each of the experimental situations designed to change the level of attention of the subjects was initiated by new inslructions. This preliminary period was followed by another 5 min period of rest, then in an anticipation period an acoustical signal (a sound clearly detectable and not unpleasant) was presented, followed by presentation of the experimental stimuli. In the situation of environmental intake these consisted of 6 colour slides projected upon a transparent paper on the window of the sound proof box at intervals of 15 set by an automatic slide projector. In the ‘stress’ inducing situation the initial letters which had to be used for forming sentences were transmitted to the subject by a microphone. After 90 set the subject was instructed to speak the sentences he had formed. Physiological measurements
All physiological measurements were recorded by a Schwarzer polygraph type V 822. It was possible to mark the acoustical signals and the projection of slides on two different channels. ECG, arterial blood pressure and (for purpose of control) frequency of breathing were recorded by a microphone in front of the patient’s nose. The ECG was recorded from the patient’s right arm and left leg (registration II). Blood pressure was measured by an Infraton FIB 4 instrument (Boucke). For purposes of data reduction, particular periods of the experiment were selected for evaluation. Thus for the evaluation of heart rate the last 20 beats in the period of rest and the first 20 in the period of stimulus presentation were selected for calculating means from the average distances between two subsequent R peaks in the ECG. As a suitable indicator of the environmental intake situation we did not select the first 20 heart beats immediately after the acoustical signal, but beats 11 to 30 after stimulus presentation in order to exclude orienting responses to the signal. During the period of environmental intake heart rate was evaluated for the total period, using average distances between the subsequent R peaks in the ECG during presentation of each of the 6 slides. For the period of sentence formation means were again calculated for the first 20 intervals between R peaks following the presentation of the initial letters. Blood pressure was evaluated by using mean values for the period of rest. For the anticipation period and the period of stimulation only one value was recorded 45 set after the acoustical signal or after start of stimulation respectively. Thus we could assume that measurements of systolic and diastolic blood pressure would not be recorded at too different points of time between subjects. * We are grateful to Mr G. Hartmetz who helped with carrying out the experimental
procedure.
Situational The order of the situations random.
Stereotypy
in Essential
Hypertension
(watching slides and forming sentences
Patients respectively)
115 was varied at
Subjects Twenty patients from the Department of Internal Medicine, suffering from essential hypertension, and 31 controls were selected for the experiment, the instructions to the controls emphasizing the medical purpose of the experiment in order to control for the factor of motivation in ‘patients’ and ‘controls’. Severity of essential hypertension was classified according to WHO criteria 1151by the physicians.* We tried to match the controls according to sex and age, the age of the 13 male and 18 female controls ranging from 20 to 45 and that of the hypertensives (severity levels 1 and 2) frcm 21 to 51 yr.
RESULTS It was decided to analyse data of hypertensives level of severity 1 and 2 separately. In spite of the resulting small groups this seemed advisable, since according to Richter-Heinrich [15] severity of symptoms in hypertensives is an essential variable for psycho-physiological reactions. Measures of reactions were calculated as differences between values obtained during stimulation and the period of ‘alerted level’ (Lacey) which by most authors [lo, 14, IS] is regarded as a suitable initial value. Differences were regarded as suitable measures since correlations between differences and initial values were close to zero in the total sample as well as in subgroups, so that controlling for initial values did not seem obligatory. Figures 1 to 4 show the profiles of means as well as individual reactions in systolic and diastolic blood pressure.
* *rN’ __--
2
#’
I-*
.-‘_._,-
FIG.
1.-Means
/’
/.’
of systolic blood pressure during a situation of environmental and a ‘situation of stress’ (forming sentences).
intake (watching slides)
As can be seen from the profiles, hypertensives differ clearly from the controls in the environmental intake condition. Patterns of reaction within the hypertensive group are all together very similar in the two different stimulus conditions. Blood pressures of the controls however, especially their systolic values, show clear differences in the two situations remaining almost constant during attention * We are grateful to Prof. Distler and his staff for this help.
116
V.
HODAPP, G. WEYER
and J.
BECKER
40mmtfg
. .
. A.
.
*
‘10 wotchinq
0
q contro/s (n=3/1 (Cl rhypertensives.~everify . hyperfenwes. severity +*eL7/l3
FIG. 2.-Reaction
slides
30 mmHg
20
levei 7 ln= 91 tevel2 In = f7)
values of systolic blood pressure (differences between anticipation period and stimulus presentation).
initial values of the
150mmHg
** . .--,,ti
0
._,_,_. - .-*
__.4.-.-._
4
-contmfs(n=31) _ . - . -_hypertensive~, severity level 1 (n z 9) _---hypertensives.severity [eveI.? (n= If)
pairedcomporisons(onticf~ot;ofl
t -tests for forminqrentences
FIG. 3.-Means
respectively):
**
-wolrhing slides lp
SITUATIONAL STEREOTYPY IN ESSENTIAL HYPERTENSION PATIENTS* V.
HODAPPt,
G. WEYERt and J.
(Received
1 I September
BECKER~
1974)
investigations with patients suffering from essential hypertension are based mainly on experiments on stress. The major interest of these investigators is testing the hypothesis that hypertensives react to stressful stimuli by larger increases in blood pressure than normals. Reaction patterns of this type interpreted as specificity of symptoms were observed by several authors [l-6] while others were not able to reproduce these results [7-91. With respect to Lacey’s concept of situational stereotypy [lo] a comparison between hypertensives and normotensives in non-stressful situations seems interesting. Lacey’s concept differs from the concept of stimulus specificity of physiological reactions in that it does not primarily refer to specificity of emotional behaviour stereotypes but rather to situational specificity of behaviour that might be interpreted in terms of perception theory. According to Lacey, situations with the impact of orienting behaviour, involving environmental intake of the organism are likely to produce deactivation of the cardiovascular system (decrease in heart rate and blood pressure) whereas situations dominated by cognitive activities with selective rejection of stimuli are characterized by activation of cardiovascular parameters. Comparability between the concept of situational stereotypy and psychological constructs of perception theory is mediated by the concept of the orienting reflex. Graham and Clifton [II] stressed that both Lacey’s theory and the concept of the orienting reflex are based on the concept of autonomic feed-back able to reinforce or diminish stimulus effects. Furthermore, strong evidence for comparability of the two constructs is provided by authors who found either simple decreases in heart rate or decreases as a component of a biphasic reaction after simple sensory stimulation
PSYCHOPHYSIOLOGICAL
[ill. The investigations of reaction patterns as described by Lacey in hypertensives seemed rewarding with respect to the following considerations: Hypertensives suffer from disturbances of circulatory regulations evidently associated with ‘high level of reactivity’ in emotionally stressful situations. Thus for instance the possibility of inefficient regulation of ‘alarm-defence-reactions’, described by Charvat et al. [ 121, is discussed by Brod [6]. According to Lacey stressful situations of this type represent part of a continuum of stimulus situations likely to produce different activities and attitudes toward the situations in the subject. It seems rewarding to learn something about circulatory regulations of hypertensives in stimulus conditions which, according to Lacey, are likely to produce decrease in heart rate and blood pressure in healthy persons. * The study was supported by ‘Deutsche Forschungsgemeinschaft, Sonderforschungsbereich 36’. i_Department of Medical Statistics and Documentation, University of Mainz, West Germany. $ Department of Psychology, University of Mainz, Section General Experimental Psychology, West Germany. Present address: Department of Psychology, University of Dusseldorf. 113
114
V. HODAPP, G. WEYERand J. BECKER
Such stimulus induced variations in cardiovascular parameters without any special emotional involvement of the subject could contribute additional information to earlier experiments on circulation. According to Richter-Heinrich, hypertensives should differ from normals in their reaction patterns in situations of ‘environmental intake’ (Lacey). She was able to demonstrate by her experiments that hypertensives with increased sympathetic autonomous activation not only react to emotionally stressful stimuli, but also to emotionally neutral weak acoustic stimuli [5]. If an overall increased level of activation may be suspected in hypertensives, Lacey’s concept seems to provide a suitable approach for testing the hypothesis of a deficient regulation of complex reaction patterns like orienting- defence-reaction according to Sokolow [13], or alarm- defencereactions according to Charvat et al. [12]. METHOD* Experimental
design
andprocedure
The two respective experimental situations were watching coloured slides of landscapes and forming sentences of words with a given initial. The first situation was taken from an experiment of Obrist’s [14]. The second, forming sentences, seemed primarily suitable because it did not require talking of the subject. Thus disturbing stimuli upon heart rate can be avoided. The subjects were placed in a sound proof cubicle (Phonax company, 2.24 x 2.24 m”) on a comfortable chair with an adjustable back. After some general initial instructions, that ‘measurements of their bodily reactions’ were going to be taken, electrodes were attached followed by a 10 min initial period of rest. During this period several measurements of blood pressure were taken in order to habituate the subject to the inflation of the manometer cuff. Each of the experimental situations designed to change the level of attention of the subjects was initiated by new inslructions. This preliminary period was followed by another 5 min period of rest, then in an anticipation period an acoustical signal (a sound clearly detectable and not unpleasant) was presented, followed by presentation of the experimental stimuli. In the situation of environmental intake these consisted of 6 colour slides projected upon a transparent paper on the window of the sound proof box at intervals of 15 set by an automatic slide projector. In the ‘stress’ inducing situation the initial letters which had to be used for forming sentences were transmitted to the subject by a microphone. After 90 set the subject was instructed to speak the sentences he had formed. Physiological measurements
All physiological measurements were recorded by a Schwarzer polygraph type V 822. It was possible to mark the acoustical signals and the projection of slides on two different channels. ECG, arterial blood pressure and (for purpose of control) frequency of breathing were recorded by a microphone in front of the patient’s nose. The ECG was recorded from the patient’s right arm and left leg (registration II). Blood pressure was measured by an Infraton FIB 4 instrument (Boucke). For purposes of data reduction, particular periods of the experiment were selected for evaluation. Thus for the evaluation of heart rate the last 20 beats in the period of rest and the first 20 in the period of stimulus presentation were selected for calculating means from the average distances between two subsequent R peaks in the ECG. As a suitable indicator of the environmental intake situation we did not select the first 20 heart beats immediately after the acoustical signal, but beats 11 to 30 after stimulus presentation in order to exclude orienting responses to the signal. During the period of environmental intake heart rate was evaluated for the total period, using average distances between the subsequent R peaks in the ECG during presentation of each of the 6 slides. For the period of sentence formation means were again calculated for the first 20 intervals between R peaks following the presentation of the initial letters. Blood pressure was evaluated by using mean values for the period of rest. For the anticipation period and the period of stimulation only one value was recorded 45 set after the acoustical signal or after start of stimulation respectively. Thus we could assume that measurements of systolic and diastolic blood pressure would not be recorded at too different points of time between subjects. * We are grateful to Mr G. Hartmetz who helped with carrying out the experimental
procedure.
Situational The order of the situations random.
Stereotypy
in Essential
Hypertension
(watching slides and forming sentences
Patients respectively)
115 was varied at
Subjects Twenty patients from the Department of Internal Medicine, suffering from essential hypertension, and 31 controls were selected for the experiment, the instructions to the controls emphasizing the medical purpose of the experiment in order to control for the factor of motivation in ‘patients’ and ‘controls’. Severity of essential hypertension was classified according to WHO criteria 1151by the physicians.* We tried to match the controls according to sex and age, the age of the 13 male and 18 female controls ranging from 20 to 45 and that of the hypertensives (severity levels 1 and 2) frcm 21 to 51 yr.
RESULTS It was decided to analyse data of hypertensives level of severity 1 and 2 separately. In spite of the resulting small groups this seemed advisable, since according to Richter-Heinrich [15] severity of symptoms in hypertensives is an essential variable for psycho-physiological reactions. Measures of reactions were calculated as differences between values obtained during stimulation and the period of ‘alerted level’ (Lacey) which by most authors [lo, 14, IS] is regarded as a suitable initial value. Differences were regarded as suitable measures since correlations between differences and initial values were close to zero in the total sample as well as in subgroups, so that controlling for initial values did not seem obligatory. Figures 1 to 4 show the profiles of means as well as individual reactions in systolic and diastolic blood pressure.
* *rN’ __--
2
#’
I-*
.-‘_._,-
FIG.
1.-Means
/’
/.’
of systolic blood pressure during a situation of environmental and a ‘situation of stress’ (forming sentences).
intake (watching slides)
As can be seen from the profiles, hypertensives differ clearly from the controls in the environmental intake condition. Patterns of reaction within the hypertensive group are all together very similar in the two different stimulus conditions. Blood pressures of the controls however, especially their systolic values, show clear differences in the two situations remaining almost constant during attention * We are grateful to Prof. Distler and his staff for this help.
116
V.
HODAPP, G. WEYER
and J.
BECKER
40mmtfg
. .
. A.
.
*
‘10 wotchinq
0
q contro/s (n=3/1 (Cl rhypertensives.~everify . hyperfenwes. severity +*eL7/l3
FIG. 2.-Reaction
slides
30 mmHg
20
levei 7 ln= 91 tevel2 In = f7)
values of systolic blood pressure (differences between anticipation period and stimulus presentation).
initial values of the
150mmHg
** . .--,,ti
0
._,_,_. - .-*
__.4.-.-._
4
-contmfs(n=31) _ . - . -_hypertensive~, severity level 1 (n z 9) _---hypertensives.severity [eveI.? (n= If)
pairedcomporisons(onticf~ot;ofl
t -tests for forminqrentences
FIG. 3.-Means
respectively):
**
-wolrhing slides lp
