Title: Memory processes in retrospective symptom (over)reporting
Other Titles: Geheugenprocessen bij retrospectieve (over)rapportering van symptomen
Authors: Walentynowicz, Marta
Issue Date: 30-Jun-2016
Abstract: Self-reported somatic symptoms play a primary role in the health care system, guiding the behavior and decisions of both patients and medical specialists. These decisions are often based on retrospective evaluations of past symptom episodes. However, both momentary and memory-based symptom ratings are vulnerable to various biasing factors leading to inaccurate (often overestimated) symptom recall.
The aim of the current doctoral project was to investigate somatic memories and the role of memory processes in retrospective symptom reporting. According to the “dual-process” perspective, symptom reporting results from the interplay between sensory-perceptual and affective-motivational components of a somatic experience. Consequently, differential processing of those components could be one of the factors affecting memory processes. Based on those assumptions, we hypothesized that biased symptom reporting emerges in response to a relative imbalance of the two components, especially when strong negative affective information overshadows a sensory component, potentially resulting in less detailed memory of sensory details. Because a relative dominance of affective over sensory processing of bodily signals could be expected among individuals with an overreactive evaluative system, the advanced hypotheses were tested among the individuals who report frequent, often medically unexplained, somatic experiences (habitual symptom reporting; HSR) and score high on negative affectivity (NA).
The first study (Chapter 2) adopted a psychometric approach to test the latent structure of symptom reporting. In line with earlier findings, symptom reporting was best explained by a bifactor model comprising one general and several symptom specific factors, which could be interpreted as reflecting the affective and sensory components of symptom experiences, respectively.
To examine the factors affecting retrospective symptom reporting, the next four studies adopted an experimental approach with standardized procedures to induce aversive bodily symptoms (pain, dyspnea) in controlled laboratory conditions. Assessment of both self-reported and psychophysiological responses to somatic stimuli took place concurrently during symptom inductions. Retrospective ratings were collected up to two (Studies 2-4) and four (Study 5) weeks after the somatic experiences. In the first two experimental studies (Chapters 3 and 4), concurrent and retrospective responses to the symptoms were compared within- and between-subjects in a study with students and a study with patients with medically unexplained dyspnea (MUD) and healthy controls. This demonstrated that (a) memory biases start to operate immediately after the somatic event, (b) intensity ratings of both concurrent and retrospective ratings are more elevated in HSR/MUD, and (c) the latter effect is mediated by the affective state associated with a somatic experience (i.e., state NA and anxiety).
In the following experimental studies (Chapters 5 and 6), symptom inductions were combined with the processing focus (PF) manipulation at encoding and at retrieval to investigate whether directing PF to either sensory-perceptual or affective-motivational aspects of somatic experience can influence retrospective symptom reporting. The manipulation of PF at encoding led to differences in affective responses as well as to the memory bias, such that the affective PF resulted in both increased affective responses to symptom inductions and increased retrospective ratings of dyspnea (but not of pain). On the other hand, the manipulation at retrieval did not influence the way symptoms or affective responses were recalled.
Finally, the topic of somatic memories was also approached from an autobiographical memory perspective (Chapter 7) showing reduced memory specificity of health-related autobiographical memories in patients with MUD compared to healthy controls.
Taken together, these studies clearly emphasize the importance of affective processing in retrospective symptom reporting. Specifically, biased symptom recall was related to an increased focus on the affective aspects of a distressing somatic experience. Consequently, this could explain not only biased symptom reporting in general, but also the greater vulnerability to retrospective symptom overreporting among individuals with an overreactive evaluative response system (higher level of NA). A detailed discussion of these findings, together with limitations of the reported studies and recommendations for future research are presented in the last chapter.
Publication status: published
KU Leuven publication type: TH
Appears in Collections:Health Psychology
Centre for Psychology of Learning and Experimental Psychopathology

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