Background
Medical settings can trigger anxiety and thereby impact patients' health outcomes, as illustrated by the white-coat effect (i.e., hypertension in the presence of medical staff). However, the psychological mechanisms and individual differences underlying such nocebo-like responses remain poorly understood. The present study investigated the implicit cognitive and emotional processing of white-coat representations in healthy controls and patients with chronic heart-failure and varying levels of illness-related anxiety (IA).
Method
Startle eyeblink modulation by pictures of clinical cues (i.e., medical staff dressed in white coats vs. casual clothes) and effects on subsequent memory performance (in a delayed recognition test) were assessed in high-IA patients (n = 20), as compared to age/sex-matched groups of low-IA patients (n = 20) and healthy controls (n = 20).
Results
White-coat pictures were linked to startle potentiation (relative to casual clothing) in all groups (irrespective of negative vs. positive facial expressions). Based on indices derived from Signal Detection Theory, both patient groups showed overall reduced memory performance than controls. In addition, high-IA individuals were less accurate at recognizing individuals previously shown in white coats.
Conclusion
Our findings suggest defense system activation by cues related to clinical settings, independent of patient characteristics. Moreover, impaired memory recall in high-anxious individuals suggests that IA leads to biased processing of white-coat representations which may be interpreted as threatening. These findings may have important implications for improving patient-practitioner interactions, especially in vulnerable populations.
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