The relationship between social factors and dyspnea perception and its respective neural processing

Dyspnea is a highly prevalent and distressing symptom which negatively affects patients as well as their caregivers. Research suggests that the biopsychosocial model is the best framework to comprehensively understand all relevant dimensions of dyspnea. However, research on the social dimension of dyspnea has been widely neglected (Chapter 1). Therefore, the aim of this doctoral project was to explore the relationship between social factors and dyspnea. All studies were conducted in healthy participants in whom dyspnea was experimentally induced, mainly by using inspiratory resistive loads. Dyspnea was investigated via self-reports and assessment of the neural processing of respiratory sensations using event-related potentials in the electroencephalogram. Since predominantly respiratory-related evoked potentials (RREPs) were used to investigate the neural processing of respiratory sensations, we examined in a first step the test-retest reliability of all RREP components Nf, P1, N1, P2, and P3 (Chapter 2). The results confirmed acceptable test-retest reliability for all RREP components with or without parallel dyspnea induction, which supports its further reliable application in respiratory research. Then, the effect of the social context, operationalized as social presence of a neutral observer (Chapter 3) and social exclusion (Chapter 4), on the perception of dyspnea and the underlying neural processing measured with RREPs was investigated. Findings showed that the presence of a neutral observer reduced perceived dyspnea either significantly or at trend level. Additionally, reduced amplitudes at trend level of the RREP component P2 were found with an observer present. Furthermore, social exclusion was associated with increased dyspnea perception and increased neural processing of respiratory sensations as indicated by increased amplitudes of RREP components P2 and P3. These findings suggest that the social context affects the perception of dyspnea and the underlying neural processing with social presence having potential beneficial and social exclusion having debilitating effects. Finally, we examined the effects of the observation of others suffering from dyspnea on the observer (Chapter 5). Findings demonstrated that observing dyspnea in others elicited vicarious mild-to-moderate dyspnea in the observer, negative affect, and increased brain responses in the electroencephalogram. This vicarious dyspnea might have clinical relevance as it could amplify suffering in caregivers who frequently observe the dyspnea in respective patients. Taken together, the current project increases the knowledge about the relationship between social factors and dyspnea and emphasizes the high relevance of social factors for the individual experience of dyspnea. In the long-run, this constitutes a prerequisite justifying a stronger integration of social interventions into existing dyspnea management strategies by incorporating beneficial and targeting debilitating social factors in order to reduce the symptom burden in dyspneic patients and their caregivers.status: publishe