Learning to have psychosomatic complaints: Conditioning of respiratory behavior and somatic complaints in psychosomatic patients

Objective: Assuming a subjective similarity between the experience of a hyperventilation episode and inhaling CO2-enriched air, we tested whether a respiratory challenge in association with a particular stimulus could result in altered respiratory behavior and associated somatic complaints upon presenting the stimulus only. Method: Psychosomatic patients (N = 28) reporting hyperventilation complaints participated in a differential conditioning paradigm using odors with a positive or negative valence as conditioned stimuli (CS+ or CS-) and 7.4% CO2-enriched air as the unconditioned stimulus (US). Three CS+ and three CS- acquisition trials were run. During the test phase, two CS+ -and two CS- -only trials were run, followed by two new test odors (with a positive or negative valence). Respiratory frequency, tidal volume, end-tidal fractional concentration of CO2, and heart rate were measured throughout the experiment. Somatic complaints were registered after each trial. Results: We observed a) increased respiratory frequency and an elevated level of somatic complaints upon presenting the CS+ only; b) a selective association effect: conditioning was only apparent with the negatively valenced CS+ odor; (c) no generalization of respiratory responses and complaints to the new odors; (d) no conditioning effect on dummy complaints that are usually not reported when inhaling CO2; (e) in exploratory comparisons with normal subjects, stronger conditioning effects on typical hyperventilation complaints in patients, and, in female subjects, on respiratory frequency. Conclusion: Respiratory responses and psychosomatic complaints can be elicited by conditioned stimuli in a highly specific way. The findings are relevant for disorders in which respiratory abnormalities and/or psychosomatic complaints may play a role and for multiple chemical sensitivity.