This theory was
published in 1992 by Arthur Barsky, M.D., an associate professor of psychiatry at Harvard Medical School.
The term Somatosensory Amplification
or more simply amplification, refers to the tendency for physical sensations to be experienced as disturbing
because they seem to be intense and unpleasant. The term also refers to the tendency to especially focus on uncomfortable
bodily sensations and consider them to be abnormal rather than normal. Amplification significantly contributes
to somatization (or preoccupation with physical sensations) that characterizes hypocondriasis and other psychosomatic
disorders, especially panic attacks and Panic Disorder. Amplification
also occurs to one extent or another in all anxiety disorders.
There are three elements involved in the amplification
process:
1. Hypervigilence: A tendency to be over
focused on bodily sensations and pay excessive attention to all sensations, especially those that are unpleasant.
2. Selective Focus: A tendency to to
select out and focus on infrequent, weak or unusual bodily sensations.
3. Mislabeling: A tendency to consider
physical sensations as abnormal and symptomatic of disease, rather than as normal and benign.
These three elements often
lead to a sense of danger and threat from bodily sensations.
There is a natural variability among people in
their sensitivity to bodily sensations, especially in their threshold and tolerance for physical discomfort and pain. Individuals
who are more sensitive to pain can be considered amplifiers, while those who are less sensitive to pain can be considered
minimizers. Amplification may be learned in childhood and/or may be a biological predisposition present from birth.
The degree of amplification varies over time, so someone may amplify a sensation at one time or state of mind, and may
not amplify it at another time or state of mind. There are four factors that influence the intensity of a sensation at any
given time: cognition, context, attention, and mood.
COGNITION
Cognition refers to thoughts or the thinking process,
so ones thoughts can significantly influence a sensation. We tend to experience a bodily sensation based upon our information,
ideas or beliefs about that sensation. An example would be the experience of a headache. If one believes the headache is the
result of stress or eye strain, there will likely be little anxiety over the headache and the headache will not seem terribly
intense. However, if one believes the headache is the result of a possible brain
tumor, the headache will likely feel much more intense. Ones thoughts about the sensation will influence the intensity of
the sensation. This commonly occurs during the process of a panic attack, and therefore contributes to the creation of the
panic attack.
CONTEXT
The circumstances or situation in which we experience
a sensation will influence the intensity of the sensation. If many people around us have become ill with a cold or flu, we
will be more inclined to believe that if we sneeze it may be a symptom of us also catching a cold or flu. At other times,
we may not have paid much attention to that sneeze, believing it to be just a random sneeze. The context can also influence
our perceptions. For example, waiting for someone who is late will cause us to be more sensitive to the approach of someone
who resembles the person we are waiting for than we normally would be.
ATTENTION
Paying attention to any sensation automatically
amplifies or intensifies it. At the same time, distraction will diminish the sensation. Thus ill people can tend to feel more
ill when frequently asked about their symptoms or condition as it causes them to focus more on their symptoms. It is commonly
known that behaviors such as yawning are called "contagious" because observing another yawn tends to make us yawn. The reason
is attention. Seeing another yawn brings our attention to our own need to yawn, which literally oxygenates our cells and feels
relaxing as well as reviving. Other behaviors that have an infectious quality are coughing and itching. Hearing someone else
cough brings our attention to our own throat where we soon notice a slight sensation of dryness or scratchiness that
we had previously been unaware of, and we then cough. Or observing someone scratch an itch brings our attention to our own
sensations of dryness or itchiness, and we too may soon be scratching.
MOOD
A mood such as anxiety tends
to make us think with a more negative bias than does a positive, relaxed mood. This can especially influence ones thoughts
about their health, safety and well-being. Anxiety causes sensations to be appraised as more ominous and dangerous,
therefore anxious people are inclined to catastrophize bodily sensations, and tend to interpret vague or
ambiguous symptoms as abnormal rather than normal. (See companion theory: "Catastrophic Misinterpretation"). Anxiety causes
self-consciousness that leads to increased self-scrutiny which amplifies preexisting sensations, and brings into focus sensations
that previously were unnoticed. Studies have demonstrated that anxiety lowers the tolerance of, and threshold for, unpleasant
or painful sensations.
These dynamics also apply equally to depressed
moods. People who are depressed also have a negative and pessimistic bias to their thinking, which causes them to focus more
on negative events and memories, including negative physical sensations. One result is a tendency to believe in negative outcomes
- that things are not going to get better and may likely only get worse. Depressed people tend to think of themselves as defective
or abnormal and tend to think about misfortune, illness or death. Depression causes people to focus their attention inward,
increasing preoccupation with physical sensations and amplifying mild and trivial discomfort, resulting in alarm.
