1. T HE I MPACT OF S TRESS ON A UTONOMIC F UNCTIONING IN C HRONIC A BDOMINAL P AIN P ATIENTS Davlyn M. Tillman Under the Direction of Dr. Lynn Walker

2. I NTRODUCTION The main topic of this study was Chronic Abdominal Pain. Chronic abdominal pain (CAP) is a recurring pain in the abdomen common in childhood. The criteria are three or more episodes of abdominal pain that occur over at least three months and affect normal daily activities (Apley, 1975). This study specifically focused on the physiological and psychological Impact of Stress on participants with Chronic Abdominal Pain Specific Effects on Autonomic Functioning – Increases in Blood Pressure Specific Effects on Positive and Negative Affect – Decreases in Positive Affect and Increases in Negative Affect

3. Goal of Study Non-recovered and recovered CAP patients and well controls were subjected to a laboratory social stressor to measure physiological and psychological responses Hypotheses Tested Non-recovered CAP patients will experience greater physiological change in blood pressure levels in relation to recovered CAP Patients and well controls Non-recovered CAP patients will experience lower positive affect and higher negative affect in relation to recovered CAP Patients and well controls

4. M ETHODS Participants 317 recovered and non-recovered CAP patients and control (“well”) participants from the Middle Tennessee area Currently between ages 13-32 Measures Health Interview (Rome III) Used to determine whether recovered or non-recovered CAP Social Competence Interview Laboratory Stressor – in-depth discussion of work, school, friend, neighborhood, money, or family stress Physiological Assessment Blood Pressure measurements taken during baseline and SCI Symptom Emotion Report (SER) Questionnaire to measure positive and negative affect

5. Procedure Participants complete 45-60 minute health interview by phone Questions on subjects such as demographics, behavior, and physical wellness Participants then come into research lab at Children’s Hospital to complete the lab session and social stressor: Baseline blood pressure measurements during landscape slideshow SER1 Survey Social Competence Interview (active and cool phase) – participants discuss chosen social stressor with interviewer SER2 Survey Recovery period blood pressure measurements during slideshow

6. R ESULTS Demographics: 317 participants in the study Mean age of 20.34 years, S.D. = 4.37 Participants were 59.6% female and 40.4% male 93 well participants, 143 recovered CAP participants, and 81 non-recovered participants 92.7 Caucasian

7. R ESULTS : B LOOD P RESSURE M EASUREMENTS Mean of baseline blood pressures were subtracted from mean of two maximum blood pressures UNIANOVA statistical test All three groups experienced increase in BP due to laboratory stressor No significant difference between groups in systolic and diastolic blood pressure changes Systolic: p<0.47 Diastolic: p<0.08

8. R ESULTS : B LOOD P RESSURE M EASUREMENTS

9. R ESULTS : P OSITIVE AND N EGATIVE A FFECT Mean score for Time 1 subtracted from mean scores for Time 2 Calculated for both positive and negative affect One way ANOVA statistical test All three groups experienced a decrease in positive affect and increase in negative affect in response to laboratory stressor No significant difference between groups in positive and negative affect changes Positive affect: p<0.052 Negative affect: p<0.605

10. R ESULTS : P OSITIVE A FFECT

11. R ESULTS : N EGATIVE A FFECT

12. C ONCLUSION Key Findings The expected changes in blood pressure, positive affect, and negative affect were similar in all three sub-groups There were no significant differences in changes for non-recovered CAP participants Potential Implications All three groups seem to have similar biological responses to social stressor The groups may instead have different perceptions of stress that cause differences in self-report of somatic symptoms Positive and Negative Affect results have implications for further studies on coping strategies in patients with chronic abdominal pain patients Limitations The exact stressor discussed during the interview differed for each participants Measurements of positive and negative affect were self-reports The SCI was a short-term stressor and different results may be seen for a chronic stressor Future Direction Studies focusing on the cognitive effects of stress on chronic abdominal pain patients such as differences in perception as opposed to the physiological effects such as blood pressure Prospective studies that test types of coping strategies and success of strategies used by those who have recovered from chronic abdominal pain

13. A CKNOWLEDGEMENTS Dr. Lynn Walker, Walker Lab, Vanderbilt Children’s Hospital Grace Shelby, Graduate Student,Walker Lab Dr. Craig Smith, Honors Program Director