assignment 3 1 psychology

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Assignments.

The assignments in this course are openly licensed, and are available as-is, or can be modified to suit your students’ needs. Selected answer keys are available to faculty who adopt Waymaker, OHM, or Candela courses with paid support from Lumen Learning. This approach helps us protect the academic integrity of these materials by ensuring they are shared only with authorized and institution-affiliated faculty and staff.

If you import this course into your learning management system (Blackboard, Canvas, etc.), the assignments will automatically be loaded into the assignment tool, where they may be adjusted, or edited there. Assignments also come with rubrics and pre-assigned point values that may easily be edited or removed.

The assignments for Introductory Psychology are ideas and suggestions to use as you see appropriate. Some are larger assignments spanning several weeks, while others are smaller, less-time consuming tasks. You can view them below or throughout the course.

You can view them below or throughout the course.

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Chapter 1. Introducing Psychology

Psychology is the scientific study of mind and behavior . The word “psychology” comes from the Greek words “psyche,” meaning life , and “logos,” meaning explanation . Psychology is a popular major for students, a popular topic in the public media, and a part of our everyday lives. Television shows such as Dr. Phil feature psychologists who provide personal advice to those with personal or family difficulties. Crime dramas such as CSI , Lie to Me , and others feature the work of forensic psychologists who use psychological principles to help solve crimes. And many people have direct knowledge about psychology because they have visited psychologists, for instance, school counselors, family therapists, and religious, marriage, or bereavement counselors.

Because we are frequently exposed to the work of psychologists in our everyday lives, we all have an idea about what psychology is and what psychologists do. In many ways I am sure that your conceptions are correct. Psychologists do work in forensic fields, and they do provide counseling and therapy for people in distress. But there are hundreds of thousands of psychologists in the world, and most of them work in other places, doing work that you are probably not aware of.

Most psychologists work in research laboratories, hospitals, and other field settings where they study the behavior of humans and animals. For instance, my colleagues in the Psychology Department at the University of Maryland study such diverse topics as anxiety in children, the interpretation of dreams, the effects of caffeine on thinking, how birds recognize each other, how praying mantises hear, how people from different cultures react differently in negotiation, and the factors that lead people to engage in terrorism. Other psychologists study such topics as alcohol and drug addiction, memory, emotion, hypnosis, love, what makes people aggressive or helpful, and the psychologies of politics, prejudice, culture, and religion. Psychologists also work in schools and businesses, and they use a variety of methods, including observation, questionnaires, interviews, and laboratory studies, to help them understand behavior.

This chapter provides an introduction to the broad field of psychology and the many approaches that psychologists take to understanding human behavior. We will consider how psychologists conduct scientific research, with an overview of some of the most important approaches used and topics studied by psychologists, and also consider the variety of fields in which psychologists work and the careers that are available to people with psychology degrees. I expect that you may find that at least some of your preconceptions about psychology will be challenged and changed, and you will learn that psychology is a field that will provide you with new ways of thinking about your own thoughts, feelings, and actions.

Psychology is in part the study of behavior. Why do you think these people are behaving the way they are?

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Psychology 1: assignment.

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Assignment 3: Popular Press vs. Peer Reviewed Articles

Overview:  Like a literature review, this assignment is intended to have you compare and contrast the writing style and potential uses of a popular press article versus a peer-reviewed primary research article that discusses a psychological phenomenon, written within the last 10 years. The articles need to address the same area of interest (for example, depression and gender, love and crying, teenage norms and ostracism etc.), but do not have to necessarily be about the same exact experiment.  For hints on appropriate psychological phenomena, reference the textbook and lecture notes.

List of journals for Psych 1 assignment

• Cognitive Neuroscience
• Cognitive Psychology
• Developmental Psychology
• Educational Psychologist
• Health Psychology
• Journal of Abnormal Psychology
• Journal of Applied Psychology
• Journal of Comparative Psychology
• Journal of Consulting & Clinical Psychology
• Journal of Counseling Psychology
• Journal of Educational Psychology
• Journal of Mind and Behavior most recent 4 years not available
• Journal of Personality and Social Psychology
• Journal of Social Psychology
• Neuroscience and Behavioral Physiology
• Personality and Social Psychology Bulletin
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• Prof. John D. E. Gabrieli

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• Brain and Cognitive Sciences

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• Cognitive Science

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Introduction to psychology, writing assignment 1.

Topic: Are studies of cognitive and emotional developments in adolescents useful for setting public policy guidelines?

To begin this assignment, you will read three sources (full citations and abstracts below):

• An analysis by Steinberg et al. of emotional and cognitive development in adolescents and how our understanding of these topics should be used in setting public policy, such as juvenile access to abortions or the death penalty;
• A criticism of this position by Fischer et al., who have a different perspective on how public policy should take into account emotional and cognitive development in juveniles; and,
• A rebuttal of the Fischer position by Steinberg et al.

Review the writing assignment guidelines given on the Syllabus . Your specific goal for Writing Assignment 1 is to analyze the arguments in the three papers, construct a coherent argument about the role of studies of cognitive and emotional development in setting public policy guidelines, and support this argument with specific evidence from the papers. A number of different approaches to this topic can satisfy the requirements of this writing assignment. For example, your thesis might address:

• In what circumstances can psychological research on cognitive and emotional development be used to set public policy?
• When, if ever, should public policy distinguish between cognitive and emotional development and why (or why not)?
• Whose view of psychological development – Steinberg or Fischer – is better for setting public policy and why?

There is no “correct” answer you are expected to discover. Instead, you should read the papers and develop your own conclusion about what role psychological research should play in setting public policy. Your thesis should clearly state your position, and you should use the rest of the paper to justify your conclusion with specific evidence from the background readings.

Abstracts are presented courtesy of the American Psychological Association.

Steinberg, L., et al. “ Are Adolescents Less Mature than Adults? Minors’ Access to Abortion, the Juvenile Death Penalty, and the Alleged APA ‘Flip-Flop’ .” American Psychologist 64, no. 7 (2009): 583–94.

Abstract : “The American Psychological Association’s (APA’s) stance on the psychological maturity of adolescents has been criticized as inconsistent. In its Supreme Court amicus brief in Roper v. Simmons (2005), which abolished the juvenile death penalty, APA described adolescents as developmentally immature. In its amicus brief in Hodgson v. Minnesota (1990), however, which upheld adolescents’ right to seek an abortion without parental involvement, APA argued that adolescents are as mature as adults. The authors present evidence that adolescents demonstrate adult levels of cognitive capability earlier than they evince emotional and social maturity. On the basis of this research, the authors argue that it is entirely reasonable to assert that adolescents possess the necessary skills to make an informed choice about terminating a pregnancy but are nevertheless less mature than adults in ways that mitigate criminal responsibility. The notion that a single line can be drawn between adolescence and adulthood for different purposes under the law is at odds with developmental science. Drawing age boundaries on the basis of developmental research cannot be done sensibly without a careful and nuanced consideration of the particular demands placed on the individual for “adult-like” maturity in different domains of functioning.”

Fischer, K. W., et al. “ Narrow Assessments Misrepresent Development and Misguide Policy .” American Psychologist 64, no. 7 (2009): 595–600.

Abstract : “Intellectual and psychosocial functioning develop along complex learning pathways. Steinberg, Cauffman, Woolard, Graham, and Banich (see record 2009-18110-001 ) measured these two classes of abilities with narrow, biased assessments that captured only a segment of each pathway and created misleading age patterns based on ceiling and floor effects. It is a simple matter to shift the assessments to produce the opposite pattern, with cognitive abilities appearing to develop well into adulthood and psychosocial abilities appearing to stop developing at age 16. Their measures also lacked a realistic connection to the lived behaviors of adolescents, abstracting too far from messy realities and thus lacking ecological validity and the nuanced portrait that the authors called for. A drastically different approach to assessing development is required that (a) includes the full age-related range of relevant abilities instead of a truncated set and (b) examines the variability and contextual dependence of abilities relevant to the topics of murder and abortion.”

Steinberg, L., et al. (2009b) “ Reconciling the Complexity of Human Development with the Reality of Legal Policy .” American Psychologist 64, no. 7 (2009): 601–4.

Abstract : “The authors respond to both the general and specific concerns raised in Fischer, Stein, and Heikkinen’s (see record 2009-18110-002 ) commentary on their article (Steinberg, Cauffman, Woolard, Graham, & Banich) (see record 2009-18110-001 ), in which they drew on studies of adolescent development to justify the American Psychological Association’s positions in two Supreme Court cases involving the construction of legal age boundaries. In response to Fischer et al.’s general concern that the construction of bright-line age boundaries is inconsistent with the fact that development is multifaceted, variable across individuals, and contextually conditioned, the authors argue that the only logical alternative suggested by that perspective is impractical and unhelpful in a legal context. In response to Fischer et al.’s specific concerns that their conclusion about the differential timetables of cognitive and psychosocial maturity is merely an artifact of the variables, measures, and methods they used, the authors argue that, unlike the alternatives suggested by Fischer et al., their choices are aligned with the specific capacities under consideration in the two cases. The authors reaffirm their position that there is considerable empirical evidence that adolescents demonstrate adult levels of cognitive capability several years before they evince adult levels of psychosocial maturity.”

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50+ Research Topics for Psychology Papers

How to Find Psychology Research Topics for Your Student Paper

• Specific Branches of Psychology
• Topics Involving a Disorder or Type of Therapy
• Human Cognition
• Human Development
• Critique of Publications
• Famous Experiments
• Historical Figures
• Specific Careers
• Case Studies
• Literature Reviews
• Your Own Study/Experiment

Are you searching for a great topic for your psychology paper ? Sometimes it seems like coming up with topics of psychology research is more challenging than the actual research and writing. Fortunately, there are plenty of great places to find inspiration and the following list contains just a few ideas to help get you started.

Finding a solid topic is one of the most important steps when writing any type of paper. It can be particularly important when you are writing a psychology research paper or essay. Psychology is such a broad topic, so you want to find a topic that allows you to adequately cover the subject without becoming overwhelmed with information.

I can always tell when a student really cares about the topic they chose; it comes through in the writing. My advice is to choose a topic that genuinely interests you, so you’ll be more motivated to do thorough research.

In some cases, such as in a general psychology class, you might have the option to select any topic from within psychology's broad reach. Other instances, such as in an  abnormal psychology  course, might require you to write your paper on a specific subject such as a psychological disorder.

As you begin your search for a topic for your psychology paper, it is first important to consider the guidelines established by your instructor.

Research Topics Within Specific Branches of Psychology

The key to selecting a good topic for your psychology paper is to select something that is narrow enough to allow you to really focus on the subject, but not so narrow that it is difficult to find sources or information to write about.

One approach is to narrow your focus down to a subject within a specific branch of psychology. For example, you might start by deciding that you want to write a paper on some sort of social psychology topic. Next, you might narrow your focus down to how persuasion can be used to influence behavior .

Other social psychology topics you might consider include:

• Prejudice and discrimination (i.e., homophobia, sexism, racism)
• Social cognition
• Person perception
• Social control and cults
• Persuasion, propaganda, and marketing
• Attraction, romance, and love
• Nonverbal communication
• Prosocial behavior

Psychology Research Topics Involving a Disorder or Type of Therapy

Exploring a psychological disorder or a specific treatment modality can also be a good topic for a psychology paper. Some potential abnormal psychology topics include specific psychological disorders or particular treatment modalities, including:

• Eating disorders
• Borderline personality disorder
• Seasonal affective disorder
• Schizophrenia
• Antisocial personality disorder
• Profile a  type of therapy  (i.e., cognitive-behavioral therapy, group therapy, psychoanalytic therapy)

Topics of Psychology Research Related to Human Cognition

Some of the possible topics you might explore in this area include thinking, language, intelligence, and decision-making. Other ideas might include:

• False memories
• Speech disorders
• Problem-solving

Topics of Psychology Research Related to Human Development

In this area, you might opt to focus on issues pertinent to  early childhood  such as language development, social learning, or childhood attachment or you might instead opt to concentrate on issues that affect older adults such as dementia or Alzheimer's disease.

Some other topics you might consider include:

• Language acquisition
• Media violence and children
• Learning disabilities
• Gender roles
• Child abuse
• Prenatal development
• Parenting styles
• Aspects of the aging process

Do a Critique of Publications Involving Psychology Research Topics

One option is to consider writing a critique paper of a published psychology book or academic journal article. For example, you might write a critical analysis of Sigmund Freud's Interpretation of Dreams or you might evaluate a more recent book such as Philip Zimbardo's  The Lucifer Effect: Understanding How Good People Turn Evil .

Professional and academic journals are also great places to find materials for a critique paper. Browse through the collection at your university library to find titles devoted to the subject that you are most interested in, then look through recent articles until you find one that grabs your attention.

Topics of Psychology Research Related to Famous Experiments

There have been many fascinating and groundbreaking experiments throughout the history of psychology, providing ample material for students looking for an interesting term paper topic. In your paper, you might choose to summarize the experiment, analyze the ethics of the research, or evaluate the implications of the study. Possible experiments that you might consider include:

• The Milgram Obedience Experiment
• The Stanford Prison Experiment
• The Little Albert Experiment
• Pavlov's Conditioning Experiments
• The Asch Conformity Experiment
• Harlow's Rhesus Monkey Experiments

Topics of Psychology Research About Historical Figures

One of the simplest ways to find a great topic is to choose an interesting person in the  history of psychology  and write a paper about them. Your paper might focus on many different elements of the individual's life, such as their biography, professional history, theories, or influence on psychology.

While this type of paper may be historical in nature, there is no need for this assignment to be dry or boring. Psychology is full of fascinating figures rife with intriguing stories and anecdotes. Consider such famous individuals as Sigmund Freud, B.F. Skinner, Harry Harlow, or one of the many other  eminent psychologists .

Psychology Research Topics About a Specific Career

​Another possible topic, depending on the course in which you are enrolled, is to write about specific career paths within the  field of psychology . This type of paper is especially appropriate if you are exploring different subtopics or considering which area interests you the most.

In your paper, you might opt to explore the typical duties of a psychologist, how much people working in these fields typically earn, and the different employment options that are available.

Topics of Psychology Research Involving Case Studies

One potentially interesting idea is to write a  psychology case study  of a particular individual or group of people. In this type of paper, you will provide an in-depth analysis of your subject, including a thorough biography.

Generally, you will also assess the person, often using a major psychological theory such as  Piaget's stages of cognitive development  or  Erikson's eight-stage theory of human development . It is also important to note that your paper doesn't necessarily have to be about someone you know personally.

In fact, many professors encourage students to write case studies on historical figures or fictional characters from books, television programs, or films.

Psychology Research Topics Involving Literature Reviews

Another possibility that would work well for a number of psychology courses is to do a literature review of a specific topic within psychology. A literature review involves finding a variety of sources on a particular subject, then summarizing and reporting on what these sources have to say about the topic.

Literature reviews are generally found in the  introduction  of journal articles and other  psychology papers , but this type of analysis also works well for a full-scale psychology term paper.

Topics of Psychology Research Based on Your Own Study or Experiment

Many psychology courses require students to design an actual psychological study or perform some type of experiment. In some cases, students simply devise the study and then imagine the possible results that might occur. In other situations, you may actually have the opportunity to collect data, analyze your findings, and write up your results.

Finding a topic for your study can be difficult, but there are plenty of great ways to come up with intriguing ideas. Start by considering your own interests as well as subjects you have studied in the past.

Online sources, newspaper articles, books , journal articles, and even your own class textbook are all great places to start searching for topics for your experiments and psychology term papers. Before you begin, learn more about  how to conduct a psychology experiment .

What This Means For You

After looking at this brief list of possible topics for psychology papers, it is easy to see that psychology is a very broad and diverse subject. While this variety makes it possible to find a topic that really catches your interest, it can sometimes make it very difficult for some students to select a good topic.

If you are still stumped by your assignment, ask your instructor for suggestions and consider a few from this list for inspiration.

• Hockenbury, SE & Nolan, SA. Psychology. New York: Worth Publishers; 2014.
• Santrock, JW. A Topical Approach to Lifespan Development. New York: McGraw-Hill Education; 2016.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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NPTEL Assignment Answers and Solutions 2024 (July-Dec). Get Answers of Week 1 2 3 4 5 6 7 8 8 10 11 12 for all courses. This guide offers clear and accurate answers for your all assignments across various NPTEL courses

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3 Ways War Affects Sleep Long Term

War ends, but the effects on sleep can linger for life..

Posted September 1, 2024 | Reviewed by Kaja Perina

• Why Is Sleep Important?
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• War has a negative and lasting impact on sleep.
• Sleep deprivation, trauma, environmental factors, and social factors can contribute to chronic suffering.
• Veterans, refugees, and even children born after a war experience disrupted sleep for years.

The right to live in peace is enshrined in the United Nations' 2016 Declaration on the Right to Peace . War and conflict affect people's lives in thousands of different ways, one of which is how we sleep. Even when war ends, the effects of that experience linger on in struggles to feel rested.

Here are three examples of how war creates chronic sleep difficulties for soldiers, victims of violence, and even the next generation of children.

1. Children Conceived After the War

Parents' war-related stress can lead to children's ongoing sleep challenges, even when those children are conceived after the war has stopped. In one study , children's sleep patterns were reported by the mothers and by the children themselves at various ages up to age 10.

These children were born in an Israeli hospital to some mothers who witnessed bombings directly and to some mothers who were not directly exposed. This war experience happened shortly before the child was conceived. The children in the study were conceived two to twelve months later.

For mothers who experienced high emotional distress during war in the months before conception, daughters' sleep was significantly affected up to age 10 (when the study ended). While boys showed no sleep disruption correlating with their mother's war distress, girls had disturbances in the areas of "night wakings, parasomnias, sleep-disordered breathing, sleep anxiety , and bedtime resistance." (The study does not mention nonbinary children.)

2. Refugees and New Social Conditions

When refugees struggle to get good sleep in their new country, the trauma of the war at home isn't the only reason. Around 6.5 million Ukrainians fled fled their country in the face of a Russian invasion. Researchers found that in some cases these refugees' subsequent sleep disruptions related to changes in diet and social rhythms (such as the timing of work).

While PTSD and other mental health struggles contribute to unsatisfying sleep , other factors can matter at least as much. Many Sudanese men who fled their country and found sanctuary in Australia suffered from insomnia , restless legs, daytime sleepiness and fatigue.Sudanese women refugees did not seem to have the same high levels of difficulties with sleep.

The men's sleep issues may not only relate to the trauma of war in their homeland, but also to low income and lack of employment opportunities in their new country.

3. Veterans and Chronic Fatigue

Soldiers rarely get enough sleep . In some cases, this sleep deprivation becomes chronic even after they've left the military. Nearly 1 in 3 US veterans who were deployed in the 1990-91 Gulf War returned with a complex condition known as Gulf War Illness.

Many people who fought in later wars, such as the American war in Iraq and Afghanistan, returned with similar symptoms, although there are some differences. The main symptoms are chronic fatigue and pain, as well as low mood and poor memory .

A study in California found that Gulf War veterans with poor sleep had a smaller brainstem than the control group. We still don't know the exact causes of Gulf War Illness, but some theories suggest it could be related to environmental conditions like dust exposure, burning oil wells, chemical weapons, and more, as well as psychological distress and PTSD .

Whatever the cause, these veterans continue to suffer from the effects of their war experience, decades later.

Marion Lougheed is an anthropologist, editor, and writer whose research focuses on the cultural dimensions of sleep. She is currently finishing up a Ph.D. in social anthropology at York University.

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Almost 3,000 prisoners waiting for psychology and addiction services 

The importance of addressing the drugs crisis in prisons around the country was brought into sharp focus last month when 11 suspected drug overdoses were rushed to hospital from Portlaoise Prison. Picture: Collins Photos

Almost 3,000 people in Irish prisons are on waiting lists to access psychology and addiction services.

The number of people waiting to for a psychology appointment is almost four times the number currently receiving mental health services in the prison system.

As of August 1, the number of people on the prison psychology service was 526 while approximately 2,090 are waiting to be seen.

According to the Irish Prison Service (IPS), the average wait time for a psychology service is 31.4 days.

In addition, the most recent figures from the Department of Justice shows that at the end of June, there were 888 prisoners waiting to access addiction counselling services.

The importance of addressing the drugs crisis in prisons around the country was brought into sharp focus last month when 11 suspected drug overdoses were rushed to hospital from Portlaoise Prison.

Earlier in the summer, prison numbers breached the 5,000 mark for the first time ever and the department estimates that up to 70% of the prisoner population have addiction issues.

It is simply not good enough that prisoners are not getting the supports that they need while in custody, Sinn Féin TD Mark Ward said.

There has been a problem with drugs in our prison for a long, long time now and if somebody is actively seeking help for their addiction they should be given that help at the earliest possible stage.

Mr Ward said it is "simply not good enough" to have a 12-week delay in accessing the necessary services.

With dangerous new drugs circulating in Irish prisons, mental health and addiction supports are more than just life-changing, they are life saving, the Dublin TD said.

Addiction therapy in prisons is provided through Merchant's Quay Ireland with 19 addiction counsellors currently working with recent recruitments set to increase this capacity.

There are approximately 350 prisoners under the care of psychiatric services who have a diagnosis such as schizophrenia and psychosis. A waiting list for those who are critically ill and require admission to the Central Mental Hospital for treatment varied between 15-25 people over the last three years with the list reviewed on a weekly basis.

Irish Penal Reform Trust (IPRT) executive director Saoirse Brady said the current situation in prisons is concerning as prison is inherently traumatic but is compounded when it is overcrowded.

Ms Brady said the IPS is failing to reach its own targets for the number of people who should be seen by a psychologist.

In 2022, the target was 2,000 prisoners but just 1,303 people were seen. Last year, the target was raised to 2,200 but the real figure fell short once again with 1,627 prisoners seen in 2023.

The IPRT will be asking for further investment in prison services in the upcoming budget to resource prison psychology service and addiction couselling.

"I would say they need to invest at least €1m in mental health and addiction services within prison to really address some of those basic needs that people have," said Ms Brady.

The IPS have put forward proposals for additional mental health support as part of the estimates process for Budget 2025, and these are being considered.

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• Published: 31 August 2024

The links between symptom burden, illness perception, psychological resilience, social support, coping modes, and cancer-related worry in Chinese early-stage lung cancer patients after surgery: a cross-sectional study

• Yingzi Yang   ORCID: orcid.org/0000-0003-4242-0444 1 , 2   na1 ,
• Xiaolan Qian 1   na1 ,
• Xuefeng Tang 1 ,
• Chen Shen 2 ,
• Yujing Zhou 3 ,
• Xiaoting Pan 2 &
• Yumei Li 4  

BMC Psychology volume  12 , Article number:  463 ( 2024 ) Cite this article

Metrics details

This study aims to investigate the links between the clinical, demographic, and psychosocial factors and cancer-related worry in patients with early-stage lung cancer after surgery.

The study utilized a descriptive cross-sectional design. Questionnaires, including assessments of cancer-related worry, symptom burden, illness perception, psychological resilience, coping modes, social support and participant characteristics, were distributed to 302 individuals in early-stage lung cancer patients after surgery. The data collection period spanned from January and October 2023. Analytical procedures encompassed descriptive statistics, independent Wilcoxon Rank Sum test, Kruskal-Wallis- H - test, Spearman correlation analysis, and hierarchical multiple regression.

After surgery, 89.07% had cancer-related worries, with a median (interquartile range, IQR) CRW score of 380.00 (130.00, 720.00). The most frequently cited concern was the cancer itself (80.46%), while sexual issues were the least worrisome (44.37%). Regression analyses controlling for demographic variables showed that higher levels of cancer-related worry (CRW) were associated with increased symptom burden, illness perceptions, and acceptance-rejection coping modes, whereas they had lower levels of psychological resilience, social support and confrontation coping modes, and were more willing to obtain information about the disease from the Internet or applications. Among these factors, the greatest explanatory power in the regression was observed for symptom burden, illness perceptions, social support, and sources of illness information (from the Internet or applications), which collectively explained 52.00% of the variance.

Conclusions

Healthcare providers should be aware that worry is a common issue for early stage lung cancer survivors with a favorable prognosis. During post-operative recovery, physicians should identify patient concerns and address unmet needs to improve patients’ emotional state and quality of life through psychological support and disease education.

Peer Review reports

Introduction

Lung cancer is a common malignant neoplasm that often causes considerable psychological distress to patients and their families [ 1 ]. Due to the increasing public awareness of health screening in recent years and the use and promotion of low-dose computed tomography (CT) screening for early screening and detection of lung cancer, the incidence of early-stage lung cancer has been increasing [ 2 ]. According to the clinical diagnostic criteria for lung cancer, early-stage non-small cell lung cancer refers to a tumor that is confined to the lung and has not metastasized to distant organs or lymph nodes, generally referring to stage I and II [ 3 , 4 ]. For individuals diagnosed with early-stage non-small cell lung cancer, radical surgical resection offers the most beneficial treatment option for extended survival [ 5 , 6 ]. It can be said that after diagnosis and active treatment of early-stage lung cancer patients, the recurrence rate 5 years after surgery is low. Although the survival rate after radical resection has improved, a decline in lung function is inevitable. According to studies [ 7 , 8 ], lung function experienced a steep decline at 1 month after lung resection, partially recovered at 3 months, and stabilized at 6 months after surgery. Patients who have undergone surgery for lung cancer often experience post-treatment symptoms, including pain, dyspnea, and fatigue, which negatively affect their quality of life [ 9 ]. A previous study conducted by our team [ 10 ] found that post-operative lung cancer patients had various unmet needs during their recovery, including physiological, safety, family and social support, and disease information. The psychological distress experienced by patients, including worry, anxiety, and fear, increases due to unmet needs after cancer treatments [ 11 , 12 ].

In recent years, there has been an increasing focus on Cancer-related worry (CRW) as a form of psychological distress experienced by cancer patients. CRW refers to the uncertainty of cancer patients’ future after cancer diagnosis. It encompasses areas of common concern to cancer patients, such as cancer itself, disability, family, work, economic status, loss of independence, physical pain, psychological pain, medical uncertainty, and death. The purpose of CRW is to reflect the unmet needs or concerns of cancer patients [ 13 , 14 , 15 ]. Unlike anxiety, worry primarily reflects the patient’s repetitive thoughts about the uncertainty of the future [ 13 ]. It is also a cognitive manifestation of the uncertainty of disease prognosis [ 16 ].

Currently, measurement scales such as the State Train Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS) are frequently used to evaluate physical symptoms caused by autonomic nervous activity in patients. However, they do not assess patients’ concerns or anxiety content [ 17 ]. Some scholars [ 13 , 17 , 18 ] have developed tools to measure the degree and content of cancer-related worries. The CRW questionnaire is a tool for measuring and evaluating the anxiety status of patients. It can also detect their needs or preferences through convenient means, allowing for the design of personalized care [ 13 ]. These questionnaires were primarily utilized to assess the level and nature of worry among cancer patients diagnosed with breast, prostate, skin, and adolescent cancers [ 19 , 20 , 21 , 22 ], However, it has not been employed in the post-operative population for early-stage lung cancer.

Theory framework

Mishel’s Uncertainty in Illness Theory [ 23 ] defines illness uncertainty as a cognitive state that arises when individuals lack sufficient information to effectively construct or categorize disease-related events. The theory explains how patients interpret the uncertainty of treatment processes and outcomes through a cognitive framework. It consists of three main components (see Fig.  1 ): (a) antecedents of uncertainty, (b) appraisal of uncertainty, and (c) coping with uncertainty. The antecedents of uncertainty include the stimulus frame (such as symptom burden), cognitive capacity (like disease perception), and structure providers (including social support and sources of disease information). Managing uncertainty requires coping modes such as emotional regulation and proactive problem-solving. Studies [ 24 ] have shown that there is a correlation between the way patients manage their emotions and the coping modes they experience when faced with difficulties. Patients with positive emotional coping modes are less likely to worry, while patients with avoidance coping modes are more likely to experience emotional distress. Furthermore, previous research [ 25 ] has shown a strong correlation between psychological resilience and cancer-related worries. Psychological resilience reflected an individual’s ability to adapt and cope with stress or adversity, and was an important indicator of a patient’s psychological traits [ 26 ]. Furthermore, it had a significant impact on their mental state and quality of life. Specifically, higher levels of cancer worries have been linked to lower levels of psychological resilience.

Based on the theoretical framework and literature research presented, it is hypothesized that factors such as psychological resilience, antecedents of disease uncertainty (symptom burden, disease perception, social support and sources of disease information), and coping modes will correlate with the level of cancer-related worries in postoperative patients with early-stage lung cancer. Therefore, the aim of this study was to investigate the potential correlates of cancer-related worry in early-stage lung cancer patients after surgery. This analysis will aid medical professionals in comprehending the worry state and unmet needs of early-stage lung cancer patients after surgery, and in tailoring rehabilitation programs and psychological interventions accordingly.

Mishel’s uncertainty in Illness theory framework

Study design

The study was cross-sectional in design. The Stimulating the Reporting of Observational Studies in Epidemiology (STROBE) checklist was completed (see S1 STROBE Checklist).

Setting and participants

This study included patients who underwent surgical treatment for lung cancer at a general hospital in Shanghai between January and October 2023. The study inclusion criteria were: (1) age over 18 years; (2) clinical diagnosis of early-stage primary non-small cell lung cancer (NSCLC), Tumor node metastasis classification (TNM) I to II [ 27 , 28 ], and received video-assisted thoracic surgery; (3) recovery time after surgery was within 1 month. Exclusion criteria were: (1) Postoperative radiotherapy and chemotherapy or second surgery may be required. (2) If other malignant tumors are present, they may also need to be treated. (3) Patients with severe psychological or mental disorders may not be candidates for this survey. (4) Patients with speech communication difficulties or hearing and visual impairments may require additional accommodations.

Sample size was calculated using G*Power software version 3.1.9 [ 29 ]. Calculate power analysis using F-test and linear multiple regression: fixed model, R2 increase as statistical test, and “A priori: Calculate required sample size - given alpha, power, and effect size” as type of power analysis. Cohen’s f2 = 0.15, medium effect size, α = 0.05, power (1-β) = 0.80, number of tested predictors = 8, total number of predictors = 10 as input parameters. The analysis showed that the minimum required sample size was 109 adults. Finally, the required sample size was determined to be over 120 adults with a probability of non-response rate of 10%.

Research team and data collection

The research team consisted of two nursing experts, four nursing researchers (one of whom had extensive experience in nursing psychology research), a group of clinical nurses, and several research assistants. To ensure the scientific quality and rigor of the research, the team was responsible for overseeing the quality of the project design and implementation process. Prior to conducting the formal survey, all research assistants received consistent training and evaluation to ensure consistent interpretation of questionnaire responses.

One month after surgery marks the first stage of the early recovery process for lung cancer patients and is a critical period for psychological adjustment [ 30 ]. Understanding a patient’s psychological state is critical to providing excellent medical care. During this period, patients typically need to visit the outpatient clinic for wound suture removal and dressing changes, further emphasizing the importance of postoperative recovery. Therefore, we chose this time frame for our research to gain a more comprehensive understanding of patients’ psychological well-being.

Prior to the start of the study, the hospital management and department head worked with us to provide comprehensive and standardized training to all participating investigators to ensure the reliability and consistency of the study. Research assistants rigorously screened patients based on predefined inclusion and exclusion criteria, which were designed to ensure a representative sample of lung cancer patients in the early recovery phase.

To obtain informed consent, patients were provided with detailed information and explanations and asked to complete the questionnaire voluntarily. To accommodate the different needs and preferences of patients, we used a combination of electronic and paper questionnaires. The electronic questionnaires were administered via the Questionnaire Star platform ( https://www.wjx.cn/ ), allowing patients to scan a two-dimensional (QR) code to access the survey. For those who preferred paper questionnaires, research assistants provided physical copies and assisted with completion as needed. The questionnaire was designed with consistent instructions to ensure that patients had a full understanding of the questions. Upon completion, each questionnaire was carefully reviewed and checked for accuracy. In addition, to reduce attrition, we obtained patients’ consent to keep their contact information, which allowed us to communicate with them further and collect additional data.

Ethical considerations

The study was approved by the hospital ethics committee. All participants gave informed consent prior to enrollment.

Sociodemographic questionnaire

We developed a sociodemographic survey based on a literature review and expert consultation. The survey includes patient demographic data such as age, sex, residence, lifestyle, education, marital status, childbearing history, religion, insurance, economic status (annual household income), smoking habits, employment status, sources of disease information, and previous psychological counseling. Clinical case information includes physical comorbidity, clinical tumor stage, and cancer type.

Cancer-related worry

The study measured participants’ cancer-related worry using the Brief Cancer-related Worry Inventory (BCWI), which was originally designed by Hirai et al. [ 13 ] to evaluate distinct concerns and anxiety levels among individuals with cancer. For this research, we used the 2019 Chinese edition of the BCWI, as introduced and updated by He et al. [ 31 ] (see Supplementary Table 2 ). The BCWI was comprised of 16 items, which were divided into three domains: (1) future prospects, (2) physical and symptomatic problems, and (3) social and interpersonal problems. Participants were asked to assess their cancer-related worries on a scale ranging from 0 to 100. Worry severity was determined by summing the scores for each item. The higher the total score, the more intense the patient’s cancer-related worry. The BCWI provided a concise evaluation of cancer-related worries in cancer patients. With only 16 items, it was able to differentiate them from symptoms of anxiety, depression, and post-traumatic stress disorder. In this study, the Cronbach’s alpha coefficient for this scale was 0.96.

Symptom burden

The M.D. Anderson Symptom Assessment Scale [ 32 ] was a widely used tool for evaluating symptom burden in cancer patients. The Chinese version of MDASI-C was translated and modified by researchers at the M.D. Anderson Cancer Center. The questionnaire included 13 multidimensional symptom items, such as pain, fatigue, nausea, restless sleep, distress, and shortness of breath, forgetfulness, loss of appetite, lethargy, dry mouth, sadness, vomiting, and numbness. Six additional items were used to evaluate the impact of these symptoms on work, mood, walking, relationships, and daily enjoyment. Patients rated the severity of their symptoms over the past 24 h on a scale of 0 (absent) to 10 (most severe), providing a comprehensive assessment of symptom burden across multiple dimensions. The Cronbach’s alpha coefficient for this study was 0.95.

Illness perception

The Brief Illness Perception Questionnaire (BIPQ) was used to measure participants’ illness perception. The scale, developed by Broadbent [ 33 ], was later revised by Mei [ 34 ] to include a Chinese version. It consisted of eight items divided into cognition, emotion, and comprehension domains as well as one open-ended question (What are the three most important factors in the development of lung cancer, in order of importance? ). The study utilized a 10-point Likert scale to rank items one through eight, with a range of 0–80 points. The ninth item required an open response. A higher total score indicated a greater tendency for individuals to experience negative perceptions and perceive symptoms of illness as more severe. In this study, the Cronbach’s alpha coefficient for this scale of eight scoring items was found to be 0.73.

Psychological resilience

The study measured participants’ psychological resilience using the 10-item Connor Davidson Resilience Scale (CD-RISC-10), originally developed by Connor and Davidson [ 35 ], and later revised by Campbell based on CD-RISC-25. The scale was designed to assess an individual’s level of emotional resilience in a passionate environment. It comprised 10 items, rated on a 5-point Likert scale (0 = never, 1 = rarely, 2 = sometimes, 3 = often, 4 = always). The total score ranged from 0 to 40 points, with higher scores indicating greater resilience. The study utilized the Chinese version of CD-RISC10, which was translated and revised by Ye et al. [ 36 ], to measure psychological resilience. The Cronbach’s alpha coefficient of the scale in this study was 0.96.

Coping modes

The study measured participants’ coping modes using the Medical Coping Modes Questionnaire (MCMQ), a specialized tool for measuring patient coping modes. The MCMQ was first designed by Feifel in 1987 [ 37 ] and was translated and revised into Chinese by Shen S and Jiang Q in 2000 [ 38 ]. It consisted of 20 items and three dimensions: confrontation (eight items), avoidance (seven items), and acceptance-resignation (five items). The study utilized a 4-point scoring system to evaluate coping events, with scores ranging from 1 to 4 based on the strength of each event. Eight items (1, 4, 9, 10, 12, 13, 18, and 19) were negatively scored, resulting in a total score range of 20 to 80 points. A higher score indicated a more frequent use of this coping mode. The three dimensions of this scale can be split into three scales for separate use. The reliability coefficients of the Confrontation Coping Mode Scale, Avoidance Coping Mode Scale, and Acceptance-resignation Coping Mode Scale were 0.69, 0.60, and 0.76.

Social Support

The study used the Perceived Social Support Scale (PSSS) developed by Zimet [ 39 ] to assess the level of self-understanding and perceived social support in postoperative lung cancer patients. The Chinese version of the PSSS, as adapted by Chou [ 40 ], showed satisfactory reliability and validity. The 12-item scale comprised of three dimensions: family, friend, and other support, and was rated using a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree). The scale’s total score ranged from 12 to 84, with a higher score indicating a greater subjective sense of social support received by individuals. The Cronbach’s alpha coefficient for this scale in this study was 0.94.

Statistical analyses

The questionnaire was validated and double-checked before being input into Excel to ensure accuracy. Statistical analysis and processing of the questionnaire data were conducted using Statistical Product and Service Solutions (SPSS) 26.0 software. All statistical tests were two-sided with a significance level of α = 0.05. The quantitative data were presented using means and standard deviations, while the qualitative data were represented by frequency distributions. The data that conforms to normal distribution was analyzed using independent sample t-test for comparison between two groups and one-way ANOVA analysis for comparison between multiple groups. Non-normal distribution data were analyzed using non-parametric Wilcoxon rank sum test for comparison between two groups and Kruskal-Wallis - H -Test for comparison between multiple groups. Additionally, Spearman correlation analysis was used to study the correlations among CRW, MDASI-C, BIPQ, CD-RISC-10, MCMQ, and PSSS. A hierarchical linear regression analysis was performed to identify the multidimensional factors affecting CRW. All variables significantly correlated with the outcome variable ( p  < 0.05) were included in the corresponding hierarchical regression analysis. Using Mishel’s Uncertainty in Illness Theory as a framework, a four-step model was adopted to study the factors influencing cancer-related concerns. The model includes individual factors such as sociodemographic and disease-related data, as well as psychological resilience, stimulus frame (symptom burden, illness perception, social support, and sources of disease information), and coping modes.

In this study, 307 questionnaires were distributed (227 electronic, 80 paper). Five paper questionnaires were invalid, resulting in 302 valid questionnaires and a recovery rate of 98.37%. The participants were 302 postoperative lung cancer patients, with 36.75% male and 63.25% female, aged 18–83 years (mean age 52.73, SD 13.07). Most patients (90.07%) were married. Additional demographic and clinical information is in Table  1 .

89.07% of people had cancer-related worries after surgery and median (interquartile range, IQR) score for CRW was 380.00 (130.00, 720.00) with a range of 0-1600. 86.42% reported worry about future prospects, 84.11% worry about physical and symptomatic problems, 79.80% worry about social and interpersonal problems. Among the 16 worry items of BCWI, the highest frequency of patient worries was “About cancer itself” (80.46%), followed by “About whether cancer might get worse in the future” (79.14%); the lowest frequency concern was “about sexual issues” (44.37%). According to the average score of the items in the three dimensions of CRW, it could be seen that patients had the highest standardized score (standardized score = median score/the total score of the dimension*100%) in future prospects (30.00%), the second standardized score in physical and symptomatic problems (20.00%), and the lowest in social and interpersonal problems (15.00%) as it is shown in Table  2 .

On the total score of the CRW scale, patients’ cancer-related worry was significantly correlated with their gender ( p  = 0.009) and annual family income ( p  = 0.018; see Table  1 ). The results suggested that gender and annual family income were related to the level of concern patients had after developing cancer. Additionally, there was a correlation between patients who received information about their disease from the internet or applications and their level of CRW ( p  = 0.024; see Table  1 ).

The correlation analysis between various scales revealed a significant correlation ( p  < 0.05; see Table 3 ) between CRW and MDASI-C, BIPQ, CD-RISC-10, and two dimensions of MCMQ (excluding avoidance). It was worth noting that avoidance coping modes did not show a correlation with CRW. In addition, according to the summary of the ninth open-ended question on the BIPQ, patients believed that the main causes of lung cancer were genetics, fatigue, stress from work, family or life, negative emotions (anger, worry) and unhealthy lifestyle (diet, work and rest, smoking), environmental factors (poor air quality, secondhand smoke, cooking fumes), and new coronavirus pneumonia (including vaccination, new coronavirus infection), etc. Further stratified linear regression analysis was conducted to determine the correlation between the dependent and independent variables (Table  4 ).

Table  4 presented the results of the hierarchical linear regression analysis for CRW in early-stage lung cancer patients. First, all scales included in the hierarchical regression analysis were tested for collinearity (variance inflation factor, VIF). The average VIF value was slightly above 1, indicating that the results were acceptable [ 41 ]. Second, the core research variables were divided into four levels according to the theoretical research, and the variables included in each level were analyzed separately. Model 1 included personal characteristics as independent variables and explained 5% of the variance in CRW. The analysis identified only two variables associated with CRW: being female (compared to male) and having low income (compared to high income). In model 2, psychological resilience was identified as an individual psychological characteristic and placed in the second level, resulting in a 9% increase in explanatory power. Model 3 added the antecedents of uncertainty, including symptom burden, illness perception, social support, and source of disease information, at the third level. This significantly increased the explanatory power of the overall regression model by 53%. The addition of coping modes, specifically confrontation coping mode and acceptance-resignation coping mode, to model 4 only increased the explanatory power of the overall regression model by 1%. The overall model demonstrated a total explanatory power of 68%. In Model 4, factors that significantly correlated with CRW included middle income( β  = 2.17), psychological resilience( β =-2.42), symptom burden( β  = 12.62), illness perception( β  = 9.17), social support( β =-3.27), and source of disease( β  = 2.01), as well as confrontation coping mode ( β =-1.98) and acceptance-resignation coping mode( β  = 2.77), see Table  4 .

This study analyzed data from 302 patients to investigate the clinical, demographic, and psychosocial factors that correlated with cancer-related worry in patients with early-stage lung cancer after surgery. The study extended our understanding of the specific content and relevant factors of psychological distress in post-operative patients with early-stage lung cancer, a relationship that had not been fully investigated.

The study revealed that Chinese patients with early stage lung cancer were primarily concerned about their future prospects related to the disease itself, while sexual life problems caused by cancer were of least concern. This finding was consistent with previous studies [ 42 ], but this study provided more specific information on patients’ cancer-related worries. Lung cancer was widely perceived as a serious illness by the public due to its high cancer-specific mortality rate and low survival rate after diagnosis [ 43 ]. Consequently, patients with lung cancer often experience significant psychological distress after diagnosis. Even if the tumor was successfully removed, patients might still face challenges during recovery [ 44 ]. According to Reese’s research [ 45 ], long-term survivors of lung cancer experienced mild sexual distress. They also noted that sexual distress was significantly associated with physical and emotional symptoms. Although this study found that patients were least concerned about sexual distress, it should be noted that this study was based on the early stages of recovery after cancer surgery. Due to the postoperative repair of their body and emotions, patients were primarily focused on meeting their physiological and safety needs [ 10 ]. Further validation and exploration are required as there are limited studies on sexual distress in post-operative patients with early-stage lung cancer.

This study found that gender and annual family income were associated with the CRW of early-stage lung cancer patients. Among them, women and patients from low-income families had higher CRW scores, which was similar to the results of CRW in other cancer studies [ 14 , 46 ]. The reason might be that women were more conscious about uncomfortable symptoms than men, and women were more concerned about the duration of the disease and subsequent treatment effects than men [ 47 ]. Moreover, lower annual family income might cause patients to face more financial pressure in terms of medical expenses and treatment, thereby increasing their concerns about the consequences of the disease [ 48 ]. In addition, several other studies have found that education level, smoking status, and tumor stage had an impact on cancer-related worry scores [ 14 , 47 ], but this study did not show statistical significance.

After controlling for demographic covariate factors, the study found a significant negative relationship between psychological resilience and CRW. In a study conducted by Chen et al. [ 49 ], lower levels of psychological resilience were observed in post-operative lung cancer patients, which had a direct impact on their emotional state. In the context of treatment and recovery after lung cancer surgery, medical professionals should prioritize enhancing patients’ psychological resilience. This could be achieved through psychological support and appropriate interventions to improve emotional health and quality of life.

The antecedents in the illness uncertainty theoretical framework, such as symptom burden, illness perception, social support, and sources of disease information, were shown to be significantly associated with patients’ cancer worries in this study. The theory of uncertainty in illness [ 50 ] posited that uncertainty was caused by stimulus frames, cognitive abilities, and structural providers. In this study, these antecedents corresponded to symptom burden, illness perception, social support, and sources of disease information, and they correlated with patient worry related to cancer. Patients with a high symptom burden, high illness perception, low social support, and excessive attention to disease information on the Internet were more likely to have high cancer-related concerns. Previous studies [ 40 , 51 ] have verified the relationship between symptom burden, illness perception, and social support with psychological distress in lung cancer patients. However, there have been few studies on this patient group after surgery for early-stage lung cancer, particularly based on the uncertainty theoretical framework. Additionally, when analyzing the antecedents of structured providers, we included the sources from which patients receive information about their disease, particularly statistics from medical staff and online platforms. Our study found that patients who frequently accessed disease information on the internet had higher cancer-related worry scores. This was consistent with previous qualitative studies [ 10 ] which had shown that patients often turn to the internet for disease-related knowledge due to a perceived lack of effective information from medical staff.

This study also explored the association of CRW with coping modes. According to the theoretical framework of uncertainty in illness, coping modes are key for managing uncertainty, as uncertainty influences patients’ coping methods. Previous research [ 51 ] has shown that different coping modes can affect patients’ emotional states. Because this study focused primarily on the factors correlated with CRW, we included coping modes as independent variables in the linear regression analysis. The results indicated that CRW was negatively correlated with the coping mode of confrontation and positively correlated with the coping mode of acceptance-resignation. Acceptance-resignation, a negative coping mode, has been shown [ 52 ] to be associated with patients’ fear of disease progression and negative attitudes toward the disease, which decreases their confidence in treatment. Poręba-Chabros et al. [ 53 ] found that negative coping patterns were significantly associated with depression. When patients adopt an acceptance-resignation coping mode, their compliance behaviors decrease as they succumb to the disease. Conversely, confrontation, a positive coping mode, can enhance patients’ psychosocial adaptability, buffer psychological distress, and improve quality of life [ 52 ]. Interestingly, avoidance coping modes did not show a correlation with CRW in the postoperative population of early stage lung cancer, which is inconsistent with previous studies [ 54 ]. This lack of correlation may be due to several factors. The focus of our study on the first month after surgery may mean that patients are more focused on immediate physical recovery rather than engaging in avoidance behaviors. The nature of avoidance coping may temporarily alleviate worry without addressing underlying concerns, resulting in no measurable effect on CRW. Sample characteristics, measurement limitations, and individual differences in coping modes may also contribute to bias. In addition, strong psychological resilience, robust support systems, positive surgical outcomes, and increased health education may make avoidance modes less relevant or impactful on CRW in this population. Although the two coping modes were found to be associated with cancer-related worry in our study, hierarchical regression analysis showed that their influence on patients’ worry was small. Future research should explore the mechanisms of cancer-related worry and coping modes based on the theoretical framework of illness uncertainty. Given the association between cancer-related worry and coping modes, psychological intervention for patients should be emphasized in clinical practice. Healthcare professionals should conduct comprehensive psychological assessments and provide effective emotional support and education to help cancer patients develop more effective coping modes and reduce worry caused by uncertainty.

Strengths and limitations

This study presented evidence for CRW and the influencing factors that postoperative patients with early-stage lung cancer face. Based on the results, healthcare providers could identify the specific unmet needs of these patients more precisely and develop effective intervention strategies to improve their emotional state and quality of life. While the existing literature has extensively discussed psychological symptoms such as anxiety, depression, and fear in patients with mid-to-late stage lung cancer, relatively little research has been conducted on the mental health of postoperative patients with early-stage lung cancer, who are an important group of long-term lung cancer survivors [ 55 ]. As the number of patients diagnosed with early-stage lung cancer increases, so does concern about their mental health and unmet needs [ 56 , 57 ].

Nonetheless, this study also has some limitations. First, the single-center cross-sectional design and relatively small sample size may limit the generalizability of the findings to the broader population of early-stage lung cancer patients.

Second, while the study adopted a theoretical framework, it primarily conducted basic factor analysis without delving into the interaction mechanisms between the identified factors. This limitation restricts our understanding of how these factors interplay to influence cancer-related worry (CRW) in postoperative patients. In addition, while the CRW variable is largely operationalized in a similar way to the BIPQ and psychological resilience, we found no high correlation between these scales, as indicated by the Variance Inflation Factor (VIF). This means that multicollinearity, or the overlap between the variables, is not an issue in our study. However, we recognize that the scales we used may have limitations and might not fully capture the specific experiences of our sample. Therefore, future research should use different methods to measure CRW and related factors to better understand their individual effects on cancer-related worry.

Third, CRW is a dynamic process [ 20 ], and this study only focused on the patients’ situation within one month after surgery. This snapshot approach may not reflect the evolving nature of CRW over time. Longitudinal studies are needed to provide a more comprehensive understanding of how CRW and its influencing factors change throughout the postoperative recovery period.

These limitations suggest that future research should adopt a longitudinal design to analyze and verify the identified factors over an extended period. Additionally, expanding the study to include multiple centers and larger, more diverse sample sizes would enhance the generalizability of the findings. Exploring the interaction mechanisms between factors using advanced analytical methods could provide deeper insights into the complexities of CRW. By addressing these limitations, future research can build on our findings to offer more robust and generalizable evidence on the psychological distress experienced by postoperative early-stage lung cancer.

Implications for practice

The results of the study indicated that early-stage lung cancer patients in China had significant concerns about their future prospects, particularly regarding the disease itself, with less attention paid to the impact of cancer on sexual life. To facilitate postoperative recovery effectively, healthcare providers must promptly identify and address these specific concerns by incorporating routine psychological assessments and developing tailored intervention strategies, such as cognitive-behavioral therapy and resilience training, to improve patients’ mental health and overall well-being.

Moreover, this study identified psychological resilience, symptom burden, illness perception, social support, sources of disease information (from the Internet or applications), and coping modes of confrontation and acceptance-resignation as key predictors of cancer-related worry in postoperative early-stage lung cancer patients. Managing patients’ postoperative emotional states and enhancing their quality of life requires a deep understanding and proactive intervention by healthcare professionals. Specific strategies include providing psychological assessments, developing individualized care plans, facilitating support groups, and utilizing technology for continuous support.

The study provided insight into cancer-related worry among Chinese patients after surgery for early-stage lung cancer. The results showed that patients were most concerned about their future prospects, particularly the disease itself, while relatively little attention was paid to their sexual distress. The study identified several key factors that correlated with cancer-related worry, including psychological resilience, symptom burden, illness perception, social support, and sources of disease information from the internet, as well as coping modes. These findings emphasized the significance of healthcare providers identifying and addressing the individual needs of patients during post-operative recovery. It is important to improve the emotional state and quality of life of patients through psychological support and disease education. This study provides guidance for post-operative care of patients with early stage lung cancer and suggests avenues for future research. Specifically, further exploration of the mechanisms of these relationships and development of effective interventions are needed.

Data availability

The data that supported the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

The authors would like to thank the nurses (Especially Gu Jingzhi and Liu Jing) and doctors at Shanghai Pulmonary Hospital for facilitating this study and all the patients who kindly participated in the survey.

Scientific clinical research project of Tongji University, JS2210319; Key disciplines of Shanghai’s Three-Year Action Plan to Strengthen Public Health System Construction (2023–2025), GWVI-11.1-28; The National Key Research and Development Plan Project of China, 2022YFC3600903.

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Yingzi Yang and Xiaolan Qian share first authorship.

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Department of Health Care, Shanghai Health and Medical Center, No. 67, Dajishan, Wuxi City, Jiangsu Province, 214063, People’s Republic of China

Yingzi Yang, Xiaolan Qian & Xuefeng Tang

School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, People’s Republic of China

Yingzi Yang, Chen Shen & Xiaoting Pan

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, No.507, Zhengmin Road, Shanghai, 200433, People’s Republic of China

Yujing Zhou

Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, No.507, Zhengmin Road, Shanghai, 200433, People’s Republic of China

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Y.Y. and Y. L designed the study. Y.Y., Y.Z., C.S and X.P. ran the study and collected the data. Y.Y., X.Q., X.T. and C.S. analyzed the data; Y.Y., and X. Q. interpreted the results and drafted the paper. Y.Y. wrote the main manuscript text and X.Q. prepared Tables  1 , 2 , 3 and 4 . Y.Y., X.T. and Y.L revised the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Xuefeng Tang or Yumei Li .

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Yang, Y., Qian, X., Tang, X. et al. The links between symptom burden, illness perception, psychological resilience, social support, coping modes, and cancer-related worry in Chinese early-stage lung cancer patients after surgery: a cross-sectional study. BMC Psychol 12 , 463 (2024). https://doi.org/10.1186/s40359-024-01946-9

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ORIGINAL RESEARCH article

The influence of cardiac synchronisation on self-attribution to external objects in male participants.

• Department of Informatics, Nagoya University, Nagoya, Japan

Interoception, the representation of our bodily state derived from physiological signals, is fundamental to our sense of self. Previous studies using cardiac feedback paradigms demonstrated interoceptive effects on self-perception. However, it remains unclear whether interoceptive information can extend self-attribution to non-bodily objects. This study aimed to elucidate whether cardiac signals can induce self-attribution to non-bodily objects and how interoceptive accuracy modulates this effect. A total of 44 male volunteers participated in an emotion assignment task where they viewed images of palms (bodily targets) and spheres (non-bodily targets) flashing in or out of sync with their heartbeat and assigned emotional images (positive/negative) to these targets. A heartbeat discrimination task was used to measure the interoceptive accuracy. The results showed no significant effect of synchronisation on emotion assignment for either the target type or the valence of the emotional images. However, participants with high interoceptive accuracy attributed both positive and negative images more to synchronised targets than those with low interoceptive accuracy. These findings suggest that although cardiac synchronisation may not uniformly facilitate the self-attribution of external objects, interoceptive accuracy may mediate attention to synchrony. Future studies should explore the conditions under which cardiac signals influence self-attribution.

1 Introduction

Interoception refers to the representation of the internal world, encompassing the mechanisms through which an organism detects, interprets, integrates, and regulates internal signals derived from physiological processes ( Chen et al., 2021 ). Although we may not be consciously aware of it, interoception significantly influences various aspects of our lives such as emotions and cognition ( Critchley and Garfinkel, 2017 , 2018 ). Furthermore, interoception dysfunction is recognised as a factor in psychiatric disorders ( Khalsa et al., 2018 ), thus highlighting the importance of understanding interoception to improve quality of life.

Interoception is considered a critical factor in the development of the sense of self ( Seth, 2013 ; Tsakiris, 2017 ). Here, we generalise the sense of self as a process of self-other attribution. Humans distinguish between sensory information related and unrelated to themselves, attributing bodies, actions, and objects to either themselves or others. As interoception involves information derived from one’s own body, interoceptive signals can facilitate self-attribution ( Palmer and Tsakiris, 2018 ). The theoretical model of the sense of self proposes multisensory integration between exteroception (e.g., vision and touch) and interoception ( Tsakiris, 2017 ; Park and Blanke, 2019 ). Empirical evidence supports this hypothesis: individuals with high interoceptive accuracy are less likely to perceive a rubber hand with synchronised touch as their own hand ( Tsakiris et al., 2011 ). Additionally, heartbeat-evoked potentials in the electroencephalogram (EEG) representing central cardiac processing co-vary with the bodily self ( Park et al., 2016 ). These studies suggest that interoception plays a crucial role in attributing our body to ourselves.

Further evidence for the relationship between interoception and the sense of self has been obtained using the cardiac feedback paradigm. Cardiac feedback involves synchronising or asynchronising participants’ real-time heartbeats with stimuli, such as changing the colour and size of these stimuli. Such stimuli can affect perception. For instance, asynchronous stimuli elicit longer looking times in infants ( Maister et al., 2017 ; Imafuku et al., 2023 ) and monkeys ( Charbonneau et al., 2022 ), while older infants and adults exhibit longer looking times for synchronous stimuli ( Imafuku et al., 2023 ; Tünte et al., 2023 ). The perception of changing flashes in response to a neutral stimulus differs depending on the synchrony of the flash with the heartbeat ( Azevedo et al., 2016 ). Some studies have illustrated the interoceptive role for sense of ownership ( Aspell et al., 2013 ; Suzuki et al., 2013 ; Heydrich et al., 2018 , 2020 ). Suzuki et al. (2013) applied cardiac feedback to the rubber hand illusion and demonstrated that ownership of the rubber hand was induced when it flashed synchronously with the participants’ heartbeats. The same paradigm was used for the full-body illusion in which participants attributed a virtual body that visualised their heartbeat to themselves ( Aspell et al., 2013 ). Another study found that individuals were more likely to identify morphed faces of themselves and others as their own when the face flashed synchronously with their heartbeat ( Sel et al., 2017 ). Heartbeat-synchronised facial stimuli also affect reaction times for self-recognition ( Ambrosini et al., 2019 ). These results suggest that heartbeat-synchronised signals facilitate self-attribution to both body and facial stimuli. However, it remains unclear whether the synchronisation of stimuli also elicits self-attribution in non-bodily stimuli, such as geometric objects. Thus, investigating body-specificity is essential to understanding the processes underlying the interoceptive role in self-attribution.

We can attribute the self to non-bodily objects. For example, in tool embodiment, we perceive non-bodily objects as part of ourselves through sensorimotor learning ( Maravita and Iriki, 2004 ). In daily life, we distinguish whether an external object belongs to us based on sensory or cognitive factors. Sensory factors include the controllability of an object or multisensory contingencies, while cognitive factors involve narrative memory. However, it remains unknown whether cardiac feedback influences the self-attribution of an object. Self-attribution to the body and to objects might involve different processes. For instance, the rubber hand illusion becomes weak or absent when the fake hand is unlike a real hand ( Tsakiris and Haggard, 2005 ; Haans et al., 2008 ). Conversely, some studies imply that the interoceptive effect on self-attribution may involve less body-specificity in visual-respiration and cardiac synchrony ( Aspell et al., 2013 ; Adler et al., 2014 ). However, the reduced body-specificity observed in a previous visual cardiac synchrony study ( Aspell et al., 2013 ) was not directly linked to self-attribution but rather to the localization of tactile stimuli. Therefore, it is necessary to clarify whether cardiac feedback influences the self-attribution to an object. Additionally, as responses to direct questions may include demand characteristics ( Lush, 2020 ), it is necessary to develop a new method for implicitly assessing participants’ sense of self regarding objects.

This study investigated whether cardiac signals can induce self-attribution to bodily and non-bodily targets. To measure the implicit sense of self towards targets, we developed a new experimental task called the emotion assignment task. In this task, participants viewed target images of a palm (i.e., a bodily target) or sphere (i.e., a non-bodily target) on a screen that flashed in or out of sync with their heartbeat and assigned emotional images (i.e., positive and negative) to the targets. According to approach-avoidance theory, humans tend to approach positive things and avoid negative things ( Elliot and Covington, 2001 ; Eerland et al., 2012 ; Saraiva et al., 2013 ). For example, Saraiva et al. (2013) demonstrated that reaction times were generally faster when approaching positive stimuli and avoiding negative stimuli in tasks involving self-relevant mannequins. Therefore, we hypothesised that participants would unconsciously assign positive and negative images to targets attributed to and not attributed to themselves, respectively. Two hypotheses were considered: first, that self-attribution would be induced, even for non-bodily targets, and second, that cardiac signals would only affect bodily targets. Additionally, we investigated whether these results were influenced by interoceptive accuracy, as measured by a modified heartbeat discrimination task ( Whitehead et al., 1977 ). Based on a previous study ( Suzuki et al., 2013 ), we predicted that participants with high interoceptive accuracy would promote self-attribution of synchronised stimuli.

2 Materials and methods

2.1 participants.

The participants were 44 healthy male students ( M  = 21.24 years, SD  = 2.45) attending Nagoya University in Japan. The sample size was determined based on an a priori power analysis. A medium effect size ( f  = 0.2) was assumed, with an alpha level of 0.05 and a desired power of 0.80. The analysis indicated that a minimum of 40 participants would be required to detect a statistically significant effect. To account for potential dropouts, we recruited 44 participants. All participants were right-handed, except for two. Owing to gender differences in interoceptive accuracy ( Prentice and Murphy, 2022 ) and brain responses to emotional stimuli ( Wrase et al., 2003 ), only male participants were recruited. Data from three participants were excluded due to recording errors in the physiological or behavioural data, leaving data from 41 male participants for the analysis. This study was approved by the Department of Psychology Ethics Committee of Nagoya University (No. NUPSY-221003-G-01). All participants provided written informed consent before the experiment. Participants were compensated for their participation.

2.2 Stimuli

A palm image was used as a bodily target, and a sphere image was used as a non-bodily target ( Figure 1 ). Target images were obtained from free 3D object online sources. 1

Figure 1 . Procedures of the emotion assignment task. Participants looked at two targets [ (A) Palm (B) Sphere], which were either in sync or out of sync with their heartbeat. After 18–22 s, an emotional image appeared at the centre, and participants assigned it to one of the targets.

For the positive and negative emotional stimuli, 50 images of mammals and 50 of insects were collected from online sources. 2 , 3 After aligning the illuminance of all images, 20 images of mammals and 20 of insects were selected for the current experiment based on the subjective ratings of 31 other participants in an independent evaluation experiment. Ratings were collected using an analogue scale ranging from very negative to very positive for valence ratings and from low to high arousal for arousal ratings. We selected 20 images of mammals and 20 of insects to equalise the arousal ratings. The valence ratings for images of mammals were significantly higher than those for insect images. Left–right reversed versions of the 40 images were created to counteract any left–right bias as participants positioned the images to the left or right during the task. Therefore, a total of 80 images (40 normal and 40 reversed) were used in the task.

2.3.1 Heartbeat synchronisation

During the self-attribution and heartbeat discrimination tasks, electrocardiogram (ECG) data were collected for real-time cardiac feedback. The ECG data were recorded using an MP160 system with an ECG100C amplifier (Biopac) and AcqKnowlege-NDT software. The luminance of the target stimuli (i.e., palm and sphere) on the screen gradually increased up to +40% from R-wave to R-wave +250 ms and decreased from R-wave +250 ms to R-wave +500 ms. In the synchronous condition, the participant’s real-time heartbeat was used, whereas in the asynchronous condition, the participant’s heartbeat from 60 s earlier was used. In the asynchronous condition, we did not change the heart rate to avoid differences in total luminance between the conditions.

2.3.2 Emotion assignment task

Participants were presented with the two target images (i.e., two palms or two spheres) on the left and right sides of the screen ( Figure 1 ). The screen was positioned 57 cm away from the participants, and the targets were within a 15° view angle. The luminance of one of the two images changed synchronously with the participant’s heartbeat, whereas that of the other changed asynchronously. After 18–22 s, an emotional image appeared at the centre of the screen. The duration was determined on the basis of a previous study that showed that ownership is established in approximately 20 s ( Finotti et al., 2023 ). Participants were instructed to intuitively assign the emotional image to either the left or right target within 1.5 s. Participants used their right index and middle fingers to respond. They were not informed whether the luminance changes of the target stimuli were synchronous or asynchronous with their heartbeat. The experiment consisted of 80 trials, with the target stimuli being palms in half of the trials and spheres in the other half. This task was conducted using a block design, with palm or sphere stimuli presented consecutively in the first half, followed by the other stimulus type in the second half. The order of the stimuli was counterbalanced across participants. Participants were allowed to take a break every 20 trials.

2.3.3 Heartbeat discrimination task

To determine whether participants could explicitly discriminate between targets flashing in sync and not in sync with their heartbeat and to calculate interoceptive accuracy, a heartbeat discrimination task was conducted after the emotion assignment task. Participants were presented with two flashing stimuli for 18–22 s, one of which was synchronised with their heartbeat and one was not. As in the attribution task, the synchronous stimuli were set to the real-time participant’s heartbeat, while the asynchronous stimuli were set to the participant’s heartbeat from 60 s prior. Subsequently, they were asked to judge which stimulus was synchronised with their heartbeat. The task consisted of 40 trials, with 20 involving spheres and 20 involving palms. This task was conducted using a block design, with palm or sphere stimuli presented consecutively in the first half, followed by the other stimulus type in the second half. The order of the stimuli was counterbalanced across the participants. No feedback was provided to participants regarding their performance.

2.4 Procedure

Prior to the experiment, participants rated 40 emotional images using a visual analogue scale to measure their subjective arousal and valence online. The valence rating ranged from 1 (very negative) to 7 (very positive), and the arousal rating ranged from 1 (very low) to 7 (very high). After completing the practice trials, participants performed an emotion assignment task. They were then informed that the stimuli were either synchronous or asynchronous with their heartbeats and completed the heartbeat discrimination task. Finally, participants were informed of the study’s aim and asked to answer some questions. The entire procedure took approximately 90 min.

2.5 Data analysis

We calculated the correct rate of the heartbeat discrimination task to determine the interoceptive accuracy. As the correct rates for the heartbeat discrimination task were not normally distributed, Wilcoxon signed rank tests were applied. Participants were divided into high and low interoceptive accuracy groups based on a binomial test of each participant’s correct rate. The sync-assignment rates for the emotion assignment task were normally distributed, except for one condition (negative and sphere). A three-factor analysis of variance (ANOVA) was performed with picture valence (positive vs. negative), target type (palm vs. sphere), and interoceptive accuracy group (high vs. low) as the independent variables and the rate of assigning emotional images to heartbeat-synchronised stimuli as the dependent variable. Additionally, we examined whether participants’ attribution responses (sync/async) were influenced by image ratings (arousal and valence) using a logistic regression analysis. Other factors potentially affecting the results were also explored, including differences in the number of flashes (luminance changes) between synchronous and asynchronous stimuli and participants’ tendencies to assign emotional images to the left or right side. All analyses were conducted using the R software (version 4.3.1).

3.1 Image ratings

The mean valence ratings were 5.49 ( SD  = 0.37) and 2.80 ( SD  = 0.47) for positive and negative images, respectively. The mean arousal ratings were 2.87 ( SD  = 0.32) and 3.50 ( SD  = 0.50) for positive and negative images, respectively.

3.2 Heartbeat discrimination task

In this task, the mean correct rate was 0.58 ( SD  = 0.12). A one-sample Wilcoxon signed-rank test showed a significant difference from the chance level of 0.5 ( V  = 4.45, p  < 0.001, r  = 0.62) ( Figure 2 ). The mean correct rates for the palm and sphere conditions were 0.57 ( SD  = 0.15) and 0.59 ( SD  = 0.13), respectively. The Wilcoxon signed-rank test showed no significant difference between the two conditions ( V  = 231, p  = 0.38, r  = 0.14). A binomial test revealed that 11 of the 41 participants discriminated the synchronised target significantly ( p -values ranged from 0.00 to 0.04, see Supplementary Table S1 ). These participants were classified into the high interoceptive accuracy group, whereas the remaining participants were classified into the low interoceptive accuracy group.

Figure 2 . Box and violin plots for the correct rate of the heartbeat discrimination task. The asterisk indicates a significant difference from the chance level of 0.5. *** p  < 0.001.

3.3 Emotion assignment task

3.3.1 anova.

In the emotion assignment task, the mean rate of assigning positive and negative images to heartbeat-synchronised targets was 0.49 ( SD  = 0.11) and 0.52 ( SD  = 0.11), respectively, in the palm condition, and 0.48 ( SD  = 0.12) and 0.50 ( SD  = 0.11), respectively, in the sphere condition ( Figure 3 ). The mean sync-assigning rates in high and low interoceptive accuracy groups were 0.53 ( SD  = 0.09) and 0.48 ( SD  = 0.12), respectively. A three-factor ANOVA showed no significant main effect of emotional images ( F (1, 39) = 0.35, p  = 0.556, η p 2 = 0.01) or target type ( F (1, 39) = 0.02, p  = 0.88, η p 2 = 0.00) but a significant main effect of interoceptive accuracy group ( F (1, 39) = 8.42, p  = 0.006, η p 2 = 0.18) ( Figure 4 ). There were no significant interactions between emotional images and target type, between emotional images and interoceptive accuracy, or between target type and interoceptive accuracy ( F -values ranged from 0.46 to 1.20, p -values from 0.28 to 0.70). The three-way interaction was also not significant ( F (1, 39) = 0.88, p  = 0.35, η p 2 = 0.02). A one-sample t-test showed a significant difference from the chance level of 0.5 in the high interoceptive accuracy group ( t (10) = 3.65, p  = 0.004, d  = 1.10), whereas there was no significant difference from the chance level in the low interoceptive accuracy group ( t (29) = −1.66, p  = 0.11, d  = −0.30).

Figure 3 . Box and violin plots for the rate of assigning an emotional (positive/negative) image to the synchronous target in the emotion assignment task. (A) Palm (bodily) target and (B) sphere (non-bodily) target.

Figure 4 . Box and violin plots for the rate of assigning an emotional image to the synchronous target by interoceptive accuracy group (high/low) in the emotion assignment task. ** p  < 0.01.

3.3.2 Logistic regression analysis

Based on participants’ responses to image ratings, we analysed the effect of images on the responses (synchronic/asynchronous) using logistic regression. The results suggested that neither valence nor arousal ratings significantly influenced the likelihood of participants’ responses being sync or async. Specifically, neither valence rating ( β  = 0.02, p  = 0.40) nor arousal rating ( β  = 0.00, p  = 0.83) were significant predictors of participants’ responses. However, interoceptive accuracy, which indicates the correct rate of each participant for the heartbeat discrimination task, was a significant predictor ( β  = −0.74, p  = 0.018). This indicates that participants who performed well on the heartbeat discrimination task were more likely to have synchronous responses.

3.3.3 Exploratory analysis

We conducted an exploratory analysis to identify other factors that may have affected the results. According to the logistic regression model, the difference in the number of flashes between sync and async targets affected the sync-assigning rate ( β  = 1.27, p  = 0.03). Participants were more likely to assign images to targets that flashed more frequently. Additionally, participants were significantly more likely to assign positive images to the right side and negative images to the left side, although the total numbers of left and right assignments were not significantly different ( Table 1 ). Pearson’s chi-square test indicated a significant association between emotional valence (negative/positive) and direction (left/right) ( X 2 (1) = 95.36, p  < 0.001), although a binomial test did not show a significant difference in the total number of left and right assignments ( p  = 0.72).

Table 1 . Number of emotional images (positive/negative) assigned to the left and right.

4 Discussion

This study examined whether cardiac signals can induce self-attribution to non-bodily and bodily targets. To measure implicit self-attribution to external stimuli, we developed a new task called the self-other-attribution task. Our main findings were as follows: (1) participants did not exhibit a significant relationship between valence and synchrony in either the bodily (palm) or non-bodily (sphere) conditions and (2) participants with high interoceptive accuracy assigned emotional images to synchronous targets significantly more often than those with low interoceptive accuracy.

Contrary to previous studies ( Suzuki et al., 2013 ; Sel et al., 2017 ), we did not find any self-attribution to cardiac-synchronous stimuli, even in the bodily stimuli. There are two possible reasons for this: (1) the experimental paradigm may not be appropriate to investigate self-attribution and (2) visual-heartbeat synchrony may not promote self-attribution.

Based on approach-avoidance theory, we predicted that participants would significantly assign positive and negative images to cardiac-synchronous and asynchronous targets, respectively; however, this tendency was not observed in the current experiment. One possibility is that a more explicit experimental condition is required to evoke an approach-avoidance response. The self-target in our experiment might have been too subtle compared to that of previous studies ( Eerland et al., 2012 ) because the participants were completely unaware of the heartbeat synchronisation. Instead, they assigned positive and negative images to the right and left sides, respectively. This may be related to the fact that most participants were right-handed, and humans typically use their dominant hand to approach and their non-dominant hand to avoid ( Casasanto, 2009 ; Brookshire and Casasanto, 2012 ). For right-handed participants, the right side was easier to access and thus connected to approach, while the left side was slightly more difficult to access and thus connected to avoidance.

One experimental difference between this study and previous studies was the way in which the asynchronous conditions were created ( Aspell et al., 2013 ; Suzuki et al., 2013 ; Sel et al., 2017 ). For the asynchronised targets, we used the same participants’ heartbeats with a 60-s delay to highlight the differences in heartbeat timing. Previous studies on real-time heartbeat feedback have often manipulated the speed of heartbeat rather than heartbeat timing ( Aspell et al., 2013 ; Suzuki et al., 2013 ; Sel et al., 2017 ). However, in these studies, the heart rate and R-R interval feedback in the asynchronised condition differed from those in the synchronised condition, which may have impacted the results. Our exploratory analysis showed that the difference in the number of flashes between the sync and async targets affected the sync-assigning rate. This suggests that an increased number of flashes might enhance the saliency of the stimuli, leading to greater assignment.

Another possibility is that visual-heartbeat synchrony may not induce self-attribution in visual stimuli. Indeed, several studies have reported negative results regarding self-attribution and interoception ( Porciello et al., 2016 ; Horváth et al., 2020 ; Moffatt et al., 2024 ). For example, Porciello et al. (2016) demonstrated that visuo-cardiac synchrony does not enhance self-attribution of the face, suggesting that their negative findings could be due to stimulus differences between the face and other body parts. However, the current study found that negative results also occurred for other body parts, such as the palm. This suggests that visual-heartbeat synchrony may not promote self-attribution, or at least that visual-heartbeat synchrony alone may be insufficient.

One possible explanation is that top-down cognitive processes are necessary to induce self-attribution in objects ( Tsakiris and Haggard, 2005 ). In previous studies, the experimental settings were more explicit, making it clear to participants that the task involved self-attribution, and the difference between the two flashing speeds may have been more noticeable ( Aspell et al., 2013 ; Suzuki et al., 2013 ). This suggests that top-down processes, such as participants’ expectations and awareness, might contribute significantly to the self-attribution that arises from synchrony. In contrast, it is possible that in this experiment, participants did not consciously notice the synchronisation of the target, leading to a lack of self-attribution due to insufficient top-down processing. Another possibility is that acquiring self-attribution outside one’s personal space is challenging. In this study, unlike in previous rubber hand illusion studies where the hand was typically positioned between participants’ actual hand and the centre of their bodies, the palm was presented on a screen away from the participants’ bodies ( Botvinick and Cohen, 1998 ; Suzuki et al., 2013 ). This distance may have made it difficult for participants to perceive the palm as their own. Thus, careful consideration should be given to the requirements for invoking the bodily illusion.

Participants with high interoceptive accuracy were significantly more likely to assign images to synchronous targets. This difference was not only significant compared to the low interoceptive group but also above the chance level, whereas the low interoceptive group showed no significant difference from the chance level. This result aligns with those of previous studies in which older infants and adults looked at cardiac-synchronous stimuli for longer than asynchronous stimuli ( Imafuku et al., 2023 ; Tünte et al., 2023 ). Synchronous stimuli may attract attention because they are familiar to adults with well-developed heartbeat attentional systems. In our study, based on previous studies ( Imafuku et al., 2023 ; Tünte et al., 2023 ), it is reasonable to assume that synchronous stimuli may unconsciously attract attention in the high interoceptive accuracy group. This kind of attention or perception of signals related to our innate state could be the basis of the sense of self, although some gaps may exist in generating self-attribution, such as whether objects are within the peripersonal space. This study provides behavioural evidence of how cardiac-synchronous signals affect our minds. Future studies should incorporate both eye-tracking and behavioural measurements to further investigate this synchronous physiological effect.

This study found that participants with high interoceptive accuracy were more likely to assign emotional images to synchronised stimuli. However, previous studies have shown a negative relationship between interoceptive accuracy and self-related measures ( Tsakiris et al., 2011 ; Honda and Nakao, 2022 ). These discrepancies are thought to stem from differences in the (1) experimental and (2) interoceptive tasks. First, continuous real-time biofeedback may be necessary for individuals with a high interoceptive accuracy to experience the sense of self relative to an external object. Second, while both the heartbeat counting task ( Schandry, 1981 ) and the heartbeat discrimination task ( Whitehead et al., 1977 ) are considered measures of interoceptive accuracy, they exhibit only a small correlation ( Hickman et al., 2020 ). These task differences likely explain the varied directional effects of interoceptive accuracy observed in previous studies ( Tsakiris et al., 2011 ; Suzuki et al., 2013 ; Honda and Nakao, 2022 ). By contrast, studies using continuous cardiac feedback and discrimination tasks similar to the current study have consistently shown a positive effect of interoceptive accuracy on self-attribution ( Suzuki et al., 2013 ). This suggests that the type of interoceptive task and inclusion of real-time biofeedback are crucial factors in determining the relationship between interoceptive accuracy and self-related measures.

There are two possible limitations in the current study. First, we recruited only male participants due to known gender differences in interoceptive accuracy ( Prentice and Murphy, 2022 ) and brain responses to emotional stimuli ( Wrase et al., 2003 ). Future studies should investigate whether our findings are consistent among female participants. Second, our method used participants’ heartbeats from 60 s earlier for the async condition, which may have limitations. Specifically, if participants’ heartbeats had self-similarity, both sync and async targets might have felt like their own heartbeats. To avoid this issue, future studies should shuffle the 60-s delayed heartbeats before presenting them in the async condition.

In conclusion, participants with high interoceptive accuracy were more likely to assign emotional images to synchronous cardiac stimuli. This implies that synchronous stimuli primarily attract attention in participants with high interoceptive accuracy, adding behavioural evidence to studies of preferential looking at synchronous stimuli ( Maister et al., 2017 ; Imafuku et al., 2023 ; Tünte et al., 2023 ). However, we did not find any effect of cardiac-synchronous signals on self-attribution to bodily and non-bodily targets. We discussed the possible reasons based on approach-avoidance theory and the potential for cardiac synchronisation to evoke self-attribution. This study illuminates future studies for a more elaborate examination of the role of cardiac signals in self-attribution.

Data availability statement

The original contributions presented in the study are included in the article/ Supplementary material , further inquiries can be directed to the corresponding author.

Ethics statement

The studies involving humans were approved by the Department of Psychology Ethics Committee of Nagoya University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

HS: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Resources, Validation, Visualization, Writing – original draft, Writing – review & editing. TH: Conceptualization, Formal analysis, Methodology, Writing – review & editing, Investigation, Resources. HO: Funding acquisition, Project administration, Supervision, Writing – review & editing.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the JSPS KAKENHI (grant number 23KJ1078) and the JST CREST (grant number JPMJCR21P1).

Acknowledgments

We thank Ayuka Sakakibara, Utana Mori, and Yusuke Hayashi for their help with data collection. We used ChatGPT (GPT-4, OpenAI) for English correction.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2024.1442942/full#supplementary-material

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2. ^ https://www.pexels.com/

3. ^ https://www.photo-ac.com/

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Keywords: interoception, self-attribution, sense of self, cardiac feedback, interoceptive accuracy, approach-avoidance

Citation: Shibata H, Harada T and Ohira H (2024) The influence of cardiac synchronisation on self-attribution to external objects in male participants. Front. Psychol . 15:1442942. doi: 10.3389/fpsyg.2024.1442942

Received: 04 June 2024; Accepted: 19 August 2024; Published: 30 August 2024.

Reviewed by:

Copyright © 2024 Shibata, Harada and Ohira. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Hiroshi Shibata, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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https://educationhub.blog.gov.uk/2024/08/20/gcse-results-day-2024-number-grading-system/

GCSE results day 2024: Everything you need to know including the number grading system

Thousands of students across the country will soon be finding out their GCSE results and thinking about the next steps in their education.   

Here we explain everything you need to know about the big day, from when results day is, to the current 9-1 grading scale, to what your options are if your results aren’t what you’re expecting.  

When is GCSE results day 2024?  

GCSE results day will be taking place on Thursday the 22 August.     

The results will be made available to schools on Wednesday and available to pick up from your school by 8am on Thursday morning.  

Schools will issue their own instructions on how and when to collect your results.   

When did we change to a number grading scale?  

The shift to the numerical grading system was introduced in England in 2017 firstly in English language, English literature, and maths.  

By 2020 all subjects were shifted to number grades. This means anyone with GCSE results from 2017-2020 will have a combination of both letters and numbers.  

The numerical grading system was to signal more challenging GCSEs and to better differentiate between students’ abilities - particularly at higher grades between the A *-C grades. There only used to be 4 grades between A* and C, now with the numerical grading scale there are 6.  

What do the number grades mean?  

The grades are ranked from 1, the lowest, to 9, the highest.  

The grades don’t exactly translate, but the two grading scales meet at three points as illustrated below.  

The bottom of grade 7 is aligned with the bottom of grade A, while the bottom of grade 4 is aligned to the bottom of grade C.    

Meanwhile, the bottom of grade 1 is aligned to the bottom of grade G.  

What to do if your results weren’t what you were expecting?  

If your results weren’t what you were expecting, firstly don’t panic. You have options.  

First things first, speak to your school or college – they could be flexible on entry requirements if you’ve just missed your grades.   

They’ll also be able to give you the best tailored advice on whether re-sitting while studying for your next qualifications is a possibility.   

If you’re really unhappy with your results you can enter to resit all GCSE subjects in summer 2025. You can also take autumn exams in GCSE English language and maths.  

Speak to your sixth form or college to decide when it’s the best time for you to resit a GCSE exam.  

Look for other courses with different grade requirements     

Entry requirements vary depending on the college and course. Ask your school for advice, and call your college or another one in your area to see if there’s a space on a course you’re interested in.    

Consider an apprenticeship    

Apprenticeships combine a practical training job with study too. They’re open to you if you’re 16 or over, living in England, and not in full time education.  

As an apprentice you’ll be a paid employee, have the opportunity to work alongside experienced staff, gain job-specific skills, and get time set aside for training and study related to your role.   

You can find out more about how to apply here .  

Talk to a National Careers Service (NCS) adviser    

The National Career Service is a free resource that can help you with your career planning. Give them a call to discuss potential routes into higher education, further education, or the workplace.   

Whatever your results, if you want to find out more about all your education and training options, as well as get practical advice about your exam results, visit the  National Careers Service page  and Skills for Careers to explore your study and work choices.   

You may also be interested in:

• Results day 2024: What's next after picking up your A level, T level and VTQ results?
• When is results day 2024? GCSEs, A levels, T Levels and VTQs

Tags: GCSE grade equivalent , gcse number grades , GCSE results , gcse results day 2024 , gsce grades old and new , new gcse grades

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