Orienting in a defensive world: mammalian modifications of our evolutionary heritage. A Polyvagal Theory

The development of a caregiver intervention to address child mental health in settings of complex humanitarian emergency: a multi-phase, multi-method approach

BACKGROUND

Effective parenting can mediate the negative impact of complex humanitarian emergencies (CHEs) on child mental health, however many caregivers struggle to parent effectively in these settings. Parenting interventions have robust evidence in many settings, however research supporting their use in CHEs is limited. We describe the development of a caregiver group intervention delivered by non-specialist staff to support child mental health in CHEs.

METHODS

A multi-phase, multi-method approach was employed: Phase 1: semi-structured interviews, analysed inductively, with specialist mental health staff in CHEs on needs and challenges in providing mental healthcare to children and caregivers. Phase 2: initial intervention development informed by Phase 1 and evidence-based theoretical approaches and psychological therapies. Phase 3: expert review of draft intervention. Phase 4: semi-structured interviews, analysed inductively, with non-specialist staff in Papua New Guinea (PNG) to evaluate relevance, comprehensibility, and applicability of the intervention. Phase 5: cultural adaptation of the intervention prior to implementation in Northern Iraq. Different operational partners and research sites were employed at different phases of development to increase diversity of inputs and support the overall vision of an intervention that addressed common mental health difficulties and underlying factors to support children and caregivers across CHEs.

RESULTS

Mental health staff in CHEs identified a significant need for interventions to support parenting and address child mental health needs. A caregiver group intervention was developed consisting of six two-hour sessions, delivered weekly by non-specialist staff, and targeting parent knowledge and skills and parent stress. Expert consultation identified aspects of the intervention to emphasise or simplify, resulting in a refined intervention with ensured clinical quality. Non-specialist staff in PNG confirmed the intervention relevance to a vulnerable population in a humanitarian setting, and the manual was determined suitable for non-specialist facilitators. Mental health literacy, stigma and cultural views (masculinity, family privacy) were identified as challenges to address. A multi-stage method of cultural adaptation in Iraq ensured the clinical and cultural accuracy, relevance, and acceptability of the intervention. Initial adaptations to the language and metaphors used in the intervention resulted in high cultural appropriateness during pilot testing. Prioritising the recruitment and engagement of male caregivers is critical.

CONCLUSIONS

A caregiver intervention to support child mental health in CHEs is available. It's development using multi-method, co-design processes will ensure its relevance and acceptability to target populations. Further research to evaluate the effectiveness and long-term effectiveness of the intervention is warranted.

Cardiac Autonomic and Affective Reactivity to Laboratory Stressors across the Menstrual Cycle: A Systematic Review

Fluctuations in steroid sex hormones are associated with altered cardiac autonomic and affective functioning across the female lifespan. The neuroendocrine pathways which modulate sex hormone changes during the menstrual cycle have reciprocal interactions with the autonomic nervous system, an integral system for self-regulation and stress response. Cardiac autonomic activity is often imbalanced among individuals with mental and physical health conditions. However, it is unclear whether variations in female-typical sex hormones across the menstrual cycle significantly alter cardiac autonomic and affective stress reactivity, which may underlie menstrual-related mood and psychosomatic symptoms. The present systematic review aims to address this gap by characterizing patterns of cardiac autonomic activity at baseline, and cardiac autonomic and affective reactivity to laboratory stress tasks across the menstrual cycle in reproductive-aged women. The review was preregistered (https://doi.org/10.17605/OSF.IO/B2Y5Q) and conducted in line with PRISMA guidelines. Twenty studies and 28 records were identified and discussed. The study found modest support for increased cardiac sympathetic activation at baseline and in response to stress, and greater affective reactivity within the luteal phase of the menstrual cycle. These results expand upon prior research demonstrating cardiac autonomic imbalance and affective vulnerability within the luteal phase to show that these patterns also influence stress reactivity. Additionally, the review aims to identify notable methodological limitations and gaps within this body of literature and suggests areas of future research to clarify the role of cardiac autonomic and affective processes in steroid sex hormone-related symptomatology.

Brain-body dysconnectivity: deficient autonomic regulation of cortical function in first-episode schizophrenia

BACKGROUND

An accumulating body of evidence indicates that peripheral physiological rhythms help regulate and organize large-scale brain activity. Given that schizophrenia (SZ) is characterized by marked abnormalities in oscillatory cortical activity as well as changes in autonomic function, the present study aimed to identify mechanisms by which central and autonomic nervous system deficits may be related. We evaluated phase-amplitude coupling (PAC) as a physiological mechanism through which autonomic nervous system (ANS) and central nervous system (CNS) activity are integrated and that may be disrupted in SZ.

METHODS

PAC was measured between high-frequency heart rate variability (HF-HRV) as an index of parasympathetic activity and electroencephalography (EEG) oscillations in 36 individuals with first-episode SZ and 38 healthy comparison participants at rest.

RESULTS

HRV-EEG coupling was lower in SZ in the alpha and theta bands, and HRV-EEG coupling uniquely predicted group membership, whereas HRV and EEG power alone did not. HRV-EEG coupling in the alpha band correlated with measures of sustained attention in SZ. Granger causality analyses indicated a stronger heart-to-brain effect than brain-to-heart effect, consistent across groups.

CONCLUSIONS

Lower HRV-EEG coupling provides evidence of deficient autonomic regulation of cortical activity in SZ, suggesting that patterns of dysconnectivity observed in brain networks extend to brain-body interactions. Deficient ANS-CNS integration in SZ may foster a breakdown in the spatiotemporal organization of cortical activity, which may contribute to core cognitive impairments in SZ such as dysregulated attention. These findings encourage pursuit of therapies targeting autonomic function for the treatment of SZ.

Decreased risk-proneness with increasing age in equally raised and kept wolves and dogs

A basic mechanism of domestication is the selection for fearlessness and acceptance of humans as social partners, which may affect risk-taking behavior and the ability to use humans as social support, both at the behavioural and physiological levels. We combined behavioural observations with heart rate parameters (i.e., HR and heart rate variability, HRV) in equally raised and housed wolves and dogs to assess the responses to food offered in the vicinity of a potential stressor (an unknown spinning object) with and without social support from a familiar human. Based on previous studies on neophobia in wolves and dogs, we expected dogs to be less scared of the object, approach more quickly, show less ambivalent behaviour, lower HR, and higher HRV, than wolves, especially at the presence of a human partner. However, we found that mainly age and the presence of a familiar human affected the behaviour of our subjects: older wolves and dogs were generally bolder and faster to approach the food and the familiar human's presence increased the likelihood of taking it. HR rate parameters were affected by age and the stage of the test. Wolves and dogs showed particularly high HRs at the beginning and end of the test sessions. We conclude that in our paradigm, wolves' and dogs' risk-proneness varied with age, rather than species. Additionally, the presence of a familiar human increased the motivation of both, dogs and wolves to take the food.

Body as First Teacher: The Role of Rhythmic Visceral Dynamics in Early Cognitive Development

Embodied cognition-the idea that mental states and processes should be understood in relation to one's bodily constitution and interactions with the world-remains a controversial topic within cognitive science. Recently, however, increasing interest in predictive processing theories among proponents and critics of embodiment alike has raised hopes of a reconciliation. This article sets out to appraise the unificatory potential of predictive processing, focusing in particular on embodied formulations of active inference. Our analysis suggests that most active-inference accounts invoke weak, potentially trivial conceptions of embodiment; those making stronger claims do so independently of the theoretical commitments of the active-inference framework. We argue that a more compelling version of embodied active inference can be motivated by adopting a diachronic perspective on the way rhythmic physiological activity shapes neural development in utero. According to this visceral afferent training hypothesis, early-emerging physiological processes are essential not only for supporting the biophysical development of neural structures but also for configuring the cognitive architecture those structures entail. Focusing in particular on the cardiovascular system, we propose three candidate mechanisms through which visceral afferent training might operate: (a) activity-dependent neuronal development, (b) periodic signal modeling, and (c) oscillatory network coordination.

Teacher stress in social interactions in the light of polyvagal theory. An ambulatory assessment approach to teachers' heart rate and heart rate variability

Background

Teaching is a genuinely social and highly demanding task. Drawing on Porges' phylogenetic polyvagal theory with three evolved systems and three associated behavioral responses (social engagement, mobilization, and immobilization), we investigated teachers' heart rate and heart rate variability in social interactions using ambulatory assessments.

Methods

We continuously measured heart rate and heart rate variability of 42 apparently healthy teachers on a work and leisure day with ambulatory electrocardiogram. We videotaped four consecutive, same-day lectures of each teacher. We trained observers to code student aggression and frontal teaching behaviors in an event sampling procedure with the behavior observation system for analyzing aggressive behavior in school settings. Additionally, perceived teacher-student relationship, social support from other teachers / school management, occupational complaints, and vital exhaustion were assessed by teacher self-reports.

Results

Teachers showed an increased heart rate and a decreased heart rate variability on a workday compared to a leisure day, anticipatory stress before classes, as well as insufficient recovery during lunchtime. Observed student aggression and high proportion of frontal teaching were associated with lower heart rate variability, while better perceived teacher-student relationship was correlated with higher heart rate variability. Differently, teachers' psychological strain and heart rate variability were unrelated to each other.

Conclusion

Corresponding to polyvagal theory, results suggest that successful social interactions are fundamental for teachers' favorable cardiological reactions.

A Pilot Controlled Trial of Relaxation Training Combined with a Video Game Reinforcing Emotional Regulation to Improve Anger Management in Children and Adolescents

Untreated anger and aggression in youth confer heightened risk for subsequent psychosocial problems. However, engaging youth in treatment for anger can be difficult given barriers to accessing care and high rates of attrition. This study examined whether learning relaxation skills and practicing them using a videogame, whose operation was contingent upon keeping heart rate close to baseline levels, could help children learn to manage anger and aggression. Youth ages 7-17 with elevated levels of anger (N = 39) were randomized to receive the active video game condition or a control game that displayed heart rate but did not stop the game if heart rate became elevated. Youth underwent baseline screening, 6 treatment sessions, and follow-up assessments at 2-weeks and 3-months. Compared to the control condition, children in the active condition demonstrated significantly greater improvements in clinician-rated aggression severity (d = 1.48) and youth-rated emotion dysregulation (d = 3.46) at 2-weeks post-treatment. The active group maintained these improvements at 3-month follow-up, but no longer significantly differed from the control group. Intervention effects were nonsignificant for parent-reported emotion dysregulation and aggression. In addition, the intervention group youth, but not control group, experienced increased time with heart rate below baseline over the course of the 6 sessions. Findings suggest a promising brief intervention for reducing aggression and emotion dysregulation in children while they are waiting for longer-term outpatient therapy. Clinical Trial Registration Number: NCT03270813.

Heart Rate Variability Biofeedback Intervention Programme to Improve Attention in Primary Schools

The importance of attentional capacity for academic performance is highlighted by the increasing demands placed on students during primary school. Between the ages of 7 and 12, there is an evolutionary improvement in attentional capacity and the school environment is considered an appropriate setting in which to develop programmes to improve attention. Heart rate variability is an appropriate indicator of attentional capacity. For all these reasons, a heart rate variability biofeedback intervention focused on breathing was developed and implemented to improve attention. The intervention consisted of two phases. In the first phase, the school teachers were trained to develop the intervention; in the second, students received five individual sessions from their teachers. In each individual session, they learned to breathe to increase their heart rate variability. A total of 272 girls and 314 boys (N = 586) aged 7-12 years participated in the programme. To study the impact of the intervention on three primary school age groups, the attention of Control and Experimental groups was assessed before and after the implementation of the programme. According to the data obtained, despite developmental improvements, the students who participated in the programme showed an increase in heart rate variability and an improvement in attentional capacity, with a greater impact on the first cycle of primary school. The usefulness of heart rate variability biofeedback interventions in improving attention in primary school is discussed and arguments for their use in children are presented.

The relationship between cardiac activity, behaviour and endogenous oxytocin and vasopressin in Prader-Willi Syndrome: An exploratory study

This study aimed to increase our understanding of cardiac activity abnormalities in Prader-Willi Syndrome (PWS) and the relationship between cardiac activity, PWS behaviours thought to be associated with cardiac vagal tone and endogenous oxytocin and vasopressin levels. We compared cardiac activity (respiratory sinus arrhythmia (RSA), low-frequency heart rate variability (LF-HRV), heart period) in 30 adolescents and adults with PWS to 30 typically developing age-matched controls. RSA, LF-HRV, and heart period were lower in individuals with PWS than in the control group. In the control group, RSA was higher for females than males. However, for those with PWS, there was no difference between the sexes. Individuals with the mUPD genetic subtype had lower RSA and LF-HRV than participants with the PWS deletion subtype and compared to typically developing controls, no difference was found between the latter two groups. Heart period was also lower for those with mUPD compared to controls. Higher RSA reduced the odds of having temper outbursts and skin-picking. RSA was lower in those with PWS and psychosis compared to those with PWS without psychosis. Finally, we found RSA correlated with vasopressin for those with mUPD but not deletion. There was no relationship between RSA and oxytocin plasma or saliva levels. Our findings suggest autonomic dysfunction in PWS that is more marked in mUPD than deletion and potentially due to greater loss of parasympathetic activity in mUPD.

Exploring autonomic dysfunction in functional dysphonia: A protocol for a case-control study and a randomized controlled trial

BACKGROUND

Although psychological factors have been implicated in patients with functional dysphonia (FD), conventional voice therapy (CVT) typically targets the aberrant voice symptoms exclusively. Yet, CVT is not always successful, and in view of the significant adverse quality of life impact combined with the financial burden on the healthcare system and society, research is needed to elucidate the underlying psychophysiology of FD and improve treatment outcomes.

OBJECTIVES

The first objective of this research project is to compare the occurrence and frequency of symptoms and/or disorders related to autonomic nervous system (ANS) dysfunction in patients with FD with gender- and age-matched vocally healthy controls, using a case-control study. The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (i.e., ANS therapy: heart rate variability (HRV) biofeedback) on both autonomic function and voice function versus CVT alone or in combination with ANS therapy (i.e., ANS therapy + CVT), using a randomized controlled trial (RCT).

METHODS

Case-control study: Autonomic (dys)function of patients with FD will be compared with gender- and age-matched vocally healthy controls, using both physiological measures (e.g., HRV, skin conductance level) and psychological patient-reported outcome measures (PROMs, e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). RCT: The FD group will be randomly assigned to the innovative ANS therapy group, the CVT group or the ANS therapy + CVT group. All patients received 1 month of treatment with 20 min of daily practice. Both the autonomic assessment and the voice assessment will be performed pretherapy and immediately after therapy by assessors blinded to group allocation and study phase.

EXPECTED RESULTS

Higher occurrences of symptoms and/or disorders related to autonomic dysfunction are expected in patients with FD compared with vocally healthy controls. Physiological outcomes: lower HRV, lower cardiac pre-ejection period, higher respiration rate and higher skin conductance level are hypothesized in patients with FD compared with vocally healthy controls. Psychological PROMs: higher self-report of feelings/symptoms related to autonomic dysfunction (e.g., perceived stress, anxiety) is expected in patients with FD compared with vocally healthy controls. The autonomic function is hypothesized to improve more after the ANS therapy and the ANS therapy + CVT compared with the CVT only. Voice function is expected to improve more after the ANS therapy + CVT compared with the ANS therapy and the CVT alone.

WHAT THIS PAPER ADDS

What is already known on the subject Autonomic dysfunction is well recognized in the field of psychology but remains understudied in the area of voice. Given that the vagus nerve, innervating the larynx, also helps to regulate the ANS, and psychological symptoms commonly observed in patients with FD may reflect ANS dysregulation, research in this area is needed. There is some preliminary evidence that autonomic dysfunction might indeed be associated with FD. However, physiological ANS measures are needed, as well as validated psychological PROMs. What this paper adds to the existing knowledge The first objective of this study is to investigate the occurrence and frequency of symptoms and/or disorders related to autonomic dysfunction in patients with FD as compared with a gender- and age-matched vocally healthy control group. Autonomic (dys)function will be determined by employing both physiological measures (e.g., HRV, skin conductance level) and psychological PROMs (e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (HRV biofeedback) versus CVT alone or in combination with ANS therapy. What are the potential or actual clinical implications of this work? Success rates of symptomatic CVT for FD are highly variable. This study is expected to lead to innovative results related to the pathogenesis and psychophysiology of FD, a prevalent voice disorder associated with a significant adverse quality of life impact and a substantial financial burden on the healthcare system and society. The results of this study will lead to crucial new insights into both the diagnosis and treatment of FD, contributing to evidence-based practice in the field of voice.

Piloting a battery to evaluate parasympathetic reactivity and externalizing behaviours during early childhood in autism spectrum disorder

Background

Respiratory Sinus Arrhythmia Reactivity (RSA-R) correlates both positively and negatively with externalizing behavior in autistic individuals. These inconsistencies may result from task-based differences. This pilot study measured RSA-R in 4-to 6-year-olds, across two time-points, using four validated tasks with matched baseline and challenge periods. Social, cognitive, sensory, and emotional tasks were employed to evaluate the use of a domain-specific approach in measuring RSA-R in young autistic children.

Methods

RSA and parent-reported externalizing behavior were collected from 16 children (Mage=5.60 years; 13 male; 12 white/caucasian; 15 non-hispanic/latine). RSA-R was measured by the difference score of the challenge task minus its corresponding comparison task. Correlations were computed to evaluate associations between RSA-R and behavior.

Results

RSA was reliably measured for 3/4 tasks (.694 ≤ ICCs ≤ .896). Only RSA-R during a social task correlated with externalizing behavior. These results support using a battery that measures a range of challenges, differing in social demands, to characterize how arousal contributes to emotion regulation demands among young autistic children.

Oxytocin in growth, reproduction, restoration and health

This article summarizes my scientific work and describes some personal experiences during this period. After my basal medical training (MD) (1971), I obtained a PhD in pharmacology (1976) and ended up as a professor of Physiology. My initial studies were within the field of gastroenterology. I showed that the gastrointestinal hormone gastrin, which stimulates HCL secretion in the stomach, was released in response to stimulation of the vagal nerve. Later I showed that the entire endocrine system of the gastrointestinal (GI) tract that promotes digestion and anabolic metabolism and growth was under vagal nerve control. I also showed that activation of the vagal nerve inhibits the function of the inhibitory substance somatostatin. 10 years later, after some big changes in my personal life, my research focus changed. I became interested in female physiology, particularly the role of oxytocin. In addition, I became aware of the situation of female scientists and started to work with questions regarding equality between women and men. I gathered a group of interested female medical students and midwives around me. We demonstrated that breastfeeding and touch (e.g., between mother and baby), via stimulation of sensory nerves in the skin, activated the endocrine system of the GI tract and, thereby, anabolic processes and growth. The effects were exerted via a vagal mechanism and involved activation of parvocellular oxytocinergic neurons from the paraventricular nucleus (PVN). We also showed that the gastrointestinal hormone cholecystokinin stimulated the release of oxytocin in a calorie-dependent way via an afferent vagal mechanism. In summary, there is a bidirectional, vagally mediated connection between the endocrine system of the GI tract and the oxytocin producing neurons in the supraoptic (SON) and paraventricular (PVN) nuclei of the hypothalamus.1. Oxytocinergic neurons from the PVN enhances the activity of the endocrine system of the GI tract and thereby growth and regeneration. The effect is exerted via efferent vagal fibers which inhibit the release of somatostatin. 2. Food in the duodenum triggers a release of cholecystokinin (CCK), which via a vagal afferent mechanism stimulates the release and function of oxytocin. This mechanism is not activated in the absence of food intake. Administration of oxytocin induces a multitude of actions, i.e., anxiolytic and sedative effects, increased pain threshold, lowering of cortisol and blood pressure and an increased activity of the endocrine system of the GI tract. Repeated administration of oxytocin may induce long-term effects and "secondary" mechanisms such as an increased activity of alpha-2- adrenoceptors are involved. Oxytocin released by suckling during breastfeeding or by touch during social interaction will induce a similar effect spectrum. Activation of the parvocellular neurons will stimulate some aspects of social behavior, induce calm and well-being, and decrease levels of fear, stress, and pain. In addition, vagal functions and the activity of the endocrine system of the GI tract will be stimulated. Together, these effects are consistent with the oxytocin-mediated calm and connection response and, in a long-term perspective, with the promotion of well-being and health. A second period of professional difficulties occurred in the late 1990s. I moved to the Swedish University of Agriculture, where I started to investigate the role of oxytocin in interactions between humans and pets, as this type of interaction had been shown to promote health. I continued to study the role of oxytocin in female reproduction, in particular, the role of oxytocin during labor and birth and in the peripartum period. In addition, I started to write books about different aspects of oxytocin. I also wanted to establish a role for oxytocin in the treatment of vaginal atrophy. Several clinical studies show that local intravaginal application of oxytocin in women with vaginal atrophy increases the regeneration of vaginal mucosal cells and function.

Abnormal circadian rhythm of heart rate variability and their association with symptoms in patients with major depressive disorder

BACKGROUND

Heart rate variability (HRV) is often reduced in patients with major depressive disorder (MDD) and is linked to symptoms. However, prior studies have mainly focused on short-term HRV, with limited exploration of the 24-h HRV circadian rhythm, despite its ability to comprehensively capture overall HRV distribution and dynamic fluctuations. In this study, we investigated the circadian rhythms of 24-h HRV indices in patients with MDD and their associations with symptom severity.

METHODS

We recorded 24-h electrocardiograms in 73 patients with MDD (53 in major depressive episode and 20 in remission period) and 31 healthy controls. An extended cosine model was used to model the circadian rhythm of six HRV indices by five parameters: the mesor, amplitude, duty cycle, curve smoothness, and acrophase. Symptom severity was evaluated using the Hamilton Depression Scale and Hamilton Anxiety Scale.

RESULTS

Compared with the control group, patients with MDD had a significantly smaller SampEn mesor, higher HF duty cycle, and lower heart rate (HR) duty cycle. They also had a significantly higher curve smoothness for HR, RMSSD, and HF. The mesor for SampEn, along with the curve smoothness for HR and ln RMSSD, were associated with certain symptoms in patients with MDD.

LIMITATIONS

The cross-sectional design and psychiatric treatment of most patients with MDD limited our findings.

CONCLUSION

Patients with MDD exhibit abnormal HRV circadian rhythms that are associated with symptoms. Moreover, 24-h ECG monitoring may potentially serve as an adjunct value to objectively evaluate clinical symptoms in these patients.

Disorders of gut-brain interaction through the lens of polyvagal theory

This paper introduces a metric capable of tracking a hypothetical brainstem "switching" mechanism involved in regulating the afferent influence of blood pressure on the vagal efferent control of heart rate. In theory, this metric could be applied to evaluate the "efficiency" of brainstem pathways involved in common mechanisms of autonomic function involving the vagal influences on the gut as well as the heart. Thus, by exploring the dynamic "efficiency" of the brainstem feedback circuit linking heart rate to posture, a clinically relevant index of vagal flexibility might be extracted that would provide a generalizable window into the vagal regulation of both the heart and gut. Recent research supports this contention and has documented that this metric, VE, appears to covary with disorders of the gut. Clinical application of this metric might identify individual vulnerabilities that frequently reflect symptoms assumed to have features of a dysregulated autonomic nervous system (i.e., dysautonomia). If this is confirmed by additional research, then this objective measure of neural regulation of autonomic function might provide insight into the pathogenesis of disorders of gut-brain interaction.

Effects of Slow Breathing Exercises on Cardiac Autonomic Functions in Anxiety Disorder-A Randomised Control Trial

Background

Anxiety disorders are commonly associated with a higher risk of fatal cardiovascular diseases (CVD). Anxiety disorders lead to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, thus weakening the key neuronal components of the autonomic nervous system (ANS) that are involved in cardiovascular functions, leading to increased cardiovascular risk.

Purpose

Impaired ANS activity, as reduced parasympathetic tone is strongly associated with an increased risk of CVD in anxiety disorders. Slow pranayama influences the ANS by activating the parasympathetic tone and deactivating the sympathetic tone in healthy volunteers and various diseased conditions. Therefore, we aimed to study the effects of slow pranayama and savasana on cardiac autonomic function tests in anxiety disorder patients.

Methods

Anxiety disorder patients (N = 140) of either sex between the age group 18 and 40 years attending the psychiatry outpatient department (OPD) in JIPMER were recruited for the study and were randomly assigned into the pranayama group and control group. The Pranayama group practised slow pranayama and savasana for 8 weeks along with routine psychiatric care, while the control group continued with routine psychiatric care only. Outcome measures were heart rate variability (HRV), baroreflex sensitivity (BRS), 30:15 ratio during lying to standing, E: I ratio during deep breathing, and ∇DBP during isometric handgrip, which were assessed before and after the intervention period.

Results

After 8 weeks in the Pranayama group, the HRV parameters showed significant improvement towards the parasympathetic domain. Also, there was a significant increase in parasympathetic reactivity with a decrease in sympathetic reactivity and significant improvement in BRS.

Conclusion

Slow pranayama and savasana practice in anxiety disorder patients as an adjunct to routine psychiatric care effectively improves cardiac autonomic function with a shift towards parasympathetic predominance, with significant improvements in cardiovascular parameters. Slow pranayamas with savasana may be incorporated into the routine care of these patients to enhance their cardiovascular health.

Volition and control in law and in brain science: neurolegal translation of a foundational concept

The law assumes that healthy adults are generally responsible for their actions and have the ability to control their behavior based on rational and moral principles. This contrasts with some recent neuroscientific accounts of action control. Nevertheless, both law and neuroscience acknowledge that strong emotions including fear and anger may "trigger" loss of normal voluntary control over action. Thus, "Loss of Control" is a partial defense for murder under English law, paralleling similar defenses in other legal systems. Here we consider the neuroscientific evidence for such legal classifications of responsibility, particularly focussing on how emotional states modulate voluntary motor control and sense of agency. First, we investigate whether neuroscience could contribute an evidence-base for law in this area. Second, we consider the societal impact of some areas where legal thinking regarding responsibility for action diverges from neuroscientific evidence: should we be guided by normative legal traditions, or by modern understanding of brain functions? In addressing these objectives, we propose a translation exercise between neuroscientific and legal terms, which may assist future interdisciplinary research.

Bidirectionality of LF when the movie makes you sad: Effects of negative emotions on heart rate variability among patients with major depression

OBJECTIVES

Heart rate variability (HRV) reflects the capacity to adapt to internal and environmental changes. Decreased HRV may indicate inadequate adaptive capacity. This study aims to investigate the relationship between the heart and brain's adaptive abilities, both at rest and when negative emotions are stimulated in depression.

SUBJECTS AND METHODS

The study included 30 patients (20 female, 10 male) with major depression (mean age = 29.8 ± 7.8) and 30 healthy controls, all of whom had similar characteristics in terms of age and gender, selected through convenience sampling. The patients were drug-free at the time of the assessment. Holter recordings were obtained while subjects watched videos stimulating anger, fear, sadness, and a neutral video, and at rest, HRV parameters were calculated. To control for interindividual variability and account for paired sampling, linear mixed effects models were employed.

RESULTS

Watching the 'sadness video' led to an increase in low frequency band (LF) [LF change (Control vs depression); Difference:-620.80 df:107 t:-2.093 P:0.039] and LF/high frequency band ratio (LF/HF) [LF/HF change (control vs depression group); Difference:-1.718 df:105 t:-2.374 P:0.020] in the depression group. The video led to a decrease in LF and LF/HF in the controls. Although the differences between the conditions and interactions with the group were significant, the effects were independent of depression severity.

CONCLUSION

In depression, brain's regulatory effect on the heart differed from controls in the sadness condition, possibly due to increased arousal levels in subjects with depression and their inability to suppress sympathetic activity when a state of sadness is stimulated.

Publication guidelines for human heart rate and heart rate variability studies in psychophysiology-Part 1: Physiological underpinnings and foundations of measurement

This Committee Report provides methodological, interpretive, and reporting guidance for researchers who use measures of heart rate (HR) and heart rate variability (HRV) in psychophysiological research. We provide brief summaries of best practices in measuring HR and HRV via electrocardiographic and photoplethysmographic signals in laboratory, field (ambulatory), and brain-imaging contexts to address research questions incorporating measures of HR and HRV. The Report emphasizes evidence for the strengths and weaknesses of different recording and derivation methods for measures of HR and HRV. Along with this guidance, the Report reviews what is known about the origin of the heartbeat and its neural control, including factors that produce and influence HRV metrics. The Report concludes with checklists to guide authors in study design and analysis considerations, as well as guidance on the reporting of key methodological details and characteristics of the samples under study. It is expected that rigorous and transparent recording and reporting of HR and HRV measures will strengthen inferences across the many applications of these metrics in psychophysiology. The prior Committee Reports on HR and HRV are several decades old. Since their appearance, technologies for human cardiac and vascular monitoring in laboratory and daily life (i.e., ambulatory) contexts have greatly expanded. This Committee Report was prepared for the Society for Psychophysiological Research to provide updated methodological and interpretive guidance, as well as to summarize best practices for reporting HR and HRV studies in humans.

Maternal heart rate variability at 3-months postpartum is associated with maternal mental health and infant neurophysiology

Previous research has demonstrated a critical link between maternal mental health and infant development. However, there is limited understanding of the role of autonomic regulation in postpartum maternal mental health and infant outcomes. In the current study, we tested 76 mother-infant dyads from diverse socioeconomic backgrounds when infants were 3-months of age. We recorded simultaneous ECG from dyads while baseline EEG was collected from the infant; ECG heart rate variability (HRV) and EEG theta-beta ratio and alpha asymmetry were calculated. Dyadic physiological synchrony was also analyzed to better understand the role of autonomic co-regulation. Results demonstrated that lower maternal HRV was associated with higher self-reported maternal depression and anxiety. Additionally, mothers with lower HRV had infants with lower HRV. Maternal HRV was also associated with higher infant theta-beta ratios, but not alpha asymmetry. Exploratory analyses suggested that for mother-infant dyads with greater physiological synchrony, higher maternal HRV predicted increased infant theta-beta ratio via infant HRV. These findings support a model in which maternal mental health may influence infant neurophysiology via alterations in autonomic stress regulation and dyadic physiological co-regulation.

Teachers' Heart Rate Variability and Behavioral Reactions in Aggressive Interactions: Teachers Can Downregulate Their Physiological Arousal, and Progesterone Favors Social Integrative Teacher Responses

Aggressive student behavior is considered one of the main risk factors for teacher stress. The present study investigated teachers' physiological and behavioral reactions when facing aggressive student behavior and examined which resources favor adaptive teacher reactions. The sample included 42 teachers. We assessed (a) teacher self-reports (i.e., resources, risk factors, and vital exhaustion) (b) classroom observations, (c) ambulatory assessments of teachers' heart rate and heart rate variability, and (d) teachers' progesterone concentrations in the hair. The present study focused on a subsample of ten teachers (9 females, Mage = 34.70, SD = 11.32) managing classes which were potentially very stressful as they had a high density of aggressive behavior. High levels of work satisfaction, hair progesterone, and a low level of work overload fostered social integrative teacher responses. Moreover, in 75% of the cases, teachers succeeded in downregulating their physiological reaction. Our results support the notion that teachers evaluate stressors in light of their resources. When they perceive their resources as insufficient for coping with a challenging situation, stress arises, and subsequently, they react inefficiently to aggressive behavior. Thus, teacher education could benefit from strengthening teacher resources and strategies for coping with aggressive student behavior.

Maternal psychophysiology profiles: associations with prenatal opioid use, maternal emotion dysregulation, and newborn neurobehavior

BACKGROUND

Opioid use among pregnant women has more than quadrupled over the past 20 years; however, comorbid risk factors such as emotion dysregulation confound the developmental consequences of prenatal opioid use. Maternal respiratory sinus arrhythmia (RSA) may help to disentangle the comorbid risk factors of prenatal emotion dysregulation and substance use and isolate their consequences on newborn neurobehavior.

METHODS

We examined maternal RSA in response to a mild, infant-related stress task in pregnant people (N = 192; 30 on medications for opioid use disorder) recruited from hospitals and a specialty prenatal clinic for substance use disorder.

RESULTS

Three latent profiles emerged based on maternal RSA reactivity. Mothers with RSA increasing (Profile 3; more nervous system dysregulation) had higher levels of emotion dysregulation than mothers with RSA decreasing (Profile 1; well-regulated nervous system responses) but were not more likely to use opioids. Additionally, RSA profiles were associated with newborn neurobehavior, including attention, regulation, handling, and arousal.

CONCLUSIONS

Given the variability in opioid use across RSA profiles and profile associations with newborn neurodevelopment, future studies should examine protective factors in pregnant individuals using opioids who show more flexible RSA responses.

IMPACT

Our study examined maternal psychophysiology and newborn outcomes in a unique population with high levels of emotion dysregulation and opioid use. Three profiles of maternal respiratory sinus arrythmia (RSA) reactivity were identified during pregnancy: decreasing, blunted, and increasing. The RSA increasing and blunted profiles were associated with higher emotion dysregulation than the decreasing profile. Most pregnant people on medications for opioid use disorder (65%) were grouped into the blunted profile, suggesting they might be more at risk for dysregulated RSA reactivity. Differences in RSA profiles were associated with newborn outcomes, with increasing and blunted RSA predicting more newborn neurobehavioral dysregulation.

Vortioxetine's impact on the autonomic nervous system in depressed children and adolescents: analysis of the heart rate variability

Relationship between depressive disorder and autonomic nervous system has been already discussed. Reduced emotional regulation is supposed to be associated with prefrontal hypofunction and subcortical hyperactivity. The aim of this study was to determine the effect of vortioxetine on heart rate variability (HRV), a parameter of cardiac autonomic regulation, in depressed hospitalized paediatric patients and assess the clinical effectiveness of the drug in this population. We performed repeated polysomnography analyses at admission and after a short treatment in hospital (15.2 days on average) and measured various HRV parameters (RRi, pNN50, RMSSD, LF-HRV, HF-HRV) during wakefulness, N3 and REM sleep stages. Out of 27 study subjects, 67% have improved depression symptoms as well as anxiety and subjective sleep quality after short vortioxetine treatment. We have found a significant decrease in parasympathetic parameters pNN50, RMSSD and HF-HRV during N3 sleep phase, though not exclusively among vortioxetine responders. The anticipated increase in cardiovagal regulation after vortioxetine treatment was not demonstrated in this pilot study, possibly due to the drug's multimodal mechanism and impact on the nucleus tractus solitarii, particularly its antagonism on 5HT-3 receptors. Application of selective drugs could further explain the effect of vortioxetine on HRV in depressed patients.

Developing a Five-Minute Normative Database of Heart Rate Variability for Diagnosing Cardiac Autonomic Dysregulation for Patients with Major Depressive Disorder

Heart rate variability (HRV) is related to cardiac vagal control and emotional regulation and an index for cardiac vagal control and cardiac autonomic activity. This study aimed to develop the Taiwan HRV normative database covering individuals aged 20 to 70 years and to assess its diagnosing validity in patients with major depressive disorder (MDD). A total of 311 healthy participants were in the HRV normative database and divided into five groups in 10-year age groups, and then the means and standard deviations of the HRV indices were calculated. We recruited 272 patients with MDD for cross-validation, compared their HRV indices with the normative database, and then converted them to Z-scores to explore the deviation of HRV in MDD patients from healthy groups. The results found a gradual decline in HRV indices with advancing age in the HC group, and females in the HC group exhibit higher cardiac vagal control and parasympathetic activity than males. Conversely, patients in the MDD group demonstrate lower HRV indices than those in the HC group, with their symptoms of depression and anxiety showing a negative correlation with HRV indices. The Taiwan HRV normative database has good psychometric characteristics of cross-validation.

Impact of Loneliness on Training Gains with Heart Rate Variability Biofeedback in the Elderly: A Pilot Study

The negative impact of loneliness on the health of the elderly is particularly noticeable because of the effects of central control on the autonomic nervous system. Such an impact can be assessed through heart rate variability (HRV) analysis and can be modified using HRV biofeedback training. This study aimed to investigate the impact of different levels of social interaction reported by the elderly on HRV before and after training with HRV biofeedback and after a follow-up period. The participants of this pilot study comprised 16 elderly people of both sexes with a mean age of 71.20 ± 4.92 years. The participants were divided into two groups, the loneliness group (N = 8) and the no-loneliness group (N = 8), based on a combination of both criteria: the institutionalization condition (institutionalized or not) and the score on the loneliness scale (high or low). All participants had their HRV components recorded at baseline, after 14 training sessions with HRV biofeedback (three times a week, 15 min each for 4.5 weeks), and after 4.5 weeks of follow-up without training. After HRV biofeedback training, HRV components increased in both groups. However, the gains lasted at follow-up only in the no-loneliness group. In conclusion, loneliness can influence the maintenance of HRV after interruption of training with HRV biofeedback in the elderly. HRV biofeedback training can be an innovative and effective tool for complementary treatment of elderly individuals, but its effects on lonely elderly individuals need to be further investigated.

Short-Term Effects of Heart Rate Variability Biofeedback on Working Memory

Drawing upon the well-documented impact of long-term heart rate variability biofeedback (HRVB) on psychophysiological responses, this study seeks to explore the short-term effects arising from a single HRVB session during and after paced breathing exercise. The research aligns with the neurovisceral integration model, emphasizing the link between heart rate variability (HRV) levels and cognitive performance. Therefore, a randomized controlled trial employing a between-subjects design was conducted with 38 participants. Each participant was assigned to either the paced breathing intervention group or the spontaneous breathing control group. The study assessed various parameters such as cardiac vagal tone, evaluated through vagally mediated HRV measures, and working memory, measured using the N-back task. Additionally, participants' affective states were assessed through self-reported questionnaires, specifically targeting attentiveness, fatigue, and serenity. The results notably reveal enhancements in the working memory task and an elevated state of relaxation and attention following the HRVB session, as evidenced by higher averages of correct responses, serenity and attentiveness scores. However, the findings suggest that this observed improvement is not influenced by changes in cardiac vagal tone, as assessed using a simple mediation analysis. In conclusion, this study presents promising insights into the impact of a single HRVB session, laying the foundation for future research advancements in this domain.

A theoretical exploration of polyvagal theory in creative arts and psychomotor therapies for emotion regulation in stress and trauma

Polyvagal theory advocates for working with the body, becoming aware of the body and connecting with the senses. Similarly, paying attention to and influencing one's physical and sensory experience is a core aspect of the creative arts and psychomotor therapies. Polyvagal theory offers opportunities for strengthening resilience by treating emotion-regulation problems, stress, and trauma, as well as restoring regulation of the autonomic nervous system. Paying attention to and influencing physical and sensory experiences are core aspects of creative arts and psychomotor therapies. This theoretical paper explores how polyvagal theory can serve as a foundational theory and support the creative arts and psychomotor therapies for emotion regulation in stress and trauma. A number of pillars in polyvagal theory have links with arts therapies, such as an emphasis on physical and sensory experience in situations of safety or threat. This theory may offer insight into the role of the body in stressful situations, the role of co-and self-regulation, and thus the functioning of and the rationale for use of creative arts and psychomotor therapies. Through interventions focused on promoting healthy autonomic responses and regulating physiological responses, clients can learn to better regulate and process their emotional experiences. Although this could be broadly useful, it would seem particularly promising in therapies focused on stress and trauma. This article provides an introduction to polyvagal theory and outlines how it can serve as an explanatory, hypothetical model for the working mechanisms that underlie creative arts and psychomotor therapies. The application of PVT in creative arts and psychomotor therapies will be explored by describing techniques for "noticing and naming" and "learning to change," as well as by highlighting the role of PVT in the therapeutic relationship. It provides case examples and discusses the role of creative arts and psychomotor therapies for stress regulation and resilience conceptualized in line with the polyvagal theory.

The Predictive Potential of Heart Rate Variability for Depression

Heart rate variability (HRV),a measure of the fluctuations in the intervals between consecutive heartbeats, is an indicator of changes in the autonomic nervous system. A chronic reduction in HRV has been repeatedly linked to clinical depression. However, the chronological and mechanistic aspects of this relationship, between the neural, physiological, and psychopathological levels, remain unclear. In this review we present evidence by which changes in HRV might precede the onset of depression. We describe several pathways that can facilitate this relationship. First, we examine a theoretical model of the impact of autonomic imbalance on HRV and its role in contributing to mood dysregulation and depression. We then highlight brain regions that are regulating both HRV and emotion, suggesting these neural regions, and the Insula in particular, as potential mediators of this relationship. We also present additional possible mediating mechanisms involving the immune system and inflammation processes. Lastly, we support this model by showing evidence that modification of HRV with biofeedback leads to an improvement in some symptoms of depression. The possibility that changes in HRV precede the onset of depression is critical to put to the test, not only because it could provide insights into the mechanisms of the illness but also because it may offer a predictive anddiagnosticphysiological marker for depression. Importantly, it could also help to develop new effective clinical interventions for treating depression.

Preschool mother-child emotional preparation program leads to significant improvement in autonomic regulation: a randomized controlled trial

Introduction

Many studies have documented the profound impact that the mother-child relationship has on child sociality and behavior. However, the biological mechanisms that govern the relationship are poorly understood. We developed a mother-child emotional preparation program (MCEP), based on a novel autonomic nervous system learning mechanism. MCEP is hypothesized to condition the child's autonomic nervous system to better meet the preschool socioemotional classroom challenges.

Methods

We conducted a randomized controlled trial of MCEP, comparing a group of children receiving standard curriculum with children receiving standard curriculum plus MCEP. Previously, we reported that the MCEP mother-child dyads (vs controls) were more emotionally connected at six months post intervention and MCEP children (vs controls) displayed better socioemotional behavior at home and in the classroom. At six months post intervention, mothers and children underwent a stressful interaction-interruption paradigm, during which we acquired child ECG. We analyzed heart rate and several measures of child heart rate variability obtained during the 10-minute post-stress recovery period.

Results

We found that MCEP children showed better autonomic regulation following the stressor, as measured by lower heart rate (p = 0.017) and increased high frequency respiratory sinus arrhythmia (RSA) or vagal tone (p = 0.043). Surprisingly, despite a sample size limited by COVID (n = 12 and 12), the effect sizes were large (g's ranging from 0.89 to 1.09). In addition, we found significant correlations with large effect sizes between autonomic measures and scores on the Welch Emotional Connection Screen (WECS).

Discussion

These findings support the conclusion that MCEP had a significant positive impact on child autonomic regulation in response to stress, which correlates with behavioral assessments of emotional connection. We discuss theoretical considerations and the implications of our findings for preschool education programs in general. This trial was retrospectively registered (clinicaltrial.gov registry NCT02970565) three months after the start of the first recruitment on April 9, 2019.

From Psychostasis to the Discovery of Cardiac Nerves: The Origins of the Modern Cardiac Neuromodulation Concept

This review explores the historical development of cardiology knowledge, from ancient Egyptian psychostasis to the modern comprehension of cardiac neuromodulation. In ancient Egyptian religion, psychostasis was the ceremony in which the deceased was judged before gaining access to the afterlife. This ritual was also known as the "weighing of the heart" or "weighing of the soul". The Egyptians believed that the heart, not the brain, was the seat of human wisdom, emotions, and memory. They were the first to recognize the cardiocentric nature of the body, identifying the heart as the center of the circulatory system. Aristotle (fourth century BC) considered the importance of the heart in human physiology in his philosophical analyses. For Galen (third century AD), the heart muscle was the site of the vital spirit, which regulated body temperature. Cardiology knowledge advanced significantly in the 15th century, coinciding with Leonardo da Vinci and Vesalius's pioneering anatomical and physiological studies. It was William Harvey, in the 17th century, who introduced the concept of cardiac circulation. Servet's research and Marcello Malpighi's discovery of arterioles and capillaries provided a more detailed understanding of circulation. Richard Lower emerged as the foremost pioneer of experimental cardiology in the late 17th century. He demonstrated the heart's neural control by tying off the vagus nerve. In 1753, Albrecht von Haller, a professor at Göttingen, was the first to discover the heart's automaticity and the excitation of muscle fibers. Towards the end of the 18th century, Antonio Scarpa challenged the theories of Albrecht von Haller and Johann Bernhard Jacob Behrends, who maintained that the myocardium possessed its own "irritability", on which the heartbeat depended, and was independent of neuronal sensitivity. Instead, Scarpa argued that the heart required innervation to maintain life, refuting Galenic notions. In contemporary times, the study of cardiac innervation has regained prominence, particularly in understanding the post-acute sequelae of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection (PASC), which frequently involves cardiorespiratory symptoms and dysregulation of the intrinsic cardiac innervation. Recently, it has been recognized that post-acute sequelae of acute respiratory infections (ARIs) due to other pathogens can also be a cause of long-term vegetative and somatic symptoms. Understanding cardiac innervation and modulation can help to recognize and treat long COVID and long non-COVID-19 (coronavirus disease 2019) ARIs. This analysis explores the historical foundations of cardiac neuromodulation and its contemporary relevance. By focusing on this concept, we aim to bridge the gap between historical understanding and modern applications. This will illuminate the complex interplay between cardiac function, neural modulation, cardiovascular health, and disease management in the context of long-term cardiorespiratory symptoms and dysregulation of intrinsic cardiac innervations.

Effects of a mindfulness course on vital signs and five facet mindfulness questionnaire scores of college students

Objective: This study examined the effects of a college mindfulness course on vital-signs and Five Facet Mindfulness Questionnaire (FFMQ) scores. Participants: Two independent groups of 20 students were enrolled in the mindfulness course during the Fall 2018 (Trial 1) and Spring 2019 (Trial 2) semesters. Methods: Blood pressure, heart rate, and respiration rate were recorded before and after in-class mindfulness meditations several times throughout each semester. FFMQ scores were recorded at the beginning and conclusion of each semester. Results: Statistical analyses indicated that 20 minutes of mindfulness meditation significantly decreased respiration rate (both trials) and heart rate (Trial 2) for female students. There were significant changes in the FFMQ mean scores for "non-react," "observe," "act aware," and "non-judge." Conclusions: These results suggest that mindfulness meditation may be beneficial for students to enhance their well-being. Recommendations are provided to further examine the implications of consistent mindfulness practices for college students.

Cardiac Autonomic Reactivity Tests in Type A and Type B Personalities

BACKGROUND

A considerable link between personality types and cardiovascular diseases (CVDs) has been seen. Autonomic responses in both type A and type B personality individuals were found to be influenced by their personality traits. The study suggests further research on cardiac autonomic functions in larger sample sizes and the use of non-invasive screening techniques like cardiovascular reflex tests to stratify participants' risk of future illness.

OBJECTIVE

This study aimed to assess autonomic stress reactivity tests in type A and type B personalities using cardiovascular reflex tests.

METHODS

This study was conducted at the Department of Physiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. The Hunter-Wolf Personality Questionnaire Scale was used to identify 60 adults, 30 of whom were classified to have type A personality and 30 have type B personality, from the psychiatry department. Autonomic function tests, such as the handgrip tests, cold pressor test, deep breathing test (DBT), lying-to-standing test (LST), and Valsalva maneuver, were performed and recorded for each subject. IBM SPSS Statistics for Windows, version 21 (released 2012; IBM Corp., Armonk, New York, United States) was used for the compilation and analysis of data.

RESULTS

 The E:I (expiration-to-inspiration) ratio and delta heart rate of the type A personality patients both significantly decreased (p = 0.000*) as compared to the type B personality patients (1.18 ± 0.03 versus 1.25 ± 0.77 and 1.18 ± 0.03 versus 1.25 ± 0.77). The Valsalva ratio of the type A personality patients decreased (1.38 ± 0.10) as compared to the type B personality patients (1.48 ± 0.18), which was statistically significant (p = 0.001*). The 30:15 ratio in the type A personality patients was significantly decreased (p = 0.03*) compared to the type B personality patients (1.12 ± 0.05 versus 1.15 ± 0.10). The handgrip test and cold pressor test results were statistically insignificant.

CONCLUSION

Compared to the type B personality patients, which exhibited an increase in both parasympathetic and sympathetic reactivity, the type A personality patients exhibited a reduction in resting cardiovascular parameters and resting autonomic tone. Consequently, in order to stratify the participants' risk of future illness, we recommend employing non-invasive procedures, such as cardiovascular reflex tests, as a screening technique.

Calm Contact Technique Based on the Endocrinological Mechanism of Hypnosis-A Theoretical Proposal

This paper proposes the "calm contact" technique: an imaginative scenario where someone is in gentle contact with a loved one where the essence of the experience is to enjoy safety and calmness in peaceful social contact. The theoretical background is outlined by combining the brain mechanisms of stress reactions and hypnosis. In addition to the ancient stress responses (flight or fight or freeze), there are oxytocin-based options at the human level: tend and befriend behavior and the state of calm and connection, which is not a stress reaction but a resting reaction. These social-based reactions could prevent the organism from the primitive freezing response. Some studies proved that "hypnosis" as a setting reduces cortisol levels and could raise oxytocin levels. The beneficial mechanisms of the "calm contact" technique are analyzed in relation to "social support" and the psychoaffective effects of central oxytocin. The subjective effects of the proposed technique are outlined based on reports of healthy volunteers. The "calm contact" technique could be an alternative or adjunct to the "safe place" technique, applying the recent findings of endocrinological brain mechanisms of hypnosis. Clinical implications and limitations are briefly summarized.

The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature

Suicide prevention represents a global imperative, and efforts to identify potential risk factors are intensifying. Among these, emotional regulation abilities represent a transdiagnostic component that may have an impactful influence on suicidal ideation and behavior. Therefore, the present systematic review aimed to investigate the association between emotion dysregulation and suicidal ideation and/or behavior in adult participants. The review followed PRISMA guidelines, and the research was performed through four major electronic databases (PubMed/MEDLINE, Scopus, PsycInfo, and Web of Science) for relevant titles/abstracts published from January 2013 to September 2023. The review included original studies published in peer-reviewed journals and in English that assessed the relationship between emotional regulation, as measured by the Difficulties in Emotional Regulation Scale (DERS), and suicidal ideation and/or behavior. In total, 44 studies were considered eligible, and the results mostly revealed significant positive associations between emotion dysregulation and suicidal ideation, while the findings on suicide attempts were more inconsistent. Furthermore, the findings also confirmed the role of emotion dysregulation as a mediator between suicide and other variables. Given these results, it is important to continue investigating these constructs and conduct accurate assessments to implement effective person-centered interventions.

Evaluating the Impact of an App-Delivered Mindfulness Meditation Program to Reduce Stress and Anxiety During Pregnancy: Pilot Longitudinal Study

BACKGROUND

Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility.

OBJECTIVE

The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy.

METHODS

A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participant's levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring.

RESULTS

Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P<.0001). Hierarchical linear modeling revealed a statistically significant reduction in the physiological data reflective of stress in 1 of 6 heart rate variability metrics, the low-frequency power band, which decreased by 13% (P=.006). A total of 65% of study participants (n=13) reported their sleep improved during the trial, and 95% (n=19) stated that learning mindfulness helped with other aspects of their lives. Participant retention was 100%, with 65% of participants (n=13) completing about two-thirds of the intervention, and 50% of participants (n=10) completing ≥95%.

CONCLUSIONS

This study found evidence to support the Headspace app as an effective intervention to aid in stress and anxiety reduction during pregnancy.

The Effect of Heart Rate Variability Biofeedback on Basketball Performance Tests

The purpose of this study is to investigate the effects of 10-week heart rate variability biofeedback training on basketball skills, free throws, and heart rate variability parameters. Twenty-four basketball players (experimental, n = 12 and control, n = 12) aged 18-24 years volunteered to participate in this study. The experimental group participated in a 10-week heart rate variability biofeedback and basketball training program, while the control group only participated in the 10-week basketball training session. Basketball free-throw performance, basketball skills, and heart rate variability tests were conducted on the experimental and control groups before and after the 10-week intervention. Consequently, we discovered that basketball free-throw performance, breathing frequency, and heart rate variability parameters, which reflect vagal modulation of parasympathetic activity, improved in participants who underwent the 10-week heart rate variability biofeedback and basketball training, and not in those who took basketball training only. Our findings propose that heart rate variability biofeedback, alongside basketball workouts, can contribute to better basketball free-throw performance potentially through improved autonomic nervous system functioning.

No Evidence That Working Memory Modulates the Plasticity of the Nociceptive System, as Measured by Secondary Mechanical Hypersensitivity

The effect of cognition on the plasticity of the nociceptive system remains controversial. In this study, we examined whether working memory can buffer against the development of secondary hypersensitivity. Thirty-five healthy women participated in 3 experimental conditions. In each condition, they underwent electrical stimulation of the skin for 2 minutes (middle-frequency electrical stimulation [MFS]), which induces secondary hypersensitivity. During MFS, participants executed either an individually tailored and rewarded n-back task (working memory condition), a rewarded reaction-time task (non-working memory condition), or no task at all (control condition). Before and after MFS, participants rated the self-reported intensity and unpleasantness of mechanical pinprick stimuli. Fear of MFS was also assessed. Heart rate variability was measured to examine potential differences between the 3 conditions and steady-state evoked potentials to the electrical stimulation were recorded to investigate differences in cortical responses. We report no significant difference in hypersensitivity between the 3 conditions. Moreover, engaging in the cognitive tasks did not affect the heart rate variability or the steady-state evoked potentials. Interestingly, higher fear of MFS predicted greater hypersensitivity. In conclusion, we found no evidence that working memory affects the plasticity of the nociceptive system, yet pain-related fear plays a role. PERSPECTIVE: This study shows that the execution of a cognitive task, irrespective of cognitive load or working memory, does not significantly modulate the development of secondary hypersensitivity, heart rate variability, or steady-state evoked potentials. However, higher pain-related fear seems to contribute to greater hypersensitivity.

A long and winding road: My personal journey to oxytocin with no return

The present paper is the personal narration of the author reviewing her scientific pathways that led her toward the study of oxytocin. My work began with a pioneering study showing a decreased number of the serotonin transporter proteins in romantic lovers. This unexpected finding promoted my interest in the neurobiology of human emotions and feelings, and significantly shifted my research focus from diseases to physiological states that underlie "love." During this time increasing experimental data broadened the spectrum of activities of oxytocin from female functions, such as parturition and lactation, to modulation of the stress and immune system. The literature also began to reveal an important role for oxytocin in a sense of safety and wellbeing, processes that are critical to both love and survival. I suggest here that future studies should disentangle different emerging questions regarding the exact role of oxytocin within human nature, as well as its possible therapeutic applications in different physiological conditions and pathological states. Understanding these, in turn, holds the potential to improve the lives of both individuals and societies.

Association of Self-Reported Autonomic Symptoms With Sensor-Based Physiological Measures

OBJECTIVE

Autonomic regulation of organ and tissues may give rise to disruptions of typical functions. The Body Perception Questionnaire Short Form (BPQ-SF) includes items that were developed to assess autonomic symptoms in daily life. This pair of studies aimed to establish previously unexplored psychometric properties of the BPQ-SF autonomic symptoms scale, develop normative values for clinical and research use, and assess the convergence of self-reports with sensor-based measures.

METHODS

Study 1 reports exploratory and confirmatory factor analysis on BPQ-SF autonomic symptom items from a large US population-based online study ( n = 2048). In study 2, BPQ-SF scores were examined for associations with heart period, respiratory sinus arrhythmia, and skin conductance during seated leg lifts in a community sample ( n = 62).

RESULTS

Study 1 results supported a two-factor supradiaphragmatic and subdiaphragmatic autonomic symptom solution (confirmatory factor analysis: root mean squared error of approximation = 0.040, Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99), although a one-factor solution also fit the data well (root mean squared error of approximation = 0.080, Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99). In study 2, heart period responses to leg lifts and rests were demonstrated at all autonomic symptom levels. However, low autonomic symptoms were associated with optimal autonomic nervous system patterns of activation and recovery to baseline levels. Moderate symptoms were associated with prolonged sympathetic activation. The highest symptom levels were associated with impaired autonomic nervous system coordination across activation and recovery.

CONCLUSIONS

Results support the utility of self-reports of autonomic symptoms in research and clinical applications, with higher symptoms likely indicating autonomic impairment.

Predicting postpartum depressive symptoms by evaluating self-report autonomic nervous system reactivity during pregnancy

OBJECTIVE

Altered self-reported autonomic reactivity is associated with worse mental health in the general population. Although dysfunctional changes in ANS during pregnancy have been investigated in relation to depressive symptoms, no studies addressed the relationship between self-report autonomic reactivity during pregnancy and depressive symptoms after the delivery. The present study aimed to assess the impact of prepartum self-reported autonomic reactivity on the development of postpartum depressive symptoms.

METHODS

In this longitudinal study, 170 women were assessed during pregnancy (i.e., second or third trimester) and after childbirth (i.e., one month after the delivery). Self-reported autonomic reactivity was assessed through the Body Perception Questionnaire - Short Form that evaluates the autonomic functions related to organs above (i.e., supradiaphragmatic reactivity) and below (i.e., subdiaphragmatic reactivity) the diaphragm. In addition, prepartum and postpartum depressive symptoms were evaluated using the Patient Health Questionnaire - 9.

RESULTS

Findings showed that higher prepartum supradiaphragmatic reactivity predicted higher depressive symptoms in the postpartum period (β = 0.112, p = 0.009) after controlling for prepartum depressive symptomatology and other potential covariates.

CONCLUSIONS

Evaluation of self-reported autonomic activity may be a useful tool to identify antenatally women at risk of postpartum depressive symptoms. Future studies are needed to evaluate the effectiveness of interventions aimed at reducing the threat-responsive autonomic reactivity at rest and improving adaptive autonomic regulation to prevent postpartum depression.

The vagal paradox: A polyvagal solution

Although there is a consistent literature documenting that vagal cardioinhibitory pathways support homeostatic functions, another less frequently cited literature implicates vagal cardioinhibitory pathways in compromises to survival in humans and other mammals. The latter is usually associated with threat reactions, chronic stress, and potentially lethal clinical conditions such as hypoxia. Solving this 'vagal paradox' in studies conducted in the neonatal intensive care unit served as the motivator for the Polyvagal Theory (PVT). The paradox is resolved when the different functions of vagal cardioinhibitory fibers originating in two anatomically distinguishable brainstem areas are recognized. One pathway originates in a dorsal area known as the dorsal motor nucleus of the vagus and the other in a ventral area of the brainstem known as nucleus ambiguus. Unlike mammals, in all ancestral vertebrates from which mammals evolved, cardioinhibitory vagal fibers primarily originate in the dorsal motor nucleus of the vagus. Thus, in mammals the vagus nerve is 'poly' vagal because it contains two distinct efferent pathways. Developmental and evolutionary biology identify a ventral migration of vagal cardioinhibitory fibers that culminate in an integrated circuit that has been labeled the ventral vagal complex. This complex consists of the interneuronal communication of the ventral vagus with the source nuclei involved in regulating the striated muscles of the head and face via special visceral efferent pathways. This integrated system enables the coordination of vagal regulation of the heart with sucking, swallowing, breathing, and vocalizing and forms the basis of a social engagement system that allows sociality to be a potent neuromodulator resulting in calm states that promote homeostatic function. These biobehavioral features, dependent on the maturation of the ventral vagal complex, can be compromised in preterm infants. Developmental biology informs us that in the immature mammal (e.g., fetus, preterm infant) the ventral vagus is not fully functional and myelinization is not complete; this neuroanatomical profile may potentiate the impact of vagal cardioinhibitory pathways originating in the dorsal motor nucleus of the vagus. This vulnerability is confirmed clinically in the life-threatening reactions of apnea and bradycardia in human preterm newborns, which are hypothetically mediated through chronotropic dorsal vagal pathways. Neuroanatomical research documents that the distribution of cardioinhibitory neurons representing these two distinct vagal source nuclei varies among mammals and changes during early development. By explaining the solution of the 'vagal paradox' in the preterm human, the paper highlights the functional cardioinhibitory functions of the two vagal source nuclei and provides the scientific foundation for the testing of hypotheses generated by PVT.

EgoActive: Integrated Wireless Wearable Sensors for Capturing Infant Egocentric Auditory-Visual Statistics and Autonomic Nervous System Function 'in the Wild'

There have been sustained efforts toward using naturalistic methods in developmental science to measure infant behaviors in the real world from an egocentric perspective because statistical regularities in the environment can shape and be shaped by the developing infant. However, there is no user-friendly and unobtrusive technology to densely and reliably sample life in the wild. To address this gap, we present the design, implementation and validation of the EgoActive platform, which addresses limitations of existing wearable technologies for developmental research. EgoActive records the active infants' egocentric perspective of the world via a miniature wireless head-mounted camera concurrently with their physiological responses to this input via a lightweight, wireless ECG/acceleration sensor. We also provide software tools to facilitate data analyses. Our validation studies showed that the cameras and body sensors performed well. Families also reported that the platform was comfortable, easy to use and operate, and did not interfere with daily activities. The synchronized multimodal data from the EgoActive platform can help tease apart complex processes that are important for child development to further our understanding of areas ranging from executive function to emotion processing and social learning.

Development and Parasympathetic Regulation in Male and Female Adolescents with Autism Spectrum Disorder: A Two-Timepoint Longitudinal Study

Prolonged dysregulation of the autonomic nervous system (ANS) may increase propensity for physical or psychiatric illness. The current study examined differences in respiratory sinus arrhythmia (RSA) regulation in 215 adolescents with or without autism spectrum disorder (ASD) at Time 1 (T1; 10-13 years old) and 1 year later (Time 2; T2). Linear mixed effects models demonstrated lower RSA regulation in ASD, and a small interaction effect, showing blunted change in RSA from T1 to T2. Developmental differences in RSA regulation were particularly notable in females with ASD and those taking psychotropic medications. Results expand previous findings of reduced parasympathetic regulation in ASD by revealing a blunted developmental slope, indicating diagnostic differences may persist or worsen over time, particularly in females.

Signal processing in the vagus nerve: Hypotheses based on new genetic and anatomical evidence

Each organism must regulate its internal state in a metabolically efficient way as it interacts in space and time with an ever-changing and only partly predictable world. Success in this endeavor is largely determined by the ongoing communication between brain and body, and the vagus nerve is a crucial structure in that dialogue. In this review, we introduce the novel hypothesis that the afferent vagus nerve is engaged in signal processing rather than just signal relay. New genetic and structural evidence of vagal afferent fiber anatomy motivates two hypotheses: (1) that sensory signals informing on the physiological state of the body compute both spatial and temporal viscerosensory features as they ascend the vagus nerve, following patterns found in other sensory architectures, such as the visual and olfactory systems; and (2) that ascending and descending signals modulate one another, calling into question the strict segregation of sensory and motor signals, respectively. Finally, we discuss several implications of our two hypotheses for understanding the role of viscerosensory signal processing in predictive energy regulation (i.e., allostasis) as well as the role of metabolic signals in memory and in disorders of prediction (e.g., mood disorders).

Athletes' self-compassion and emotional resilience to failure: the mediating role of vagal reactivity

Whether athletes' self-compassion predicts their emotional resilience to failure has yet to be empirically tested. Moreover, as an important physiological process of stress regulation, vagal reactivity is a plausible physiological mechanism for this relationship. Through a laboratory-based observational study of 90 college athletes, this research explores the influence of athletes' trait self-compassion on their emotional resilience when recalling failure, and examines whether vagal reactivity plays a mediating role. The results show that self-compassion did not significantly predict athletes' positive emotions but did significantly predict better recovery from negative emotions after recalling failure events. Furthermore, vagal reactivity was a significant mediator between self-compassion and recovery from negative emotions.

FUNDAMENTAL CHALLENGES AND LIKELY REFUTATIONS OF THE FIVE BASIC PREMISES OF THE POLYVAGAL THEORY

The polyvagal collection of hypotheses is based upon five essential premises, as stated by its author (Porges, 2011). Polyvagal conjectures rest on a primary assumption that the brainstem ventral and dorsal regions in mammals each have their own unique mediating effects upon vagal control of heart rate. The polyvagal hypotheses link these putative dorsal- vs. ventral-vagal differences to socioemotional behavior (e.g. defensive immobilization, and social affiliative behaviors, respectively), as well as to trends in the evolution of the vagus nerve (e.g. Porges, 2011 & 2021a). Additionally, it is essential to note that only one measurable phenomenon-as index of vagal processes-serves as the linchpin for virtually every premise. That phenomenon is respiratory sinus arrhythmia (RSA), heart-rate changes coordinated to phase of respiration (i.e. inspiration vs. expiration), often employed as an index of vagally, or parasympathetically, mediated control of heart rate. The polyvagal hypotheses assume that RSA is a mammalian phenomenon, since Porges (2011) states "RSA has not been observed in reptiles." I will here briefly document how each of these basic premises have been shown to be either untenable or highly implausible based on the available scientific literature. I will also argue that the polyvagal reliance upon RSA as equivalent to general vagal tone or even cardiac vagal tone is conceptually a category mistake (Ryle, 1949), confusing an approximate index (i.e. RSA) of a phenomenon (some general vagal process) with the phenomenon, itself.

Mindful Coping Power Effects on Children's Autonomic Nervous System Functioning and Long-Term Behavioral Outcomes

Mindful Coping Power (MCP) was developed to enhance the effects of the Coping Power (CP) preventive intervention on children's reactive aggression by integrating mindfulness training into CP. In prior pre-post analyses in a randomized trial of 102 children, MCP improved children's self-reported anger modulation, self-regulation, and embodied awareness relative to CP but had fewer comparative effects on parent- and teacher-reported observable behavioral outcomes, including reactive aggression. It was hypothesized that MCP-produced improvements in children's internal awareness and self-regulation, if maintained or strengthened over time with ongoing mindfulness practice, would yield improvements in children's observable prosocial and reactive aggressive behavior at later time points. To appraise this hypothesis, the current study examined teacher-reported child behavioral outcomes at a one-year follow-up. In the current subsample of 80 children with one-year follow-up data, MCP produced a significant improvement in children's social skills and a statistical trend for a reduction in reactive aggression compared with CP. Further, MCP produced improvements in children's autonomic nervous system functioning compared with CP from pre- to post-intervention, with a significant effect on children's skin conductance reactivity during an arousal task. Mediation analyses found that MCP-produced improvements in inhibitory control at post-intervention mediated program effects on reactive aggression at the one-year follow-up. Within-person analyses with the full sample (MCP and CP) found that improvements in respiratory sinus arrhythmia reactivity were associated with improvements in reactive aggression at the one-year follow-up. Together, these findings indicate that MCP is an important new preventive tool to improve embodied awareness, self-regulation, stress physiology, and observable long-term behavioral outcomes in at-risk youth. Further, children's inhibitory control and autonomic nervous system functioning emerged as key targets for preventive intervention.

Impairments in Physiological Reactivity to Emotive Stimuli After Traumatic Brain Injury: A Systematic Review of Skin Conductance and Heart Rate Variability Evidence

OBJECTIVE

To examine evidence of impairments in physiological reactivity to emotive stimuli following traumatic brain injury (TBI).

METHODS

A search of PsychINFO, CINAHL (Cumulative Index to Allied Health Literature), Web of Science, EMBASE (Excerpta Medica dataBASE), and Scopus databases was conducted from 1991 to June 24, 2021, for studies comparing changes in skin conductance or heart rate variability to emotive stimuli between adults with TBI and controls. Two reviewers independently assessed eligibility and rated methodological quality.

RESULTS

Twelve eligible studies examined physiological reactivity to laboratory-based emotive stimuli, which included nonpersonal pictures/videos, posed emotion, stressful events, and personal event recall. Overall, 9 reported evidence that individuals with TBI experience lower physiological reactivity to emotive stimuli compared with healthy controls, although the findings varied according to the type and valence of emotional stimuli and physiological parameter. Most studies using nonpersonal pictures or videos found evidence of lower physiological reactivity in TBI participants compared with controls.

CONCLUSIONS

Based on laboratory-based studies, individuals with TBI may experience lower physiological reactivity to emotive stimuli. Further research is needed to investigate physiological responses to personally relevant emotional stimuli in real-world settings and to understand the interplay between physiological reactivity, subjective experiences, and behavior.

Associations between Autonomic and Endocrine Reactivity to Stress in Adolescence: Related to the Development of Anxiety?

Internalizing disorders in adolescence have been associated with disturbances in autonomic and endocrine functioning. Because the prefrontal cortex and the limbic system play a central role in regulating both the autonomic and the endocrine systems, their joint functioning is hypothesized to provide information about the potential development of internalizing symptoms throughout adolescence, notably in the preclinical stage. This hypothesis was tested in a sample of 198 adolescents from the general population. Heart rate variability (HRV) and skin conductance levels (SCLs) were measured before, during, and after a public speaking task. These autonomic parameters were associated with cortisol response to the task in the complete sample as well as in low- and high-anxiety adolescents separately. Self-reported social anxiety, low HRV, and high SCL recovery values were predictive of cortisol response. Importantly, in low-anxiety adolescents, only HRV during the task predicted the cortisol response, whereas, in their highly anxious peers, both HRV and SCL were strongly associated with this response. In the latter finding, age was a prominent factor. Additional analyses supported the idea that the interaction of autonomic and endocrine reactivity is subject to natural development. These findings provide evidence that adolescence might be a period of highly interactive emotional–neurobiological development, particularly with respect to the development of stress management skills.

Initial Outcomes of the Safe and Sound Protocol on Patients with Adult Autism Spectrum Disorder: Exploratory Pilot Study

Sensory impairments are common features of autism spectrum disorder (ASD) and are associated with its social impairments. However, there is no established treatment for these impairments in adults with ASD. The Safe & Sound Protocol (SSP) is a listening program designed to improve social communication skills by reducing auditory hypersensitivity. We investigated the effectiveness of the SSP for adults with ASD. We administered the SSP to six participants with ASD aged 21-44 years old, and the effects were assessed using the Social Responsiveness Scale, Second Edition (SRS-2). Secondary outcomes were assessed using the Center for Epidemiological Studies Depression Scale (CES-D), State-Trait Anxiety Inventory (STAI), WHO Quality of Life 26 (WHOQOL-BREF), and Adolescent/Adult Sensory Profile (A/ASP). In this study, only the Social Awareness scale of the SRS-2 Family-Report showed a significant improvement after the intervention. In addition, it was significantly correlated with physical health of WHOQOL-BREF (r = -0.577, p = 0.012), state and trait anxiety of STAI (r = 0.576, p = 0.012; r = 0.708, p = 0.00009, respectively), and CES-D (r = 0.465, p = 0.05). In conclusion, the SSP has a partial effect on social impairments in adults with ASD, specifically on the Social Awareness subscale of the SRS-2.

Gut-Brain Axis Perspective on Negative Symptoms and Their Neighbors in Early Adolescence: Can We Move Care Upstream?

The current study investigated symptom network patterns in adolescents from a gut-brain-axis (GBA) biopsychosocial perspective. Our secondary analysis of data from the Adolescent Brain Cognitive Development Study assessed symptom relationships using network analysis to provide information about multivariate structural dependencies among 41 signs and symptoms. Cross-sectional EBICglasso symptom networks were evaluated to assess patterns associated with anhedonia and depressed mood. Significant differences were identified between symptom neighbors of anhedonia compared with depressed mood based on stratification by age. The GBA perspective revealed several symptom neighbors that could expand clinical assessment, diagnosing criteria, education, and interventions for adolescents at risk for, or with, anhedonia or depressed mood. Results speak to the unique impact of symptoms on health that are not interchangeable with other symptoms and do not have equal effects. Mental health nurses should consider a holistic and proactive precision health approach to improving health and well-being through evidence-based assessment of symptom associations. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].