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

Quantifying the Autonomic Response to Stressors-One Way to Expand the Definition of "Stress" in Animals

Quantifying how whole organisms respond to challenges in the external and internal environment ("stressors") is difficult. To date, physiological ecologists have mostly used measures of glucocorticoids (GCs) to assess the impact of stressors on animals. This is of course too simplistic as Hans Seyle himself characterized the response of organisms to "noxious stimuli" using multiple physiological responses. Possible solutions include increasing the number of biomarkers to more accurately characterize the "stress state" of animal or just measuring different biomarkers to more accurately characterize the degree of acute or chronic stressors an animal is experiencing. We focus on the latter and discuss how heart rate (HR) and heart rate variability (HRV) may be better predictors of the degree of activation of the sympathetic-adrenal-medullary system and complement or even replace measures of GCs as indicators of animal health, welfare, fitness, or their level of exposure to stressors. The miniaturization of biological sensor technology ("bio-sensors" or "bio-loggers") presents an opportunity to reassess measures of stress state and develop new approaches. We describe some modern approaches to gathering these HR and HRV data in free-living animals with the aim that heart dynamics will be more integrated with measures of GCs as bio-markers of stress state and predictors of fitness in free-living animals.

Vagal Flexibility Mediates the Association Between Resting Vagal Activity and Cognitive Performance Stability Across Varying Socioemotional Demands

Vagal flexibility describes the ability to modulate cardiac vagal responses to fit a dynamic range of challenges. Extant theory on vagal function implies that vagal flexibility is a mediating mechanism through which resting vagal activity, a putative individual difference related to self-regulation, affects adaptive behavior and cognition. Nevertheless, little research has directly tested this hypothesis, thereby leaving fundamental mechanisms of vagal function and adaptability unclear. To this end, 47 healthy subjects completed a 5 min baseline followed by Stroop tasks combined with concurrent auditory distractors. There were four different Stroop task conditions that varied the social and emotional content of the auditory distractors. Electrocardiogram was continuously recorded to assess vagal responses to each condition as heart rate variability [root mean square of successive differences (RMSSDs)] reactivity. Vagal flexibility significantly mediated the association between resting vagal activity and stability of inhibition performance (Stroop interference) scores. In particular, higher resting RMSSD was related to higher standard deviation of RMSSD reactivity scores, reflecting greater differences in RMSSD reactivity between distractor conditions (i.e., greater vagal flexibility). Greater vagal flexibility was in turn related to more stability in Stroop interference across the same conditions. The mean of RMSSD reactivity scores across conditions was not significantly related to resting RMSSD or stability in Stroop performance, and mean RMSSD reactivity did not mediate relations between resting RMSSD and stability in Stroop performance. Overall, findings suggest that vagal flexibility may promote the effects of resting vagal activity on stabilizing cognitive inhibition in the face of environmental perturbations.

Sleep restriction alters children's positive emotional responses, but effects are moderated by anxiety

BACKGROUND

An abundance of cross-sectional research links inadequate sleep with poor emotional health, but experimental studies in children are rare. Further, the impact of sleep loss is not uniform across individuals and pre-existing anxiety might potentiate the effects of poor sleep on children's emotional functioning.

METHODS

A sample of 53 children (7-11 years, M = 9.0; 56% female) completed multimodal, assessments in the laboratory when rested and after two nights of sleep restriction (7 and 6 hr in bed, respectively). Sleep was monitored with polysomnography and actigraphy. Subjective reports of affect and arousal, psychophysiological reactivity and regulation, and objective emotional expression were examined during two emotional processing tasks, including one where children were asked to suppress their emotional responses.

RESULTS

After sleep restriction, deleterious alterations were observed in children's affect, emotional arousal, facial expressions, and emotion regulation. These effects were primarily detected in response to positive emotional stimuli. The presence of anxiety symptoms moderated most alterations in emotional processing observed after sleep restriction.

CONCLUSIONS

Results suggest inadequate sleep preferentially impacts positive compared to negative emotion in prepubertal children and that pre-existing anxiety symptoms amplify these effects. Implications for children's everyday socioemotional lives and long-term affective risk are highlighted.

Impact of hypnotic safety on disorders of gut-brain interaction: A pilot study

Functional gastrointestinal disorders, i.e., abdominal conditions without identifiable structural etiologies, are seen frequently in primary care and specialty practices. As subtle physiological processes have been identified as potential contributing factors to these functional disorders, these disorders have been recently relabeled, Disorders of Gut-Brain Interaction (DGBI). Moreover, some of these processes, e.g., sympathetic nervous system activity and inflammation, are being increasingly related to psychosocial factors such as situational stress and histories of trauma, abuse, and neglect. As the activity of the autonomic nervous system (ANS) has been long considered to be a contributory factor for DGBI, the present study utilized a theory-driven model based on the Polyvagal Theory to optimize ANS activity for the promotion of healthy digestive activity. Specifically, a hypnotic intervention to increase neuroception of safety was employed with three female college students diagnosed with functional dyspepsia and irritable bowel syndrome in a single-subject design. This intervention was found to be associated with increases in the experience of safe/warm positive affect and decreases in symptoms of functional dyspepsia and irritable bowel syndrome as well as depression and anxiety. The hypnotic intervention for the promotion of a sense of safety is recommended for the treatment of other functional somatic disorders as well as trauma-related conditions. Potential complications related to individuals with prolonged trauma and attachment issues also are reviewed.

Playback of Alarm and Appetitive Calls Differentially Impacts Vocal, Heart-Rate, and Motor Response in Rats

Our rudimentary knowledge about rat intraspecific vocal system of information exchange is limited by experimental models of communication. Rats emit 50-kHz ultrasonic vocalizations in appetitive states and 22-kHz ones in aversive states. Both affective states influence heart rate. We propose a behavioral model employing exposure to pre-recorded playbacks in home-cage-like conditions. Fifty-kHz playbacks elicited the most vocalizations (>60 calls per minute, mostly of 50-kHz type), increased heart rate, and locomotor activity. In contrast, 22-kHz playback led to abrupt decrease in heart rate and locomotor activity. Observed effects were more pronounced in singly housed rats compared with the paired housed group; they were stronger when evoked by natural playback than by corresponding artificial tones. Finally, we also observed correlations between the number of vocalizations, heart rate levels, and locomotor activity. The correlations were especially strong in response to 50-kHz playback.

The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap

This review evaluates current knowledge about obsessive-compulsive disorder (OCD), with the goal of providing a roadmap for future directions in research on the psychopharmacology of the disorder. It first addresses issues in the description and diagnosis of OCD, including the structure, measurement, and appropriate description of the disorder and issues of differential diagnosis. Current pharmacotherapies for OCD are then reviewed, including monotherapy with serotonin reuptake inhibitors and augmentation with antipsychotic medication and with psychologic treatment. Neuromodulatory therapies for OCD are also described, including psychosurgery, deep brain stimulation, and noninvasive brain stimulation. Psychotherapies for OCD are then reviewed, focusing on behavior therapy, including exposure and response prevention and cognitive therapy, and the efficacy of these interventions is discussed, touching on issues such as the timing of sessions, the adjunctive role of pharmacotherapy, and the underlying mechanisms. Next, current research on the neurobiology of OCD is examined, including work probing the role of various neurotransmitters and other endogenous processes and etiology as clues to the neurobiological fault that may underlie OCD. A new perspective on preclinical research is advanced, using the Research Domain Criteria to propose an adaptationist viewpoint that regards OCD as the dysfunction of a normal motivational system. A systems-design approach introduces the security motivation system (SMS) theory of OCD as a framework for research. Finally, a new perspective on psychopharmacological research for OCD is advanced, exploring three approaches: boosting infrastructure facilities of the brain, facilitating psychotherapeutic relearning, and targeting specific pathways of the SMS network to fix deficient SMS shut-down processes. SIGNIFICANCE STATEMENT: A significant proportion of patients with obsessive-compulsive disorder (OCD) do not achieve remission with current treatments, indicating the need for innovations in psychopharmacology for the disorder. OCD may be conceptualized as the dysfunction of a normal, special motivation system that evolved to manage the prospect of potential danger. This perspective, together with a wide-ranging review of the literature, suggests novel directions for psychopharmacological research, including boosting support systems of the brain, facilitating relearning that occurs in psychotherapy, and targeting specific pathways in the brain that provide deficient stopping processes in OCD.

Long-term modulation of cardiac activity induced by inhibitory control over emotional memories

Efforts to exclude past experiences from conscious awareness can lead to forgetting. Memory suppression is central to affective disorders, but we still do not really know whether emotions, including their physiological causes, are also impacted by this process in normal functioning individuals. In two studies, we measured the after-effects of suppressing negative memories on cardiac response in healthy participants. Results of Study 1 revealed that efficient control of memories was associated with long-term inhibition of the cardiac deceleration that is normally induced by disgusting stimuli. Attempts to suppress sad memories, by contrast, aggravated the cardiac response, an effect that was closely related to the inability to forget this specific material. In Study 2, electroencephalography revealed a reduction in power in the theta (3-8 Hz), alpha (8-12 Hz) and low-beta (13-20 Hz) bands during the suppression of unwanted memories, compared with their voluntary recall. Interestingly, however, the reduction of power in the theta frequency band during memory control was related to a subsequent inhibition of the cardiac response. These results provide a neurophysiological basis for the influence of memory control mechanisms on the cardiac system, opening up new avenues and questions for treating intrusive memories using motivated forgetting.

Multidimensional Emotion Regulation Moderates the Relation Between Behavioral Inhibition at Age 2 and Social Reticence with Unfamiliar Peers at Age 4

Behavioral inhibition (BI), a temperament trait characterized by fear and wariness in novel situations, has been identified as a risk factor for later social reticence and avoidance of peer interactions. However, the ability to regulate fearful responses to novelty may disrupt the link between BI and socially reticent behavior. The present study examined how and whether both behaviorally-manifested and physiological indices of emotion regulation moderate the relation between BI and later social reticence. Participants in this study included 88 children followed longitudinally from ages 2 to 4. At age 2, children completed the BI Paradigm in which children's responses to novel objects and adults were observed. At age 4, children's baseline respiratory sinus arrhythmia (RSA) was assessed and mothers reported on children's negative emotionality and soothability. Social reticence at age 4 was observed during a free play session with 3 unfamiliar peers. Results from saturated path models revealed a significant two-way interaction between BI and baseline RSA and a three-way interaction between BI, negative emotionality, and baseline RSA when predicting socially reticent behavior at age 4. At high levels of baseline RSA and high levels of negative emotionality, the association between BI and social reticence was negative. The relation between BI and later social reticence was only positive and significant at low levels of baseline RSA combined with high levels of negative emotionality. The results suggest that either strong physiological regulation or low negative emotionality seems sufficient to buffer inhibited young children against later social reticence.

Respiratory Sinus Arrhythmia Correlates With Depressive Symptoms Following Mild Traumatic Brain Injury

Abstract. Depression is a pervasive psychiatric problem following mild traumatic brain injury (mTBI). However, the onset and course of symptom expression following mTBI can differ from that of spontaneous episodes of depression. Here, we aimed to assess a physiological metric closely linked to depression: respiratory sinus arrhythmia (RSA), a measure of high frequency heart rate variability. RSA is reduced during depressive episodes, and higher resting RSA has been shown to predict future recovery from depression. In this study, we investigated if these patterns were observed throughout the typical timeframe of sub-acute mTBI recovery. Although RSA did not differ between mTBI ( n = 50) and control ( n = 27) groups, depressive symptoms were reliably correlated with RSA only in the mTBI group. This pattern was consistent 2 weeks, 2 months, and 4 months post-injury. Furthermore, resting RSA shortly following injury predicted the trajectory of depressive symptoms 2 months later. These findings generalize the connection between RSA and depression to a clinical population where depressive symptoms are common but often difficult to parse from other post-trauma consequences.

Extinction Learning as a Potential Mechanism Linking High Vagal Tone with Lower PTSD Symptoms among Abused Youth

Childhood abuse is a potent risk factor for psychopathology, including posttraumatic stress disorder (PTSD). Research has shown high resting vagal tone, a measure of parasympathetic nervous system function, protects abused youth from developing internalizing psychopathology, but potential mechanisms explaining this effect are unknown. We explored fear extinction learning as a possible mechanism underlying the protective effect of vagal tone on PTSD symptoms among abused youth. We measured resting respiratory sinus arrhythmia (RSA) and skin conductance responses (SCR) during a fear conditioning and extinction task in youth with variability in abuse exposure (N = 94; aged 6-18 years). High RSA predicted lower PTSD symptoms and enhanced extinction learning among abused youths. In a moderated-mediation model, extinction learning mediated the association of abuse with PTSD symptoms only among youth with high RSA. These findings highlight extinction learning as a possible mechanism linking high vagal tone to decreased risk for PTSD symptoms among abused youth.

Acute and Post-Traumatic Stress Disorders: A biased nervous system

Acute stress disorder and post-traumatic stress disorder are generally triggered by an exceptionally intense threat. The consequences of this traumatogenic situation are explored here in chronological order, from exposure to the threat to development of symptoms. Such a situation may disrupt the equilibrium between two fundamental brain circuits, referred to as the "defensive" and "cognitive". The defensive circuit triggers the stress response as well as the formation of implicit memory. The cognitive circuit triggers the voluntary response and the formation of explicit autobiographical memory. During a traumatogenic situation, the defensive circuit could be over-activated while cognitive circuit is under-activated. In the most severe cases, overactivation of the defensive circuit may cause its brutal deactivation, resulting in dissociation. Here, we address the underlying neurobiological mechanisms at every scale: from neurons to behaviors, providing a detailed explanatory model of trauma.

Design and Psychometric Analysis of the Stressors and Modulators of Gestational Stress Inventory (SMGSI)

Gestational stress is associated with many maternal and child complications, however, this association must be taken with care, since there are studies that find inconsistent results between stress measures and maternal complications. It is believed that the lack of convergence is due to the way in which gestational stress is evaluated.The aim of the present study was to design and validate an instrument based on a bio-psycho-social model of gestational stress. The design and validation process of the inventory was divided into four phases: (a) Construction of the items bank and content validity, (b) construct validity, (c) inventory reliability and (d) convergent and discriminant validity with psychometric instruments that have been used in other investigations to evaluate gestational stress.A valid and reliable Stressors and Modulators of Gestational Stress Inventory (SMGSI) conformed by two scales was developed: (a) Gestational stressors, which is formed by two factors, the psychological stressors and social stressors with a variance of 48.5% and 51.8% and a reliability of .79 and .67, respectively; and (b) gestational stress modulators integrated by 8 items that explain 55.2% of the variance and with a reliability of .92. In conclusion, a valid and reliable tool was obtained that measures gestational stress from a bio-psycho-social perspective. This inventory allows for the identification of allostatic and pantostatic stress, making it useful as a diagnostic tool to prevent maternal and childhood complications that are associated with chronic gestational stress.

It Takes More Than Two to Tango: Building Secure Attachment Through Hypnotic and Ego-State Relationships

This article explores how hypnotic strategies can be used within a polyvagal science framework to help create more secure attachment within the therapeutic relationship, as well as within the client in terms of ego-state relationships. Principles of safety and connection are emphasized, along with specific strategies to access the attachment circuits of the ventral vagal system, including the necessity of being present with the client without agenda. Uses of hypnosis related to safety and connection and methods to work with the center core self to facilitate empowerment, self-cohesion, and conflict-free experience are also reviewed. From an ego-state therapy perspective, a discussion of hypnosomatic approaches to connect with preverbal, nonverbal, and somatic aspects of self to accomplish developmental repair and facilitate secure attachment is also offered, along with case examples. A three-step model, which attempts to integrate polyvagal, somatic, and hypnotic approaches, is offered by the author to help structure corrective experiences for clients with trauma.

The pupil: a window on social automatic processing in autism spectrum disorder children

BACKGROUND

Faces are crucial social stimuli, eliciting automatic processing associated with increased physiological arousal in observers. The level of arousal can be indexed by pupil diameter (the 'Event-Related Pupil Dilation', ERPD). However, many parameters could influence the arousal evoked by a face and its social saliency (e.g. virtual vs. real, neutral vs. emotional, static vs. dynamic). A few studies have shown an atypical ERPD in autism spectrum disorder (ASD) patients using several kinds of faces but no study has focused on identifying which parameter of the stimulus is the most interfering with face processing in ASD.

METHODS

In order to disentangle the influence of these parameters, we propose an original paradigm including stimuli along an ecological social saliency gradient: from static objects to virtual faces to dynamic emotional faces. This strategy was applied to 186 children (78 ASD and 108 typically developing (TD) children) in two pupillometric studies (22 ASD and 47 TD children in the study 1 and 56 ASD and 61 TD children in the study 2).

RESULTS

Strikingly, the ERPD in ASD children is insensitive to any of the parameters tested: the ERPD was similar for objects, static faces or dynamic faces. On the opposite, the ERPD in TD children is sensitive to all the parameters tested: the humanoid, biological, dynamic and emotional quality of the stimuli. Moreover, ERPD had a good discriminative power between ASD and TD children: ASD had a larger ERPD than TD in response to virtual faces, while TD had a larger ERPD than ASD for dynamic faces.

CONCLUSIONS

This novel approach evidences an abnormal physiological adjustment to socially relevant stimuli in ASD.

Healthcare communication distress scale: Pilot factor analysis and validity

OBJECTIVE

To develop psychometrically an evidence-based, patient-centred measure of patient-practitioner communication. We explored the underlying constructs of a self-report questionnaire measuring adult patients' enduring perceptions of their emotional experiences when communicating with primary healthcare practitioners.

METHODS

A cross-sectional on-line survey included 16 items from a piloted questionnaire, as well as existing measures of generalised anxiety, psychological distress, and body vigilance. Exploratory factor analysis and hierarchical multiple regression were used to explore underlying constructs in an Australian sample (N = 220).

RESULTS

A 6-item communication distress factor and a 3-item environmental arousal factor were supported, indicating good face validity and internal consistency. Bivariate correlations support convergent and discriminant validity for both factors. Hierarchical analysis exploring predictors of communication distress included sex, age, and chronic condition status; and scores on body vigilance, anxiety, distress, and environmental arousal in healthcare. Environmental arousal was the most important significant predictor of communication distress.

CONCLUSION

The patient communication questionnaire can be developed into a brief scale to measure patient distress associated with engaging with, and communicating in, healthcare settings.

PRACTICE IMPLICATIONS

A brief self-report measure to identify patients' communication distress and environmental arousal could assist in clinical practice and provide useful data in healthcare communication research.

Factor Structure and Psychometric Properties of the Body Perception Questionnaire-Short Form (BPQ-SF) Among Chinese College Students

Objective

Body perception, including body awareness and reactivity, is featured in a range of mental health conditions. However, research on Chinese questionnaires assessing body perception has been surprisingly absent. The present study aimed to investigate the factor structure and psychometric properties of the Body Perception Questionnaire–Short Form (BPQ-SF) among Chinese.

Methods

the current sample included 688 Chinese college students. Self-report scales were used to measure body perception, somatization, and depressive somatic and psychological symptoms.

Results

Confirmatory factor analysis supported a three-factor model of the BPQ-SF, involving body awareness, supradiaphragmatic reactivity, and subdiaphragmatic reactivity. Good internal consistency and test–retest reliability were observed. Convergent validity was established by significant correlations with scores of somatization and somatic symptoms of depression. Divergent validity was evidenced by non-significant association with ratings on psychological symptoms of depression. The very short form of the body awareness subscale of BPQ can be an alternative to the body awareness subscale when scale length is the priority.

Conclusion

The BPQ-SF possessed three latent factors and demonstrated good psychometric properties that can measure body perception among Chinese in a reliable and valid way.

Parasympathetic and sympathetic nervous systems interactively predict change in cognitive functioning in midlife adults

The two branches of the autonomic nervous system (ANS) have been individually linked to changes in cognitive functioning: The parasympathetic nervous system (PNS) has been associated with healthy cognitive aging, whereas excessive sympathetic nervous system (SNS) activity has been linked to heightened cognitive decline. Despite these separate findings and despite the integrative nature of the ANS, little work has examined the two branches simultaneously to better understand their interactive effects on changes in cognitive functioning in midlife adults. We examined cognitive change in two waves of the Midlife in the United States (MIDUS) study cognitive project and indexed PNS and SNS activity from heart rate variability and epinephrine levels, respectively, from the MIDUS biomarker project (minimum n = 843, 57.9% female, mean age at first wave = 53.8 years). Our findings indicate that greater PNS responsivity (i.e., greater withdrawal and greater recovery) in response to cognitive challenge is associated with attenuated cognitive decline, but only among individuals with low SNS levels; at higher SNS levels, the effects of the PNS on cognitive decline are attenuated. These results suggest that future research targeting the ANS and cognitive aging should consider both ANS branch's effects simultaneously.

A Bradycardia-Based Stress Calculator for the Neonatal Intensive Care Unit: A Multisystem Approach

Early life stress in the neonatal intensive care unit (NICU) can predispose premature infants to adverse health outcomes and neurodevelopment delays. Hands-on-care and procedural pain might induce apneas, hypoxic events, and sleep-wake disturbances, which can ultimately impact maturation, but a data-driven method based on physiological fingerprints to quantify early-life stress does not exist. This study aims to provide an automatic stress detector by investigating the relationship between bradycardias, hypoxic events and perinatal stress in NICU patients. EEG, ECG, and SpO 2 were recorded from 136 patients for at least 3 h in three different monitoring groups. In these subjects, the stress burden was assessed using the Leuven Pain Scale. Different subspace linear discriminant analysis models were designed to detect the presence or the absence of stress based on information in each bradycardic spell. The classification shows an area under the curve in the range [0.80-0.96] and a kappa score in the range [0.41-0.80]. The results suggest that stress seems to increase SpO 2 desaturations and EEG regularity as well as the interaction between the cardiovascular and neurological system. It might be possible that stress load enhances the reaction to respiratory abnormalities, which could ultimately impact the neurological and behavioral development.

Convergence of behavioral and cardiac indicators of distress in toddlerhood: A systematic review and narrative synthesis

The objective of the current study was to systematically review the available literature on the relation between behavioral and cardiac indicators used to measure distress in toddlerhood. After ascertaining the eligibility of 2,424 articles through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PROSPERO (International Prospective Register of Systematic Reviews) guided search process, 22 articles ( N = 2,504) that investigated associations between behavioral and cardiac indicators of distress in toddlerhood were identified. The narrative synthesis described the overall relation (direction [positive, negative], strength [Cohen’s D]) between behavioral and cardiac indicators and was organized by cardiac indicator (i.e., heart rate [HR], heart period, respiratory sinus arrhythmia, pre-ejection period) and type of behavior measured (i.e., coding for expressed emotion behaviors vs. emotion regulation behaviors). Methodological characteristics (i.e., timing of measurement for behavioral and cardiac indicators [concurrent, predictive], length of measurement epochs, inclusion of covariates and moderators) were also described. HR was consistently positively ( D = .05 to .54) related to expressed emotion behaviors. No other cardiac and behavioral indicators were consistently related. Methodological differences related to behavioral and cardiac indicators utilized, timing of measurement, and length of measurement epochs may be responsible for heterogeneity in findings. The findings suggest that researchers might get divergent results depending on whether distress is measured with cardiac or behavioral indicators of distress in toddlerhood. Suggestions for future psychophysiological research with young children are offered.

Reliability of short-term measurements of heart rate variability: Findings from a longitudinal study

Research on heart rate variability (HRV) received increasing attention. This study analysed the reliability of the most common HRV parameters for baseline measurements. 103 healthy students (83 women, M = 21.72 ± 3.31 years) participated in five short-term HRV sessions, each including supine, sitting, and standing positions, respectively, spanning a time interval of eleven months. Relative reliability was evaluated by intraclass correlation coefficients, and absolute reliability by standard errors of measurement, smallest real differences, and 95 % limits of random variation. No systematic mean differences between measurements emerged. Intraclass correlation coefficients were quite low (supine: .49-.64, sitting: .40-.57, standing: .35-.56). Absolute reliability indicators revealed pronounced variations between test and retest. Influences of posture and time between measurements on reliability were small and unsystematic. We conclude that such high levels of within-subjects variability in HRV measurements (a) hamper the detection of changes over time, and (b) should be considered carefully in future analyses.

Parent-adolescent physiological synchrony: Moderating effects of adolescent emotional insecurity

The present study investigated physiological synchrony in the parasympathetic nervous system among fathers, mothers, and adolescents during a real-time family interaction, and child characteristics that may moderate the level of physiological synchrony. Our sample consisted of 191 families with adolescents (M_age  = 12.4 years) and both of their parents, who participated in a triadic family conflict discussion. During the discussion, respiratory sinus arrhythmia (RSA) was measured for all three family members. Multilevel analysis indicated a significant positive concurrent synchrony between adolescents and their mothers, as well as between fathers and mothers on a minute-to-minute basis. No RSA synchrony was found between adolescents and their fathers. Furthermore, adolescent emotional insecurity significantly moderated mother-adolescent RSA synchrony. Whereas adolescents with low emotional insecurity exhibited positive synchrony with their mothers, no synchrony was observed when adolescent emotional insecurity was high. In conclusion, findings of the present study illuminate the patterns of RSA synchrony among parents and adolescents and highlight a link between adolescent emotional insecurity and attenuated mother-adolescent physiological synchrony.

Associations between physiological responses to social-evaluative stress and daily functioning in first-episode schizophrenia

Schizophrenia (SZ) is associated with impaired adaptive functioning, including difficulties managing the demands of independent living, work, school, and interpersonal relationships. Prior studies have linked the physiological stress response with less effective coping in daily life. Differences in stress-response tendencies may also support heterogeneity in daily functioning in SZ. The present study examined two established measures of the stress response in patients with first-episode SZ. Salivary cortisol was included as an index of hypothalamic-pituitary-adrenal response. Vagal suppression (VS), a measure of stress-related reduction in heart rate variability, was used to assess parasympathetic flexibility. Greater cortisol response and VS to social-evaluative stress were predicted to be associated with better functioning in SZ over and above relationships with social cognition and neurocognition, two well-established predictors of functional outcome. Thirty-eight first-episode SZ outpatients and 29 healthy comparison subjects (HC) provided social cognitive, neurocognitive, and physiological measurements before and after the Trier Social Stress Test (TSST). Although SZ and HC did not differ on VS to the TSST, patients exhibited significant associations between VS and functioning across all four domains of the Role Functioning Scale. Furthermore, greater VS predicted more effective functioning with friends, beyond the contributions associated with social cognition and neurocognition, and strengthened the positive effects of higher levels of social cognition on independent living/self-care. VS elicited by social-evaluative stress in the laboratory may reflect stress-response tendencies in daily life that are relevant for daily functioning in first-episode SZ.

The Covid-19 Pandemic is a Paradoxical Challenge to Our Nervous System: A Polyvagal Perspective

The spread of the SARSCov2 virus presents an unprecedented event that rapidly introduced widespread life threat, economic de-stabilization, and social isolation. The human nervous system is tuned to detect safety and danger, integrating body and brain responses via the autonomic nervous system. Polyvagal Theory provides a perspective to understand the impact of the pandemic on mental and physical health. This perspective highlights the important role of the state of the autonomic nervous system in exacerbating or dampening threat reactions to the pandemic. In addition, the theory alerts us to the impact of clinical history (e.g., trauma) on autonomic regulation as an important compounding risk factor lowering the threshold to behaviorally and physiologically destabilize in response to the pandemic. The theory provides a strategy to dampen the adverse reactions to threat (e.g., acute stress disorders) through portals of social engagement that evolved to downregulate defenses to promote calmness and connectedness.

Group versus individual format of intervention for aggressive children: Moderators and predictors of outcomes through 4 years after intervention

This study originated in collaboration with Thomas Dishion because of concerns that a group format for aggressive children might dampen the effects of cognitive-behavioral intervention. Three hundred sixty aggressive preadolescent children were screened through teacher and parent ratings. Schools were randomized to receive either an individual or a group format of the child component of the same evidence-based program. The results indicate that there is variability in how group-based cognitive-behavioral intervention can affect aggressive children through a long 4-year follow-up after the end of the intervention. Aggressive children who have higher skin conductance reactivity (potentially an indicator of poorer emotion regulation) and who have a variant of the oxytocin receptor gene that may be associated with being hyperinvolved in social bonding have better outcomes in their teacher-rated externalizing behavior outcomes over time if they were seen individually rather than in groups. Analyses also indicated that higher levels of the group leaders' clinical skills predicted reduced externalizing behavior problems. Implications for group versus individual format of cognitive-behavioral interventions for aggressive children, and for intensive training for group therapists, informed by these results, are discussed.

Stress hypothesis overload: 131 hypotheses exploring the role of stress in tradeoffs, transitions, and health

Stress is ubiquitous and thus, not surprisingly, many hypotheses and models have been created to better study the role stress plays in life. Stress spans fields and is found in the literature of biology, psychology, psychophysiology, sociology, economics, and medicine, just to name a few. Stress, and the hypothalamic-pituitaryadrenal/interrenal (HPA/I) axis and sympathetic nervous system (SNS), are involved in a multitude of behaviors and physiological processes, including life-history and ecological tradeoffs, developmental transitions, health, and survival. The goal of this review is to highlight and summarize the large number of available hypotheses and models, to aid in comparative and interdisciplinary thinking, and to increase reproducibility by a) discouraging hypothesizing after results are known (HARKing) and b) encouraging a priori hypothesis testing. For this review I collected 214 published hypotheses or models dealing broadly with stress. In the main paper, I summarized and categorized 131 of those hypotheses and models which made direct connections among stress and/or HPA/I and SNS, tradeoffs, transitions, and health. Of those 131, the majority made predictions about reproduction (n = 43), the transition from health to disease (n = 38), development (n = 23), and stress coping (n = 18). Additional hypotheses were classified as stage-spanning or models (n = 37). The additional 83 hypotheses found during searches were tangentially related, or pertained to immune function or oxidative stress, and these are listed separately. Many of the hypotheses share underlying rationale and suggest similar, if not identical, predictions, and are thus not mutually exclusive; some hypotheses spanned classification categories. Some of the hypotheses have been tested multiple times, whereas others have only been examined a few times. It is the hope that multi-disciplinary stress researchers will begin to harmonize their naming of hypotheses in the literature so as to build a clearer picture of how stress impacts various outcomes across fields. The paper concludes with some considerations and recommendations for robust testing of stress hypotheses.

Ambulatory Assessment of Psychological and Physiological Stress on Workdays and Free Days Among Teachers. A Preliminary Study

Objective

Teachers are affected by high levels of job stress, leading to one of the highest rates of burnout. The purpose of our pilot study was to investigate the diurnal course of teachers’ psychological and physiological stress responses [cortisol levels, alpha-amylase, heart rate (HR), and heart rate variability (HRV)]. Another aim of the project was to test the applicability of ambulatory assessment methods in daily teaching situations.

Methods

In a non-clinical sample of eight primary school teachers (mean age = 43, SD = 15.22, 6 females) in Switzerland, continuous biopsychological data on two workdays and a free day were assessed. The teachers’ HRs and HRV were measured continuously using an ambulatory ECG. Additionally, eight saliva samples were collected from the teachers repeatedly throughout the day to determine the diurnal course of salivary cortisol and alpha-amylase (sAA). Perceived stress and anger ratings were assessed simultaneously.

Results

As hypothesized, the teachers’ morning cortisol levels, perceived stress, and anger levels were significantly higher, and their overall HRV was significantly lower on workdays than on a free day. Conversely, sAA levels and HRs showed no significant differences between working and free days. Salivary markers exhibited the expected diurnal course, with decreasing cortisol and increasing sAA levels over the course of the day, while self-rated stress reached the maximum at midday during working days.

Conclusion

The results of the present explorative study show that physiological and psychological parameters differ within working and free days for teachers. A comparison between working and free days resulted in differences in morning cortisol levels, HRV as well as stress and anger levels. The ambulatory assessment method was found to be applicable in daily teaching situations.

Emotion regulation training in the treatment of obesity in young adolescents: protocol for a randomized controlled trial

BACKGROUND

The prevalence rates of childhood obesity are increasing. The current multidisciplinary treatments for (childhood) obesity are effective but only moderately and in the short term. A possible explanation for the onset and maintenance of childhood obesity is that it reflects a maladaptive mechanism for regulating high levels of stress and emotions. Therefore, the current RCT study aims to test the effectiveness of adding an emotion regulation training to care as usual (multidisciplinary obesity treatment) in young inpatients (10-14) involved in an obesity treatment program compared to care as usual alone. The research model for this RCT study states that when high levels of stress are regulated in a maladaptive way, this can contribute to the development of obesity.

METHODS

The current study will recruit 140 youngsters (10-14 years) who are involved in an inpatient multidisciplinary obesity treatment (MOT) program. After giving consent to participate in the study, youngsters will be randomly assigned, during consecutive waves, to one of two conditions: care as usual (receiving MOT) or intervention (receiving MOT in addition to emotion regulation training). The training itself consists of 12 weekly sessions, followed by a booster session after 3 and 5 months. The participants will be tested pretraining, post-training, and at 6 months' follow-up. We hypothesize that, compared to the control condition, youngsters in the intervention condition will (1) use more adaptive emotion regulation strategies and (2) report less emotional eating, both primary outcome measures. Moreover, on the level of secondary outcome measures, we hypothesize that youngsters in the intervention condition, compared with the control condition, will (3) report better sleep quality, (4) undergo improved weight loss and weight loss maintenance, and (5) experience better long-term (6-months) psychological well-being.

DISCUSSION

This study will add to both the scientific and clinical literature on the role of emotion regulation in the development and maintenance of different psychopathologies, as emotion regulation is a transdiagnostic factor.

TRIAL REGISTRATION

The RCT study protocol is registered at ISRCTN Registry, with study ID "ISRCTN 83822934." Registered on 13 December 2017.

Systematic Review of the Effects of Skin-to-Skin Care on Short-Term Physiologic Stress Outcomes in Preterm Infants in the Neonatal Intensive Care Unit

BACKGROUND

Infants in the neonatal intensive care unit (NICU) are exposed to many stressors. There is growing evidence that chronic stress early in life has long-term neurodevelopmental implications. Skin-to-skin care (SSC) is an intervention used to reduce stress in the NICU.

CLINICAL QUESTION

In premature infants in the NICU, what is the available evidence that SSC improves short-term physiologic stress outcomes compared with incubator care?

SEARCH STRATEGY

PubMed and CINAHL were searched for terms related to SSC, stress, physiology, and premature infants. Of 1280 unique articles, 19 were identified that reported on research studies comparing SSC with incubator care in the NICU and reported stress-related physiologic outcome measures.

RESULTS

Although there have been some mixed findings, the research supports that SSC improves short-term cardiorespiratory stress outcomes compared with incubator care. The evidence is clearer for studies reporting stress hormone outcomes, with strong evidence that SSC reduces cortisol and increases oxytocin levels in preterm infants.

IMPLICATIONS FOR PRACTICE AND RESEARCH

SSC is safe and has stress-reducing benefits. SSC should be considered an essential component to providing optimal care in the NICU. More research is needed to determine the timing of initiation, duration, and frequency of SSC to optimize the stress-reducing benefits. Future research should include the most fragile infants, who are most likely to benefit from SSC, utilize power analyses to ensure adequate sample sizes, and use sophisticated data collection and analysis techniques to more accurately evaluate the effect of SSC on infants in the NICU.

Post-Traumatic Stress, Mother's Emotion Regulation, and Parenting in Survivors of Intimate Partner Violence

Post-traumatic stress symptoms (PTSS) are high among female survivors of intimate partner violence (IPV), and children of parents experiencing PTSS are at heightened risk for a wide range of emotional and behavioral problems. Parenting has significant influence on child adjustment, and although links have been found between parental psychopathology and maladaptive parenting, little is known about the factors that may explain this relation. The current study examines mother's emotion regulation (ER) as a factor influencing the relation between mother PTSS and parenting around children's emotions in a study sample of sixty-four female survivors of IPV and their 6- to 12-year-old children. Mothers reported on their own PTSS and their parenting. Respiratory sinus arrhythmia (RSA) was used as a psychophysiological index of mother's ER. Experiential components of mother's ER was also measured by observer coding of the Meta-Emotion Interview, a structured assessment that asks parents about their attitudes toward and experiences with emotions, including their regulation of emotions. Mother's RSA reactivity moderated the relation between PTSS and negative parenting. There was also a significant indirect relation between mothers' PTSS symptom severity and supportive parenting reactions through mothers' self-report of ER. Results suggest that mother's ER abilities represent factors that significantly affect associations between maternal PTSS and parent's emotion socialization practices. Implications for assessment and intervention with families exposed to the stress of IPV are discussed.

Body-Centered Interventions for Psychopathological Conditions: A Review

World-wide, billions of dollars are spent each year on body-centered interventions to alleviate both physical and psychological pathologies. Given the high demand and increasing popularity of body-centered interventions, there is need for a systematic organization of empirical evidence associated with body-centered therapies. This article reviews the psychological effects of body-centered interventions on emotional well-being, including both self and other-administered (receptive) therapies. Theory behind body-centered interventions rely upon the bidirectional communication pathway between the brain and body. We investigated the bidirectional communication pathway between the brain and body by evaluating evidence across multiple body-centered therapies. The research reviewed includes studies that investigate effects of massage therapy, reflexology, acupuncture, functional relaxation, emotional freedom technique, Rolfing, yoga, tai-chi, and dance/movement therapy on psychological conditions across the lifespan. Results demonstrated that overall, massage therapy, tai-chi, dance/movement therapy, functional relaxation, reflexology, acupuncture and emotional freedom technique seem to alleviate stress, depression, anxiety, bipolar disorder and facilitate pain reduction. Of these, the most robust evidence available was for massage therapy, indicating it is an effective intervention for numerous age groups and populations. Rolfing and reflexology had the least amount of support, with few studies available that had small sample sizes. Although these conclusions are limited by scarcity of high-quality empirical data and contradictory findings, available evidence indicates that body-centered interventions can be effective in reducing psychopathology and supports the proposed mechanism of the bidirectional pathway between the brain and body: the body holds the potential to influence the mind. Integrating body-centered therapies in both clinical settings and as self-care could lead to better outcomes. Lastly, we propose the first taxonomy of body-centered interventions and empirical evidence of their effectiveness for clinicians and researchers.

Heart Rate Variability for the Prediction of Treatment Response in Major Depressive Disorder

Major depressive disorder (MDD) is one of the disabling diseases in the world-wide, and known to increase cardiac morbidity and mortality. Therefore, previous studies related heart rate variability (HRV) have been conducted to evaluate and diagnose MDD, and to predict treatment outcomes in patient with MDD. We reviewed extensively on the previous peer-reviewed publications associated with this issue, using Pub-Med. In this review article, we introduce the basic concept of HRV and HRV measures, and present several important findings associated with diagnosis and treatment prediction in MDD with using HRV parameters. Furthermore, we discuss the possible underlying mechanism of this phenomenon, and suggest several considerations for the future research.

Group differences between practitioners and novices in hemispheric processing of attention and emotion before and after a session of Falun Gong qigong

We examined the hemispheric effects of Falun Gong qigong (FLG), a movement meditation practice, using a systematic approach to hemispheric function by administering the Emotion Lateralized Attention Network Test (ELANT) to measure the interaction of the Conflict Resolution, Spatial Orienting, and Emotion networks. Measuring both behavior (ELANT, DV = accuracy) and physiology (HF-HRV), we compared experienced FLG practitioners (n = 19) to novices serving as an active control group (n = 16) before and after a 91-min sequence of FLG qigong exercises. We compared practitioners and novices using a hierarchy of intrahemispheric and interhemispheric control relations that can be tested with the ELANT. Practitioners exhibited a prominent short-term effect in which they improved relative to novices on trials requiring complex interhemispheric transfer (η_P² = 0.21). Two baseline group differences, suggesting long-term effects of FLG, both involved the left hemisphere. First, practitioners were selectively spared the negative effects of processing positive emotion cues preceding left hemisphere targets (η_P² = 0.34). Second, only practitioners showed improved left-hemisphere Conflict Resolution at higher levels of HF-HRV (r² = 0.40). The data showed that FLG practitioners had increased flexibility in the management of a limited attentional resource pool that is accessible to both hemispheres.

Sympathetic-Parasympathetic Interaction and Externalizing Problems in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) exhibit significant difficulties with emotion regulation and reactivity, which may be linked to underlying psychophysiology. The present study examined associations between autonomic nervous system activity and individual differences in externalizing behavior problems in children with ASD. A multisystem approach was adopted to consider the interplay between markers of sympathetic (electrodermal reactivity-EDA-R) and parasympathetic reactivity (respiratory sinus arrhythmia reactivity-RSA-R) in relation to behavioral challenges. Fifty-two children with ASD ages 6-10 years contributed complete psychophysiological data. Measures of EDA-R and RSA-R (RSA withdrawal) were obtained in response to a laboratory challenge task and parents reported on child externalizing behavior problems using a standardized questionnaire and a structured clinical interview. An equifinality model was supported, with two distinct psychophysiological pathways linked to heightened externalizing behavior problems. Greater RSA-R was associated with more externalizing problems in the context of higher levels of EDA-R, and lower EDA-R was associated with increased externalizing problems at lower levels of RSA-R. Findings underscore the importance of considering the role of psychophysiology in the unfolding of comorbid externalizing problems in children with ASD. Potential implications for tailoring coregulatory supports are discussed. Autism Res 2019, 12: 1805-1816. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Children with autism spectrum disorder (ASD) exhibit elevated rates of challenging behavior. This study identified specific psychophysiological profiles (low sympathetic-low parasympathetic reactivity, and high sympathetic-high parasympathetic reactivity) that may place these children at greater risk for behavior problems. Findings have implications for better understanding behavioral challenges in children with ASD, and for tailoring supports to address underlying psychophysiology.

The association between mothers' and daughters' positive affect is moderated by child cardiac vagal regulation

INTRODUCTION

Extensive research has supported the importance of children's positive affect in fostering prosperous psychosocial adjustment. Children's positive affect is believed to be significantly shaped by their environment in general and their caregivers' positive affect in particular. The current study investigates the role of child cardiac vagal regulation, a psychophysiological marker for social engagement, in shaping the association between maternal positive affect and child positive affect.

METHODS

Mothers and daughters (n_dyads  = 28) participated in two experimental conditions. In the non-interactive condition, they separately drew a picture without interacting. In the cooperative condition, they drew a picture together. We measured child respiratory sinus arrhythmia (RSA), a widely used indicator of cardiac vagal regulation, during both conditions. We also coded maternal and child positive affect during the cooperative condition.

RESULTS

Maternal positive affect was related to child positive affect, but only for children with medium-to-high tonic levels of RSA and RSA increases from non-interaction to interaction.

DISCUSSION

Results suggest that child RSA plays a significant role in positive emotion socialization, by making children more susceptible to the emotional cues of their caregivers. Hence, child RSA should be taken into account in preventive and therapeutic efforts regarding child positive affect socialization.

Could affect regulation via vagal nerve self- stimulation be a maintaining factor in non-suicidal self-harm?

BACKGROUND

Non-suicidal self-injury (NSSI) is a serious and common phenomenon which has been linked with emotion or affect regulation. The capacity for top-down emotion regulation has also been linked to vagal tone. Vagal tone is known to be low in groups with a propensity to engage in NSSI.

HYPOTHESIS

Some forms of NSSI, both direct and indirect, may result in vagal stimulation. The resulting increase in vagal tone may be linked to activation of prefrontal areas and improved top-down emotion regulation. This may be a maintaining factor in NSSI.

EVALUATION

Cutting with the sight of blood, the use of ligatures, eating disorders and risky sexual behaviour, behaviours that could be considered direct or indirect forms of NSSI, are all plausible methods of vagal self-stimulation.

CONCLUSION

NSSI may increase vagal tone. This may result in improved top down emotion regulation and result in a calmer emotional state. These vagal effects may be important maintaining factors in self-harm. This has important implications for the study and possible management of a common and serious issue.

The brain-adipocyte-gut network: Linking obesity and depression subtypes

Major depressive disorder (MDD) and obesity are dominant and inter-related health burdens. Obesity is a risk factor for MDD, and there is evidence MDD increases risk of obesity. However, description of a bidirectional relationship between obesity and MDD is misleading, as closer examination reveals distinct unidirectional relationships in MDD subtypes. MDD is frequently associated with weight loss, although obesity promotes MDD. In contrast, MDD with atypical features (MDD-AF) is characterised by subsequent weight gain and obesity. The bases of these distinct associations remain to be detailed, with conflicting findings clouding interpretation. These associations can be viewed within a systems biology framework-the psycho-immune neuroendocrine (PINE) network shared between MDD and metabolic disorders. Shared PINE subsystem perturbations may underlie increased MDD in overweight and obese people (obesity-associated depression), while obesity in MDD-AF (depression-associated obesity) involves more complex interactions between behavioural and biomolecular changes. In the former, the chronic PINE dysfunction triggering MDD is augmented by obesity-dependent dysregulation in shared networks, including inflammatory, leptin-ghrelin, neuroendocrine, and gut microbiome systems, influenced by chronic image-associated psychological stress (particularly in younger or female patients). In MDD-AF, behavioural dysregulation, including hypersensitivity to interpersonal rejection, fundamentally underpins energy imbalance (involving hyperphagia, lethargy, hypersomnia), with evolving obesity exaggerating these drivers via positive feedback (and potentially augmenting PINE disruption). In both settings, sex and age are important determinants of outcome, associated with differences in emotional versus cognitive dysregulation. A systems biology approach is recommended for further research into the pathophysiological networks underlying MDD and linking depression and obesity.

Children's physiological reactivity in emotion contexts and prosocial behavior

INTRODUCTION

Building on prior evidence that prosocial behavior is related to the regulation of personal distress in difficult situations, and given that physiological regulation is a central contributor to effective emotion regulation, this investigation evaluated whether and how children's autonomic nervous system (ANS) reactivity during emotion challenges influenced later expressions of prosocial behavior.

METHODS

The current study utilized a diverse sample of school-aged children (N = 169; 47.9% female; 47.3% Latinx) to evaluate relations between children's parasympathetic (i.e., respiratory sinus arrhythmia; RSA) and sympathetic (i.e., pre-ejection period; PEP) reactivity in response to each of three film-elicited emotion challenges (i.e., sadness, happiness, and fear) at age 7 and both observed and parent-reported prosocial behavior one year later.

RESULTS

Children's parasympathetic reactivity to a film eliciting sadness evidenced a nonlinear relation with later prosocial sharing such that children who evidenced either RSA withdrawal or augmentation in response to the sad emotion challenge engaged in higher levels of prosocial behavior than children who evidenced relatively low or absent reactivity. Parasympathetic reactivity to films eliciting happiness or fear was not significantly related to later prosocial behavior. Likewise, children's sympathetic reactivity in response to the emotion challenges did not significantly predict later prosocial behavior.

CONCLUSIONS

These findings provide preliminary support for a nonlinear association between children's parasympathetic emotion reactivity and later prosocial behavior, and suggest that children's ANS regulation in sad emotion contexts may be particularly important for understanding prosocial development.

Relationship of Emotional Intelligence, Intelligence Quotient, and Autonomic Reactivity Tests in Undergraduate Medical Students

BACKGROUND

Emotional intelligence is emerging as a determinant of success of an individual in their professions. Therefore, this study was designed to decipher the association of emotional intelligence, intelligence quotient, and autonomic stress reactivity tests in undergraduate medical students.

METHOD

Fifty-two undergraduate medical students were recruited in this study. Validated questionnaires for EI-self report and performance based-and IQ were filled by all the participants. Autonomic reactivity tests-lying to standing, deep breathing (DBT), Valsalva maneuver, cold pressor (CPT), and handgrip tests-were also performed. Correlational analysis was done using GraphPad Prism version 5.00.

RESULTS

Performance-based EI had a positive correlation with DBT responses and an inverse relation with CPT response. Additionally, sub-grouping on the basis of emotional quotient (EQ) and IQ and comparing their autonomic profile revealed an important pattern of parasympathetic reactivity-wherein it was higher in both high > EQ high IQ low > EQ low IQ high > both low .

CONCLUSIONS

Emotional intelligence is associated with autonomic reactivity responses. EQ has a positive relation to parasympathetic system while a negative relation to sympathetic system emphasizing the association of sympatho-vagal balance with the emotional intelligence of an individual. Also, parasympathetic responses in an individual differed significantly in groups based on EQ and IQ which again focuses on the strong relation between higher parasympathetic reactivity and emotional intelligence. This study highlights the probable role of emotional intelligence in medical students in deciphering not only their empathy towards patients, but also their physiological responses and cognitive capacity.

Intergenerational transmission of emotion dysregulation: Part I. Psychopathology, self-injury, and parasympathetic responsivity among pregnant women

The World Health Organization recently reported that maternal mental health is a major public health concern. As many as one in four women suffer from psychiatric disorders at some point during pregnancy or the first postpartum year. Furthermore, self-injurious thoughts and behaviors (SITBs) represent one of the leading causes of death among women during this time. Thus, efforts to identify women at risk for serious forms of psychopathology and especially for SITBs are of utmost importance. Despite this urgency, current single-diagnostic approaches fail to recognize a significant subset of women who are vulnerable to perinatal stress and distress. The current study was among the first to investigate emotion dysregulation-a multilevel, transdiagnostic risk factor for psychopathology-and its associations with stress, distress, and SITBs in a sample of pregnant women (26-40 weeks gestation) recruited to reflect a range of emotion dysregulation. Both self-reported emotion dysregulation and respiratory sinus arrhythmia, a biomarker of emotion dysregulation, demonstrated expected associations with measures of mental health, including depression, anxiety, borderline personality pathology, and SITBs. In addition, self-reported emotion dysregulation was associated with blunted respiratory sinus arrhythmia responsivity to an ecologically valid infant cry task. Findings add to the literature considering transdiagnostic risk during pregnancy using a multiple-levels-of-analysis approach.

The Role of Heart Rate Variability in Mindfulness-Based Pain Relief

Mindfulness meditation is a self-regulatory practice premised on sustaining nonreactive awareness of arising sensory events that reliably reduces pain. Yet, the specific analgesic mechanisms supporting mindfulness have not been comprehensively disentangled from the potential nonspecific factors supporting this technique. Increased parasympathetic nervous system (PNS) activity is associated with pain relief corresponding to a number of cognitive manipulations. However, the relationship between the PNS and mindfulness-based pain attenuation remains unknown. The primary objective of the present study was to determine the role of high-frequency heart rate variability (HF HRV), a marker of PNS activity, during mindfulness-based pain relief as compared to a validated, sham-mindfulness meditation technique that served as a breathing-based control. Sixty-two healthy volunteers (31 females; 31 males) were randomized to a 4-session (25 min/session) mindfulness or sham-mindfulness training regimen. Before and after each group's respective training, participants were administered noxious (49°C) and innocuous (35°C) heat to the right calf. HF HRV and respiration rate were recorded during thermal stimulation and pain intensity and unpleasantness ratings were collected after each stimulation series. The primary analysis revealed that during mindfulness meditation, higher HF HRV was more strongly associated with lower pain unpleasantness ratings when compared to sham-mindfulness meditation (B = -.82, P = .04). This finding is in line with the prediction that mindfulness-based meditation engages distinct mechanisms from sham-mindfulness meditation to reduce pain. However, the same prediction was not confirmed for pain intensity ratings (B = -.41). Secondary analyses determined that mindfulness and sham-mindfulness meditation similarly reduced pain ratings, decreased respiration rate, and increased HF HRV (between group ps < .05). More mechanistic work is needed to reliably determine the role of parasympathetic activation in mindfulness-based pain relief as compared to other meditative techniques. Perspective: Mindfulness has been shown to engage multiple mechanisms to reduce pain. The present study extends on this work to show that higher HRV is associated with mindfulness-induced reductions in pain unpleasantness, but not pain intensity ratings, when compared to sham-mindfulness meditation. These findings warrant further investigation into the mechanisms engaged by mindfulness as compared to placebo.

Respiratory Sinus Arrhythmia Mediates Links Between Borderline Personality Disorder Symptoms and Both Aggressive and Violent Behavior

Although emotion dysregulation (ED) is a core symptom of borderline personality disorder (BPD), tests of associations between ED and aggression and violence-which are common to BPD-are sparse. The authors evaluated mediating effects of an autonomic vulnerability to ED on links between BPD symptoms and (a) reactive aggression, (b) proactive aggression, and (c) histories of interpersonal violence in a sample of young adults (N = 104), ages 18-22 years. Low baseline respiratory sinus arrhythmia (RSA) mediated the association between BPD symptoms and reactive aggression. In contrast, although BPD symptoms were correlated with proactive aggression, no mediational effect was found. In addition, low RSA mediated the association between BPD symptoms and histories of interpersonal violence. Collectively, these findings add evidence that neurobiological vulnerability to ED contributes to aggressive and violent behavior among those with BPD.

Autonomic complexity and emotion (dys-)regulation in early childhood across high- and low-risk contexts

Developing the ability to regulate one's emotions in accordance with contextual demands (i.e., emotion regulation) is a central developmental task of early childhood. These processes are supported by the engagement of the autonomic nervous system (ANS), a physiological hub of a vast network tasked with dynamically integrating real-time experiential inputs with internal motivational and goal states. To date, much of what is known about the ANS and emotion regulation has been based on measures of respiratory sinus arrhythmia, a cardiac indicator of parasympathetic activity. In the present study, we draw from dynamical systems models to introduce two nonlinear indices of cardiac complexity (fractality and sample entropy) as potential indicators of these broader ANS dynamics. Using data from a stratified sample of preschoolers living in high- (i.e., emergency homeless shelter) and low-risk contexts (N = 115), we show that, in conjunction with respiratory sinus arrhythmia, these nonlinear indices may help to clarify important differences in the behavioral manifestations of emotion regulation. In particular, our results suggest that cardiac complexity may be especially useful for discerning active, effortful emotion regulation from less effortful regulation and dysregulation.