Divergent associations of antecedent- and response-focused emotion regulation strategies with midlife cardiovascular disease risk

Reconceptualizing complex posttraumatic stress disorder: A predictive processing framework for mechanisms and intervention

In this article, we introduce a framework for interpreting Complex Posttraumatic Stress Disorder (C-PTSD) through predictive processing, a neuroscience concept explaining the brain's interpretation and prediction of sensory information. While closely related to PTSD, C-PTSD encompasses additional symptom clusters marked by disturbances in self-organization (DSO), such as negative self-concept, affect dysregulation, and relational difficulties, typically resulting from prolonged traumatic stressors. Our model leverages advances in computational psychiatry and neuroscience, offering a mechanistic explanation for these symptoms by illustrating how prolonged trauma disrupts the brain's predictive processing. Specifically, altered predictive mechanisms contribute to C-PTSD's symptomatology, focusing on DSO: (1) Negative self-concept emerges from maladaptive priors that bias perception towards self-criticism, misaligning expected and actual interoceptive states; (2) Misalignment between predicted and actual interoceptive signals leads to affect dysregulation, with sensitivity to bodily cues; and (3) Relationship challenges arise from skewed social prediction errors, fostering mistrust and withdrawal. This precision-focused approach sheds light on the dynamics underpinning C-PTSD and highlights potential intervention targets aimed at recalibrating the predictive processing system.

Maternal emotion regulation abilities affect adolescent depressive symptoms by mediating their emotion regulation ability: An ERP study

Adolescents with major depressive disorder (MDD) experience significant difficulties in emotion regulation. This study aimed to explore emotion regulation in adolescents with depression using an emotion regulation paradigm combined with event-related potentials (ERP) while investigating the relationship between maternal emotion regulation and adolescent depressive symptoms through a mediation model. Overall, 38 healthy controls (HC) and 57 adolescents with depression (MDD) rated the pictures they saw according to aversive reappraisal (reappraisal of an aversive picture or down-regulate aversive emotions), aversive watch, and neutral conditions. Adolescents with depression gave more negative ratings to aversive images, and the emotional regulation success index (ERSI) of adolescents with depression was lower than that of healthy individuals. ERP data revealed an elevation in late positive potential (LPP) amplitude during the aversive reappraisal and aversive watch conditions compared with that in the neutral condition in the MDD group. Compared with the HC group, adolescents with depression showed larger LPP amplitudes under aversive watch conditions. The aversive reappraisal condition evoked a larger LPP than that in the other conditions in the HC group in the late time windows. The ΔLPP (separating the variability in the ERP wave associated with emotion regulation) was larger in the HC group than in the MDD group. Mediation analysis revealed that maternal emotion regulation influenced adolescent depression levels through its effect on the adolescent's emotion regulation. These findings provide important insights into the emotion regulation process in adolescents with depression and offer suggestions for clinical interventions.

Perceived stress moderates emotion regulation success in real-world contexts: an ecologically-valid multilevel investigation

BACKGROUND

Emotion regulation plays a crucial role in well-being in everyday life. Effective emotion regulation depends upon adaptively matching a given strategy to a given situation. Recent research has begun to explore these interactions in the context of daily reports of perceived stress, affect, and emotion regulation strategy usage. To further understand these differences in strategy efficacy in an ecologically valid context, we examined responses to real world stressors in a young adult sample.

METHODS

We surveyed a range of emotion regulation strategies, including two forms of cognitive reappraisal (i.e., reinterpretation, which involves cognitively reframing one's emotional responses, and psychological distancing, which involves adopting an objective, impartial perspective). Participants reported strategy usage, momentary perceived stress, and affect in response to multiple ecological momentary assessments over a period of 7 days.

RESULTS

Analyses of links between strategy usage and affect revealed that rumination was significantly negatively associated with more positive affect ratings. Further, a significant interaction between momentary perceived stress and reinterpretation usage was observed on affect, such that reinterpretation was more adaptive during situations perceived as less stressful.

CONCLUSION

These results provide further insight into the importance of situational context in determining the effectiveness of particular emotion regulation strategies.

Emotion suppression and acute physiological responses to stress in healthy populations: a quantitative review of experimental and correlational investigations

Emotion suppression may be linked to poor health outcomes through elevated stress-related physiology. The current meta-analyses investigate the magnitude of the association between suppression and physiological responses to active psychological stress tasks administered in the laboratory. Relevant articles were identified through Medline, PsychINFO, PubMed, and ProQuest. Studies were eligible if they (a) used a sample of healthy, human subjects; (b) assessed physiology during a resting baseline and active psychological stress task; and (c) measured self-report or experimentally manipulated suppression. Twenty-four studies were identified and grouped within two separate random effects meta-analyses based on study methodology, namely, manipulated suppression (k = 12) and/or self-report (k = 14). Experimentally manipulated suppression was associated with greater physiological stress reactivity compared to controls (Hg = 0.20, 95% CI [0.08, 0.33]), primarily driven by cardiac, hemodynamic, and neuroendocrine parameters. Self-report trait suppression was not associated with overall physiological stress reactivity but was associated with greater neuroendocrine reactivity (r = 0.08, 95% CI [0.01, 0.14]). Significant moderator variables were identified (i.e., type/duration of stress task, nature of control instructions, type of physiology, and gender). This review suggests that suppression may exacerbate stress-induced physiological arousal; however, this may differ based upon the chosen methodological assessment of suppression.

Emotion regulation tendencies and cardiovascular responses to repeated acute psychological stress

Poor emotion regulation has been associated with cardiovascular disease (CVD) through maladaptive cardiovascular responses to psychological stress. However, there has been scant research examining the relationship between emotion regulation and habituation of cardiovascular responses to recurrent stress, which may be more directly applicable to the experience of stress in everyday life. The aims of the current study were to examine the associations between emotion regulation tendencies and cardiovascular stress reactivity, as well as habituation of cardiovascular reactivity across repeated stressors. A sample of 453 participants (mean (SD) age = 19.5 (1.3) years; 62 % women) completed a repeated stress paradigm, which consisted of two 10-minute baselines and two identical 4-minute stress tasks, separated by a 10-minute recovery period. Heart rate (HR) was measured continuously; systolic/diastolic blood pressures (SBP/DBP) were measured every 2 min. At the end of the visit, participants completed the Emotion Regulation Questionnaire (ERQ) and Difficulties in Emotion Regulation Scale (DERS). Results indicate that impulse control difficulties when distressed (a DERS subscale) were significantly associated with blunted SBP, DBP, and HR reactivity to both stressors, as well as impaired HR habituation across the stressors. None of the ERQ subscales (cognitive reappraisal, expressive suppression) were found to be associated with cardiovascular stress reactivity or habituation. The outcomes of this study demonstrate a potential underlying physiological pathway through which impulse control difficulties when distressed may contribute to CVD risk. This study also reveals the importance of extending traditional cardiovascular stress reactivity protocols to include multiple exposures of the same stress task.

Inflammation and emotion regulation: a narrative review of evidence and mechanisms in emotion dysregulation disorders

Emotion dysregulation (ED) describes a difficulty with the modulation of which emotions are felt, as well as when and how these emotions are experienced or expressed. It is a focal overarching symptom in many severe and prevalent neuropsychiatric diseases, including bipolar disorders (BD), attention deficit/hyperactivity disorder (ADHD), and borderline personality disorder (BPD). In all these disorders, ED can manifest through symptoms of depression, anxiety, or affective lability. Considering the many symptomatic similarities between BD, ADHD, and BPD, a transdiagnostic approach is a promising lens of investigation. Mounting evidence supports the role of peripheral inflammatory markers and stress in the multifactorial aetiology and physiopathology of BD, ADHD, and BPD. Of note, neural circuits that regulate emotions appear particularly vulnerable to inflammatory insults and peripheral inflammation, which can impact the neuroimmune milieu of the central nervous system. Thus far, few studies have examined the link between ED and inflammation in BD, ADHD, and BPD. To our knowledge, no specific work has provided a critical comparison of the results from these disorders. To fill this gap in the literature, we review the known associations and mechanisms linking ED and inflammation in general, and clinically, in BD, ADHD, and BD. Our narrative review begins with an examination of the routes linking ED and inflammation, followed by a discussion of disorder-specific results accounting for methodological limitations and relevant confounding factors. Finally, we critically discuss both correspondences and discrepancies in the results and comment on potential vulnerability markers and promising therapeutic interventions.

Predicting real-world emotion and health from spontaneously assessed linguistic distancing using novel scalable technology

Individuals who are better at regulating their emotions have been shown to have better physical and mental health outcomes. One promising emotion regulation strategy is psychological distancing, which involves appraising a stimulus with objectivity or spatial/temporal distance. Language-based psychological distancing (linguistic distancing [LD]) refers to the degree to which one implements psychological distancing naturally via language. A crucial, underexamined mechanism that may account for real-world emotion and health self-reports is spontaneous (i.e., implicit) LD. Using HealthSense, a novel, scalable, mobile health assessment application, we collected lexical transcriptions for personally specific negative and positive events as well as emotion and health-relevant data over 14 days (data collected in 2021) and examined how implicit LD during negative and positive events relates to well-being over time. Primary analyses revealed that higher LD during negative events was associated with lower levels of stress as well as greater emotional and physical well-being within persons. LD during positive events on 1 day predicted greater reports of happiness 2 days later within persons. LD during positive events was associated with fewer symptoms of depression and LD during negative events was associated with greater physical well-being among persons. Exploratory analyses revealed that average depression, rumination, and perceived stress across the 2 weeks were significantly negatively associated with LD during negative events between persons. The present results expand understanding of the relationship between LD and mental and physical health risks and motivate future research on low-burden, scalable interventions involving LD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A new understanding of the cognitive reappraisal technique: an extension based on the schema theory

Cognitive reappraisal is a widely utilized emotion regulation strategy that involves altering the personal meaning of an emotional event to enhance attention to emotional responses. Despite its common use, individual differences in cognitive reappraisal techniques and the spontaneous recovery, renewal, and reinstatement of negative responses across varying contexts may limit its effectiveness. Furthermore, detached reappraisal could cause distress for clients. According to Gross's theory, cognitive reappraisal is an effortless process that can occur spontaneously. When guided language triggers cognitive reappraisal as an emotion regulation strategy in laboratory or counseling settings, clients experience improved emotional states, but this induced strategy may not necessarily guide them in regulating emotions in similar future situations. Therefore, effectively applying cognitive reappraisal techniques in clinical practice to help clients alleviate emotional distress in daily life remains a significant concern. Exploring the mechanism of cognitive reappraisal reveals that reconstructing stimulus meaning is akin to extinction learning, which entails fostering cognitive contingency that the original stimulus provoking negative emotions will no longer result in negative outcomes in the current context. However, extinction learning is a new learning process rather than an elimination process. The activation of new learning relies on the presentation of critical cues, with contextual cues often playing a vital role, such as a safe laboratory or consulting room environment. We propose a new understanding of cognitive reappraisal based on the schema theory and the dual-system theory, emphasizing the significance of environmental interaction and feedback in constructing new experiences and updating schemata. This approach ultimately enriches the schema during training and integrates the new schema into long-term memory. Bottom-up behavioral experiences as schema enrichment training provide the foundation for top-down regulation to function. This method can assist clients in activating more suitable schemata probabilistically when encountering stimuli in real life, forming stable emotions, and achieving transfer and application across diverse contexts.

Emotion Regulation Strategies Relate to Ambulatory Cardiovascular Activity in an American Indian Community

OBJECTIVE

Poor emotion regulation is associated with risk for cardiovascular disease. However, much of this research is conducted in primarily White samples, thus limiting our understanding of this relationship in other racial/ethnic groups. American Indians (AIs) are uniquely and disproportionately at risk for cardiovascular disease. As such, the present study aimed to examine the relationships between emotion regulation strategies and ambulatory cardiovascular activity in an entirely AI sample.

METHODS

The sample consisted of 100 AI adults living on a tribal reservation. Emotion regulation strategies (expressive suppression, cognitive reappraisal) were assessed via the Emotion Regulation Questionnaire. Using ecological momentary assessment, daily measurements of psychological stress and ambulatory cardiovascular activity were taken during a 7-day monitoring period. Statistical analyses included bivariate correlations, hierarchical linear regression models, and mediation models.

RESULTS

Expressive suppression was associated with higher systolic and diastolic blood pressure, as well as higher pulse rate. In contrast, cognitive reappraisal was associated with lower systolic and diastolic blood pressure, lower pulse rate, and lower average daily psychological stress. These results remained statistically significant after adjusting for age, sex, body mass index, anxiety, depression, and early life trauma. In addition, psychological stress mediated the associations between blood pressure and cognitive reappraisal, but not expressive suppression.

CONCLUSIONS

These results provide preliminary evidence for divergent associations of two emotion regulation strategies with cardiovascular activity and psychological stress in an AI community. Modifying health interventions to include training in effective emotion regulation may be beneficial.

Inflammation and emotion regulation: Findings from the MIDUS II study

Emotion regulation (ER) strategies are thought to contribute to mental as well as physical health outcomes. Two common ER strategies include expressive suppression, or inhibition of emotional expression, and cognitive reappraisal, which involves changing how to think about an emotion-eliciting event in order to change its emotional impact. Recent reports have hypothesized that one potential way in which ER may be linked to health outcomes is via the immune system. However, information on this putative link is scarce. The present study aims to explore whether peripheral inflammatory biomarkers are associated with individual differences in ER-strategy use. Participants (n = 117) from the Midlife in the United States II (MIDUS II) study completed the Emotion Regulation Questionnaire (ERQ), and provided a blood sample for immune biomarker extraction including interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), E-selectin, Intercellular Adhesion Molecule-1 (ICAM-1), and fibrinogen. Results showed higher levels of expressive suppression were associated with decreased IL-10, TNF-α, and ICAM-1 levels (controlling for age, sex, BMI, total prescribed medications, and depressive symptoms). Consistent with these findings, hierarchical regression results identified TNF-α as a significant predictor of expressive suppression use. In contrast, no inflammatory markers were associated with predicted use of cognitive reappraisal. Our findings suggest a link between inflammation and specific ER-strategy use. Future research should consider the effects of pro-vs. anti-inflammatory cytokines on adaptive ER and subsequent mental and physical health.

Are coping strategies and variability in their use associated with lifespan?

OBJECTIVES

Some stress-related coping strategies contribute to survival among medical populations, but it is unclear if they relate to longevity in the general population. While coping strategies are characterized as being adaptive or maladaptive, whether capacity to tailor their implementation to different contexts (i.e., flexibility of use) may influence lifespan is unknown.

METHOD

In 2004-2006, participants from the Midlife Development in the United States study completed a validated coping inventory including 6 strategies and provided information on sociodemographics, health status, and biobehavioral factors (N = 4398). Deaths were ascertained from death registries with follow-up until 2018. Accelerated failure time models estimated percent changes and 95% confidence intervals (CI) in predicted lifespan associated with use of individual coping strategies. As a proxy for flexibility, participants were also classified as having lower, moderate, or greater variability in strategies used, using a standard deviation-based algorithm.

RESULTS

After controlling for sociodemographics and health status, maladaptive strategies (e.g., per 1-SD increase in Denial = -5.50, 95%CI = -10.50, -0.21) but not adaptive strategies (e.g., Planning) were related to shorter lifespan. Greater versus moderate variability levels were related to a 15% shorter lifespan. Estimates were somewhat attenuated when further controlling for lifestyle factors.

CONCLUSION

Although most associations were of modest magnitude, use of some maladaptive coping strategies appeared related to shorter lifespan. Compared to moderate levels, greater coping variability levels were also clearly detrimental for lifespan. Although adaptive strategies were unrelated to longevity, future work should examine other favorable strategies (e.g., acceptance) and more direct measures of flexibility (e.g., experience sampling methods).

A Brief mHealth-Based Psychological Intervention in Emotion Regulation to Promote Positive Subjective Well-Being in Cardiovascular Disease Patients: A Non-Randomized Controlled Trial

The emotional impact that a cardiovascular disease may have on a person’s life can affect the prognosis and comorbidity of the disease. Therefore, emotion regulation is most important for the management of the disease. The aim of this study was to analyze the effectiveness of a brief mHealth psychological intervention in emotion regulation to promote positive subjective well-being in cardiovascular disease patients. The study sample (N = 69, 63.7 ± 11.5 years) was allocated to either the experimental group (n = 34) or control group (n = 35). The intervention consisted of a psychoeducational session in emotion regulation and an mHealth-based intervention for 2 weeks. Positive subjective well-being as a primary outcome and self-efficacy to manage the disease as a secondary outcome were assessed at five time points evaluated over a period of 6 weeks. The experimental group showed higher improvement in positive subjective well-being and self-efficacy for managing the disease compared to the control group over time. The experimental group also improved after the intervention on all outcome measures. Brief mHealth interventions in emotion regulation might be effective for improving positive subjective well-being and self-efficacy to manage the disease in cardiovascular patients.

Multivariate Brain Activity while Viewing and Reappraising Affective Scenes Does Not Predict the Multiyear Progression of Preclinical Atherosclerosis in Otherwise Healthy Midlife Adults

Cognitive reappraisal is an emotion regulation strategy that is postulated to reduce risk for atherosclerotic cardiovascular disease (CVD), particularly the risk due to negative affect. At present, however, the brain systems and vascular pathways that may link reappraisal to CVD risk remain unclear. This study thus tested whether brain activity evoked by using reappraisal to reduce negative affect would predict the multiyear progression of a vascular marker of preclinical atherosclerosis and CVD risk: carotid artery intima-media thickness (CA-IMT). Participants were 176 otherwise healthy adults (50.6% women; aged 30-51 years) who completed a functional magnetic resonance imaging task involving the reappraisal of unpleasant scenes from the International Affective Picture System. Ultrasonography was used to compute CA-IMT at baseline and a median of 2.78 (interquartile range, 2.67 to 2.98) years later among 146 participants. As expected, reappraisal engaged brain systems implicated in emotion regulation. Reappraisal also reduced self-reported negative affect. On average, CA-IMT progressed over the follow-up period. However, multivariate and cross-validated machine-learning models demonstrated that brain activity during reappraisal failed to predict CA-IMT progression. Contrary to hypotheses, brain activity during cognitive reappraisal to reduce negative affect does not appear to forecast the progression of a vascular marker of CVD risk.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-021-00098-y.

Mindfulness and Behavior Change

Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 12 May 2020. The protocol, as accepted by the journal, can be found at https://doi.org/10.6084/m9.figshare.c.4878591.v1.

Emotional Vulnerability to Short Sleep Predicts Increases in Chronic Health Conditions Across 8 Years

BACKGROUND

Sleep is a robust determinant of next-day emotions, but people vary in the extent that their emotions fluctuate on days following short sleep duration. These individual differences in day-to-day sleep and emotion dynamics may have long-term health implications.

PURPOSE

To evaluate emotional vulnerability to short sleep (within-person associations between sleep duration and next-day emotions) as a risk factor for future chronic conditions.

METHODS

Adults aged 33-84 (N = 1,426; 57% female) in the Midlife in the United States Study reported sleep duration and emotions by telephone for eight consecutive days. Chronic conditions were assessed via checklist at baseline and at a median follow-up of eight years (range: 5-10 years). Short sleep was examined in three ways: person-centered continuous variable, ≤6 hr, and <7 hr; long sleep was defined as ≥9 hr.

RESULTS

Multilevel structural equation models revealed that people with greater negative emotions following nights of sleep ≤6 hr (vs. their negative emotions after longer sleep) had increased chronic conditions at follow-up, compared to people who were less emotionally vulnerable to short sleep (Est. = 1.04, SE = .51, p < .028). Smaller declines in positive emotions following ≤6 hr of sleep were marginally predictive of lower risk for chronic conditions (Est. = -.77, SE = .44, p = .054). Emotional vulnerability to <7, ≥9, and continuous sleep hours were not associated with subsequent chronic conditions.

CONCLUSIONS

Emotional vulnerability to short sleep is a unique risk factor for the development of chronic conditions, independent of mean-level sleep duration and emotions.

Emotion regulation in patients with cardiovascular disease: development and validation of the stress and anxiety regulation strategies scale (STARTS)

BACKGROUND AND OBJECTIVES

Anxiety and stress influence the onset and prognosis of cardiovascular disease (CVD), but little is known about what CVD patients do when experiencing stress/anxiety. This study aimed to identify the behavioral strategies CVD patients use to regulate these emotions.

DESIGN

Instrumental and longitudinal.

METHODS

A theoretically-guided scale, the Stress and Anxiety Regulation Strategies (STARTS), was developed considering the target population's characteristics. CVD patients were recruited at three different points (N_T1= 721, N_T2= 566, N_T3= 311).

RESULTS

At T1 exploratory factor analysis was conducted (random sample 1). The validity of the most parsimonious three-factor solution was subsequently found via confirmatory factor analysis at T1 (random sample 2), T2, and T3, revealing good and stable model fit. The factors represented strategies differentiated by the type and level of activity required (passive, intellectual, and physical strategies). The scale showed good test-retest reliability and internal consistency. Correlation and regression analyses with positive and negative affect, psychological wellbeing (stress, anxiety, depression), and cardiac self-efficacy provided evidence for the validity of STARTS score. Physical and passive strategies showed opposite patterns.

CONCLUSIONS

The scale shows adequate psychometric properties for assessing the strategies used by CVD patients to regulate stress and anxiety.

How You Deal with Your Emotions Is How You Drive. Emotion Regulation Strategies, Traffic Offenses, and the Mediating Role of Driving Styles

Past research indicated the importance of traffic safety and driving behaviors for the sustainability of the traffic system. The aim of this study was to examine the effect of emotion regulation on drivers’ tendency to obey or transgress traffic rules. A sample of 554 Romanian drivers completed a set of measures assessing their driving styles, traffic offenses, and their habitual use of three emotion regulation strategies. The results of the mediation analyses showed that two of these strategies, i.e., reappraisal and experiential avoidance, are associated with less traffic offenses, and that specific driving styles mediate these effects. While the behavioral effects of experiential avoidance were mixed in valence, reappraisal was found to diminish the use of maladaptive driving styles and to foster careful driving. Overall, this pattern of results indicates the potential benefits of future interventions aiming to develop drivers’ abilities to regulate their emotions, especially through reappraisal, for increasing traffic safety.

Connecting cognition, cardiology, and chromosomes: Cognitive reappraisal impacts the relationship between heart rate variability and telomere length in CD8+CD28- cells

Individuals who poorly regulate emotion exhibit premature aging and worse general health. Telomere shortening, a prognostic biomarker of physical health, is related to aging, poor immunocompetence and autonomic nervous system functioning. Cognitive reappraisal is one type of emotion regulation strategy, which involves changing one's appraisal of an aversive situation to modify its emotional impact. Heart rate variability (HRV; i.e., oscillations in heart rate) relates to emotion regulatory processes, such that higher HRV typically reflects greater regulatory capacity. Previous research has identified a positive association between HRV and telomere length. Importantly, the association between HRV and telomere length may change depending on how often an individual uses cognitive reappraisal. One hundred and thirty-seven healthy participants completed measures of cognitive reappraisal frequency, HRV, and underwent blood draws to measure telomere length (computed with the relative ratio of telomere repeat copy number to single copy gene number) in the T cell effector population, CD8+CD28-. Cognitive reappraisal moderated the relationship between telomere length and HRV such that individuals with high cognitive reappraisal frequency had a significant positive association between HRV and telomere length, while individuals with average and less than average frequency did not exhibit this relationship. The results suggest that frequent usage of cognitive reappraisal enhances the already positive influence of HRV on chromosomal integrity in CD8+CD28- T lymphocytes. Although future research is needed to test these effects causally, these findings suggest that regularly using emotion regulation techniques may buffer the relationship between autonomic nervous system functioning and chromosomal integrity in immune cells.

Real Men Don't Cry: Skill Expressing Discrete Emotions Differentially Predicts Cardiovascular Disease Risk in Men and Women

BACKGROUND

Expressing emotions effectively is central to social functioning and has links to health and cardiovascular disease (CVD) risk. Previous work has linked the ability to smile to lower CVD risk in men but has not studied other expressions or considered the context of these skills.

PURPOSE

To test whether the ability to express fear, anger, sadness, happiness, and disgust cross-sectionally predict CVD risk in both genders and whether links are moderated by the ability to decode others' emotional signals.

METHODS

A community sample of 125 men and women (30-75 years) provided trait emotion data before a laboratory visit where blood was drawn and performance-based assessments of the ability to signal and decode emotions were administered. Expressive accuracy was scored using FaceReader software. Projected CVD risk was calculated using Framingham, a New Zealand (NZ) specific, and Atherosclerosis CVD (ASCVD) risk algorithms.

RESULTS

Accuracy expressing happiness predicted lower projected risk, whereas greater accuracy expressing fear and sadness predicted higher risk. Gender frequently moderated these links; greater accuracy expressing happiness predicted lower risk in men but not women. Conversely, greater accuracy expressing fear predicted higher risk in men, whereas greater accuracy expressing sadness predicted lower risk in women but, again, higher risk in men. The ability to accurately decode others' emotions moderated some links.

CONCLUSIONS

The ability to signal emotion has complex links to health parameters. The ability to flexibly regulate expressions in accordance with gender norms may be one useful way of thinking about adaptive expressive regulation.

Emotion Regulation and Immune Functioning During Grief: Testing the Role of Expressive Suppression and Cognitive Reappraisal in Inflammation Among Recently Bereaved Spouses

OBJECTIVE

Losing a spouse is a distressing life event that can negatively affect both mental and physical health. Stress-induced health consequences often include increased risk of cardiovascular disease and altered immune system functioning marked by increased inflammation. Here, we sought to identify individual difference factors that covary with problematic inflammatory outcomes.

METHOD

We measured recently bereaved spouses' (n = 99) propensity to use emotion regulation strategies and peripheral inflammation, as measured by levels of proinflammatory cytokines after ex vivo stimulation of peripheral leukocytes with T-cell agonists. Specifically, we measured participants' use of cognitive reappraisal, an adaptive emotion regulation strategy in many contexts, and expressive suppression, a less adaptive emotion regulation strategy that involves actively inhibiting emotions after already experiencing them.

RESULTS

Bereaved spouses who self-reported frequently using expressive suppression as an emotion regulation strategy tended to have a more pronounced inflammatory response, as indexed by higher levels of a composite cytokine index consisting of interleukin (IL) 17A, IL-2, IL-6, tumor necrosis factor α, and interferon-γ (b = 0.042), as well as tumor necrosis factor α (b = 0.083) and interferon-γ (b = 0.098) when analyzed individually. Notably, these associations were observed in both unadjusted and adjusted models, with the latter including known covariates of inflammation and other potential confounding variables.

CONCLUSIONS

These findings suggest that bereaved spouses' use of emotion regulation strategies is associated with altered immune functioning, and such a link may be an important biological pathway by which interventions targeting affect may improve immune system-related health outcomes.

Cognitive reappraisal and nasal cytokine production following experimental rhinovirus infection

Following exposure to the common cold (i.e., rhinovirus), locally produced nasal cytokines (rather than the infection itself) drive the progression of one's symptoms (Hendley et al., 1973; Cohen et al., 1999). Stress-induced local inflammation exacerbates local cytokine production (e.g., marital hostility; Kiecolt-Glaser et al., 2005). An individual's ability to effectively manage their emotions is a critical component of positive health and well-being. Here, we evaluated whether one's self-reported frequency of cognitive reappraisal, an adaptive emotion regulation strategy, predicts nasal cytokine production following experimental rhinovirus exposure. Emotion regulation strategies were assessed at baseline prior to experimental infection. After the baseline assessment, each participant was exposed to a strain of rhinovirus (RV-39) and followed for 5 days in quarantine. Nasal interleukin (IL)-1β, IL-6, and IL-8 and subjective symptoms were assessed at baseline and on each of the 5 days of quarantine. A multilevel analysis of the data for 159 participants with documented infection demonstrated that less frequent use of cognitive reappraisal predicted heightened production of the nasal cytokine composite. Those who self-reported using cognitive reappraisal strategies less frequently displayed elevated nasal IL-6 and IL-8. Among the 63 participants with clinical cold, less frequent use of cognitive reappraisal was associated with heightened production of nasal IL-1β, IL-6, and IL-8. In ancillary analyses, the composite of nasal cytokines was associated with the severity of one's subjective symptoms across the 5 days. Findings suggest that emotion regulation strategies, particularly cognitive reappraisal, influence illness trajectories during rhinovirus infection.

Emotion, Social Relationships, and Physical Health: Concepts, Methods, and Evidence for an Integrative Perspective

Emotional characteristics and processes are robust predictors of the development and course of major medical illnesses and premature mortality, as are a variety of indicators of the presence and quality of personal relationships. Despite clear evidence of close interconnection between these two domains of risk and protection, affective characteristics and relationships have largely been studied separately as influences on health. After a recent conference on integrative perspectives on emotions, relationships and health co-sponsored by the American Psychosomatic Society and the Society for Affective Science, the present review builds on prior calls for integration, related theory, and current research to outline what is known about the interconnection of these domains as it specifically relates to their overlapping influences on health. Areas of interest include the following: their interconnected roles over the course of development, which may inform current efforts to understand the influence of early life events on adult health; the parallel positive and negative factors in both domains that could have distinct influences on health; the role of emotion regulation in relationship contexts; and measurement, design, and analysis approaches to capture the dyadic and dynamic aspects of these interconnected influences on health. We conclude with a discussion of an emerging research agenda that includes the following: common biological foundations of affective and relationship processes, the cultural embeddedness of affective and relationship processes, the potential contribution of affective-relational processes to health disparities, and implications for intervention research.

Emotion regulation in patients with heart failure: Its relationship with depressive symptoms and rehospitalization

OBJECTIVE

To examine the role of emotion regulation and its relationship to mental and physical health in patients with heart failure (HF).

METHODS

Patients hospitalized with HF were screened for depressive symptoms with the two-item Patient Health Questionnaire (PHQ-2) and classified as screen-positive if endorsing ≥1 item and otherwise as screen-negative. One month after hospital discharge, the Emotion Regulation Questionnaire (ERQ) was administered to assess suppression and reappraisal as emotion regulation strategies. In all participants who completed the ERQ (N = 394), all-cause rehospitalization and depressive symptoms using the PHQ-9 were assessed at 1-, 3-, and 6-months after hospital discharge.

RESULTS

Overall, PHQ-9 scores decreased by 6-months (-0.13 points/month, p = .003), and although suppression showed a small association with depression, neither strategy modulated the slope of the decline in depressive symptoms. Multivariable-adjusted Cox models showed that reappraisal and suppression were not related to all-cause rehospitalization in the entire cohort. However, increasing reappraisal reduced rehospitalization risk by 24% for screen-positive patients (N = 311, HR = 0.76, p = .02), but increased it by 94% in screen-negative patients (N = 83, HR = 1.94, p = .009).

CONCLUSION

Suppression and reappraisal showed specific and divergent associations in patients with HF: Suppression may relate to depressive symptoms. Reappraisal was associated with rehospitalization, but differently for patients with a positive vs. negative depression screen. Further studies are needed to examine whether emotion-regulation skill training can improve mental and physical health in depressed patients with HF or ameliorate depression in those at-risk.

Direct and indirect associations of cognitive reappraisal and suppression with disease biomarkers

OBJECTIVE

Habitual use of emotion regulation strategies may influence physical health. We examined whether the tendencies to employ cognitive reappraisal and suppression were associated with health biomarkers, and whether stress and sleep quality mediated these associations. Design & main outcome measures: Using data from the Biomarkers substudy (n = 1255) of the national Midlife in the U.S. Study, we tested the hypothesis that there would be indirect, but not direct, associations of cognitive reappraisal and suppression to biomarker indicators of multisystem physiological dysregulation, that is, allostatic load (AL). We computed the proportion of biomarkers in the highest risk quartile within seven biological systems, and summed these scores to compute AL. Associations with the biological systems were also examined separately.

RESULTS

Neither reappraisal nor suppression was directly associated with AL or biomarker function in the seven biological systems. Suppression was indirectly associated with higher AL and greater dysregulation in the inflammatory, metabolic, and hypothalamic-pituitary-adrenal systems via its relations to stress and sleep, p < 0.05. Reappraisal was indirectly associated with lower AL and less metabolic and inflammatory dysregulation, ps<0.05.

CONCLUSIONS

Suppression and reappraisal may have different downstream health effects via stress, sleep, and biomarker expression, suggesting malleable emotion regulation strategies may be an important intervention target.

Neural Mechanisms Linking Emotion with Cardiovascular Disease

PURPOSE OF REVIEW

The present review discusses brain circuits that are engaged by negative emotions and possibly linked to cardiovascular disease risk. It describes recent human brain imaging studies that relate activity in these brain circuits to emotional processes, peripheral physiology, preclinical pathophysiology, as well as clinical outcomes.

RECENT FINDINGS

Negative emotions and the regulation of negative emotions reliably engage several brain regions that cross-sectional and longitudinal brain imaging studies have associated with CVD risk markers and outcomes. These brain regions include the amygdala, anterior cingulate cortex, medial prefrontal cortex, and insula. Other studies have applied advanced statistical techniques to characterize multivariate patterns of brain activity and brain connectivity that associate with negative emotion and CVD-relevant peripheral physiology. Brain imaging studies on emotion and cardiovascular disease risk are expanding our understanding of the brain-body bases of psychosocial and behavioral risk for cardiovascular disease.

Trait emotion regulation strategies and diurnal cortisol profiles in healthy adults

OBJECTIVE

Experimental studies have shown that 2 emotion regulation strategies-suppression and reappraisal-are associated with differential profiles of physiological activation in response to a stress test. The present study aims to add to those findings by investigating whether individual differences in trait emotion regulation strategies are associated with diurnal cortisol patterns in a naturalistic context.

METHOD

A sample of 46 men and women from the Midlife in the United States II (MIDUS II) study completed the Emotion Regulation Questionnaire (ERQ) and provided 4 salivary cortisol samples per day over 4 consecutive days. Trait reappraisal and suppression were tested as predictors of 3 cortisol parameters averaged across days: cortisol awakening response (CAR), diurnal cortisol slope (DCS), and area under the curve with respect to ground (AUCg).

RESULTS

Higher scores on the suppression scale were associated with more physiological activation, as indicated by steeper CAR and flatter DCS. Suppression was not associated with AUCg, and reappraisal was not predictive of any cortisol parameter.

CONCLUSIONS

Individual differences in suppression, but not reappraisal, were linked to greater cortisol activation in this naturalistic study. These preliminary results add to a growing body of findings that link suppression to adverse psychological and physiological profiles. (PsycINFO Database Record

Measuring Childhood Adversity in Life Course Cardiovascular Research: A Systematic Review

OBJECTIVE

Identifying the life course health effects of childhood adversity is a burgeoning area of research, particularly in relation to cardiovascular disease (CVD). However, adversity measurement varies widely across studies, which may hamper our ability to make comparisons across studies and identify mechanisms linking adversity to CVD. The purposes of this review are to summarize adversity measurement approaches in the context of CVD, identify gaps, and make recommendations for future research.

METHODS

PubMed and PsycINFO searches were conducted through June 2016. Studies were selected if CVD end point or predisease risk markers were investigated in association with a measure of childhood adversity. Forty-three studies were reviewed. A meta-analysis was not conducted because of the variation in exposures and outcomes assessed.

RESULTS

Adversity measurement was heterogeneous across studies. Metrics included different sets of adverse events, relational factors, and socioeconomic indicators. Thirty-seven percent measured childhood adversity prospectively, 23% examined a CVD end point, and 77% treated adversity as an unweighted summary score. Despite the heterogeneity in measurement, most studies found a positive association between childhood adversity and CVD risk, and the association seems to be dose-response.

CONCLUSIONS

The literature on childhood adversity and CVD would benefit from improving consistency of measurement, using weighted adversity composites, modeling adversity trajectories over time, and considering socioeconomic status as an antecedent factor instead of a component part of an adversity score. We suggest conceptual and analytic strategies to enhance, refine, and replicate the observed association between childhood adversity and CVD risk.

Gender-specific health implications of minority stress among lesbians and gay men

OBJECTIVES

Lesbians and gay men are exposed to unique minority stressors. We examined the health implications of one type of distal minority stressor (victimisation) and one type of proximal minority stressor (sexual identity concealment due to anticipated stigma) among lesbians and gay men. Gender-specific health implications were assessed.

METHODS

Data were collected via an online survey involving an Australian sample of 1,470 gay men and 1,264 lesbians. Survey questions assessed demographics, experiences of different forms of sexual identity-related victimisation and sexual identity concealment in a variety of contexts. Health outcomes included self-reported general health, illicit drug use, frequency of alcohol consumption, smoking status, and weight status.

RESULTS

Gay men reported higher rates of victimisation and identity concealment than lesbians. Controlling for demographic differences, experiences of victimisation were associated with poorer self-rated health, illicit drug use, and smoking among both gay men and lesbians. In contrast, identity concealment was linked with poorer health outcomes among lesbians only.

CONCLUSIONS

Our findings offer new insights into the potential antecedents of the health inequalities that have previously been reported for these populations.

A social neuroscience-informed model for teaching and practising compassion in health care

CONTEXT

Empathy and compassion are important catalysts for the healing process, but some research suggests their decline during training and practice. Compassion involves recognition, understanding, emotional resonance and empathic concern for another's concerns, distress, pain and suffering, coupled with their acknowledgement, and motivation and relational action to ameliorate these conditions.

COMPASSION, ALTRUISM AND REWARD

Neuroscientists have identified neural networks that generate shared representations of directly experienced and observed feelings, sensations and actions. When shared representations evoke empathic concern or compassion for another's painful situation, humans experience altruistic motivation to help. The resulting behaviours are associated with activation of areas in the brain associated with affiliation and reward.

COMPASSION MODULATORS

Activation of these neural networks is sensitive to multiple inter- and intrapersonal influences. These include the ability to focus one's attention, the ability to receive and accurately interpret input about distress, the perspective one adopts in order to understand another's experience, self-other boundary awareness, the degree to which one values another's welfare, the ability to recognise and regulate one's own emotions, the ability to attend to one's own wellbeing through self-care and self-compassion, effective communication skills, reflection and meta-cognition.

CONCLUSIONS

Current research suggests that compassion can be modulated through education and training and is associated with positive emotions, a sense of affiliation, reward and prosocial behaviours. A compassion process model and framework with examples of educational goals, interventions and resources for curriculum development are described. However, education must be aligned with changes in clinical practice to sustain compassionate care.