An autonomic flexibility–neurovisceral integration model of anxiety and cardiac vagal tone

Effects of man-made electromagnetic fields on heart rate variability parameters of general public: a systematic review and meta-analysis of experimental studies

OBJECTIVES

The effects of man-made electromagnetic fields (EMFs) on the cardiovascular system have been investigated in many studies. In this regard, the cardiac autonomic nervous system (ANS) activity due to EMFs exposure, assessed by heart rate variability (HRV), was targeted in some studies. The studies investigating the relationship between EMFs and HRV have yielded conflicting results. We performed a systematic review and meta-analysis to assess the data's consistency and identify the association between EMFs and HRV measures.

CONTENT

Published literature from four electronic databases, including Web of Science, PubMed, Scopus, Embase, and Cochrane, were retrieved and screened. Initially, 1601 articles were retrieved. After the screening, 15 original studies were eligible to be included in the meta-analysis. The studies evaluated the association between EMFs and SDNN (standard deviation of NN intervals), SDANN (Standard deviation of the average NN intervals for each 5 min segment of a 24 h HRV recording), and PNN50 (percentage of successive RR intervals that differ by more than 50 ms).

SUMMARY

There was a decrease in SDNN (ES=-0.227 [-0.389, -0.065], p=0.006), SDANN (ES=-0.526 [-1.001, -0.05], p=0.03) and PNN50 (ES=-0.287 [-0.549, -0.024]). However, there was no significant difference in LF (ES=0.061 (-0.267, 0.39), p=0.714) and HF (ES=-0.134 (0.581, 0.312), p=0.556). In addition, a significant difference was not observed in LF/HF (ES=0.079 (-0.191, 0.348), p=0.566).

OUTLOOK

Our meta-analysis suggests that exposure to the environmental artificial EMFs could significantly correlate with SDNN, SDANN, and PNN50 indices. Therefore, lifestyle modification is essential in using the devices that emit EMs, such as cell phones, to decrease some signs and symptoms due to EMFs' effect on HRV.

Mediating Effect of Heart Rate Variability on the Relationship Between Anxiety Symptoms and Blood Pressure in Patients with Primary Hypertension

Patients with hypertension (HTN) are at increased risk of developing cardiovascular disease, which can be reduced with blood pressure (BP) control. Anxiety can contribute to high BP and low heart rate variability (HRV). Although relationships between social support, self-rated health-status (SRHS), anxiety and measures of HRV and BP have been suggested, they have not been clearly established. This cross-sectional correlational study aimed to 1) examine relationships between social support, SRHS, and anxiety; and 2) examine if HRV mediated relationships between anxiety symptoms and BP. Patients with primary HTN were recruited from a cardiovascular outpatient clinic using convenience sampling (N = 300). Data included scale scores for SRHS, social support, and anxiety (Hospital Anxiety and Depression Scale). A handheld limb-lead electrocardiogram monitor measured HRV, using the ratio of low-frequency bands to high-frequency bands; an automatic sphygmomanometer measured systolic and diastolic blood pressure (SBP and DBP, respectively). Path analysis of structural equation models examined relationships between variables; the bootstrap method examined the mediating effects of HRV. Analysis showed scores for SRHS and social support had a direct effect on anxiety scores. Scores for anxiety directly affected HRV and BP. HRV also had a direct effect on BP. Bootstrapping indicated HRV mediated the relationship between anxiety symptoms and BP. The final model indicated SRHS, social support, and anxiety symptoms together explained 80% of SBP and 33% of DBP. These findings suggest HRV could be used to measure the effectiveness of strategies aimed at reducing anxiety and improving control of BP.

Childhood Family Stress and Women's Health: Parasympathetic Activity as a Risk and Resiliency Factor

Childhood family stress (CFS) exacerbates risk for physical health problems across the lifespan. Health risks associated with CFS are particularly relevant for women who tend to endorse more CFS than men. Importantly, some evidence suggests that individuals may vary in their susceptibility to CFS. Parasympathetic activity, which helps to regulate automatic bodily activity (e.g., breathing, digestion), has been proposed to represent a marker of plasticity to environmental exposure. However, no research to date has tested whether parasympathetic activity may modulate the impact of early adversity on health. We examined whether parasympathetic activity would moderate the link between CFS and health complaints in a sample of 68 undergraduate women (Mean age = 19.44). Participants self-reported CFS and health complaints. Parasympathetic activity was indexed using high-frequency heart rate variability (HF-HRV) and was evaluated by measuring changes in HF-HRV in response to and following a laboratory-based stress induction. Multiple regression analyses indicated that CFS was significantly associated with more health complaints. Further, HF-HRV in response to stress and during recovery relative to baseline significantly moderated relationship between CFS and health complaints. Specifically, more CFS was significantly associated with more health complaints among women who showed mean or greater decreases in HF-HRV in response to stress. Additionally, lower levels of CFS were associated with fewer health complaints among women who showed mean or greater HF-HRV during recovery relative to baseline. Findings highlight the importance of parasympathetic activity in modulating stress-health links.

Alterations in Vagal Tone Are Associated with Changes in the Gut Microbiota of Adults with Anxiety and Depression Symptoms: Analysis of Fecal Metabolite Profiles

Accumulating evidence suggests that interactions between the brain and gut microbiota significantly impact brain function and mental health. In the present study, we aimed to investigate whether young, healthy adults without psychiatric diagnoses exhibit differences in metabolic stool and microbiota profiles based on depression/anxiety scores and heart rate variability (HRV) parameters. Untargeted nuclear magnetic resonance-based metabolomics was used to identify fecal metabolic profiles. Results were subjected to multivariate analysis through principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA), and the metabolites were identified through VIP score. Metabolites separating asymptomatic and symptomatic groups were acetate, valine, and glutamate, followed by sugar regions, glutamine, acetone, valerate, and acetoacetate. The main metabolites identified in high vagal tone (HVT) and low vagal tone (LVT) groups were acetate, valerate, and glutamate, followed by propionate and butyrate. In addition to the metabolites identified by the PLS-DA test, significant differences in aspartate, sarcosine, malate, and methionine were observed between the groups. Levels of acetoacetate were higher in both symptomatic and LVT groups. Valerate levels were significantly increased in the symptomatic group, while isovalerate, propionate, glutamate, and acetone levels were significantly increased in the LVT group. Furthermore, distinct abundance between groups was only confirmed for the Firmicutes phylum. Differences between participants with high and low vagal tone suggest that certain metabolites are involved in communication between the vagus nerve and the brain.

Update: factors influencing heart rate variability-a narrative review

Objective

Heart rate variability (HRV) is an important non-invasive marker for the assessment of an organism's autonomic physiological regulatory pathways. Lower HRV has been shown to correlate with increased mortality. HRV is influenced by various factors or diseases. The aim of this narrative review is to describe the current state of knowledge on factors influencing HRV and their significance for interpretation.

Methods

The narrative review only included reviews, meta-analyses, and cohort studies which were published until 2021. HRV confounders were grouped into four categories (non-influenceable physiological factors, diseases, influenceable lifestyle factors and external factors).

Results

The review found that HRV was decreased not only in non-influenceable physiological factors (e.g., age, gender, ethnicity) but also in connection with various number of acute and chronic diseases (e.g., psychiatric diseases, myocardial infarction, heart failure), influenceable lifestyle factors (e.g., alcohol abuse, overweight, physical activity), and external factors (e.g., heat, noise, shift work, harmful- and hazardous substances).

Conclusion

In order to improve the quality of HRV studies and to ensure accurate interpretation, it is recommended that confounders be taken into account in future diagnostic measurements or measurements in the workplace (e.g., as part of health promotion measures) in order to counteract data bias.

Anxiety is related to slower RSA oscillation during stress response and regulation

Respiratory sinus arrhythmia (RSA), an index of the parasympathetic nervous system activity, has been considered indicative of stress response and emotion regulation. However, the relationship between RSA and anxiety remains inconclusive, partly because previous research has primarily focused on static RSA levels. In this nonclinical sample (N = 75, Mage = 20.89 ± 1.72 SD, 48 males), we used a damped oscillator model to characterize RSA dynamics across 30-s epochs while participants completed the Trier social stress test. Results showed that RSA constantly oscillated during the three periods of TSST (namely Rest, Stress, and Recovery). Importantly, slower RSA oscillation in the Stress period was related to elevated state anxiety, whereas in the Recovery period, it was related to higher trait anxiety. These findings demonstrated the dynamic nature of RSA during the whole course of stress response. Slower RSA oscillation may indicate inflexible and tardy physiological regulation which may give rise to anxiety issues.

Is autonomic functioning distinctly associated with anxiety and unsociability in preschoolers?

There are many benefits of peer interactions for children's social, emotional, and cognitive development, and isolation from peers may have negative consequences for children. Although biological processes may underlie social withdrawal broadly, distinct patterns may be associated with withdrawal behaviors depending on their underlying motivation (e.g., shy versus disinterested). This study investigated the role of autonomic nervous system activity, as assessed via skin conductance level (SCL) and respiratory sinus arrhythmia (RSA) in predicting changes in unsociability (e.g., lack of interest in peers) and anxious-fearfulness (e.g., discomfort among peers). Data were collected using a community sample of 92 US preschool children (45.7% female; Mage = 45.51 months, SDage = 3.81 months) at two time points one year apart. Gender differences were also explored. Baseline physiology was assessed while viewing a neutral video clip, and reactivity was assessed while viewing social exclusion and post-aggression discussion videos. For all children, coinhibition (i.e., SCL inhibition accompanied by RSA inhibition) to the post-aggression discussion video and blunted SCL activation to the exclusion video were prospectively associated with higher levels of anxious-fearfulness one year later. For boys only, baseline reciprocal sympathetic activation (i.e., SCL activation and RSA inhibition) was prospectively related to higher levels of unsociability one year later. For girls only, RSA inhibition in response to the post-aggression discussion video was prospectively related to higher levels of unsociability one year later. Findings contribute to a growing literature on autonomic reactivity in preschoolers' adjustment and suggest possible differences in the physiological processes underlying unsociability and anxious-fearfulness.

Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science

This updated guideline replaces the "Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science" first published in 2014. Based on the older version of the guideline, the authors have reviewed and evaluated the findings on the use of heart rate (HR) and heart rate variability (HRV) that have been published in the meantime and incorporated them into a new version of this guideline.This guideline was developed for application in clinical practice and research purposes in the fields of occupational medicine and occupational science to complement evaluation procedures with respect to exposure and risk assessment at the workplace by the use of objective physiological workload indicators. In addition, HRV is also suitable for assessing the state of health and for monitoring the progress of illnesses and preventive medical measures. It gives an overview of factors influencing the regulation of the HR and HRV at rest and during work. It further illustrates methods for measuring and analyzing these parameters under standardized laboratory and real workload conditions, areas of application as well as the quality control procedures to be followed during the recording and evaluation of HR and HRV.

High-Frequency Heart Rate Variability Is Prospectively Associated With Sleep Complaints in a Healthy Working Cohort

OBJECTIVE

Vagus nerve functioning, as indexed by high-frequency heart rate variability (HF-HRV), has been implicated in a wide range of mental and physical health conditions, including sleep complaints. This study aimed to test associations between HF-HRV measured during sleep (sleep HF-HRV) and subjective sleep complaints 4 years later.

METHODS

One hundred forty-three healthy employees (91% male; MAge = 47.8 years [time 2], SD = 8.3 years) of an industrial company in Southern Germany completed the Jenkins Sleep Problems Scale, participated in a voluntary health assessment, and were given a 24-hour ambulatory heart rate recording device in 2007. Employees returned for a health assessment and completed the Jenkins Sleep Problems Scale 4 years later.

RESULTS

Hierarchical regression analyses showed that lower sleep HF-HRV measured in 2007 was associated with higher self-reported sleep complaints 4 years later after controlling for covariates (rab,c = -0.096, b = -0.108, 95% CI, -0.298 to 0.081, ΔR2 = 0.009, p = .050).

CONCLUSIONS

These data are the first to show that lower sleep HF-HRV predicted worse sleep 4 years later, highlighting the importance of vagus nerve functioning in adaptability and health.

Social interaction anxiety and sleep quality in youth: Individual difference in childhood adversity and cardiac vagal control

BACKGROUND

Social interaction anxiety and sleep problems are prevalent during adolescence. Social interaction anxiety undermines sleep quality, however, little is known whether the association between social interaction anxiety and sleep quality is moderated by environmental factors such as childhood adversity and individual factors such as cardiac vagal control. This study sought to investigate the moderating effects of childhood adversity and cardiac vagal control on the link between social interaction anxiety and sleep quality.

METHOD

The Social Interaction Anxiety Scale, the Pittsburgh Sleep Quality Index and the Childhood Trauma Questionnaire were administered to 274 adolescents, who received 3-min resting ECG recording to assess respiratory sinus arrhythmia (RSA) as an index of cardiac vagal control.

RESULTS

Social interaction anxiety was negatively associated with sleep quality, and this association was moderated by childhood adversity and cardiac vagal control. In specific, social interaction anxiety was negatively associated with sleep quality among adolescents with low childhood adversity regardless of cardiac vagal control. Sleep quality was generally disrupted when adolescents exposed to high childhood adversity, but the negative association between social interaction anxiety and sleep quality among adolescents with high childhood adversity could be amortized by high cardiac vagal control.

LIMITATIONS

Cross-sectional design precluded establishing causality among variables.

CONCLUSION

These findings suggest that high cardiac vagal control reflecting better self-regulation might buffer the negative effect of social interaction anxiety on sleep quality particularly among adolescents exposed to early life stress.

Exploring the causal relationships and mediating factors between depression, anxiety, panic, and atrial fibrillation: A multivariable Mendelian randomization study

BACKGROUND

Atrial fibrillation is a significant cardiovascular disease, and the increased risk of its occurrence may be influenced by mental disorders. Currently, the causal relationship between them remains controversial. Our aim is to ascertain the relationship between atrial fibrillation and mental disorders including depression, anxiety, and panic, as well as the risk factors mediating this relationship, through the judgment of genetic susceptibility.

METHODS

We utilized the summarized statistics from nine large-scale genome-wide association studies (in European populations), including depression (PGC, N = 807,553), anxiety (FinnGen, N = 429,209), panic (PGC, N = 230,878), diabetes (UK Biobank, N = 655,666), smoking (IEU, 607,291), hypertension (UK biobank, N = 463,010), obstructive sleep apnea (IEU, N = 476,853), obesity (UK biobank, N = 463,010), and AF (IEU, N = 1,030,836). By applying bidirectional two-sample Mendelian randomization and multivariable Mendelian randomization to depression, anxiety, panic, and AF, we analyzed their causal relationships and the independent influence of specific risk factors. Furthermore, a two-step MR approach was used to assess the mediating effects of diabetes, smoking, hypertension, obstructive sleep apnea, and obesity.

RESULTS

Results from the Two-Sample Mendelian Randomization Inverse Variance Weighted Random Effects Model show: the occurrence of genetically predicted depression is related to an increased risk of atrial fibrillation (AF) (OR: 1.073; [95 % CI: 1.005-1.146] P < 0.05), and panic is more significantly associated than depression (OR: 1.017; [95 % CI: 1.008-1.027] P < 0.001), while anxiety has no causal relationship with the occurrence of AF (OR: 1.023; [95 % CI: 0.960-1.092], P > 0.05), and AF is not significantly related to the occurrence of depression, anxiety, or panic (P > 0.05). After correcting for the other two risk factors using multivariable Mendelian randomization, depression remains significantly related to the occurrence of AF (β: 0.075; 95 % CI: [0.006, 0.144], P < 0.05), while panic and anxiety are not related to the occurrence of AF. Among them, the risk factors for AF occurrence, hypertension and obesity, are mediators between depression and AF, with mediation proportions of 74.9 % and 14.3 %, respectively. The mediating effects of diabetes, smoking, and obstructive sleep apnea were found to be not statistically significant. The above results are robust after sensitivity analysis.

CONCLUSION

Our results identified that the genetic susceptibility to depression is an independent risk factor for the occurrence of AF, and that hypertension and obesity can mediate this process. Panic also poses some risk to the onset of AF. This demonstrates that controlling hypertension and obesity for emotional management is of great importance in preventing the occurrence of AF.

Prediction of the efficacy of group cognitive behavioral therapy using heart rate variability based smart wearable devices: a randomized controlled study

BACKGROUND

Depression and anxiety are common and disabling mental health problems in children and young adults. Group cognitive behavioral therapy (GCBT) is considered that an efficient and effective treatment for these significant public health concerns, but not all participants respond equally well. The aim of this study was to examine the predictive ability of heart rate variability (HRV), based on sensor data from consumer-grade wearable devices to detect GCBT effectiveness in early intervention.

METHODS

In a study of 33 college students with depression and anxiety, participants were randomly assigned to either GCBT group or a wait-list control (WLC) group. They wore smart wearable devices to measure their physiological activities and signals in daily life. The HRV parameters were calculated and compared between the groups. The study also assessed correlations between participants' symptoms, HRV, and GCBT outcomes.

RESULTS

The study showed that participants in GCBT had significant improvement in depression and anxiety symptoms after four weeks. Higher HRV was associated with greater improvement in depressive and anxious symptoms following GCBT. Additionally, HRV played a noteworthy role in determining how effective GCBT was in improve anxiety(P = 0.002) and depression(P = 0.020), and its predictive power remained significant even when considering other factors.

CONCLUSION

HRV may be a useful predictor of GCBT treatment efficacy. Identifying predictors of treatment response can help personalize treatment and improve outcomes for individuals with depression and anxiety.

TRIAL REGISTRATION

The trial has been retrospectively registered on [22/06/2023] with the registration number [NCT05913349] in the ClinicalTrials.gov. Variations in heart rate variability (HRV) have been associated with depression and anxiety, but the relationship of baseline HRV to treatment outcome in depression and anxiety is unclear. This study predicted GCBT effectiveness using HRV measured by wearable devices. 33 students with depression and anxiety participated in a trial comparing GCBT and wait-list control. HRV parameters from wearables correlated with symptoms (PHQ, PSS) and GCBT effectiveness. Baseline HRV levels are strongly associated with GCBT treatment outcomes. HRV may serve as a useful predictor of efficacy of GCBT treatment,facilitating personalized treatment approaches for individuals with depression and anxiety.

Higher baseline heart rate variability in CCHS patients with progestin-associated recovery of hypercapnic ventilatory response

After a fortuitous observation of two cases of chemosensitivity recovery in women with congenital central hypoventilation syndrome (CCHS) who took desogestrel, we aimed to evaluate the ventilatory response to hypercapnia of five CCHS patients with or without treatment consisting of desogestrel (DESO) or levonorgestrel (LEVO). Only two patients became responsive to hypercapnia under treatment, according to their basal vagal heart rate variability. These results suggest that heart rate variability may be promising tool to discriminate patients susceptible to become responsive to hypercapnia under DESO-LEVO treatment.Clinical Trials Identifier NCT01243697.

Heart rate variability: Evaluating a potential biomarker of anxiety disorders

Establishing quantifiable biological markers associated with anxiety will increase the objectivity of phenotyping and enhance genetic research of anxiety disorders. Heart rate variability (HRV) is a physiological measure reflecting the dynamic relationship between the sympathetic and parasympathetic nervous systems, and is a promising target for further investigation. This review summarizes evidence evaluating HRV as a potential physiological biomarker of anxiety disorders by highlighting literature related to anxiety and HRV combined with investigations of endophenotypes, neuroimaging, treatment response, and genetics. Deficient HRV shows promise as an endophenotype of pathological anxiety and may serve as a noninvasive index of prefrontal cortical control over the amygdala, and potentially aid with treatment outcome prediction. We propose that the genetics of HRV can be used to enhance the understanding of the genetics of pathological anxiety for etiological investigations and treatment prediction. Given the anxiety-HRV link, strategies are offered to advance genetic analytical approaches, including the use of polygenic methods, wearable devices, and pharmacogenetic study designs. Overall, HRV shows promising support as a physiological biomarker of pathological anxiety, potentially in a transdiagnostic manner, with the heart-brain entwinement providing a novel approach to advance anxiety treatment development.

Vagally-mediated HRV as a marker of trait rumination in healthy individuals? A large cross-sectional analysis

The tendency to ruminate (i.e., repetitive, self-referential, negative thoughts) is a maladaptive form of emotional regulation and represents a transdiagnostic vulnerability factor for stress-related psychopathology. Vagally-mediated heart rate variability (vmHRV) provides a non-invasive, surrogate measure of vagal modulation of the heart, and higher HRV is considered an indicator of susceptibility, or ability to respond to stress. Past research has suggested a link between trait rumination and vmHRV; however, inconsistent results exist in healthy individuals. In this study, we investigated the association between the tendency to ruminate, brooding, and reflection (using the Ruminative Response Scale) with vmHRV measured at baseline in a healthy population using a large cross-sectional dataset (N = 1189, 88% female; mean age = 21.55, ranging from 17 to 48 years old), which was obtained by combining samples of healthy individuals from different studies from our laboratory. The results showed no cross-sectional correlation between vmHRV and trait rumination (confirmed by Bayesian analysis), even after controlling for important confounders such as gender, age, and depressive symptoms. Also, a non-linear relationship was rejected. In summary, based on our results in a large sample of healthy individuals, vmHRV is not a marker of trait rumination (as measured by the Ruminative Response Scale).

Central autonomic network and early prognosis in patients with disorders of consciousness

The central autonomic network (CAN) plays a crucial role in modulating the autonomic nervous system. Heart rate variability (HRV) is a valuable marker for assessing CAN function in disorders of consciousness (DOC) patients. We used HRV analysis for early prognosis in 58 DOC patients enrolled within ten days of hospitalization. They underwent a five-minute electrocardiogram during baseline and acoustic/visual stimulation. The coma recovery scale-revised (CRS-R) was used to define the patient's consciousness level and categorize the good/bad outcome at three months. The high-frequency Power Spectrum Density and the standard deviation of normal-to-normal peaks in baseline, the sample entropy during the stimulation, and the time from injury features were used in the support vector machine analysis (SVM) for outcome prediction. The SVM predicted the patients' outcome with an accuracy of 96% in the training test and 100% in the validation test, underscoring its potential to provide crucial clinical information about prognosis.

Autonomic nervous system responses in the intermediate band to cranial cutaneous stimulation

Cardiovascular rhythms representing functional states of the autonomic nervous system (ANS) are insufficiently reflected by the current physiological model based on low and high frequency bands (LF, HF, resp.). An intermediate (IM) frequency band generated by a brainstem pacemaker was included in systemic physiological ANS analyses of forehead skin perfusion (SP), ECG, and respiration. Data of 38 healthy participants at T0 and T1 (+1 week) before, during, and following osteopathic cranial vault hold (CVH) stimulation were analyzed including momentary frequencies of highest amplitude, amplitudes in low (0.05-0.12 Hz), IM (0.12-0.18 Hz), and high (0.18-0.4 Hz) frequency bands, and established heart rate variability (HRV) metrics. During CVH, LF interval durations increased, whereas IM/HF band durations decreased significantly. Amplitudes increased significantly in all frequency bands. A cluster analysis found one response pattern dominated by IM activity (47% of participants) with highly stable 0.08 Hz oscillation to CVH, and one dominated by LF activity (0.10 Hz) at T0, increasing to IM activity at T1. Showing frequency ratios at ≈3:1, respiration was not responsible for oscillations in PPG during CVH. HRV revealed no significant responses. Rhythmic patterns in SP and respiration matched previous findings on a reticular "0.15 Hz rhythm". Involvement of baroreflex pathways is discussed as alternative explanation.

Facial infrared thermography as an index of social anxiety

Previous research on physiological indices of social anxiety has offered unclear results. In this study, participants with low and high social anxiety performed five social interaction tasks while being recorded with a thermal camera. Each task was associated with a dimension assessed by the Social Anxiety Questionnaire for Adults (1 = Interactions with strangers. 2 = Speaking in public/Talking with people in authority, 3 = Criticism and embarrassment, 4 = Assertive expression of annoyance, disgust or displeasure, 5 = Interactions with the opposite sex). Mixed-effects models revealed that the temperature of the tip of the nose decreased significantly in participants with low (vs. high) social anxiety (p < 0.001), while no significant differences were found in other facial regions of interest: forehead (p = 0.999) and cheeks (p = 0.999). Furthermore, task 1 was the most effective at discriminating between the thermal change of the nose tip and social anxiety, with a trend for a higher nose temperature in participants with high social anxiety and a lower nose temperature for the low social anxiety group. We emphasize the importance of corroborating thermography with specific tasks as an ecological method, and tip of the nose thermal change as a psychophysiological index associated with social anxiety.

Patterns of respiratory sinus arrhythmia and trajectories of anxiety and depressive symptoms in early adolescence

In children and adults, individual differences in patterns of respiratory sinus arrhythmia (RSA; i.e., interactions between resting RSA and RSA reactivity to stress) have emerged as a central predictor of internalizing symptoms. However, it is unclear whether individual differences in patterns of RSA also contribute to internalizing symptoms during the key developmental period of early adolescence, when rates of internalizing symptoms sharply increase. In the present multi-wave longitudinal study, we assessed whether patterns of RSA predicted trajectories of the two most common types of internalizing symptoms among adolescents: anxiety and depression. In the baseline session, we assessed RSA at rest and in response to a psychosocial stressor (Trier Social Stress Test [TSST]) in a sample of 75 early adolescents (Mage = 12.85). Youth then completed measures of anxiety and depressive symptoms at baseline and four times over approximately two years. Findings indicate that RSA patterns predicted trajectories of anxiety, but not depression. Specifically, region of significance analyses indicated that individuals with high resting RSA who demonstrated RSA augmentation to the lab stressor evinced decreasing anxiety over the follow-up period. In direct contrast, adolescents with high resting RSA in combination with RSA withdrawal to the stressor exhibited a trajectory of increasing anxiety. Findings provide preliminary evidence for understanding RSA as a developmentally salient risk or protective factor.

Does Mandala Art Therapy Improve Psychological Well-Being of Gynecological Cancer Patients During the Perioperative Period? A Quasi-Experimental Study

BACKGROUND

Women with gynecological cancer often experience psychological distress, particularly in response to surgical procedures. The impact of mandala art therapy (MAT) during the perioperative period for gynecological cancer patients remains uncertain. We aimed to examine the effects of the MAT program in women with gynecological cancer.

METHODS

Employing a quasi-experimental design, we recruited 126 gynecological cancer patients from a university hospital through convenience sampling. Participants were assigned to either receive the MAT program or standard perioperative care. The interventions comprised a three-session MAT program guided by a team of trained mandala psychologists. Generalized estimating equations (GEE) were employed to analyze the effects of MAT over time.

RESULTS

A total of 126 patients were enrolled, and 118 completed the entire study. Over 90% of participants completed the perioperative MAT interventions, reporting relatively high satisfaction with the program (7.70 out of 10). Individuals in the MAT group exhibited improved therapeutic effects on STAI-S, VASS, and vital signs over time. Notably, significant group*time interaction effects were noted in STAI-S scores at both the first evaluation, T1 (β = -4.220, P < .005) and the third evaluation, T3 (β = -3.797, P < .05), and VASS scores at T1 (β = -11.186, P < .005), T2 (β = -9.915, P < .05) and T3 (β = -9.831, P < .05). Regarding vital signs, the multivariate GEE model revealed significant interaction effects in systolic blood pressure values at both T1 (β = -7.102, P < .05) and T3 (β = -10.051, P < .005), diastolic blood pressure values at T3 (β = -6.441, P < .005), and pulse values at T1 (β = -6.085, P < .005). No significant differences were observed between groups for pain, hope, or self-acceptance.

CONCLUSION

This study posited that MAT could serve as a valuable complementary approach in perioperative care for addressing the psychological needs of women with gynecological cancer. Subsequent research employing more robust methodologies and larger, more diverse participant samples will be necessary to validate these conclusions.

Heart Rate Variability during Online Video Game Playing in Habitual Gamers: Effects of Internet Addiction Scale, Ranking Score and Gaming Performance

Previous studies have demonstrated that individuals with internet gaming disorder (IGD) display abnormal autonomic activities at rest and during gameplay. Here, we examined whether and how in-game autonomic activity is modulated by human characteristics and behavioral performance of the player. We measured heart rate variability (HRV) in 42 male university student habitual gamers (HGs) when they played a round of League of Legends game online. Short-term HRV indices measured in early, middle and late phases of the game were compared between the players at high risk of developing IGD and those at low risk, as assessed by the revised Chen Internet addiction scale (CIAS-R). Multiple linear regression (MLR) was used to identify significant predictors of HRV measured over the whole gameplay period (WG), among CIAS-R, ranking score, hours of weekly playing and selected in-game performance parameters. The high-risk players showed a significantly higher low-frequency power/high-frequency power ratio (LF/HF) relative to the low-risk players, regardless of game phase. MLR analysis revealed that LF/HF measured in WG was predicted by, and only by, CIAS-R. The HRV indicators of sympathetic activity were found to be predicted only by the number of slain in WG (NSlain), and the indicators of parasympathetic activity were predicted by both CIAS-R and NSlain. Collectively, the results demonstrated that risk of developing IGD is associated with dysregulated autonomic balance during gameplay, and in-game autonomic activities are modulated by complex interactions among personal attributes and in-game behavioral performance of the player, as well as situational factors embedded in game mechanics.

Heart rate variability status at rest in adult depressed patients: a systematic review and meta-analysis

Purposes

A meta-analysis was conducted to examine the differences in heart rate variability (HRV) between depressed patients and healthy individuals, with the purpose of providing a theoretical basis for the diagnosis of depression and the prevention of cardiovascular diseases.

Methods

To search China National Knowledge Infrastructure (CNKI), WanFang, VIP, PubMed, Web of Science, Science Direct, and Cochrane Library databases to collect case-control studies on HRV in depressed patients, the retrieval date is from the establishment of the database to December 2022. Effective Public Health Practice Project (EPHPP) scale was used to evaluate literature quality, and Stata14.0 software was used for meta-analysis.

Results

This study comprised of 43 papers, 22 written in Chinese and 21 in English, that included 2,359 subjects in the depression group and 3,547 in the healthy control group. Meta-analysis results showed that compared with the healthy control group, patients with depression had lower SDNN [Hedges' g = -0.87, 95% CI (-1.14, -0.60), Z = -6.254, p < 0.01], RMSSD [Hedges' g = -0.51, 95% CI (-0.69,-0.33), Z = -5.525, p < 0.01], PNN50 [Hedges' g = -0.43, 95% CI (-0.59, -0.27), Z = -5.245, p < 0.01], LF [Hedges' g = -0.34, 95% CI (-0.55, - 0.13), Z = -3.104, p < 0.01], and HF [Hedges' g = -0.51, 95% CI (-0.69, -0.33), Z = -5.669 p < 0.01], and LF/HF [Hedges' g = -0.05, 95% CI (-0.27, 0.18), Z = -0.410, p = 0.682] showed no significant difference.

Conclusion

This research revealed that HRV measures of depressed individuals were lower than those of the healthy population, except for LF/HF, suggesting that people with depression may be more at risk of cardiovascular diseases than the healthy population.

Risk of depression and anxiety disorders according to long-term glycemic variability

BACKGROUND

Poor glycemic control has been linked to psychiatric symptoms. However, studies investigating the relationship between glycemic variability (GV) and depression and anxiety disorders are limited. We investigated the association of GV with depression and anxiety disorders. In addition, the relationship between trends in fasting plasma glucose (FPG) levels and these disorders were explored.

METHODS

We analyzed the National Health Insurance Service-National Sample Cohort database (2002-2013) with 151,814 participants who had at least three health screenings between 2002 and 2010. Visit-to-visit FPG variability was measured as variability independent of the mean (VIM). Depression and anxiety disorders were diagnosed using ICD-10 codes (F41 for anxiety and F32 or F33 for depression) after index date. We analyzed the association between GV and incidences of these disorders using Kaplan-Meier and Cox proportional hazards methods. Trajectory analysis was conducted to explore the relationship between FPG trends and these disorders.

RESULTS

During follow-up, 7166 and 14,149 patients were newly diagnosed with depression and anxiety disorders, respectively. The highest quartile group of FPG-VIM had a greater incidence of depression and anxiety than the lowest quartile group, with adjusted hazard ratios of 1.09 (95 % confidence interval [CI]: 1.02-1.17) and 1.08 (95 % CI: 1.03-1.14). Group with persistent hyperglycemia, identified through trajectory clustering of FPG levels, had a 1.43-fold increased risk of depression compared to those with consistently low FPG levels.

LIMITATIONS

Potential selection bias by including participants with at least three health screenings.

CONCLUSIONS

High GV and persistent hyperglycemia are associated with increased incidence of depression and anxiety disorders.

Childhood emotional dysregulation paths for suicide-related behaviour engagement in adolescence

This study aimed at identifying the heterogeneous trajectories of emotional dysregulation across childhood and to study the relationship between specific trajectories and adolescent suicide-related behaviour (SRB). Data from the Millennium Cohort Study (N = 13,853 children; 49.07% female, M = 3.13 years at baseline, SD = 0.2) were used to identify the emotional dysregulation trajectories from 3 to 8 years old, using growth mixture modelling. Moreover, 1992 participants (52.86% female) from the initial sample were used to study the relationship between childhood emotional dysregulation trajectory and engagement in both self-harm and suicide attempt at age 17, using logistic regression. Some other time-invariant and proximal (adolescent) risk factors were incorporated into this analysis. Six emotional dysregulation trajectories were identified. Self-harm at age 17 was significantly associated with the history of self-harm and other proximal factors, but not with emotional dysregulation trajectory membership. Childhood trajectories featured by earlier emotional dysregulation were associated with higher risk of lifetime suicide attempt, as well as other proximal factors (concurrent self-harm). This study found differential risk profiles involved in both SRB forms. A relationship between early emotional dysregulation and suicide attempt engagement in adolescence was identified. Early interventions should be developed to deal with SRB risk factors from childhood.

Brief mindfulness meditation intervention improves attentional control of athletes in virtual reality shooting competition: Evidence from fNIRS and eye tracking

Attentional control is a crucial cognitive ability for sports performance. The current research aimed to investigate whether a brief (20-min) pre-competition mindfulness meditation (MM) intervention enhances athletes' attentional control during competitions and alters the activity of brain regions related to attentional control. We created a virtual reality shooting competition to compare the eye-gaze indicators and functional near-infrared spectroscopy (fNIRS) parameters of 78 university athletes after 20 min of MM or 20 min of mind wandering (MW). Participants' average fixation durations (AFDs) on task-relevant information (targets) were significantly longer in the MM group. In contrast, both average fixation counts (AFCs) and AFDs on task-irrelevant information (the ranking screen) were significantly lower in the MM group than in the MW group. Additionally, the MM group exhibited significantly stronger activation of the left and right dorsolateral prefrontal cortex (dlPFC) as well as higher levels of oxygenated haemoglobin [HbO] and greater functional connectivity (FC) of the right dlPFC, which was considered evidence of recruitment for attentional control. Moreover, the MM group achieved significantly better shooting performance than the MW group. Overall, the findings suggest that one session 20-min MM practice pre-competition facilitates focus during competition and improves athletic performance. We recommend the application of brief mindfulness practice in sports, especially in closed-skill sports that require high attention participation (e.g., shooting, archery, darts, golf, gymnastics, skating etc.).

Effect of Biofeedback-Based Interventions on the Psychological Outcomes of Pediatric Populations: A Systematic Review and Meta-analysis

We performed a systematic and meta-analytic review of biofeedback-based interventions on psychological outcomes among pediatric populations. The literature search for this study was conducted in eight databases, including PubMed, the Cochrane Library, Scopus, CINAHL, Embase (OVID), Web of Science, PsycINFO (all via Ovid SP), and Google Scholar. The methodological quality of the studies was assessed using the Critical Appraisal Checklists for experimental and quasi-experimental studies that was developed by the Joanna Briggs Institute. We analyzed the effects of biofeedback-based interventions on psychological outcomes in the pediatric population by following the Preferred Reporting System for Systematic Reviews and Meta-Analysis. This systematic review and meta-analysis included nine studies with a total sample size of 658 children. In this study, EEG, EMG, and heart rate variability biofeedback were utilized to treat psychological symptoms in children. All studies focused on anxiety, with only one studying depression. As a result, it was found that all types of biofeedback effectively reduced children's anxiety levels. It was recommended that biofeedback-based interventions should be used to reduce children's anxiety.

Autonomic nervous system flexibility for understanding brain aging

A recent call was made for autonomic nervous system (ANS) measures as digital health markers for early detection of Alzheimer's disease and related dementia (AD/ADRD). Nevertheless, contradictory or inconclusive findings exist. To help advance understanding of ANS' role in dementia, we draw upon aging and dementia-related literature, and propose a framework that centers on the role of ANS flexibility to guide future work on application of ANS function to differentiating the degree and type of dementia-related brain pathologies. We first provide a brief review of literature within the past 10 years on ANS and dementia-related brain pathologies. Next, we present an ANS flexibility model, describing how the model can be applied to understand these brain pathologies, as well as differentiate or even be leveraged to modify typical brain aging and dementia. Lastly, we briefly discuss the implication of the model for understanding resilience and vulnerability to dementia-related outcomes.

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

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

A novel self-report scale of interoception: the three-domain interoceptive sensations questionnaire (THISQ)

OBJECTIVES

The self-reported perception of bodily sensations is assumed predictive for health and disease. Existing questionnaires mostly focus on aversive sensations, and associated emotions and cognitions, which potentially confounds associations between interoception and illness. Therefore, we developed the Three-domain Interoceptive Sensations Questionnaire (THISQ), assessing self-reported perception of neutral respiratory, cardiac, and gastroesophageal sensations.

DESIGN

Using cross-sectional surveys, we developed and validated the THISQ.

MAIN OUTCOME MEASURES

In Sample 1 (n = 357), a pool of 28 Dutch items was subjected to exploratory factor analysis. Eighteen items with a primary factor loading >.40 were retained for confirmatory factor analysis in Sample 2 (n = 374) and Sample 3 (n = 484) for the validation of the Dutch and English questionnaire, respectively.

RESULTS

Analyses supported the 3-factor solution: cardiorespiratory activation, cardiorespiratory deactivation, and gastroesophageal sensations. Scales showed acceptable to good internal consistency. Convergent validity was confirmed by significant medium associations between THISQ scores and other self-report measures of interoception. Divergent validity was supported by non-significant or small associations with measures of negative affectivity and symptom-related anxiety.

CONCLUSION

Our findings suggest that the Dutch and English THISQs are valid and reliable self-report measures of interoception, which could advance our understanding of interoceptive processes in health and disease.

Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2021.2009479 .

Stress reappraisal improves the autonomic nervous system response of test anxious individuals: Evidence from heart rate variability

BACKGROUND

Stress belief plays an important role in stress response. This study investigated whether individuals with high test anxiety/low test anxiety (HTA/LTA) held different stress belief, and tested the effect of stress reappraisal on reducing test anxiety related autonomic nervous system (ANS) response.

METHODS

51 HTA students and 49 LTA students were recruited using the Test Anxiety Scale (TAS). They completed a 10-min intelligence test (including preparation, test, and recovery phases), then were randomly assigned to reappraisal group and control group to complete the test again. Heart rate variability (HRV) was recorded throughout the protocol. Beliefs about Stress Scale was obtained before and after the experiment. Stress belief were manipulated using a 2-min film clip that orienting participant to the enhancing nature of stress. Emotional changes were assessed.

RESULTS

HTA individuals held more negative stress beliefs and showed greater emotional arousal during the test than the LTA individuals. Their negative stress belief was associated with higher TAS score and worse HRV response. (2) When facing an exam, LTA individuals exhibited increased low-frequency HRV and stable high-frequency HRV, while HTA individuals showed stable low-frequency HRV and decreased high-frequency HRV. (3) HTA individuals who underwent reappraisal showed a reduction in test anxiety and in low-frequency/high-frequency HRV ratio.

CONCLUSIONS

The ANS activity of HTA individuals is imbalanced in the test situations. Stress belief is a meaningful variable in anxiety related ANS activity. Stress reappraisal can effectively reduce test anxiety and improve the balance of ANS activity of HTA individuals.

Examining the Relations Between Children's Vagal Flexibility Across Social Stressor Tasks and Parent- and Clinician-Rated Anxiety Using Baseline Data from an Early Intervention for Inhibited Preschoolers

Early behavioral inhibition (BI) is a known risk factor for later anxiety disorder. Variability in children's parasympathetic nervous system (PNS) functioning may provide insight into the substantial heterogeneity in anxiety outcomes for children high in BI. However, gaps persist due to an over-reliance on static measures of functioning, which limits our ability to leverage PNS functioning to identify risk for anxiety. We address these gaps using baseline data from an early intervention study of inhibited preschoolers by characterizing vagal flexibility (VF), an index of non-linear change in PNS functioning, across social stressor tasks and by examining the associations between VF and anxiety. One hundred and fifty-one parents and their 3.5- to 5-year-old children were selected on the basis of BI to participate in an early intervention program (ClinicalTrials.gov registration: NCT02308826). A structural equation modeling framework was used to model children's VF across tasks designed to mimic exposure to novel social interactions and to test the predictive links between VF and anxiety. Children who showed less VF, characterized by less suppression and flatter recovery, were rated by both parents and clinicians as more anxious. Moreover, a multiple group model showed that children meeting diagnostic criteria for social anxiety disorder demonstrated significantly less VF across social stressor tasks. Among inhibited youth, reduced VF is a risk factor for anxiety and may reflect an individual's reduced capacity to actively cope with external demands. Study results contribute to our understanding of the regulatory processes underlying risk for anxiety in early childhood.

Anticipatory cardiac deceleration estimates cognitive performance in virtual reality beyond tonic heart period and heart period variability

Anticipatory cardiac deceleration is the lengthening of heart period before an expected event. It appears to reflect preparation that supports rapid action. The current study sought to bolster anticipatory deceleration as a practical and unique estimator of performance efficiency. To this end, we examined relationships between deceleration and virtual reality performance under low and high time pressure. Importantly, we investigated whether deceleration separately estimates performance beyond basal heart period and basal high-frequency heart rate variability (other vagally influenced metrics related to cognition). Thirty participants completed an immersive virtual reality (VR) cognitive performance task across six longitudinal sessions. Anticipatory deceleration and basal heart period/heart period variability were quantified from electrocardiography collected during pre-task anticipatory countdowns and baseline periods, respectively. At the between-person level, we found that greater anticipatory declaration was related to superior accuracy and faster response times (RT). The relation between deceleration and accuracy was stronger under high relative to low time pressure, when good performance requires greater efficiency. Findings for heart period and heart period variability largely converge with the prior literature, but importantly, were statistically separate from deceleration effects on performance. Lastly, deceleration effects were detected using anticipatory periods that are more practical (shorter and more intermittent) than those typically employed. Taken together, findings suggest that anticipatory deceleration is a unique and practical correlate of cognitive-motor efficiency apart from heart period and heart period variability in virtual reality.

Behavioral and Biological Indicators of Risk and Well-Being in a Sample of South African Youth

Self report measures have been widely used in research to illustrate high rates of exposure to violence among youth in trauma-saturated regions, such as Cape Town, South Africa. To better understand the risk and resilience factors of youth who have been exposed to, witnessed, or directly experienced violence, the current study used a multi-method assessment in a naturalistic setting that included heart rate variability (an index of regulatory flexibility and cardiovascular health), a computerized risk-taking task, and self report measures. Youth (N = 83) from Cape Town, South Africa, participated in a psychobiological assessment. Findings suggest elevated age-adjusted heart rate variability compared to age related norms, which is indicative of overregulation of behavior and emotion. Additionally, youth, all of whom had witnessed or experienced violence at least once, demonstrated a low risk taking and reward seeking propensity. Low risk taking in the context of elevated heart rate variability may reflect youth's affective and behavioral inhibition, suggestive of stress among children who have an overgeneralized threat response. These results both demonstrate the feasibility of psychophysiological research in community youth settings, and counter the traditional narrative that there is an overarching lack of capacity to regulate and a high propensity to risk in violence-exposed youth.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-021-00426-1.

Social gaze behavior and hyperarousal in young females with fragile X syndrome: A within-person approach

Children with fragile X syndrome (FXS) often avoid eye contact, a behavior that is potentially related to hyperarousal. Prior studies, however, have focused on between-person associations rather than coupling of within-person changes in gaze behaviors and arousal. In addition, there is debate about whether prompts to maintain eye contact are beneficial for individuals with FXS. In a study of young females (ages 6-16), we used eye tracking to assess gaze behavior and pupil dilation during social interactions in a group with FXS (n = 32) and a developmentally similar comparison group (n = 23). Participants engaged in semi-structured conversations with a female examiner during blocks with and without verbal prompts to maintain eye contact. We identified a social-behavioral and psychophysiological profile that is specific to females with FXS; this group exhibited lower mean levels of eye contact, significantly increased mean pupil dilation during conversations that included prompts to maintain eye contact, and showed stronger positive coupling between eye contact and pupil dilation. Our findings strengthen support for the perspective that gaze aversion in FXS reflects negative reinforcement of social avoidance behavior. We also found that behavioral skills training may improve eye contact, but maintaining eye contact appears to be physiologically taxing for females with FXS.

Alterations in heart rate variability and pro-inflammatory cytokine TNF-alpha in individuals with panic disorder

Based on the autonomic flexibility-neurovisceral integration model, panic disorder (PD) has been associated with a generalized proinflammatory state and lower cardiac vagal tone. The heart rate variability (HRV) provides an index of cardiac autonomic function and reflects the parasympathetic innervation to the heart regulated by the vagus nerve. The aim of this study was to explore the heart rate variability, pro-inflammatory cytokines and their associations in individuals with PD. Short-term HRV with time and frequency domain indices as well as pro-inflammatory cytokines Interleukin-6 (IL-6) and Tumor Necrosis Factor alpha (TNF-alpha) were assessed in seventy individuals with PD (mean age: 35.64 ± 14.21 years) and thirty-three healthy controls (mean age: 38.33 ± 14.14 years). Individuals with PD showed significantly lower HRV in the time and frequency domain parameters during a short-term resting condition. A lower TNF-alpha concentration could be observed in individuals with PD in comparison to healthy controls, but no differences in IL-6. Furthermore, the HRV parameter absolute power in the low-frequency band 0.04-0.15 Hz (LF) predicted TNF-alpha concentrations. In conclusion, a lower cardiac vagal tone, decreased adaptive autonomic nervous system (ANS), and higher pro-inflammatory cytokine state could be observed in individuals with PD compared to healthy controls.

Somatovisceral influences on emotional development

Frameworks of emotional development have tended to focus on how environmental factors shape children's emotion understanding. However, individual experiences of emotion represent a complex interplay between both external environmental inputs and internal somatovisceral signaling. Here, we discuss the importance of afferent signals and coordination between central and peripheral mechanisms in affective response processing. We propose that incorporating somatovisceral theories of emotions into frameworks of emotional development can inform how children understand emotions in themselves and others. We highlight promising directions for future research on emotional development incorporating this perspective, namely afferent cardiac processing and interoception, immune activation, physiological synchrony, and social touch.

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

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

Anterior cingulate and medial prefrontal cortex oscillations underlie learning alterations in trait anxiety in humans

Anxiety has been linked to altered belief formation and uncertainty estimation, impacting learning. Identifying the neural processes underlying these changes is important for understanding brain pathology. Here, we show that oscillatory activity in the medial prefrontal, anterior cingulate and orbitofrontal cortex (mPFC, ACC, OFC) explains anxiety-related learning alterations. In a magnetoencephalography experiment, two groups of human participants pre-screened with high and low trait anxiety (HTA, LTA: 39) performed a probabilistic reward-based learning task. HTA undermined learning through an overestimation of volatility, leading to faster belief updating, more stochastic decisions and pronounced lose-shift tendencies. On a neural level, we observed increased gamma activity in the ACC, dmPFC, and OFC during encoding of precision-weighted prediction errors in HTA, accompanied by suppressed ACC alpha/beta activity. Our findings support the association between altered learning and belief updating in anxiety and changes in gamma and alpha/beta activity in the ACC, dmPFC, and OFC.

Heart rate variability in generalized anxiety disorder, major depressive disorder and panic disorder: A network meta-analysis and systematic review

BACKGROUND

Heart rate variability (HRV) in patients with emotional disorders and healthy controls (HCs) has been investigated in many studies but the difference between these emotional disorders was unclear.

METHODS

The PubMed, Embase, Medline and Web of Science databases were systematically searched for studies published in English that compared HCs with generalized anxiety disorder (GAD), major depressive disorder (MDD), panic disorder (PD) patients in HRV. We conducted a network meta-analysis to compare HRV in patients with GAD, MDD, PD and HCs. HRV outcomes, including time domain indices (the standard deviation of NN intervals (SDNN) and the root mean square of the successive differences between normal heartbeats (RMSSD)), and frequency domain indices (High-frequency (HF), Low-frequency (LF) and the ratio of LF to HF (LF/HF)) were obtained. A total of 4008 participants from 42 studies were included.

RESULTS

The results of pairwise meta-analysis showed that compared with controls, GAD, PD and MDD patients exhibited significantly reduced HRV. Similar findings were also confirmed in network meta-analysis. The most important finding from network meta-analysis was that GAD patients had significantly lower SDNN than PD patients (SMD = -0.60, 95 % CI [-1.09, -0.11]).

CONCLUSION

Our findings provided a potential objective biological marker to distinguish between GAD and PD. In the future, a large sample of research is needed to directly compare HRV of various mental disorders, which is crucial for finding biomarkers to distinguish them.

Screening of obstructive sleep apnea syndrome by the deep breathing technique

STUDY OBJECTIVES

Obstructive sleep apnea syndrome (OSAS) is associated with alterations in heart rate variability (HRV) in relation to chronic autonomic dysfunction. We tested the ability of the deep breathing technique-a simple way to evaluate HRV-to identify patients with OSAS.

METHODS

Consecutive patients referred for suspected OSAS (without obesity, diabetes, and heart diseases) were included. They underwent a measure of HRV at rest and of heart rate oscillations during expiration vs inspiration (DeltaHRDB) when breathing deeply at the resonant frequency of 6 cycles per minute (deep breathing technique) while sitting awake, followed by a nighttime polysomnography. We measured DeltaHRDB and performed temporal and spectral HRV analysis.

RESULTS

Of 31 included participants (77% male), 14 had mild to moderate OSAS (apnea-hypopnea index median [IQR]: 18 [12]) and 17 had no OSAS. The conventional HRV analysis did not reveal any difference between the groups with vs without OSAS. However, the DeltaHRDB was lower in those with than without OSAS. Lower DeltaHRDB correlated with higher apnea-hypopnea index, arousal index, and desaturation degree. A DeltaHRDB below 11 beats per minute (bpm) predicted OSAS with a sensitivity of 100% and specificity of 86%.

CONCLUSIONS

The deep breathing technique accurately identifies a reduction in cardiac changes in patients with mild to moderate OSAS. It could be used as a simple screening tool to select patients for polysomnography.

CITATION

Onanga M, Joanny S, Rivals I, et al. Screening of obstructive sleep apnea syndrome by the deep breathing technique. J Clin Sleep Med. 2023;19(2):293-302.

Allostasis and metastasis: The yin and yang of childhood self-regulation

Most research has studied self-regulation by presenting experimenter-controlled test stimuli and measuring change between baseline and stimulus. In the real world, however, stressors do not flash on and off in a predetermined sequence, and there is no experimenter controlling things. Rather, the real world is continuous and stressful events can occur through self-sustaining interactive chain reactions. Self-regulation is an active process through which we adaptively select which aspects of the social environment we attend to from one moment to the next. Here, we describe this dynamic interactive process by contrasting two mechanisms that underpin it: the "yin" and "yang" of self-regulation. The first mechanism is allostasis, the dynamical principle underlying self-regulation, through which we compensate for change to maintain homeostasis. This involves upregulating in some situations and downregulating in others. The second mechanism is metastasis, the dynamical principle underling dysregulation. Through metastasis, small initial perturbations can become progressively amplified over time. We contrast these processes at the individual level (i.e., examining moment-to-moment change in one child, considered independently) and also at the inter-personal level (i.e., examining change across a dyad, such as a parent-child dyad). Finally, we discuss practical implications of this approach in improving the self-regulation of emotion and cognition, in typical development and psychopathology.

How Long Is Long Enough? Controlling for Acute Caffeine Intake in Cardiovascular Research

Caffeine substantially affects cardiovascular functioning, yet wide variability exists in caffeine control procedures in cardiovascular reactivity research. This study was conducted in order to identify a minimal abstention duration in habitual coffee consumers whereby cardiovascular reactivity is unconfounded by caffeine; Six hours (caffeine's average half-life) was hypothesized. Thirty-nine subjects (mean age: 20.9; 20 women) completed a repeated measures study involving hand cold pressor (CP) and memory tasks. Caffeinated and decaffeinated coffee were administered. The following cardiovascular indices were acquired during pre-task, task, and post-task epochs prior to coffee intake, 30 min-, and six hours post-intake: Heart rate (HR), high-frequency heart rate variability (HF-HRV), root mean squared successive differences (RMSSD), systolic and diastolic blood pressures (SBP, DBP), mean arterial pressure (MAP), pre-ejection period (PEP), left ventricular ejection time (LVET), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI). Results support the adequacy of a six-hour abstention in controlling for caffeine-elicited cardiovascular changes. The current study offers a suggested guideline for caffeine abstention duration in cardiovascular research in psychophysiology. Consistent practice in caffeine abstention protocols would promote validity and reliability across such studies.

Exploring Subtypes of Repetitive Behavior in Children with Autism Through Functional Analysis and Wearable Technology: a Pilot Biobehavioral Assessment

Objectives

Prior research has established assessment methodologies, such as functional analysis to identify specific contexts in which restricted and repetitive behavior (RRB) occurs, and measures of heart rate variability (HRV) to index the level of autonomic arousal in individuals with autism spectrum disorder (ASD). Yet, a gap remains in integrating multiple assessment methodologies to examine the complex underlying mechanisms of RRB. This study piloted a multi-disciplinary approach to assess both the functional behavioral and neurophysiological factors that may underlie occurrences of RRB. The study (a) evaluated the effect of a modified functional analysis protocol on delineating functional subtypes of RRB and (b) explored the effect of using a wearable technology within a functional analysis on identifying the relationship between RRB and HRV.

Method

A single-case alternating treatment design was used to randomly alternate noncontingent low-stimulation and high-stimulation conditions in a modified functional analysis protocol. Simultaneous measurement of RRB and HRV was obtained through direct behavioral observations and a wristband that collects blood volume pulse, respectively. Visual analysis of time series data was used to determine the functional subtypes of RRB, and nonparametric correlational analyses were conducted to determine the association between HRV and RRB.

Results

Findings from a sample of six participants suggest preliminary effectiveness of the assessment protocol in identifying subtypes of RRB and a significant correlation between HRV and RRB.

Conclusions

This study demonstrates the potential effect and usability of a wearable technology-aided biobehavioral approach to assess RRB and HRV in individuals with ASD.

Differential relationship of observer-rated and self-rated depression and anxiety scales with heart rate variability features

Heart rate variability (HRV) is a known psychophysiological marker for diverse psychiatric symptoms. In this study, we aimed to explore the potential for clinical use of HRV by investigating the interrelationship between HRV indices and clinical measures mainly used to assess depressive and anxious symptoms. Participants who reported depressive and anxious symptoms were designated into the following groups: group 1, clinician-rated and self-rated depression; group 2, only self-rated depression; group 3, clinician-rated and self-rated anxiety; group 4, only self-rated anxiety. Statistical comparisons were performed between these groups to investigate the association between HRV and clinical measures. As a result, HRV variables showed significant correlations only with the clinician-rated assessments. Moreover, both time and frequency domain HRV indices were significantly different between groups 1 and 2, but groups 3 and 4 showed significant differences only in frequency domain HRV indices. Our study showed that HRV is an objective indicator for depressive or anxious symptoms. Additionally, it is considered a potential indicator for predicting the severity or state of depressive symptoms rather than of anxious symptoms. This study will contribute to increasing the diagnostic utility of discriminating those symptoms based on HRV in the future.

Early temperamental and biological predictors of dimensions of social withdrawal in childhood

Social wariness and preference for solitude, two dimensions of social withdrawal, show unique associations with various socioemotional difficulties in childhood, including internalizing and peer problems. However, their early childhood predictors remain vastly undocumented. The present study aimed to examine whether early indicators of reactivity in situations of unfamiliarity such as behavioral inhibition, affect, and cortisol independently, or in interaction with emotion regulation as indexed by vagal tone, predict later social wariness and preference for solitude. Participants were 1209 children from the Quebec Newborn Twin Study. Vagal tone was assessed at 5 months, and behavioral inhibition, affect, and cortisol were assessed at 19 months in situations of unfamiliarity. Mothers, teachers, and peers evaluated social wariness and preference for solitude repeatedly from 4 to 10 years old. Findings show that three temperamental dimensions, social inhibition, nonsocial inhibition, and affect accounted for the variability in reactions to unfamiliarity. Behavioral inhibition to social unfamiliarity at 19 months predicted social wariness during the preschool years. Poor vagal regulation at 5 months exacerbated the risk associated with negative affect at 19 months to predict preference for solitude during the preschool years. Overall, results show that social wariness and preference for solitude may follow different developmental pathways.

Vasomotor symptoms of menopause, autonomic dysfunction, and cardiovascular disease

Cardiovascular disease (CVD), the leading cause of death among US adults, is more prevalent in menopausal females compared with age-matched males. Vasomotor symptoms of menopause (VMS; hot flashes/flushes and night sweats) are common among females undergoing menopausal transition and have been associated with elevated blood pressure (BP) and increased CVD risk. Autonomic dysregulation of BP has been posited as a contributing factor to the elevated CVD risk in menopausal females with VMS. This review includes 1) a brief overview of the relationship between VMS and CVD, 2) mechanisms of hot flushes and their potential impact on short- and long-term BP regulation, and 3) how the disruption of autonomic function associated with VMS might provide a mechanistic pathway to CVD development. Finally, this review will highlight knowledge gaps and future directions toward better understanding of hot flush physiology and VMS contributions to CVD.

Association between Heart Rate Variability Indices and Depressed Mood in Patients with Panic Disorder

Objective

Heart rate variability (HRV) reflects the regulation of the autonomic nervous system. Panic disorder is highly associated with autonomic dysfunction, and is often accompanied by depression. The aim of this study is to determine the association between depression and HRV indices in patients with panic disorder.

Methods

A total of 110 outpatients diagnosed with panic disorder participated in this study. The medical records of patients with panic disorder who visited the outpatient clinic of Konkuk University Hospital between December 2018 and March 2020 were retrospectively reviewed. Measurements used in this study include the Panic Disorder Severity Scale-Self Report, Beck Depression Inventory (BDI-II), Insomnia Severity Index, and HRV. Patients were divided into depressive and non-depressive groups based on their BDI-II scores. The association between HRV indices and depressive symptoms was statistically analyzed.

Results

The low frequency/high frequency (LF/HF) ratio was reduced in patients with depression (mean = -0.095, p = 0.004 in the above moderate depressive group, mean = -0.120, p = 0.020 in the severe depressive group). Significant correlations were found between depressive symptoms and standard deviation of NN interval (SDNN) (ms) (-0.19, p = 0.044), very low frequency (VLF) (ms2/Hz) (-0.22, p = 0.021), LF (-0.25, p = 0.008), HF (-0.19, p = 0.043), and LF/HF (-0.25, p = 0.009). Multiple linear regression analysis showed that BDI predicted SDNN (ms), VLF (ms2/Hz), LF, HF, and LF/HF.

Conclusion

We confirmed that the LF/HF ratio decreases when depression is accompanied by panic disorder. HRV indices may be useful markers for detecting depressive symptoms in patients with panic disorder.

Prediction of Specific Anxiety Symptoms and Virtual Reality Sickness Using In Situ Autonomic Physiological Signals During Virtual Reality Treatment in Patients With Social Anxiety Disorder: Mixed Methods Study

BACKGROUND

Social anxiety disorder (SAD) is the fear of social situations where a person anticipates being evaluated negatively. Changes in autonomic response patterns are related to the expression of anxiety symptoms. Virtual reality (VR) sickness can inhibit VR experiences.

OBJECTIVE

This study aimed to predict the severity of specific anxiety symptoms and VR sickness in patients with SAD, using machine learning based on in situ autonomic physiological signals (heart rate and galvanic skin response) during VR treatment sessions.

METHODS

This study included 32 participants with SAD taking part in 6 VR sessions. During each VR session, the heart rate and galvanic skin response of all participants were measured in real time. We assessed specific anxiety symptoms using the Internalized Shame Scale (ISS) and the Post-Event Rumination Scale (PERS), and VR sickness using the Simulator Sickness Questionnaire (SSQ) during 4 VR sessions (#1, #2, #4, and #6). Logistic regression, random forest, and naïve Bayes classification classified and predicted the severity groups in the ISS, PERS, and SSQ subdomains based on in situ autonomic physiological signal data.

RESULTS

The severity of SAD was predicted with 3 machine learning models. According to the F1 score, the highest prediction performance among each domain for severity was determined. The F1 score of the ISS mistake anxiety subdomain was 0.8421 using the logistic regression model, that of the PERS positive subdomain was 0.7619 using the naïve Bayes classifier, and that of total VR sickness was 0.7059 using the random forest model.

CONCLUSIONS

This study could predict specific anxiety symptoms and VR sickness during VR intervention by autonomic physiological signals alone in real time. Machine learning models can predict the severe and nonsevere psychological states of individuals based on in situ physiological signal data during VR interventions for real-time interactive services. These models can support the diagnosis of specific anxiety symptoms and VR sickness with minimal participant bias.

TRIAL REGISTRATION

Clinical Research Information Service KCT0003854; https://cris.nih.go.kr/cris/search/detailSearch.do/13508.

Using passive or active back-support exoskeletons during a repetitive lifting task: influence on cardiorespiratory parameters

The objective of this laboratory study was to assess the cardiorespiratory consequences related to the use of different back-support exoskeletons during a repetitive lifting task. Fourteen women and thirteen men performed a dynamic stoop lifting task involving full flexion/extension of the trunk in the sagittal plane. This task was repeated for 5 min with a 10 kg load to handle. Four conditions were tested: with a passive exoskeleton (P-EXO), with two active exoskeletons (A-EXO1 and A-EXO2), as well as without exoskeleton (FREE). The oxygen consumption rate and cardiac costs were measured continuously. Results showed a significantly lower (p < 0.05) oxygen consumption rate for all exoskeletons as compared to FREE (12.6 ± 2.2 ml/kg/min). The values were also significantly lower (p < 0.001) for A-EXO1 (9.1 ± 1.8 ml/kg/min) compared to A-EXO2 (11.0 ± 1.8 ml/kg/min) and P-EXO (11.8 ± 2.4 ml/kg/min). Compared to FREE (59.7 ± 12.9 bpm), the cardiac cost was significantly reduced (p < 0.001) only for A-EXO1 (45.1 ± 11.5 bpm). Several factors can explain these differences on the cardiorespiratory parameters observed between exoskeletons: the technology used (passive vs active), the torque provided by the assistive device, the weight of the system, but also the level of anthropomorphism (related to the number of joints used by the exoskeleton). Our results also highlighted the lack of interaction between the exoskeleton and sex. Thereby, the three back-support exoskeletons tested appeared to reduce the overall physical workload associated with a repetitive lifting task both for men and women.

Autonomic Dysregulation in Child Social Anxiety Disorder: An Experimental Design Using CBT Treatment

Models of social anxiety disorder (SAD) stress the relevance of physiological arousal. So far, limited research has been conducted in children with SAD in experimental stress designs. Thus, examining autonomic arousal, children with and without SAD completed a standardized social stressor (Trier Social Stress Test for Children-C; TSST-C). Pre-existing differences to healthy controls (HC) were expected to decrease after receiving cognitive behavior therapy (CBT). Children with SAD (n = 64) and HC children (n = 55) completed a TSST-C. Children with SAD participated in a second TSST-C after either cognitive-behavioral treatment or a waitlist-control period (WLC). As expected, children with SAD showed blunted heart rate reactivity compared to HC children. Further, children with SAD had elevated levels of tonic sympathetic arousal as indexed by skin conductance level compared to HC. Children with SAD showed lower parasympathetic arousal during the baseline compared to HC. Children receiving treatment did not differ from children in the WLC condition in a repeated social stress test. Psychophysiological differences between children with SAD and HC children could be confirmed as indicated by previous research. The lack of physiological effects of the intervention as an experimental manipulation might be related to slower changes in physiology compared to e.g. cognition.