Perseverate or decenter? Differential effects of metacognition on the relationship between parasympathetic inflexibility and symptoms of depression in a multi-wave study

Integrating dynamic psychophysiological indices across time and contexts: Elucidating mechanisms, risk markers, and intervention targets

Why should researchers measure psychophysiological processes repeatedly over time? The study of psychophysiology inherently involves sampling biological processes as they manifest over time. The most common approach is to use a brief sample to make conclusions about how individuals or groups differ. Although these types of between-subject comparisons have utility for understanding individual and group differences, many of the important conceptual questions in the field involve processes that are dynamic, varying within individuals over time. Using examples from the literature on affect regulation, this conceptual review contrasts three types of study designs: the classic single-observation design and the aggregated and temporally linked repeated observation designs, which have great promise for measuring variables that fluctuate dynamically over time. Importantly, these designs can be integrated to elucidate research questions about risk (when and for whom will the likelihood of an unwanted outcome occurring increase?), mechanisms (how and why does a change in psychophysiology contribute to a change in another process of interest?), and interventions (how and when should interventions take place to modify an outcome?). Researchers are encouraged to implement intensive sampling in their research, which can be conducted in traditional laboratory settings (e.g., fMRI, event-related brain potentials, and heart rate variability) and in ecologically valid contexts in everyday life using ambulatory assessment.

Is a brief mindfulness ecological momentary intervention more efficacious than a self-monitoring app for social anxiety disorder? A randomized controlled trial

Despite their proliferation, limited knowledge exists regarding possible benefits of brief mindfulness ecological momentary interventions (MEMIs) for social anxiety disorder (SAD). Propositions that MEMIs could alleviate SAD symptoms and related clinical outcomes remain untested. This trial evaluated a 14-day MEMI for SAD. Participants with self-reported SAD were randomized to MEMI (n = 96) or self-monitoring app (SM; n = 95). Whereas MEMI instructed mindfulness exercises, SM prompted only self-monitoring five times daily for 14 days. Participants completed state-level self-reports of depression, anxiety, and mindfulness pre-post-mindfulness practice and SAD symptoms, worry, depression severity, repetitive negative thinking, and trait mindfulness at pre-randomization, post-intervention, and 1-month follow-up (1MFU). Hierarchical linear modeling was conducted. The MEMI yielded statistically significantly larger improvements in momentary depression, anxiety, and mindfulness (Cohen's d = -0.10-0.11). Although no between-group effects emerged in alleviating SAD fear and avoidance, excessive worry, depression severity, repetitive negative thinking, and trait mindfulness (-0.13-0.15), within-group effects were significantly small-to-large from pre-post and pre-1MFU (-4.62-0.67). A significant reduction in depression severity occurred in MEMI (-0.63--0.60) but not SM (-0.31--0.29). Brief MEMI and SM yielded nondifferent sustained effects on SAD, comorbid symptoms, and risk factors, highlighting its potential value within stepped-care delivery settings.

Depressive rumination and heart rate variability: A pilot study on the effect of biofeedback on rumination and its physiological concomitants

Objective

Recent studies suggest that lower resting heart rate variability (HRV) is associated with elevated vulnerability to depressive rumination. In this study, we tested whether increases in HRV after HRV-biofeedback training are accompanied by reductions in rumination levels.

Materials and methods

Sixteen patients suffering from depression completed a 6-week HRV-biofeedback training and fourteen patients completed a control condition in which there was no intervention (waitlist). The training included five sessions per week at home using a smartphone application and an ECG belt. Depressive symptoms and autonomic function at rest and during induced rumination were assessed before and after each of the two conditions. We used a well-established rumination induction task to provoke a state of pervasive rumination while recording various physiological signals simultaneously. Changes in HRV, respiration rate, skin conductance, and pupil diameter were compared between conditions and time points.

Results

A significant correlation was found between resting HRV and rumination levels, both assessed at the first laboratory session (r = -0.43, p < 0.05). Induction of rumination led to an acceleration of heart rate and skin conductance increases. After biofeedback training, resting vagal HRV was increased (p < 0.01) and self-ratings of state anxiety (p < 0.05), rumination (p < 0.05), perceived stress (p < 0.05), and depressive symptoms (QIDS, BDI; both p < 0.05) were decreased. In the control condition, there were no changes in autonomic indices or depressive symptomatology. A significant interaction effect group x time on HRV was observed.

Conclusion

Our results indicate that a smartphone-based HRV-biofeedback intervention can be applied to improve cardiovagal function and to reduce depressive symptoms including self-rated rumination tendencies.

Decentering predicts attenuated perseverative thought and internalizing symptoms following stress exposure: A multi-level, multi-wave study

While research identifies a growing list of risk factors for anxiety and depression, it is equally important to identify potential protective factors that may prevent or reduce vulnerability to developing internalizing psychopathology. We hypothesized that forms of perseverative thinking, such as rumination and worry, act as mechanisms linking negative life experiences and prospective symptoms of anxiety and depression. More specifically, we investigated whether decentering, the meta-cognitive capacity to adopt a distanced perspective toward one's thoughts and feelings, serves as a protective factor at various points along this mediational pathway. A sample of 181 undergraduate students were recruited and assessed at five time points over a 12-week period. Multilevel modeling indicated that decentering was associated with an attenuated impact of (1) negative events on prospective depressive symptoms; (2) negative events on prospective brooding, and (3) brooding, pondering and worry on prospective internalizing symptoms. Multilevel moderated mediation analyses provided partial support for the hypothesis that perseverative thinking would mediate the longitudinal associations between negative life events and internalizing symptoms, with decentering attenuating risk at several connections of the indirect pathways. The strongest support was provided for moderated mediation models in which decentering was associated with attenuated relationships between negative events, brooding, and symptoms of depression. This study is the first to elucidate the role of decentering as a protective factor against anxiety and depressive symptoms at different points in the path from stress to perseverative thought to internalizing symptoms. Decentering therefore may be a critical target for clinical intervention to promote resilience against anxiety and depression.

Cardiac autonomic functioning and clinical outcome in adolescent borderline personality disorder over two years

The present study aimed to expand on previous findings that pre-treatment autonomic nervous system (ANS) functioning serves as a predictor of clinical outcome in adolescent borderline personality disorder (BPD), while examining whether the relationship between ANS functioning and treatment outcome may vary as a function of early life maltreatment (ELM). ANS stress response was examined considering changes in heart rate (HR) and vagally-mediated heart rate variability (vmHRV) over different conditions of the Montreal Imaging Stress Task (MIST) in a clinical sample of N = 27 adolescents across the spectrum of BPD severity. Participants received in- and/or outpatient treatment, while clinical data was assessed at routine follow-ups. Clinical outcome was defined by change in the number of fulfilled BPD criteria (as measured using the SCID-II), severity of psychopathology (CGI-S), and global level of functioning (GAF), measured 12 and 24 months after baseline assessments. Mixed-effects (random-intercept/random slope) linear regression models were calculated to examine markers of ANS function as potential predictors of clinical outcome. Irrespective of the presence of ELM exposure, both vmHRV resting-state and stress recovery measures were identified as significant predictors of clinical outcome over time. This study adds to the existing literature by replicating and expanding on preliminary findings, considering also physiological reactivity and recovery in addition to resting-state measures of ANS functioning. The present results further highlight the potential of markers of ANS functioning to serve as objective measures in the process of monitoring patient progress and to make predictions regarding treatment outcome in psychiatry research.

Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature

Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.

The interplay of self-critical rumination and resting heart rate variability on subjective well-being and somatic symptom distress: A prospective study

OBJECTIVE

The aim of this prospective study was to investigate the association of self-critical rumination, autonomic function (indexed by a time domain metric of resting heart rate variability-RMSSD), subjective well-being and somatic symptom distress.

METHOD

84 healthy participants (73 females; mean age = 23.56, SD = 3.35 years) completed the Somatic Symptom Severity Scale of the Patient Health Questionnaire and Mental Health Continuum Short Form at two timepoints (at baseline and six months later). Resting heart rate variability (HRV) was assessed at baseline, along with content specific rumination using the Self-Critical Rumination Scale. Four moderation analyses were performed to test these associations.

RESULTS

The interaction between resting HRV and self-critical rumination significantly explained somatic symptom distress at baseline. For those participants who had high resting HRV, somatic symptom distress was basically independent from the level of self-critical rumination. At the same time, lower resting HRV was associated with higher somatic symptom distress, especially in the presence of more ruminative thoughts. Prospectively, however, the interaction between rumination and resting HRV was not a significant predictor of somatic symptom distress. The association between resting HRV and self-critical rumination did not explain the variance on subjective well-being, but subjective well-being was negatively related to self-critical rumination.

CONCLUSION

Our findings potentially indicate that self-critical rumination could have a long-term negative impact on psychological functioning, even in a non-clinical sample, and highlight that a lower level of parasympathetic activation, assessed with RMSSD, might be an important factor in the relationship of self-critical rumination and somatic symptom distress.

Depressed mood, brooding rumination and affective interference: The moderating role of heart rate variability

Facilitated processing of negative information might contribute to the etiopathogenesis and maintenance of depressive symptoms. Cardiac vagal tone, indexed by heart rate variability (HRV), is believed to represent a proxy of the functional integrity of the neural networks implicated in brooding rumination, affective interference and depression. The present study examined whether HRV may moderate the relation between brooding rumination, affective interference and depressive symptoms in a sample of healthy individuals (n = 68) with different degrees of depressed mood. Self-report measures of depression and brooding were collected, whereas the emotional Stroop task was employed to measure affective interference. Three-minute resting-state electrocardiogram was recorded to obtain time- and frequency-domain vagally mediated HRV parameters. Stepwise linear regression analyses revealed that HRV was a significant moderator of the positive association between depression and brooding rumination, but not of the association between depression and affective interference. An integrated model is supported, in which vagally mediated HRV appeared to potentiate the positive link between depressive symptoms and brooding rumination. Considering that HRV and brooding rumination were found to have an interacting role in determining the severity of depressive symptoms, they may represent potential clinical targets in the prevention and treatment of depressive symptoms.

Inflexible autonomic responses to sadness predict habitual and real-world rumination: A multi-level, multi-wave study

Inflexibility of the autonomic nervous system is relevant to depression vulnerability, but the downstream behavioral consequences of autonomic inflexibility are not well understood. Rumination, a perseverative thinking style that characterizes depression, is one candidate phenotype relevant to autonomic inflexibility. Undergraduates (N = 134) completed a sadness induction while respiratory sinus arrhythmia was measured, and completed four waves of follow-up over twelve weeks during which rumination, stressful events, and symptoms of depression were measured. Individuals with less autonomic flexibility had higher levels of trait rumination, and were more likely to ruminate in daily life, regardless of stress exposure, whereas individuals with more autonomic flexibility ruminated more only in the context of stress. These findings provide the first evidence that autonomic inflexibility may confer vulnerability to context-insensitive rumination. This work suggests a potential behavioral mechanism by which autonomic inflexibility leads to problems with self-regulation and depression, suggesting multiple avenues for intervention to target these markers of vulnerability.

The contributions of affective traits and emotion regulation to internalizing disorders: Current state of the literature and measurement challenges

Dysfunctional affective processes are central to the experience of internalizing disorders (e.g., depression, anxiety, and related disorders). Specifically, extreme positive affect and elevated negative affect each have unique and robust patterns of associations with internalizing symptoms. This article examines affect as both an individual difference and a within-person dynamic process that unfolds over time. Recent research is reviewed that clarifies the hierarchical structure of affect and facet-level associations with symptoms, affect-laden traits that confer risk for internalizing psychopathology, models of emotion regulation, and how emotion regulation abilities and strategies contribute to or detract from psychological well-being. Several measurement challenges in this literature are identified and discussed, including possible conceptual and content overlap, mood-state distortion, naturalistic assessment in daily life, and the benefits and limitations of self-reported affective experience. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Brain-heart interaction in perseverative cognition

The move from the concept of homeostasis to that of allostasis has led reactivity stress research to widen the object of its investigation: from the brief physiological response that occurs when one is facing a stressor to what happens when one is anticipating or recovering from a stressor. A paradigmatic example is represented by perseverative cognition, during which human beings react "as if" they were constantly facing a concrete stressor. The core idea behind this review is that the cognitive inflexibility that characterizes perseverative cognition is reflected in both our body (by increased autonomic nervous system rigidity assessed by heart rate variability; HRV) and our brain (by reduced prefrontal-amygdala functional connectivity). This is a review of studies conducted in different settings (laboratory, daily life), populations (healthy, major depression, generalized anxiety), location (United States, Europe), and age groups (children, adults) that consistently replicated the association between autonomic, subjective, and behavioral measures of cognitive inflexibility during perseverative cognition. Moreover, compelling neuroimaging data suggest that HRV reduction from pre- to post-induction of perseverative cognition is associated with both structural and functional brain abnormalities reflecting impaired prefrontal inhibitory control over subcortical structures (e.g., diminished prefrontal-amygdala functional connectivity). The integration of neuroscience techniques with clinical autonomic research has advanced our understanding of the neurobiology of brain-heart interaction during perseverative cognition, potentially yielding to more effective treatment packages. This is clinically relevant if one considers that perseverative cognition is a pervasive transdiagnostic factor that carries prognostic risk for both psychological and somatic health.

Heart rate variability mediates the link between rumination and depressive symptoms: A longitudinal study

Ruminative thinking about negative feelings has been prospectively associated with increases in depressive symptoms and heightened risk for new onsets of major depression. One putative pathophysiological mechanism underlying this link might be represented by autonomic nervous system dysfunction. The objective of this longitudinal study was to evaluate the interplay between rumination, autonomic function (as revealed by heart rate variability (HRV) analysis), and depressive symptoms in healthy young subjects, over a three-year period. Rumination and depressive symptoms were evaluated in twenty-two women and twenty men at three assessment points (Time 0, 1 and 2) by the score on the Ruminative Response Scale, and the Center for Epidemiological Studies Depression Scale, respectively. Vagally-mediated HRV was assessed in a laboratory session (Time 0) and in two ambulatory sessions at Time 1 and Time 2 (~13 and 34months after Time 0, respectively). Ruminative thinking was found to be (i) a stable trait characteristic, (ii) more prevalent in women than men, and (iii) positively correlated with depressive symptoms. Moreover, resting HRV was negatively correlated with both rumination and depressive symptoms. Finally, HRV at Time 1 mediated the relationship between rumination at Time 0 and depressive symptoms at Time 2. We conclude that autonomic dysfunction, specifically low vagal tone, may be prospectively implicated in the generation of depressive symptoms in a non-clinical setting.

Resting Heart Rate Variability, Facets of Rumination and Trait Anxiety: Implications for the Perseverative Cognition Hypothesis

The perseverative cognition hypothesis (PCH) posits that perseveration, defined as the repetitive or sustained activation of cognitive representations of a real or imagined stressor, is a primary mechanism linking psychological (or stress) vulnerability with poor health and disease. Resting vagally mediated heart rate variability (vmHRV) is an important indicator of self-regulatory abilities, stress vulnerability and overall health. Those with lower resting vmHRV are more vulnerable to stress, and thus more likely to engage in perseverative cognition and experience subsequent negative mental health outcomes such as anxiety. Recent research suggests that rumination—one of the core mechanisms underlying perseveration—is a construct containing (at least) two maladaptive (depressive and brooding) and one adaptive (reflective) types of rumination. However, to date, research has not examined how the association between resting vmHRV may differ between these three facets of rumination, in addition to these facets’ mechanistic role in linking lower resting vmHRV with greater trait anxiety. The current cross-sectional study explores these relationships in a sample of 203 participants (112 females, 76 ethnic minorities, mean age = 19.43, standard deviation = 1.87). Resting vmHRV was assessed during a 5-min-resting period using an Electrocardiogram (ECG). Both trait rumination (including the three facets) and anxiety were assessed via self-report scales. Significant negative associations were found between resting vmHRV and maladaptive, but not adaptive, forms of perseveration. Similarly, mediation analyses showed a significant indirect relationship between resting vmHRV and anxiety through maladaptive, but not adaptive, facets of rumination. Our findings support the PCH such that those with stress vulnerability, as indexed by lower resting vmHRV, are more likely to engage in maladaptive perseverative cognition and thus experience negative outcomes such as anxiety. Our data also lend a novel outlook on the PCH; resting vmHRV is not related to reflective rumination and thus, this facet of perseveration may be a neutral, but not beneficial, factor in the link between stress vulnerability and psychological well-being.