Polyvagal Theory: A biobehavioral journey to sociality

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

Background

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

Methods

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

Results

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

Conclusion

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

Using lifestyle interventions and the gut microbiota to improve PTSD symptoms

Posttraumatic stress disorder is part of a spectrum of psychological symptoms that are frequently linked with a single defining traumatic experience. Symptoms can vary over the lifespan in intensity based on additional life stressors, individual stability, and connectedness to purpose. Historically, treatment has centered on psychotropic agents and individual and group therapy to increase the individual's window of tolerance, improve emotional dysregulation, and strengthen relationships. Unfortunately, there is a growing segment of individuals with posttraumatic stress disorder who do not respond to these traditional treatments, perhaps because they do not address the multidirectional relationships between chronic cortisol, changes in the brain gut microbiota system, neuroinflammation, and posttraumatic symptoms. We will review the literature and explain how trauma impacts the neuroendocrine and neuroimmunology within the brain, how these processes influence the brain gut microbiota system, and provide a mechanism for the development of posttraumatic stress disorder symptoms. Finally, we will show how the lifestyle psychiatry model provides symptom amelioration.

Beyond fight or flight: The protective role of pre-pandemic meditation practice against anxiety and perceived stress

The COVID-19 pandemic generated distinct mental health challenges, characterised by stress and anxiety due to its unpredictable duration and continuous threat. This study examined the role of meditation practice on anxiety symptoms and perceived stress, considering co-variables such as self-compassion, acceptance, awareness, brooding, lockdown duration, and sociodemographic characteristics. The study used a longitudinal design and data were collected through online surveys from April 2020 to January 2021 (at four different time points) and included 238 participants from Portugal (165 had prior experience with meditation practices, 73 were non-meditators) with a mean age of 43.08 years (SD = 10.96). Linear mixed models revealed that over time, during the lockdown, the non-meditators group demonstrated a greater increase of anxiety symptoms (β = -0.226, SE = 0.06, p = 0.006) and perceived stress (β = -0.20, SE = 0.06, p = 0.004), whereas the meditators group showed non-significant (p > 0.05) variations in anxiety and stress symptoms during the same period of time. The effect of meditation on anxiety symptoms was moderated by sex, days of lockdown, self-compassion, and acceptance. The effect of meditation on perceived stress was moderated by sex, years of education, days of lockdown, and levels of awareness. Additionally, the study explored the potential predictive effect of different meditation session lengths, indicating that longer meditation practices offered greater protection against an increase in anxiety symptoms. These findings highlight the importance of cultivating self-regulation skills and investing in preventive mental health strategies to promote well-being and autonomy. Mental health professionals should prioritise educating communities on evidence-based practices like meditation and compassion exercises to enhance overall health.

Feasibility of the Remembering Warmth and Safeness Intervention in older ADRD caregivers

BACKGROUND

The number of older adults in the U.S. living with ADRD is projected to increase dramatically by 2060. As older adults increasingly assume informal caregiving responsibilities, community-based intervention to sustain caregiver well-being is a dementia research priority.

OBJECTIVE

To evaluate the feasibility of the RWSI among older ADRD caregivers. The RWSI is informed by the Neurovisceral Integration Model, in which memories that engage safety signals cultivate feelings of safety and well-being.

METHODS

A within-subjects pre/post-intervention design with older ADRD caregivers to evaluate feasibility (acceptability, demand, fidelity) and empirical promise (well-being).

RESULTS

The feasibility of the RWSI, implemented with fidelity, was strongly endorsed, as participants attended each intervention session, after which reported experiencing feelings of warmth and safeness, and provided the highest possible acceptability ratings. Participant narratives provided corroboration.

DISCUSSION

Findings support the feasibility of the RWSI in older ADRD caregivers, providing the basis for continued research.

Effects of a Single Session of Mindfulness and Compassion on Skin Temperature in Breast Cancer Survivors

Previous studies have suggested that mindfulness programs can be useful, in a significant sector of the population, to reduce stress when practiced for at least 8 weeks. The objective of the present investigation was to explore the effect of a single session of mindfulness practice in reducing stress in female cancer survivors. Two repeated measures studies were applied; in the first one, it was performed individually, while in the second one, it was performed in a group. Psychosocial measures were administered, and skin temperature was recorded as a marker of autonomic nervous activity. The results indicate that only when the mindfulness exercise was presented did the skin temperature increase (p < 0.05), with a large effect size (d > 0.8) during compassion, suggesting sympathetic decline. Furthermore, the psychosocial functioning of the group of female cancer survivors was like that of the non-clinical population. The data are discussed in the context of Polyvagal Theory, a theoretical model of biopsychosocial functioning, and evidence is provided on the effect of mindfulness and compassion on reducing stress and inducing positive affect in female cancer survivors.

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

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

Frequency and severity of autonomic dysfunction assessed by objective hemodynamic responses and patient-reported symptoms in individuals with myasthenia gravis

Introduction

Myasthenia gravis (MG), a rare autoimmune disorder, poses diagnostic and management challenges, with increasing incidence in Europe and significant impact on patient quality of life. Despite prevalent autonomic symptoms, comprehensive assessments integrating subjective and objective measures are lacking. We aimed to investigate the prevalence and severity of autonomic dysfunction in patients with MG and healthy controls (HCs).

Materials and methods

We used beat-to-beat hemodynamic responses during standardized autonomic function tests (AFTs) and the Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaire. Study participants including, 53 patients with MG and 30 age- and sex matched HCs underwent standardized cardiovascular AFTs and completed the COMPASS-31 questionnaire. Patients were categorized into Non-CAN and CAN groups based on their Cardiovascular Autonomic Neuropathy (CAN) status, as evaluated using the Composite Autonomic Scoring Scale (CASS). During the AFTs, cardiovascular parameters including heart rate, systolic blood pressure (BP), diastolic BP, mean BP, stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR) were measured.

Results

Twenty patients with MG (38%) exhibited mild CAN (CASS ≥2) with a median total CASS score of 1.00 and CASS 0.00 in HCs. Adrenergic impairment was observed in 27 patients (52%), with 13 patients (24.5%) exhibiting longer pressure recovery time after Valsalva maneuver (VM). Cardiovagal impairment was evident in 71% of patients, with abnormal results observed in 39.6% for the deep breathing test and 56.6% for the VM. CAN MG showed worse scores than HCs for the total COMPASS-31 (p < 0.001), orthostatic (OI) (p < 0.001), secretomotor (p = 0.004), and pupillomotor domains (p = 0.004). Total COMPASS-31 and OI scores were correlated with worse disease outcomes (disease duration, severity), hemodynamic parameter changes (SV, CO, TPR) during phase II late of VM, and with changes (Δtilt-supine) in Δsystolic BP, Δdiastolic BP, Δmean BP, ΔTPR during head-up-tilt test, but not with CASS score.

Conclusion

Our findings demonstrate mild cardiovascular autonomic impairment in adrenergic and cardiovagal domains in patients with MG. Additionally, patient-reported autonomic symptoms correlated with hemodynamic changes during AFTs and worse disease outcomes and not with the grade of autonomic abnormalities. Incorporating beat-to-beat hemodynamics during AFTs may offer further insights for characterizing orthostatic intolerance symptoms in MG group.

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

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

Validation of the Italian version of the Neuroception of Psychological Safety Scale (NPSS)

Research on the neuroscience of fear in both humans and non-humans has suggested that a lack of acquisition of safety cues might be a biological hallmark of posttraumatic stress disorder (PTSD). Danger perception, and in particular, feeling as one's own life is in danger, is thought to represent a major predictor of PTSD. Persistent danger perception is concurrently associated with a persistence of lack of safety. However, despite several research efforts, no validated psychometric tools exist regarding psychological safety as a unique core construct in the domain of a soothing-contentment system. By including social, compassionate, and bodily components, the Neuroception of Psychological Safety Scale (NPSS), neurophysiologically rooted in the polyvagal theory, aims to specifically assess psychological safety. Originally developed in English, we employed a rather large non clinical sample to validate our Italian translation of the NPSS (n = 338) and the scale was found to retain a three-factor structure. In light of its positive moderate correlations with the Unconditional Self-Kindness Scale (ρ = 0.376) and the Self-Compassion Scale-Short-Form (ρ = 0.481), good convergent validity and robust psychometric properties were shown by the NPSS. The Subjective Traumatic Outlook Questionnaire (ρ = -0.283) and the three subscales of the Body Perception Questionnaire-22-Body Awareness (ρ = -0.103), Supradiaphragmatic Reactivity (ρ = -0.234), and Body Awareness/Subdiaphragmatic Reactivity (ρ = -0.146)-were found to have weak negative correlations with the NPSS, which further demonstrated its good discriminant validity. Eventually, the NPSS was found to show good test-retest reliability (intraclass correlation coefficient = 0.922; three-week time interval), and its usage is fostered in clinical and research contexts where the evaluation of psychological safety is of relevance.

Altered parasympathetic activity during sleep and emotionally arousing wakefulness in frequent nightmare recallers

Nightmare disorder is characterized by dysfunctional emotion regulation and poor subjective sleep quality reflected in pathophysiological features such as abnormal arousal processes and sympathetic influences. Dysfunctional parasympathetic regulation, especially before and during rapid eye movement (REM) phases, is assumed to alter heart rate (HR) and its variability (HRV) of frequent nightmare recallers (NM). We hypothesized that cardiac variability is attenuated in NMs as opposed to healthy controls (CTL) during sleep, pre-sleep wakefulness and under an emotion-evoking picture-rating task. Based on the polysomnographic recordings of 24 NM and 30 CTL participants, we examined HRV during pre-REM, REM, post-REM and slow wave sleep, separately. Additionally, electrocardiographic recordings of resting state before sleep onset and under an emotionally challenging picture-rating task were also analyzed. Applying repeated measures analysis of variance (rmANOVA), a significant difference was found in the HR of NMs and CTLs during nocturnal segments but not during resting wakefulness, suggesting autonomic dysregulation, specifically during sleep in NMs. As opposed to the HR, the HRV values were not significantly different in the rmANOVA in the two groups, implying that the extent of parasympathetic dysregulation on a trait level might depend on the severeness of dysphoric dreaming. Nonetheless, in the group comparisons, the NM group showed increased HR and reduced HRV during the emotion-evoking picture-rating task, which aimed to model the nightmare experience in the daytime, indicating disrupted emotion regulation in NMs under acute distress. In conclusion, trait-like autonomic changes during sleep and state-like autonomic responses to emotion-evoking pictures indicate parasympathetic dysregulation in NMs.

Evidence-based approach to mitigate cumulative stress in pediatric nurses through the development of respite rooms

BACKGROUND

The cumulative stress toll on nurses increased during the COVID-19 pandemic. An evidence-based practice (EBP) project was conducted to understand what is known about the impacts of cumulative stress within nursing and if there are ways to mitigate stress during a nurse's shift.

AIM/IMPLEMENTATION

A project team from three clinical units completed an extensive literature review and identified the need to promote detachment while supporting parasympathetic recovery. Based on this review, leaders from three pediatric clinical units (neonatal intensive care unit, cardiovascular intensive care unit, and acute pulmonary floor) implemented respite rooms.

OUTCOMES

Follow-up outcomes showed a statistically significant stress reduction. For all shifts combined, the Wilcoxon Signed-Rank Test revealed that perceived stress scores from an 11-point Likert scale (0 = no stress and 10 = maximum perceived stress) were significantly lower in the post-respite room (Md = 3, n = 68) compared to in the pre-respite room (Md = 6, n = 68), Z = -7.059, p < .001, with a large effect size, r = .605. Nurses and other staff frequently utilized respite rooms during shifts.

IMPLICATIONS FOR PRACTICE

Clinical inquiry and evidence-based practice processes can mitigate cumulative stress and support staff wellbeing. Respite rooms within the hospital can promote a healthy work environment among nurses and promote a self-care culture change. Evidence-based strategies to mitigate cumulative stress using respite rooms are a best practice to promote nurse wellbeing and mitigate cumulative stress.

The vagal paradox: A polyvagal solution

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

Resting parasympathetic activity is associated with malodor-induced change in perceived foreignness of speakers

INTRODUCTION

To protect against infection, individuals have evolved context-dependent pathogen-avoidant strategies, including selective social behaviors aimed at avoiding foreign individuals who may possess greater risk of infection. Parasympathetic nervous system (PNS) activity is associated with social engagement and regulation of the classical immune system but has not been widely investigated in relation to changes in intergroup perception and the behavioral immune system.

METHOD

The current research investigated the relationship between parasympathetic activity and perceived foreignness of in and outgroup speakers during exposure to a pathogen-relevant odor (butyric acid). High-frequency heart rate variability was measured at rest and while participants rated foreignness of speakers with and without the odor present.

RESULTS

Findings show that exposure to the odor was associated with higher foreignness perceptions of outgroup speakers and lower foreignness perceptions of ingroup speakers. This effect was especially evident among individuals with higher resting parasympathetic activity.

CONCLUSION

These results suggest that the PNS may play a role in changes in social perceptions during a behavioral immune response.

Child emotion lability is associated with within-task changes of autonomic activity during a mirror-tracing task

Adaptive biological and emotional stress responding are both critical for healthy human development. However, the complex associations between the two are not fully understood. The current study addresses this gap in research by studying associations of child emotion regulation and lability with within-task changes in the biological stress response during a mirror-tracing task. Participants were 59 families including two parents and a child between 5 and 12 years old (52.2% female). Parents reported on family demographics and completed the Emotion Regulation Checklist. Child skin conductance level (SCL) and respiratory sinus arrhythmia (RSA) were recorded during a baseline task and during a 3-minute mirror-tracing task. Within-task patterns of SCL and RSA during the task were estimated with multilevel modeling (measures within persons). The emotion regulation subscale was unrelated to any facet of SCL/RSA time courses. However, lower emotion lability was related to SCL patterns that changed less during the task and were overall lower. For RSA, lower emotion lability was related to higher initial RSA that significantly decreased during the task. These findings suggest that higher child emotion lability may promote increased physiological arousal of target organs during challenging activities.

The integrative process promoted by EMDR in dissociative disorders: neurobiological mechanisms, psychometric tools, and intervention efficacy on the psychological impact of the COVID-19 pandemic

Dissociative disorders (DDs) are characterized by a discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, bodily representation, motor control, and action. The life-threatening coronavirus disease 2019 (COVID-19) pandemic has been identified as a potentially traumatic event and may produce a wide range of mental health problems, such as depression, anxiety disorders, sleep disorders, and DD, stemming from pandemic-related events, such as sickness, isolation, losing loved ones, and fear for one's life. In our conceptual analysis, we introduce the contribution of the structural dissociation of personality (SDP) theory and polyvagal theory to the conceptualization of the COVID-19 pandemic-triggered DD and the importance of assessing perceived safety in DD through neurophysiologically informed psychometric tools. In addition, we analyzed the contribution of eye movement desensitization and reprocessing (EMDR) to the treatment of the COVID-19 pandemic-triggered DD and suggest possible neurobiological mechanisms of action of the EMDR. In particular, we propose that, through slow eye movements, the EMDR may promote an initial non-rapid-eye-movement sleep stage 1-like activity, a subsequent access to a slow-wave sleep activity, and an oxytocinergic neurotransmission that, in turn, may foster the functional coupling between paraventricular nucleus and both sympathetic and parasympathetic cardioinhibitory nuclei. Neurophysiologically informed psychometric tools for safety evaluation in DDs are discussed. Furthermore, clinical and public health implications are considered, combining the EMDR, SDP theory, and polyvagal conceptualizations in light of the potential dissociative symptomatology triggered by the COVID-19 pandemic.

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

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

Close encounters with oxytocin

The purpose of this narrative review is to use a personal perspective to describe unanticipated and pivotal findings that drew the author into the study oxytocin. Oxytocin was originally described as a "female reproductive hormone." However, supporting reproduction is only one of a myriad of functions now attributed to oxytocin. Oxytocin promotes survival and resilience in both sexes and across the lifespan, especially in the context of stress or trauma and helps to explain the health benefits of relationships. Oxytocin works in the context of individual histories and in conjunction with other molecules, as well as the autonomic nervous system and immune factors. The chemical properties of oxytocin make it biologically active, but difficult to measure. As a deeper understanding of the biology of oxytocin is emerging, we may use knowledge of the properties of oxytocin to uncover adaptive strategies that protect and heal in the face of stress and adversity in both males and females.

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

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

The Evolution of Sociality and the Polyvagal Theory

The polyvagal theory (PT), offered by Porges (2021), proposes that the autonomic nervous system (ANS) was repurposed in mammals, via a "second vagal nerve", to suppress defensive strategies and support the expression of sociality. Three critical assumptions of this theory are that (1) the transition of the ANS was associated with the evolution of 'social' mammals from 'asocial' reptiles; (2) the transition enabled mammals, unlike their reptilian ancestors, to derive a biological benefit from social interactions; and (3) the transition forces a less parsimonious explanation (convergence) for the evolution of social behavior in birds and mammals, since birds evolved from a reptilian lineage. Two recently published reviews, however, provided compelling evidence that the social-asocial dichotomy is overly simplistic, neglects the diversity of vertebrate social systems, impedes our understanding of the evolution of social behavior, and perpetuates the erroneous belief that one group-non-avian reptiles-is incapable of complex social behavior. In the worst case, if PT depends upon a transition from 'asocial reptiles' to 'social mammals,' then the ability of PT to explain the evolution of the mammalian ANS is highly questionable. A great number of social behaviors occur in both reptiles and mammals. In the best case, PT has misused the terms 'social' and 'asocial'. Even here, however, the theory would still need to identify a particular suite of behaviors found in mammals and not reptiles that could be associated with, or explain, the transition of the ANS, and then replace the 'asocial' and 'social' labels with more specific descriptors.

Cardiac Vagal Regulation Is Impeded in Children With Cyclic Vomiting Syndrome

INTRODUCTION

The pathophysiology underlying cyclic vomiting syndrome (CVS) remains undefined. Scant data and distinct clinical features point to altered autonomic nervous system function. Autonomic signaling can be noninvasively assessed through cardiac indices of parasympathetic vagal regulation, which is reduced in children with disorders of gut-brain interaction. We aimed to examine dynamic cardiac vagal regulation in children with CVS compared with that in healthy controls (HC).

METHODS

A total of 31 children with CVS evaluated in a tertiary care CVS center and 66 HC (ages 8-18 years) underwent cardiac autonomic function assessment. Electrocardiogram recordings were conducted during 3-minute sit/stand/sit posture challenges. The electrocardiogram-derived variables heart period, respiratory sinus arrhythmia (RSA), and vagal efficiency (VE) were analyzed using linear regression and mixed-effects modeling.

RESULTS

After exclusion of medication confounders, 23 patients with CVS were included in analyses. Both groups were comparable in age, gender, and body mass index. Compared with HC, children with CVS had shorter heart period (standardized mean difference range: 1.15-1.22, all P values < 0.05) and lower RSA (SMD range: 0.66-0.88, all P values < 0.05). Patients with CVS had significantly lower VE during the entire course of posture shifts, compared with HC ( B = -19.87, SE = 6.95, t = -2.86, P = 0.005, SMD = 0.76).

DISCUSSION

Children with CVS have suboptimal parasympathetic autonomic regulation compared with HC, indexed by reduced RSA and VE, even during their interepisodic well phase. Abnormal vagal modulation may underlie CVS pathophysiology, comorbidities, and triggers. Assessing VE during posture stressors could inform therapeutic interventions.

Appeasement: replacing Stockholm syndrome as a definition of a survival strategy

Background: Stockholm syndrome or traumatic bonding (Painter & Dutton, Patterns of emotional bonding in battered women: Traumatic bonding. International Journal of Women's Studies, 8(4), 363-375, 1985) has been used in mainstream culture, legal, and some clinical settings to describe a hypothetical phenomenon of trauma survivors developing powerful emotional attachments to their abuser. It has frequently been used to explain the reported 'positive bond' between some kidnap victims and their captor's, although scarce empirical research has supported this assertion. It has been used in various situations where interpersonal violence and mind control are reported and where clear power differentials exist, such as in child sexual abuse, intimate partner violence, human trafficking, and hostage situation scenarios.Objective: We propose replacing Stockholm syndrome with 'appeasement,' a term that can be explained through a biopsychological model (i.e. Polyvagal Theory) to describe how survivors may appear emotionally connected with their perpetrators to effectively adapt to life-threatening situations by calming the perpetrator.Conclusion: We believe the term appeasement will demystify the reported survivor experiences and will, in the eyes of the public, victims, and survivors, provide a science-based explanation for their narratives of survival that may initially appear to be contradictory. By understanding the potent reflexive neurobiological survival mechanisms embedded in appeasement, individuals and families can operationalise their survival from a perspective that supports resilience, a healthy long-term recovery, and normalises their coping responses as survival techniques.

Addressing Emotional Dysregulation and Potential Pharmacogenetic Implication of 5-HTTLPR Genotype in Attention Deficit Hyperactivity Disorder

Background

This review unpacks the emotional presentation of externalizing behaviors in attention deficit hyperactivity disorder (ADHD), by diving into the psychophysiology, neurophysiology, and neurogenetics in relation to executive function. The correlations among these three variables are identified, showing that standard assessments for ADHD leave out the emotional dysregulation element. This may lead to suboptimal management outcomes during the developmental progression into adolescence and adulthood.

Summary

The emotional impulsivity manifestation in adolescence and adulthood related to the under-managed emotional dysregulation in childhood is found to be associated with subtle confounding impact of 5-HTTLPR (serotonin-transporter-linked promoter region) genotype. The genotype of interest affects the neurochemistry, neurophysiology, and psychophysiology of the cognition for executive function. The established practice of using methylphenidate in treating ADHD surprisingly has a neurogenetic effect in targeting the genotype of interest. Methylphenidate provides neuroprotective effects throughout the neurodevelopment timeline from childhood to adulthood.

Key Messages

The emotional dysregulation element in ADHD which is often overlooked should be addressed to improve the prognostic outcomes in adolescence and adulthood.

Sex, love and oxytocin: Two metaphors and a molecule

Dozens of studies, most conducted in the last four decades, have implicated oxytocin, as well as vasopressin and their receptors, in processes that mediate selective sociality and the consequences of early experience. Oxytocin is critical for the capacity to experience emotional safety and healthy sexuality. Oxytocin also plays a central role in almost every aspect of physical and mental health, including the coordination of sociality and loving relationships with physiological reactions to challenges across the lifespan. Species, including prairie voles, that share with humans the capacity for selective social bonds have been a particularly rich source of insights into the behavioral importance of peptides. The purpose of this historical review is to describe the discovery of a central role for oxytocin in behavioral interactions associated with love, and in the capacity to use sociality to anticipate and cope with challenges across the lifespan - a process that here is called "sociostasis."

The genomic impact of kindness to self vs. others: A randomized controlled trial

OBJECTIVE

Prosocial behavior has been linked to improved physical health, but the biological mechanisms involved remain unclear. This study tested whether a 4-week kindness intervention could reduce expression of a stress-related immune response gene signature known as the Conserved Transcriptional Response to Adversity (CTRA).

METHODS

In a diverse sample of community adults (N = 182), study participants were randomly assigned to perform 3 kind acts for other people, to perform 3 kind acts for themselves, or to list daily activities (control), on one day per week over 4 weeks. CTRA gene expression was measured by RNA sequencing of dried blood spots (DBS) collected at baseline and 5 weeks later (1 week after completing study assignments). Participants' descriptions of their kind acts were coded for protocol adherence and act content.

RESULTS

Participants who were randomized to perform kind acts for others showed significant reductions in CTRA gene expression relative to controls. Participants who were randomized to perform kind acts for themselves also showed significant reductions in CTRA gene expression relative to controls, but this pattern emerged only for those who failed to perform the requested self-kind acts (protocol non-adherent). Those who fully adhered to the self-kindness protocol showed no change in CTRA gene expression and did not differ from controls. Act content analyses implicated self-stress-reducing behavior in the paradoxical effects of self-kindness and the physical presence of others in the effects of prosocial behavior.

CONCLUSIONS

Prosocial engagement-doing something kind for others rather than oneself-reduces CTRA gene expression. The nature of kind acts and their intended recipient plays a key role in shaping the genomic impact of kindness.

Cognition, Behavior, Sexuality, and Autonomic Responses of Women with Hypothalamic Amenorrhea

(1) Background: Functional Hypothalamic Amenorrhea (FHA) can be caused by the hyper activation of neuro-endocrine responses to stress. Among other endocrine factors and hypothalamic dysfunctions, the psychophysiological stress response can very frequently lead to an inhibition of the gonadal-pituitary axis. The aim of this study was to investigate the level of neurovegetative activation in a group of young women affected by this condition. (2) Methods: Twenty-five women (mean age = 21.1 ± 4.34) with FHA were consecutively recruited. Information on psycho-physiological distress was collected through a Psychopathological assessment (with the administration of three psychometric tests) and the Psychophysiological Stress Profile (PSP). Their data were compared with a control group. (3) Results: In the PSP, the patients displayed significantly higher values compared to controls in terms of the parameters of muscle tension (sEMG), skin conductance (SCL/SCR), heart rate (HR), and peripheral temperature (PT). Furthermore, autonomic hyper-activation at rest, marked reactivity to stress, and reduced recovery were seen. Moreover, a condition characterized by psychological distress (anxiety and somatic complaints, depressed and irritable mood, obsessive-compulsive traits) emerged. (4) Conclusions: The results highlight autonomic hyper-activation in FHA, which is also associated with psychological distress. Considering that FHA is a condition that affects multiple systems between mind and body, a multimodal, multidimensional, and multidisciplinary assessment of stress is becoming an emerging need.

Heart Rate Variability: A Personal Journey

Heart rate variabfility (HRV) has been a focal point throughout my academic history. To put into perspective, I have published studies spanning seven decades focusing on HRV (1969-2022). My interest in HRV started early in graduate school and continues to be an important portal informing my theoretical perspective. The current paper tracks some of this history, which started as an empirical observation and moved through several scientific stages including development of quantitative methods and investigations of neural mechanisms. Along this journey a variety of hypotheses were tested including the relative sensitivity of HRV metrics to neural mechanisms, psychological processes, and medical diagnoses. In addition, the research led to the identification of portal of intervention that have become strategies to optimize mental and physical health. These apparent disparate programs of inquiry have been tightly merged as the Polyvagal Theory evolved. In the sections below, I have shared my personal journey through these stages of scientific inquiry and my attempts to integrate the new knowledge in an expansive theoretical model.

Oxytocin and oxygen: the evolution of a solution to the ‘stress of life’

Oxytocin (OT) and the OT receptor occupy essential roles in our current understanding of mammalian evolution, survival, sociality and reproduction. This narrative review examines the hypothesis that many functions attributed to OT can be traced back to conditions on early Earth, including challenges associated with managing life in the presence of oxygen and other basic elements, including sulfur. OT regulates oxidative stress and inflammation especially through effects on the mitochondria. A related nonapeptide, vasopressin, as well as molecules in the hypothalamic–pituitary–adrenal axis, including the corticotropin-releasing hormone family of molecules, have a broad set of functions that interact with OT. Interactions among these molecules have roles in the causes and consequence of social behaviour and the management of threat, fear and stress. Here, we discuss emerging evidence suggesting that unique properties of the OT system allowed vertebrates, and especially mammals, to manage over-reactivity to the ‘side effects’ of oxygen, including inflammation, oxidation and free radicals, while also supporting high levels of sociality and a perception of safety.

This article is part of the theme issue ‘Interplays between oxytocin and other neuromodulators in shaping complex social behaviours’.

Sympathetic Vagal Balance and Cognitive Performance in Young Adults during the NIH Cognitive Test

Compromised cognitive function is associated with increased mortality and increased healthcare costs. Autonomic nervous system arousal, as measured by an electrocardiogram (ECG), has received recent attention because of its association with the blood perfusion of brain regions involved with cognitive function. The purposes of this study were to determine whether the ECG HR variation, as measured by the standard deviation of the heart rate N-to-N intervals (SDNN), and sympathetic vagal tone, as estimated by the low-frequency/high-frequency ratio (LF/HF), are increased with cognitive performance during the NIH Cognitive Test (Picture Sequence, Dimensional Change Card Sort, Flanker, and List Sorting). A total of 62 young people without cognitive impairment participated in this study. We discovered that the ECG LF/HF ratio was increased in the top 50% of participants who could: (1) inhibit information and stay attentive to a desired task during the Flanker Test; (U = 329, p = 0.03; R² = 0.76); and (2) promote cognitive function flexibility during the DCCS Test; (U = 55, p = 0.007; R² = 0.98). Taken together, these findings support that the arousal level influences performance during a cognitive test.

Love and fear: A special issue

Love and fear were forged by the same fundamental evolutionary processes that permitted life on Earth. Both love and fear are deeply interwoven with the adaptive management of stress and disease. Love and fear share common roots and both can play a role in reproduction, survival, perceived safety and wellbeing. This special issue of Comprehensive Psychoneuroendocrinology focuses specifically on the causes and consequences of love from the interactive perspectives of evolution, neurobiology and culture.

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This introduction presents the reasons for a special issue on love and fear.

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It outlines what the different contributions to the special issue bring to the topic.

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It concludes by emphasizing the importance of studies in this field.

Compassion Focused Group Therapy for People With a Diagnosis of Bipolar Affective Disorder: A Feasibility Study

Background

Compassion focused therapy (CFT) is an evolutionary informed, biopsychosocial approach to mental health problems and therapy. It suggests that evolved motives (e.g., for caring, cooperating, competing) are major sources for the organisation of psychophysiological processes which underpin mental health problems. Hence, evolved motives can be targets for psychotherapy. People with certain types of depression are psychophysiologically orientated towards social competition and concerned with social status and social rank. These can give rise to down rank-focused forms of social comparison, sense of inferiority, worthlessness, lowered confidence, submissive behaviour, shame proneness and self-criticism. People with bipolar disorders also experience elevated aspects of competitiveness and up rank status evaluation. These shift processing to a sense of superiority, elevated confidence, energised behaviour, positive affect and social dominance. This is the first study to explore the feasibility of a 12 module CFT group, tailored to helping people with a diagnosis of bipolar disorder understand the impact of evolved competitive, status-regulating motivation on their mental states and the value of cultivating caring and compassion motives and their psychophysiological regulators.

Methods

Six participants with a history of bipolar disorder took part in a CFT group consisting of 12 modules (over 25 sessions) as co-collaborators to explore their personal experiences of CFT and potential processes of change. Assessment of change was measured via self-report, heart rate variability (HRV) and focus groups over three time points.

Results

Although changes in self-report scales between participants and across time were uneven, four of the six participants consistently showed improvements across the majority of self-report measures. Heart rate variability measures revealed significant improvement over the course of the therapy. Qualitative data from three focus groups revealed participants found CFT gave them helpful insight into: how evolution has given rise to a number of difficult problems for emotion regulation (called tricky brain) which is not one's fault; an evolutionary understanding of the nature of bipolar disorders; development of a compassionate mind and practices of compassion focused visualisations, styles of thinking and behaviours; addressing issues of self-criticism; and building a sense of a compassionate identity as a means of coping with life difficulties. These impacted their emotional regulation and social relationships.

Conclusion

Although small, the study provides evidence of feasibility, acceptability and engagement with CFT. Focus group analysis revealed that participants were able to switch from competitive focused to compassion focused processing with consequent improvements in mental states and social behaviour. Participants indicated a journey over time from 'intellectually' understanding the process of building a compassionate mind to experiencing a more embodied sense of compassion that had significant impacts on their orientation to (and working with) the psychophysiological processes of bipolar disorder.

An overview of the phylogeny of cardiorespiratory control in vertebrates with some reflections on the 'Polyvagal Theory'

Mammals show clear changes in heart rate linked to lung ventilation, characterized as respiratory sinus arrhythmia (RSA). These changes are controlled in part by variations in the level of inhibitory control exerted on the heart by the parasympathetic arm of the autonomic nervous system (PNS). This originates from preganglionic neurons in the nucleus ambiguous that supply phasic, respiration-related activity to the cardiac branch of the vagus nerve, via myelinated, efferent fibres with rapid conduction velocities. An elaboration of these central mechanisms, under the control of a 'vagal system' has been endowed by psychologists with multiple functions concerned with 'social engagement' in mammals and, in particular, humans. Long-term study of cardiorespiratory interactions (CRI) in other major groups of vertebrates has established that they all show both tonic and phasic control of heart rate, imposed by the PNS. This derives centrally from neurones located in variously distributed nuclei, supplying the heart via fast-conducting, myelinated, efferent fibres. Water-breathing vertebrates, which include fishes and larval amphibians, typically show direct, 1:1 CRI between heart beats and gill ventilation, controlled from the dorsal vagal motor nucleus. In air-breathing, ectothermic vertebrates, including reptiles, amphibians and lungfish, CRI mirroring RSA have been shown to improve oxygen uptake during phasic ventilation by changes in perfusion of their respiratory organs, due to shunting of blood over across their undivided hearts. This system may constitute the evolutionary basis of that generating RSA in mammals, which now lacks a major physiological role in respiratory gas exchange, due to their completely divided systemic and pulmonary circulations.

Polyvagal Theory: A Science of Safety

Contemporary strategies for health and wellbeing fail our biological needs by not acknowledging that feelings of safety emerge from internal physiological states regulated by the autonomic nervous system. The study of feelings of safety has been an elusive construct that has historically been dependent upon subjectivity. Acknowledging that feelings of safety have a measurable underlying neurophysiological substrate would shift investigations of feelings of safety from a subjective to an objective science. Polyvagal Theory provides an innovative scientific perspective to study feelings of safety that incorporates an understanding of neuroanatomy and neurophysiology. This perspective identifies neural circuits that downregulate neural regulation of threat reactions and functionally neutralize defensive strategies via neural circuits communicating cues of safety that enable feelings of safety to support interpersonal accessibility and homeostatic functions. Basically, when humans feel safe, their nervous systems support the homeostatic functions of health, growth, and restoration, while they simultaneously become accessible to others without feeling or expressing threat and vulnerability. Feelings of safety reflect a core fundamental process that has enabled humans to survive through the opportunistic features of trusting social engagements that have co-regulatory capacities to mitigate metabolically costly defense reactions. Through the study of neural development and phylogeny, we can extract foundational principles and their underlying mechanisms through which the autonomic nervous system leads to feelings of safety and opportunities to co-regulate. Several principles highlight the validity of a science of safety that when implemented in societal institutions, ranging from healthcare to education, would enhance health, sociality, and lead to greater productivity, creativity, and a sense of wellbeing. By respecting our need to feel safe as a biological imperative linked to survival, we respect our phylogenetic heritage and elevate sociality as a neuromodulator that functionally provides the scientific validation for a societal focus on promoting opportunities to experience feelings of safety and co-regulation.

Prevention of Unhealthy Weight, Disordered Eating, and Poor Body Image in Children. Perspectives From Norwegian Parents and Healthcare Professionals

Background

Childhood obesity (ChO) and eating disorders are on the rise, with concerning effects on health. Early prevention is essential as interventions after problems arise are costly and with a low success rate. In Norway, prevention of ChO has been largely weight-centered, without desired effects. Confident Body, Confident Child (CBCC) is a universal program aimed at preventing ChO, disturbed eating, and body image problems through a health-centered intervention for parents of children between 2 and 6 years. The current study is part of a cultural adaptation and translation of CBCC into Norwegian.

Methods

Focus groups with parents (n = 16) and professionals (n = 11) were held around healthy eating, activity, and body image, with an emphasis on possible barriers for prevention as well as approaches considered helpful. The interviews were analyzed using interpretative phenomenological analysis.

Results

Parents and professionals described parental stress connected to high standards, conflicting information, and parental comparison. A narrowing sense of normality around healthy living was described with little flexibility resulting in "all-or-nothing" thinking. Parents were anxious to say or do the wrong thing when regulating children's food intake and when faced with comments about appearance. Parents and professionals described parental concern around children not eating enough, and professionals described an increase in parents using food as regulation. Both parents and professionals expressed that having a child with overweight was tied to a sense of failure and shame. Interventions related to overweight seemed to increase stress and shame, further complicating follow-up. As an alternative, parents and professionals expressed a desire for interventions with normalizing information around "good-enough" parenting related to food and weight.

Discussion

The described fear of doing something wrong and lack of flexibility is interpreted within a stress-sensitive understanding, where stress and shame can influence parents toward mobilizing action or disengagement, presenting as dichotomous behaviors of "all-or-nothing".

Conclusion

Interventions that can normalize parental concerns in a non-moralizing way may reduce stress and shame. CBCC addresses all the major concerns raised in this study, providing parents with evidence-based information they can implement into everyday life. The Norwegian cultural adaptation added extra emphasis on normalization and shame-reduction.

Feeling Safe and Nostalgia in Healthy Aging

The population of older adults worldwide is growing, with an urgent need for approaches that develop and maintain intrinsic capacity consistent with healthy aging. Theory and empirical research converge on feeling safe as central to healthy aging. However, there has been limited attention to resources that cultivate feeling safe to support healthy aging. Nostalgia, "a sentimental longing for one's past," is established as a source of comfort in response to social threat, existential threat, and self-threat. Drawing from extant theory and research, we build on these findings to position nostalgia as a regulatory resource that cultivates feeling safe and contributes to intrinsic capacity to support healthy aging. Using a narrative review method, we: (a) characterize feeling safe as a distinct affective dimension, (b) summarize the character of nostalgia in alignment with feeling safe, (c) propose a theoretical account of the mechanisms through which nostalgia cultivates feeling safe, (d) highlight the contribution of nostalgia to feeling safe and emotional, physiological, and behavioral regulatory capabilities in healthy aging, and (e) offer conclusions and direction for research.

Oxytocin and love: Myths, metaphors and mysteries

Oxytocin is a peptide molecule with a multitude of physiological and behavioral functions. Based on its association with reproduction - including social bonding, sexual behavior, birth and maternal behavior - oxytocin also has been called "the love hormone." This essay specifically examines association and parallels between oxytocin and love. However, many myths and gaps in knowledge remain concerning both. A few of these are described here and we hypothesize that the potential benefits of both love and oxytocin may be better understood in light of interactions with more ancient systems, including specifically vasopressin and the immune system. Oxytocin is anti-inflammatory and is associated with recently evolved, social solutions to a variety of challenges necessary for mammalian survival and reproduction. The shared functions of oxytocin and love have profound implications for health and longevity, including the prevention and treatment of excess inflammation and related disorders, especially those occurring in early life and during periods of chronic threat or disease.

Habitual use of psychological coping strategies is associated with physiological stress responding during negative memory recollection in humans

Research has identified a variety of strategies people use to cope with stress and that the adaptiveness of various strategies depends on the context in which they are used. However, important questions remain about the role of physiological stress response systems in supporting, influencing, or changing from coping strategies. This study works toward addressing this gap by examining associations between skin conductance level (SCL) and habitual use of coping strategies. It was hypothesized that more use of problem-focused strategies would be associated with SCL trajectories that were more stable and decreased less steeply, with the opposite trend hypothesized for more use of emotion-focused strategies. Participants were 188 college students (78% female) who reported their use of 14 coping strategies. SCL was recorded during recall of a negative family memory from childhood for five minutes. Trajectories of SCL during the recall were estimated with multilevel modeling. Greater self-distraction, planning, active coping, use of emotional support, and coping flexibility were related to trajectories of SCL that decreased less steeply and were more stable. Problem-focused coping and coping flexibility are, therefore, related to reduced SCL reactivity and promoting these skills may benefit mental health.

The Brainstem-Informed Autism Framework: Early Life Neurobehavioral Markers

Autism spectrum disorders (ASD) have long-term implications on functioning at multiple levels. In this perspective, we offer a brainstem-informed autism framework (BIAF) that traces the protracted neurobehavioral manifestations of ASD to early life brainstem dysfunctions. Early life brainstem-mediated markers involving functions of autonomic/arousal regulation, sleep-wake homeostasis, and sensorimotor integration are delineated. Their possible contributions to the early identification of susceptible infants are discussed. We suggest that the BIAF expands our multidimensional understanding of ASD by focusing on the early involvement of brainstem systems. Importantly, we propose an integrated BIAF screener that brings about the prospect of a sensitive and reliable early life diagnostic scheme for weighing the risk for ASD. The BIAF screener could provide clinicians substantial gains in the future and may carve customized interventions long before the current DSM ASD phenotype is manifested using dyadic co-regulation of brainstem-informed autism markers.