Exploring the possible mechanisms of blunted cardiac reactivity to acute psychological stress

How is variability in physiological responses to social stress related to punishment and reward sensitivities? Preliminary findings from the revised reinforcement sensitivity theory of personality perspective

OBJECTIVE

Although personality traits are assumed to have biological/physiological foundations, research has yielded mixed evidence regarding the relationship between personality and physiological stress responses. Moreover, the field has often overlooked the contemporary neuroscience-based personality approach, known as the Reinforcement Sensitivity Theory (RST) of Personality, in stress research.

METHOD

The present study examined the relationship between the revised RST's personality dimensions and heart rate and skin conductance level (SCL) in response to the Trier Social Stress Test in a sample of 61 healthy university students.

RESULTS

Piecewise latent growth curve analysis controlling for the participants' current life stress, smoking use, and caffeine intake revealed that individuals with higher behavioral inhibition exhibited higher physiological reactivity, whereas those with high reward sensitivity showed smaller heart rate reactivity. The behavioral disengagement facet of the behavioral inhibition scale was associated with reduced sympathetic arousal during the stress task. Additionally, reward interest was associated with a larger recovery of SCL.

CONCLUSION

Results were generally in line with the revised theory. The study findings were discussed within the paradigm of the approach-avoidance conflict and highlighted the importance of reward sensitivity in stress resilience.

Surgeon reported measures of stress and anxiety prior to and after elective gynecological surgery

INTRODUCTION

Performing surgical procedures is a recognized source of stress for surgeons. Vocational stress is an important contributor to performance, patient care, and burnout with dispositional and environmental factors contributing. Accurately assessing surgeon stress is critical to measuring effectiveness of stress reduction programs. The primary aim was to identify differences between surgeons' self-reported anticipated stress and anxiety prior to gynecological surgery, compared with their recollection of experienced stress and anxiety during surgery. Secondary aims assessed any differences by level of training, surgical type, and surgeon role.

MATERIAL AND METHODS

Attending and resident gynecologists performing routine elective surgeries completed a visual analog scale (VAS) assessing perceived stress and the State-Trait Anxiety Inventory (STAI) prior to and immediately after completing 161 elective surgeries including total laparoscopic hysterectomy, laparoscopic excision of moderate-severe endometriosis, or hysteroscopic myomectomy.

RESULTS

Eight attending gynecologists and nine residents participated. Residents commenced as primary surgeon in 62/90 (69%) procedures. Stress experienced during surgery was greater than anticipated in 92/161 (57%) surgery episodes (mean VAS increase: 3.9; 95% CI: 1.1-6.8, p = 0.009). State anxiety was greater than anticipated in 99/161 (62%) episodes (mean state anxiety increase: 4.4; 95% CI: 3.0-5.8, p < 0.001). Greater preprocedural anticipatory stress and anxiety was observed in residents vs. attending gynecologists (VAS 51.9 vs. 22.8, p < 0.001; state anxiety 38.3 vs. 28.1, p < 0.001) and in primary vs. assistant surgeons (VAS 47.2 vs. 29.9, p < 0.001; state anxiety 36.9 vs. 28.3, p < 0.001). Intraoperative stress and anxiety were greater in primary surgeons (VAS 50.4 vs. 30.5, p < 0.001; anxiety 41.3 vs. 32.5, p < 0.001) and residents (VAS 43.4 vs. 31.7, p < 0.001; anxiety 53.5 vs. 33.7, p < 0.001) compared with assistants and attending gynecologists. Perceived stress and anxiety were positively correlated at both timepoints (r = 0.68, p < 0.001; r = 0.82, p < 0.001).

CONCLUSIONS

When asked to reflect on stress experienced during surgery, our data show that stress during surgery is greater than anticipated for many surgical episodes. Self-reported stress symptoms commence prior to surgery and are more commonly reported by surgeons operating as primary surgeon and by those in training. Future research should focus on determinants of presurgical stress and examine when stressors become inhibitory to performance.

A pilot exploration of the relationships between optimism, affect, and cardiovascular reactivity

Introduction

Cardiovascular reactivity refers to changes in blood pressure and heart rate in response to internal or external stimuli. Previous research has shown that excessively high and low cardiovascular reactivity are associated with an increased risk of cardiac problems. Dispositional optimism has been associated with numerous health benefits, including better cardiovascular responses to stressors, and reduced mortality risk. Conversely, pessimism has been associated with negative health outcomes and worse cardiovascular reactivity to stress. Mood, comprising positive and negative affect, can significantly impact psychological adjustment and physical health. Therefore, it is important to consider mood as a potential confounding variable in the link between optimism and cardiovascular reactivity. The study hypothesized that optimism and pessimism would still influence cardiovascular reactivity even when mood variables were controlled for.

Methods

A within-subjects correlational design with 107 young adult participants was used. Sociodemographic and clinical questionnaires were administered to collect information on participants' characteristics. The Dispositional Optimism Scale (LOT-R) and the Positive and Negative Affect Scale (PANAS) were used to assess participants' levels of optimism, pessimism, and mood. Measures of cardiovascular reactivity, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), were taken during a stressor task (PASAT).

Results

There is a moderate positive correlation between dispositional optimism and positive affect, while pessimism demonstrated a moderate positive association with negative affect. Linear regression analyses were conducted, controlling baseline reactivity variables, gender, and body mass index. The results showed that pessimism had a significant negative effect on SBP reactivity, suggesting that higher levels of pessimism decreased SBP response. Optimism had a significant positive effect on DBP reactivity, while pessimism had a significant negative effect.

Discussion

Overall, these results suggest that dispositional optimism and pessimism are related to cardiovascular reactivity, even after controlling for positive and negative affect. Pessimism was associated with lower SBP reactivity, while both optimism and pessimism influenced DBP reactivity. These findings are consistent with previous research indicating that optimism enables more effective stress management during challenging events, whereas pessimism can serve as a risk factor, heightening the likelihood of experiencing future cardiac issued caused by blunted cardiovascular reactivity.

Cardiovascular reactivity, stress, and personal emotional salience: Choose your tasks carefully

Both greater cardiovascular reactivity and lesser reactivity ("blunting") to laboratory stressors are linked to poor health outcomes, including among people who have a history of traumatic experiences. In a sample of recently separated and divorced adults (N = 96), this study examined whether differences in cardiovascular reactivity might be explained by differences in the personal emotional salience of the tasks and trauma history. Participants were assessed for trauma history, current distress related to their marital dissolution, and cardiovascular reactivity during two tasks, a serial subtraction math stressor task and a divorce-recall task. Participants with a greater trauma history evidenced less blood pressure reactivity to the serial subtraction task (a low personal emotional salience task) when compared to participants with less trauma history. In contrast, participants with a greater trauma history evidenced higher blood pressure reactivity to the divorce-recall task, but only if they also reported more divorce-related distress (high personal emotional salience). These associations were not significant for heart rate reactivity. Among people with a history of more traumatic experiences, a task with low personal salience was associated with a lower blood pressure response, whereas a task with higher personal emotional salience was associated with a higher blood pressure response. Future studies examining cardiovascular reactivity would benefit from determining the personal emotional salience of tasks, particularly for groups that have experienced stressful life events or trauma.

Blunted cardiovascular reactivity may serve as an index of psychological task disengagement in the motivated performance situations

Challenge and threat models predict that once individuals become engaged with performance, their evaluations and cardiovascular response determine further outcomes. Although the role of challenge and threat in predicting performance has been extensively tested, few studies have focused on task engagement. We aimed to investigate task engagement in performance at the psychological and physiological levels. We accounted for physiological task engagement by examining blunted cardiovascular reactivity, the third possible cardiovascular response to performance, in addition to the challenge/threat responses. We expected that low psychological task engagement would be related to blunted cardiovascular reactivity during the performance. Gamers (N = 241) completed five matches of the soccer video game FIFA 19. We recorded psychological task engagement, heart rate reactivity, and the difference between goals scored and conceded. Lower psychological task engagement was related to blunted heart rate reactivity during the performance. Furthermore, poorer performance in the previous game was related to increased task engagement in the subsequent match. The findings extend existing literature by providing initial evidence that blunted cardiovascular reactivity may serve as the index of low task engagement.

Lower Cardiovascular Reactivity is Associated with More Childhood Adversity and Poorer Midlife Health: Replicated Findings from the Dunedin and MIDUS Cohorts

Cardiovascular reactivity has been proposed as a biomarker linking childhood adversity and poorer health. The current study examined the association of childhood adversity, cardiovascular reactivity, and health in the Dunedin (n=922) and MIDUS studies (n=1,015). In both studies, participants who experienced more childhood adversity had lower cardiovascular reactivity. In addition, people with lower cardiovascular reactivity had poorer self-reported health and greater inflammation. Dunedin participants with lower cardiovascular reactivity were aging biologically faster, and MIDUS participants with lower heart rate reactivity had increased risk of early mortality. Cardiovascular reactivity was not associated with hypertension in either study. Results were partially accounted for by greater reactivity among more conscientious, less depressed, and higher-functioning participants. These results suggest that people who experienced childhood adversity have a blunted physiological response, which is associated with poorer health. The findings highlight the importance of accounting for individual differences when assessing cardiovascular reactivity using cognitive stressor tasks.

Cardiovascular Stress Reactivity and Health: Recent Questions and Future Directions

OBJECTIVE

High cardiovascular reactions to psychological stress are associated with the development of hypertension, systemic atherosclerosis, and cardiovascular disease. However, it has become apparent that low biological stress reactivity also may have serious consequences for health, although less is known about the mechanisms of this. The objectives of this narrative review and opinion article are to summarize and consider where we are now in terms of the usefulness of the reactivity hypothesis and reactivity research, given that both ends of the reactivity spectrum seem to be associated with poor health, and to address some of the key criticisms and future challenges for the research area.

METHODS

This review is authored by the members of a panel discussion held at the American Psychosomatic Society meeting in 2019, which included questions such as the following: How do we measure high and low reactivity? Can high reactivity ever indicate better health? Does low or blunted reactivity simply reflect less effort on task challenges? Where does low reactivity originate from, and what is a low reactor?

RESULTS

Cardiovascular (and cortisol) stress reactivity are used as a model to demonstrate an increased understanding of the different individual pathways from stress responses to health/disease and show the challenges of how to understand and best use the reconstruction of the long-standing reactivity hypothesis given recent data.

CONCLUSIONS

This discussion elucidates the gaps in knowledge and key research issues that still remain to be addressed in this field, and that systematic reviews and meta-analyses continue to be required.

Eveningness, depression and cardiovascular reactivity to acute psychological stress: A mediation model

The psychological pathways linking depression to blunted cardiovascular reactivity (CVR) are still being elucidated. The purpose of the present study was to test whether the association between eveningness, a diurnal/sleep-wake preference and CVR would be mediated by depressive symptoms. One hundred and eighty-two healthy young adults completed measures of morningness/eveningness (the Morningness-Eveningness Questionnaire; MEQ-SA), depressive symptoms (Hospital Anxiety and Depression Scale; HADS) and had their blood pressure and heart rate monitored throughout a standardised stress testing protocol. Results indicated that depressive symptoms were negatively associated with systolic blood pressure (SBP) but not diastolic blood pressure (DBP) or heart rate (HR) reactions to the stress task. Eveningness was also negatively associated with both SBP and DBP, but not HR. As such, those who reported increased depressive symptomology, and higher scores on eveningness displayed a more blunted cardiovascular response. Furthermore, the latter relationship was mediated by depressive symptoms such that those reporting higher scores on eveningness also reported increased depressive symptomology and this resulted in blunted CVR for SBP. These findings withstood adjustment for several confounding factors including time of testing. In conclusion, the present findings highlight the importance of considering eveningness when looking at the depression-blunted CVR relationship.

Instructed reappraisal and cardiovascular habituation to recurrent stress

Instructed reappraisal has previously been associated with a challenge-oriented cardiovascular response profile, indexed by greater cardiac output (CO) and lower total peripheral resistance (TPR), in response to a single stress exposure. The present study builds on this research by employing a stress habituation paradigm where participants completed a speech task twice; in which prior to the second task participants heard reappraisal instructions (i.e., view feelings of stress arousal as something that is beneficial) or control instructions. This paradigm allowed us to (a) test if reappraisal aids cardiovascular habituation to recurrent stress, and (b) examine if reappraisal leads to a within-participant change in CO/TPR responding from an uninstructed task to an instructed reappraisal task. Habitual use of reappraisal was assessed using the Emotion Regulation Questionnaire. The analyses report upon 173 young adults (121 women, 52 men). Cardiovascular parameters were measured continuously using the Finometer Pro. All participants demonstrated similar cardiovascular habituation during the second stress exposure (lower SBP, CO, and HR); suggesting that reappraisal did not aid cardiovascular habituation to recurrent stress. Reappraisal instructions did not lead to a challenge-oriented response compared to both the control group and responses to the uninstructed task. This study is the first to examine the relationship between instructed reappraisal and cardiovascular habituation and identifies that habitual use of reappraisal does not interact with reappraisal instructions to influence cardiovascular responses to stress.

Is stressor-evoked cardiovascular reactivity a pathway linking positive and negative emotionality to preclinical cardiovascular disease risk?

Stressor-evoked cardiovascular reactivity, trait positive emotionality, and negative emotionality are all associated with cardiovascular disease. It is unknown, however, whether cardiovascular reactivity may constitute a pathway by which trait positive or negative emotionality relates to disease risk. Accordingly, this study modeled the cross-sectional relationships between trait positive and negative emotionality, stressor-evoked cardiovascular reactivity, and severity of a subclinical vascular marker of cardiovascular risk, carotid artery intima-media thickness (CA-IMT). The sample consisted of healthy, midlife adults free from clinical cardiovascular disease (N = 286; ages 30-54; 50% female). Trait positive and negative emotionality were measured by three questionnaires. Heart rate and blood pressure reactivity were assessed across three stressor tasks. CA-IMT was assessed by ultrasonography. Latent factors of positive and negative emotionality, blood pressure reactivity, heart rate reactivity, and CA-IMT were created using structural equation modeling. Greater negative emotionality was marginally associated with more CA-IMT (β = .21; p = .049), but lower blood pressure reactivity (β = -.19; p = .03). However, heightened blood pressure (β = .21; p = .03), but not heart rate reactivity (β = -.05; p = .75), associated with greater CA-IMT. Positive emotionality was uncorrelated with cardiovascular reactivity (blood pressure: β = -.04; p = .61; heart rate: β = .16; p = .11) and CA-IMT (β = .16; p = .07). Although trait negative emotionality associates with a known marker of cardiovascular disease risk, independent of positive emotionality, it is unlikely to occur via a stressor-evoked cardiovascular reactivity pathway.

Urban Emotion Sensing Beyond 'Affective Capture': Advancing Critical Interdisciplinary Methods

The use of mobile sensor methodologies in urban analytics to study 'urban emotions' is currently outpacing the science required to rigorously interpret the data generated. Interdisciplinary research on 'urban stress' could help inform urban wellbeing policies relating to healthier commuting and alleviation of work stress. The purpose of this paper is to address-through methodological experimentation-ethical, political and conceptual issues identified by critical social scientists with regards to emotion tracking, wearables and data analytics. We aim to encourage more dialogue between the critical approach and applied environmental health research. The definition of stress is not unambiguous or neutral and is mediated by the very technologies we use for research. We outline an integrative methodology in which we combine pilot field research using biosensing technologies, a novel method for identifying 'moments of stress' in a laboratory setting, psychometric surveys and narrative interviews on workplace and commuter stress in urban environments.

Blunted cardiovascular reactivity to acute psychological stress predicts low behavioral but not self-reported perseverance: A replication study

Emerging evidence suggests that individuals with poor behavioral perseverance show low or blunted physiological responses to acute psychological stress. For example, a recent preliminary laboratory study demonstrated that blunted responders give up sooner and take fewer attempts when endeavoring to complete an impossible puzzle, but do not self-report poor perseverance. This present research is a replication of the previous study with an increased sample size, longer recovery periods between tasks and addition of social evaluation to the cold pressor. Participants (147) completed a self-report perseverance questionnaire (Short Grit Scale) and behavioral perseverance tasks (impossible Euler puzzle and socially evaluated cold-pressor (SECPT)). The number of attempts and time spent trying to complete the unsolvable puzzle, and duration of hand submergent during the SECPT, were recorded as behavioral perseverance measures. Difference in blood pressure (BP) and pulse rate (PR) from baseline to a 10-min paced auditory serial addition task (PASAT) were computed as reactivity. As previously, reactivity did not relate to self-reported perseverance and blunted BP reactivity to the PASAT was associated with less time persevering at the unsolvable puzzle. Additionally, blunted BP and PR reactivity to the PASAT related to poorer perseverance during the SECPT. These findings, replicating the previous study, increase confidence that blunted reactivity is a physiological marker of poor behavioral perseverance. Moreover, given that self-reported perseverance does not relate to reactivity, this suggests that blunted responders are not conscious of this detriment in perseverance, but likely need additional support when persistence is critical (e.g., during behavior change).

Childhood trauma and type D personality: The endocrine and cardiovascular effects on stress reactivity

Both exaggerated and blunted cardiovascular stress reactions are associated with health problems. Moreover, early life experiences and personality traits affect stress responses. Regarding the childhood traumas and type D personality, this study aimed to compare the endocrine and cardiovascular reactions against acute laboratory stress. Results showed that the simultaneous existence of childhood traumatic experiences and type D personality leads to exaggerated stress reactivity, while each factor results in a blunted cardiovascular response. Although the cardiovascular responses are dampened in type D personality people, their endocrine reactions are exaggerated. The underlying mechanisms of blunted cardiovascular reactivity differ between childhood trauma and type D personality groups.

Swearing as a Response to Pain: Assessing Hypoalgesic Effects of Novel "Swear" Words

Previous research showing that swearing alleviates pain is extended by addressing emotion arousal and distraction as possible mechanisms. We assessed the effects of a conventional swear word (“fuck”) and two new “swear” words identified as both emotion-arousing and distracting: “fouch” and “twizpipe.” A mixed sex group of participants (N = 92) completed a repeated measures experimental design augmented by mediation analysis. The independent variable was repeating one of four different words: “fuck” vs. “fouch” vs. “twizpipe” vs. a neutral word. The dependent variables were emotion rating, humor rating, distraction rating, cold pressor pain threshold, cold pressor pain tolerance, pain perception score, and change from resting heart rate. Mediation analyses were conducted for emotion, humor, and distraction ratings. For conventional swearing (“fuck”), confirmatory analyses found a 32% increase in pain threshold and a 33% increase in pain tolerance, accompanied by increased ratings for emotion, humor, and distraction, relative to the neutral word condition. The new “swear” words, “fouch” and “twizpipe,” were rated as more emotional and humorous than the neutral word but did not affect pain threshold or tolerance. Changes in heart rate and pain perception were absent. Our data replicate previous findings that repeating a swear word at a steady pace and volume benefits pain tolerance, extending this finding to pain threshold. Mediation analyses did not identify a pathway via which such effects manifest. Distraction appears to be of little importance but emotion arousal is worthy of future study.

American Indian young adults display diminished cardiovascular and cortisol responses to acute psychological stress

American Indian adults are at an increased risk for cardiovascular disease compared with non-Hispanic white adults. Scant research exists examining the underlying physiological and psychological mechanisms associated with these risks. This study aimed to examine possible psychological and physiological stress-related mechanisms related to cardiovascular disease risk in healthy American Indian and non-Hispanic white adults. Forty American Indian (60% female, Mean age = 19.93, SD = 2.08 years) and 45 non-Hispanic white (70% female, Mean age = 20.18, SD = 2.22 years) participants attended an in-person laboratory session. Salivary cortisol and cardiovascular activity were measured before (baseline), during, and after exposure to a 10-minute mental arithmetic task. Compared to non-Hispanic white participants, American Indian had diminished salivary cortisol (p < .001), blood pressure (p's < .001), and heart rate (p = .041) responses to acute psychological stress. These effects could not be accounted for by differences in task performance or self-reported engagement. Previous research has shown that exaggerated responses to stress are associated with increased risk of cardiovascular disease. However, diminished responses to stress are associated with early childhood stress and future adverse behaviors (e.g., addiction, obesity). Diminished reactivity may influence behaviors that can impact future development of cardiovascular disease in American Indian populations.

HEMODYNAMIC RESPONSE AFTER CONCURRENT CROSS EXERCISE IN HYPERTENSIVE WOMEN

ABSTRACT Introduction: Systemic arterial hypertension is a disease that mainly affects women. Objective: This study aimed to verify the hypotensive effect and blood pressure reactivity in women submitted to a concurrent cross exercise (CC) session. Methods: Fifteen volunteers (54±3) performed aerobic exercise alternated with a series of weights exercises, for the analysis of blood pressure variation (by the oscillometric method) and pressure reactivity (by the Cold pressure test) before and after exercise. Results: The results demonstrated the occurrence of post-exercise hypotension in the systolic phase in the comparison between CC and C post-exercise (−11.65 mmHg). CC led to attenuation of 7mmHg and 4mmHg for SBP and DBP, respectively, in the blood pressure reactivity after one session. Conclusion: It is concluded that concurrent cross exercise ensures hypotension and positive reactivity of systolic blood pressure. Level of evidence II; Therapeutic studies-Investigating the results of treatment.

Establishing the validity of a novel passive stress task

Laboratory tasks used to elicit a cardiovascular stress response in the laboratory can involve either active or passive coping. However, in previous work, passive stress tasks often incorporate a distinct physical stress element, such as the handgrip or cold pressor task, meaning observed changes in cardiovascular parameters may be the result of the physical element of the stressor rather than truly reflecting psychological stress. The present study aimed to establish the validity of a psychological passive stressor; one more analogous to active tasks than those previously employed in laboratory studies. Twenty-six young, healthy adults completed a speech task in the laboratory following a resting baseline period. Twelve months later, they were invited back to the laboratory and watched the video recording of their speech. Analyses confirmed that while both tasks elicited significant SBP and DBP change (all ps < .001), only the active task was associated with HR and CO reactivity (both ps < .001), while only the passive task was associated with TPR reactivity (p = .028). Furthermore, the passive stressor was associated with a mixed hemodynamic profile, whereas the active stressor was associated with a clear myocardial profile. This study confirms that watching a video recording of oneself complete a speech task is associated with a more vascular response profile, a response associated with passive coping contexts.

Trait dominance and cardiovascular functioning during social stress

Cardiovascular reactivity (CVR) to stress has been found to be an important indicator of future ill health, and individual differences in personality have been posited to explain disparities in outcomes. Dominance is associated with forceful persons who desire hierarchy in social interactions. This study investigated dominance and CVR during social or asocial stressors. Sixty-one women, categorized as low, moderate, or high in dominance using the Jackson Personality Research Form, completed a social or asocial stressor while undergoing cardiovascular measurement during baseline, stressor, and recovery phases. A 3 × 2 × 3 analysis of covariance revealed a significant Phase × Stressor × Dominance interaction for systolic blood pressure (SBP). Women with lower and moderate dominance-but not women with higher dominance-exhibited greater SBP responses to stress in the social condition compared with the asocial condition. No significant difference was found for women with higher dominance, indicative of blunted SBP during the social stressor. During recovery, women with lower dominance had marginally elevated SBP in the social condition compared with the asocial condition. The current study extends prior knowledge of the association between dominance and CVR, such that greater dominance was associated with blunted SBP and lower dominance was associated with attenuated recovery to social stress.

A Randomized Controlled Trial of a Mindfulness-Based Weight Loss Intervention on Cardiovascular Reactivity to Social-Evaluative Threat Among Adults with Obesity

Objective

Mindfulness-based interventions have been found to reduce psychological and physiological stress reactivity. In obesity, however, stress reactivity is complex, with studies showing both exaggerated and blunted physiological responses to stressors. A nuanced view of stress reactivity is the "challenge and threat" framework, which defines adaptive and maladaptive patterns of psychophysiological stress reactivity. We hypothesized that mindfulness training would facilitate increased challenge-related appraisals, emotions, and cardiovascular reactivity, including sympathetic nervous system activation paired with increased cardiac output (CO) and reduced total peripheral resistance (TPR) compared to a control group, which would exhibit an increased threat pattern of psychophysiological reactivity to repeated stressors.

Methods

Adults (N=194) with obesity were randomized to a 5.5-month mindfulness-based weight loss intervention or an active control condition with identical diet-exercise guidelines. Participants were assessed at baseline and 4.5 months later using the Trier Social Stress Task. Electrocardiogram, impedance cardiography, and blood pressure were acquired at rest and during the speech and verbal arithmetic tasks to assess pre-ejection period (PEP), CO, and TPR reactivity.

Results

Mindfulness participants showed significantly greater maintenance of challenge-related emotions and cardiovascular reactivity patterns (higher CO and lower TPR) from pre to post-intervention compared to control participants, but groups did not differ in PEP. Findings were independent of changes in body mass index.

Conclusions

Mindfulness training may increase the ability to maintain a positive outlook and mount adaptive cardiovascular responses to repeated stressors among persons with obesity though findings need to be replicated in other populations and using other forms of mindfulness interventions.

Ventromedial prefrontal cortex connectivity during and after psychological stress in women

The ventromedial prefrontal cortex (vmPFC) integrates sensory, affective, memory-related, and social information from diverse brain systems to coordinate behavioral and peripheral physiological responses according to contextual demands that are appraised as stressful. However, the functionality of the vmPFC during stressful experiences is not fully understood. Among 40 female participants, the present study evaluated (a) functional connectivity of the vmPFC during exposure to and recovery following an acute psychological stressor, (b) associations among vmPFC functional connectivity, heart rate, and subjective reports of stress across individuals, and (c) whether patterns of vmPFC functional connectivity were associated with distributed brain networks. Results showed that psychological stress increased vmPFC functional connectivity with individual brain areas implicated in stressor processing (e.g., insula, amygdala, anterior cingulate cortex) and decreased connectivity with the posterior cingulate cortex and thalamus. There were no statistical differences in vmPFC connectivity to individual brain areas during recovery, as compared with baseline. Spatial similarity analyses revealed stressor-evoked increased connectivity of the vmPFC with the so-called dorsal attention, ventral attention, and frontoparietal networks, as well as decreased connectivity with the default mode network. During recovery, vmPFC connectivity increased with the frontoparietal network. Finally, individual differences in heart rate and perceived stress were associated with vmPFC connectivity to the ventral attention, frontoparietal, and default mode networks. Psychological stress appears to alter network-level functional connectivity of the vmPFC in a manner that further relates to individual differences in stressor-evoked cardiovascular and affective reactivity.

History of Preeclampsia Adds to the Deleterious Effect of Chronic Stress on the Cardiac Ability to Flexibly Adapt to Challenge

Preeclampsia, a pregnancy-specific disorder, presents a major health problem during gestation, but is also associated with increased risk for cardiovascular complications in later life. We aimed to investigate whether chronic stress experience and preeclampsia may have additive adverse effects on the cardiac ability to flexibly adapt to challenge, that is, to mount an appropriately vigorous heart rate response to an acute psychological challenge, or whether they may perhaps have synergistic effects (e.g., mutual augmentation of effects). Blunted cardiac responding to challenge has been linked to poor health outcomes in the longer term. Women previously affected by preeclampsia and women after uncomplicated pregnancies were tested 15-17 weeks post-partum in a standardized stress-reactivity protocol, while cardiovascular variables were simultaneously recorded. Changes in heart rate and blood pressure in response to the stressor were analyzed with regard to the effects of history of preeclampsia and chronic stress experience. Findings indicated blunted cardiac responses in women with higher chronic stress experience (p = 0.020) and, independently from that, in women with a history of preeclampsia (p = 0.018), pointing to an additive nature of the effects of preeclampsia and chronic stress on impaired cardiovascular functioning. Consequently, if both are present, a history of preeclampsia may add to the already deleterious effects of the experience of chronic stress. The additive nature of the effects suggests that stress-reducing interventions, albeit they will not eliminate the heightened cardiovascular risk in patients with a history of preeclampsia, may improve their overall prognosis by avoiding further accumulation of risk.

Deranged emotional and cortisol responses to a psychosocial stressor in anorexia nervosa women with childhood trauma exposure: Evidence for a "maltreated ecophenotype"?

Exposure to trauma in the childhood and abnormal interpersonal stress reactivity are believed to contribute to the pathophysiology of anorexia nervosa (AN), which suggests a possible role of the hypothalamus-pituitary adrenal (HPA) axis. Although an effect of early traumatic experiences on the cortisol awakening response has been proved in patients with AN, the consequences of childhood trauma exposure on HPA axis reactivity to psychosocial stressors has been never investigated in such individuals. Therefore, we have assessed emotional and cortisol responses to an acute psycho-social stress in AN patients with a history of childhood trauma exposure. Twenty-four AN women and 17 healthy women were enrolled in the study. Patients were classified as maltreated (Mal) or non-maltreated (noMal) according to their Childhood Trauma Questionnaire scores. Participants underwent the Trier Social Stress Test (TSST) and their emotional responses were measured through the state scale of the State-Trait Anxiety Inventory. Saliva samples were collected to measure cortisol production. Compared to both healthy subjects and noMal AN patients, Mal AN women exhibited a blunted cortisol response to TSST. With respect to healthy controls, pre-TSST anxiety levels were enhanced in both AN groups; moreover, Mal AN patients displayed a reduced anxiety increase after TSST as compared to both noMal patients and healthy women. Our findings for the first time provide the evidence of deranged biological and emotional responses to an acute social stress in AN patients with childhood trauma exposure, corroborating the idea of a maltreated ecophenotype in AN as in other psychiatric disorders.

Reduced cardiovascular activation following chronic stress in caregivers of people with anorexia nervosa

Caring for offspring diagnosed with eating disorders (EDs) puts caregivers under high levels of chronic stress, which have negative consequences for their health. Unfortunately, caregivers have received little attention from mental health professionals. Chronic stress experienced by informal caregivers has been associated with the alteration of body homeostasis, and therefore, the functioning of various physiological systems. This could be the basis of health problems in informal caregivers of people with EDs. The main objective of this study was to analyze physiological response, in terms of heart rate (HR) and heart rate variability (HRV), to an acute laboratory stressor in a sample of informal caregivers of individuals with anorexia nervosa (n = 24) compared to a sample of noncaregivers (n = 26). In addition, the relationship between depressive mood and the aforementioned cardiovascular response parameters was analyzed in the group of caregivers. Caregivers had higher high-frequency (HF) power HRV, and lower HR, low-frequency (LF) power HRV and LF/HF ratio values than noncaregivers, which suggests lower cardiovascular reactivity to the acute stressor than noncaregivers. Moreover, a blunted HR response to stress was associated with high depressive mood scores in caregivers. Hence, it seems that the worse the mood the lower the cardiovascular reactivity to stressful events in this population. Developing and implementing psychotherapeutic interventions focused on stress management would help caregivers to reduce their stress levels and cope more effectively with stressors.