Hostility and distraction have differential influences on cardiovascular recovery from anger recall in women

Childhood Maltreatment and Leukocyte Telomere Length: Cardiac Vagal Activity Influences the Relation in Older Adults

OBJECTIVE

Childhood maltreatment is associated with shorter leukocyte telomere length (LTL). However, the influence of cardiac vagal control on this relation is unknown. We examined whether cardiac vagal control at rest and in response to stress moderates or cross-sectionally mediates the relationship between childhood maltreatment and LTL.

METHODS

Participants were 1179 men and women (aged 65 [7.2] years) suffering from coronary artery disease or non-cardiovascular chronic disease. They completed a childhood maltreatment questionnaire and underwent a stress protocol while electrocardiogram was monitored. High-frequency heart rate variability (HF-HRV) measures were obtained at rest, during stress, and after stress in absolute and normalized units (nu). LTL was measured using quantitative polymerase chain reaction. Mediation and moderation analyses were performed.

RESULT

HF-HRV and HF-HRV in normalized units (HFnu) measures did not mediate the childhood maltreatment-LTL relation. However, baseline HFnu ( p = .027) and HFnu reactivity ( p = .051) moderated the relation. Specifically, maltreatment was associated with significantly lower LTL among those with baseline HFnu at ( b = -0.059, p = .003) or below the mean ( b = -0.103, p < .001), but not among those with higher baseline HFnu. It was also associated with significantly lower LTL among participants who showed either blunted ( b = -0.058, p = .004) or increased HFnu ( b = -0.099, p = .001) responses to stress but not in those with large decreases in HFnu.

CONCLUSIONS

Childhood maltreatment was associated with lower LTL in those who showed a distinct cardiac vagal profile at baseline and in response to stress. The mechanisms and implications remain to be determined.

The Effects of Heart Rate Variability (HRV) Biofeedback on HRV Reactivity and Recovery During and After Anger Recall Task for Patients with Coronary Artery Disease

Patients with coronary artery disease (CAD) often experience anger events before cardiovascular events. Anger is a psychological risk factor and causes underlying psychophysiological mechanisms to lose balance of the autonomic nervous system (ANS). The heart rate variability (HRV) was the common index for ANS regulation. It has been confirmed that heart rate variability biofeedback (HRV-BF) restored ANS balance in patients with CAD during the resting state. However, the effects of HRV-BF during and after the anger event remain unknown. This study aimed to examine the effects of HRV-BF on ANS reactivity and recovery during the anger recall task in patients with CAD. This study was a randomized control trial with a wait-list control group design, with forty patients in the HRV-BF group (for six sessions) and 44 patients in the control group. All patients received five stages of an anger recall task, including baseline, neutral recall task, neutral recovery, anger recall task, and anger recovery. HRV reactivity in the HRV-BF group at the post-test was lower than that in the control group. HRV recovery at the post-test in the HRV-BF group was higher than that in the control group. The HRV-BF reduced ANS reactivity during anger events and increased ANS recovery after anger events for CAD patients. The possible mechanisms of HRV-BF may increase total HRV, ANS regulation, and baroreflex activation at anger events for patients with CAD, and may be a suitable program for cardiac rehabilitation.

Physiological Responses to Narrative Anger Recall and Correlates to Anger, Forgiveness, and Rumination

Abstract. Narrative recall, or describing an event from one’s past, is a common method to study anger in the laboratory. However, most research using this method has not included a neutral speaking control, and therefore the physiological response attributable to emotion versus the act of speech is unknown. We evaluated heart rate, blood pressure, skin conductance level, heart rate variability, and salivary alpha-amylase during silent baseline, neutral speaking, anger recall, and recovery periods, and correlated these measures with trait anger, forgiveness, and rumination ( n = 104). Only systolic blood pressure and skin conductance levels were elevated in the anger recall period above the values in the neutral speaking period, showing the need for this important control. Alpha-amylase was inversely correlated to forgiveness, particularly in females. A neutral speaking control is critical for anger recall protocols because the physiological responses are mostly due to speaking, not anger. Salivary alpha-amylase may be a promising autonomic marker in studies of forgiveness and anger.

Parasympathetic Response Patterns are Associated with Metabolic Syndrome Among Older Women but Not Men

Background

Little is known about the role of physiological stress responses in metabolic syndrome (MetS).

Purpose

To examine whether patterns of autonomic response to psychological stress are associated with MetS and whether this association is moderated by sex

Methods

1121 men and women (M_age = 65.3 ± 6.77 years) with and without coronary artery disease (CAD) underwent an anger recall stressor task. Heart rate and heart-rate variability (HRV; HF, LF/HF) were assessed. Clusters of participants showing similar patterns of response across baseline, stress, and recovery periods were created using ACECLUS and FASTCLUS in SAS. Logistic regressions included clusters and interaction between clusters and sex as independent variables, controlling for relevant covariates. ANCOVAs were conducted in secondary analyses utilizing a continuous composite representation of MetS.

Results

Men and women showing greater tonic and phasic HR elevations were more likely to meet MetS criteria (OR = 1.45, [95% CI = 1.02–2.07], p = .037). HF-HRV cluster interacted significantly with sex (p < .001) to predict MetS. In women, those with significant parasympathetic withdrawal to stress and poor recovery were more likely to have MetS than women with a more moderate response (OR = 2.56, [95% CI = 1.23–5.41], p = .013). Women who displayed stress-related parasympathetic activation were also at greater risk of MetS (OR = 2.30, [95% CI = 1.30–4.07], p = .004). Results using a continuous measure of MetS were generally consistent with these findings.

Conclusion

Among older participants with CAD or other noncardiovascular disease, hyperreactivity to stress was associated with greater prevalence of MetS, particularly in women. Consistent with emerging literature, women who showed blunting or activation of parasympathetic responses to stress were similarly at greater risk.

Religiosity, Education, John Henryism Active Coping, and Cardiovascular Responses to Anger Recall for African American Men

The present study examined if high levels of religious attendance (ORG), private religious activity (NOR), or intrinsic religiosity (SUB) buffer cardiovascular responses to active speech and anger recall lab stressors alone and by John Henryism Active Coping (JHAC) and educational attainment. A sample of 74 healthy African American males, aged 23 to 47 years, completed psychosocial surveys and a lab reactivity protocol involving active speech and anger recall with a 5-minute baseline and ensuing recovery periods. Measures of religiosity, JHAC, and education were related to continuous measures of systolic and diastolic blood pressure (BP), for each task and rest period with repeated measures ANOVA tests. The period by education by JHAC interaction effect was significant for diastolic BP responses at low but not higher NOR. At low education and low NOR, diastolic BP levels increased significantly during anger recall and ensuing recovery for high but not low JHAC persons. Thus, being deprived of education and private religious activity may put these African American men in a vulnerable situation where higher effort coping may exacerbate their cardiovascular reactivity and recovery to anger induction.

The effects of audiovisual distraction on the muscle sympathetic responses to experimental muscle pain

Pain elicited by intramuscular infusion of hypertonic saline solution causes muscle sympathetic nerve activity (MSNA) to increase in some subjects, yet decrease in others. Although the direction of the response is not predictable based on baseline physiological and psychological parameters, we know that it results from sustained functional changes in specific brain regions that are responsible for the behavioral and cardiovascular responses to psychological stressors, as well as those involved in attention. The aim of this study was to investigate whether MSNA responses to experimental muscle pain in humans could be altered with an audiovisual stimulus that served to distract them from the pain. MSNA was recorded from the left common peroneal nerve of 20 young healthy individuals during a 45-min intramuscular infusion of hypertonic saline solution into the ipsilateral tibialis anterior muscle. The distracting stimulus commenced 15 min after the start of the infusion and lasted for 15 min. Fifteen subjects showed an increase in mean burst amplitude of MSNA (to 176.4 ± 7.9% of baseline), while five showed a decrease (to 73.1 ± 5.2% of baseline); distraction had no effect on these profiles. These results indicate that even though the subjects were attending to the audiovisual stimulus, and were presumably distracted from the pain, it failed to alter the MSNA responses to muscle pain.

Cardiac vagal control as a marker of emotion regulation in healthy adults: A review

In the last two decades, a growing body of theory and research has targeted the role of cardiac vagal control (CVC) in emotional responding. This research has either focused on resting CVC (also denoted as cardiac vagal tone) or phasic changes in CVC (also denoted as vagal reactivity) in response to affective stimuli. The present paper is aimed at reporting a review of the papers published between 1996 and 2016, and focused on the results of 135 papers examining cardiac vagal control as a physiological marker of emotion regulation in healthy adults. The review shows that studies have employed a wide array of methodologies and measures, often leading to conflicting results. High resting CVC has been associated with better down-regulation of negative affect, use of adaptive regulatory strategies, and more flexible emotional responding. Concerning phasic changes, research has consistently found decreased CVC in response to stress, while CVC increases have been shown to reflect either self-regulatory efforts or recovery from stress. Despite conflicting results, we conclude that existing literature supports the use of CVC as a noninvasive, objective marker of emotion regulation.

The Relationship between Expressive/Suppressive Hostility Behavior and Cardiac Autonomic Activations in Patients with Coronary Artery Disease

BACKGROUND

Hostility is an important psychosocial risk factor in coronary artery disease (CAD). Expressive and suppressive hostility behaviors are related to cardiovascular response in healthy adults. However, the relationships of these behavioral dimensions to cardiac autonomic activations in CAD remain unclear.

METHOD

This study involved 76 patients with CAD to whom a hostility inventory was administered, who were instructed to recall a neutral event and an anger-related event. Heart rate and blood pressure were obtained for each patient as the indices of cardiovascular response; heart rate variability was transformed from electrocardiograph and as the indices of cardiac autonomic activation.

RESULTS

The results showed that CAD patients with expressive hostility behavior experienced higher cardiovascular autonomic activations during the neutral and anger recall tasks, and lower parasympathetic activations during the recovery after an anger episode. On the other hand, CAD patients with suppressive hostility behavior experienced both sympathetic and parasympathetic activations during the baseline and recovery stages, as well as simultaneously activated higher parasympathetic response.

CONCLUSIONS

The results of this study suggested that it is appropriate to extend the cardiac autonomic activation model for expressive and suppressive hostility behaviors in patients with CAD.

KEY WORDS

Cardiac autonomic; Coronary artery disease; Expressive hostility; Suppressive hostility behaviors.

Cardiovascular recovery from psychological and physiological challenge and risk for adverse cardiovascular outcomes and all-cause mortality

OBJECTIVE

Exaggerated cardiovascular (CV) reactivity to laboratory challenge has been shown to predict future CV morbidity and mortality. CV recovery has been less studied and has yielded inconsistent findings, possibly due to the presence of moderators. Reviews on the relationship between CV recovery and CV outcomes have been limited to cross-sectional studies and have not considered methodological factors. We performed a comprehensive meta-analytic review of the prospective literature investigating CV recovery to physical and psychological challenge and adverse CV outcomes.

METHODS

We searched PsycINFO and PubMed for prospective studies investigating the relationship between CV recovery and adverse CV outcomes. Studies were coded for variables of interest and for effect sizes. We conducted a random-effects weighted meta-analysis. Moderators were examined with analysis of variance-analog and meta-regression analyses.

RESULTS

Thirty-seven studies met the inclusion criteria (n = 125,386). Impaired recovery from a challenge predicted adverse CV outcomes (summary effect, r = 0.17, p < .001). Physical challenge was associated with larger predictive effects than psychological challenge. Moderator analyses revealed that recovery measured at 1 minute postexercise, passive recovery, use of mortality as an outcome measure, and older sample age were associated with larger effects.

CONCLUSIONS

Poor recovery from laboratory challenges predicts adverse CV outcomes, with recovery from exercise serving as a particularly strong predictor of CV outcomes. The overall effect size for recovery and CV outcomes is similar to that observed for CV reactivity and suggests that the study of recovery may have incremental value for understanding adverse CV outcomes.

The Effect of Exercise and Distraction on Blood Pressure Recovery Following an Anger-Provoking Stressor in Normotensive Young Adults

Ruminating about a prior anger provoking event is found to elevate blood pressure (BP) and delay BP recovery. Delayed BP recovery may be associated with increased risk of hypertension. Interventions that improve BP recovery may be beneficial for cardiovascular health. The purposes of this study were to evaluate the influence of rumination and anger on BP reactivity and recovery, to compare the effect of an exercise intervention or distraction intervention on BP recovery and to explore if exercise improved BP recovery by distracting participants from stressor-related rumination and anger. Healthy, normotensive participants (n = 79, mean age 22.2 ± 4.0 years) underwent an anger-recall interview stressor task, 3 min of exercise (walking), distraction (reading) or no-intervention (quiet sitting) and a 15 min recovery period. State anger reactivity was associated with Δ diastolic (D) BP reactivity and approached significance with Δ systolic (S) BP reactivity. Trait rumination was associated with greater SBP during recovery. Δ SBP recovery did not differ between the exercise, distraction and no-intervention groups. Although there were no differences in Δ DBP recovery between the exercise and no-intervention groups, distraction improved Δ DBP recovery compared to the exercise intervention but not the no-intervention. The proportion of anger-related thoughts (state rumination) in the exercise group did not differ from the distraction or no-intervention groups. However, a smaller proportion of participants in the distraction intervention reported an anger-related thought during recovery compared to the no-intervention group with 76% of their thoughts relating to the provided distraction. Overall, post-stressor exercise was not found to improve BP recovery while reading was effective at distracting individuals from angry thoughts (state rumination) but had no effect on BP compared to no-intervention.

Exploring the blood volume amplitude and pulse transit time during anger recall in patients with coronary artery disease

BACKGROUND AND PURPOSE

One psychopathological mechanism that links anger to coronary artery disease (CAD) is cardiac autonomic imbalance. Blood volume amplitude (BVA) and pulse transit time (PTT) are related to peripheral arterial elasticity and cardiac conduction, which are used as indirect markers for autonomic activation. The purposes of this study were to examine the relationships between BVA and PTT, and the reactivity of BVA and PTT during the anger recall task in patients with CAD.

METHODS AND SUBJECTS

A total of 112 patients with CAD and 93 healthy controls were recruited; BVA and PTT were collected during baseline, the neutral episode, the anger episode, and after recovery.

RESULTS

There were significant positive correlations between BVA and PTT in all participants. BVA reactivity during the anger episode was greater in patients with CAD than in healthy controls, and there were also lower BVA recovery values after the neutral and anger episodes. However, there was no significant difference in BVA reactivity between the two groups in the neutral episode. PTT recovered to baseline levels after the neutral and anger episodes in healthy controls, but not in the patients with CAD.

CONCLUSION

BVA and PTT were associated with peripheral vascular elasticity and cardiac conduction that were regulated by the cardiac autonomic system. Peripheral vasoconstriction and changes in travel time between left ventricular and peripheral vasculature during the anger episode, and impaired recovery to baseline levels may relate to the psychopathological mechanisms of CAD.

Type A personality, hostility, time urgency and unintentional injuries among Chinese undergraduates: a matched case-control study

Background

Associations between type A behaviour pattern (TABP) and injuries are inconsistent. These inconsistencies may be due to different effects of various components of TABP, namely time urgency/impatience, hostility and competitive drive. It is important to examine the relationship between the global TABP, its two components, and unintentional injuries, among undergraduates in China.

Methods

On the basis of a previous cross-sectional study, we conducted a matched case–control study. 253 cases and an equal number of age-, gender-, and major-matched controls were included. The questionnaire solicited socio-demographic information, the experience of injuries, the scale of TABP, and other potential confounding factors. Besides the correlation between the global TABP and injuries, the influences of the two components of TABP on injuries were also evaluated. Conditional logistic regression was used to determine the crude odds ratios (ORs) and adjusted ORs of injury events.

Results

A dose–response relationship was apparent among students who rated themselves higher on the TABP scale (P-value for trend, 0.002), with a crude OR of 2.93 (95% CI: 0.93–9.19) for injuries comparing those with TABP to those with type B behaviour pattern (TBBP). After adjustment for potential confounding factors, TABP remained statistically significant, and the adjusted OR was 5.52 (95% CI: 1.43–21.27); from a comparison of students with TABP to those with TBBP. A dose–response relationship was also apparent between the hostility component and nonfatal injuries, both in crude analysis and after adjusting for other confounders. The relationship between time-hurry and injuries was not statistically significant, based on univariate and multivariate analyses.

Conclusions

Both the global TABP and the hostility component were associated with a dose response increase in the risk of non-fatal unintentional injuries among Chinese undergraduates. Further studies need to be conducted to confirm or reject this correlation.

Absorption in self-selected activities is associated with lower ambulatory blood pressure but not for high trait ruminators

BACKGROUND

A range of nonpharmacological interventions (e.g., meditation) have positive effects on blood pressure (BP) but tend to have poor adherence. These interventions may lower BP partly by absorbing and directing attention away from one's negative thoughts. We hypothesized that recurring self-selected activities (SSAs) that are attentionally absorbing may similarly lower BP. We examined the effect of reported engagement in SSAs during the previous month prior to participation on ambulatory BP (ABP) and whether those prone to rumination were less likely to show these effects.

METHODS

Participants (n = 38) reported engagement in SSAs and how absorbing they were, responded to trait rumination and perceived stress questionnaires, wore an ABP monitor for 24 hours, and at each ABP measurement answered electronic diary questions assessing activity levels, affect, social interactions, and caffeine and tobacco use.

RESULTS

Regression analyses tested whether the reported absorption of SSAs, trait rumination, and their interaction predicted daytime and nighttime systolic and diastolic ABP. Greater absorption predicted lower daytime and nighttime ABP (bs = -18.83 to -8.79; Ps < .05), but this relationship was moderated by trait rumination (bs = 3.72 to 9.97; Ps < .05). Follow-up analyses revealed that absorption was unrelated to ABP for those with high trait rumination but that more absorption predicted lower ABP for those less prone to rumination.

CONCLUSIONS

Our results suggest that regular engagement in absorbing SSAs is related to lower ABP. These findings have implications for the development of nonpharmacological interventions and suggest SSAs may serve as an adjuvant intervention strategy to lower BP.

A test of Spielberger's state-trait theory of anger with adolescents: five hypotheses

Spielberger's state-trait theory of anger was investigated in adolescents (n = 201, ages 10-18, 53% African American, 47% European American, 48% female) using Deffenbacher's five hypotheses formulated to test the theory in adults. Self-reported experience, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) responses to anger provoking imagery scripts found strong support for the application of this theory to adolescents. Compared with the low trait anger (LTA) group, adolescents with high trait anger (HTA) produced increased HR, SBP, and DBP, and greater self-report of anger to anger imagery (intensity hypothesis) but not greater self-report or cardiovascular reactivity to fear or joy imagery (discrimination hypothesis). The HTA group also reported greater frequency and duration of anger episodes and had longer recovery of SBP response to anger (elicitation hypothesis). The HTA group was more likely to report negative health, social, and academic outcomes (consequence hypothesis). Adolescents with high hostility reported more maladaptive coping with anger, with higher anger-in and anger-out than adolescents with low hostility (negative expression hypothesis). The data on all five hypotheses supported the notion that trait anger is firmly entrenched by the period of adolescence, with few developmental differences noted from the adult literature.

Timing effects of antecedent- and response-focused emotion regulation strategies

Distraction and cognitive reappraisal influence the emotion-generative process at early stages and have been shown to effectively attenuate emotional responding. Inhibiting emotion-expressive behavior is thought to be less beneficial due to later implementation, but empirical results are mixed. Thus, the current study examined the temporal dynamics of these emotion regulation strategies at attenuating the late positive potential (LPP) while participants were shown unpleasant pictures. Results revealed that all strategies successfully reduced the LPP and self-reported negative affect. We confirmed that distraction attenuated the LPP earlier than cognitive reappraisal. Surprisingly, expressive suppression affected emotional responding as early as distraction. This suggests that suppression was used preventively and disrupted the emotion-generative process from the very beginning instead of targeting the emotional response itself. Thus, the obtained results point to the importance of considering the point in time when response-focused emotion regulation strategies are being implemented.

Trait hostility, perceived stress, and sleep quality in a sample of normal sleepers

Objective. To date, no studies have directly examined the effects of cognitive trait hostility on prospectively assessed sleep quality. This is important as individuals with heightened trait hostility demonstrate similar patterns of reactivity to perceived stressors as is often reported by poor sleepers. The present study hypothesized that increased trait hostility is associated with poorer subjective sleep quality and that perceived stress mediates this relationship. Methods. A sample of 66 normal sleepers completed daily sleep and stress logs for two weeks. Trait hostility was measured retrospectively. Results. The cognitive dimension of trait hostility was significantly correlated with subjectively rated sleep quality indicators, and these relationships were significantly mediated by perceived daily stress. Individuals with higher levels of trait cognitive hostility reported increased levels of perceived stress which accounted for their poorer sleep ratings as measured by both retrospective and prospective measures. Conclusions. Overall, the findings indicate that high levels of cognitive hostility are a significant risk factor for disturbed sleep and suggest that this might be a fruitful target for clinical intervention.

Effects of glucose ingestion on autonomic and cardiovascular measures during rest and mental challenge

BACKGROUND

High levels of dietary sugar consumption may result in dysregulated glucose metabolism and lead to elevated cardiovascular disease risk via autonomic nervous system and cardiovascular dysfunction. Altered cardiovascular function can be examined using perturbation tasks such as mental challenge. This study examined the effects of controlled glucose intake on cardiovascular measures at rest and in responses to mental challenge in a laboratory setting.

METHOD

Using a double blind within-subjects design, participants were monitored at baseline, following ingestion of a glucose or taste-control solution, during structured speech (SS), anger recall (AR) and recovery (N=24, 288 repeated measures; age = 21±2 years). Pre-ejection period (PEP), heart rate (HR), stroke index (SI), cardiac index (CI), blood pressure and total peripheral resistance (TPR) were measured throughout the protocol.

RESULTS

Glucose resulted in sustained decreased PEP levels compared to control condition (Δ=11.98±9.52 vs. 3.27±7.65 m·s, P<.001) and transient increases in resting HR (P=.011), CI (P=.040) and systolic blood pressure (P=.009). Glucose did not result in increased cardiovascular reactivity to mental challenge tasks, but was associated with a delayed HR recovery following AR (P=.032).

CONCLUSION

Glucose intake resulted in a drop in PEP indicating increased sympathetic nervous system activity. No evidence was found for glucose-related exaggerated cardiovascular responses to mental challenge. Dysregulated glucose metabolism may result in elevated cardiovascular disease risk as a result of repeated glucose-induced elevations of sympathetic nervous system activity.

The effects of intrapersonal anger and its regulation in economic bargaining

Anger is a common cause of strained negotiations. This research investigated the effects of experiencing anger (Experiment 1) and regulating anger (Experiment 2) on ultimatum bargaining. Experiment 1 showed that relative to a control condition, angered participants proposed less fair offers and rejected more offers when bargaining with the person who angered them. Experiment 2 replicated Experiment 1, and additionally showed that regulating anger via reappraisal and distraction both reduced anger. However, only reappraisal effectively reduced anger for the duration of the negotiation. Participants who reappraised proposed fairer offers than those in the distraction condition, but did not differ in offers accepted. This research may have implications for what emotion regulation strategy should be employed in economic bargaining. However, future research is required to determine the most effective timing and components of reappraisal for promoting beneficial outcomes in bargaining contexts.

The multiple systems model of angry rumination

Angry rumination is perseverative thinking about a personally meaningful anger-inducing event and is a risk factor for aggression. This article presents a new model for understanding angry rumination across five levels of analysis: cognitive, neurobiological, affective, executive control, and behavioral. The type of rumination that occurs at the cognitive level moderates affective responding and neurobiological activation, which influences executive control and aggression. Angry rumination recruits brain regions implicated in cognitive control, emotion regulation, negative affect, physiological arousal, social cognition, and self-reflection on emotional states. Moreover, angry rumination temporarily reduces self-control, which can increase aggression. The article suggests a functional account of angry rumination, identifies gaps in our knowledge, and proposes future research directions based on hypotheses derived from the model.

The immediate and delayed cardiovascular benefits of forgiving

BACKGROUND

The putative health benefits of forgiveness may include long-term buffering against cardiovascular reactivity associated with rumination. Although studies show short-term benefits of adopting a forgiving perspective, it is uncertain whether this perspective protects against repeated future rumination on offenses, which may be necessary for long-term health benefits. Also unclear is whether forgiveness offers unique benefits beyond simple distraction.

METHODS

Cardiovascular parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], and heart rate) were measured while 202 participants thought about a previous offense from an angry or forgiving perspective or were distracted. All participants were then distracted for 5 minutes, after which they freely ruminated on the offense.

RESULTS

Angry rumination initially yielded the greatest increase in blood pressure from baseline (mean [M] [standard deviation {SD}]: SBP = 9.24 [11.16]; M [SD]: DBP = 4.69 [7.48]) compared with forgiveness (M [SD]: SBP = 3.30 [6.48]; M [SD]: DBP = 1.51 [4.94]) and distraction (M [SD]: SBP = 4.81 [6.28]; M [SD]: DBP = 1.75 [3.80]), which did not differ from each other (p > .30). During free rumination, however, those who had previously focused on forgiveness showed less reactivity (M [SD]: SBP = 7.33 [9.61]; M [SD]: DBP = 4.73 [7.33]) than those who had been distracted (M [SD]: SBP = 10.50 [7.77]; M [SD]: DBP = 7.71 [6.83]) and those who previously focused on angry rumination (M [SD]: SBP = 12.04 [11.74]; M [SD]: DBP = 8.64 [12.63]). There were no differences for heart rate.

CONCLUSIONS

Forgiveness seems to lower reactivity both during the initial cognitive process and, more importantly, during mental recreations of an offense soon thereafter, potentially offering sustained protection, whereas effects of distraction appear transient.

Assessing the relationship between rumination and cortisol: a review

OBJECTIVE AND METHODS

For individuals who ruminate, or mentally rehearse past stressful events, the physiological effects of a stressor may be longer lasting. This is well-supported within the cardiovascular domain. In the context of the hypothalamic-pituitary-adrenal (HPA) axis and cortisol, the results are inconsistent. This review summarizes key theoretical and methodological issues that contribute to these mixed findings among the 15 studies to date that have examined the association between rumination and cortisol.

RESULTS

State measures of rumination were consistently linked to increased cortisol concentrations. Stress-related rumination questionnaires were often positively associated with cortisol, whereas depression-related rumination scales predicted lower cortisol concentrations or were unrelated to cortisol. Rumination manipulations in the laboratory (e.g., ruminative self-focused writing tasks compared to distraction writing tasks) influenced cortisol concentrations, but often did not increase cortisol relative to baseline values. Studies that utilized social-evaluative stressor tasks to examine the relationship between rumination and cortisol levels generally showed that rumination predicted greater cortisol reactivity or delayed recovery. Results from studies examining rumination and basal cortisol or the cortisol awakening response were inconsistent.

CONCLUSION

The ways in which researchers conceptualize and assess rumination and the associated cortisol response influences the association between rumination and cortisol. Suggestions for future studies in this area of research are provided.

Rumination as a mediator of chronic stress effects on hypertension: a causal model

Chronic stress has been linked to hypertension, but the underlying mechanisms remain poorly specified. We suggest that chronic stress poses a risk for hypertension through repeated occurrence of acute stressors (often stemming from the chronic stress context) that cause activation of stress-mediating physiological systems. Previous models have often focused on the magnitude of the acute physiological response as a risk factor; we attempt to extend this to address the issue of duration of exposure. Key to our model is the notion that these acute stressors can emerge not only in response to stressors present in the environment, but also to mental representations of those (or other) stressors. Consequently, although the experience of any given stressor may be brief, a stressor often results in a constellation of negative cognitions and emotions that form a mental representation of the stressor. Ruminating about this mental representation of the stressful event can cause autonomic activation similar to that observed in response to the original incident, and may occur and persist long after the event itself has ended. Thus, rumination helps explain how chronic stress causes repeated (acute) activation of one's stress-mediating physiological systems, the effects of which accumulate over time, resulting in hypertension risk.

Cardiovascular and psychological reactivity and recovery from harassment in a biracial sample of high and low hostile men and women

BACKGROUND

This study emphasizes the importance of studying the emotional, motivational, and cognitive characteristics accompanying and the potential hemodynamic mechanisms underlying cardiovascular reactivity to and recovery from interpersonal conflict.

PURPOSE

The relation of dispositional hostility to cardiovascular reactivity during a frustrating anagram task and post-task recovery was investigated.

METHODS

The sample was composed of 99 healthy participants (age, 18-30 years; 53% women; 51% Caucasian; 49% African American)-half randomly assigned to a harassment condition. High and low hostility groups were created by a median split specific to sex and race subgroup score distributions on the Cook-Medley Hostility Scale. It was hypothesized that hostility would interact with harassment such that harassed, high hostile individuals would display the greatest cardiovascular and emotional reactivity and slowest recovery of the four groups. Participants completed a 10-min baseline, a 6-min anagram task, and a 5-min recovery period with blood pressure, heart rate, pre-ejection period, stroke index, cardiac index, and total peripheral resistance index measured.

RESULTS

Harassed participants displayed significantly greater cardiovascular responses and lower positive affect to the task and slower systolic blood pressure (SBP) recovery than did nonharassed participants. The high hostile group, irrespective of harassment, showed blunted cardiovascular responses during the task and delayed SBP recovery than the low hostile group.

CONCLUSION

Although the predicted interaction between hostility and harassment was not supported in the context of cardiovascular responses, such an interaction was observed in the context of blame attributions, whereby harassed hostile participants were found to blame others for their task performance than the other subgroups.

Clinical and physiological correlates of irritability in depression: results from the Netherlands study of depression and anxiety

Objective. Irritable and nonirritable depressed patients differ on demographic and clinical characteristics. We investigated whether this extends to psychological and physiological measures. Method. We compared irritable and nonirritable unipolar depressed patients on symptomatology, personality, and (psycho)physiological measures (cortisol, cholesterol, and heart rate variability). Symptomatology was reassessed after one year, and we also compared depressed patients who were irritable or non-irritable at both time points (Irr++ versus Irr--). Results. Almost half (46%; N = 420) of the sample was classified as irritable. These patients scored higher on depression severity, anxiety, hypomanic symptoms, and psychological variables. No differences were observed on physiological markers after correction for depression severity. The same pattern was found when comparing Irr++ and Irr-- groups. Conclusion. Irritable and non-irritable depressed patients differ on clinical and psychological variables, but not on the currently investigated physiological markers. The clinical relevance of the distinction and the significance of the hypomanic symptoms remain to be demonstrated.

Salivary cortisol responses to a psychosocial laboratory stressor and later verbal recall of the stressor: The role of trait and state rumination

This study investigated whether trait rumination predicts greater increases in salivary cortisol concentration and delayed recovery in response to a standardized, acute laboratory psychosocial stressor (modified Trier Social Stress Test). It also tested whether trait and state rumination predict reactivation of the cortisol response during later verbal recall of the stressor. Fifty-nine undergraduates (31 females; 28 males) completed the stress protocol and returned 2 weeks later for a surprise interview about the first session, conducted in either a supportive or unsupportive context. Participants completed a measure of trait rumination and reported negative thoughts about the stressor in the 2 weeks between sessions (state rumination). Trait rumination was associated with greater reactivity of salivary cortisol level and delayed recovery from the stressor, F(1,310) = 6.77, p < 0.001. It also predicted greater cortisol reactivity when recalling the stressor, but only for males in the unsupportive interview context, F(2,119) = 7.53, p < 0.001. This effect was heightened for males who also scored high on state rumination, F(2,119) = 7.53, p < 0.001. Rumination was not associated with cortisol responses to the interviews in females. The findings indicate that rumination may play a role in prolonging cortisol stress responses through delayed recovery and reactivation and that rumination disposition and the context of stressor recall are important in understanding the rumination-cortisol response association.

Chronic psychosocial stress and hypertension

Genetic and behavioral factors do not fully explain the development of hypertension, and there is increasing evidence suggesting that psychosocial factors may also play an important role. Exposure to chronic stress has been hypothesized as a risk factor for hypertension, and occupational stress, stressful aspects of the social environment, and low socioeconomic status have each been studied extensively. The study of discrimination is a more recent and rapidly growing area of investigation and may also help to explain the well-known racial disparities in hypertension. Research regarding mechanisms underlying stress effects on hypertension has largely focused on cardiovascular reactivity, but delayed recovery to the pre-stress level is increasingly being evaluated as another possible pathway. Recent findings in each of these areas are reviewed, and directions for future research are discussed.

The influence of forgiveness and apology on cardiovascular reactivity and recovery in response to mental stress

To investigate the relation between forgiveness and apology as they relate to cardiovascular reactivity and recovery, 29 men and 50 women were exposed to an interpersonal transgression (i.e., verbal harassment) while performing a serial subtraction task. Participants were categorized into high and low forgiveness groups based on scores on the forgiving personality scale. Following the task, approximately half of the participants received an apology from the experimenter for his/her comments during the task. Although no group differences in cardiovascular reactivity were observed during the serial subtraction task, persons high in forgiveness displayed more rapid diastolic and mean arterial blood pressure recovery than persons low in forgiveness. In response to the apology, participants displayed greater high frequency heart rate variability recovery compared to those who did not receive an apology. A significant apology x sex interaction was observed for diastolic blood pressure and mean arterial blood pressure. Women who received an apology exhibited faster recovery from the transgression than women who did not receive an apology. In contrast, men who received an apology exhibited delayed recovery from the transgression compared to men who did not receive an apology. These results indicate that there are potentially healthful benefits to forgiveness and apology, but the relation is influenced by situation and by sex.

Cortisol is significantly correlated with cardiovascular responses during high levels of stress in critical care personnel

OBJECTIVE

Everyday stressors elicit adaptive changes in the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system. Data on the relationship between these two systems under real-life conditions are sparse. We, therefore, sought to examine the association between HRV and salivary cortisol, which were recorded simultaneously in a stress-exposed, prospective, occupational cohort.

METHODS

The study population comprised 88 nurses. We recorded heart rate (HR) and HRV during 301 working shifts. Participants provided salivary cortisol samples at the beginning of their work shift and every 2 hours thereafter. Samples were collected during three investigation periods spread over 9 months. Change scores for cortisol were calculated as deviations from the expected circadian baseline. Change scores from the grand diurnal mean in the time domain-based root mean square of successive differences served to index alterations in HRV. To account for the temporal delay between changes in HR/HRV and changes in salivary cortisol, the latter were compared with the changes in HR/HRV observed 15 minutes to 45 minutes before the cortisol sampling.

RESULTS

During periods of high stress as indexed by high cortisol levels, we found significant associations between cortisol levels and HR (r = .48, p < .001) and HRV (r = -.28, p = .05). However, during low stress periods, these associations were attenuated and became nonsignificant.

CONCLUSIONS

These data suggest a relative independence in the regulation of the HPA axis and the autonomic nervous system in response to everyday stressors but synchrony of both systems in highly stressful situations.

Hostility and anger in: cardiovascular reactivity and recovery to mental arithmetic stress

BACKGROUND

Hostility and anger have been attributed as psychosocial risk factors for coronary heart disease. Heightened cardiovascular reactivity (CVR), and poor recovery, to provocative stressors are thought to hasten this risk.

PURPOSE

To examine the relationship between hostility and anger inhibition (AI), and the moderating situational influences of harassment and evaluation, in predicting CVR and recovery to mental arithmetic (MA) stress using a multiple regression approach.

METHODS

48 male undergraduate students engaged in the following 3 minute tasks during recording of the electrocardiogram, impedance cardiography, and blood pressure: baseline, MA, and evaluation. Hostility and AI were assessed with the Cook-Medley Hostility Scale and the Speilberger Anger In subscale, respectively.

RESULTS

An interaction between hostility and AI showed high diastolic blood pressure reactivity to the MA task among hostile anger inhibitors. Harassment did not modify this effect. However, harasser evaluation predicted prolonged systolic blood pressure (SBP) responding among men scoring high in AI, and facilitated SBP recovery among those scoring low on AI.

CONCLUSIONS

The findings highlight the interactive influences of AI and hostility in predicting CVR to stress and underscore the importance of recovery assessments in understanding the potentially pathogenic associations of these constructs.

Trait anger management style moderates effects of actual ("state") anger regulation on symptom-specific reactivity and recovery among chronic low back pain patients

OBJECTIVES

We examined whether "state" anger regulation-inhibition or expression-among chronic low back pain (CLBP) patients would affect lower paraspinal (LP) muscle tension following anger-induction, and whether these effects were moderated by trait anger management style.

METHOD

Eighty-four CLBP patients underwent harassment, then they regulated anger under one of two conditions: half expressed anger by telling stories about people depicted in pictures, whereas half inhibited anger by only describing objects appearing in the same pictures. They completed the anger-out and anger-in subscales (AOS; AIS) of the anger expression inventory.

RESULTS

General Linear Model procedures were used to test anger regulation condition by AOS/AIS by period interactions for physiological indexes. Significant three-way interactions were found such that: a) high trait anger-out patients in the inhibition condition appeared to show the greatest LP reactivity during the inhibition period followed by the slowest recovery; b) high trait anger-out patients in the expression condition appeared to show the greatest systolic blood pressure (SBP) reactivity during the expression period followed by rapid recovery.

CONCLUSIONS

Results implicate LP muscle tension as a potential physiological mechanism that links the actual inhibition of anger following provocation to chronic pain severity among CLBP patients. Results also highlight the importance of mismatch situations for patients who typically regulate anger by expressing it. These CLBP patients may be at particular risk for elevated pain severity if circumstances at work or home regularly dictate that they should inhibit anger expression.

Cardiovascular functioning, personality, and the social world: the domain of hierarchical power

The present paper considers connections between cardiovascular functioning (i.e., disease status and acute stress responses) and social dominance, and its counterpart, social submissiveness, both of which are part of the broader domain of "hierarchical power" [Bugental, D.B., 2000. Acquisition of the algorithms of social life: a domain-based approach. Psychological Bulletin 126, 187-219]. Empirical research on connections between dominance/submissiveness and cardiovascular morbidity and mortality in humans is reviewed, as is research on dominance/submissiveness and cardiovascular reactivity to, and recovery from, acute stressors. Three general conclusions are established. First, in both cross-sectional and longitudinal investigations, trait and behavioral indicators of dominance have been positively associated with cardiovascular disease severity, incidence, and progression, whereas preliminary evidence from two studies suggests that trait submissiveness may protect against poorer disease outcomes. Second, among men and women, trait dominance is associated with reactivity to and recovery from acute stressors, particularly social challenges. Third, linkages between dominance/submissiveness and cardiovascular functioning, especially cardiovascular reactivity, are characterized by gender-specific patterning, and this patterning emerges as a function of social context. Implications for the next generation of research concerning social dominance, gender, and cardiovascular functioning are discussed.

Risk for mania and positive emotional responding: too much of a good thing?

Although positive emotion research has begun to flourish, the extremes of positive emotion remain understudied. The present research used a multimethod approach to examine positive emotional disturbance by comparing participants at high and low risk for episodes of mania, which involves elevations in positive emotionality. Ninety participants were recruited into a high or low mania risk group according to responses on the Hypomanic Personality Scale. Participants' subjective, expressive, and physiological emotional responses were gathered while they watched two positive, two negative, and one neutral film clip. Results suggested that participants at high risk for mania reported elevated positive emotion and irritability and also exhibited elevated cardiac vagal tone across positive, negative, and neutral films. Discussion focuses on the implications these findings have for the diagnosis and prevention of bipolar disorder, as well as for the general study of positive emotion.

The influence of trait and state rumination on cardiovascular recovery from a negative emotional stressor

The purpose of this study was to evaluate the influence of trait and state rumination on cardiovascular recovery following a negative emotional stressor. Cardiovascular data was collected from 64 undergraduate women during a 10-min baseline period, 5-min emotional recall stress task, and a 15-min recovery period. Trait rumination was assessed using the Stress Reactive Rumination Scale and state rumination was assessed 5 and 10 min after the stressor, using a thought-report technique. Results indicated that trait and state rumination interacted such that low trait ruminators who were ruminating at 10 min after the termination of the stressor had poorer diastolic blood pressure and high-frequency heart rate variability recovery compared to low trait ruminators who were not ruminating. State rumination was not associated with cardiovascular recovery in high trait ruminators. Results suggest that rumination may play a role in the association between stress and hypertension by prolonging cardiovascular activation following stress.

Hostility, emotional expression, and hemodynamic responses to laboratory stressors: reactivity attenuating effects of a tendency to express emotion interpersonally

The present study examined the interactive effects of hostility and a predisposition towards emotional expression or suppression in interpersonal situations. We also attempted to partially replicate findings from a recent investigation which provided evidence of lower myocardial and greater vascular responses in high-hostile relative to low-hostile individuals. Undergraduate students (n=99) participated in a protocol consisting of rest periods, speech preparation and presentation, a social-evaluative mental arithmetic task, and a stress interview. After classifying participants into high/low hostility by high/low interpersonal emotional expression groups using median-splits, high-hostile individuals showed lower HR and SBP responses to speech preparation and reported greater threat appraisal and negative affect than low-hostile participants. High-hostile interpersonal expressors and male interpersonal expressors displayed lower DBP and TPR reactivity, respectively, than high-hostile or male suppressors. High-hostile expressors also reported lower levels of positive affect than high-hostile suppressors, and expressors reported lower threat appraisals than suppressors, irrespective of hostility. Findings are discussed in terms of an absence of conflict or ambivalence over interpersonal emotional expression for high-hostile expressors and are suggestive of potential health benefits of expressing emotion interpersonally for at-risk groups.

Autonomic Stress Response Modes and Ambulatory Heart Rate Level and Variability

The major goals of this study were (1) to determine consistency of autonomic response modes to different laboratory stressors, and (2) to evaluate the strength of the association between autonomic response modes and ambulatory heart rate and variability. The sample consisted of 45 healthy participants. Parasympathetic (PNS) and sympathetic (SNS) reactivity to and recovery from laboratory stressors (handgrip, logical-mathematical, mirror-tracing, and rumination tasks) were estimated by high frequency heart rate variability (HF-HRV), preejection period (PEP), and baroreflex sensitivity (BRS). Ambulatory HR was measured for 24 h on a work and a nonwork day, counterbalanced. As BRS was less reliable compared to PEP and HF-HRV, the latter two parameters were selected for the computation of SNS/PNS patterns. Autonomic modes were consistent across tasks and more stable during the recovery periods. Moreover, recovery appeared to be sensitive to the emotionality of tasks. Reactivity and recovery patterns differed as a function of gender, with women showing higher vagal tone at baseline, higher HR reactivity to the logical task, greater BRS decrease during the rumination task, and a larger decrease in vagal tone during recovery after the rumination task. After controlling for gender and baseline HR and variability, autonomic profiles during reactivity and recovery periods captured substantially different ambulatory information. Specifically, autonomic profiles during reactivity significantly predicted ambulatory HR level during waking hours, whereas autonomic profile during recovery was linked with ambulatory HRV. Coactivation of SNS and PNS activity was associated with the highest ambulatory HR levels and variability. Findings from the laboratory were consistent with a dimensional autonomic model viewing SNS and PNS contributions to heart rate on orthogonal axes and individual stress response stereotypy. Laboratory task-related autonomic reactivity and recovery may reflect parallel differences in HR level and variability in everyday life.

Damned if you do, damned if you don't: The differential effect of expression and inhibition of anger on cardiovascular recovery in Black and White males

Appropriate regulation of emotions is an important component of health. The physiological effects of coping with anger are a topic of particular interest. In a pioneering series of studies Hokanson found that the mode of anger expression following anger instigation had differential effects on vascular recovery. These differential effects were thought to be a result of social learning of avoidance responses. The present study examined this hypothesis in the context of ethnic differences in cardiovascular recovery responses to anger instigation. Twenty-four African American (AA) and 26 European American (EA) males engaged in two debates, one racially themed and one non-racially themed, with an EA confederate. Cardiovascular measures were recorded at baseline, during the debates and during 10-minute recovery periods following each debate. Anger expression preceding the recovery period was manipulated such that half the participants could express their anger toward the confederate and half had to inhibit their anger toward the confederate. Results showed that both AA and EA participants that inhibited their anger had delayed total peripheral resistance recovery. Importantly, for the other dependent variables differential recovery responses were observed such that EA participants that expressed their anger recovered more quickly whereas AA participants that expressed their anger recovered more slowly. These results are consistent with Hokanson's social learning theory of recovery from anger instigation and have important implications for research on emotion regulation and health.

Recreating cardiovascular responses with rumination: the effects of a delay between harassment and its recall

Cardiovascular responses occur not only in the immediate presence of stressors, but also while later thinking about those experiences. Evidence suggests that these delayed responses, such as those produced by ruminating about prior angering experiences, may play an important role in the development of cardiovascular disease. We examine whether physiological consequences of rumination depend on the delay between a stressor and its recall, and whether the magnitude of physiological responses decreases with repetition. Twenty-two participants experienced a three-minute harassment stressor, and later spent 3 min vividly recalling the task. Half the subjects returned for the first time after a week, and half returned after half an hour, and then also after a week. Blood pressure and heart rate were monitored during a baseline period, and during each session's stressor or rumination period. Results indicated that rumination was sufficient to elevate blood pressure (systolic and diastolic) above baseline, that the delay made no difference to the magnitude of the elevation, but that the second rumination seemed to be associated with a smaller response than the first. Response to the stressor was not associated with rumination responses, but the first rumination response was significantly correlated with the second. The effects of stress may be experienced long after the actual stressor is passed, and people who experience large delayed responses may not be the same as those with high initial responses. The "hot" affective portion of rumination may not be diminished by the passage of time, but by prior recreation of the experience.

Arousal of negative emotions and symptom-specific reactivity in chronic low back pain patients

Anger may have greater effects on chronic pain severity than other negative emotions and may do so by increasing muscle tension near the site of injury (symptom-specific reactivity). For patients with chronic low back pain (CLBP), relevant muscles are lower paraspinals (LP). Ninety-four CLBP patients and 79 controls underwent anger and sadness recall interviews. EMG and cardiovascular activity were recorded. Patients exhibited greater LP tension increases during anger and slower recovery than controls. Only patients showed greater LP reactivity during anger than sadness. For both groups, trapezius reactivity during anger and sadness did not differ. LP reactivity to anger correlated with everyday pain severity for patients. Anger-induced symptom-specific LP reactivity may be linked to chronic pain aggravation among CLBP patients.

The role of angry rumination and distraction in blood pressure recovery from emotional arousal

OBJECTIVE

Cardiovascular recovery of prestress baseline blood pressure has been implicated as a possible additional determinant of sustained blood pressure elevation. We hypothesize that angry ruminations may slow the recovery process.

METHOD

A within-subjects design was used in which resting baseline blood pressure and heart rate measurements were assessed on 60 subjects, who then took part in two anger-recall tasks. After each task, subjects sat quietly and alone during a 12-minute recovery period randomized to with or without distractions. During baseline, task, and recovery, blood pressure was continuously monitored; during recovery, subjects reported their thoughts at five fixed intervals.

RESULTS

Fewer angry thoughts were reported in the distraction condition (17%) compared with no distraction (31%; p = .002); an interaction showed that this effect was largely the result of the two intervals immediately after the anger-recall task. Trait rumination interacted with distraction condition such that high ruminators in the no-distraction condition evidenced the poorest blood pressure recovery, assessed as area under the curve (p = .044 [systolic blood pressure] and p = .046 [diastolic pressure]).

CONCLUSIONS

People who have a tendency to ruminate about past anger-provoking events may be at greater risk for target organ damage as a result of sustained blood pressure elevations; the effect is exacerbated when distractions are not available to interrupt the ruminative process.