When stress becomes the new normal: Alterations in attention and autonomic reactivity in repeated traumatization

Child Traumatic Stress and COVID-19: The Impact of the Pandemic on a Clinical Sample of Children in Trauma Treatment

Given the scope and duration of the COVID-19 pandemic, it is not surprising that research has documented negative effects to youth's mental health. Yet, there is negligible research on the impact of the pandemic among clinical samples of youth receiving treatment for pre-existing trauma exposure and symptoms. The current study investigates COVID-19 as an index trauma, and if prior traumatic stress scores mediate the relationship between pandemic-related exposure and subsequent traumatic stress.

METHODS

This is a study of 130 youth ages 7-18 receiving trauma treatment at an academic medical center. The University of California Los Angeles Post-traumatic Stress Disorder-Reaction Index (UCLA-PTSD-RI) was completed by all youth during intake as part of routine data collection. From April, 2020 to March, 2022 the UCLA Brief COVID-19 Screen for Child/Adolescent PTSD was also administered to assess trauma exposures and symptoms specifically-related to the pandemic experience. Univariate and bivariate analyses were conducted on all variables of interest to describe response patterns cross-sectionally and longitudinally; a mediational analysis was used to determine if prior trauma symptoms mediate the relationship between COVID-19 exposure and response. Additionally, interviews were conducted with youth using a series of open-ended questions about their perceptions of safety, threat and coping related to the pandemic.

RESULTS

A quarter of the sample reported COVID-19 related exposures that would meet Criterion A for PTSD. Participants whose UCLA-COVID scores that exceeded the clinical cutoff had lower scores on two items measuring social support. There was no evidence of full or partial mediation. Responses to interview questions revealed low levels of threat reactivity, perceptions of no to little impact, positive changes, varying opinions on social isolation, some evidence of inaccurate messaging and adaptive coping using strategies learned in treatment.

IMPLICATIONS

The findings broaden our understanding of the impact of COVID-19 on vulnerable children and provide insight into how prior trauma history and the provision of evidence-based trauma treatment impact a youth's response to pandemic conditions.

The association between exposure to community violence and somatic symptoms through bullying victimization among African American adolescents in Chicago: A developmental trauma approach

BACKGROUND

The developmental trauma theory suggests that traumatic events impede the ability of individuals to form interpersonal relationships, impair cognition, affect, and increase the vulnerability of adolescents to develop psychopathology. However, few studies have examined the applicability of this theory among African American adolescents who were exposed to community violence and adverse outcomes, including bullying victimization and somatic symptoms.

AIMS

Therefore, the purpose of the present study is to first test the association between exposure to community violence and somatic symptoms. Then, we explored whether bullying victimization mediated the relationship between exposure to community violence and somatic symptoms while controlling for gender differences and substance use (n = 622).

RESULTS

Results suggest that exposure to community violence is positively associated with somatic symptoms. Moreover, the association between exposure to community violence and somatic symptoms was mediated by bullying victimization.

DISCUSSION AND CONCLUSION

These results were consistent with the developmental trauma theory, such that trauma could increase the vulnerability for future victimization, thus, leading to somatic symptoms. Implications for research and practice are discussed.

Attentional bias in individuals with depression and adverse childhood experiences: influence of the noradrenergic system?

RATIONALE

Major depressive disorder (MDD) is a severe mental disorder with affective, cognitive, and somatic symptoms. Mood congruent cognitive biases, including a negative attentional bias, are important for development, maintenance, and recurrence of depressive symptoms. MDD is associated with maladaptive changes in the biological stress systems such as dysregulations of central noradrenergic alpha2-receptors in the locus coeruleus-noradrenergic system, which can affect cognitive processes including attention. Patients with adverse childhood experiences (ACE), representing severe stress experiences in early life, might be particularly affected.

OBJECTIVES

With an experimental design, we aimed to gain further knowledge about the role of noradrenergic activity for attentional bias in MDD patients with and without ACE.

METHODS

We tested the effect of increased noradrenergic activity induced by the alpha2-receptor blocker yohimbine on attentional bias in a placebo-controlled repeated measures design. Four groups were included as follows: MDD patients with and without ACE, and healthy participants with and without ACE (total N = 128, all without antidepressant medication).

RESULTS

A significant effect of MDD on attentional bias scores of sad face pictures (p = .037) indicated a facilitated attentional processing of sad face pictures in MDD patients (compared to non-MDD individuals). However, we found no such effect of ACE. For attentional bias of happy face pictures, we found no significant effects of MDD and ACE. Even though a higher increase of blood pressure and salivary alpha-amylase following yohimbine compared to placebo indicated successful noradrenergic stimulation, we found no significant effects of yohimbine on attentional bias of happy or sad face pictures.

CONCLUSIONS

Our results are consistent with the hypothesis of a negative attentional bias in MDD patients. However, as we found no effect of ACE or yohimbine, further research is needed to understand the mechanisms by which ACE increases the risk of MDD and to understand the biological basis of the MDD-related negative attentional bias.

Acute stress reduces the emotional attentional blink: Evidence from human electrophysiology

The present study is the first to examine the time-dependent mechanism of acute stress on emotional attentional blink (EAB) with event-related potential (ERP) measures. We explored the stage characteristics of stress affecting EAB, whether it affects the early selective attention process (marked by early posterior negativity) or the late working memory consolidation (marked by late positive potential). Sixty-one healthy participants were exposed to either a Trier Social Stress Test (TSST) or a control condition, and salivary cortisol was measured to reflect the stress effect. ERPs were recorded during an attentional blink (AB) paradigm in which target one (T1) were negative or neutral images. Results showed stress generally reduced AB effects. Specifically, stress promoted the early selective attention process of target two (T2) following a neutral T1 but did not affect T2 consolidation into working memory. Correlational analyses further confirmed the positive effect of cortisol and negative emotional state on AB performance. Moreover, the ERP results of acute stress on AB conformed to the trade-off effect between T1 and T2; that is, stress reduced T1 late working memory consolidation and improved T2 early selective attention process. These findings further demonstrated that stress did not change the central resource limitation of AB. In general, stress generates a dissociable effect on AB early- and late-stage processing; namely, acute stress reduce the AB effect mainly from the improvement of participants' overall ability to select the targets in the early stage.

Early life maltreatment and resting-state heart rate variability: A systematic review and meta-analysis

Recent focus on the consequences of early life adversity (ELA) in neurobiological research led to a variety of findings suggesting alterations in several physiological systems, such as the cardiovascular system. In this systematic review and meta-analysis, we focused on the relationship between early life maltreatment (ELM), one form of ELA, and resting vagal activity indexed by resting-state heart rate variability (HRV). A systematic search of the literature yielded 1'264 hits, of which 32 studies reporting data for group comparisons or correlations were included. By quantitative synthesis of existing studies using random-effect models, we found no evidence for a relationship between ELM exposure and resting vagal activity in principal. Conducting meta-regression analyses, however, we found the relationship between ELM and resting vagal activity to significantly vary as a function of both age and the presence of psychopathology. In light of the current multitude of vastly unclear pathways linking ELM to the onset of disease, we emphasize the need for further research and outline several aspects to consider in future studies.

Differential Effects of Early Adversity and Posttraumatic Stress Disorder on Amygdala Reactivity: The Role of Developmental Timing

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with altered processing of threat-related stimuli. Neurobiological models implicate right amygdala hyperreactivity in these alterations, but this potential biomarker also has been observed in individuals exposed to adverse childhood experiences (ACEs) (i.e., abuse and neglect) without psychopathology. Separation of the differential contributions of PTSD and ACEs to amygdala reactivity might benefit from incorporating the developmental timing of the events.

METHODS

We conducted comprehensive retrospective interviews assessing ACEs for each life year between the ages of 1 and 17 years in a sample of 60 women exposed to trauma (including 34 participants with PTSD and 26 healthy participants). Functional magnetic resonance imaging was used to extract amygdala reactivity to threatening versus neutral scenes. Amygdala reactivity was predicted from PTSD diagnosis, total ACE severity, and ACE severity by life year using random forest regression.

RESULTS

PTSD and ACEs significantly predicted reactivity in the right amygdala (R² = 7%) but did not explain variance in the left amygdala. ACEs during both a prepubertal (ages 3 and 4) and a postpubertal (ages 16 and 17) period emerged as particularly predictive, while total ACE severity did not contribute to prediction. Follow-up analyses revealed a positive relationship between amygdala activity and PTSD and a negative relationship between amygdala activity and ACEs during predictive life years.

CONCLUSIONS

The opposing effects of PTSD and ACEs caution against simplistic etiological and diagnostic interpretations of amygdala function. The identification of potentially sensitive periods for the effects of ACEs on amygdala reactivity to threat may help to uncover interactions between traumatization and development of PTSD.

Impact of Chronic Stress on Attention Control: Evidence from Behavioral and Event-Related Potential Analyses

Chronic stress affects brain function, so assessing its hazards is important for mental health. To overcome the limitations of behavioral data, we combined behavioral and event-related potentials (ERPs) in an attention network task. This task allowed us to differentiate between three specific aspects of attention: alerting, orienting, and execution. Forty-one participants under chronic stress and 31 non-stressed participants were enrolled. On the performance level, the chronically stressed group showed a significantly slower task response and lower accuracy. Concerning ERP measures, smaller cue-N1, cue-N2, and larger cue-P3 amplitudes were found in the stressed group, indicating that this group was less able to assign attention to effective information, i.e., they made inefficient use of cues and had difficulty in maintaining alerting. In addition, the stressed group showed larger target-N2 amplitudes, indicating that this group needed to allocate more cognitive resources to deal with the conflict targets task. Subgroup analysis revealed lower target-P3 amplitudes in the stressed than in the non-stressed group. Group differences associated with the attention networks were found at the ERP level. In the stressed group, excessive depletion of resources led to changes in attention control. In this study, we examined the effects of chronic stress on individual executive function from a neurological perspective. The results may benefit the development of interventions to improve executive function in chronically stressed individuals.

Trajectories of Resting Heart Period and Shyness in Adolescent Females Exposed to Child Maltreatment

Relatively little is known about the psychophysiological processes underlying the development of socioemotional vulnerabilities that are common among adolescents exposed to child maltreatment. Using a prospective, longitudinal design, we investigated whether trajectories of resting heart period (HP; a physiological correlate of stress vulnerability) across three visits (separated by 6 months) was associated with shyness (a type of socioemotional vulnerability) in adolescent females exposed to child maltreatment (N = 55; M_age = 14.07 years). Adolescents' resting HP across visits was best characterized by two latent trajectories: a stable high class (25.5%) and a stable low class (74.5%). The stable low HP trajectory was associated with higher shyness at Time 1 (T1), and HP trajectory moderated the association between T1 and Time 3 (T3) shyness. Females in the stable low HP trajectory demonstrated stability of shyness from T1 to T3, whereas T1 and T3 shyness were unrelated for females in the stable high HP trajectory. We also found that shyness at T1 and T3 was associated with greater levels of anxiety at T3. These findings illustrate heterogeneity in the developmental patterns of resting autonomic activity in adolescent females exposed to child maltreatment; such differences may influence the continuity of some traits linked with socioemotional vulnerability such as shyness.

Effects of early maternal care on adolescent attention bias to threat in nonhuman primates

Attention bias towards threat using dot-probe tasks has mainly been reported in adults with stress-related disorders such as PTSD and other anxiety disorders, in some cases associated with early life stress or traumatic experiences. Studies during adolescence are scarce and inconsistent, which highlights the need to increase our understanding of the developmental processes that predict attentional biases, given that this is a time of emergence of psychopathology. Here, we use a translational nonhuman primate model of early life stress in the form of infant maltreatment to examine its long-term impact on attentional biases during adolescence using the dot-probe task and identify interactions with early life risk factors, such as prenatal exposure to stress hormones and emotional/stress reactivity during infancy. Maltreated animals showed higher reaction times to social threat than animals that experienced competent maternal care, suggesting interference of negative valence stimuli on attentional control and cognitive processes. Higher emotional reactivity during infancy in Maltreated animals predicted attention bias towards threat, whereas higher levels of prenatal cortisol exposure was associated with bias away (avoidance of) threat in maltreated and control groups. Our findings suggest that different postnatal experiences and early biobehavioral mechanisms regulate the development of emotional attention biases during adolescence.

Zoning out: Automatic and conscious attention biases are differentially related to dissociative and post-traumatic symptoms

Few studies of attention bias in traumatized samples directly compare automatic and conscious (e.g. supraliminal) attentional strategies. Additionally, research to-date indicates inconsistent evidence for threat-related attention bias in individuals with PTSD symptoms. This may be due to the heterogeneity in PTSD symptoms and concurrent dissociation, particularly derealization and depersonalization, since these may contribute to decreased awareness of, or slower responding to, threatening stimuli. Using an internet-based paradigm, the current study measured attention biases in a visual dot-probe task using rapid (250 ms), brief supraliminal (500 ms), and long-latency supraliminal (2000 ms) exposures. One hundred and forty-seven adult participants completed a range of trauma-related symptom measures. Results indicated a significant association between PTSD symptoms and bias toward threat in the 2000 ms exposure. Both state and trait derealization were significantly related to a bias away from threat at the 250 ms exposure, indicating a reflexive avoidance of rapidly presented threat cues. State measures of dissociation were also related to avoidance of threat in the 500 ms condition. Findings highlight the disparate effects of trauma-related symptoms on attention, and have significant clinical implications for dissociative symptoms as a target of treatment in traumatized samples.