RSA fluctuation in major depressive disorder

Bidirectionality of LF when the movie makes you sad: Effects of negative emotions on heart rate variability among patients with major depression

OBJECTIVES

Heart rate variability (HRV) reflects the capacity to adapt to internal and environmental changes. Decreased HRV may indicate inadequate adaptive capacity. This study aims to investigate the relationship between the heart and brain's adaptive abilities, both at rest and when negative emotions are stimulated in depression.

SUBJECTS AND METHODS

The study included 30 patients (20 female, 10 male) with major depression (mean age = 29.8 ± 7.8) and 30 healthy controls, all of whom had similar characteristics in terms of age and gender, selected through convenience sampling. The patients were drug-free at the time of the assessment. Holter recordings were obtained while subjects watched videos stimulating anger, fear, sadness, and a neutral video, and at rest, HRV parameters were calculated. To control for interindividual variability and account for paired sampling, linear mixed effects models were employed.

RESULTS

Watching the 'sadness video' led to an increase in low frequency band (LF) [LF change (Control vs depression); Difference:-620.80 df:107 t:-2.093 P:0.039] and LF/high frequency band ratio (LF/HF) [LF/HF change (control vs depression group); Difference:-1.718 df:105 t:-2.374 P:0.020] in the depression group. The video led to a decrease in LF and LF/HF in the controls. Although the differences between the conditions and interactions with the group were significant, the effects were independent of depression severity.

CONCLUSION

In depression, brain's regulatory effect on the heart differed from controls in the sadness condition, possibly due to increased arousal levels in subjects with depression and their inability to suppress sympathetic activity when a state of sadness is stimulated.

Predicting postpartum depressive symptoms by evaluating self-report autonomic nervous system reactivity during pregnancy

OBJECTIVE

Altered self-reported autonomic reactivity is associated with worse mental health in the general population. Although dysfunctional changes in ANS during pregnancy have been investigated in relation to depressive symptoms, no studies addressed the relationship between self-report autonomic reactivity during pregnancy and depressive symptoms after the delivery. The present study aimed to assess the impact of prepartum self-reported autonomic reactivity on the development of postpartum depressive symptoms.

METHODS

In this longitudinal study, 170 women were assessed during pregnancy (i.e., second or third trimester) and after childbirth (i.e., one month after the delivery). Self-reported autonomic reactivity was assessed through the Body Perception Questionnaire - Short Form that evaluates the autonomic functions related to organs above (i.e., supradiaphragmatic reactivity) and below (i.e., subdiaphragmatic reactivity) the diaphragm. In addition, prepartum and postpartum depressive symptoms were evaluated using the Patient Health Questionnaire - 9.

RESULTS

Findings showed that higher prepartum supradiaphragmatic reactivity predicted higher depressive symptoms in the postpartum period (β = 0.112, p = 0.009) after controlling for prepartum depressive symptomatology and other potential covariates.

CONCLUSIONS

Evaluation of self-reported autonomic activity may be a useful tool to identify antenatally women at risk of postpartum depressive symptoms. Future studies are needed to evaluate the effectiveness of interventions aimed at reducing the threat-responsive autonomic reactivity at rest and improving adaptive autonomic regulation to prevent postpartum depression.

Development and Parasympathetic Regulation in Male and Female Adolescents with Autism Spectrum Disorder: A Two-Timepoint Longitudinal Study

Prolonged dysregulation of the autonomic nervous system (ANS) may increase propensity for physical or psychiatric illness. The current study examined differences in respiratory sinus arrhythmia (RSA) regulation in 215 adolescents with or without autism spectrum disorder (ASD) at Time 1 (T1; 10-13 years old) and 1 year later (Time 2; T2). Linear mixed effects models demonstrated lower RSA regulation in ASD, and a small interaction effect, showing blunted change in RSA from T1 to T2. Developmental differences in RSA regulation were particularly notable in females with ASD and those taking psychotropic medications. Results expand previous findings of reduced parasympathetic regulation in ASD by revealing a blunted developmental slope, indicating diagnostic differences may persist or worsen over time, particularly in females.

Toward personalized circuit-based closed-loop brain-interventions in psychiatry: using symptom provocation to extract EEG-markers of brain circuit activity

Symptom provocation is a well-established component of psychiatric research and therapy. It is hypothesized that specific activation of those brain circuits involved in the symptomatic expression of a brain pathology makes the relevant neural substrate accessible as a target for therapeutic interventions. For example, in the treatment of obsessive-compulsive disorder (OCD), symptom provocation is an important part of psychotherapy and is also performed prior to therapeutic brain stimulation with transcranial magnetic stimulation (TMS). Here, we discuss the potential of symptom provocation to isolate neurophysiological biomarkers reflecting the fluctuating activity of relevant brain networks with the goal of subsequently using these markers as targets to guide therapy. We put forward a general experimental framework based on the rapid switching between psychiatric symptom states. This enable neurophysiological measures to be derived from EEG and/or TMS-evoked EEG measures of brain activity during both states. By subtracting the data recorded during the baseline state from that recorded during the provoked state, the resulting contrast would ideally isolate the specific neural circuits differentially activated during the expression of symptoms. A similar approach enables the design of effective classifiers of brain activity from EEG data in Brain-Computer Interfaces (BCI). To obtain reliable contrast data, psychiatric state switching needs to be achieved multiple times during a continuous recording so that slow changes of brain activity affect both conditions equally. This is achieved easily for conditions that can be controlled intentionally, such as motor imagery, attention, or memory retention. With regard to psychiatric symptoms, an increase can often be provoked effectively relatively easily, however, it can be difficult to reliably and rapidly return to a baseline state. Here, we review different approaches to return from a provoked state to a baseline state and how these may be applied to different symptoms occurring in different psychiatric disorders.

Resting respiratory sinus arrhythmia is related to emotion reactivity to social-evaluative stress

BACKGROUND

Higher resting parasympathetic nervous system activity, as indexed by respiratory sinus arrhythmia (RSA), has been considered a marker of emotion regulatory capacity and is consistently related to better mental health. However, it remains unclear how resting RSA relates to emotion reactivity to acute social-evaluative stress, a potent predictor of depression and other negative outcomes.

METHOD

A sample of 89 participants (Mage = 18.36, SD = 0.51; 58.43 % female) provided measures of RSA at rest and then completed the Trier Social Stress Test, a standardized laboratory-based social-evaluative stress task that involves public speaking and mental arithmetic while being evaluated by two confederate judges. Participants reported a variety of emotions (e.g., negative emotion, positive emotion) at baseline and immediately after the stress task.

RESULTS

Participants with higher resting RSA showed greater increases in negative emotion, guilt, depressive emotion, and anger, as well as greater decreases in positive emotion after the task.

LIMITATION

Data were limited to a relatively small sample of late adolescents, who may be particularly responsive to social-evaluative stress compared to adults.

CONCLUSIONS

Findings suggest that higher resting RSA may enhance emotion responses to social-evaluative stress in adolescents, potentially due to active engagement and responding to rather than passively viewing stimuli. Higher resting RSA may promote flexible emotion responses to the social environment, which may account for associations between higher RSA and better mental health.

Interoceptive sensibility differentiates the predictive pattern of emotional reactivity on depression

The role of emotional reactivity in the psychopathology of depression has been studied widely but not comprehensively. Inconsistencies in existing literature indicate the presence of other factors may affect this dynamic. An individual's method of processing their physiological sensations is a third variable because emotions are psychophysiological. This study identified the predictiveness of ease of activation, intensity, and duration of negative and positive emotions on depressive symptoms differentiated by interoceptive sensibility (IS). A total of 270 community participants filled-in questionnaires assessing their IS, habitual emotional reactivity, depressive severity, and response bias. A two-step clustering analysis identified the IS characteristics. Negative and positive reactivity models among each IS cluster were tested using bootstrapping regression, controlling for gender and response bias. IS can be clustered into "high IS," "low IS," and "worriers." Both positive and negative reactivity's predictiveness patterns on depression were different between IS clusters. Lower positive reactivity predicted depression among individuals with low IS (harder to activate positive emotions) and worriers (shorter duration of positive emotions) but not among individuals with high IS. Those with high IS also exhibited the highest positive reactivity. Ease of activating negative emotions predicted depression among high IS individuals, and a longer duration of negative emotions predicted depression among worriers. IS may affect the psychopathology of depression through subjective emotional reactivity. Thus, IS characteristics can be incorporated into intervention plans.

Diagnostic and Physical Effects in Parasympathetic Response to Social Evaluation in Youth With and Without Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) may demonstrate atypical autonomic (ANS) responses; however, research remains inconsistent. This study examined parasympathetic response during social evaluation in 241 youth (10-13 years) with ASD (n = 138) or typical development (TD; n = 103). Diagnosis, age, pubertal development, and body mass index (BMI) were hypothesized to be associated with ANS function. Linear mixed effects models demonstrated lower RSA in ASD relative to TD in a base model with no covariates. However, when accounting for differences in BMI, there was no evidence of atypical parasympathetic regulation in youth with ASD. As lower parasympathetic regulation may increase susceptibility for a number of conditions, it will be important to elucidate the link between BMI and the ANS, especially in ASD.

Subjective memory in adults over 50 years of age: associations with affective and physiological markers of emotion regulation

OBJECTIVES

To examine associations among subjective memory reports, psychophysiological markers of emotion regulation, and cognitive performance in healthy adults over 50 years of age.

METHOD

A cross-sectional laboratory study was conducted with healthy, community-dwelling, non-depressed adults (M age = 60.4 years, SD = 8.4). The Metamemory in Adulthood (MIA) questionnaire provided reports of subjective memory capacity and stability (versus decline) and anxiety about memory. Poorer emotion regulation was marked by greater negative affect (NA) and lower high frequency heart rate variability (HF-HRV) responses to a challenging working memory task. Regression models were used to identify associations between subjective memory and emotion regulation markers, and structural equation modeling was used to explore whether emotion regulation mediated associations between subjective memory and objective task performance.

RESULTS

A total of 115 participants were included in the final sample. Subjective memory decline (indicated by lower scores on memory stability) was associated with lower HF-HRV response and worse working memory performance. Poorer subjective memory capacity and more anxiety about memory were both associated with greater negative affect in response to the working memory task. There was an indirect effect of subjective memory capacity on working memory performance through negative affect response.

CONCLUSIONS

The findings here suggest that worse subjective memory may signal reduced capacity for emotion regulation. Along with known cognitive risks of depression and anxiety, more subtle emotion regulation difficulties may be involved in pathways of poor cognitive aging.

Associations between heart rate variability, peripheral inflammatory markers and major depressive disorder

BACKGROUND

Measures for the irregularity of the heartbeat, for example respiratory sinus arrhythmia, have been implicated as a measure for restorative functions of the vegetative nervous system.

METHODS

In the current observational study, we investigated 265 subjects, 70 of whom had a lifetime history of major depression, with a plethysmographic heartbeat monitor, blood sampling, as well as a range of psychiatric questionnaires.

RESULTS

Subjects with a history of MDE had significantly reduced respiratory sinus arrhythmia (RSA) as compared to never-depressed controls; in the whole sample, higher RSA went with lower anxiety/fear variables, especially in subscores related to cardiac symptoms as well as being afraid of dying. A reduced RSA was also associated with an increased concentration of cytokines (TNFa, IL1a, IL6, IFNg) and thyroid-stimulating hormone in the serum, pointing to a possible triangular relationship between immune system, vegetative nervous system, and emotional dysregulation.

LIMITATIONS

We used a plethysmographic device for the measurement of heartbeat instead of an electrocardiogram, and had a single time point only.

CONCLUSIONS

This data corroborate the idea that a disequilibrium of the vegetative nervous, especially if accompanied by a dysregulation system in immune function, can increase the risk for depression. Conversely, vagal stimulation and anti-inflammatory treatments may support the treatment with antidepressants.

Cardiac Autonomic and Cardiac Vagal Control During and After Depressive and Happiness Autobiographical Memories in Patients With Major Depressive Disorder

BACKGROUND

Heart rate variability (HRV) and respiratory sinus arrhythmia (RSA) are indices of cardiac autonomic and cardiac vagal control (CVC), both of which are markers of emotional regulation and physical health. This study examined (1) the differences in cardiac autonomic regulation and CVC during baseline, depressive, and happiness autobiographical memory tasks between participants with major depressive disorder (MDD group) and healthy controls (HC group); (2) the associations between depressive symptoms and cardiac autonomic and CVC; and (3) the reactivity and recovery of cardiac autonomic and CVC between the MDD and HC groups.

METHODS

A total of 168 and 178 participants were included in the MDD and HC groups, respectively. Demographic data and the Beck Depression Inventory-II were collected before the experimental procedure. Lead II electrocardiograph (ECG) was measured during baseline, depressive, and happiness autobiographical memory tasks, and then interbeat intervals from ECG were converted to the time and frequency domains of HRV and RSA.

RESULTS

The participants in the MDD group showed lower HRV (including standard deviation of normal to normal intervals, low frequency, the natural logarithm of low frequency, and the natural logarithm of high frequency) and CVC (RSA and lnRSA) than those in the HC group. Depressive symptoms were positively correlated with heart rate and negatively correlated with the indices of cardiac autonomic and CVC. There was significantly increased reactivity and recovery of cardiac autonomic and CVC during and after depressive and happiness autobiographical memory tasks in the HC group, but not in the MDD group.

DISCUSSION

Participants with MDD had cardiac autonomic and CVC dysregulation, decreased reactivity, and did not recover to baseline after emotional provocations. These results can be the theoretical basis for clinical intervention by using HRV biofeedback to restore cardiac autonomic regulation and CVC during and after emotional events in the future.

Autonomic Symptoms in Older Adults Are Common and Associated With Health-Related Quality of Life

Background: Autonomic symptoms are common in older adults, and a large body of literature focusing on age-related diseases shows that autonomic symptoms in these diseases constrain Health-Related Quality of Life (HRQoL). To our best knowledge, the association between autonomic symptoms in older adults, independent of specific diseases, and HRQoL has not yet been assessed. Aim: To assess the frequency and the effect of autonomic symptoms in general, as well as orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor symptoms, on HRQoL in older adults. Methods: Cross-sectional data of the fourth visit of the Tübinger evaluation of Risk factors for Early detection of Neurodegeneration (TREND) study were included. Autonomic symptoms, as assessed with the Composite Autonomic Symptom Score 31 (COMPASS 31), were quantified and compared with HRQoL, as assessed with the EuroQol five-level version (EQ-5D-5L). Statistical analyses included Spearman's rank correlation and multiple linear regression analysis. Results: The analysis included 928 participants with a median of 68 years; 47% were women. Of those, 85% reported at least one autonomic symptom. Gastrointestinal and secretomotor symptoms were most common. The COMPASS 31 total score and all subdomains were significantly associated with reduced HRQoL. Among the subdomains, the strongest correlations with HRQoL were found for gastrointestinal and bladder symptoms. Overall, autonomic symptoms alone explained 20% of the variance of HRQoL; when depressive mood was added, the model explained 32%. Conclusion: Autonomic symptoms are associated with HRQoL and depressive symptoms in older adults.

Resting parasympathetic nervous system activity is associated with greater antiviral gene expression

Parasympathetic nervous system activity can downregulate inflammation, but it remains unclear how parasympathetic nervous system activity relates to antiviral activity. The present study examined associations between parasympathetic nervous system activity and cellular antiviral gene regulation in 90 adolescents (M_age = 16.28, SD = 0.73; 51.1% female) who provided blood samples and measures of cardiac respiratory sinus arrhythmia (RSA), twice, five weeks apart. Using a multilevel analytic framework, we found that higher RSA (an indicator of higher parasympathetic nervous system activity)-both at rest and during paced breathing-was associated with higher expression of Type I interferon (IFN) response genes in circulating leukocytes, even after adjusting for demographic and biological covariates. RSA was not associated with a parallel measure of inflammatory gene expression. These results identify a previously unrecognized immunoregulatory aspect of autonomic nervous system function and highlight a potential biological pathway by which parasympathetic nervous system activity may relate to health.

Interactive effects of childhood maltreatment and tonic respiratory sinus arrhythmia on young adults' depressive symptoms

The goal of the current study was to investigate the moderating effect of tonic respiratory sinus arrhythmia (RSA) in the relation between childhood maltreatment and depression symptoms among young adults. A total of 98 participants (70 women) aged 17-22 years completed questionnaires on childhood maltreatment and depressive symptoms. RSA data were obtained during a resting condition in the laboratory. Results indicated that childhood maltreatment interacted with tonic RSA to predict depressive symptoms, even after controlling for age and body mass index (BMI) of each participant. Specifically, higher levels of childhood maltreatment were associated with higher levels of depressive symptoms, but only among young adults who exhibited lower tonic RSA. The results indicated that the association between childhood maltreatment and depressive symptoms depends on young adults' physiological functioning/flexibility. Findings suggest that consideration of external environmental factors in combination with internal physiological factors is critical to understand young adults' mental health.

Cardiac autonomic functioning across stress and reward: Links with depression in emerging adults

The autonomic nervous system (ANS) has received much attention as a potential low-cost, peripheral indicator of depression. Despite theoretical support, however, results have been mixed as to whether indices of the ANS reliably index depression. In response, the present study sought to clarify the relation between ANS activity and depression by examining cardiac autonomic balance (CAB) and cardiac autonomic regulation (CAR), two composite indices of the parasympathetic and sympathetic nervous system, within both a stressful and rewarding context. We hypothesized that CAB_Stress, representing the difference between the parasympathetic and sympathetic branches in response to stress, and CAR_Reward, representing the summation of the two branches in response to reward, will be most indicative of depressogenic risk. We examined the parasympathetic (i.e., respiratory sinus arrhythmia) and sympathetic (i.e., pre-ejection period) responses of 97 emerging adults (M_age = 18.93) for a stress (i.e., negative mood induction) and reward (i.e., probabilistic learning) task, as well as their depressive symptoms at baseline, 3-week, and 6-week follow-up. Analyses found partial support for our hypotheses, revealing greater CAR_Reward (i.e., coactivation of both branches) was related to lower depressive symptoms. Further, exploratory analyses examining gender differences found lower CAB_Stress (i.e., sympathetically-oriented response) was predictive of an increasing trajectory of depression, but only among males. Overall, the current study highlights the importance of simultaneously examining both branches of the ANS across various environmental contexts. Research and clinical implications of the current findings are discussed.

Heart Rate Variability Changes in Patients With Major Depressive Disorder: Related to Confounding Factors, Not to Symptom Severity?

Background

The aim of this study was to assess the electrophysiological and other influencing factors correlating with symptom severity in patients with major depressive disorder (MDD) under three different conditions: baseline, stress exposure, and relaxation following stress exposure.

Methods

Symptom severity was assessed using the Beck Depression Inventory (BDI-II) in 89 inpatients (37 women; mean age 51 years) with MDD. Resting heart rate (RHR), heart rate variability (HRV), respiration rate (RR), skin conductance (SC), and skin temperature (ST) were recorded at baseline for 300 s, under stress exposure for 60 s, and under self-induced relaxation for 300 s. Age, nicotine consumption, body mass index, and blood pressure were evaluated as influencing factors.

Results

The BDI-II mean score was 29.7 points. Disease severity correlated positively with SC elevation under stress exposure and with a higher RR in the relaxed state, but no association was found between HRV and symptom severity. Age and higher blood pressure were both associated with lower HRV and higher RHR.

Conclusion

The results indicate that, in patients with MDD, changes in the autonomic nervous system (ANS) are complex; and the assessment of ANS reactivity to stressors is useful. Elevated blood pressure might be underdiagnosed, although it is already relevant in patients with MDD in their early 50s.

Respiratory sinus arrhythmia reactivity in anxiety and posttraumatic stress disorder: A review of literature

Respiratory sinus arrhythmia (RSA) reactivity is thought to indicate how adaptively one responds to stress. RSA reactivity has been examined across anxiety disorders and posttraumatic stress disorder (PTSD), to better understand the psychophysiological stress response of these disorders. The current state of the literature is mixed, and the association between RSA reactivity and PTSD/anxiety is unclear. This review examines RSA reactivity in response to laboratory stressor tasks across samples with anxiety and PTSD. Results indicated a complex literature that may suggest an association between anxiety/PTSD and RSA reactivity. There is evidence to suggest a pattern of heightened RSA withdrawal in PTSD and trait anxious samples. There was little evidence to suggest a heightened RSA withdrawal pattern in other anxiety disorders. This review also highlights methodological considerations which may allow for clearer interpretations of RSA reactivity. The current literature includes heterogeneity across stressor tasks, RSA measures, and comorbidities that complicates interpretation of results. Studies using samples with comorbid depression produce more consistent evidence of heightened RSA withdrawal in anxiety/PTSD. Future directions for understanding the contribution of these variables (i.e., stressor tasks, RSA measures, comorbid depression) and mechanisms contributing to the possible association between RSA reactivity and anxiety/PTSD are considered.

Is my patient too sad to approach their fear? Depression severity and imaginal exposure outcomes for patients with OCD

BACKGROUND AND OBJECTIVES

There is conflicting research on how comorbid depression impacts the treatment of obsessive compulsive disorder (OCD) with exposure with response prevention. To better understand this relationship, the current study tests theoretical claims that greater depression limits motivation to engage in exposures, restricts habituation, and interferes with adaptive learning.

METHODS

Fifty-one individuals with OCD completed a diagnostic interview and self-report questionnaires assessing depression symptom severity and then participated in a standardized imaginal exposure protocol, in which they repeatedly approached an idiosyncratic fear deemed "moderately anxiety-provoking."

RESULTS

Contrary to expectations, linear regression models indicated that depression symptom severity was not independently associated with motivation, subjective or objective within-session habituation or adaptive learning outcomes. However, the perceived likelihood of the best-case scenario occurring as a result of the exposure moderated the relationship between depression severity and motivation to engage in the exposure exercise.

LIMITATIONS

Use of a one-session exposure protocol precludes conclusions regarding how depression is associated with outcomes in a full ERP treatment.

CONCLUSIONS

Depression symptom severity was not independently associated with motivation, habituation, or adaptive learning. The observed non-significant effects suggest that degree of depression, on its own, is not a meaningful indicator of how patients with OCD will fare an exposure intervention.

Cardiovascular Variability and Reactivity in Major Depressive Disorder

Abstract. This study investigated cardiovascular variability and stress reactivity in major depressive disorder (MDD). While previous research has documented reduced heart rate variability, knowledge about blood pressure variability in MDD remains scarce. Regarding reactivity, a particular focus was placed on the time courses of the cardiovascular responses, which may provide insight into the autonomic mechanisms underlying the hypo-reactivity expected in MDD. In 76 MDD patients and 71 healthy controls, blood pressure was continuously recorded at rest and during mental stress induced by a 3-min serial subtraction task. Compared to controls, patients exhibited lower systolic and diastolic blood pressure, heart rate variability, and systolic and diastolic blood pressure variability. Moreover, smaller stress-related changes in heart rate, systolic and diastolic blood pressure, and sensitivity of the cardiac baroreflex arose in patients. Cardiovascular parameters did not differ between patients using antidepressants and unmedicated patients. According to time-course analysis, reduced hemodynamic modulations in MDD mainly occurred after 50 s of the stress period. Low heart rate variability in MDD reflects deficient top-down integration of the brain mechanisms allowing flexible autonomic and behavioral control; diminished blood pressure variability is indicative of poor homeostatic capacity with respect to the regulation of blood pressure and organ perfusion. Moreover, blunted cardiovascular reactivity implies poor adjustment of energetic resources to internal and environmental demands and may be a correlate of deficient motivational dynamics characterizing MDD. While cardiovascular hypo-reactivity in MDD may be mediated by baroreflex and adrenergic mechanisms, the fast-acting parasympathetic system may play a subordinate role.

Physiological responses to proposals during dyadic decision-making conversations

A novel conversation-analytically informed paradigm was used to examine how joint decision-making interaction, with its various types of proposal sequences, is reflected in the physiological responses of participants. Two types of dyads–dyads with one depressed and one non-depressed participant (N = 15) and dyads with two non-depressed participants (N = 15)–engaged in a series of conversational joint decision-making tasks, during which we measured their skin conductance (SC) responses. We found that the participants’ SC response rates were higher and more synchronized during proposal sequences than elsewhere in the conversation. Furthermore, SC response rates were higher when the participant was in the role of a proposal speaker (vs. a proposal recipient), and making a proposal was associated with higher SC response rates for participants with depression (vs. participants without depression). Moreover, the SC response rates in the proposal speaker were higher when the recipient accepted (vs. not accepted) the proposal. We interpret this finding with reference to accepting responses suggesting a commitment to future action, for which the proposal speaker may feel specifically responsible for. A better understanding of the physiological underpinnings of joint decision-making interaction may help improve democratic practices in contexts where certain individuals experience challenges in this regard.

The "Tongmai Tiaoshen" abdominal massage therapy of traditional Chinese medicine improves sleep quality of chronic insomnia patients: A case report

BACKGROUND AND PURPOSE

"Tongmai Tiaoshen" practices are effective for treating psychophysiological disorders. Herein, we report the treatment of a post-menopausal female patient with chronic insomnia using "Tongmai Tiaoshen" abdominal massage therapy.

MATERIALS AND METHODS

A 62-year-old woman who had chronic insomnia due to deficiency of heart and spleen accompanied by anxiety and depression for 30 years was treated with "Tongmai Tiaoshen" abdominal massage therapy for six weeks. The Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Rating Scale (HDRS), and Self-Rating Anxiety Scale (SAS) scores were recorded before and after treatment to evaluate treatment efficacy.

RESULTS

Compared with the baseline, PSQI, HDRS, and SAS scores were significantly lower after application of the abdominal massage therapy.

CONCLUSION

The "Tongmai Tiaoshen" abdominal massage therapy may alleviate the symptoms of chronic insomnia caused by deficiency of heart and spleen, thus improving the quality of sleep and mitigating the state of anxiety and depression.

From Stress to Depression: Bringing Together Cognitive and Biological Science

One of the most consistent findings in the depression literature is that stressful life events predict the onset and course of depressive episodes. Cognitive and biological responses to life stressors have both been identified, albeit largely independently, as central to understanding the association between stress and depression. I maintain that the largest advances in the understanding of depression will come from examining the ways that cognitive and biological responses to stressors reciprocally influence one another and, in doing so, contribute to the onset and maintenance of depression. I summarize the cognitive and biological stress responses implicated in depression and then describe the reciprocal ways that they are associated with each other. Finally, I discuss the broader implications of taking this integrated approach and suggest directions and considerations for future research.

Person-centered profiles of parasympathetic physiology, anxiety symptoms, and depressive symptoms in mothers and fathers of young children

Respiratory sinus arrhythmia (RSA) is a biomarker of mental health, but RSA-symptom relations in parents of young children are understudied. We examined how anxiety symptoms, depressive symptoms, resting RSA, and RSA reactivity during challenging parent-child interactions clustered in a community sample of mothers (N = 126) and fathers (N = 87) of 3-year-olds and whether profiles predicted child emotional and behavioral dysregulation at age 4. Mothers fit four profiles (Typical, Mild Risk, Moderate Risk/Withdrawal, and Moderate Risk/Augmentation), suggesting that RSA reactivity was distinct by predominant symptom type at higher levels of risk: specifically, heightened RSA withdrawal was associated with a higher probability of anxiety symptoms and RSA augmentation was associated with a higher probability of depressive symptoms. Fathers fit three profiles (Typical, Mild Risk, and Moderate Risk) where Moderate Risk was characterized by RSA augmentation and a higher probability of both anxiety and depressive symptoms. Mild risk profiles showed heightened resting RSA for mothers and fathers but no differences in RSA reactivity. Both mild and moderate risk profiles predicted higher child dysregulation 1 year later compared to typical profiles. Findings offer preliminary evidence that parasympathetic physiology covaries with symptoms differently for mothers and fathers and that parental profiles of physiology and symptoms inform children's developmental psychopathology.

Respiratory Sinus Arrhythmia Correlates With Depressive Symptoms Following Mild Traumatic Brain Injury

Abstract. Depression is a pervasive psychiatric problem following mild traumatic brain injury (mTBI). However, the onset and course of symptom expression following mTBI can differ from that of spontaneous episodes of depression. Here, we aimed to assess a physiological metric closely linked to depression: respiratory sinus arrhythmia (RSA), a measure of high frequency heart rate variability. RSA is reduced during depressive episodes, and higher resting RSA has been shown to predict future recovery from depression. In this study, we investigated if these patterns were observed throughout the typical timeframe of sub-acute mTBI recovery. Although RSA did not differ between mTBI ( n = 50) and control ( n = 27) groups, depressive symptoms were reliably correlated with RSA only in the mTBI group. This pattern was consistent 2 weeks, 2 months, and 4 months post-injury. Furthermore, resting RSA shortly following injury predicted the trajectory of depressive symptoms 2 months later. These findings generalize the connection between RSA and depression to a clinical population where depressive symptoms are common but often difficult to parse from other post-trauma consequences.

Acute aerobic exercise increases respiratory sinus arrythmia reactivity and recovery to a sad film among individuals at risk for depression

Cardiac vagal control (CVC), as indexed by abnormalities in resting, reactivity, and recovery levels of respiratory sinus arrythmia (RSA), has been proposed as an index of impaired self-regulatory capacity in depression. Aerobic exercise has been shown to improve positive and negative affective responses and influence autonomic function; however, it is unknown whether exercise impacts RSA reactivity and subsequent recovery to emotional challenges among individuals at risk for depression. The present study aimed to determine the effects of moderate-intensity aerobic exercise on RSA reactivity and recovery to a sad film. Using a within-subjects design, 47 individuals with variable symptoms of depression completed a 30-min session of exercise and a sedentary control condition on separate days prior to viewing a sad film. On the control day, individuals with elevated depressive symptom severity displayed less vagal withdrawal to the sad film and exhibited impaired post-film RSA recovery. Following exercise, individuals with elevated depressive symptom severity demonstrated a higher degree of vagal withdrawal to the sad film and subsequent post-film recovery that matched individuals with lower depressive symptom severity. These findings suggest that a single session aerobic exercise may be an effective approach to increase emotional and self-regulatory capacity among individual at risk for, or currently experiencing, depression.

Firm parenting and youth adjustment: Stress reactivity and dyadic synchrony of respiratory sinus arrhythmia

Parental behaviors are potent risk and protective factors for youth development of externalizing problems. Firm control is a parenting strategy that is inconsistently linked to youth adjustment, possibly due to variations in individual biological contexts. Growing research shows that dyadic coregulation of the autonomic nervous system (e.g., parent-child physiological synchrony) is a neurobiological mechanism that links parenting to youth adjustment. However, physiological synchrony may be context-dependent (e.g., adaptive in positive interactions, maladaptive in negative interactions). We aimed to test the role of dyadic synchrony in respiratory sinus arrhythmia (RSA) during parent-child conflict as a mediator between parent firm control and youth's externalizing problems. To capture youth's stress reactivity, we also tested how galvanic skin response reactivity (GSR-R) moderated this indirect path. The sample included 101 dyads of low socioeconomic-status at-risk preadolescents and parents. Results indicated that youth higher levels of GSR-R significantly intensified the link between parent firm control and dyadic RSA synchrony during conflict. Dyadic RSA synchrony further predicted youth increased in externalizing problems. Overall, results suggest that when parents employ firm control parenting with highly reactive teens, dyadic RSA synchrony elevates, potentially modeling less optimal coping with conflict for the youth, which is associated with increased externalizing problems.

Features of autonomic cardiovascular control during cognition in major depressive disorder

Previous research has suggested reduced parasympathetic cardiac regulation during cognitive activity in major depressive disorder (MDD). However, little is known about possible abnormalities in sympathetic control and cardiovascular reactivity. This study aimed to provide a comprehensive analysis of autonomic cardiovascular control in the context of executive functions in MDD. Thirty six MDD patients and 39 healthy controls participated. Parameters of sympathetic (pre-ejection period, PEP) and parasympathetic control (high and low frequency heart rate variability, HF HRV, LF HRV; and baroreflex sensitivity, BRS) as well as RR interval were obtained at rest and during performance of executive function tasks (number-letter task, n-back task, continuous performance test, and Stroop task). Patients, as compared to controls, exhibited lower HF HRV and LF HRV during task execution and smaller shortenings in PEP and RR interval between baseline and tasks. They displayed longer reaction times during all conditions of the tasks and more omission errors and false alarms on the continuous performance test. In the total sample, on-task HF HRV, LF HRV and BRS, and reactivity in HF HRV, LF HRV, and PEP, were positively associated with task performance. As performance reduction arose independent of executive function load of the tasks, the behavioral results reflect impairments in attention and processing speed rather than executive dysfunctions in MDD. Abnormalities in cardiovascular control during cognition in MDD appear to involve both divisions of the autonomic nervous system. Low tonic parasympathetic control and blunted sympathetic reactivity imply reduced physiological adjustment resources and, by extension, provide suboptimal conditions for cognitive performance.

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

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

Exploring Key Physiological System Profiles at Rest and the Association with Depressive Symptoms in Autism Spectrum Disorder

Depression is often associated with dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS). Individuals with autism spectrum disorder (ASD) may experience physiological dysregulation and psychological comorbidities; however, the extent to which the interactions between these systems predict internalizing symptoms in ASD has not been investigated. The study examined interactions with the HPA axis and ANS in 10-13-year-old children with ASD (n = 41) and typical development (TD; n = 46). The interrelated systems uniquely contributed to depressive symptoms in ASD above and beyond any system in isolation. A reciprocal, parasympathetic-dominant ANS was related to fewer affective symptoms in ASD. Findings highlight the importance of examining arousal across multiple systems to more precisely identify profiles associated with maladaptive psychiatric outcomes in ASD.

The Physiological Regulation of Emotion During Social Interactions: Vagal Flexibility Moderates the Effects of a Military Parenting Intervention on Father Involvement in a Randomized Trial

To make prevention programs more effective and understand "what works for whom," evidence regarding what individual characteristics predict intervention responsiveness is needed. Previous studies have evaluated a military parent training program known as After Deployment Adaptive Parenting Tools/ADAPT, yet less is understood about the program's varying effects for fathers. We tested the physiological regulation of emotion during social interactions as a moderator predicting fathers' responsiveness in a randomized trial of ADAPT, in which emotion regulation was operationally measured through vagal flexibility (VF; dynamic changes in cardiac vagal tone). Families with a child aged between 4 and 13 years for whom physiological data were gathered (n = 145) were randomly assigned to ADAPT (14-week face-to-face group intervention) or a control group (services as usual). Fathers in these families were National Guard/Reserve members who had been deployed to war in Iraq and/or Afghanistan and recently returned. Prior to the intervention, cardiac data was collected in-home throughout a set of family interaction tasks and VF was operationalized as the changes in high frequency (HF) power of heart rate variability (HRV) from a reading task to a problem-solving task. Parenting behaviors were observed and coded based on theory-driven indicators pre-intervention and at 1-year follow-up. Results of structural equation modeling showed that VF significantly moderated fathers' intervention responsiveness, such that fathers with higher vs. lower VF exhibited more effective parenting at 1-year follow-up if they were randomized into ADAPT vs. the control group. This study is the first to demonstrate that parasympathetic vagal functioning may be a biomarker to predict response to a military parenting intervention to enhance parenting in combat deployed fathers. The implications for precision-based prevention are discussed.

Associations between physiological responses to social-evaluative stress and daily functioning in first-episode schizophrenia

Schizophrenia (SZ) is associated with impaired adaptive functioning, including difficulties managing the demands of independent living, work, school, and interpersonal relationships. Prior studies have linked the physiological stress response with less effective coping in daily life. Differences in stress-response tendencies may also support heterogeneity in daily functioning in SZ. The present study examined two established measures of the stress response in patients with first-episode SZ. Salivary cortisol was included as an index of hypothalamic-pituitary-adrenal response. Vagal suppression (VS), a measure of stress-related reduction in heart rate variability, was used to assess parasympathetic flexibility. Greater cortisol response and VS to social-evaluative stress were predicted to be associated with better functioning in SZ over and above relationships with social cognition and neurocognition, two well-established predictors of functional outcome. Thirty-eight first-episode SZ outpatients and 29 healthy comparison subjects (HC) provided social cognitive, neurocognitive, and physiological measurements before and after the Trier Social Stress Test (TSST). Although SZ and HC did not differ on VS to the TSST, patients exhibited significant associations between VS and functioning across all four domains of the Role Functioning Scale. Furthermore, greater VS predicted more effective functioning with friends, beyond the contributions associated with social cognition and neurocognition, and strengthened the positive effects of higher levels of social cognition on independent living/self-care. VS elicited by social-evaluative stress in the laboratory may reflect stress-response tendencies in daily life that are relevant for daily functioning in first-episode SZ.

The mindful attention and awareness scale is associated with lower levels of high-frequency heart rate variability in a laboratory context

Trait mindfulness has been associated with well-being. A key component of trait mindfulness is intentional attention and awareness which is most commonly measured by the Mindful Attention and Awareness Scale (MAAS). This study investigated the relationship between the MAAS and cardiovascular (HF-HRV, heart rate) reactivity to two laboratory stressors that evoked different patterns of change in heart rate (HR). One stressor (viewing a video of a surgery) evoked HR deceleration while the other stressor (mental arithmetic) evoked HR acceleration. Undergraduate students completed the MAAS and were then exposed to the two stressors while ECG (electrocardiography) was recorded. Findings support the reliability of the stressors to induce expected differential cardiovascular responses and explicate the role of parasympathetic activation. Further, a main effect for MAAS was observed indicating that across laboratory conditions, persons scoring higher on the MAAS had lower HF-HRV relative to persons scoring lower on the MAAS. These findings suggest that higher levels of intentional attention and awareness in a laboratory context might promote parasympathetic withdrawal because these participants were more vigilant, experienced higher cognitive load, and detected more threat cues. Implications for the MAAS and cardiovascular responses to stress are discussed.

Tuning of brain-autonomic coupling by prior threat exposure: Implications for internalizing problems in Mexican-origin adolescents

Exposure to threat increases the risk for internalizing problems in adolescence. Deficits in integrating bodily cues into representations of emotion are thought to contribute to internalizing problems. Given the role of the medial prefrontal cortex in regulating bodily responses and integrating them into representations of emotional states, coordination between activity in the medial prefrontal cortex and autonomic nervous system responses may be influenced by past threat exposure with consequences for the emergence of internalizing problems. A sample of 179 Mexican-origin adolescents (88 female) reported on neighborhood and school crime, peer victimization, and discrimination when they were 10-16 years old. At age 17, participants underwent a functional neuroimaging scan during which they viewed pictures of emotional faces while respiratory sinus arrhythmia (RSA) and skin conductance responses were measured. Adolescents also reported symptoms of internalizing problems. Greater exposure to threats across adolescence was associated with more internalizing problems. Threat exposure was also associated with stronger negative coupling between the ventromedial prefrontal cortex and RSA. Stronger negative ventromedial prefrontal cortex-RSA coupling was associated with fewer internalizing problems. These results suggest the degree of coordinated activity between the brain and parasympathetic nervous system is both enhanced by threat experiences and decreased in adolescents with more internalizing problems.

Sleep disturbance and physiological regulation among young adults with prior depression

Sleep disturbance and respiratory sinus arrhythmia (RSA) are well-known to be independently associated with depression. Yet, it remains unclear how sleep disturbance and impaired physiological regulation (indexed by RSA) may synergistically contribute to depression risk. The current study examined the relationship between sleep disturbance (duration, insomnia) on daily depressive symptoms, and whether RSA moderated this relationship in a sample of young adults with a history of depression. To examine hypotheses, participants (N = 102, ages 18-22) completed a laboratory socio-evaluative stressor task to assess RSA at rest and reactivity. Participants then completed daily measures of sleep duration, insomnia symptoms, and depressive symptoms for two weeks. For main effects, multilevel modeling indicated that shorter overall sleep duration (but not insomnia) predicted higher depressive symptoms, and individual fluctuations in insomnia symptoms (but not sleep duration) predicted higher levels of next-day depressive symptoms. Lower resting RSA, but not reactivity, potentiated these relationships. Individual differences in sleep disturbance (duration and insomnia) predicted prospective levels of depressive symptoms among individuals with lower physiological regulation (indexed by lower RSA), who were particularly vulnerable to the daily effects of sleep disturbance on depressed mood. These results suggest the need to examine both daily sleep disturbance and physiological regulation to understand who may be at greatest risk for depression.

Children with facial paralysis due to Moebius syndrome exhibit reduced autonomic modulation during emotion processing

BACKGROUND

Facial mimicry is crucial in the recognition of others' emotional state. Thus, the observation of others' facial expressions activates the same neural representation of that affective state in the observer, along with related autonomic and somatic responses. What happens, therefore, when someone cannot mimic others' facial expressions?

METHODS

We investigated whether psychophysiological emotional responses to others' facial expressions were impaired in 13 children (9 years) with Moebius syndrome (MBS), an extremely rare neurological disorder (1/250,000 live births) characterized by congenital facial paralysis. We inspected autonomic responses and vagal regulation through facial cutaneous thermal variations and by the computation of respiratory sinus arrhythmia (RSA). These parameters provide measures of emotional arousal and show the autonomic adaptation to others' social cues. Physiological responses in children with MBS were recorded during dynamic facial expression observation and were compared to those of a control group (16 non-affected children, 9 years).

RESULTS

There were significant group effects on thermal patterns and RSA, with lower values in children with MBS. We also observed a mild deficit in emotion recognition in these patients.

CONCLUSION

Results support "embodied" theory, whereby the congenital inability to produce facial expressions induces alterations in the processing of facial expression of emotions. Such alterations may constitute a risk for emotion dysregulation.

Associations of depression severity with heart rate and heart rate variability in young adults across normative and clinical populations

Limitations of current depression treatments may arise from a lack of knowledge about unique psychophysiological processes that contribute to depression across the full range of presentations. This study examined how individual variations in heart rate (HR) and heart rate variability (HRV) are related to depressive symptoms across normative and clinical populations in 152 young adults (aged 18-35 years). Moderating effects of sex and antidepressant medication status were considered. Electrocardiogram data were collected during "vanilla" baseline and in response to positive and negative emotional cues. Linear regressions and repeated-measures mixed models were used to assess the relationships between Beck Depression Inventory-II (BDI-II) scores, sex, antidepressant use, and cardiovascular outcomes. Baseline models yielded significant main effects of BDI-II and sex on HR and significant interactions between antidepressant medication status and BDI-II on HRV outcomes. The main effects of BDI-II and sex on HR were no longer significant after controlling for cardiorespiratory fitness. Participants who denied current antidepressant use (n = 137) exhibited a negative association and participants who endorsed current antidepressant (n = 15) use exhibited a positive association between BDI-II scores and HRV. Emotional reactivity models were largely non-significant with the exception of a significant main effect of antidepressant medication status on high-frequency HRV reactivity. Results indicated antidepressant medication use may moderate the relationship between depression severity and cardiovascular functioning, but this requires replication given the modest proportion of medicated individuals in this study. Overall, findings suggest cardiovascular processes and cardiorespiratory fitness are linked to depression symptomatology and may be important to consider in depression treatment.

Emotion dysregulation, temperamental vulnerability, and parental depression in adolescents: Correspondence between physiological and informant-report measures

Although numerous studies reveal altered respiratory sinus arrhythmia (RSA) among children, adolescents, and adults who exhibit emotion dysregulation, effects of temperamental vulnerability and parental mental health on RSA remain unclear. We evaluated the relationship among emotion regulation, RSA, and RSA reactivity in a pooled sample of 24 vulnerable and 31 resilient adolescents (mean age = 13.69 years; 60% girls), including associations with temperamental vulnerability and parental depressive symptoms. Participants watched a neutral film clip while their resting RSA was recorded, and then completed a reward and frustration task, using an affective Posner paradigm. Temperament and emotion regulation were assessed via self-report and parent report, and parents reported on their own depressive symptoms. Low resting RSA was associated with temperamental negative emotionality, whereas greater RSA reactivity to frustration was associated with maladaptive emotion regulation strategies. No significant relations were found between RSA and parental depressive symptoms. This study elucidates the role of RSA as a biomarker of individual differences in emotion dysregulation and temperamental vulnerability and stresses the importance of considering multiple units of analyses, as well as functional domains, when studying emotional responding and regulation in adolescents.

Lower resting cardiac autonomic balance in young adults with current major depression

Research on cardiac autonomic function in major depressive disorder (MDD) has predominantly examined cardiac vagal control and adopted a model of reciprocal autonomic balance. A proposed bivariate autonomic continuum uses cardiac autonomic balance (CAB) and cardiac autonomic regulation (CAR) models, derived from normalized values of respiratory sinus arrhythmia and pre-ejection period, to more adequately index patterns of autonomic control. The purpose of this study was to assess resting levels of CAB and CAR among young adults with and without a current diagnosis of major depression. One hundred forty-two young adults (n = 65 MDD, n = 77 healthy controls; 20.8 ± 2.6 years) completed a structured diagnostic interview, cardiovascular assessment, and a maximal aerobic fitness test. The findings revealed that CAB, but not CAR, significantly predicted current MDD status (OR = 0.70, 95% CI [0.53, 0.93]), an effect that remained after controlling for aerobic fitness and body mass index. Although CAB was found to be a significant predictor of current MDD status among a sample of young adults, there remained substantial variation in autonomic control that was not captured by the traditional model of reciprocal autonomic balance.

Gut permeability and depressive symptom severity in unmedicated adolescents

OBJECTIVE

This study examined gut permeability in unmedicated adolescents with and without major depressive disorder.

METHOD

Medically healthy, non-medicated, 12-17 year-old females in a major depressive episode (MDE) or healthy controls, without any psychiatric condition, were enrolled. They completed the Children's Depression Rating Scale-Revised (CDRS-R) and underwent a clinical interview. Preejection period (PEP) and respiratory sinus arrhythmia (RSA) data were collected to measure autonomic nervous system activity. Following an overnight fast, participants ingested lactulose and mannitol and collected urine for 4 hours while still fasting, to examine gut permeability. Plasma cytokines (interleukin 1β, interleukin 6, and tumor necrosis factor α) were measured. Correlational analyses were used to examine the associations between relevant variables.

RESULTS

41 female participants (age: 14.8 ± 1.6 years, n = 25 with MDE) were enrolled. PEP, but not RSA, was inversely associated with neurovegetative symptom severity on the CDRS-R (r = -0.31, p < 0.06). In the 30 participants with gut permeability data, the lactulose to mannitol ratio (LMR) was significantly positively associated with depression severity, particularly neurovegetative symptom severity (r = 0.37, p < 0.05). Notably, the association between neurovegetative symptom severity and PEP was substantially reduced after adjusting for LMR. Additionally, depression severity was significantly associated with circulating cytokines.

CONCLUSIONS

This is the first study to examine gut permeability in unmedicated adolescents, offering preliminary support for a mechanistic pathway linking sympathetic nervous system activation to increased gut permeability and activation of the innate immune system, likely contributing to the emergence of neurovegetative symptoms of depression.

Should heart rate variability be "corrected" for heart rate? Biological, quantitative, and interpretive considerations

Metrics of heart period variability are widely used in the behavioral and biomedical sciences, although somewhat confusingly labeled as heart rate variability (HRV). Despite their wide use, HRV metrics are usually analyzed and interpreted without reference to prevailing levels of cardiac chronotropic state (i.e., mean heart rate or mean heart period). This isolated treatment of HRV metrics is nontrivial. All HRV metrics routinely used in the literature exhibit a known and positive relationship with the mean duration of the interval between two beats (heart period): as the heart period increases, so does its variability. This raises the question of whether HRV metrics should be "corrected" for the mean heart period (or its inverse, the heart rate). Here, we outline biological, quantitative, and interpretive issues engendered by this question. We provide arguments that HRV is neither uniformly nor simply a surrogate for heart period. We also identify knowledge gaps that remain to be satisfactorily addressed with respect to assumptions underlying existing HRV correction approaches. In doing so, we aim to stimulate further progress toward the rigorous use and disciplined interpretation of HRV. We close with provisional guidance on HRV reporting that acknowledges the complex interplay between the mean and variability of the heart period.

Respiratory sinus arrhythmia reactivity across empirically based structural dimensions of psychopathology: A meta-analysis

Low resting respiratory sinus arrhythmia (RSA) is observed in many mental health conditions, including anxiety disorders, mood disorders, schizophrenia spectrum disorders, disruptive behavior disorders, and nonsuicidal self-injury, among others. Findings for RSA reactivity are more mixed. We evaluate associations between RSA reactivity and empirically derived structural categories of psychopathology-including internalizing, externalizing, and thought problems-among physically healthy adults. We searched multiple electronic databases for studies of RSA among participants who were assessed either dimensionally using well-validated measures or diagnostically using structured interviews. Strict inclusion criteria were used to screen 3,605 published reports, which yielded 37 studies including 2,347 participants and 76 effect sizes. We performed a meta-analysis, with meta-analytic regressions of potential moderators, including psychopathology subtypes. The sample-wide meta-analytic association between RSA reactivity and psychopathology was quite small, but heterogeneity was considerable. Moderation analyses revealed significant RSA reactivity (withdrawal) specifically in externalizing samples. Additional moderators included (a) stimulus conditions used to elicit RSA reactivity (only negative emotion inductions were effective), (b) sex (women showed greater RSA reactivity than men), and (c) adherence to established methodological guidelines (e.g., higher electrocardiographic sampling rates yielded greater RSA reactivity). These findings indicate that associations between RSA reactivity and psychopathology are complex and suggest that future studies should include more standardized RSA assessments to increase external validity and decrease measurement error.

Heart rate and high frequency heart rate variability during stress as biomarker for clinical depression. A systematic review

The interaction of physical and mental vulnerability and environmental constraints is thought to foster the development of psychiatric disorders such as major depressive disorder (MDD). A central factor in the development of psychopathology is mental stress. Despite some evidence for parasympathetic withdrawal and sympathetic overactivity in MDD, the psychophysiological response to stress in depression is not clear-cut. Given the growing interest in heart rate and heart rate variability as indicators for remote monitoring of patients, it is important to understand how patients with MDD react to stress in a laboratory-controlled environment. We conducted a systematic review of studies using electrocardiography to derive heart rate and heart rate variability during stress in patients with clinical depression. We focused on well-validated stress tasks- the mental arithmetic stress task, the Trier social stress task and public speaking task- to minimize confounding effects due to the nature of the stressor. The majority of studies found hypo-reactivity during stress as a hallmark of depression as evidenced by lower fluctuation in heart rate and heart rate variability in the high-frequency band. We address the potential underlying biological mechanisms, the influence of covariates on these measures and briefly discuss the specificity and potential for remote monitoring by using these variables.

The impact of childhood trauma and psychophysiological reactivity on at-risk women's adjustment to parenthood

Adverse childhood experiences (ACEs) have an impact on women's adaptation to parenthood, but mechanisms are poorly understood. Autonomic nervous system reactivity was tested as a potential mediating mechanism in a sample of 193 at-risk primiparous women. ACEs were measured retrospectively during pregnancy. A baby cry-response task was administered during pregnancy while indicators of sympathetic reactivity (pre-ejection period; PEP) and parasympathetic reactivity (respiratory sinus arrhythmia; RSA) were recorded. Parenting self-efficacy, anxiety, and depressive symptoms were measured during pregnancy and 1 year after giving birth. Harsh discipline was measured 2 years after giving birth. Structural equation modeling was employed to test whether baseline PEP and RSA and reactivity mediated links between ACEs and postnatal outcomes, adjusted for prenatal variables. High ACEs predicted less RSA reactivity (p = .02), which subsequently predicted increases in depressive symptoms (p = .03). The indirect effect was not significant (p = .06). There was no indirect link between high ACEs and harsh parenting through PEP nor RSA (n = 98). The parasympathetic nervous system may be involved in negative affective responses in the transition to parenthood among women exposed to childhood trauma.

"Switch-Off" of Respiratory Sinus Arrhythmia Can Occur in a Minority of Subjects During Functional Magnetic Resonance Imaging (fMRI)

A group of 23 healthy scanner naïve participants of a functional magnetic resonance imaging (fMRI) study with increased state anxiety exhibited 0.1 Hz oscillations in blood-oxygenation-level-dependent (BOLD) signals, heart rate (HR) beat-to-beat intervals (RRI) and respiration. The goal of the present paper is to explore slow oscillations in respiration and RRI and their phase-coupling by applying the dynamic "wave-by-wave" analysis. Five participants with either high or moderate levels of fMRI-related anxiety (age 23.8 ± 3.3y) were found with at least one bulk of consecutive breathing waves with a respiration rate between 6 to 9 breaths/min in a 5-min resting state. The following results were obtained: (i) Breathing oscillations with dominant frequencies at 0.1 Hz and 0.15 Hz displayed a 1:1 coupling with RRI. (ii) Inspiration time was significantly longer than expiration time. (iii) RRI minima (start of HR decrease) coincided with the early inspiration, and RRI maxima (start of HR increase) coincided with the late inspiration. (iv) RRI rhythm led over the respiratory rhythm. This phase-coupling pattern is quite contrary to typical respiratory sinus arrhythmia where HR increases during inspiration and decreases during expiration.