Affective instability in daily life is predicted by resting heart rate variability

Relations between daily stressful events, exertion, heart rate variability, and thoracolumbar fascia deformability: a case report

BACKGROUND

The posture of performance-oriented sport climbers adapts in a way that likely promotes the development of low back pain. The thoracolumbar fascia, while also contributing to performance, seems to be involved in that process. Furthermore, there has been evidence of the stiffening of the fascial structures in disorders associated with negative affectivity. The study aims to investigate the relationship between the autonomic nervous system and the deformability of the thoracolumbar fascia in a sport climber in a natural setting.

CASE PRESENTATION

Over a 30 day period, a 50-year-old German male reported daily morning resting heart rate variability and daily inventory of stressful events. The thoracolumbar fascia deformation was measured daily using ultrasound in a manual therapy clinic. A time series analysis was performed to detect possible time-delayed relationships between the variables. A cluster analyses revealed two distinguishable heart rate variability clusters (heart rate variability clusters 1 and 2). Both clusters were correlated with thoracolumbar fascia deformation and daily inventory of stressful events. Higher heart rate variability cluster 1 immediately caused lower thoracolumbar fascia deformation. Heart rate variability cluster 1 parameters mediated the effect of daily inventory of stressful events on a decrease in thoracolumbar fascia deformation with a 2-day delay. One heart rate variability cluster 2 parameter mediated the effect of daily inventory of stressful events on an increase in thoracolumbar fascia deformation with a 7-day delay.

CONCLUSION

Heart rate variability cluster 1 values, which probably indicate sympathetic nervous system activity, are directly related to thoracolumbar fascia. Presumably, the sympathetic nervous system mediated the effect of daily inventory of stressful events on a lower thoracolumbar fascia deformation with a 2-day delay, followed by a supercompensation, most likely parasympathetically mediated. Coaches and trainers should be aware of these mechanisms and consider monitoring during training to minimize potential additional risk factors for impaired performance and health.

Resting vagally-mediated heart rate variability in the laboratory is associated with momentary negative affect and emotion regulation in daily life

Vagally-mediated heart rate variability (vmHRV) is a physiological index reflecting parasympathetic activity that has been linked to emotion regulation (ER) capacity. However, very limited research has examined associations of physiological indices of regulation such as vmHRV with emotional functioning in daily life. The few studies that exist have small samples sizes and typically focus on only a narrow aspect of ER or emotional functioning. In this study, we examined associations between vmHRV assessed in the laboratory and emotional/mental health functioning in daily life using a 7-day ecological momentary assessment design in 303 adult community participants. We hypothesized that higher resting vmHRV would be associated with higher positive affect (PA), lower negative affect (NA), less affective variability, greater well-being, fewer dysphoria symptoms, greater use of engagement ER strategies, and less use of avoidance ER strategies, as assessed in daily life. Results revealed that higher resting vmHRV in the laboratory (as indexed by both high frequency heart rate variability, HF-HRV, and the root mean of successive square deviations between heart beats, RMSSD) was significantly associated with less frequent use of avoidance ER strategies in daily life. Theoretical and clinical implications are discussed, including the association of vmHRV with negatively valenced, rather than positively valenced, daily life experiences.

Complex Emotion Dynamics Contribute to the Prediction of Depression: A Machine Learning and Time Series Feature Extraction Approach

Emotion dynamics have demonstrated mixed ability to predict depressive symptoms and outperform traditional metrics like the mean and standard deviation of emotion reports. Here, we expand the types of emotion dynamic features used in prior work and apply a machine learning algorithm to predict depression symptoms. We obtained seven ecological momentary assessment (EMA) studies from previous work on depression and emotion dynamics (N = 890). These studies measured self-reported sadness, positive affect, and negative affect 5 to 10 times per day for 7 to 21 days (schedule varied across studies). These data were fed through a feature extraction routine to generate hundreds of emotion dynamic features. A gradient boosting machine (GBM) using all available emotion dynamics features was the best of all models assessed. This model's out-of-sample prediction (R 2 pred) for depression severity ranged from .20 to .44 depending on EMA interpolation method and samples included in the analysis. It also explained significantly more variance than a benchmark model of individuals' mean emotion ratings over the assessment period, R 2 pred = .089. Comprehensive feature mining of emotion dynamics obtained during EMA may be necessary to identify processes that predict depression symptoms beyond mean emotion ratings.

Transcranial direct current stimulation improves heart rate variability: A systematic review and meta-analysis

BACKGROUND

Heart rate variability (HRV) is a useful tool for evaluating cardiovascular autonomic nervous system (ANS) functions. This systematic review and meta-analysis examined the potential effects of transcranial direct current stimulation (tDCS) protocols on HRV parameters.

METHODS

This study acquired 97 comparisons from 24 qualified studies for data synthesis. Using standardized mean difference (SMD), individual and overall effect sizes were estimated to show differences in HRV variables between active tDCS and sham stimulation conditions. More positive effect size values indicated that active tDCS caused greater increases in HRV than sham stimulation. Furthermore, moderator variable analyses were performed to determine whether changes in HRV variables differed depending on (a) task types (physical stress versus psychological stress versus resting condition), (b) targeted brain regions, (c) stimulation polarity, (d) characteristics of participants, and (e) specific HRV variables. Finally, we used meta-regression analyses to determine whether different tDCS parameters (i.e., the number of tDCS sessions, stimulation duration, and density) were associated with changes in HRV patterns.

RESULTS

The random-effects model meta-analysis showed that tDCS protocols significantly improved HRV variables (SMD = 0.400; P < 0.001). Moreover, for increasing HRV during the physical stress task (SMD = 1.352; P = 0.001), anodal stimulation on the M1 was effective, while combined polarity stimulation on the PFC improved HRV during the psychological stress task (SMD = 0.550; P < 0.001) and resting condition (SMD = 0.192; P = 0.012). Additional moderator variables and meta-regression analyses failed to show that tDCS protocols had positive effects in certain conditions, such as different stimulus polarity, characteristics of participants, specific HRV variables, and tDCS parameters.

CONCLUSION

These findings tentatively suggest that using tDCS protocols to stimulate optimal targeted brain areas may be effective in improving HRV patterns potentially related to cardiovascular ANS functions.

Infant emotion regulation in the context of stress: Effects of heart rate variability and temperament

Stressful events are inherently emotional. As a result, the ability to regulate emotions is critical in responding effectively to stressors. Differential abilities in the management of stress appear very early in life, compelling a need to better understand factors that may shape the capacity for emotion regulation (ER). Variations in both biologic and behavioural characteristics are thought to influence individual differences in ER development. We sought to determine the differential contributions of temperament and heart rate variability (HRV; an indicator of autonomic nervous system function) to infant resting state emotionality and emotional reactivity in response to a stressor at 6 months of age. Participants included 108 mother-infant dyads. Mothers completed a measure of infant temperament at 6 months postnatal. Mother and infant also participated in a standardized stressor (the Repeated Still Face Paradigm) at that time. Electrocardiographic data were acquired from the infant during a baseline resting state and throughout the stressor. Fast Fourier Transformation was used to analyse the high frequency (HF) domain of HRV, a measure of parasympathetic nervous system activity. Infant ER was measured via standardized coding of emotional distress behaviours from video-records at baseline and throughout the stressor. Severity of mothers' depressive symptoms was included as a covariate in analyses. Results of linear regression indicate that neither temperament nor HRV were associated significantly with an infant's emotional resting state, although a small effect size was found for the relationship between infant negative affectivity and greater emotional distress (β = 0.23, p = 0.08) prior to the stressor. Higher HF-HRV (suggesting parasympathetic dominance) was related to greater emotional distress in response to the stressor (β = 0.34, p = 0.009). This greater emotional reactivity may reflect a more robust capacity to mount an emotional response to the stressor when infants encounter it from a bedrock of parasympathetic activation. Findings may inform eventual markers for assessment of ER in infancy and areas for intervention to enhance infant management of emotions, especially during stressful events.

Affect variability and cortisol in context: The moderating roles of mean affect and stress

Positive and negative affect have been shown to have implications for hormones like cortisol but how moment to moment changes in affect (i.e., affect variability) influence cortisol secretion is less well understood. Additionally, context characteristics such as mean affect and stress may influence the association between affect variability and cortisol output. In the current study, we examined affect, stress, and cortisol data from 113 participants (age range = 25-63, M = 35.63, SD = 11.34; 29% male; 42% White/Caucasian, 37% Asian or Pacific Islander, 13% Hispanic/Latino, 4% Black/African American, 1% Native American, Eskimo, or Aleut, 4% selected "other" for their race/ethnicity). Participants completed ecological momentary assessments assessing positive and negative affect and stress four times per day for five days and provided saliva samples at each time point. Saliva was assayed for cortisol, and area under the curve with respect to ground was computed. In a three-way interaction, both positive affect mean level and stress moderated the association between positive affect variability and cortisol (b = -1.55, t(100) = -3.29, SE = 0.47, p <.01, β = -4.05). When breaking down this three-way interaction, in the context of low stress and high mean positive affect, variability was positively related to total cortisol output. In contrast, in the context of high stress and high mean positive affect, variability was negatively related to total cortisol output. While greater positive affect variability is generally worse for health-relevant outcomes (as prior research has shown and as we show here at low levels of stress), at high levels of stress, fluctuation in affect may be adaptive. For someone experiencing a high stress week, having fluctuations in positive affect may mean that they are adaptively changing to meet their environmental needs especially when they typically report high mean positive affect levels. There were no associations between negative affect variability and cortisol secretion nor did mean negative affect or stress play a moderating role for negative affect variability. This study provides evidence that positive affect variability's association with cortisol secretion throughout the day may vary based on stress and mean positive affect levels.

Parent Anxiety, Depression, Protective Responses, and Parenting Stress in the Context of Parent and Child Chronic Pain: A Daily Diary Study of Parent Variability

Parents with (vs without) chronic pain report poorer psychosocial functioning (eg, worse mental health, parenting difficulties), which has been linked to poorer child outcomes (eg, child pain). However, emerging research suggests that individuals vary in their functioning from day-to-day, particularly those with chronic pain. This study used daily diaries to compare parents with (versus without) chronic pain on variability in their anxiety, mood, protective responses, and parenting stress. We also examined parent chronic pain status as a moderator of the associations between parent variability and youth daily pain and interference. Participants were 76 youth with chronic pain (Mage = 14.26; 71.1% female) and one of their parents (89.5% mothers; n = 38 or 50.0% endorsing chronic pain). Parents and youth completed self-report questionnaires and 7 days of diaries. Parent variability was calculated to reflect the frequency and size of day-to-day changes. Multilevel models revealed that parents with (vs without) chronic pain were significantly more variable in their parenting stress, but not in their anxiety, mood, or protective responses. Contrary to hypotheses, parent variability was not significantly related to youth daily pain intensity or interference and parent chronic pain did not moderate any associations. Instead, mean levels of parent anxiety, protective responses, and parenting stress across the week significantly predicted youth daily pain interference. Findings suggest that while variability was observed among parents (with and without chronic pain) of youth with chronic pain, it did not significantly predict youth's daily pain-related functioning. Further research is needed to confirm these initial findings. PERSPECTIVE: Parents with chronic pain have expressed concerns that the variable nature of their pain negatively impacts their children. Our results found that parents (with and without chronic pain) were variable in their anxiety, mood, protective responses, and parenting stress, but this variability did not significantly predict youth's chronic pain-related functioning.

Mean Affect Moderates the Association between Affect Variability and Mental Health

Increasing evidence suggests that within-person variation in affect is a dimension distinct from mean levels along which individuals can be characterized. This study investigated affect variability's association with concurrent and longitudinal mental health and how mean affect levels moderate these associations. The mental health outcomes of depression, panic disorder, self-rated mental health, and mental health professional visits from the second and third waves of the Midlife in the United States Study were used for cross-sectional (n = 1,676) and longitudinal outcomes (n = 1,271), respectively. These participants took part in the National Study of Daily Experiences (NSDE II), where they self-reported their affect once a day for 8 days, and this was used to compute affect mean and variability. Greater positive affect variability cross-sectionally predicted a higher likelihood of depression, panic disorder, mental health professional use, and poorer self-rated mental health. Greater negative affect variability predicted higher panic disorder probability. Longitudinally, elevated positive and negative affect variability predicted higher depression likelihood and worse self-rated mental health over time, while greater positive affect variability also predicted increased panic disorder probability. Additionally, mean affect moderated associations between variability and health such that variability-mental health associations primarily took place when mean positive affect was high (for concurrent mental health professional use and longitudinal depression) and when mean negative affect was low (for concurrent depression, panic disorder, self-rated mental health, and longitudinal self-rated mental health). Taken together, affect variability may have implications for both short- and long-term health and mean levels should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-024-00238-0.

The emotion paradox in the aging body and brain

With age, parasympathetic activity decreases, while sympathetic activity increases. Thus, the typical older adult has low heart rate variability (HRV) and high noradrenaline levels. Younger adults with this physiological profile tend to be unhappy and stressed. Yet, with age, emotional experience tends to improve. Why does older adults' emotional well-being not suffer as their HRV decreases? To address this apparent paradox, I present the autonomic compensation model. In this model, failing organs, the initial phases of Alzheimer's pathology, and other age-related diseases trigger noradrenergic hyperactivity. To compensate, older brains increase autonomic regulatory activity in the pregenual prefrontal cortex (PFC). Age-related declines in nerve conduction reduce the ability of the pregenual PFC to reduce hyperactive noradrenergic activity and increase peripheral HRV. But these pregenual PFC autonomic compensation efforts have a significant impact in the brain, where they bias processing in favor of stimuli that tend to increase parasympathetic activity (e.g., stimuli that increase feelings of safety) and against stimuli that tend to increase sympathetic activity (e.g., threatening stimuli). In summary, the autonomic compensation model posits that age-related chronic sympathetic/noradrenergic hyperactivity stimulates regulatory attempts that have the side effect of enhancing emotional well-being.

The Predictive Potential of Heart Rate Variability for Depression

Heart rate variability (HRV),a measure of the fluctuations in the intervals between consecutive heartbeats, is an indicator of changes in the autonomic nervous system. A chronic reduction in HRV has been repeatedly linked to clinical depression. However, the chronological and mechanistic aspects of this relationship, between the neural, physiological, and psychopathological levels, remain unclear. In this review we present evidence by which changes in HRV might precede the onset of depression. We describe several pathways that can facilitate this relationship. First, we examine a theoretical model of the impact of autonomic imbalance on HRV and its role in contributing to mood dysregulation and depression. We then highlight brain regions that are regulating both HRV and emotion, suggesting these neural regions, and the Insula in particular, as potential mediators of this relationship. We also present additional possible mediating mechanisms involving the immune system and inflammation processes. Lastly, we support this model by showing evidence that modification of HRV with biofeedback leads to an improvement in some symptoms of depression. The possibility that changes in HRV precede the onset of depression is critical to put to the test, not only because it could provide insights into the mechanisms of the illness but also because it may offer a predictive anddiagnosticphysiological marker for depression. Importantly, it could also help to develop new effective clinical interventions for treating depression.

Craving dynamics and related cerebral substrates predict timing of use in alcohol, tobacco, and cannabis use disorders

Background

Patients treated for Substance Use Disorders exhibit highly fluctuating patterns of craving that could reveal novel prognostic markers of use. Accordingly, we 1) measured fluctuations within intensively repeated measures of craving and 2) linked fluctuations of craving to connectivity indices within resting-state (rs) brain regions to assess their relation to use among patients undergoing treatment for Alcohol, Tobacco and Cannabis Use Disorders.

Method

Participants -64 individuals with SUD for tobacco, alcohol, or cannabis and 35 healthy controls-completed a week of Ecological Momentary Assessment (EMA) during which they reported craving intensity and substance use five times daily. Before EMA, a subsample of 50 patients, and 34 healthy controls also completed resting-state (rs)-MRI acquisitions. Craving temporal dynamics within each day were characterized using Standard Deviation (SD), Auto-Correlation Factor (ACF), and Mean Successive Square Difference (MSSD). Absolute Difference (AD) in craving between assessments was a prospective prediction measure.

Results

Within-day, higher MSSD predicted greater substance use while controlling for mean craving. Prospectively higher AD predicted later increased substance use independently of previous use or craving level. Moreover, MSSD was linked to strength in five functional neural connections, most involving frontotemporal systems. Cerebello-thalamic and thalamo-frontal connectivity were also linked to substance use and distinguished the SUD from the controls.

Conclusion

To the best of our knowledge, this is the first study to indicate that instability in craving may be a trigger for use in several SUD types, beyond the known effect of craving intensity.

Affect variability and physical health: The moderating role of mean affect

Research has only begun to explore how affect variability relates to physical health and has typically not assessed long-term associations nor considered the moderating role of mean affect. Therefore, we used data from the Midlife in the United States Study waves 2 (N = 1512) and 3 (N = 1499) to test how affect variability predicted concurrent and long-term physical health while also testing the moderating role of mean affect. Results indicated that greater negative affect variability was associated concurrently with a greater number of chronic conditions (p = .03) and longitudinally with worse self-rated physical health (p < .01). Greater positive affect variability was associated concurrently with more chronic conditions (p < .01) and medications (p < .01) and longitudinally with worse self-rated physical health (p = .04). Further, mean negative affect played a moderating role such that at lower levels of mean negative affect, as affect variability increased, so did the number of concurrent chronic conditions (p < .01) and medications (p = .03) and the likelihood of reporting worse long-term self-rated physical health (p < .01). Thus, the role of mean affect should be considered when testing short- and long-term associations between affect variability and physical health.

Heart rate variability (HRV) as a way to understand associations between the autonomic nervous system (ANS) and affective states: A critical review of the literature

Evidence suggests affective disorders such as depression and bipolar disorder are characterised by dysregulated autonomic nervous system (ANS) activity. These findings suggest ANS dysregulation may be involved in the pathogenesis of affective disorders. Different affective states are characterised by different ANS activity patterns (i.e., an increase or decrease in sympathetic or parasympathetic activity). To understand how ANS abnormalities are involved in the development of affective disorders, it is important to understand how affective states correlate with ANS activity before their onset. Using heart rate variability (HRV) as a tool to measure ANS activity, this review aimed to look at associations between affective states and HRV in non-clinical populations (i.e., in those without medical and psychiatric disorders). Searches on PubMed and Google Scholar were completed using the following search terms: heart rate variability, autonomic nervous system, sympathetic nervous system, parasympathetic nervous system, affective state, mood and emotion in all possible combinations. All but one of the studies examined (N = 13), demonstrated significant associations between affect and HRV. Findings suggest negative affect, encompassing both diffused longer-term experiences (i.e., mood) as well as more focused short-term experiences (i.e., emotions), may be associated with a reduction in parasympathetic activity as measured through HRV parameters known to quantify parasympathetic activity (e.g., high frequency (HF)-HRV). HRV measures typically linked to reduction in parasympathetic activity appear to be linked to negative affective states in non-clinical populations. However, given the complex and possibly non-linear relationship between HRV and parasympathetic activity, further studies need to clarify specificity of these findings. Future studies should investigate the potential utility of HRV measures as biomarkers for monitoring changes in affective states and for early detection of onset and relapse of depression in patients with affective disorders.

The Role of Emotion Regulation for General Self-Efficacy in Adolescents Assessed Through Both Neurophysiological and Self-Reported Measures

Background

Self-efficacy, the belief in one's ability and capacity to organize and execute actions required to achieve desired results, is associated with adolescent academic achievement and reduced risk for psychopathology. Adolescent emotion regulation represents an important component in the relationship between self-efficacy and developmental outcomes, but the underlying neurophysiological mechanisms are poorly understood. It is unclear how emotion regulation strategies, which change with experience, and emotion regulation capacity, which is largely determined by genetics, contribute to the development of self-efficacy.

Aim

The present study aims to explore the relationship between emotion regulation and self-efficacy in adolescents. We hypothesize that neurophysiological emotion regulation capacity moderates the relationship between emotion regulation strategies and self-efficacy.

Methods

The present study applied a cross-sectional design. A sample of high-school students (N = 45, nfemale = 31, age = 17-18) provided answers on the General Self-Efficacy Questionnaire and the Emotion Regulation Questionnaire. Vagal tone was used as an indicator for emotion regulation capacity.

Results

In the initial correlational analysis, reappraisal, but not expressive suppression nor vagal tone was associated with self-efficacy. Vagal tone was not associated with any self-report measures of emotion regulation or self-efficacy. Contrary to our hypothesis, vagal tone did not moderate the relationship between emotion regulation and self-efficacy.

Conclusion

This is the first study assessing the relationship between neurophysiological indicators of emotion regulation and self-efficacy. Our results do not indicate that vagal tone moderates the relationship between emotion regulation strategies and general self-efficacy. Future studies should also assess the possible influence of metacognition and interoception on relationships.

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.

The Influence of Emotion Regulation on the Association Between Depression and Heart Rate Variability in Cardiac Patients

OBJECTIVE

Poor vagally mediated heart rate variability (vmHRV) is a mechanism linking depression to coronary heart disease (CHD). Reduced vmHRV is also considered an index of emotion dysregulation-the frequent use of maladaptive emotion regulation strategies, one of the most important being expressive suppression-which is a key component of depression. Therefore, this study aimed to investigate the moderating role of expressive suppression in the relation between depression and vmHRV in patients with CHD.

METHODS

The sample included 235 patients with CHD (mean [standard deviation] age = 61.6 [9.8] years; 12% women) admitted to cardiac rehabilitation after a cardiac intervention. The Beck Depression Inventory-II was administered to assess depressive symptoms. Emotion regulation strategies based on either expressive suppression or cognitive reappraisal were assessed through the Emotion Regulation Questionnaire. Resting electrocardiographic recordings were collected for 5 minutes to compute HRV indices.

RESULTS

Expressive suppression moderated the relation between depressive symptoms and vmHRV ( b = -0.03, p = .012). Patients with lower expressive suppression scores showed no association between depressive symptoms and vmHRV ( b = -0.00, p = .94), whereas those with higher expressive suppression scores showed a significant negative association between depressive symptoms and vmHRV ( b = -0.05, p = .015).

CONCLUSIONS

The use of expressive suppression is likely to potentiate the relation between depressive symptoms and poor vmHRV, which could increase the cardiac risk in these patients. Targeting emotion regulation skills in cardiac rehabilitation programs may be useful for reducing the impact of depression in cardiac patients.

Personal Pain Sensitivity Prediction from Ultra-short-term Resting Heart Rate Variability

Pain is a subjective experience with interpersonal perception sensitivity differences. Pain sensitivity is of scientific and clinical interest, as it is a risk factor for several pain conditions. Resting heart rate variability (HRV) is a potential pain sensitivity measure reflecting the parasympathetic tone and baroreflex function, but it remains unclear how well the prediction can achieve. This work investigated the relationship between different ultra-short-term HRV features and various pain sensitivity representations from heat and electrical pain tests. From leave-subject-out cross-validated results, we found that HRV can better predict a composite pain sensitivity score built from different tests and measures than a single measure in terms of the agreement between predictions and observations. Heat pain sensitivity was more possibly predicted than electrical pain. SDNN, RMSSD and LF better predicted the composite pain sensitivity score than other feature combinations, consis-tent with pain's physical and emotional attributes. It should be emphasized that the validity is probably limited within HRV at the resting state rather than an arbitrary measurement. This work implies a potential pain sensitivity prediction possibility that may be worth further validation.

Heart rate variability, mood and performance: a pilot study on the interrelation of these variables in amateur road cyclists

Objective

The present study seeks to explore the relationship between measures of cycling training on a given day and the heart rate variability (HRV) and mood states obtained the following morning. The association between HRV and mood state is also studied, as is the relationship between internal and external measures of training.

Methods

During a 6-week period, five recreational road cyclists collected 123 recordings of morning HRV and morning mood, and 66 recordings of training power and rate of perceived exertion (RPE). Training power was used as an external measure of performance and RPE as an internal measure of performance. The HRV parameters used in the study were the mean of RR intervals (mean RR) and the standard deviation of all RR intervals (SDNN) as time domain analysis, and the normalized high frequency band (HFnu), normalized low frequency band (LFnu) and the ratio between low and high frequency bands, as frequency domain analysis. Mood was measured using a 10-point cognitive scale.

Results

It was found that the higher the training power on a given day, the lower the HFnu and the higher LF/HF were on the following morning. At the same time, results showed an inverse relationship between training and mood, so the tougher a training session, the lower the mood the following day. A relationship between morning HRV and mood was also found, so that the higher mean RR and HFnu, the more positive the mood (r = 0.497 and r = 0.420 respectively; p < 0.001). Finally, RPE correlated positively with external power load variables (IF: r = 0.545; p < 0.001).

Conclusion

Altogether, the results indicate a relationship between training of cyclists on a given day and their morning HRV and mood state on the following day. Mood and HRV also seem positively related. It is argued that developing a monitoring system that considers external and internal training loads, together with morning mood, could help understand the state of the individual, enabling feedback to athletes to facilitate the adaptation to training and to prevent problems associated with overtraining. However, more research is needed to further understand the association between the different variables considered.

Cardiovascular Autonomic Modulation during Metronomic Breathing and Stress Exposure in Patients with Borderline Personality Disorder

INTRODUCTION

Given the growing evidence of reduced heart rate variability in psychiatric diseases associated with emotional instability, we investigated cardiovascular autonomic modulation in patients with borderline personality disorder (BPD) during resting state, parasympathetic stimulation (metronomic breathing), and sympathetic stimulation (mental arithmetic stress test).

METHODS

In 29 BPD outpatients and 30 controls, we recorded RR-intervals (RRI), blood pressure, skin conductance levels, and respiratory frequency during resting state, metronomic breathing, stress anticipation, stress exposure, and stress recovery. We calculated baroreflex sensitivity (BRS) and parameters of heart rate variability, including the root mean square of successive differences (RMSSD), an index of cardiovagal modulation.

RESULTS

During resting state, BPD patients showed higher blood pressure and shorter RRI, as well as lower RMSSD and BRS than controls. Metronomic breathing increased RMSSD and BRS in BPD patients. During the stress exposure, BRS significantly decreased in controls, but not in BPD patients. Furthermore, BPD patients showed less cardioacceleration in response to stress exposure than controls. During stress recovery, we found increases in RMSSD and BRS in controls, but not in BPD patients.

CONCLUSION

Our data show reduced cardiovascular autonomic modulation in BPD patients during resting state, psychophysiological relaxation, and stress exposure. The results indicate a vagal modulation deficit in this cohort. Breathing techniques, such as metronomic breathing, might be helpful to reduce stress and to increase vagal tone in BPD patients.

Heart rate variability is associated with disease severity in psychosis spectrum disorders

While a growing literature links cardiac autonomic dysregulation to a variety of psychiatric disorders, the relationship between cardiac autonomic functioning and specific symptoms in schizophrenia (SZ) and bipolar disorder (BD) remains elusive. Thus, we investigated heart rate variability (HRV), a proxy for vagal activity, as a biological marker for symptom severity in patients with SZ and BD. HRV was calculated in 35 patients with SZ and 52 patients with BD, as well as in 149 healthy controls. In the patient groups, symptom severity and function were measured by the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Results showed that HRV was significantly lower in both clinical groups compared to the healthy controls, with no significant HRV differences between patient groups. PANSS general psychopathology scores, GAF symptom scores, and GAF function scores showed statistically significant associations with HRV across groups. These results suggest that disease severity is associated with autonomic dysfunction and that HRV may provide a potential biomarker of disease severity in SZ and BD.

Determinants of Positive and Negative Affect among Adolescents and Young Adults in Indonesia: A Population-Based Survey

Positive and negative affect are crucial for mental health. However, the determinant factors of positive and negative affect have yet to be examined between adolescents and young adults. This study aimed to explore the determinant factors of positive and negative affect, comparing their effects among adolescents and young adults and among the two sexes in Indonesia. We undertook secondary data analyses of the Indonesia Family Life Survey for this cross-sectional study. Questionnaires on sociodemographic characteristics, physical and mental health-related variables, and childhood family experiences from 2014 were used as independent variables, and positive and negative affect were used as the dependent variables. Hierarchical linear regression was performed to investigate the factors associated with positive and negative affect and to compare their effects between adolescents and young adults. The hierarchical linear regression revealed that sociodemographic characteristics, perceived health, smoking, chronic condition, acute morbidity, sleep, childhood family experiences, depression, personality type, life satisfaction, happiness, and experience of disasters were associated with positive and negative affect among adolescents and young adults in Indonesia. Identification of positive and negative affect as well as their associated factors among adolescents and young adults should be considered when developing preventive programs in the community.

Personal Resources and Organizational Outcomes: Sex as a Moderator of the Complex Relationships Between Self-Esteem, Heart Rate Variability, and Work-Related Exhaustion

Global self-esteem represents a protective personal resource lowering the risk of psychological distress. Research conducted in the work setting has confirmed the psychosocial benefits of high self-esteem. However, research linking self-esteem to neurobiological adaptability appears quite scarce. In this study, we propose a theoretical model in which self-esteem predicts work-related exhaustion indirectly, through the mediation of heart rate variability (HRV) and negative affect at work. Moreover, we explore the relationship between self-esteem and HRV. From one side, one would expect a positive link between self-esteem and HRV, signaling higher autonomic adaptability. However, recent studies have shown that in women, such associations become more complex, with even reversed patterns as compared with that in men. Thus, we included sex as a moderator of the relationship between HRV and self-esteem. The model was tested on a sample of 110 individuals working in the relational professions (54% males; M _age = 42.6, SD = 13.73), observed for an entire workday. Results confirmed the protective role of self-esteem against the experience of negative affect and (indirectly) work-related exhaustion. Symptoms of exhaustion at work were also negatively predicted by HRV, and both HRV and negative affect acted as mediators of the relationship between self-esteem and work-related exhaustion. Notably, sex differences emerged in the association between global self-esteem and cardiac vagal tone at work: in women, self-esteem was negatively related to HRV, which in turn led to higher work-related exhaustion, whereas in men, no evidence of this indirect effect appeared. Burnout prevention programs should not ignore important sex differences in how individuals respond to work-related stress.

Using the Ball-in-Bowl Metaphor to Outline an Integrative Framework for Understanding Dysregulated Emotion

Dysregulated emotion plays an important role for mental health problems. To elucidate the underlying mechanisms, researchers have focused on the domains of strategy-based emotion regulation, psychophysiological self-regulation, emotion evaluations, and resulting emotion dynamics. So far, these four domains have been looked at in relative isolation from each other, and their reciprocal influences and interactive effects have seldom been considered. This domain-specific focus constrains the progress the field is able to make. Here, we aim to pave the way towards more cross-domain, integrative research focused on understanding the raised reciprocal influences and interactive effects of strategy-based emotion-regulation, psychophysiological self-regulation, emotion evaluations, and emotion dynamics. To this aim, we first summarize for each of these domains the most influential theoretical models, the research questions they have stimulated, and their strengths and weaknesses for research and clinical practice. We then introduce the metaphor of a ball in a bowl that we use as a basis for outlining an integrative framework of dysregulated emotion. We illustrate how such a framework can inspire new research on the reciprocal influences and interactions between the different domains of dysregulated emotion and how it can help to theoretically explain a broader array of findings, such as the high levels of negative affect in clinical populations that have not been fully accounted for by deficits in strategy-based emotion regulation and the positive long-term consequences of accepting and tolerating emotions. Finally, we show how it can facilitate individualized emotion regulation interventions that are tailored to the specific regulatory impairments of the individual patient.

Affect fluctuations examined with ecological momentary assessment in patients with current or remitted depression and anxiety disorders

BACKGROUND

There is increasing interest in day-to-day affect fluctuations of patients with depressive and anxiety disorders. Few studies have compared repeated assessments of positive affect (PA) and negative affect (NA) across diagnostic groups, and fluctuation patterns were not uniformly defined. The aim of this study is to compare affect fluctuations in patients with a current episode of depressive or anxiety disorder, in remitted patients and in controls, using affect instability as a core concept but also describing other measures of variability and adjusting for possible confounders.

METHODS

Ecological momentary assessment (EMA) data were obtained from 365 participants of the Netherlands Study of Depression and Anxiety with current (n = 95), remitted (n = 178) or no (n = 92) DSM-IV defined depression/anxiety disorder. For 2 weeks, five times per day, participants filled-out items on PA and NA. Affect instability was calculated as the root mean square of successive differences (RMSSD). Tests on group differences in RMSSD, within-person variance, and autocorrelation were performed, controlling for mean affect levels.

RESULTS

Current depression/anxiety patients had the highest affect instability in both PA and NA, followed by remitters and then controls. Instability differences between groups remained significant when controlling for mean affect levels, but differences between current and remitted were no longer significant.

CONCLUSIONS

Patients with a current disorder have higher instability of NA and PA than remitted patients and controls. Especially with regard to NA, this could be interpreted as patients with a current disorder being more sensitive to internal and external stressors and having suboptimal affect regulation.

Emotional Granularity Increases With Intensive Ambulatory Assessment: Methodological and Individual Factors Influence How Much

Individuals differ in their ability to create instances of emotion that are precise and context-specific. This skill - referred to as emotional granularity or emotion differentiation - is associated with positive mental health outcomes. To date, however, little work has examined whether and how emotional granularity might be increased. Emotional granularity is typically measured using data from experience sampling studies, in which participants are prompted to report on their emotional experiences multiple times per day, across multiple days. This measurement approach allows researchers to examine patterns of responses over time using real-world events. Recent work suggests that experience sampling itself may facilitate increases in emotional granularity in depressed individuals, such that it may serve both empirical and interventional functions. We replicated and extended these findings in healthy adults, using data from an intensive ambulatory assessment study including experience sampling, peripheral physiological monitoring, and end-of-day diaries. We also identified factors that might distinguish individuals who showed larger increases over the course of experience sampling and examined the extent of the impact of these factors. We found that increases in emotional granularity over time were facilitated by methodological factors, such as number of experience sampling prompts responded to per day, as well as individual factors, such as resting respiratory sinus arrhythmia. These results provide support for the use of experience sampling methods to improve emotional granularity, raise questions about the boundary conditions of this effect, and have implications for the conceptualization of emotional granularity and its relationship with emotional health.

The Role of Affect as a Mediator between Coping Resources and Heart Rate Variability among Older Adults

BACKGROUND

Heart rate variability (HRV) has been suggested as an indicator of capacity to adapt effectively to physiological or environmental challenges and of physical and psychological health in old age.

AIMS

The study assessed levels of high-frequency HRV (HF-HRV) among older adults in relation to positive and negative affect and the mediating role of positive and negative affect in the association between coping resources (perceived social support and sense of mastery) and HF-HRV.

METHOD

Participants were 187 men and women in three assisted-living residences who were independent in activities of daily living (93.4% participation rate). The participants completed sense of mastery, multidimensional scale of perceived social support, and positive and negative affect questionnaires. HF-HRV was derived from electrocardiography data measured by a Holter monitoring device for 15 minutes.

RESULTS

The empirical model showed good fit indices indicating that higher HF-HRV was associated with lower negative affect, and negative affect mediated the association between perceived social support and HF-HRV. In addition, perceived social support and sense of mastery were associated with higher positive affect and lower negative affect.

CONCLUSIONS

Although this was a cross-sectional study, it suggests that HF-HRV may be a link between affect and health in old age. It also suggests the importance of identification and intervention with older adults and their support systems to reduce negative affect.

Clusters of Psychological Symptoms in Breast Cancer: Is There a Common Psychological Mechanism?

BACKGROUND

Breast cancer patients tend to experience numerous concurrent psychological symptoms that form clusters. It has been proposed that a common psychological mechanism may underlie the membership of symptoms in a given cluster, but this hypothesis has never been investigated. Maladaptive emotion regulation (ER) is one possible common mechanism.

OBJECTIVE

This study examined cross-sectional and prospective relationships between subjective (experiential avoidance, expressive suppression, and cognitive reappraisal) and objective (high-frequency heart rate variability) measures of ER and clusters of psychological symptoms among women receiving radiation therapy for breast cancer.

METHOD

A total of 81 women completed a battery of self-report scales before (T1) and after (T2) radiotherapy, including measures of anxiety, depression, fear of cancer recurrence, insomnia, fatigue, pain, and cognitive impairments. Resting high-frequency heart rate variability was measured at T1.

RESULTS

Latent profile analyses identified between 2 and 3 clusters of patients with similar levels of symptoms at T1 and T2 and with a similar profile of symptom changes between T1 and T2. Discriminant analyses showed that higher levels of avoidance and suppression predicted membership in symptom clusters that included more severe symptoms cross-sectionally at T1 and at T2 (both P values < .0001). However, ER at T1 did not significantly predict membership in clusters of symptom changes between T1 and T2 (P = .15).

CONCLUSION

Maladaptive ER strategies, more particularly suppression and avoidance, are a possible psychological mechanism underlying clusters of cancer-related psychological symptoms.

IMPLICATIONS FOR PRACTICE

Psychological interventions targeting maladaptive ER strategies have the potential to treat several psychological symptoms simultaneously.

Emotion dynamics across adulthood in everyday life: Older adults are more emotionally stable and better at regulating desires

Older adults report experiencing improved emotional health, such as more intense positive affect and less intense negative affect. However, there are mixed findings on whether older adults are better at regulating emotion-a hallmark feature of emotional health-and most research is based on laboratory studies that may not capture how people regulate their emotions in everyday life. We used experience sampling to examine how multiple measures of emotional health, including mean affect, dynamic fluctuations between affective states and the ability to resist desires-a common form of emotion regulation-differ in daily life across adulthood. Participants (N = 122, ages 20-80) reported how they were feeling and responding to desire temptations for 10 days. Older adults experienced more intense positive affect, less intense negative affect, and were more emotionally stable, even after controlling for individual differences in global life satisfaction. Older adults were more successful at regulating desires, even though they experienced more intense desires than younger adults. In addition, adults in general experiencing more intense affect were less successful at resisting desires. These results demonstrate how emotional experience is related to more successful desire regulation in everyday life and provide unique evidence that emotional health and regulation improve with age. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prenatal maternal mood entropy is associated with child neurodevelopment

Emerging evidence indicates that the predictability of signals early in life may influence the developing brain. This study examines links between a novel indicator of maternal mood dysregulation, mood entropy, and child neurodevelopmental outcomes. Associations between prenatal maternal mood entropy and child neurodevelopment were assessed in 2 longitudinal cohorts. Maternal mood was measured several times over pregnancy beginning as early as 15 weeks' gestation. Shannon's mood entropy was applied to distributions of mothers' responses on mood questionnaires. Child cognitive and language development were evaluated at 2 and 6-9 years of age. Higher prenatal maternal mood entropy was associated with lower cognitive development scores at 2 years of age and lower expressive language scores at 6-9 years of age. These associations persisted after adjusting for maternal pre and postnatal mood levels and for other relevant sociodemographic factors. Our findings identify maternal mood entropy as a novel predictor of child neurodevelopment. Characterizing components of maternal mood in addition to level of severity or valence may further our understanding of specific processes by which maternal mood shapes child development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Investigating the relationship between emotional granularity and cardiorespiratory physiological activity in daily life

Emotional granularity describes the ability to create emotional experiences that are precise and context-specific. Despite growing evidence of a link between emotional granularity and mental health, the physiological correlates of granularity have been under-investigated. This study explored the relationship between granularity and cardiorespiratory physiological activity in everyday life, with particular reference to the role of respiratory sinus arrhythmia (RSA), an estimate of vagal influence on the heart often associated with positive mental and physical health outcomes. Participants completed a physiologically triggered experience-sampling protocol including ambulatory recording of electrocardiogram, impedance cardiogram, movement, and posture. At each prompt, participants generated emotion labels to describe their current experience. In an end-of-day survey, participants elaborated on each prompt by rating the intensity of their experience on a standard set of emotion adjectives. Consistent with our hypotheses, individuals with higher granularity exhibited a larger number of distinct patterns of physiological activity during seated rest, and more situationally precise patterns of activity during emotional events: granularity was positively correlated with the number of clusters of cardiorespiratory physiological activity discovered in seated rest data, as well as with the performance of classifiers trained on event-related changes in physiological activity. Granularity was also positively associated with RSA during seated rest periods, although this relationship did not reach significance in this sample. These findings are consistent with constructionist accounts of emotion that propose concepts as a key mechanism underlying individual differences in emotional experience, physiological regulation, and physical health.

Reduction of depressive symptoms during inpatient treatment is not associated with changes in heart rate variability

Vagally mediated heart rate variability (HRV) is a psychophysiological indicator of mental and physical health. Limited research suggests there is reduced vagal activity and resulting lower HRV in patients with Major Depressive Disorder (MDD); however little is actually known about the association between HRV and symptoms of depression and whether the association mirrors symptom improvement following psychotherapy. The aim of this study was to investigate the association between antidepressant therapy, symptom change and HRV in 50 inpatients (68% females; 17–68 years) with a diagnosis of MDD. Severity of depressive symptoms was assessed by self-report (Beck Depression Inventory II) and the Hamilton Rating Scale of Depression. Measures of vagally mediated HRV (root mean square of successive differences and high-frequency) were assessed at multiple measurement points before and after inpatient psychotherapeutic and psychiatric treatment. Results showed an expected negative correlation between HRV and depressive symptoms at intake. Depressive symptoms improved (d = 0.84) without corresponding change in HRV, demonstrating a de-coupling between this psychophysiological indicator and symptom severity. To our knowledge, this study is the first to examine an association between HRV and depressive symptoms before and after psychotherapy. The observed de-coupling of depression and HRV, and its methodological implications for future research are discussed.

A Multi-Method Approach to Understand Parent Behaviors During Child Acute Pain

Abstract. Parent behaviors strongly predict child responses to acute pain; less studied are the factors shaping parent behaviors. Heart rate variability (HRV) is considered a physiological correlate of emotional responding. Resting or “trait” HRV is indicative of the capacity for emotion regulation, while momentary changes or “state” HRV is reflective of current emotion regulatory efforts. This study aimed to examine: (1) parent state HRV as a contributor to parent verbal behaviors before and during child pain and (2) parent trait HRV as a moderator between parent emotional states (anxiety, catastrophizing) and parent behaviors. Children 7–12 years of age completed the cold pressor task (CPT) in the presence of a primary caregiver. Parents rated their state anxiety and catastrophizing about child pain. Parent HRV was examined at 30-second epochs at rest (“trait HRV”), before (“state HRV-warm”), and during their child’s CPT (“state HRV-cold”). Parent behaviors were video recorded and coded as coping-promoting or distress-promoting. Thirty-one parents had complete cardiac, observational, and self-report data. A small to moderate negative correlation emerged between state HRV-cold and CP behaviors during CPT. Trait HRV moderated the association between parent state catastrophizing and distress-promoting behaviors. Parents experiencing state catastrophizing were more likely to engage in distress-promoting behavior if they had low trait HRV. This novel work suggests parents who generally have a low (vs. high) HRV, reflective of low capacity for emotion regulation, may be at risk of engaging in behaviors that increase child distress when catastrophizing about their child’s pain.

Blood pressure in bipolar disorder: evidence of elevated pulse pressure and associations between mean pressure and mood instability

BACKGROUND

Bipolar disorder (BD) is associated with excess and premature cardiovascular mortality. Elevated blood pressure (BP) is a leading contributor to cardiovascular risk. However, few studies have examined BP in BD in comparison to other psychiatric disorders. Furthermore, the association between BP and mood instability is not presently clear despite increasing interest in repurposing existing antihypertensive medications as possible novel BD treatments. Thus we examined BP differences between BD and borderline personality disorder (BPD), a disorder with a similar symptom profile through chronic mood instability.

METHODS

A total of 106 adults (38 BD, 25 BPD, and 43 healthy controls), evaluated in the Automated Monitoring of Symptom Severity (AMoSS) study, completed a week-long home blood pressure monitoring assessment and ecological momentary assessment of mood. We examined group-wise differences in mean BP and BP variability and their association with mood instability.

RESULTS

BD individuals had a significantly wider resting pulse pressure (40.8 ± 7.4, mmHg) compared to BPD (35.7 ± 5.3, mmHg, P = 0.03) and control participants (37.3 ± 6.3, mmHg, P = 0.036). Systolic BP was negatively associated with sad mood instability, and all measures of mean BP (systolic, diastolic, and mean arterial pressure) were negatively associated with positive mood instability.

CONCLUSIONS

This study demonstrates BP differences between BD and healthy and clinical controls that are within a normotensive range. Early pulse pressure widening may be a modifiable pathophysiological feature of BD that confers later cardiovascular risk. BP may be an important transdiagnostic predictor of mood instability and a potential explicit treatment target.

Emotion context insensitivity in depression: Toward an integrated and contextualized approach

Major depressive disorder (MDD) is characterized by pervasive mood disturbance as well as deficits in emotional processing, reactivity, and regulation. There is accumulating evidence that MDD is characterized by emotional patterns consistent with environmental disengagement, as reflected in attenuated positive and negative emotional reactivity, consistent with Emotion Context Insensitivity (ECI) theory. However, MDD individuals vary considerably in the extent to which they exhibit specific alterations in patterns of emotional responding. Emotions are complex, multicomponent processes that invoke responses across multiple functional domains and levels of analysis, including subjective experience, behavior, autonomic regulation, cognition, and neural processing. In this article, I review the current state of the literature on emotional responding and MDD from the lens of ECI. I focus on the importance of assessing emotional indices from multiple levels of analysis across development and contexts. I also discuss methodological and measurement issues that may contribute to inconsistent findings. In particular, I emphasize how psychophysiological measures can help elucidate emotional processes that underlie the pathophysiology of MDD as part of an integrated and contextualized approach.

Taking context to heart: Momentary emotions, menstrual cycle phase, and cardiac autonomic regulation

Emotions have long been discussed in conjunction with the autonomic nervous system. Most research on emotion-autonomic linkages does not consider sex differences or an evident underlying mechanism for sex differences: menstrual cycle phase. Further, most research is limited to cross-sectional and laboratory studies. The degree to which emotion-autonomic associations manifest in everyday life may be different and may vary by sex and, for women, by menstrual cycle phase. This study employs the ambulatory monitoring of cardiovascular measures (e.g., heart rate and heart rate variability; HRV) and concurrent emotional states (e.g., sadness, stress, anxiety, anger, and happiness) in everyday life to better characterize emotion-autonomic associations as a function of sex and menstrual cycle phase. Participants (N = 174; 87 female) ages 18 to 46 (31.23 ± 6.49) were monitored over a 5-day observation period (one 2- and one 3-day session), using an ambulatory 24-hour electrocardiogram to monitor heart rate and ecological momentary assessment to record emotions every ~30 min. Women were monitored in both the early to mid-follicular and -luteal phases and men in two comparably distanced sessions. Multilevel models indicated that across sex, negative emotions and happiness were associated with elevated heart rate. Relative to men, women exhibited an elevated heart rate and reduced HRV during reports of anger. For women, during the luteal phase, but not follicular phase, momentary sadness, stress, and anxiety predicted increased heart rate and reduced HRV. These findings demonstrate the importance of considering sex and menstrual cycle phase in research investigating emotion-autonomic linkages.

Implicit Affect, Heart Rate Variability, and the Metabolic Syndrome

OBJECTIVE

Greater negative affect has been associated with an increased risk of the metabolic syndrome (METs). However, all studies to date have examined this association using explicit affect measures based on subjective ratings of emotional experiences. Prior studies suggest that implicit affect, representing the automatic, prereflective appraisal process involved in conscious emotional experiences, is associated with physiological stress responses independent of explicit affect. Furthermore, low resting heart rate variability (HRV) may increase the risk of stress-related diseases. The goals of this study were to evaluate the associations between implicit and explicit affect and METs and to assess whether these associations were amplified by lower HRV.

METHODS

This secondary analysis of a larger study included 217 middle-aged women who completed measures of implicit affect, explicit affect, high-frequency HRV, and the different components of METs.

RESULTS

There was a significant interaction between implicit negative affect and HRV predicting METs (odds ratio = 0.57, 95% confidence interval = 0.35-0.92), such that the combination of higher implicit affect and lower HRV was associated with a greater likelihood of METs. Similarly, there was a main effect of implicit negative affect as well as an interaction between implicit negative affect and HRV on the lipid accumulation product (b (standard error) = -0.06 (0.02), 95% confidence interval = -0.11 to -0.02), a combination of waist circumference and triglycerides.

CONCLUSIONS

Higher implicit negative affect in the context of lower HRV may be related to a greater risk of METs. The present findings highlight the relevance of including implicit affect measures in psychosomatic medicine research.

Altered regulation of negative affect in patients with fibromyalgia: A diary study

BACKGROUND

Fibromyalgia is characterized by widespread musculoskeletal pain and often accompanied by cognitive and emotional problems. Adaptation to fibromyalgia may therefore also rely on one's ability to regulate emotional problems. In this study, we examined two indices of emotion regulation, that is, (a) affective instability, involving frequent large fluctuations in self-reported affect, and (b) resting heart rate variability (HRV).

METHODS

Participants were 46 patients with fibromyalgia (M_age  = 45.4 years; 39 females) and 46 matched healthy controls (M_age  = 44.9 years; 37 females). Heart rate was monitored under resting conditions to derive HRV. Subsequently, participants completed an electronic end-of-day diary for 14 consecutive days assessing daily levels of pain, disability, negative affect (NA) and positive affect (PA). Affective instability was operationalized as the mean square of successive differences in daily mood.

RESULTS

Results indicate increased levels of NA instability and reduced levels of HRV in patients with fibromyalgia in comparison with healthy controls. Furthermore, HRV and NA instability were inversely related. Finally, in patients, higher NA instability was related to increased pain disability.

CONCLUSIONS

Current findings support the idea that patients with fibromyalgia are confronted with fluctuating emotions. These results may have important implications for treatment as they provide support for the use of emotion regulation skills training in patients with fibromyalgia to impact upon NA instability.

SIGNIFICANCE

This study provides novel insight in the link between emotion regulation indices,that is, heart-rate variability and negative affective (NA) instability, in patients with fibromyalgia, and presents evidence for differences in both emotion regulation indices between patients with fibromyalgia and healthy people. Furthermore, results link increased NA instability with increased levels of daily disability in patients with fibromyalgia. Together, these findings offer support for a key role of emotion regulation in fibromyalgia outcomes, providing pathways for clinical practice.

Exploring the Effects of a Brief Biofeedback Breathing Session Delivered Through the BioBase App in Facilitating Employee Stress Recovery: Randomized Experimental Study

Background

Recovery from stress is a predictive factor for cardiovascular health, and heart rate variability (HRV) is suggested to be an index of how well people physiologically recover from stress. Biofeedback and mindfulness interventions that include guided breathing have been shown to be effective in increasing HRV and facilitating stress recovery.

Objective

This study aims to assess the effectiveness of a brief app-based breathing intervention (BioBase) in enhancing physiological recovery among employees who were induced to cognitive and emotional stress.

Methods

In total, we recruited 75 full-time employees. Interbeat (RR) intervals were recorded continuously for 5 min at baseline and during cognitive and emotional stress induction. The session ended with a 5-min recovery period during which participants were randomly allocated into 3 conditions: app-based breathing (BioBase), mindfulness body scan, or control. Subjective tension was assessed at the end of each period.

Results

Subjective tension significantly increased following stress induction. HRV significantly decreased following the stress period. In the recovery phase, the root mean square of successive RR interval differences (P=.002), the percentage of successive RR intervals that differed by >50 ms (P=.008), and high frequency (P=.01) were significantly higher in the BioBase breathing condition than in the mindfulness body scan and the control groups.

Conclusions

Biofeedback breathing interventions digitally delivered through a commercially available app can be effective in facilitating stress recovery among employees. These findings contribute to the mobile health literature on the beneficial effects of brief app-based breathing interventions on employees’ cardiovascular health.

A Systematic Review of Associations Between Interoception, Vagal Tone, and Emotional Regulation: Potential Applications for Mental Health, Wellbeing, Psychological Flexibility, and Chronic Conditions

Background: Interoception and heart rate variability have been found to predict outcomes of mental health and well-being. However, these have usually been investigated independently of one another.

Objectives: This systematic review aimed to explore a key gap in the current literature, that being, identifying whether HRV and interoception predict emotional regulation outcomes and strategies.

Methods: The process of article retrieval and selection followed the PRISMA guidelines. Databases PsychINFO, Web of Science, PubMed, CINAHL, and MEDLINE were scanned for papers published. Preliminary inclusion and exclusion criteria were specified following the PICO framework, whilst the CHARMS framework was used to help formulate the research question, and critically assess for bias.

Results: Two hundred and thirty-seven studies were identified after initial database searches. Of these, eight studies were included in the final selection. Six studies explored the associations between HRV and ER, whilst three investigated the associations between interoception and ER (one study included both). Results show that greater HRV and interoception are associated with better ER. Specifically, high parasympathetic activity largely predicted the use of adaptive ER strategies such as reappraisal, and better acceptance of emotions. High interoception, instead, was predictive of effective downregulation of negative emotions and handling of social uncertainty, there was no association with any specific ER strategy.

Conclusions: Awareness of one's own bodily feelings and vagal activation seem to be of central importance for the effective regulation of emotional responses. However, one limitation is the small sample of studies found, thus more studies in this area are needed in the future.

Association of Positive Affect Instability With All-Cause Mortality in Older Adults in England

IMPORTANCE

There is increasing recognition that positive affective states have a protective association for all-cause mortality. However, positive states of happiness and excitement vary over time, and little is known about the association of fluctuations in positive affect with survival.

OBJECTIVE

To investigate the association of positive affect instability, conceptualized as fluctuations in momentary positive affect, with mortality in a population-based sample of older adults in England.

DESIGN, SETTING, AND PARTICIPANTS

This survey study used data from a longitudinal survey collected in wave 2 (2004) of the English Longitudinal Study of Ageing, a nationally representative sample of older men and women living in England, with follow-up continuing until March 2018. Participants included people aged 50 years or older at recruitment. Data were analyzed from September 2019 to April 2020.

MAIN OUTCOMES AND MEASURES

The main outcome was all-cause mortality. Positive and negative affect were measured at 4 time points over the course of 1 day: soon after waking, 30 minutes after waking, at 7:00 pm, and at bedtime.

RESULTS

Data were analyzed from 3834 participants (mean [SD] age at baseline, 64.0 [7.4] years; 2082 [54.3%] women) with a mean (SD) follow-up of 12.25 (2.60) years. Adjusting for demographic characteristics, baseline illness, health behaviors, and mean level and instability in negative affect, Cox proportional hazards regression showed that high positive affect instability was associated with greater mortality, with a hazard ratio of 1.25 (95% CI, 1.04-1.49; P = .02). Associations did not differ by age, suggesting that the increased mortality risk associated with high positive affect instability was not restricted to older ages.

CONCLUSION AND RELEVANCE

These findings suggest that temporal fluctuations in positive affect were associated with mortality risk in older adults. These findings illustrate the value of incorporating dynamic assessments of positive affect in distal health outcomes such as mortality.

Emotion Regulation Difficulties Are Not Always Associated With Negative Outcomes on Women: The Buffer Effect of HRV

The Heart Rate Variability (HRV) is regularly associated with depression and trait emotion regulation. However, the interaction between HRV and emotional disturbances is still debated. Only a few studies indicate that HRV moderates the effect of personality traits involved in psychopathological disorders. Since the regulation of emotions is a transdiagnostic factor for most psychological disorders, this study aimed to explore whether HRV moderates the relationship between trait emotion dysregulation and depressive symptoms. We collected data from 148 participants via online questionnaires and HRV measurements at rest. Results show for the 114 female remaining in the study that whereas high emotion regulation difficulties led to higher depressive symptoms severity when resting HRV is low, depressive symptoms remain stable in the same condition but when resting HRV is high. Overall, high resting HRV appears to dampen the consequences of trait emotion regulation difficulties. Further studies are needed to confirm this result, but this suggests that usual response tendencies could be overcome by deactivating or inhibitory processes such as those implied in cognitive flexibility reflected through HRV, according to the neurovisceral integration model.

Affect variability and inflammatory markers in midlife adults

OBJECTIVE

Higher affect variability (the extent to which individuals vary in their affect over time) has been associated with poorer health indicators, but associations with inflammation are less well understood. The purpose of the present study was to examine whether affect variability was associated with inflammation in ways consistent with the stability theory or the fragile positive affect theory, and whether associations were linear or nonlinear.

METHOD

In a racially diverse sample (N = 231; Aged 25-65; 65% female; 62% Black; 25% Hispanic), we examined whether positive affect (PA) and negative affect (NA) variability exhibited linear or quadratic associations with circulating inflammatory cytokines (a composite measure comprised of IL-1β, IL-4, IL-6, IL-8, IL-10, TNF-α, IFN-γ), and C-reactive protein (CRP) and whether person-mean affect moderated these associations. Affective states were assessed using ecological momentary assessments (EMAs) 5 times per day for 2 weeks, with a blood draw at the end of the EMA period. Individual standard deviations of affective states indexed affect variability.

RESULTS

A quadratic association indicated that moderate NA variability was associated with lower CRP. There was evidence of significant moderation by linear associations with PA only: For those with higher person-mean PA, PA variability was positively associated with the cytokine composite. Both person-mean PA and person-mean NA moderated quadratic associations, such that for those with high person-mean affect, both high and low affect variability was associated with systemic inflammation.

CONCLUSION

Results are in line with fragile affect theory suggesting that associations between affect variability and health indicators may vary by person-mean affect. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Indian classical music with incremental variation in tempo and octave promotes better anxiety reduction and controlled mind wandering-A randomised controlled EEG study

Studies have reported the benefits of music-listening in stress-reduction using musical pieces of specific scale or 'Raaga'. But the influence of lower-level musical properties (like tempo, octave, timbre, etc.) lack research backing. Carnatic music concerts use incremental modulations in tempo and octave (e.g.: 'Ragam-Tanam-Pallavi') to elevate the mood of audiences. Therefore, the current study aimed to examine the anxiolytic effect of this musical property. A randomised controlled cross-over study with 21 male undergraduate medical students was followed. 11 participants listened to 'Varying music' (VM: instrumental music with incremental variations in tempo and octave) and 10 listened to 'Stable music' (SM: instrumental music without such variations), thrice daily for 6 days, both clips recorded in Raaga-Kaapi and silence being the control intervention. Electroencephalography (EEG) and Electrocardiography (for heart rate variability or HRV) were done on all 6 days. Beck's Anxiety inventory and State-trait anxiety scale were administered on Day-1 and Day-6. A significant anxiety score reduction was seen only in VM. VM showed marked decrease in lower frequency EEG power in bilateral temporo-parieto-occipital regions compared to silence, whereas SM showed increase in higher frequencies. Relatively, VM showed more midline power reduction (i.e., lower default mode network or DMN activity) and SM showed greater left-dominant alpha/beta asymmetry (i.e., greater right brain activation). During both music interventions HRV remained stable, unlike silence intervention. We speculate that, gradual transition between lower-slower and higher-faster music portions of VM induces a 'controlled-mind wandering' state involving balanced switching between heightened mind wandering ('attention to self') and reduced mind wandering ('attention to music') states, respectively. Therefore, music-selection has remarkable influence on stress-management and warrants further research.

Attention and cardiac phase boost judgments of trust

Fluctuations in mental and bodily states have both been shown to be associated with negative affective experience. Here we examined how momentary fluctuations in attentional and cardiac states combine to regulate the perception of positive social value. Faces varying in trustworthiness were presented during a go/no-go letter target discrimination task synchronized with systolic or diastolic cardiac phase. Go trials lead to an attentional boosting of perceived trust on high trust and ambiguous neutral faces, suggesting attention both boosted existing and generated positive social value. Cardiac phase during face presentation interacted with attentional boosting of trust, enhancing high trust faces specifically during relaxed diastolic cardiac states. Confidence judgments revealed that attentional trust boosting, and its cardiac modulation, did not reflect altered perceptual or response fluency. These results provide evidence for how moment-to moment fluctuations in top-down mental and bottom-up bodily inputs combine to enhance a priori and generate de novo positive social value.

Towards a precision psychiatry approach to anxiety disorders with ecological momentary assessment: the example of panic disorder

Background

Treatments for anxiety disorders are among the most effective in psychiatry. Yet, there is considerable room for improvement.

Aim

In this paper, we discuss the value of ecological momentary assessment as a research method and clinical tool.

Methods

We begin by describing ecological momentary assessment and its advantages, including the ability to collect ecologically valid information about mental disorders, in real time, in individual patients. We then illustrate the value of this approach for anxiety disorder treatment using two patients with panic disorder who completed ecological momentary assessments for 2 weeks before and after a cognitive-behavioural therapy intervention. We focus especially on two key pieces of information provided by ecological momentary assessment data: information about symptom dynamics and information about the relationships among symptoms as they unfold over time within individual patients.

Perspective

Although considerable work is needed to further develop this methodology in the context of anxiety disorder treatment, we believe that these pieces of information may ultimately inform our understanding of how anxiety disorder treatments have their effect and how those treatments can be tailored to individual patients.

The Test-Retest Reliability of Heart Rate Variability and Its Association With Personality Functioning

Background: Heart rate variability (HRV) is a widely used non-invasive index of emotion regulation ability. The main aim of our study was to investigate the relationship between HRV and level of personality functioning in a clinical sample, most of whom had a personality disorder. Our secondary aim was to examine the test-retest reliability of HRV in our sample as there is a lack of knowledge regarding the test-retest reliability in psychiatric populations. We hypothesized that trait HRV would be negatively associated with impairments of personality functioning. Method: Thirty-two adults (23 females, mean age = 27) with threshold or subthreshold personality disorders were recruited from two psychiatric outpatient clinics in Norway. Impairment of personality functioning was assessed by the first module of the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders (SCID-5-AMPD-I); Level of Personality Functioning Scale (LPFS). HRV was assessed during resting conditions with spontaneous breathing over three separate days. Trait HRV was calculated by averaging all three HRV assessments. The test-retest reliability of HRV was assessed using intraclass correlations. Results: Contrary to expected, a positive association between trait HRV and the LPFS Self-direction domain emerged. This was driven by positive associations between the LPFS and HRV at time point 2. Overall, the test-retest reliability of HRV was comparable to previous studies on healthy subjects. However, the reliability coefficients for the first two time points were considerably lower relative to the second and third time points. Conclusions: We propose that impairment of personality functioning may have increased the proportion of variance in HRV attributed to state relative to trait. This could explain the lower test-retest reliability for the first two time points. The increased test-retest reliability for the last two time points could reflect a habituation to the testing situation and hence, less pronounced influences of state in the second and third time points.

Using ambulatory assessment to measure dynamic risk processes in affective disorders

BACKGROUND

Rapid advances in the capability and affordability of digital technology have begun to allow for the intensive monitoring of psychological and physiological processes associated with affective disorders in daily life. This technology may enable researchers to overcome some limitations of traditional methods for studying risk in affective disorders, which often (implicitly) assume that risk factors are distal and static - that they do not change over time. In contrast, ambulatory assessment (AA) is particularly suited to measure dynamic "real-world" processes and to detect fluctuations in proximal risk for outcomes of interest.

METHOD

We highlight key questions about proximal and distal risk for affective disorders that AA methods (with multilevel modeling, or fully-idiographic methods) allow researchers to evaluate.

RESULTS

Key questions include between-subject questions to understand who is at risk (e.g., are people with more affective instability at greater risk than others?) and within-subject questions to understand when risk is most acute among those who are at risk (e.g., does suicidal ideation increase when people show more sympathetic activation than usual?). We discuss practical study design and analytic strategy considerations for evaluating questions of risk in context, and the benefits and limitations of self-reported vs. passively-collected AA.

LIMITATIONS

Measurements may only be as accurate as the observation period is representative of individuals' usual life contexts. Active measurement techniques are limited by the ability and willingness to self-report.

CONCLUSIONS

We conclude by discussing how monitoring proximal risk with AA may be leveraged for translation into personalized, real-time interventions to reduce risk.