Socioemotional self- and co-regulation in functional seizures: comparing high and low posttraumatic stress.

Functional seizures (FS) are seizure-like symptoms without electroencephalogram (EEG)-based epileptic activity. Those with FS often show emotion-related dysfunction and disrupted interpersonal relationships, in which posttraumatic stress disorder symptoms (PTS) may play a role. We sought to better understand trauma comorbidities and socioemotional processes in FS, including affectionate touch, a form of social connection linked to emotion regulation and awareness. We administered questionnaires online to a community sample of 89 trauma-exposed FS participants (FS diagnoses were self-reported), 51 with and 38 without clinical-level PTS (FS-PTShi, FS-PTSlo) and 216 seizure-free matched trauma-exposed controls (TCs), 91 with and 125 without clinical-level PTS (TC-PTShi, TC-PTSlo) per the Posttraumatic Stress Disorder Symptom Checklist (PCL). As hypothesized, both FS-PTShi and FS-PTSlo reported more emotional avoidance (Brief Experiential Avoidance Questionnaire), more emotion regulation difficulties (Difficulties in Emotion Regulation Scale), and more perceived stress (Perceived Stress Scale) than PTS-matched counterparts. FS-PTShi also reported less reappraisal (Emotion Regulation Questionnaire), more loneliness (UCLA Loneliness Scale), and less frequent affectionate touch (Physical Affection Scale) during waking and surrounding sleep than TC-PTShi, whereas FS-PTSlo and TC-PTSlo did not differ. Neither FS group differed from PTS-matched controls in emotion suppression (Emotion Regulation Questionnaire) or comfort with social touch (Social Touch Questionnaire). Among FS, FS-PTShi reported more difficulties than FS-PTSlo on nearly all measures (non-significant trend for social support). Findings underscore potential synergistic effects of FS and PTS clinical symptoms in shaping experiences of one's emotions and social world, suggesting fostering meaningful connections with others, including via affectionate touch, is an important treatment target.

Affective Experience and Regulation via Sleep, Touch, and "Sleep-Touch" Among Couples.

Touch associated with sleep (sleep-touch; reported physical contact during or shortly before/after sleep) is underexplored as a distinct contributor to affect regulatory processes associated with adult sleep. Given the affect-regulating effects of interpersonal touch, we theorized that among healthy co-sleeping adults, sleep-touch would add to sleep-related effects on affective "resetting," resulting in the experience of calmer, more regulated states. We studied 210 married heterosexual couples (aged 20-67 years, 79% non-Hispanic white, 13% Latinx) assigned 14 days of twice-daily (morning/evening) sleep/mood diaries. Multilevel daily (within-couple) mediation analyses showed that as hypothesized, more reported sleep-touch was associated with happier/calmer and less angry/irritable morning mood. In turn, happier/calmer mood was associated with greater enjoyment of time with spouse (for both spouses). Sleep-touch also was linked directly to both evening positive spousal events and enjoyment ratings. Sleep-touch was associated indirectly with fewer negative spousal events and less spouse-related stress via less angry/irritable morning mood (both spouses). Further, wives' sleep-touch was related to happier/calmer husband mood and evening enjoyment; husbands' sleep-touch was unrelated to wives' reports. All associations with sleep-touch were present while accounting for subjective sleep quality, prior evening mood, non-sleep-related physical affection, day in study, and weekend versus weekday. We speculate that among relatively healthy satisfied couples, physical touch during and surrounding sleep may add to sleep's restorative and affect-regulatory functions, suggesting a pathway through which co-sleeping can improve affect regulation and ultimately relationships and health.

Shame in patients with psychogenic nonepileptic seizure: A narrative review.

Psychogenic Nonepileptic Seizures (PNES) have been linked to dysregulated emotions and arousal. However, the question which emotions may be most relevant has received much less attention. In this multidisciplinary narrative review, we argue that the self-conscious emotion of shame is likely to be of particular importance for PNES. We summarize current concepts of the development of shame processing and its relationship with other emotional states. We demonstrate the potential of acute shame to cause a sudden disruption of normal cognitive function and trigger powerful behavioral, cognitive, physiological and secondary emotional responses which closely resemble key components of PNES. These responses may lead to the development of shame avoidance strategies which can become disabling in themselves. We discuss how excessive shame proneness and shame dysregulation are linked to several psychopathologies often associated with PNES (including depression and PTSD) and how they may predispose to, precipitate and perpetuate PNES disorders, not least by interacting with stigma. We consider current knowledge of the neurobiological underpinnings of shame and PNES. We explore how shame could be the link between PNES and a heterogeneous range of possible etiological factors, and how it may link historical aversive experiences with individual PNES events occurring much later and without apparent external trigger. We argue that, in view of the potential direct links between shame and PNES, the well-documented associations of shame with common comorbidities of this seizure disorder and the well-characterized relationship between chronic shame and stigma, there is a compelling case to pay greater attention to shame in relation to PNES. Its role in the treatment of patients with PNES is discussed in a separate, linked review incorporating case vignettes to highlight the complex interactions of different but interlinked shame-related issues in individual patients.

An interdisciplinary approach to the screening, diagnosis, and treatment of OEF/OIF Veterans with mild traumatic brain injury.

OBJECTIVE: To implement an Integrated TBI Screening Clinic (ITSC) during the mandatory TBI evaluation process at the Department of Veterans Affairs. Referral outcomes were examined regarding Veterans who were determined to need a full neuropsychological evaluation versus those for whom mental health treatment was clinically indicated. Correlations among cognitive measures, posttraumatic stress disorder (PTSD), anxiety, depression, and insomnia symptoms were also examined. METHOD: This study was a retrospective chart review study that included 138 Veterans seen between 2011 and 2014 in a post-deployment primary care clinic. Descriptive statistics and correlations were completed using the: screening Module of the Neuropsychological Assessment Battery (S-NAB), PTSD Checklist-Military version (PCL-M), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Insomnia Severity Index (ISI). RESULTS: 19.8% of Veterans required a referral for a full neuropsychological exam and 72.7% were referred for additional mental health services (with some Veterans being referred to both). Significant correlations were found among higher PTSD, depression, anxiety symptoms, with poorer attention and memory (all p < .05). Only PTSD was significantly correlated with poorer executive functioning (r = 0.19, p < .05). CONCLUSION: Integration of a multidisciplinary neuropsychological screening exam during a primary care visit with OEF/OIF Veterans may assist in better delineating symptoms.

How to do things with words: Two seminars on the naming of functional (psychogenic, non-epileptic, dissociative, conversion, ) seizures.

Amongst the most important conditions in the differential diagnosis of epilepsy is the one that manifests as paroxysms of altered behaviour, awareness, sensation or sense of bodily control in ways that often resemble epileptic seizures, but without the abnormal excessive or synchronous electrical activity in the brain that defines these. Despite this importance, there remains little agreement - and frequent debate - on what to call this condition, known inter alia as psychogenic non-epileptic seizures (PNES), dissociative seizures (DS), functional seizures (FS), non-epileptic attack disorder (NEAD), pseudoseizures, conversion disorder with seizures, and by many other labels besides. This choice of terminology is not merely academic - it affects patients' response to and understanding of their diagnosis, and their ability to navigate health care systems.This paper summarises two recent discussions hosted by the American Epilepsy Society and Functional Neurological Disorders Society on the naming of this condition. These discussions are conceptualised as the initial step of an exploration of whether it might be possible to build consensus for a new diagnostic label.

A framework for understanding the pathophysiology of functional neurological disorder.

The symptoms of functional neurological disorder (FND) are a product of its pathophysiology. The pathophysiology of FND is reflective of dysfunction within and across different brain circuits that, in turn, affects specific constructs. In this perspective article, we briefly review five constructs that are affected in FND: emotion processing (including salience), agency, attention, interoception, and predictive processing/inference. Examples of underlying neural circuits include salience, multimodal integration, and attention networks. The symptoms of each patient can be described as a combination of dysfunction in several of these networks and related processes. While we have gained a considerable understanding of FND, there is more work to be done, including determining how pathophysiological abnormalities arise as a consequence of etiologic biopsychosocial factors. To facilitate advances in this underserved and important area, we propose a pathophysiology-focused research agenda to engage government-sponsored funding agencies and foundations.

Brain boosters: Evaluating a pilot program for memory complaints in veterans.

This study investigated the feasibility and preliminary effectiveness of a pilot program designed to address subjective memory complaints among Veterans. The program, Brain Boosters, consisted of 10 once-weekly group sessions, during which psychoeducation and cognitive enhancement strategies were used to target memory concerns and related processes, specifically attentional difficulties. Given that memory complaints often are associated with psychiatric comorbidities, sessions also incorporated strategies for reducing symptoms of depression, posttraumatic stress, and insomnia. Controlling for age, we examined pre- to posttreatment change in symptom ratings for 96 Veterans (aged 22 to 87 years) who participated in the Brain Boosters program. The effect of Brain Boosters on memory complaints interacted with age: younger (but not older) Veterans reported reductions in memory impairment from pre- to posttreatment. Additionally, irrespective of age, from pre- to posttreatment Veterans reported fewer attentional difficulties and fewer depression symptoms. Ratings of posttraumatic stress and insomnia symptoms did not change, although insomnia was negatively associated with age. Linear regression controlling for age revealed that reductions in attention problems predicted reductions in perceived memory impairment. Findings from this exploratory, uncontrolled pilot study suggest that a psychoeducational cognitive enhancement group is feasible to conduct in a heterogeneous Veteran population, and may be associated with improvements in perceived memory functioning for younger Veterans, and in attention and depression symptoms for Veterans across age groups. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Emotional Reactivity as a Vulnerability for Psychogenic Nonepileptic Seizures? Responses While Reliving Specific Emotions.

OBJECTIVE: Dysfunction in emotional processes is a hypothesized contributor to functional neurological disorders (FNDs), yet few studies have evoked real-time emotion during multimethod assessment incorporating subjective, behavioral, and psychophysiological indicators. This approach may reveal clinical and neurobiological vulnerability to FND and clarify how dysfunctional emotional processes serve as perpetuating factors. METHODS: Eleven participants with video-EEG-confirmed diagnoses of psychogenic nonepileptic seizures (PNES) were compared with 49 seizure-free trauma control subjects (TCs) with or without clinically elevated posttraumatic stress symptoms (25 clinically elevated [TC-clin], 24 not clinically elevated [TC-nonclin]). Participants recalled and described memories evoking anger, shame, happiness, and neutral feelings. RESULTS: Even though PNES patients and TCs reported similar amounts of emotional experience, PNES patients reported more difficulty reliving emotions and were less likely to complete the relived shame task. During and after reliving happiness, PNES and TC-clin groups showed respiratory sinus arrhythmia (RSA) decreases, indicating parasympathetic withdrawal, whereas the TC-nonclin group showed RSA increases. CONCLUSIONS: Findings from this pilot study are consistent with previous research and clinical observations that emotional engagement may be more effortful for PNES patients. Patterns of RSA change, which may also point to greater effortful engagement, were similar in PNES and TC-clin groups, suggesting that traumatic stress reactions may play a part. At the same time, experience of greater difficulty or avoidance may be even greater among PNES patients. Especially when regulatory resources are already limited, accumulated effort, coupled with self-threatening contexts such as shame, may be particularly problematic for those with PNES and perhaps other FNDs.

Diagnostic utility of the Minnesota Multiphasic Personality Inventory-2 Restructured Form in the epilepsy monitoring unit: Considering sex differences.

Psychological assessment measures are frequently used to evaluate patients in epilepsy monitoring units. One goal of that assessment is to contribute information that may help with differential diagnosis between epilepsy and psychogenic nonepileptic seizures (PNES). The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) is one such measure. Del Bene et al. (2017) recently published an analysis that was the first to compare MMPI-2-RF scale elevations between diagnostic groups stratified by sex. The purpose of the present study was to replicate that analysis in a larger sample. Similar to previous work, we found that both men and women with PNES were more likely than men and women with epilepsy to report high levels of somatic complaints (2 to 5 times greater odds of somatic symptom reporting) and a variety of types of complaints. Mood disturbance scales were not significantly elevated in our PNES sample. Results contribute to the small body of research on sex differences in patients with PNES and suggest that somatization is a key characterization across sexes.

Convergence in feeling, divergence in physiology: How culture influences the consequences of disgust suppression and amplification among European Americans and Asian Americans.

Much empirical work documents the downsides of suppressing emotions. Emerging research points to the need for a more sophisticated and culturally informed approach to understanding the consequences of emotion regulation. To that end, we employed behavioral, self-report, and psychophysiological measures to examine the consequences of two types of emotion regulation (suppression and amplification) in a sample of 28 Asian Americans and 31 European Americans. Participants were shown a neutral film and then a series of disgust-eliciting films during which they were asked to regulate their response by suppressing or amplifying their emotional behavior (counterbalanced). Despite self-reporting equal levels of disgust, European Americans showed greater skin conductance reactivity than Asian Americans in both regulation conditions, but not in response to a neutral film. These findings extend work on divergence in the consequences of emotion regulation across different cultural groups, which could help identify optimal emotion regulation strategies for health and well-being.

Implicit and explicit self-esteem discrepancies in people with psychogenic nonepileptic seizures.

PURPOSE: Self-esteem (SE), or one's sense of competence and worth, is reduced in many mental and physical disorders. Low SE is associated with perceived stigma and disability and poor treatment outcomes. The present study examined implicit and explicit SE (automatic and deliberate views about the self) in people with epilepsy and people with psychogenic nonepileptic seizures (PNESs). Discrepancies between implicit SE and explicit SE have been found to correlate with psychological distress in disorders often associated with PNESs but are relatively unexplored in PNESs. We hypothesized that, compared with epilepsy, PNESs would be associated with lower self-reported SE and greater discrepancies between implicit SE and explicit SE. METHODS: Thirty adults with PNESs, 25 adults with epilepsy, and 31 controls without a history of seizures were asked to complete the Rosenberg Self-esteem Scale as a measure of explicit SE and an Implicit Relational Assessment Procedure as a measure of implicit SE. The State-Trait Anxiety Inventory and Patient Health Questionnaire-15 (a somatic symptom inventory) were also administered. RESULTS: We found significant group differences in explicit (p<0.001) but not implicit SE. Patients with PNESs reported lower SE than the other groups. No group differences were found in implicit SE. Implicit-explicit SE discrepancies were larger in the group with PNESs than in the other groups (p<0.001). Higher frequency of PNESs (but not epileptic seizures) was associated with lower explicit SE (rs=-.83, p<0.01) and greater SE discrepancies (i.e., lower explicit relative to implicit SE; rs=.65, p<0.01). These relationships remained significant when controlling for anxiety and somatization. CONCLUSION: Patients with PNESs had lower explicit SE than those with epilepsy or healthy controls. In keeping with our expectations, there were greater discrepancies between implicit SE and explicit SE among patients with PNESs than in the other groups. Our results, including the strong relationship between PNES frequency, anxiety, and explicit-implicit SE discrepancies, support the interpretation that PNESs serve to reduce cognitive dissonance, perhaps protecting patients' implicit SE.

Anxiety and avoidance in psychogenic nonepileptic seizures: the role of implicit and explicit anxiety.

This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit-explicit anxiety discrepancies were only identified in patients with PNESs (p<.001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r=.63, p<.01) and frequency of seizures (r=.67, p<.01); implicit anxiety correlated with frequency of seizures only (r=.56, p<.01). Our findings demonstrate the role of implicit anxiety in PNESs and provide additional support for the contribution of explicit anxiety and experiential avoidance to this disorder.

Alterations of consciousness in psychogenic nonepileptic seizures: emotion, emotion regulation and dissociation.

Impairment of consciousness and reduced self-control are key features of most psychogenic nonepileptic seizures (PNESs), although, compared with patients with epilepsy, those with PNESs demonstrate greater conscious awareness during their seizures. The neurobiological underpinnings of PNESs and of alterations of awareness associated with PNESs remain relatively unknown. We suggest that an understanding of conscious experiences and discrepancies between subjective impairment of consciousness and the lack of objectifiable neurobiological changes in PNESs may benefit from an examination of emotion processing, including understanding sensory, situational, and emotional triggers of PNESs; emotional and physiological changes during the attacks; and styles of emotional reactivity and regulatory capacity. We also suggest that in addition to the typical comparisons between patients with PNESs and those with epilepsy, studies of PNESs would benefit from the inclusion of comparison groups such as those with PTSD, dissociation, and other forms of psychopathology where dissociative and emotion regulatory mechanisms have been explored more fully. We conclude that current evidence and theory suggest that impairment of consciousness in PNESs is only "dissociative" in one subgroup of these seizures, when consciousness is suppressed as a collateral effect of the excessive inhibition of emotion processing. We propose that PNES behaviors and experiences of reduced control or awareness may also represent direct behavioral manifestation of overwhelming emotions, or that minor emotional fluctuations or relatively neutral stimuli may trigger PNESs through conditioning or other preconscious processes. Future studies exploring the neurobiological mechanisms underpinning PNESs are likely to be more fruitful if researchers bear in mind that it is unlikely that all PNESs result from the same processes in the brain.

Job stress and dyadic synchrony in police marriages: a preliminary investigation.

Despite reports documenting adverse effects of stress on police marriages, few empirical studies focus on actual emotional behaviors of officers and spouses. In this preliminary investigation, 17 male police officers and their nonpolice wives completed daily stress diaries for 1 week and then participated in a laboratory-based discussion about their respective days. Conversations were video-recorded and coded for specific emotional behaviors reflecting hostility and affection, which are strong predictors of marital outcomes. We examined associations between officers' job stress (per diaries and the Police Stress Survey) and couples' emotional behavior (mean levels and behavioral synchrony) using a dyadic repeated measures design capitalizing on the large number of observations available for each couple (1020 observations). When officers reported more job stress, they showed less hostility, less synchrony with their wives' hostility, and more synchrony with their wives' affection; their wives showed greater synchrony with officers' hostility and less synchrony with officers' affection. Therefore, for officers, greater job stress was associated with less behavioral negativity, potentially less attunement to wives' negativity, but potentially greater attunement to wives' affection-perhaps a compensatory strategy or attempt to buffer their marriage from stress. These attempts may be less effective, however, if, as our synchrony findings may suggest, wives are focusing on officers' hostility rather than affection. Although it will be important to replicate these results given the small sample, our findings reveal that patterns of behavioral synchrony may be a key means to better understand how job stress exacts a toll on police marriages.

Processes linking cultural ingroup bonds and mental health: the roles of social connection and emotion regulation.

Cultural and ethnic identities influence the relationships individuals seek out and how they feel and behave in these relationships, which can strongly affect mental and physical health through their impacts on emotions, physiology, and behavior. We proposed and tested a model in which ethnocultural identifications and ingroup affiliations were hypothesized explicitly to enhance social connectedness, which would in turn promote expectancy for effective regulation of negative emotions and reduce self-reported symptoms of depression and anxiety. Our sample comprised women aged 18-30 currently attending college in the Southwestern US, who self-identified as Hispanic of Mexican descent (MAs; n = 82) or as non-Hispanic White/European American (EAs; n = 234) and who completed an online survey. In the full sample and in each subgroup, stronger ethnocultural group identity and greater comfort with mainstream American culture were associated with higher social connectedness, which in turn was associated with expectancy for more effective regulation of negative emotions, fewer depressive symptoms, and less anxiety. Unexpectedly, preference for ingroup affiliation predicted lower social connectedness in both groups. In addition to indirect effects through social connection, direct paths from mainstream comfort and preference for ingroup affiliation to emotion regulation expectancy were found for EAs. Models of our data underscore that social connection is a central mechanism through which ethnocultural identities-including with one's own group and the mainstream cultural group-relate to mental health, and that emotion regulation may be a key aspect of this linkage. We use the term ethnocultural social connection to make explicit a process that, we believe, has been implied in the ethnic identity literature for many years, and that may have consequential implications for mental health and conceptualizations of processes underlying mental disorders.

Emotion in psychogenic nonepileptic seizures: responses to affective pictures.

We examined emotional responses to standard affective pictures in 18 psychogenic nonepileptic seizure (PNES) patients. Given reports of trauma and posttraumatic stress symptoms (PTS) in many PNES patients, comparison groups were seizure-free individuals high and low in PTS (PTS-high, PTS-low; n=18 per group). Patients with psychogenic nonepileptic seizures (1) reported more emotional intensity to neutral and pleasant pictures than PTS-low and more intensity to neutral pictures than PTS-high, and (2) showed less positive emotional behavior to pleasant pictures than PTS-high. Groups did not differ in pleasantness/unpleasantness ratings, negative emotional behavior, cardiac interbeat interval, or respiratory sinus arrhythmia (RSA) reactivity to the pictures. Patients with psychogenic nonepileptic seizures reported more general emotion regulation difficulties and showed lower baseline RSA than PTS-low but not PTS-high. In sum, intense emotional experience and diminished positive emotional behavior characterized PNES patients' emotional responses.

Dynamics of choice during estimation of subjective value.

This study characterized preferential choice in binary trials and investigated intra-session variations in response time (RT). In Experiment 1, participants (N=77) were asked to choose the preferred of two images of body wash; all unique combinations of 19 images were presented. The results showed: (a) marked and consistent individual preferences for specific stimuli; (b) RT decreased monotonically with increasing exposure to each stimulus; (c) RT decreased exponentially as a function of relative preference ranking of the 2 images in a trial; and (d) a regression model efficiently predicted trial RT as a function of exposure and relative preference. Experiment 2 (N=112) explored the effect of amount of exposure on RT, and relative preference as a function of the type of choice task (a previously completed vs. a new choice task). The results showed that: (a) within a single choice task, amount of exposure and relative preference between the stimuli predicted the systematic changes in RT observed in Exp. 1; and (b) when the choice task changed, the effects of previous amount of exposure, and relative stimulus preference did not transfer to the new task.

Coherent with laughter: subjective experience, behavior, and physiological responses during amusement and joy.

Emotion research historically has adopted a fairly homogeneous view of positive emotions. The aim of the current study was to explore how two positive emotions, amusement and joy, differ in subjective, behavioral, cardiovascular, and respiratory characteristics. Thirty-nine participants viewed two film clips, each selected to elicit amusement or joy. As predicted, participants reported more amusement, showed more positive facial expressions and laughter, and exhibited less heart rate deceleration and a larger increase in respiratory amplitude in response to the amusement clip than in response to the joy clip. In addition, subjective, behavioral, and physiological indicators were more closely related in amusement than joy, which was largely attributable to laughter during amusement. The current study adds to a growing literature suggesting the importance of adopting a more nuanced conceptualization of positive emotion.

Emotion Control Values and Responding to an Anger Provocation inAsian-American and European-American Individuals.

The present research examined whether Asian-American (AA) versus European-American (EA) women differed in experiential, expressive, or autonomic physiological responding to a laboratory anger provocation and assessed the mediating role of values about emotional control. Results indicate that AA participants reported and behaviorally displayed less anger than EA participants, while there were no group differences in physiological responses. Observed differences in emotional responses were partially mediated by emotion control values, suggesting a potential mechanism for effects of cultural background on anger responding.

Cardiovascular costs of emotion suppression cross ethnic lines.

Previous research has shown that inhibiting emotion-expressive behavior (emotion suppression) leads to increased sympathetic activation of the cardiovascular system [Gross, J.J. and Levenson, R.W. (1993). Emotional suppression: physiology, self-report, and expressive behavior. J. Pers. Soc. Psychol. 64(6), 970-986]. Ethnic differences have been reported in how frequently suppression is used as an emotion regulation strategy [Gross, J.J. and John, O. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J. Pers. Soc. Psychol. 85(2), 348-362]; however, it remains unknown whether there are ethnic differences in the physiological consequences of suppression. To test this, 168 participants from four ethnic groups (African American, Chinese American, European American, Mexican American) watched a disgust-eliciting film clip; half were instructed to suppress their emotions and half simply watched the film. Consistent with previous research, suppression was associated with decreased facial behavior, increased cardiovascular activation, and no impact on subjective emotional experience. Ethnicity failed to moderate these effects, indicating the generality of the cardiovascular consequences of emotion suppression across ethnic background.