The influence of acute stress exposure on cognitive reappraisal: a psychophysiological study.

Successful and efficient emotion regulation (ER) is a key mechanism for mental health. However, acute stress may impact the ability to cognitively regulate negative emotions due to its immediate effects on executive functioning. Based on previous studies, we expected that the time at which ER is tested after a stressor might have a decisive influence, with impairments in ER being more pronounced immediately after stress as compared to a later post-stress phase. To investigate such a time-dependent effect of stress on ER, we investigated 50 healthy adults (26 female) who were exposed to either the Trier Social Stress Test (n = 25) or a control condition (n = 25). Afterwards subjects conducted a cognitive ER task during which they were instructed to either regulate (cognitive reappraisal) or passively view neutral and negative visual stimuli. The ER task was divided into an early (0-20 minutes) and a late post-stress phase (20-40 minutes). Salivary cortisol and α-amylase were assessed as markers of the neuroendocrine stress response. Self-reported emotional state, the mean activity of the late positive potential measured via electroencephalogram (EEG), and corrugator electromyographic activity (EMG) were used as indices of ER. While the groups did not differ in the early post-stress phase, our results suggest a stress-related impairment in ER in the late post-stress phase. This effect was evident in all ER outcome variables (subjective rating, EEG, and EMG data). These results suggest a time-specific stress effect on cognitive reappraisal, which would have implications for reappraisal as a possible stress management technique.

Self-compassion buffers the link between self-criticism and depression in trauma-exposed firefighters.

Firefighters are frequently exposed to highly stressful, potentially traumatic events (PTEs). More than 50%, however, show no significant elevation in trauma-related symptomatology (e.g., depression). In the past, self-compassion has been discussed to promote psychological and behavioral flexibility that is vital to a successful adaptation to PTEs. The goal of this study was to understand whether and how self-compassion may alleviate personal suffering in the face of PTEs. We hypothesized that individuals who encounter their profession-related affective experiences with greater self-compassion, show lower levels of depressive symptoms because self-compassion buffers processes that perpetuate negative affectivity in response to PTEs (i.e., self-critical tendencies). Male firefighters (N = 123) completed self-report questionnaires about the severity of current depressive symptoms; prior traumatic, duty-related events; and the self-compassion scale that assesses two distinct factors: self-criticism and self-compassion. A stepwise regression model was employed to examine differential and interactive contributions of self-criticism and self-compassion to symptoms of depression across the cumulative range of exposure to PTEs. Our results indicate that the positive association between self-criticism and depression is buffered by enhanced levels of self-compassion. This moderation, however, only emerged for firefighters with substantial amounts of PTEs experience in the past. The present work provides insight into protective effects of self-compassion in the face of cumulative PTEs. It suggests that, particularly for severely trauma-exposed firefighters, self-compassion may confer resilience, that is, act as a protective factor from the development of depressive symptoms. Findings are discussed in light of counseling implications. (PsycINFO Database Record

Large-scale network functional interactions during distraction and reappraisal in remitted bipolar and unipolar patients.

OBJECTIVES: The human brain is organized into large-scale networks that dynamically interact with each other. Extensive evidence has shown characteristic changes in certain large-scale networks during transitions from internally directed to externally directed attention. The aim of the present study was to compare these context-dependent network interactions during emotion regulation and to examine potential alterations in remitted unipolar and bipolar disorder patients. METHODS: We employed a multi-region generalized psychophysiological interactions analysis to quantify connectivity changes during distraction vs reappraisal pair-wise across 90 regions placed throughout the four networks of interest (default-mode, frontoparietal, salience, and dorsal attention networks). Using network contingency analysis and permutation testing, we estimated the likelihood that the number of significant condition-dependent connectivity changes in every pair of networks exceeds the number expected by chance. We first examined the pattern of functional connectivity in 42 healthy subjects (sample I) and then compared these connectivity patterns across healthy individuals (n=23) and remitted bipolar (n=21) and unipolar disorder patients (n=21) in an independent sample II. RESULTS: In sample I, distraction compared to reappraisal was characterized by reduced connectivity within the default-mode network and between the default-mode and two cognitive control networks and increased connectivity among the cognitive control networks. In sample II, both patient groups exhibited abnormally increased default-mode intra- and inter-network connectivity during distraction compared to reappraisal. CONCLUSIONS: The present study highlights the role of large-scale network interactions in emotion regulation and provides preliminary evidence of default-mode inter- and intra-network connectivity impairments in remitted bipolar and unipolar patients during emotion regulation.

Investigation of Hydrocolloid Plant Polysaccharides as Potential Candidates to Mimic the Functions of MUC5B in Saliva.

The successful substitution of complex physiological fluids, such as human saliva, remains a major challenge in drug development. Although there are a large number of saliva substitutes on the market, their efficacy is often inadequate due to short residence time in the mouth, unpleasant mouthfeel, or insufficient protection of the teeth. Therefore, systems need to be identified that mimic the functions of saliva, in particular the salivary mucin MUC5B and the unique physiological properties of saliva. To this end, plant extracts known to contain hydrocolloid polysaccharides and to have mucus-forming properties were studied to evaluate their suitability as saliva substitutes. The aqueous plant extracts of Calendula officinalis, Fucus sp. thalli, and lichenan from Lichen islandicus were examined for composition using a range of techniques, including GC-MS, NMR, SEC, assessment of pH, osmolality, buffering capacity, viscoelasticity, viscoelastic interactions with human saliva, hydrocolloid network formation, and in vitro cell adhesion. For this purpose, a physiologically adapted adhesive test was developed using human buccal epithelial cells. The results show that lichenan is the most promising candidate to mimic the properties of MUC5B. By adjusting the pH, osmolality, and buffering capacity with K2HPO4, it was shown that lichenan exhibited high cell adhesion, with a maximum detachment force that was comparable to that of unstimulated whole mouth saliva.

Neural correlates of emotion regulation deficits in remitted depression: the influence of regulation strategy, habitual regulation use, and emotional valence.

Regulating emotions through reappraisal has been shown to elicit abnormal neural activation patterns in currently depressed patients. It is, however, unclear if this deficit generalizes to other emotion regulation strategies, if it persists when patients recover, and if it is related to habitual use of reappraisal strategies. Therefore, we measured the neural responses to emotional images with functional magnetic resonance imaging in remitted patients with previous episodes of major depression and healthy controls. While viewing the images participants regulated the elicited emotions using either a reappraisal or a distraction strategy. Habitual reappraisal use was measured with the Cognitive Emotion Regulation Questionnaire. Depressed patients showed a selective deficit in down-regulating amygdala responses to negative emotional stimuli using reappraisal. This down-regulation of amygdala activity was strongest in participants high in habitual reappraisal use. Activity in the regulating control-network including anterior cingulate and lateral orbitofrontal cortex was increased during both emotion regulation strategies. The findings in remitted patients with previous episodes of major depression suggest that altered emotion regulation is a trait-marker for depression. This interpretation is supported by the relation of habitual reappraisal use to amygdala down-regulation success.

How to regulate emotion? Neural networks for reappraisal and distraction.

The regulation of emotion is vital for adaptive behavior in a social environment. Different strategies may be adopted to achieve successful emotion regulation, ranging from attentional control (e.g., distraction) to cognitive change (e.g., reappraisal). However, there is only scarce evidence comparing the different regulation strategies with respect to their neural mechanisms and their effects on emotional experience. We, therefore, directly compared reappraisal and distraction in a functional magnetic resonance imaging study with emotional pictures. In the distraction condition participants performed an arithmetic task, while they reinterpreted the emotional situation during reappraisal to downregulate emotional intensity. Both strategies were successful in reducing subjective emotional state ratings and lowered activity in the bilateral amygdala. Direct contrasts, however, showed a stronger decrease in amygdala activity for distraction when compared with reappraisal. While both strategies relied on common control areas in the medial and dorsolateral prefrontal and inferior parietal cortex, the orbitofrontal cortex was selectively activated for reappraisal. In contrast, the dorsal anterior cingulate and large clusters in the parietal cortex were active in the distraction condition. Functional connectivity patterns of the amygdala activation confirmed the roles of these specific activations for the 2 emotion regulation strategies.

Look After Yourself: Students Consistently Showing High Resilience Engaged in More Self-Care and Proved More Resilient During the COVID-19 Pandemic.

The COVID-19 pandemic has prompted severe restrictions on everyday life to curb the spread of infections. For example, teaching at universities has been switched to an online format, reducing students' opportunities for exchange, and social interaction. Consequently, their self-reported mental health has significantly decreased and there is a pressing need to elucidate the underlying mechanisms-ideally considering not only data collected during the pandemic, but also before. One hundred seventeen German university students aged 18-27 were assessed for known resilience factors (optimism, self-care, social support, generalized self-efficacy) and subsequently completed surveys on stress experiences and mental health every 3 months over a period of 9 months before the outbreak of the pandemic and once during the first lockdown in Germany. For each timepoint before the pandemic, we regressed participants' mental health against the reported stressor load, such that the resulting residuals denote better or worse than expected outcomes, i.e., the degree of resilient functioning. We then tested whether different expressions in the resilience factors were predictive of distinct resilient functioning trajectories, which were identified through latent class growth analysis. Finally, we investigated whether trajectory class, resilience factors, and perceived stress predicted resilience during the pandemic. Results show rather stable resilient functioning trajectories, with classes differing mainly according to degree rather than change over time. More self-care was associated with a higher resilient functioning trajectory, which in turn was linked with the most favorable pandemic response (i.e., lower perceived stress and more self-care). Although findings should be interpreted with caution given the rather small sample size, they represent a rare examination of established resilience factors in relation to resilience over an extended period and highlight the relevance of self-care in coping with real-life stressors such as the pandemic.

Measuring stress in clinical and nonclinical subjects using a German adaptation of the Perceived Stress Scale.

Background/Objective: Stress is perceived differently across individuals, which might be particularly true for nonclinical and clinical subjects. For this reason, we tested a German adaption of the 10-item Perceived Stress Scale (PSS-10) for model fit and measurement invariance in a big nonclinical and clinical sample. Method: We (1) conducted multiple confirmatory factor analysis (CFA) in 1,248 nonclinical subjects and 575 outpatients, (2) measurement invariance with multigroup CFA, (3) assessed correlations with relevant constructs and (4) calculated internal consistencies for overall stress and the subscales Helplessness and Self-efficacy. Results: In both samples, CFA revealed a robust two-factorial structure with an excellent model fit. Group comparisons revealed strict measurement invariance. Correlations with associated measures support validity. Internal consistencies were good to very good. Conclusions: We show highly satisfactory psychometric properties of the German PSS-10 for nonclinical and clinical individuals. Measurement invariance analyses demonstrated that varying stress levels of people with a different mental health status are due to true interindividual differences.

Antecedentes/Objetivo: El estrés se percibe de manera diferente entre los individuos, lo que podría ser particularmente cierto para los sujetos no clínicos y clínicos. Por esta razón, probamos una adaptación alemana de la Perceived Stress Scale de 10 ítems (PSS-10) para el ajuste del modelo y la invarianza de la medición en una gran muestra clínica y no clínica. Método: Realizamos (1) un análisis factorial confirmatorio múltiple (CFA) en 1.248 sujetos no clínicos y 575 pacientes ambulatorios, (2) invarianza de medición con CFA multigrupo, (3) correlaciones con constructos relevantes y (4) cálculos de la consistencia interna para la escala general y las subescalas Desvalidez y Autoeficacia. Resultados: En ambas muestras, el CFA reveló una estructura robusta de dos factores con un excelente ajuste del modelo. Las comparaciones grupales indicaron invarianza estricta. Las correlaciones con las medidas asociadas respaldan la validez. Los coeficientes de consistencia interna fueron buenos a muy buenos. Conclusión: Mostramos propiedades psicométricas altamente satisfactorias de la version alemana de la PSS-10 para individuos no clínicos y clínicos. Los análisis de invarianza de medición demostraron que los niveles variables de estrés de las personas con un estado de salud mental diferente se deben a diferencias interindividuales verdaderas.

Mania risk is characterized by an aberrant optimistic update bias for positive life events.

BACKGROUND: Early cognitive models of mania posit that a cognitive triad consisting of unrealistically optimistic beliefs about the self, world and future may predispose vulnerable individuals to develop manic symptoms. Hypomanic personality traits (HYP) pose such a vulnerability factor in the etiopathogenesis of mania. METHODS: To test the cognitive tenet of overly optimistic views of the future, 24 individuals with high-HYP and 24 age- and sex-matched controls (low-HYP) performed a belief update paradigm, during which they estimated their personal chances to experience future positive and negative life events. Afterwards, they were presented with the statistical likelihood of each event occurring to a peer living in the same socio-cultural environment and given the chance to adjust their initial estimates. RESULTS: High-HYP individuals exhibited an asymmetric belief revision for positive events, reflected by an exaggerated incorporation of better-than-expected and an impaired integration of worse-than-expected information, relative to their low-HYP control counterparts. The strength of this optimistic update bias was linked to the trait sensitivity of the behavioral approach system. Furthermore, high-HYP individuals demonstrated a more optimistic initial prediction bias, characterized by greater overestimations of their likelihood to experience positive events, and reported enhanced trait optimism. LIMITATIONS: The cross-sectional study relied on an extreme-group design to define mania risk. CONCLUSIONS: Due to the crucial role of future-oriented beliefs in guiding decision-making and goal-directed behavior, this optimistic update bias for positive events may cognitively underpin the mania-typical engagement in highly pleasurable activities despite warnings for harmful consequences.

Increased impulsivity as a vulnerability marker for bipolar disorder: evidence from self-report and experimental measures in two high-risk populations.

BACKGROUND: Heightened impulsivity has been suggested as a possible risk factor for bipolar disorder (BD). However, studies on high-risk populations are scarce and have mainly focused on individuals with a genetic risk. The present study investigated two high-risk samples for BD with regard to several aspects of the impulsivity construct. METHODS: Unaffected relatives of BD patients (genetically defined high-risk group, N=29) and participants scoring high on the Hypomanic Personality Scale (psychometrically defined high-risk sample, N=25) were being compared to respective control groups (N=27 and N=25) using a multi-method approach. Participants were accessed on the Barratt Impulsiveness Scale-11 (BIS-11, trait impulsivity), the Stop Signal Task (response inhibition), and the Cambridge Gambling Task (impulsive behavior in decision-making processes). RESULTS: Both high-risk groups reported heightened impulsivity on the BIS-11, as well as impulsive decision-making, whereas no significant group differences in response inhibition were observed. LIMITATIONS: Limitations were the lack in specificity of the results for BD and the cross-sectional study design, which does not allow conclusions about the influence of impulsivity on the development of or resilience for BD in risk groups. CONCLUSIONS: Our findings support the assumption that increased trait impulsivity and impulsive decision-making are a vulnerability marker for and an endophenotype of BD.

Regulating the blink: Cognitive reappraisal modulates attention.

Our brain is unable to fully process all the sensory signals we encounter. Attention is the process that helps selecting input from all available information for detailed processing and it is largely influenced by the affective value of the stimuli. This study examined if attentional bias toward emotional stimuli can be modulated by cognitively changing their emotional value. Participants were presented with negative and neutral images from four different scene-categories depicting humans ("Reading", "Working", "Crying" and "Violence"). Using cognitive reappraisal subjects decreased and increased the negativity of one negative (e.g., "Crying") and one neutral (e.g., "Reading") category respectively, whereas they only had to watch the other two categories (e.g., "Working" and "Violence") without changing their feelings. Subsequently, subjects performed the attentional blink paradigm. Two targets were embedded in a stream of distractors, with the previously seen human pictures serving as the first target (T1) and rotated landmark/landscape images as the second (T2). Subjects then reported T1 visibility and the orientation of T2. We investigated if the detection accuracy of T2 is influenced by the change of the emotional value of T1 due to the reappraisal manipulation. Indeed, T2 detection rate was higher when T2 was preceded by a negative image that was only viewed compared to negative images that were reappraised to be neutral. Thus, more resources were captured by images that have been reappraised before, i.e., their negativity has been reduced. This modulatory effect of reappraisal on attention was not found for neutral images. Possibly upon re-exposure to negative stimuli subjects had to recall the previously performed affective change. In this case resources may be allocated to maintain the reappraised value and therefore hinder the detection of a temporally close target. Complimentary self-reported ratings support the reappraisal manipulation of negative images.

Inefficiency of emotion regulation as vulnerability marker for bipolar disorder: evidence from healthy individuals with hypomanic personality.

OBJECTIVE: Emotion regulation deficits are a key characteristic of bipolar disorder (BD). In the present study, we asked if deficits in emotion regulation are also a vulnerability marker for BD. To this end, we investigated a healthy group of participants at high-risk for developing BD, defined on the basis of a hypomanic personality trait. We examined the neural correlates of two emotion regulation strategies, reappraisal and distraction. METHOD: Twenty-two individuals with higher risk for BD and twenty-four controls were investigated in a functional magnetic resonance imaging paradigm. Participants were presented with negative, positive and neutral pictures and were either required to passively view the images, to down-regulate the emotional response by reappraising the pictures' content, or to perform a distracting arithmetic task. RESULTS: High-risk individuals showed increased emotional reactivity to negative stimuli, indicated by heightened amygdala activation during passive viewing. High-risk participants were also less successful in down-regulating amygdala activity using reappraisal of negative stimuli. During distraction from positive stimuli, high-risk individuals showed heightened task-related activity in the inferior parietal cortex, suggesting increased distractibility by task-irrelevant positive background stimuli. There were no differences in habitual emotion regulation as assessed by a self-report questionnaire. LIMITATIONS: Generalizability of the present results is limited by the age- and education-homogenous sample and the small sample size. CONCLUSIONS: This is the first study to report neural correlates of increased emotional reactivity and deficient emotion regulation in healthy individuals at risk for BD. These findings suggest inefficient emotion regulation through reappraisal and distraction in individuals with high hypomanic personality who are supposed to be at higher risk to develop bipolar disorder.

Time course of emotion-related responding during distraction and reappraisal.

Theoretical accounts of emotion regulation (ER) discriminate various cognitive strategies to voluntarily modify emotional states. Amongst these, attentional deployment (i.e. distraction) and cognitive change (i.e. reappraisal), have been shown to successfully down-regulate emotions. Neuroimaging studies found that both strategies differentially engage neural structures associated with selective attention, working memory and cognitive control. The aim of this study was to further delineate similarities and differences between the ER strategies reappraisal and distraction by investigating their temporal brain dynamics using event-related potentials (ERPs) and their patterns of facial expressive behavior. Twenty-one participants completed an ER experiment in which they had to either passively view positive, neutral and negative pictures, reinterpret them to down-regulate affective responses (reappraisal), or solve a concurrently presented mathematical equation (distraction). Results demonstrate the efficacy of both strategies in the subjective control of emotion, accompanied by reductions of facial expressive activity (Corrugator supercilii and Zygomaticus major). ERP results indicated that distraction, compared with reappraisal, yielded a stronger and earlier attenuation of the late positive potential (LPP) magnitude for negative pictures. For positive pictures, only distraction but not reappraisal had significant effect on LPP attenuation. The results support the process model of ER, separating subtypes of cognitive strategies based on their specific time course.

Emotional modulation of the attentional blink and the relation to interpersonal reactivity.

The extent of the attentional blink effect on detection rates in rapid serial visual presentations is modulated by the emotionality of the stimuli. Emotionally salient stimuli are detected more often, even if presented in the attentional blink period, and elicit an enlarged P3 response, which has been interpreted as enhanced consolidation. This effect correlates with individual differences in trait affectivity such as anxiety or dysphoria. Here, we ask if it is also related to the capacity to detect emotions in others, i.e., to interpersonal social traits. We therefore presented emotional and neutral images depicting social scenes as targets in an attentional blink design and measured detection rates and event-related potentials. In addition, we recorded self-reports of empathy as measured by the Interpersonal Reactivity Index. The results show enhanced performance for emotional stimuli and increased P3 amplitudes, which correlated with individual differences in empathy. The data suggest that self-reported empathy goes along with enhanced processing of emotion in social stimuli, even under stimulus conditions that are suboptimal for conscious target detection.

Neural correlates of emotional distractibility in bipolar disorder patients, unaffected relatives, and individuals with hypomanic personality.

OBJECTIVE: Neuropsychological deficits and emotion dysregulation are present in symptomatic and euthymic patients with bipolar disorder. However, there is little evidence on how cognitive functioning is influenced by emotion, what the neural correlates of emotional distraction effects are, and whether such deficits are a consequence or a precursor of the disorder. The authors used functional MRI (fMRI) to investigate these questions. METHOD: fMRI was used first to localize the neural network specific to a certain cognitive task (mental arithmetic) and then to test the effect of emotional distractors on this network. Euthymic patients with bipolar I disorder (N=22), two populations at high risk for developing the disorder (unaffected first-degree relatives of individuals with bipolar disorder [N=17]), and healthy participants with hypomanic personality traits [N=22]) were tested, along with three age-, gender-, and education-matched healthy comparison groups (N=22, N=17, N=24, respectively). RESULTS: There were no differences in performance or activation in the task network for mental arithmetic. However, while all participants exhibited slower responses when emotional distractors were present, this response slowing was greatly enlarged in bipolar patients. Similarly, task-related activation was generally increased under emotional distraction; however, bipolar patients exhibited a further increase in right parietal activation that correlated positively with the response slowing effect. CONCLUSIONS: The results suggest that emotional dysregulation leads to exacerbated neuropsychological deficits in bipolar patients, as evidenced by behavioral slowing and task-related hyperactivation. The lack of such a deficit in high-risk populations suggests that it occurs only after disease onset, rather than representing a vulnerability marker.

Goal-directed behavior under emotional distraction is preserved by enhanced task-specific activation.

Despite the distracting effects of emotional stimuli on concurrent task performance, humans are able to uphold goal-directed behavior. Here, we investigated the hypothesis that this effect is due to the enhanced recruitment of task-specific neural resources. In a two-step functional magnetic resonance imaging study, we first localized those areas involved in mental arithmetics by contrasting arithmetic problems with a number detection task. The resulting activation maps were then used as masks in a second experiment that compared the effects of neutral and emotional distracter images on mental arithmetics. We found increased response times in the emotional distracter condition, accompanied by enhanced activation in task-specific areas, including superior parietal cortex, dorsolateral and dorsomedial prefrontal cortex. This activation increase correlated with larger behavioral impairment through emotional distraction. Similar error rates in both conditions indicate that cognitive task performance is preserved through enhanced recruitment of task-specific neural resources when emotional distracter stimuli are present.

Aripiprazole improves olanzapine-associated obsessive compulsive symptoms in schizophrenia.

Many schizophrenic patients have comorbid obsessive-compulsive syndromes (OCS) frequently associated with antiserotonergic second-generation antipsychotics such as clozapine and olanzapine. Whereas cognitive behavioral therapy and antiobsessive antidepressants brought up inconsistent results, pharmacological add-on strategies were able to alleviate OCS. One suggestive agent for antiobsessive add-on treatment is aripiprazole, a partial agonist at dopamine and serotonin receptors. Here, we summarize the course of a patient with paranoid schizophrenia. She developed OCS during long-term treatment with olanzapine at 20 mg/d over a period of 10 years. Baseline assessment showed severe obsessions (Yale Brown Obsessive Compulsive Scale (YBOCS) subscale score : 13) and compulsions (YBOCS subscale score : 10), whereas the psychotic syndrome was compensated (Positive and Negative Syndrome Scale, 11/17/28). The combination with aripiprazole (15 mg/) over a period of 12 weeks resulted in a marked improvement of OCS (YBOCS, 8/3) and some further improvement of the psychotic symptoms (Positive and Negative Syndrome Scale, 9/13/27). This observation points toward an antiobsessive potency of aripiprazole in combination with olanzapine, quite similar to approaches involving clozapine. Hence, the proposed strategy should be further evaluated in prospective controlled trials.