Emotion Regulation Strategies Relate to Ambulatory Cardiovascular Activity in an American Indian Community.

OBJECTIVE: Poor emotion regulation is associated with risk for cardiovascular disease. However, much of this research is conducted in primarily White samples, thus limiting our understanding of this relationship in other racial/ethnic groups. American Indians (AIs) are uniquely and disproportionately at risk for cardiovascular disease. As such, the present study aimed to examine the relationships between emotion regulation strategies and ambulatory cardiovascular activity in an entirely AI sample. METHODS: The sample consisted of 100 AI adults living on a tribal reservation. Emotion regulation strategies (expressive suppression, cognitive reappraisal) were assessed via the Emotion Regulation Questionnaire. Using ecological momentary assessment, daily measurements of psychological stress and ambulatory cardiovascular activity were taken during a 7-day monitoring period. Statistical analyses included bivariate correlations, hierarchical linear regression models, and mediation models. RESULTS: Expressive suppression was associated with higher systolic and diastolic blood pressure, as well as higher pulse rate. In contrast, cognitive reappraisal was associated with lower systolic and diastolic blood pressure, lower pulse rate, and lower average daily psychological stress. These results remained statistically significant after adjusting for age, sex, body mass index, anxiety, depression, and early life trauma. In addition, psychological stress mediated the associations between blood pressure and cognitive reappraisal, but not expressive suppression. CONCLUSIONS: These results provide preliminary evidence for divergent associations of two emotion regulation strategies with cardiovascular activity and psychological stress in an AI community. Modifying health interventions to include training in effective emotion regulation may be beneficial.

Heart Rate Reactivity to Acute Psychological Stress Predicts Higher Levels of Posttraumatic Stress Disorder Symptoms During the COVID-19 Pandemic.

OBJECTIVE: Increased autonomic arousal is a proposed risk factor for posttraumatic stress disorder (PTSD). Few studies have prospectively examined the association between physiological responses to acute psychological stress before a traumatic event and later PTSD symptoms. The present prospective study examined whether cardiovascular responses to an acute psychological stress task before the COVID-19 global pandemic predicted PTSD symptoms related to the ongoing pandemic. METHODS: Participants (n = 120) were a subsample of an ongoing research study. Phase 1 consisted of a 10-minute baseline and 4-minute acute psychological stress task with blood pressure and heart rate recorded throughout. Phase 2 was initiated 2 weeks after the COVID-19 pandemic declaration. Participants completed the Impact of Event Scale-Revised (IES-R) with respect to the ongoing pandemic. Hierarchical linear regression analyses were used to examine whether cardiovascular stress reactivity predicted COVID-19 PTSD symptoms. RESULTS: Heart rate reactivity significantly predicted IES intrusion (ß = -0.208, t = -2.28, p = .025, ΔR2 = 0.041, confidence interval = -0.021 to -0.001) and IES hyperarousal (ß = -0.224, t = -2.54, p = .012, ΔR2 = 0.047, confidence interval = -0.22 to - 0.003), but not IES avoidance (p = .077). These results remained statistically significant after adjustment for sex, socioeconomic status, baseline cardiovascular activity, neuroticism, race, ethnicity, body mass index, and adverse childhood experiences. There were no statistically significant associations between blood pressure and any of the Impact of Event Scale-Revised subscales (p values > .12). CONCLUSIONS: Diminished heart rate responses (i.e., lower physiological arousal) to acute psychological stress before the COVID-19 pandemic significantly predicted reported PTSD symptoms during the crisis.

Emotion Regulation Strategies Predict PTSS During the COVID-19 Pandemic in an American Indian Population.

BACKGROUND: Poor emotion regulation is associated with post-traumatic stress symptoms (PTSS). However, limited prospective research prevents any directional conclusions. No known studies have assessed emotion regulation with PTSS in American Indians, a high-risk population for poor mental health outcomes. The present prospective study explored whether emotion regulation strategies (cognitive reappraisal, expressive suppression) predicted later PTSS related to the COVID-19 global pandemic in a solely American Indian sample. METHODS: American Indian participants (N = 210; Mean (SD) age = 54.85(13.08) years, 58.7% female) completed the Emotion Regulation Questionnaire (ERQ) during Phase 1 (a few weeks before pandemic declaration) and the Impact of Event Scale-Revised (IES-R) with respect to the COVID-19 pandemic during Phase 2 (7-8 weeks after pandemic declaration). Bivariate correlations and hierarchical linear regression analyses were utilized. RESULTS: ERQ reappraisal was negatively associated with IES-R total scores, such that higher reappraisal predicted lower PTSS. In contrast, ERQ suppression was positively associated with IES-R total scores, such that higher suppression predicted higher PTSS. CONCLUSIONS: Greater suppression and lower reappraisal predicts PTSS in response to the COVID-19 pandemic in an entirely American Indian sample, providing critical information for future interventions in a population at high-risk for mental health disparities.

Further Examining Positive Affect in Relation to Worry: A Synergistic Effect Between Positive Affect Expressivity and Proneness to Positive Affect.

There is emerging interest in understanding positive affect dysfunction in relation to anxiety, including worry. This set of two studies examined the association between the inhibition of affect expression (general affect expressivity in Study 1, positive affect expressivity in Study 2) and worry, with a particular interest in the moderating role of proneness to experience positive affect. Subjects were US-residing adults (Study 1 N = 502, Study 2 N = 250) who were recruited through a crowdsourcing website and completed self-report measures of study variables. Moderated regression was used to examine study predictions that affect expression would negatively correlate with worry when coupled with diminished positive affect. Proneness toward negative affect was included as a covariate within multivariate analyses. An interactive effect between affect expressivity and positive affect was supported in Study 2 (positive affect expressivity) but not Study 1 (general affect expressivity) in relation to worry. A diminished tendency to express positive affect was associated with greater worry when coupled with less positive affect. Study results and future directions are discussed in terms of the potential emotion-regulatory functions of positive affect expressivity as it relates to worry.

Emotion suppression and acute physiological responses to stress in healthy populations: a quantitative review of experimental and correlational investigations.

Emotion suppression may be linked to poor health outcomes through elevated stress-related physiology. The current meta-analyses investigate the magnitude of the association between suppression and physiological responses to active psychological stress tasks administered in the laboratory. Relevant articles were identified through Medline, PsychINFO, PubMed, and ProQuest. Studies were eligible if they (a) used a sample of healthy, human subjects; (b) assessed physiology during a resting baseline and active psychological stress task; and (c) measured self-report or experimentally manipulated suppression. Twenty-four studies were identified and grouped within two separate random effects meta-analyses based on study methodology, namely, manipulated suppression (k = 12) and/or self-report (k = 14). Experimentally manipulated suppression was associated with greater physiological stress reactivity compared to controls (Hg = 0.20, 95% CI [0.08, 0.33]), primarily driven by cardiac, hemodynamic, and neuroendocrine parameters. Self-report trait suppression was not associated with overall physiological stress reactivity but was associated with greater neuroendocrine reactivity (r = 0.08, 95% CI [0.01, 0.14]). Significant moderator variables were identified (i.e., type/duration of stress task, nature of control instructions, type of physiology, and gender). This review suggests that suppression may exacerbate stress-induced physiological arousal; however, this may differ based upon the chosen methodological assessment of suppression.

Emotion regulation tendencies and cardiovascular responses to repeated acute psychological stress.

Poor emotion regulation has been associated with cardiovascular disease (CVD) through maladaptive cardiovascular responses to psychological stress. However, there has been scant research examining the relationship between emotion regulation and habituation of cardiovascular responses to recurrent stress, which may be more directly applicable to the experience of stress in everyday life. The aims of the current study were to examine the associations between emotion regulation tendencies and cardiovascular stress reactivity, as well as habituation of cardiovascular reactivity across repeated stressors. A sample of 453 participants (mean (SD) age = 19.5 (1.3) years; 62 % women) completed a repeated stress paradigm, which consisted of two 10-minute baselines and two identical 4-minute stress tasks, separated by a 10-minute recovery period. Heart rate (HR) was measured continuously; systolic/diastolic blood pressures (SBP/DBP) were measured every 2 min. At the end of the visit, participants completed the Emotion Regulation Questionnaire (ERQ) and Difficulties in Emotion Regulation Scale (DERS). Results indicate that impulse control difficulties when distressed (a DERS subscale) were significantly associated with blunted SBP, DBP, and HR reactivity to both stressors, as well as impaired HR habituation across the stressors. None of the ERQ subscales (cognitive reappraisal, expressive suppression) were found to be associated with cardiovascular stress reactivity or habituation. The outcomes of this study demonstrate a potential underlying physiological pathway through which impulse control difficulties when distressed may contribute to CVD risk. This study also reveals the importance of extending traditional cardiovascular stress reactivity protocols to include multiple exposures of the same stress task.

Cardiovascular stress reactivity, habituation, and adiposity.

The relationship between adiposity and cardiovascular disease morbidity and mortality is complex. One pathway through which adiposity may influence future health outcomes is by altering how biological systems respond to stress. The current study aimed to examine the association between two metrics of adiposity (body mass index and waist-hip ratio) and two indices of cardiovascular stress responses (reactivity and habituation). A sample of 455 participants (Mean age = 19.47, SD = 1.25 years; BMI = 24.32, SD = 5.04 kg/m2 ; 62% female; 17.9% Hispanic/Latino; 65.2% White, 18.7% Asian, 7.9% Black, 0.2% American Indian/Alaska Native, and 7% other) completed two acute psychosocial stress tasks. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded throughout each stressor. In unadjusted and adjusted models, there were no statistically significant associations between adiposity and HR, SBP, or DBP stress reactivity or habituation. The current data do not support the hypothesis that adiposity influences health by altering cardiovascular responses to acute psychological stress. Results are at odds with prior population-level studies and the single prior study examining adiposity and habituation. At the same time, results are in line with mounting evidence that adiposity itself does not drive poor cardiovascular outcomes seen in people classified as overweight or obese.

Extraversion is associated with lower cardiovascular reactivity to acute psychological stress.

BACKGROUND AND AIMS: Extraversion has been associated with positive physical health outcomes, with adaptive cardiovascular responses to stress being one potential physiological mechanism. The present study examined the influence of extraversion on both cardiovascular reactivity and cardiovascular habituation to an acute psychological stress task (Paced Auditory Serial Addition Test (PASAT)) in a sample of healthy undergraduate students. METHODS: A sample of 467 undergraduate students completed the Big Five Inventory (BFI) to assess trait extraversion and attended a single stress testing session. The testing session included two identical stress-testing protocols, each consisting of a 10-minute baseline and 4-minute PASAT. Cardiovascular parameters including heart rate (HR), systolic/diastolic blood pressure (S/DBP) and mean arterial pressure (MAP) were recorded throughout the testing session. State measures of positive affect (PA) and negative affect (NA), as well as post task measures of self-reported stress were used to assess psychological experiences of the stress task. RESULTS: Extraversion was significantly associated with lower self-reported stress in response to the initial stress exposure, but not the second stress exposure. Higher levels of extraversion were associated with lower SBP, DBP, MAP and HR reactivity in responses to both exposures to the stressor. However, no significant associations were observed between extraversion and cardiovascular habituation to recurring psychological stress. CONCLUSION: Extraversion is associated with lower cardiovascular reactivity to acute psychological stress and this relationship persists upon repeated exposures to the same stressor. Cardiovascular responses to stress may indicate a potential mechanism facilitating the association between extraversion and positive physical health outcomes.

Cardiovascular reactions to acute psychological stress and academic achievement.

Cardiovascular reactions to acute psychological stress have been associated with cognitive function. However, previous work has assessed cardiovascular reactions and cognitive function in the laboratory at the same time. The present study examined the association between cardiovascular reactions to acute psychological stress in the laboratory and academic performance in final year high school students. Heart rate, blood pressure, stroke volume, and cardiac output reactions to an acute psychological stress task were measured in 131 participants during their final year of high school. Performance on high school A-levels were obtained the following year. Higher heart rate and cardiac output reactivity were associated with better A-level performance. These associations were still statistically significant after adjusting for a wide range of potentially confounding variables. The present results are consistent with a body of literature suggesting that higher heart rate reactions to acute psychological stress are associated with better cognitive performance across a variety of domains.

Trait neuroticism does not relate to cardiovascular reactivity or habituation to repeated acute psychosocial stress.

Neuroticism has been associated with adverse cardiovascular health. Adverse cardiovascular health outcomes have also been linked to cardiovascular reactivity and cardiovascular reactivity habituation to acute psychosocial stress. As such, cardiovascular stress reactivity and habituation may be a factor in the association between neuroticism and disease risk. However, studies of the relationship between neuroticism and cardiovascular reactivity have produced mixed results. Moreover, the relationships between neuroticism, cardiovascular reactivity habituation, and general affect across a repeated stress paradigm have not been examined. The present study aimed to assess the relationships between neuroticism, positive and negative affect, and cardiovascular reactivity and habituation to acute psychosocial stress in a large, demographically diverse sample. Participants (N = 426) completed two 4-min mental arithmetic stressors, each with a separate baseline, in a single laboratory session while having discrete blood pressure and heart rate measurements taken. State positive and negative affect were measured immediately following informed consent, after receiving task instructions, and after each stress task. Trait neuroticism was measured using the Big Five Inventory. Each stress task elicited significant cardiovascular changes. Trait neuroticism was not significantly associated with cardiovascular reactivity or cardiovascular reactivity habituation, within or across stress tasks (all p's > 0.12). Across the entire study protocol, neuroticism was significantly related to lower positive affect and higher negative affect (both p's < 0.001). Trait neuroticism did not relate to stress-related cardiovascular adjustments but might confer a predisposition toward high negative affect.

Individual differences in emotion regulation prospectively predict early COVID-19 related acute stress.

Preliminary prospective research suggests emotion dysregulation may confer vulnerability to poor stress responses. The present prospective study extends this research by examining both specific emotion regulation strategies and global emotion regulation difficulties in the context of acute stress following onset of the COVID-19 global pandemic in 119 young adults. As part of a larger study, emotion regulation was assessed prior to pandemic onset (January 2019 - February 2020) using two standard measures (Emotion Regulation Questionnaire, ERQ, Gross & John, 2003; Difficulties in Emotion Regulation Scale, DERS, Gratz & Roemer, 2004). A self-report assessment of acute stress was conducted 2-3½ weeks after the COVID-19 pandemic declaration. Results demonstrated cognitive reappraisal and expressive suppression (i.e., ERQ) were not individually predictive of acute stress; however, there was a significant interaction of suppression by reappraisal. Simple effects indicated suppression was negatively associated with acute stress only when reappraisal levels were high. Greater global emotion regulation difficulties (i.e., DERS), particularly nonacceptance of emotions and limited access to emotion regulation strategies, significantly predicted greater acute stress. These results provide further evidence of the temporal relationship between emotion dysregulation and stress reactions, and also suggest the expected effects of emotion regulation strategies may differ across contexts.

Adverse childhood experiences, sex, and cardiovascular habituation to repeated stress.

Adverse childhood experiences (ACEs) are robustly associated with later cardiovascular disease. Alterations in cardiovascular responses to stress may be an underlying mechanism. The present study examined whether ACEs predicted habituation of cardiovascular responses across two acute laboratory stress tasks, and whether this differed between men and women. During a single laboratory visit, 453 healthy young adults completed two identical stress-inducing protocols, each involving a 10-minute baseline and 4-minute acute psychological stress task. Heart rate (HR) and systolic/diastolic blood pressure (S/DBP) were recorded throughout. Participants also completed the Adverse Childhood Experiences scale. Cardiovascular responses habituated from the first to second stress task on average across the entire sample. However, women-but not men-with higher self-reported ACEs displayed less habituation of HR and DBP, but not SBP, across the stress tasks. Results suggest that ACEs may alter the body's ability to adaptively respond to stress exposures in adulthood, specifically in women.

Cynical hostility relates to a lack of habituation of the cardiovascular response to repeated acute stress.

Hostility is associated with increased risk for cardiovascular disease. Heightened cardiovascular reactivity to psychological stress has been proposed as a potential mechanism. Recent work has emphasized a need to measure cardiovascular reactivity across multiple stress exposures to assess potential habituation over time. The aims of the current study were (a) to examine the relationship between each of the three main components of hostility (i.e., emotional, cognitive, and behavioral) and cardiovascular reactivity at two separate stress testing visits and (b) to examine the relationship between hostility components and cardiovascular reactivity habituation. This study utilized previously collected data from the Pittsburgh Cold Study 3. One hundred and ninety-six participants (Mean (SD)[range] age = 29.9 (10.8)[18-55] years, 42.9% female, 67.3% Caucasian) completed 2 separate, identical laboratory sessions, consisting of a 20-min baseline and 15-min stress (Trier Social Stress Test). Heart rate and systolic/diastolic blood pressure were recorded throughout. Reactivity was calculated separately for heart rate, systolic, and diastolic blood pressure (stress-baseline). Participants also completed a modified version of the Cook-Medley Hostility Scale. Results indicated that greater cognitive hostility (i.e., cynicism) was associated with blunted cardiovascular reactivity at Visit 1 and less cardiovascular reactivity habituation between visits, even when controlling for confounding variables. No significant relationships to cardiovascular reactivity or habituation were found for emotional (i.e., hostile affect) or behavioral (i.e., aggressive responding) components. Outcomes for total hostility did not survive adjustment for confounders. These results identify a potential pathway through which hostility, particularly cynicism, contributes to disease risk.

Frequency and perceptions of life stress are associated with reduced cardiovascular stress-response adaptation.

Psychological stress is a risk factor for cardiovascular disease. Individual differences in cardiovascular responses to stress may be an underlying mechanism. The literature examining the relationships between frequency and perceptions of life stress with cardiovascular reactivity to acute stress in the laboratory is inconclusive. Recent work highlights the need to measure cardiovascular reactivity across multiple stress exposures to obtain more comprehensive profiles of reactivity by assessing adaptation over time. The aims of the current study were to examine the relationships between frequency and perceptions of stressful life events with cardiovascular reactivity, as well as adaptation of cardiovascular reactivity over time. Four hundred and fifty-three healthy, young adults (mean (SD) age = 19.5 (1.3) years, 62% female, 66.2% Caucasian, 17.7% Hispanic) completed a single laboratory visit, which included two identical, stress-testing protocols, each consisting of a 10-minute baseline and 4-minute stress task. Heart rate (HR) and systolic/diastolic blood pressure (S/DBP) were recorded throughout. Participants completed the Undergraduate Stress Questionnaire (USQ) and Perceived Stress Scale (PSS). Results indicate that greater frequency and perceptions of life stress were independently associated with blunted HR and DBP reactivity at the first stress exposure and less habituation of HR and DBP reactivity across both exposures, even after controlling for confounding variables. The present study suggests that higher frequency and perceptions of stress in daily life may harm the body's ability to respond effectively to short-term stress and also disrupt healthy adaptation of stress responses over repeated exposures, thus increasing risk of cardiovascular disease outcomes.

State gratitude is associated with lower cardiovascular responses to acute psychological stress: A replication and extension.

Positive affect is associated with more adaptive responses to psychological stress. However, few studies have examined the association between gratitude, a specific type of positive affect, with physiological responses to acute psychological stress. The current study aimed to replicate and extend on previous work examining the associations between state and trait gratitude and cardiovascular stress reactivity in 324 (59.9% female, 67.0% Caucasian, 17.9% Hispanic) healthy participants. State gratitude was measured at the beginning of the laboratory session using the Gratitude Adjective Checklist-Three Items. Trait gratitude was measured using the Gratitude Questionnaire-Six Items. Blood pressure and heart rate reactions to an acute mental arithmetic task were measured. In regression models that adjusted for baseline cardiovascular activity, body mass index, sex, depressive symptomology, performance on the acute mental arithmetic task, and state positive affect, state gratitude was associated with lower systolic blood pressure reactivity. There were no associations between trait gratitude and any of the cardiovascular variables. Results support previous work demonstrating that state, but not trait, gratitude is related to cardiovascular stress reactivity. Higher levels of state gratitude immediately preceding a stressful encounter may be protective.