The misjudgment of interoceptive awareness: Systematic overrating of interoceptive awareness among individuals with lower interoceptive metacognitive skills.

Knowing when perceiving inner bodily signals better and when perceiving them worse is a health relevant but understudied dimension of interoception. Therefore, the present study assessed interoceptive metacognition (IMC) as the skill to adequately monitor interoceptive accuracy in the cardiac domain. We used the Graz Ambulatory Interoception task (GRAIT), which applied two intervals of the heartbeat tracking task 12 times a day for 3 days in total to n = 66 participants. We assessed IMC as the relative correspondence between interoceptive accuracy and the subjective confidence ratings. We found that 6 % of the total IMC variance was due to person, which was assessed reliable (RKRn=0.81). Furthermore, the between-person variation of IMC was negatively associated with the MAIA (especially attention regulation and self-regulation). People who believe that they are aware of their interoceptive experiences (MAIA) showed lower IMC. This study advocates the assessment of interoception in everyday life.

Today's positive affect predicts tomorrow's experience of meaningful coincidences: a cross-lagged multilevel analysis.

The perception of meaningful patterns in random arrangements and unrelated events takes place in our everyday lives, coined apophenia, synchronicity, or the experience of meaningful coincidences. However, we do not know yet what predicts this phenomenon. To investigate this, we re-analyzed a combined data set of two daily diary studies with a total of N = 169 participants (mean age 29.95 years; 54 men). We investigated if positive or negative affect (PA, NA) predicts the number of meaningful coincidences on the following day (or vice versa). By means of a cross-lagged multilevel modelling approach (Bayesian estimation) we evaluated with which of two theoretical assumptions the data are more in line. First, if meaningful coincidences are facilitated by a broader and more flexible thinking style, PA should positively predict meaningful coincidences at the following day. However, if the experience of meaningful coincidences signifies a strategy to cope with negative feeling states, NA should predict the experience of meaningful coincidences during the following day. In favour of a more flexible thinking style, we found that PA predicted the number of perceived coincidences the following day. We did not find any effect for NA, and therefore, no evidence arguing for the coping mechanism hypothesis of meaningful coincidences.

Originalbeiträge (Originals). Primäremotionen und Bindung bei psychischer Störung.

Primaryemotions and attachment in mental disorder Objectives: There is increasing evidence for associations between primary emotions and attachment with mental illness. This study illuminates the mediation relationship of these psychodynamic constructs in relation to psychiatric disorders. METHODS: 921 subjects (69.9 % female) were examined, who completed the questionnaires Brief Affective Neuroscience Personality Scales including a LUST Scale, Experiences in Close Relationships - Revised 8, and ICD-10 Symptom Rating online. A path analysis was conducted to evaluate the mediation effects of attachment anxiety. RESULTS: A disease-specific pattern of direct associations between primary emotions, attachment anxiety, and psychological impairment emerged (all p < .01). Attachment exerted mediating effects primarily for SADNESS (p < .01), and to a lesser extent for LUST and CARE (p > .01).The model provided variance resolution ranging from7%(eating disorders) to 47%(depression). CONCLUSION: The results demonstrate the relevance of affective explanations regarding the development of psychological symptoms, as well as therapeutic implications.

An Investigation of Patients' and Doctors' Autonomic Nervous System Responses Throughout News-Focused Medical Consultations.

Although it is clear that people experience physiological arousal in anticipation of news-focused medical consultations, our knowledge of people's experiences during and throughout these consultations is scarce. We examine interbeat interval responses (IBI) of patients and doctors during real-life medical consultations to understand how the experiences of both parties change throughout these encounters and whether they differ from each other. We also examine how the type of news delivered affects responses. We measured the IBI responses of patients and their oncologists throughout 102 consultations in which providers delivered news (classified as good, bad, or status quo) to patients about a recent computerized tomography scan. We observed two distinct phases of consultations: an initial "news" delivery phase and a subsequent "information" phase. During the news phase, on average, patients' IBI responses rapidly increased-indicating less autonomic arousal over time - whereas doctors' responses did not change over time. In contrast, throughout the information phase, on average, both patients' and doctors' responses remained steady. During the information phase, responses differed based on news type: on average, status quo consultations involved an increase in autonomic arousal, whereas good and bad news consultations involved no changes. Lastly, we observed significant variability in patients' responses during both phases. In sum, on average, patients (but not doctors) experience decreases in autonomic arousal while news is being delivered, suggesting that anticipatory distress regarding these consultations wanes quickly. However, our results also indicate that patients' experiences vary from one another, and future research should focus on factors explaining this variability.

Resilience moderates the relationship between the psychological impact of COVID-19 and anxiety.

Psychological resilience is considered to constitute an important factor for protecting mental health, especially during times of crises, like the COVID-19 pandemic outbreak. However, there is a lack of research on the potential buffering effect of resilience on the psychological impact of COVID-19 as related to mental health. Therefore, the aim of the current study was to examine protective effects of resilience on mental health during the initial stage of the COVID-19 outbreak in Austria. Analysis was based on data collected from 4,113 Austrian residents, who participated in an anonymous online survey. The survey addressed sociodemographic data, the subjective response to COVID-19 (Impact of Event Scale; IES-R), mental health status (Depression Anxiety Stress Scale; DASS-21), and resilience (Resilience-Scale; RS-11). Structural equation modelling showed significant positive associations between the IES-R score and depressive symptoms, stress and anxiety, respectively. Resilience was significantly negatively associated with depression, stress, and anxiety. Furthermore, resilience moderated the relation between the impact of COVID-19 and anxiety symptoms. However, there was no moderating effect of resilience on the relationship between IES-R and both depression and stress. The psychological impact of COVID-19 on anxiety symptoms seems to vary with the level of resilience. Moderating effects of resilience on the relation between impact of COVID-19 and stress and depression symptoms could not be confirmed. Further studies are needed to evaluate the long-term effects of resilience on stress and mental health during the COVID-19 pandemic.

A laboratory medical anamnesis interview elicits psychological and physiological arousal.

Since medical communication can be perceived as stressful, the assessment of patients' physiological arousal and behavior during anamnesis interviews may lead to a better understanding of doctor-patient interactions. Therefore, the aim of this study was to test physiological arousal and word use in a laboratory anamnesis interview. In total, sixty-five participants with a mean age of 25.0 years were randomly assigned either to an experimental group (n = 35, 65.7% women) in which they underwent an anamnesis interview or to a control group (n = 30, 73.3% women). Physiological arousal was assessed by salivary cortisol, salivary alpha-amylase (sAA), heart rate (HR) and heart rate variability (HRV). Psychological arousal was assessed using the Positive and Negative Affect Schedule (PANAS). Anamnesis interviews were analyzed using the Linguistic Inquiry and Word Count text analysis tool (LIWC). Participants of the experimental group showed an increase of sAA, HR and negative affect (p's ≤.0.05). Moreover, higher cortisol area under the curve with respect to ground (AUCg) was associated with lesser use of positive emotion words during the interview and subsequent higher negative affect (p's <.05). These results indicate that talking about one's own and family's medical history in anamnesis interview induces physiological arousal. Our findings suggest that anamnesis interviews could not only induce higher negative affect, but also induce physiological arousal, underscoring the importance of good doctor-patient communication.

Eating Habits and Eating Disorder Associated Behavior in Bipolar Disorder.

ABSTRACT: A relevant comorbidity of bipolar disorder (BD) is eating disorders (EDs). Crossed vulnerability factors as eating disorder-specific symptoms (EDSSs) may trigger the onset of both disorders in either direction. The Structured Inventory for Anorexic and Bulimic Eating Disorders for Self-Report was used to examine the occurrence of EDs in euthymic/subsyndromal individuals with BD ( n = 86) and healthy controls ( n = 86) matched for age and sex. Furthermore, we explored EDSSs with the subscales "general psychopathology and social integration," "bulimic symptoms," "body image and slimness ideal," "sexuality and body weight," "counteract," and "atypical binge." Higher rates of all EDSSs were reported in BD. Younger individuals with BD showed higher expression in "bulimic symptoms," "body image and slimness ideal," and "atypical binge" subscales. No participants fulfilled ED diagnosis. The findings show a link between EDSS and BD. Clinicians should pay attention to a multimodal intervention, considering risk factors, investigating eating habits and ED associated behaviors.

Feelings from the Heart Part II: Simulation and Validation of Static and Dynamic HRV Decrease-Trigger Algorithms to Detect Stress in Firefighters.

Several mobile devices have multiple sensors on board and interact with smartphones. This allows for a complex online evaluation of physiological data, important for interactive psychophysiological assessments, which targets the triggering of psychological states based on physiological data such as heart rate variability (HRV). However, algorithms designed to trigger meaningful physiological processes are rare. One exception is the concept of additional HRV reduction (AddHRVr), which aims to control for metabolic-related changes in cardiac activity. In this study we present an approach, based on data of a previous study, which allows algorithm settings to be derived that could be used to automatically trigger the assessment of psychosocial states by online-analysis of transient HRV changes in a sample of 38 firefighters. Settings of a static and a dynamic AddHRVr algorithm were systematically manipulated and quantified by binary triggers. These triggers were subjected to multilevel models predicting increases of objective stress during a period of 24 h. Effect estimates (i.e., odds) and bootstrap power simulations were calculated to inform about the most robust algorithm settings. This study delivers evidence that a dynamic AddHRVr algorithm can trigger transitions of stress, which should be further validated in future interactive psychophysiological assessments.

Functional coupling of brain networks during creative idea generation and elaboration in the figural domain.

The neuroscientific investigation of creative cognition has advanced by considering the functional connectivity between brain regions and its dynamic changes over time, which are consistent with stages in the ideation process. Surprisingly, although the communication between neuronal networks takes place in a time-scale of milliseconds, EEG studies investigating a time-course in cortico-cortical communication during creative ideation are rare and findings are typically restricted to the verbal domain. Therefore, this study examined functional coupling using EEG (task-related phase-locking in the upper-alpha range) during creative thinking in the figural domain. Using an innovative computerized experimental paradigm, we specifically investigated the stage of idea generation and the stage of idea elaboration in an adapted picture completion task. The findings confirmed a hypothesized increase of functional coupling from idea generation to elaboration, which was most pronounced in frontal-central as well as frontal-temporal networks. The connectivity in the frontal-parietal/occipital network already increased during idea generation and remained constant during elaboration. Importantly, more original participants generally showed higher functional connectivity in all brain networks. This elevated functional coupling with frontal brain regions might reflect increased executive processes related to internal attention, motor planning, and semantic selection processes supporting highly original thought in the figural domain.

Autonomic dysfunction in posttraumatic stress disorder indexed by heart rate variability: a meta-analysis.

BACKGROUND: Changes in autonomic nervous system (ANS) function have been observed in a variety of psychological disorders, including posttraumatic stress disorder (PTSD). Analysis of heart rate variability (HRV) provides insight into the functioning of the ANS. Previous research on PTSD found lower HRV in PTSD patients compared to controls, indicating altered sympathetic and parasympathetic activity, but findings are inconsistent. The purpose of this meta-analysis was to examine differences in HRV indices between individuals with PTSD and healthy controls at baseline and during stress. METHODS: The included primary studies present an aggregate of studies analyzing different HRV indices. Examined HRV indices were standard deviation of the normalized NN-intervals (SDNN), root mean square of successive differences (RMSSD), low-frequency (LF) and high-frequency (HF) spectral components, LF/HF ratio, and heart rate (HR). Moderating effects of study design, HRV and PTSD assessment, and sample characteristics were examined via subgroup-analyses and meta-regressions. RESULTS: Random-effects meta-analyses for HRV parameters at rest revealed significant group differences for RMSSD and HF-HRV, suggesting lower parasympathetic activity in PTSD. The aggregated effect size for SDNN was medium, suggesting diminished total variability in PTSD. A small effect was found for LF-HRV. A higher LF/HF ratio was found in the PTSD sample as compared to controls. Individuals with PTSD showed significantly higher HR. During stress, individuals with PTSD showed higher HR and lower HF-HRV, both indicated by small effect sizes. CONCLUSIONS: Findings suggest that PTSD is associated with ANS dysfunction.

Psychological correlates of COVID-19 pandemic in the Austrian population.

BACKGROUND: COVID-19 poses the greatest challenge for the entire world since the Second World War. Governments are forced to define strict measures to avoid the spreading of the virus, which may further impose psychological burden for the majority of the population. The aim of this study was to evaluate the psychological distress in Austria during the initial stage of the COVID-19 outbreak. METHODS: From 25 March to 3 April 2020, an anonymous online survey was conducted. Target group included all members of the Austrian population older than 16 years. The survey addressed the following areas (1) and sociodemographic data, (2) physical and mental health; (3) knowledge and concerns about COVID-19; (4) contact with infected people; (5) prevention efforts; (6) need for further information. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale (DASS-21) were used to assess mental health. Analyses were based on 4126 individuals (74% female, age: M = 38.68, SD = 13.36). RESULTS: 43.3% rated the psychological impact as moderate (5.6%) or severe (37.7%). 26.5% reported moderate (13.3%) to severe (13.2%) depression; 20.3% moderate (8.9%) to severe (11.4%) anxiety and 21.2% reported to suffer from moderate (10.5%) or severe stress (10.7%). Being female, higher age, lower levels of education, concern about family members, internet as main source of information, student or pupil status, poor self-rated health, and downplaying the seriousness of the problem were significantly associated with higher psychological burden. Protective factors were the possibility to work in home office, frequent (indirect) contact with family or friends, the availability of virus-specific information, confidence in the diagnosis capability, and physical activity during the crisis. CONCLUSION: This study is among the first in Europe on the psychological correlates of the COVID-19 pandemic. 37.7% of the Austrian study population reported a severe psychological impact on the event and 1 in 10 is considered to suffer from severe depression, anxiety or stress. The present findings inform about the identification of protective factors, psychologically vulnerable groups and may guide the development of psychological interventions.

[Use of smartphone apps in secondary stroke prevention]. / Apps in der Sekundärprävention nach Schlaganfall.

Modifiable risk factors such as hypertension, obesity or smoking have been reported to explain up to 90% of risk for ischemic stroke. Treatment of these risk factors is known to decrease the risk of recurrent stroke events. We performed a computer-based literature research from June to August 2018 using the electronic database PubMed to investigate the effect of smartphone apps on risk factor control for secondary stroke prevention as well as feasibility and patient satisfaction with mobile health. Studies evaluating interventions by smartphone or tablet devices in stroke patients and reported results regarding risk factors, feasibility or patient satisfaction were considered (n = 10). Identified data showed significant improvement regarding the control of risk factors hypertension and diabetes as well as significant improvements of the lifestyle risk factors physical inactivity and obesity. Stroke patients perceive smartphone apps mostly as useful and are open-minded regarding mHealth, provided that these complement rather than replace personal medical care.

Creativity is associated with a characteristic U-shaped function of alpha power changes accompanied by an early increase in functional coupling.

Although there exists increasing knowledge about brain correlates underlying creative ideation in general, the specific neurocognitive mechanisms implicated in different stages of the creative thinking process are still under-researched. Some recent EEG studies suggested that alpha power during creative ideation varies as a function of time, with the highest levels of alpha power after stimulus onset and at the end of the creative thinking process. The main aim of the present study was to replicate and extend this finding by applying an individual differences approach, and by investigating functional coupling between long distance cortical sites during the process of creative ideation. Eighty-six participants performed the Alternate Uses (AU) task during EEG assessment. Results revealed that more original people showed increased alpha power after stimulus onset and before finalizing the process of idea generation. This U-shaped alpha power pattern was accompanied by an early increase in functional communication between frontal and parietal-occipital sites during the creative thinking process, putatively indicating activation of top-down executive control processes. Participants with lower originality showed no significant time-related variation in alpha power and a delayed increase in long distance functional communication. These findings are in line with dual process models of creative ideation and support the idea that increased alpha power at the beginning of the creative ideation process may indicate more associative modes of thinking and memory processes, while the alpha increases at later stages may indicate executive control processes, associated with idea elaboration/evaluation.

Synchronization of intrinsic 0.1-Hz blood-oxygen-level-dependent oscillations in amygdala and prefrontal cortex in subjects with increased state anxiety.

Low-frequency oscillations with a dominant frequency at 0.1 Hz are one of the most influential intrinsic blood-oxygen-level-dependent (BOLD) signals. This raises the question if vascular BOLD oscillations (originating from blood flow in the brain) and intrinsic slow neural activity fluctuations (neural BOLD oscillations) can be differentiated. In this study, we report on two different approaches: first, on computing the phase-locking value in the frequency band 0.07-0.13 Hz between heart beat-to-beat interval (RRI) and BOLD oscillations and second, between multiple BOLD oscillations (functional connectivity) in four resting states in 23 scanner-naïve, anxious healthy subjects. The first method revealed that vascular 0.1-Hz BOLD oscillations preceded those in RRI signals by 1.7 ± 0.6 s and neural BOLD oscillations lagged RRI oscillations by 0.8 ± 0.5 s. Together, vascular BOLD oscillations preceded neural BOLD oscillations by ~90° or ~2.5 s. To verify this discrimination, connectivity patterns of neural and vascular 0.1-Hz BOLD oscillations were compared in 26 regions involved in processing of emotions. Neural BOLD oscillations revealed significant phase-coupling between amygdala and medial frontal cortex, while vascular BOLD oscillations showed highly significant phase-coupling between amygdala and multiple regions in the supply areas of the anterior and medial cerebral arteries. This suggests that not only slow neural and vascular BOLD oscillations can be dissociated but also that two strategies may exist to optimize regulation of anxiety, that is increased functional connectivity between amygdala and medial frontal cortex, and increased cerebral blood flow in amygdala and related structures.

Life Satisfaction and Hemodynamic Reactivity to Mental Stress.

BACKGROUND: Satisfaction with life has been considered a health-protective variable, which could impact cardiovascular morbidity and mortality. However, few studies have examined the physiological pathways involved in the potentially salutary effect of life satisfaction. It was hypothesized that life satisfaction should be associated with a cardiovascular response profile that signals challenge (i.e., higher cardiac output, lower peripheral resistance), rather than threat during a mental stress task. METHODS: A sample of 75 healthy, medication-free men without clinical signs of psychological disorders who worked full-time and occupied highly demanding positions participated in this study. They performed two mental stress tasks (n-back) with varying degrees of difficulty. The tasks were embedded between a baseline and a recovery period. Cardiovascular and hemodynamic variables (heart rate, blood pressure, cardiac output, total peripheral resistance) were recorded by means of impedance cardiography. RESULTS: Individuals who were more satisfied with their life displayed higher cardiac output and lower peripheral resistance levels during the stress tasks, indicating a challenge rather than a threat profile. Findings were robust when controlled for physical activity, smoking, age, and depressive symptoms. CONCLUSIONS: Life satisfaction could be positively correlated with beneficial hemodynamic stress reactivity, indicating that individuals with higher levels of life satisfaction can more adaptively cope with stress. Increased cardiac output and decreased peripheral resistance during stress may constitute one route through which life satisfaction can benefit health.

Daily positive affect and nocturnal cardiac activation.

BACKGROUND: Positive affect (PA) has been suggested to benefit health via psychobiological pathways. Studies found higher cardiac vagal tone in individuals who exhibit a positive emotional style. PURPOSE: This study aimed to examine the relationship between momentary-assessed PA and nocturnal heart rate (HR) and heart rate variability (HRV) in everyday life. METHODS: Participants were 60 healthy adults who provided multiple ratings of activated (e.g., dynamic, activated) and deactivated PA (e.g., relaxed, even-tempered) and negative affect (NA) throughout one day. HR and HRV were recorded the subsequent night. RESULTS: Aggregated deactivated PA throughout the day was associated with higher nocturnal HRV and lower HR. Activated PA and NA were unrelated with both cardiac variables. Findings were independent of other demographic and behavioral confounds. CONCLUSIONS: Feeling relaxed, calm, content, and even-tempered throughout the day might have beneficial effects on the heart during sleep, although the causality of this effect remains speculative because of the correlational design of this study.

Cognitive Avoidant Coping Is Associated with Higher Carotid Intima Media Thickness Among Middle-Aged Adults.

BACKGROUND: Cognitive avoidant coping (CAV) has been associated with elevated autonomic stress reactivity, thus presumably elevating risk for cardiovascular diseases. However, more direct evidence for this hypothesis is lacking. PURPOSE: The purpose of this study was to relate carotid intima media thickness (IMT) to CAV in nonclinical participants. METHODS: A total of 124 participants (61 women) with a mean age of 37.52 years (SD = 7.93, MIN = 30, MAX = 60) participated in the study. IMT was assessed by ultrasonic imaging and CAV via questionnaire (Mainz Coping Inventory; MCI). RESULTS: Regression analysis revealed that although CAV was not significantly associated with IMT, there was a significant interaction of CAV and age. Whereas for younger adults, there was no significant relation for older individuals, CAV and IMT were significantly positively associated. CONCLUSIONS: Findings suggest that CAV could constitute a risk factor for cardiovascular diseases with increasing age.

The cardiac correlates of feeling safe in everyday life: A Bayesian replication study.

BACKGROUND: Feeling safe and secure has been proposed to dampen autonomic arousal and buffer threat responses. In a previous study, we could show that momentary ratings of subjective safety were associated with elevated heart rate variability (specifically, root mean square of successive differences; RMSSD) and lower heart rate in everyday life, thus suggesting a health-protective role of feeling safe. METHODS: This study aimed to replicate this effect in a sample of N = 79 adults, applying Bayesian statistics with prior effects of the original study. RESULTS: Using an ecological momentary assessment (EMA) across three days we could replicate the effect of lower heart rate and higher RMSSD in moments when participants felt more safe. In accordance with the original study, we could also show that the effect on heart rate were independent of RMSSD, thus suggesting a contribution of sympathetic activity to this effect. CONCLUSION: The findings confirm the connection between momentary feelings of safety and cardiac regulation, thus substantiating research on the health-protective role of psychological safety.

Acute fasting modulates autonomic nervous system function and ambulatory cardiac interoception.

Intermittent fasting has been associated with diverse physical and psychological health benefits. According to previous research, fasting-induced alterations in psychophysiological functioning should facilitate the accurate detection of an internal bodily signal (like the heart), which is referred to as interoceptive accuracy. In two within-subjects studies we aimed to examine whether an intermittent fasting protocol (i) evokes distinct autonomic nervous system changes in the laboratory and (ii) improves (objectifiable) interoceptive accuracy and sensibility (i.e., the subjective belief in perceiving bodily signals) in everyday life. Study 1 (N = 36) found increasing heart rate variability (precisely, the root mean square of successive differences; RMSSD) accompanied by a more vascular than myocardial response following a 16 h fast. Study 2 (N = 40) applied an ecological momentary assessment design including intermittent fasting (8 h normal eating followed by 16 h fasting) and normal eating (24 h normal eating) for three consecutive days each. Findings suggested a tendency toward higher interoceptive accuracy and sensibility during the fasting regimen, which was particularly pronounced in individuals exhibiting lower RMSSD. Together, findings suggest that (short-term) fasting seems to facilitate momentary attention to organismic cues due to alterations in autonomic nervous system function.

Influence of anxious attachment on the relationship between primary emotions and substance-related addictive behaviors.

Objectives: To date there is no universally accepted model that describes the development of substance related addictive behavior. In order to address this gap, the study sought to examine whether the association between primary emotions and the inclination toward addictive behavior is mediated by an anxious attachment style. Methods: The total sample consisted of 900 German speaking non-clinical adults (age: M = 27; SD = 9.60; 71.6% female). Structural Equation Modeling (SEM) was applied to examine the connection between the primary emotions (SADNESS and ANGER), and the latent variables attachment anxiety and symptoms of addictive behavior. Results: Substance use symptomatology was correlated with higher attachment anxiety (r = 0.15), SADNESS (r = 0.15), and ANGER (r = 0.11). The effect of SADNESS on addictive behavior is mediated by attachment anxiety (p < 0.01) whereas ANGER had a direct effect on addictive behavior (p < 0.01). The final SEM explains 4% of the variance of addictive behaviors and 22% of attachment anxiety. Conclusion: Our findings suggest that both SADNESS and ANGER, along with attachment anxiety, are dispositions that contribute to the risk of engaging in addictive behavior. However, while ANGER directly influences addictive behavior, SADNESS acts through its impact on attachment anxiety.