The Use of Rumination and Reappraisal in Adolescents Daily Life: Links to Affect and Emotion Regulation Style.

This study explored the association between temperament-i.e., positive affect (PA) and negative affect (NA)-and emotion regulation (ER), and what momentary factors influence the selection of rumination or reappraisal during adolescents' daily life. The type of social situation in which negative events occurred, the self-rated degrees of discomfort, the types of predominant emotions experienced, and the use of reappraisal and rumination were assessed at 24 different times with an ecological momentary assessment approach given to 71 adolescents. PA, NA, and ER style were evaluated using self-reports. Bivariate Pearson correlations analysis revealed that NA and negative ER style correlated positively with the rumination use whereas PA correlated negatively with the rumination use. Negative ER style moderated the relationship between NA and the frequency with which rumination was used. The moderated function of positive ER style could not be tested due to its lack of association with the rumination use. Adolescents selected rumination more often during family-related events and when experiencing depression-like emotions. No interaction effects were shown between negative ER style and the momentary factors related with the type of social situation and the type of prevailing emotion during negative event. No associations between study variables and reappraisal were found. This study provides a better understanding of ER patterns in adolescence.

Decrements in Adolescent Cardiac Complexity During Mother-Adolescent Conflicts.

The present study aimed to provide further evidence on the usefulness of non-linear cardiac measures when examining the output of the cardiac system. Scale-invariant self-similarity and entropy, in addition to heart rate variability (HRV) given by time- and frequency-domain measures were calculated in a sample of N = 55 healthy adolescents (Mage = 14.122, SDage = 0.698) during 10-min positive (non-stressful) and negative (stressful) interactions with their mothers. We also explored sex influence in adolescents' cardiac output using both HRV measures and non-linear cardiac measures. Repeated measures MANOVA revealed a marginal within-group effect for HRV measures, F(3,51) = 2.438, p = 0.075, η2p = 0.125), and a significant within-group effect for non-linear cardiac measures, F(6, 48) = 3.296, p = 0.009, η2p = 0.292, showing a significant decrement in adolescents' cardiac complexity during the negative interaction. No significant effect for sex was found in either non-linear cardiac measures or HRV measures, but results suggest lower cardiac scaling in females than in males. These findings suggest a real-time scale predominance in heart rate output when adolescents face an aversive situation and support the importance of non-linear cardiac measures to gain insight into the cardiac system and its regulatory mechanisms. Further research is needed to examine sex-differences in cardiac complexity during aversive situations.

Adolescents at risk of anxiety in interaction with their fathers: Studying non-verbal and physiological synchrony.

Adolescence is a vulnerable period in terms of the onset of anxiety disorders, and dyadic parent-adolescent interactions may play a key role in either increasing or reducing the risk of psychopathologies. This study examines the presence of physiological synchrony (specifically, linkage in interbeat interval series) and non-verbal synchrony in positive and negative interactions between adolescents (aged 13-16) and their fathers. Non-verbal synchrony was quantified through the coordination of the interactants' body movements, using an automated video-analysis algorithm (motion energy analysis). Participants were made up of 53 parent-adolescent dyads, the latter at either low (n = 28) or high (n = 25) risk of anxiety. Adolescents at low risk of anxiety displayed statistically significant levels of non-verbal synchrony with their fathers during positive interactions. Non-verbal synchrony was not found in the father-adolescent dyads featuring adolescents at high risk of anxiety. Physiological synchrony was not significantly present above chance level in either of the groups of adolescents. Overall, the results suggest that adolescents at high risk of anxiety may have difficulties in managing non-distressing interactions with their fathers. The results also suggest that physiological synchrony is not a straightforward phenomenon.

Anxiety in Early Adolescence: Heterogeneous Developmental Trajectories, Associations with Risk Factors and Depressive Symptoms.

This study aimed: (1) to identify heterogeneous trajectories of anxiety symptoms in early adolescence; (2) to analyze the relationships between risk factors and identified trajectories; (3) to study the association between anxiety symptom trajectories and depression symptom course. Anxiety and depressive symptoms of 825 participants (44.40% boys; mean initial age = 13.01, SD = 0.56) was assessed every 6 months over an 18-month period. Trajectory identification relied on latent-variable approach. As a result, 2-4 trajectories were identified for social phobia (SP), generalized anxiety (GA) and panic symptoms, revealing at least a low-symptom course and a trajectory of elevated symptoms (at-risk trajectory). Being girl and sibling cohabitation were related to at-risk trajectories, and a course of low effortful control and heightened negative affectivity. Finally, SP and GA symptoms were related to heightened depressive symptom courses. Relevant implications towards tailored prevention and intervention are highlighted to promote a healthy development across adolescence.

Differences in Autonomic Flexibility in Adolescents with Distinct Emotion Regulation Styles during Acute Stress.

An inverted U-shaped pattern in heart rate (HR) and a U-shaped pattern in heart rate variability (HRV) are easily recognizable when individuals experience any acute stressor. How cardiac complexity (scaling and entropy) changes under acute stress is not well known. Psychologically, emotion regulation (ER) style is likely to influence the individual's specific behavioral response when affronting stress. This study tested whether adolescents with distinct ER styles would show different patterns of linear and nonlinear cardiac changes under stressful conditions. We predicted less autonomic flexibility for adolescents with a highly negative emotional regulation (HNER) style (n = 10) than for those adolescents with a highly positive emotional regulation (HPER) style (n=10). Further, associations between linear and nonlinear measures during each condition were examined for each group. Repeated measures ANOVAs revealed that HR and HRV changed according to the predicted pattern. Higuchi's fractal dimension and Sample Entropy followed a U-shaped pattern, whereas the short-term scaling exponent followed the reverse pattern. Cardiac changes across conditions were larger in the HPER group. Significant associations between linear and nonlinear measures were found in the HPER group but not in the HNER group. Results are cautiously discussed within a multiscale framework of fluctuations of the different cardiac features.

Adolescents' Positive Cognitive Emotion Regulation Predicts Heart Trajectories During a Mother-Adolescent Conflict Interaction.

This paper aimed to (a) validate a novel technique that quantifies the length of the trajectories the cardiac system follows within a two-dimensional state-space, and (b) test its usefulness to better understand how cognitive emotion regulation (CER) style is associated with cardiac output. A positive CER style was assessed in a sample of healthy adolescents (n = 57), and mean and total distances, in addition to heart rate variability (HRV) measures and cardiac entropy (SampEn), were calculated during a conflict discussion with the adolescents' mothers. Associations between distances and HRV measures in time and frequency-domains and SampEn were examined to better understand the physiological meaning of distances; further, whether a positive CER style would predict distances, HRV, and SampEn. Correlation analysis revealed that associations of distances with time-domain HRV measures were stronger than associations with frequency-domain HRV measures, while correlations between distances and SampEn were moderate. Hierarchical multiple regression analysis revealed that a positive CER style predicted distances and SampEn, but not HRV measures. Distances are clearly time-domain measures of HRV, but only partly capture the complexity of the heart signal. The results highlight the importance of assessing heart rate dynamics beyond HRV in the study of CER.

Nociception Coma Scale-Revised: Nurses' Experience in Clinical Practice.

BACKGROUND: The Nociception Coma Scale-Revised (NCS-R) is a rating scale developed and validated for measurement of nociception and pain among patients with brain injuries in unresponsive wakefulness syndrome or minimally conscious state. However, little is known about its use in daily clinical practice. AIMS: The aim of this study was to explore clinical experience with the NCS-R by means of focus group interviews with nurses and nurse assistants in a subacute rehabilitation ward for patients with severe brain injuries. DESIGN: Qualitative focus group interview study. SETTINGS: Department for highly specialized neurorehabilitation for patients with severe brain injuries. PARTICIPANTS/SUBJECTS: Nurses and nurse assistants. METHODS: In total, 12 experienced registered nurses and nurse assistants participated in two recorded focus group interviews. The participants were selected from the subacute neurorehabilitation ward on the following criteria: Employed at the ward for at least 11 months and being introduced to and having experience with using the NCS-R in own patients for a minimum period of 6 months. An inductive qualitative analysis was conducted by reading the interview text through several times, and meaning units were defined first separately and later jointly between the authors. Then meaning units were coded and categorized into subthemes and themes. RESULTS: We found three themes, general relevance of the NCS-R, NCS-R versus level of consciousness, and overall assessment of pain in patients with disorders of consciousness, with a total of eight subthemes. CONCLUSIONS: The content and subscales of the NCS-R are relevant for pain assessment in patients with severe brain injury in subacute rehabilitation. However, with the present cutoff value at 4 points, challenges are associated with using NCS-R, especially in patients with unresponsive wakefulness syndrome because they are at risk of not being assessed with respect to pain.

How Far has Your Heart Travelled? Examining Heart System Trajectories in State Space.

This paper introduces a new measure to evaluate heart output from a dynamical systems approach. The measure is based on the time delay technique for two-dimensional state space reconstruction from time series of interbeat intervals. The system's trajectories within this space are depicted and the mean distance, as well as the total and maximum distances travelled by the system, are calculated in pixels. Preliminary data from adolescents with highly positive emotional regulation (HPER) style (n=10) and adolescents with highly negative (HNER) style (n=10) who underwent a protocol of stress induction show the usefulness of the new metrics to distinguish the dynamical behavior of the heart systems from these groups. Repeated measures ANOVAs revealed that changes in all three distances across conditions (baseline, anticipation of stress, exposure to stress, and recovery) were significant in the HPER group but not in the HNER group. As to the physiological meaning of the new measure a correlational analysis revealed that associations with time-domain HRV measures were stronger than associations with frequency-domain HRV measures in both groups. Because of the small sample size, bootstrap resampling was used to obtain confidence intervals. Distances calculated with the new measure are sensitive to the ER-related cardiac flexibility under acute stress conditions. However, the physiological meaning of the new indices remains unclear.

Sustained Anxiety Scores are Associated with the Fractal Dynamics of the Heartbeat in Early Adolescents.

The risk of suffering anxiety disorders is associated with sustained subthreshold symptoms of anxiety. This study evaluated the stability of anxiety scores (high, moderate or low) across a six-month period in early adolescents (N = 95). The associations between sustained anxiety, vagally-mediated heart rate variability (vmHRV), sympathetic activity, and heart rate fractal dynamics in everyday life conditions were analyzed. The anxiety scores from 71.50% of participants remained at the same level. The linear correlations between anxiety and cardiac measures were weak but a group-based approach revealed that the fractal dimension (FD) from stable-low anxiety participants was higher than the FD from participants with stable-moderate anxiety scores but not higher than the FD from the stable-high anxiety group. The short-term correlations' exponent a1 from the stable-high anxiety group was higher than the a1 from the stable-moderate anxiety group but not higher than the exponent from the stable-low anxiety group. No differences were found in the vmHRV nor sympathetic activity. The lack of a direct association between the complexity of the heart rate and the level of sustained anxiety suggests a nonlinear pattern of associations that would be in accordance with the optimum variability principle.

Impaired cardiac profile in adolescents with an increasing trajectory of anxiety when confronting an acute stressor.

Maladaptive patterns of cardiac adjustment to stress in adolescents may reveal their vulnerability to anxiety disorders (ADs). Traditional research in this field has focused on anxiety levels, whereas the time course of anxiety has rarely been considered. Nevertheless, since overall anxiety decreases as adolescence progresses, increasing time courses are clinically relevant and can be associated with maladaptive contextual adjustment. In this study, the cardiac pattern of adjustment to stress in adolescents with increasing anxiety was analysed. A sample of 44 adolescents (M = 14.88 years, SD = 0.53, 45.45% boys) were exposed to a socially relevant stress induction protocol, and their cardiac functioning was recorded. Participants with a trajectory of increasing anxious symptomatology over a 12-month period (n = 24) showed attenuated heart rate levels in the stage of maximum stress in comparison to their non-increasing anxious counterparts (p < 0.05), as well as a heightened pattern of sample entropy throughout the stress induction (p < 0.05). These findings suggest a loss of cardiac flexibility in those adolescents at risk of ADs when confronting an acute stressor.

Allometric Control of Affective Fluctuations in Early Adolescents: Their Association with Anxiety Symptoms and Temperament Traits.

Many physiological systems are multistable, i.e. they operate at different time scales under an allometric control process. The multistability of affective fluctuations has been clearly illustrated in a sample of adults, but little is known about their dynamics in adolescents. The main aim of this study was to determine whether affective fluctuations in adolescents show multistability and to explore their relationship with anxiety symptomatology and temperamental factors. Twenty-five early adolescents self-reported their daily mood, anxiety and worry levels twice a day over a 100-day period. The time series were analysed using the allometric aggregation method to obtain the scaling exponent h. Almost all the (Hurst) scaling exponents were 0.5 > h > 1. The worry exponents were related to temperament factors, whereas the anxiety exponents were related to social phobia symptoms. The results substantiate that affective fluctuations in adolescents are multistable, lending support to the presence of allometric control mechanisms.

Heart rate complexity and attentional orienting: a new look at the role of vagal tone.

This study is aimed at elucidating (a) whether heart rate (HR) complexity measures are associated with the attentional orienting function, and (b) which of these measures better predicts orienting efficiency indexes. Vagal tone, sample entropy, scaling exponents ?1 and ?2, and fractal dimension (FD) were calculated in HR time series (n=109). Vagal tone, entropy, and FD were positively associated with orienting, while this association was negative for ?2. These results show that HR scaling properties, which underlie the role of vagal tone and reflect allometric control mechanisms, are associated with orienting deficits. FD was the best predictor of attentional orienting.

Attentional control, attentional network functioning, and emotion regulation styles.

Attentional network functioning in emotionally neutral conditions and self-reported attentional control (AC) were analysed as predictors of the tendency to engage in dysfunctional emotion regulation strategies. Diminished attentional orienting predicted an increased tendency to engage in brooding rumination, and enhanced alertness predicted a greater chance of suppression, beyond trait anxiety and self-reported AC, which were not predictive of either rumination or suppression. This is the first study to show that some forms of dysfunctional emotion regulation are related to the attentional network functioning in emotionally neutral conditions. Results are discussed in relation to regulatory temperament and anxiety-related attentional biases literature.

Distinguishing youths at risk for anxiety disorders from self-reported BIS sensitivity and its psychophysiological concomitants.

The aim of the study was to explore the psychophysiological concomitants of self-reported behavioral inhibition system (BIS) sensitivity in adolescents (12 to 17 years old) supposed to be at risk for anxiety disorders. Twenty participants with high scores in self-reported BIS sensitivity (at-risk group) were matched in age and sex to 20 participants scoring in the normal range in BIS sensitivity (control group). Negative affect, negative emotion regulation style, and anxiety symptomatology were assessed by means of self-reported measures. Cardiac and electrodermal response signals were recorded during baseline, paced breathing, exposure to an attentional task with response cost and fear-relevant slides conditions. The at-risk group exhibited higher scores on measures of negative affect, negative emotion regulation style, and anxiety symptomatology than their control counterparts. After controlling for negative styles of emotion regulation, groups did not differ in skin conductance reactivity during the attentional task with response cost, but participants at risk exhibited more nonspecific skin conductance responses than the control group during baseline recording. Regarding the cardiac concomitants, participants at risk presented lower vagal tone at resting conditions as compared to participants in the control group. Additionally, at-risk participants exhibited lower flexibility across experimental conditions in heart rate and cardiac sample entropy measures than participants in the control group. These findings add knowledge on psychophysiological concomitants of BIS sensitivity and are discussed in light of associations between temperament and development of anxiety disorders in youth. They show how psychophysiological patterns observed in resting conditions could be useful endophenotypes to reliably detect individuals at risk before the disorder onset.

Self-focused cognitive emotion regulation style as associated with widespread diminished EEG fractal dimension.

The cognitive regulation of emotions is important for human adaptation. Self-focused emotion regulation (ER) strategies have been linked to the development and persistence of anxiety and depression. A vast array of research has provided valuable knowledge about the neural correlates of the use of specific self-focused ER strategies; however, the resting neural correlates of cognitive ER styles, which reflect an individual's disposition to engage in different forms of ER in order to manage distress, are largely unknown. In this study, associations between theoretically negative ER style (self-focused or not) and the complexity (fractal dimension, FD) of the resting EEG at frontal, central, parietal, and occipital regions were investigated in 58 healthy volunteers. The Cognitive Emotion Regulation Questionnaire was used as the self-report measure of ER style. Results showed that a diminished FD over the scalp significantly correlated with self-focused ER style scores, even after controlling for negative affect, which has been also considered to influence the use of ER strategies. The lower the EEG FD, the higher were the self-focused ER style scores. Correlational analyses of specific self-focused ER strategies showed that self-blaming and rumination were negatively associated with diminished FD of the EEG, but catastrophizing and blaming others were not. No significant correlations were found for ER strategies more focused on situation or others. Results are discussed within the self-organized criticality theory of brain dynamics: The diminished FD of the EEG may reflect a disposition to engage in self-focused ER strategies as people prone to ruminate and self-blame show a less complex resting EEG activity, which may make it more difficult for them to exit their negative emotional state.

Complexity of everyday life heart rate dynamics and attentional control in healthy students.

Effective regulation of emotions requires the ability to voluntarily manage attention, i.e. attentional control (AC), which has been related to heart rate variability and vagal tone in laboratory based research. In this study, we calculated the correlation dimension (CD), the fractal-like properties (scaling exponents ?1 and ?2, and fractal dimension) and the sample entropy of heart rate time series obtained from ECG recordings (4 hours long each) taken from a sample of healthy students (n=47) during everyday activities. AC was assessed through a self-reported questionnaire. As expected, a linear positive correlation was found between AC scores and CD and entropy, but no associations were found between AC and ?1 and fractal dimension. The association between AC and ?2 was negative and marginally significant. No associations were found between AC and linear heart rate variability measures. These results show that nonlinear measures of long, everyday life, heart rate time series may provide useful information about the AC ability of healthy students.

Effects of temperament and emotion regulation styles in determining negative emotional states.

INTRODUCTION: The interplay of reactive and regulatory temperamental processes appears to be essential for a better understanding of emotional states and disorders. In this study we explored the prospective relationship between reactive temperament (negative affect), regulatory temperament (effortful control), negative emotion regulation styles (rumination and suppression) and self-recorded anxiety, worry, and avoidance in naturalistic conditions. METHOD: Thirty-two young adults were first assessed through questionnaires on negative affectivity, effortful control, and two forms of negative emotion regulation (rumination and suppression). After this they recorded anxiety, worry, and avoidance three times a day over 50 consecutive days through an on-line access electronic diary. RESULTS: High levels of negative affect and low levels of effortful control were associated with higher levels of anxiety, worry, and avoidance (p<.01). The prospective association between negative affectivity and avoidance was moderated by effortful control (Total R(2)=.49). Moreover, the brooding facet of rumination totally mediated the association between negative affect and anxiety with a significant indirect effect (Effect=.30, Boot CI95%=.09 to .69). CONCLUSIONS: Avoidance patterns are significantly determined by negative affect--effortful control interaction and rumination, especially brooding, totally mediates the relationship between negative affect and anxiety.

Temperamental Change in Adolescence and Its Predictive Role on Anxious Symptomatology.

Growing evidence supports the hypothesis that temperamental traits are not static throughout adolescence. The known links between both reactive and regulatory temperament and anxiety symptoms should be investigated bearing this hypothesis in mind. This study collected self-reported data on behavioral inhibition system (BIS) sensitivity, attentional control (AC), and anxiety symptomatology, from 296 adolescents (64.2% girls; M = 12.96 years at the first assessment, SD = 0.47) every six months, four times over eighteen months. The relationships between temperament factors (AC and BIS sensitivity), considered longitudinally (by means of their trajectories) and anxiety symptoms were investigated using Multigroup Latent Growth Modeling (MLGM), as well as the mediating effect of sex on trajectories and anxiety. BIS sensitivity decreased over time and showed differential patterns across sexes. AC remained relatively stable and we found no sex influence on its trajectory. On the other hand, we observed that the BIS sensitivity trajectory was a significant predictor of anxiety symptomatology at age 15. In conclusion, temperamental changes between the ages of 13 and 15 seem to play a relevant role in explaining subsequent anxiety symptomatology, under the mediating influence of sex.

Slope of change throughout exposure treatment for flight phobia: the role of autonomic flexibility.

This study tested the hypothesis that flight-phobic patients experience change at different rates even when they are receiving identical treatment. Faster within-session rates of change (WSRC) were expected for patients who required fewer exposure sessions. The study also tested the theoretical role of autonomic flexibility on WSRC. High flexibility should be associated with faster rates of change. Thirty-seven flight-phobic patients were successfully treated with a computer-assisted fear of flying treatment. A significant negative correlation was found between total number of sessions and WSRC: The fewer sessions patients attended, the faster their rate of change was. The role of autonomic flexibility was partially supported: A significant correlation between heart rate variability and WSRC revealed that flexible patients improved faster than less-flexible patients.

Emotion Regulation Style and Daily Rumination: Potential Mediators between Affect and Both Depression and Anxiety during Adolescence.

Adolescence is a vulnerable period for depressive and anxious symptom development, and emotion regulation (ER) may be one mechanism linking temperament-i.e., positive affect (PA) and negative affect (NA)-with such symptomatology. Rumination is a common ER strategy that is traditionally assessed using self-reported questionnaires, but it would also be interesting to examine it with an Ecological Momentary Assessment (EMA) approach. Sixty-five adolescents (Mage = 14.69; SDage = 0.82; range = 14-17 years old; 53.80% girls) completed self-report measures of temperament, ER style, depression and anxiety, and underwent an EMA to investigate rumination use. Results revealed that negative ER style and rumination use mediated the relationship between NA and depression, while only rumination use mediated the relationship between PA and depression. Moreover, NA contributed to increase anxiety, but negative ER style did not significantly mediate this relationship. Rumination use also had no effect on anxiety. This study provides further support for the relationship between temperament, ER, and internalizing problems. It seems that both a negative ER style and rumination use mediate the relationship between NA and depression whereas only NA had a significant direct effect on anxiety. Furthermore, PA buffered the effect of rumination use on depression in this study.