Alexithymia predicts arousal-based processing deficits and discordance between emotion response systems during emotional imagery.

Alexithymia is believed to involve deficits in emotion processing and imagery ability. Previous findings suggest that it is especially related to deficits in processing the arousal dimension of emotion, and that discordance may exist between self-report and physiological responses to emotional stimuli in alexithymia. The current study used a well-established emotional imagery paradigm to examine emotion processing deficits and discordance in participants (N = 86) selected based on their extreme scores on the Toronto Alexithymia Scale-20. Physiological (skin conductance, heart rate, and corrugator and zygomaticus electromyographic responses) and self-report (valence, arousal ratings) responses were monitored during imagery of anger, fear, joy, and neutral scenes and emotionally neutral high arousal (action) scenes. Results from regression analyses indicated that alexithymia was largely unrelated to responses on valence-based measures (facial electromyography, valence ratings), but that it was related to arousal-based measures. Specifically, alexithymia was related to higher heart rate during neutral and lower heart rate during fear imagery. Alexithymia did not predict differential responses to action versus neutral imagery, suggesting specificity of deficits to emotional contexts. Evidence for discordance between physiological responses and self-report in alexithymia was obtained from within-person analyses using multilevel modeling. Results are consistent with the idea that alexithymic deficits are specific to processing emotional arousal, and suggest difficulties with parasympathetic control and emotion regulation. Alexithymia is also associated with discordance between self-reported emotional experience and physiological response to emotion, consistent with prior evidence.

Acoustic startle and prepulse inhibition predict smoking lapse in posttraumatic stress disorder.

Most smokers who attempt to quit lapse within the first week and are ultimately unsuccessful in their quit attempt. Nicotine withdrawal exacerbates cognitive and attentional problems and may be one factor in smoking relapse. The startle reflex response and prepulse inhibition (PPI) of the response are sensitive to arousal and early attentional dysregulation. The current study examined whether startle response and PPI are related to early smoking lapse, and if this differs in people with and without posttraumatic stress disorder (PTSD). Participants with (N = 34) and without (N = 57) PTSD completed a startle reflex and PPI assessment during (1) ad lib smoking (2) on the first day of abstinence during a quit attempt. Most (88%) participants lapsed within the first week of the quit attempt. PTSD status predicted shorter time to lapse. Larger startle magnitude and greater PPI predicted a longer duration before smoking lapse. When diagnostic groups were examined separately, greater PPI predicted a longer successful quit attempt only in participants with a PTSD diagnosis. The startle reflex response and PPI may provide an objective, neurophysiological evaluation of regulation of arousal and early attentional processes by nicotine, which are important factors in smoking cessation success.

Enhancing the benefits of written emotional disclosure through response training.

Writing about a personal stressful event has been found to have psychological and physical health benefits, especially when physiological response increases during writing. Response training was developed to amplify appropriate physiological reactivity in imagery exposure. The present study examined whether response training enhances the benefits of written emotional disclosure. Participants were assigned to either a written emotional disclosure condition (n=113) or a neutral writing condition (n=133). Participants in each condition wrote for 20 minutes on 3 occasions and received response training (n=79), stimulus training (n=84) or no training (n=83). Heart rate and skin conductance were recorded throughout a 10-minute baseline, 20-minute writing, and a 10-minute recovery period. Self-reported emotion was assessed in each session. One month after completing the sessions, participants completed follow-up assessments of psychological and physical health outcomes. Emotional disclosure elicited greater physiological reactivity and self-reported emotion than neutral writing. Response training amplified physiological reactivity to emotional disclosure. Greater heart rate during emotional disclosure was associated with the greatest reductions in event-related distress, depression, and physical illness symptoms at follow-up, especially among response trained participants. Results support an exposure explanation of emotional disclosure effects and are the first to demonstrate that response training facilitates emotional processing and may be a beneficial adjunct to written emotional disclosure.

A test of Spielberger's state-trait theory of anger with adolescents: five hypotheses.

Spielberger's state-trait theory of anger was investigated in adolescents (n = 201, ages 10-18, 53% African American, 47% European American, 48% female) using Deffenbacher's five hypotheses formulated to test the theory in adults. Self-reported experience, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) responses to anger provoking imagery scripts found strong support for the application of this theory to adolescents. Compared with the low trait anger (LTA) group, adolescents with high trait anger (HTA) produced increased HR, SBP, and DBP, and greater self-report of anger to anger imagery (intensity hypothesis) but not greater self-report or cardiovascular reactivity to fear or joy imagery (discrimination hypothesis). The HTA group also reported greater frequency and duration of anger episodes and had longer recovery of SBP response to anger (elicitation hypothesis). The HTA group was more likely to report negative health, social, and academic outcomes (consequence hypothesis). Adolescents with high hostility reported more maladaptive coping with anger, with higher anger-in and anger-out than adolescents with low hostility (negative expression hypothesis). The data on all five hypotheses supported the notion that trait anger is firmly entrenched by the period of adolescence, with few developmental differences noted from the adult literature.

Efficacy of a cognitive-behavioral treatment for insomnia and nightmares in Afghanistan and Iraq veterans with PTSD.

OBJECTIVE: Sleep disturbances are a core and salient feature of posttraumatic stress disorder (PTSD). Pilot studies have indicated that combined cognitive-behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares improves sleep as well as PTSD symptoms. METHOD: The present study randomized 40 combat veterans (mean age 37.7 years; 90% male and 60% African American) who served in Afghanistan and/or Iraq (Operation Enduring Freedom [OEF]/Operation Iraqi Freedom [OIF]) to 4 sessions of CBT-I with adjunctive IRT or a waitlist control group. Two thirds of participants had nightmares at least once per week and received the optional IRT module. RESULTS: At posttreatment, veterans who participated in CBT-I/IRT reported improved subjectively and objectively measured sleep, a reduction in PTSD symptom severity and PTSD-related nighttime symptoms, and a reduction in depression and distressed mood compared to the waitlist control group. CONCLUSION: The findings from this first controlled study with OEF/OIF veterans suggest that CBT-I combined with adjunctive IRT may hold promise for reducing both insomnia and PTSD symptoms. Given the fact that only half of the patients with nightmares fully implemented the brief IRT protocol, future studies should determine if this supplement adds differential efficacy to CBT-I alone.

A startling absence of emotion effects: Active attention to the startle probe as a motor task cue appears to eliminate modulation of the startle reflex by valence and arousal.

Research has shown that during emotional imagery, valence and arousal each modulate the startle reflex. Here, two imagery-startle experiments required participants to attend to the startle probe as a simple reaction time cue. In experiment 1, four emotional conditions differing in valence and arousal were examined. Experiment 2, to accentuate potential valence effects, included two negative high arousal, a positive high arousal and a negative low arousal condition. Imagery effectively manipulated emotional valence and arousal, as indicated by heart rate and subjective ratings. Compared to baseline, imagery facilitated startle responses. However, valence and arousal failed to significantly affect startle magnitude in both experiments and startle latency in Experiment 1. Results suggest that emotional startle modulation is eclipsed when the probe is significant for task completion and/or cues a motor response. Findings suggest that an active, rather than defensive, response set may interfere with affective startle modulation, warranting further investigation.

The effect of nicotine and trauma context on acoustic startle in smokers with and without posttraumatic stress disorder.

RATIONALE: Exaggerated startle response is a prominent feature of posttraumatic stress disorder (PTSD) although results examining differences in the acoustic startle response (ASR) between those with and without PTSD are mixed. One variable that may affect ASR among persons with PTSD is smoking. Individuals with PTSD are more likely to smoke and have greater difficulty quitting smoking. While smokers with PTSD report that smoking provides significant relief of negative affect and PTSD symptoms, the effects of smoking or nicotine deprivation on startle reactivity among smokers with PTSD are unknown. OBJECTIVES: The purposes of the current study were to (1) examine baseline acoustic startle response (ASR) in smokers with and without PTSD under conditions of overnight abstinence, (2) evaluate the effect of smoking on ASR, and (3) evaluate the contextual effects of trauma versus neutral script presentations. METHODS: ASR was measured among 48 smokers with and without PTSD in the context of a 2 (group: PTSD vs. non-PTSD) x 2 (context: trauma vs. neutral) x 3 (smoking condition: usual brand cigarette vs. denicotinized cigarette vs. no smoking) design. RESULTS: Effects of modest size indicated that (1) PTSD participants demonstrated higher ASR (2) compared to non-PTSD participants, PTSD participants reported greater negative affect following a trauma-related script, and (3) following a trauma-related script and smoking a usual brand cigarette, PTSD participants demonstrated higher ASR. CONCLUSIONS: Although many smokers with PTSD report that smoking reduces PTSD symptoms, results suggest that smoking may actually potentiate or maintain an exaggerated startle response.

The effects of cigarette smoking on script-driven imagery in smokers with and without posttraumatic stress disorder.

The study investigated the effects of smoking a nicotinized or denicotinized cigarette on craving, affect and posttraumatic stress disorder (PTSD) symptoms while recalling neutral, stressful and traumatic events in smokers with and without PTSD. Smokers completed laboratory sessions during which they were presented with audiotapes of personalized scripts followed by smoking a cigarette. The effect of the script and cigarette conditions on dependent variables was evaluated. There was a main effect of script type across groups for smoking craving, negative affect and PTSD symptoms, with increased symptoms in trauma and stressful conditions. Responses were significantly higher in PTSD smokers. Smoking either cigarette type resulted in decreased craving, negative affect and PTSD symptoms in both groups. A second script presentation following smoking elicited similar responses, suggesting the ameliorative effect of having smoked a cigarette was short-lived. These results support that context and non-pharmacologic effects of smoking are important variables in smoking craving and mood, particularly in smokers with PTSD.