A closer look into the affect dynamics of adolescents with depression and the interactions with their parents: An ecological momentary assessment study.

Adolescents with depression tend to perceive behavior of parents as less positive than adolescents without depression, but conclusions are based on retrospective reports assessed once or over long time intervals, with the risk of memory biases affecting the recall. The current study used ecological momentary assessments to examine the link between adolescent affect and the amount of warmth and criticism expressed by both mothers and fathers in families with adolescents with depression versus adolescents without psychopathology in daily life. It also explored the possible bias by assessing parenting on the momentary, daily (EMA), and retrospective level. The sample consisted of 34 adolescents with depression and 58 parents and 80 healthy controls and 151 parents (adolescents: Mage = 15.8, SD = 1.41; 67.5% girls, parents: Mage = 49.3, SD = 5.73; 54.1% mothers). Participants completed retrospective questionnaires and four surveys a day for 14 consecutive days. Preregistered multilevel models showed that momentary parenting reports of adolescents with depression and healthy controls did not differ. The associations between perceived parenting of both mothers and fathers and adolescent affect did also not differ between the two groups. These results illustrate that adolescents generally benefit from supportive parenting, but substantial differences between individuals were found. In contrast to the momentary data, both adolescents with depression and their parents did report more negative parenting on retrospective questionnaires than healthy controls and their parents indicating that adolescents with depression may have a negativity bias in their retrospective recall. These findings are highly relevant for clinical practice and underscore the need for careful assessments on different time scales and including all family members.

Tracking real-time proximity in daily life: A new tool to examine social interactions.

Social interactions, spending time together, and relationships are important for individuals' well-being, with people feeling happier when they spend more time with others. So far, most information about the frequency and duration of spending time together is based on self-report questionnaires. Although recent technological innovations have stimulated the development of objective approaches for measuring physical proximity in humans in everyday life, these methods still have substantial limitations. Here we present a novel method, using Bluetooth low-energy beacons and a smartphone application, to measure the frequency and duration of dyads being in close proximity in daily life. This method can also be used to link the frequency and duration of proximity to the quality of interactions, by using proximity-triggered questionnaires. We examined the use of this novel method by exploring proximity patterns of family interactions among 233 participants (77 Dutch families, with 77 adolescents [Mage = 15.9] and 145 parents [Mage = 48.9]) for 14 consecutive days. Overall, proximity-based analyses indicated that adolescents were more often and longer in proximity to mothers than to fathers, with large differences between families in frequency and duration. Proximity-triggered evaluations of the interactions and parenting behavior were generally positive for both fathers and mothers. This innovative method is a promising tool that can be broadly used in other social contexts to yield new and more detailed insights into social proximity in daily life.

A Network Study of Family Affect Systems in Daily Life.

Adolescence is a time period characterized by extremes in affect and increasing prevalence of mental health problems. Prior studies have illustrated how affect states of adolescents are related to interactions with parents. However, it remains unclear how affect states among family triads, that is adolescents and their parents, are related in daily life. This study investigated affect state dynamics (happy, sad, relaxed, and irritated) of 60 family triads, including 60 adolescents (Mage = 15.92, 63.3% females), fathers and mothers (Mage = 49.16). The families participated in the RE-PAIR study, where they reported their affect states in four ecological momentary assessments per day for 14 days. First, we used multilevel vector-autoregressive network models to estimate affect dynamics across all families, and for each family individually. Resulting models elucidated how family affect states were related at the same moment, and over time. We identified relations from parents to adolescents and vice versa, while considering family variation in these relations. Second, we evaluated the statistical performance of the network model via a simulation study, varying the percentage missing data, the number of families, and the number of time points. We conclude with substantive and statistical recommendations for future research on family affect dynamics.

Adolescents' and parents' affect in relation to discrepant perceptions of parental warmth in daily life.

The current study aimed to evaluate how adolescents' and parents' perceptions of daily parenting-and their discrepancies-relate to daily parent and adolescent affect. Daily parental warmth and affect were assessed using electronic diaries in 150 American adolescent-parent dyads (61.3% females, Mage = 14.6, 83.3% White; 95.3% mothers, Mage = 43.4; 89.3% White) and in 80 Dutch adolescents with 79 mothers and 72 fathers (63.8% females, Mage = 15.9, 91.3% White; Mage = 49.0, 97.4% White). Results of preregistered models indicated that individuals' affect may be more important for perceptions of parenting than discrepancies between parent-adolescent reports of parenting for affect, stressing the need to be aware of this influence of affect on parenting reports in clinical and research settings.

Effects of non-invasive vagus nerve stimulation on cognitive and autonomic correlates of perseverative cognition.

Perseverative cognitions can provoke psychophysiological stress in the absence of an actual stressor and are considered important transdiagnostic vulnerability factors for several (mental) health issues. These stress-related cognitive processes are reflected by both cognitive (assessed by self-reports) and autonomic inflexibility (assessed by heart rate variability; HRV), with a key role attributed to the vagus nerve. Interestingly, modulation of the afferent branches of the vagus can be achieved with transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive technique that employs a low-intensity electrical current applied to the ear. In a sample of healthy individuals, we investigated the effects of taVNS of the left concha, compared to sham (earlobe) stimulation, on the cognitive and autonomic correlates of perseverative cognition following a psychosocial stress task. Interestingly, taVNS significantly reduced cognitive rigidity, reflected by reduced subjective perseverative thinking after psychosocial stress. Although there were no direct effects on autonomic correlates of perseverative cognition, individual differences in perseverative thinking after the stressor significantly affected the effects of taVNS on HRV. Specifically, more autonomic inflexibility during the stress task (i.e., reduced HRV) was associated with increases in perseverative thinking afterward for the sham condition, but not the active taVNS condition. Additional exploratory analyses revealed no significant moderation of stimulation intensity. Overall, the study findings endorse the association between perseverative cognitions and vagus nerve functioning.

High-frequency variability in heart rate is related to COVID-19-associated worries six years later.

Elevated resting heart rate variability (HRV) in the high frequency range has been proposed to be protective against worrying when facing environmental stressors. Yet, prospective studies using real-life stressors are still scarce. The present study set out to replicate the previous finding of reduced resting HRV predicting COVID-19-associated worries in a larger, more homogenous sample over a longer period of time (N = 123; age: 42.32 [SD:10.72]; 65.9 % female; average time lag: six years). In addition, we were interested in investigating the specificity of this effect with respect to worry content, other physiological markers of autonomic functions, and additional potentially relevant covariates with a special focus on a potential moderating effect of sex on this association. In regression analyses adjusting for age, sex, BMI and smoking status, the interaction between HRV and sex was significant, with women depicting a stronger association between HRV and COVID-19 associated worries. Further sensitivity analyses revealed the specificity of the effect for HRV as distinct from mean heart rate, as well as its dependence on previous COVID-19 infection, but not COVID-19 vaccination status and chronic stress level. These data are in line with theories that propose that higher HRV levels can be protective against the deleterious effects of real-life environmental stressors. However, our results also point to the specificity of this effect, especially with respect to worry content and sex.

Perceptions of Parenting in Daily Life: Adolescent-Parent Differences and Associations with Adolescent Affect.

Adolescents can perceive parenting quite differently than parents themselves and these discrepancies may relate to adolescent well-being. The current study aimed to explore how adolescents and parents perceive daily parental warmth and criticism and whether these perceptions and discrepancies relate to adolescents' daily positive and negative affect. The sample consisted of 80 adolescents (Mage = 15.9; 63.8% girls) and 151 parents (Mage = 49.4; 52.3% women) who completed four ecological momentary assessments per day for 14 consecutive days. In addition to adolescents' perception, not parents' perception by itself, but the extent to which this perception differed or overlapped with adolescents' perception was related to adolescent affect. These findings highlight the importance of including combined adolescents' and parents' perspectives when studying dynamic parenting processes.

The Link between Parental Support and Adolescent Negative Mood in Daily Life: between-Person Heterogeneity in within-Person Processes.

Lack of parental support is related to more adolescent negative mood. However, little is known about how fluctuations of parental support relate to fluctuations of negative mood within adolescents in daily life. The current study aimed to elucidate these processes at a day to day micro-level and examined to which extent adolescents would differ in the association between perceived parental support and adolescent negative mood. The sample consisted of 242 Dutch adolescents (Mage = 13.82, 63.2% female) who completed ecological momentary assessments of 3 weeks 3 months apart. Results from the multilevel regression analyses showed that, on average, adolescents experienced higher levels of negative mood on days when they perceived their parents to be less supportive. Substantial individual differences were found in this association, however, these were partially explained by the level of depressive symptoms and perceived parental intrusiveness. These findings suggest that advice on parental support should be tailored to the unique characteristics of the adolescent.

Assessing New Methods to Optimally Detect Episodes of Non-metabolic Heart Rate Variability Reduction as an Indicator of Psychological Stress in Everyday Life: A Thorough Evaluation of Six Methods.

Frequent or chronic reduction in heart rate variability (HRV) is a powerful predictor of cardiovascular disease, and psychological stress has been suggested to be a co-determinant of this reduction. Recently, we evaluated various methods to measure additional HRV reduction in everyday life and to relate these reductions to psychological stress. In the current paper, we thoroughly evaluate these methods and add two new methods in both newly acquired and reanalyzed datasets. All of these methods use a subset of 24 h worth of HRV and movement data to do so: either the first 10 min of every hour, the full 24 h, a combination of 10 min from three consecutive hours, a classification of level of movement, the data from day n to detect episodes in day n + 1, or a range of activities during lab calibration. The method that used the full 24 h worth of data detected the largest percentage of episodes of reduced additional HRV that matched with self-reported stress levels, making this method the most promising, while using the first 10 min from three consecutive hours was a good runner-up.

Does the COVID-19 pandemic impact parents' and adolescents' well-being? An EMA-study on daily affect and parenting.

Due to the COVID- 19 outbreak in the Netherlands (March 2020) and the associated social distancing measures, families were enforced to stay at home as much as possible. Adolescents and their families may be particularly affected by this enforced proximity, as adolescents strive to become more independent. Yet, whether these measures impact emotional well-being in families with adolescents has not been examined. In this ecological momentary assessment study, we investigated if the COVID-19 pandemic affected positive and negative affect of parents and adolescents and parenting behaviors (warmth and criticism). Additionally, we examined possible explanations for the hypothesized changes in affect and parenting. To do so, we compared daily reports on affect and parenting that were gathered during two periods of 14 consecutive days, once before the COVID-19 pandemic (2018-2019) and once during the COVID-19 pandemic. Multilevel analyses showed that only parents' negative affect increased as compared to the period before the pandemic, whereas this was not the case for adolescents' negative affect, positive affect and parenting behaviors (from both the adolescent and parent perspective). In general, intolerance of uncertainty was linked to adolescents' and parents' negative affect and adolescents' positive affect. However, Intolerance of uncertainty, nor any pandemic related characteristics (i.e. living surface, income, relatives with COVID-19, hours of working at home, helping children with school and contact with COVID-19 patients at work) were linked to the increase of parents' negative affect during COVID-19. It can be concluded that on average, our sample (consisting of relatively healthy parents and adolescents) seems to deal fairly well with the circumstances. The substantial heterogeneity in the data however, also suggest that whether or not parents and adolescents experience (emotional) problems can vary from household to household. Implications for researchers, mental health care professionals and policy makers are discussed.

Noradrenergic Regulation of Cognitive Flexibility: No Effects of Stress, Transcutaneous Vagus Nerve Stimulation, and Atomoxetine on Task-switching in Humans.

Cognitive flexibility allows us to adaptively switch between different responsibilities in important domains of our daily life. Previous work has elucidated the neurochemical basis underlying the ability to switch responses to a previously nonreinforced exemplar and to switch between attentional sets. However, the role of neuromodulators in task switching, the ability to rapidly switch between two or more cognitive tasks afforded by the same stimuli, is still poorly understood. We attempted to fill this gap by manipulating norepinephrine levels using stress manipulation (Study 1a, n = 48; between-group design), transcutaneous vagus nerve stimulation at two different intensities (Study 1b, n = 48; sham-controlled between-group design), and pharmacological manipulation (Study 2, n = 24; double-blind crossover design), all of which increased salivary cortisol measures. Participants repeatedly switched between two cognitive tasks (classifying a digit as high/low [Task 1] or as odd/even [Task 2]), depending on the preceding cue. On each trial, a cue indicated the task to be performed. The cue-stimulus interval was varied to manipulate the time to prepare for the switch. Participants showed typical switch costs, which decreased with the time available for preparation. None of the manipulations modulated the size of the switch costs or the preparation effect, as supported by frequentist and Bayesian model comparisons. Task-switching performance reflects a complex mix of cognitive control and bottom-up dynamics of task-set representations. Our findings suggest that norepinephrine does not affect either of these aspects of cognitive flexibility.

Moving beyond belief: A narrative review of potential biomarkers for transcutaneous vagus nerve stimulation.

Transcutaneous vagus nerve stimulation (tVNS) is a non-invasive neurostimulation technique that is currently being tested as a potential treatment for a myriad of neurological and psychiatric disorders. However, the working mechanisms underlying tVNS are poorly understood and it remains unclear whether stimulation activates the vagus nerve for every participant. Finding a biological marker of tVNS is imperative, as it can help guide research on clinical applications and can inform researchers on optimal stimulation sites and parameters to further optimize treatment efficacy. In this narrative review, we discuss five potential biomarkers for tVNS and review currently available evidence for these markers for both invasive and tVNS. While some of these biomarkers hold promise from a theoretical perspective, none of the potential biomarkers provide clear and definitive indications that tVNS increases the vagal activity or augments activity in the locus coeruleus-noradrenaline network. We conclude the review by providing several recommendations for how to tackle the challenges and opportunities when researching potential biomarkers for the effects of tVNS.

International Consensus Based Review and Recommendations for Minimum Reporting Standards in Research on Transcutaneous Vagus Nerve Stimulation (Version 2020).

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation (tVNS) across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation(VNS) and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice.

Transcutaneous vagus nerve stimulation does not affect attention to fearful faces in high worriers.

People suffering from chronic worries pay excessive attention to emotional information. In this study we examined whether a reduced ability to inhibit attention from fearful faces (i.e. inhibition of return; IOR) can be attributed to the low vagus nerve activity observed in high worriers. Our pre-registered hypothesis was that transcutaneous auricular vagus nerve stimulation (tVNS) would enhance IOR to fearful faces. Ninety-four students who scored above a pre-determined cut-off on the Penn State Worry Questionnaire were randomly allocated to receive either tVNS (n = 45) or sham stimulation of the earlobe (n = 49). Meanwhile, to assess IOR, they performed an emotional exogenous cueing task wherein neutral and fearful faces predicted the target location at chance level. Resting levels of HRV were also collected before stimulation onset. Results showed that levels of trait worry were associated with reduced IOR, but resting levels of HRV were not. Critically, tVNS did not affect performance on the exogenous cueing task when compared to sham stimulation. These findings did not confirm the hypothesized causal role of vagus nerve activity in maintaining disrupted IOR for emotional information. They also provide evidence that high levels of worry are associated with generally reduced IOR. This points to a clear need to understand the neurobiological basis of inhibitory problems in worriers.

Transcutaneous vagus nerve stimulation and extinction of prepared fear: A conceptual non-replication.

Transcutaneous stimulation of the auricular branch of the vagus nerve (tVNS) may accelerate fear extinction in healthy humans. Here, we aimed to investigate this hypothesis in healthy young participants in a prepared learning paradigm, using spider pictures as conditioned stimuli. After a fear conditioning phase, participants were randomly allocated to receive tVNS (final N = 42) or sham stimulation (final N = 43) during an extinction phase. Conditioned fear was assessed using US expectancy ratings, skin conductance and fear potentiated startle responses. After successful fear acquisition, participants in both groups showed a reduction of fear over the course of the extinction phase. There were no between-group differences in extinction rates for physiological indices of fear. Contrary to previous findings, participants in the tVNS condition also did not show accelerated declarative extinction learning. Participants in the tVNS condition did have lower initial US expectancy ratings for the CS- trials than those who received sham stimulation, which may indicate an enhanced processing of safety cues due to tVNS. In conclusion, the expected accelerated extinction due to tVNS was not observed. The results from this study call for more research on the optimal tVNS stimulation intensity settings.

Effectiveness of a smartphone-based worry-reduction training for stress reduction: A randomized-controlled trial.

OBJECTIVE: Perseverative cognition (e.g. worry) and unconscious stress are suggested to be important mediators in the relation between stressors and physiological health. We examined whether a smartphone-based worry-reduction training improved a physiological marker of stress (i.e. increased heart rate variability [HRV]) and unconscious stress. DESIGN: Randomised-controlled trial was conducted with individuals reporting work stress (n = 136). Participants were randomised to the experimental, control or waitlist condition (resp. EC, CC, WL). The EC and CC registered emotions five times daily for four weeks. The EC additionally received a worry-reduction training with mindfulness exercises. MAIN OUTCOME MEASURES: Primary outcome was 24-h assessments of HRV measured at pre-, mid- and post-intervention. Secondary outcomes were implicit affect and stress. Effects on heart rate and other psychological outcomes were explored. RESULTS: A total of 118 participants completed the study. No change from pre- to post-intervention was observed for the primary or secondary outcomes. The change over time was not different between conditions. CONCLUSION: Findings suggest that the training was ineffective for improving HRV or psychological stress. Future studies may focus on alternative smartphone-based stress interventions, as stress levels are high in society. There is need for easy interventions and smartphones offer possibilities for this.

Generalized Unsafety Theory of Stress: Unsafe Environments and Conditions, and the Default Stress Response.

Prolonged physiological stress responses form an important risk factor for disease. According to neurobiological and evolution-theoretical insights the stress response is a default response that is always "on" but inhibited by the prefrontal cortex when safety is perceived. Based on these insights the Generalized Unsafety Theory of Stress (GUTS) states that prolonged stress responses are due to generalized and largely unconsciously perceived unsafety rather than stressors. This novel perspective necessitates a reconstruction of current stress theory, which we address in this paper. We discuss a variety of very common situations without stressors but with prolonged stress responses, that are not, or not likely to be caused by stressors, including loneliness, low social status, adult life after prenatal or early life adversity, lack of a natural environment, and less fit bodily states such as obesity or fatigue. We argue that in these situations the default stress response may be chronically disinhibited due to unconsciously perceived generalized unsafety. Also, in chronic stress situations such as work stress, the prolonged stress response may be mainly caused by perceived unsafety in stressor-free contexts. Thus, GUTS identifies and explains far more stress-related physiological activity that is responsible for disease and mortality than current stress theories.

Converging evidence that subliminal evaluative conditioning does not affect self-esteem or cardiovascular activity.

Self-esteem moderates the relationship between stress and (cardiovascular) health, with low self-esteem potentially exacerbating the impact of stressors. Boosting self-esteem may therefore help to buffer against stress. Subliminal evaluative conditioning (SEC), which subliminally couples self-words with positive words, has previously been successfully used to boost self-esteem, but the existing studies are in need of replication. In this article, we aimed to replicate and extend previous SEC studies. The first 2 experiments simultaneously examined whether SEC increased self-esteem (Experiment 1, n = 84) and reduced cardiovascular reactivity to a stressor in high worriers (Experiment 2, n = 77). On the basis of these results, the 3rd experiment was set up to examine whether an adjusted personalized SEC task increased self-esteem and reduced cardiac activity in high worriers (n = 81). Across the 3 experiments, no effects were found of SEC on implicit or explicit self-esteem or affect or on cardiovascular (re)activity compared to a control condition in which the self was coupled with neutral words. The results do not support the use of the subliminal intervention in its current format. As stress is highly prevalent, future studies should focus on developing other cost-effective and evidence-based interventions.

New methods to optimally detect episodes of non-metabolic heart rate variability reduction as an indicator of psychological stress in everyday life.

Cardiovascular disease is the leading cause of death in the western world. Frequent or chronic reductions in heart rate variability (HRV) are a powerful predictor of cardiovascular disease. Psychological stress has been suggested to be an important factor in the development of reduced HRV. Recently, Verkuil et al. (2016) introduced a laboratory-based method to measure additional HRV reduction in everyday life, and reductions in HRV related to psychological stress. In the current paper, we discuss alternative methods to detect additional HRV reductions, in real life data sets without the necessity of laboratory-based calibration, and even in existing data sets. All of these methods use a subset of 24h' worth of HRV and movement data to do so: either the first 10min of every hour, the full 24h, a combination of 10min from three consecutive hours, or a classification of level of movement. We also present a method to visualize HRV and movement data to be able to detect episodes of reduced additional HRV optically. The method that used the full 24h' worth of data detected the largest percentage of episodes of reduced additional HRV that actually match with self-reported stress levels, making this method the most promising.