Reappraisal is less effective than distraction in downregulation of neural responses to physical threats-An event-related potential investigation.

Evolutionary threats (ETs), such as predatory animals and heights, elicit stronger fear responses and are more often the subject of specific phobias, as compared to modern threats (MTs, such as guns and motorcycles). Since processing of ET depends on lower-order, phylogenetically conserved neural fear circuits, it may be less susceptible to higher-order (vs. simpler) cognitive emotion regulation. Given the relevance for treatment of specific phobias, we tested this hypothesis in an ERP study. Sixty-one female participants passively watched high- and low-threat pictures of evolutionary (snakes, lizards) and modern (guns, water-guns) origin, and downregulated responses to the high-threat pictures (snakes and guns) using either cognitive reappraisal or a simpler cognitive distraction strategy. ET elicited stronger early (EPN) and sustained (LPP) attention processing compared to MT. Both strategies successfully downregulated subjective and LPP (but not EPN) responses compared to passive watching. Although reappraisal was more effective subjectively, distraction downregulated the LPP earlier and stronger than reappraisal, irrespective of the threat type. These findings provide novel evidence that neural responses to physical threat might be less susceptible to cognitive emotion regulation via higher-order (reappraisal) versus simpler (distraction) strategies, irrespective of the evolutionary or modern relevance of threat. Combining both strategies could be beneficial for the emotion regulation-enhancing interventions for specific phobias. Distraction could be used during initial exposure, to reduce immediate emotion responding and help endure the contact with the feared stimulus, whereas reappraisal could be used subsequently, when emotions are less intense, to change maladaptive thoughts about the stimulus for future encounters.

High working memory load impairs reappraisal but facilitates distraction - An event-related potential investigation.

The present experiments investigated the impact of working memory (WM) load on emotion regulation (ER) efficacy using reappraisal (Experiment 1, n = 30) and distraction (Experiment 2, n = 30). Considering that WM is necessary for storage, elaboration, and manipulation of information and that reappraisal acts by storing, elaborating, and manipulating the stimulus meaning, we hypothesized that high (versus low) WM-load would reduce reappraisal efficacy. By contrast, given that distraction acts by blocking elaborated processing of the stimulus meaning, we expected that high WM-load would enhance distraction efficacy. To test these predictions, we employed a dual-task paradigm in which a low- or high WM-load task was combined with an ER (reappraisal or distraction) task. We measured the Late Positive Potential (LPP)-an electrocortical marker of sustained motivated attention, and a well-established index of emotional arousal-in response to negative pictures. Results confirmed that although reappraisal successfully reduced the LPP amplitude in the down- compared to up-regulation condition in low WM-load trials, high WM-load eliminated this difference, suggesting the disrupting influence of high WM-load on ER for reappraisal (Experiment 1). By contrast, although distraction failed to modulate the LPP amplitude in low WM-load trials, the difference between down- and no-regulation conditions was significant when distraction was combined with high WM-load, suggesting the facilitatory influence of high WM-load on ER for distraction (Experiment 2). Our findings show that the effect of WM-load on ER is strategy-dependent, and that the availability of WM resources is an important situational moderator of ER efficacy in healthy young adults.

Deep-Breathing Biofeedback Trainability in a Virtual-Reality Action Game: A Single-Case Design Study With Police Trainers.

It is widely recognized that police performance may be hindered by psychophysiological state changes during acute stress. To address the need for awareness and control of these physiological changes, police academies in many countries have implemented Heart-Rate Variability (HRV) biofeedback training. Despite these trainings now being widely delivered in classroom setups, they typically lack the arousing action context needed for successful transfer to the operational field, where officers must apply learned skills, particularly when stress levels rise. The study presented here aimed to address this gap by training physiological control skills in an arousing decision-making context. We developed a Virtual-Reality (VR) breathing-based biofeedback training in which police officers perform deep and slow diaphragmatic breathing in an engaging game-like action context. This VR game consisted of a selective shoot/don't shoot game designed to assess response inhibition, an impaired capacity in high arousal situations. Biofeedback was provided based on adherence to a slow breathing pace: the slower and deeper the breathing, the less constrained peripheral vision became, facilitating accurate responses to the in-game demands. A total of nine male police trainers completed 10 sessions over a 4-week period as part of a single-case experimental ABAB study-design (i.e., alternating sessions with and without biofeedback). Results showed that eight out of nine participants showed improved breathing control in action, with a positive effect on breathing-induced low frequency HRV, while also improving their in-game behavioral performance. Critically, the breathing-based skill learning transferred to subsequent sessions in which biofeedback was not presented. Importantly, all participants remained highly engaged throughout the training. Altogether, our study showed that our VR environment can be used to train breathing regulation in an arousing and active decision-making context.

Oscillatory brain responses to emotional stimuli are effects related to events rather than states.

Emotional cues draw attention, thereby enabling enhanced processing. Electrophysiological brain research in humans suggests that increased gamma band activity and decreased alpha band activity over posterior brain areas is associated with the allocation of attention. However, emotional events can alternate quickly, like rapidly changing news items and it remains unknown whether the modulation of brain oscillations happens in a stimulus induced manner, changing with each individual stimulus, or whether the events lead to prolonged, state-like changes. To investigate this, we measured the electroencephalogram (EEG) during a passive viewing task (N = 32) while emotional pictures International Affective Picture System (IAPS) were presented in blocks containing either pleasant and neutral or unpleasant and neutral pictures. As predicted, we found decreased alpha and increased gamma power over posterior areas in response to unpleasant compared to pleasant pictures (and also compared to neutral pictures for gamma power). When testing the neutral pictures of the unpleasant and pleasant block against each other, we found no significant difference, which speaks to a stimulus induced effect of alpha and gamma power rather than a state effect. In addition, the inter-trial interval (ITI) between the pictures did not differ between the unpleasant and pleasant block either, corroborating this conclusion. Since emotional pictures can at the same time elicit a freezing-like response and we were interested in whether this freezing-like response co-occurs with enhanced attention, we also collected postural sway data. However, within this EEG-setup, postural analyses indicated no stimulus-related effects nor a correlation with EEG-data. We interpret the alpha and gamma band results as reflecting event-related attention toward unpleasant compared to pleasant (and neutral) pictures and discuss this finding in light of previous EEG research and in combination with behavioral research on threat-induced reductions in body sway (freezing-like response).

Breathing Biofeedback for Police Officers in a Stressful Virtual Environment: Challenges and Opportunities.

As part of the Dutch national science program "Professional Games for Professional Skills" we developed a stress-exposure biofeedback training in virtual reality (VR) for the Dutch police. We aim to reduce the acute negative impact of stress on performance, as well as long-term consequences for mental health by facilitating physiological stress regulation during a demanding decision task. Conventional biofeedback applications mainly train physiological regulation at rest. This might limit the transfer of the regulation skills to stressful situations. In contrast, we provide the user with the opportunity to practice breathing regulation while they carry out a complex task in VR. This setting poses challenges from a technical - (real-time processing of noisy biosignals) as well as from a user-experience perspective (multi-tasking). We illustrate how we approach these challenges in our training and hope to contribute a useful reference for researchers and developers in academia or industry who are interested in using biosignals to control elements in a dynamic virtual environment.

Effects of threat and sleep deprivation on action tendencies and response inhibition.

The ability to control action is crucial for adaptive responding, but may be compromised in situations involving strong emotions (e.g., threat) or when people are deprived of resources (e.g., sleep). As compromised action control can have large consequences in threatening situations, for example when police officers face a potentially armed suspect, we experimentally investigated how acute threat and partial sleep deprivation affect the ability to control impulsive responses, in 52 healthy young adults performing a simulated shooting task. The results showed that acute threat increased the tendency to act quickly (i.e., reduced response times; b = 9.46, SE = 2.90, 95% CI [3.49, 15.29], p = .001) and impaired response inhibition (i.e., increased stop signal reaction times; b = -4.91, SE = 2.31, 95% CI [-9.47, -0.44], p = .035). In addition, 3 nights of partial sleep deprivation (5 hr [n = 28] vs. 8 hr [n = 24] of sleep), led to a significant decrease in overall response accuracy (b = -0.22, SE = 0.09, 95% CI [-0.40, -0.05], p = .025). Contrary to expectations, our results did not show increased threat sensitivity in sleep-deprived individuals (all p > .13). Nevertheless, they may have important implications for professionals who are required to maintain behavioral control under high levels of threat and who experience disturbed sleep due to for example, shift work, as both factors negatively affected performance. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exogenous testosterone affects early threat processing in socially anxious and healthy women.

Testosterone plays an important role in social threat processing. Recent evidence suggests that testosterone administration has socially anxiolytic effects, but it remains unknown whether this involves early vigilance or later, more sustained, processing-stages. We investigated the acute effects of testosterone administration on social threat processing in 19 female patients with Social Anxiety Disorder (SAD) and 19 healthy controls. Event-related potentials (ERPs) were recorded during an emotional Stroop task with subliminally presented faces. Testosterone induced qualitative changes in early ERPs (<200ms after stimulus onset) in both groups. An initial testosterone-induced spatial shift reflected a change in the basic processing (N170/VPP) of neutral faces, which was followed by a shift for angry faces suggesting a decrease in early threat bias. These findings suggest that testosterone specifically affects early automatic social information processing. The decreased attentional bias for angry faces explains how testosterone can decrease threat avoidance, which is particularly relevant for SAD.

Defensive freezing links Hypothalamic-Pituitary-Adrenal-axis activity and internalizing symptoms in humans.

The Hypothalamic-Pituitary-Adrenal (HPA)-axis plays an important role in the expression of defensive freezing. Adaptive freezing reactivity, characterized by an immediate increase in acute stress and timely termination upon threat offset or need to act, is essential for adequate stress coping. Blunted HPA-axis activity in animals is associated with blunted freezing reactivity and internalizing symptoms. Despite their potential relevance, it remains unknown whether these mechanisms apply to humans and human psychopathology. Using a well-established method combining electrocardiography and posturography, we assessed freezing before, immediately after, and one hour after a stress induction in 92 human adolescents. In line with animal models, human adolescents showed stress-induced freezing, as quantified by relative reductions in heart rate and body sway after, as compared to before, stress. Moreover, relatively lower basal cortisol was associated with reduced stress-induced freezing reactivity (i.e., less immediate freezing and less recovery). Path analyses showed that decreased freezing recovery in individuals with reduced cortisol levels was associated with increased levels of internalizing symptoms. These findings suggest that reduced freezing recovery may be a promising marker for the etiology of internalizing symptoms.

Sequential unfolding of appraisals: EEG evidence for the interaction of novelty and pleasantness.

An important question in emotion research is what elicits emotions and causes variations in their quality and intensity. Appraisal theories propose a cognitive process through which stimuli are evaluated on a number of different criteria. The combination of results on these criteria determines which specific emotion is elicited. In the present study, we addressed several questions regarding the mechanisms underlying this process, specifically whether appraisal criteria are processed (a) in a fixed sequence, (b) independently of each other, and (c) by different neural structures or circuits. Two appraisal criteria, stimulus novelty and pleasantness, were manipulated with a 3-stimulus oddball paradigm with affective pictures. Electroencephalographic (EEG) markers for the appraisal processes were distinguished using a spatiotemporal clustering analysis. Consistent with theories that assume a fixed sequence of the appraisal process, the analyses revealed early effects of novelty on global field power and the topographical pattern of EEG activity, followed in time by effects involving pleasantness. Moreover, both measures showed significant interactions of novelty and pleasantness in late processing stages (650 ms-800 ms), indicating that the processing of pleasantness depends on the preceding appraisal of novelty. The results of spatiotemporal clustering suggest that the late processing of highly relevant stimuli is not based on a single mechanism, but consists of the initial activation of distinct neural processes to evaluate novel stimuli, followed by activation of different neural mechanisms for the combined evaluation of both novel and highly valenced (i.e., unpleasant or pleasant) stimuli (a distinction that is not apparent in conventional event-related potential measures).

Psychophysiological evidence for cortisol-induced reduction in early bias for implicit social threat in social phobia.

The stress hormone cortisol is important for the regulation of social motivational processes. High cortisol levels have been associated with social fear and avoidance, which play an important role in social anxiety disorder (SAD), as does hypervigilant processing of social threat. However, causal effects of cortisol on threat processing in SAD remain unclear. In an event-related potential (ERP) study we investigated the effects of cortisol on task-irrelevant (implicit) processing of social threat in SAD, exploring the temporal dynamics as well as the role of symptom severity and stimulus awareness. Angry face processing was measured in participants with clinical SAD after double-blind, within-subject oral administration of cortisol (50mg) and placebo, using a masked and an unmasked emotional Stroop task. Both tasks showed significantly increased P2 midline ERP amplitudes for angry compared to neutral and happy faces in the placebo condition, reflecting an early attentional bias for social threat in SAD. Furthermore, cortisol administration significantly decreased P2 amplitudes for masked angry faces. This effect correlated with social anxiety, showing stronger decreases in patients with higher levels of social anxiety. These results indicate a highly specific effect of cortisol on early motivated attention to social threat and, together with previous findings, highlight the importance of motivational context (stimulus- or task-relevance) as well as symptom severity.

Cortisol-induced enhancement of emotional face processing in social phobia depends on symptom severity and motivational context.

We investigated the effects of cortisol administration on approach and avoidance tendencies in 20 patients with social anxiety disorder (SAD). Event-related brain potentials (ERPs) were measured during a reaction time task, in which patients evaluated the emotional expression of photographs of happy and angry faces by making an approaching (flexion) or avoiding (extension) arm movement. Patients showed significant avoidance tendencies for angry but not for happy faces, both in the placebo and cortisol condition. Moreover, ERP analyses showed a significant interaction of condition by severity of social anxiety on early positive (P150) amplitudes during avoidance compared to approach, indicating that cortisol increases early processing of social stimuli (in particular angry faces) during avoidance. This result replicates previous findings from a non-clinical sample of high anxious individuals and demonstrates their relevance for clinical SAD. Apparently the cortisol-induced increase in processing of angry faces in SAD depends on symptom severity and motivational context.

Cortisol administration enhances the coupling of midfrontal delta and beta oscillations.

There is increasing evidence that the strength of the relation between slow (SW) and fast (FW) wave activity in the EEG is associated with specific motivational states and their corresponding neuroendocrine patterns. Enhanced correlations between SW and FW have been related to anxiety, behavioral inhibition and high basal cortisol levels. However, the direct effects of cortisol on SW-FW coupling have not been experimentally studied yet. The present study investigated whether cortisol administration increases SW-FW coupling. Resting state EEG recordings were obtained from 40 right-handed healthy male subjects with extreme low or high scores on a behavioral inhibition scale, after placebo and cortisol (50 mg) administration. As expected, cortisol resulted in a significant increase in correlation between SW (delta) and FW (beta) activity compared to placebo. In addition, delta-beta correlation was significantly higher in high compared to low behaviorally inhibited subjects in both conditions. These results suggest that cortisol can modify brain activity, increasing a pattern associated with anxiety and behavioral inhibition. This is in line with findings associating cortisol with behavioral inhibition and anxiety.

The effects of cortisol administration on approach-avoidance behavior: an event-related potential study.

We investigated the effects of cortisol administration (50 mg) on approach and avoidance tendencies in low and high trait avoidant healthy young men. Event-related brain potentials (ERPs) were measured during a reaction time task, in which participants evaluated the emotional expression of photographs of happy and angry faces by making an approaching (flexion) or avoiding (extension) arm movement. The task consisted of an affect-congruent (approach happy faces and avoid angry faces) and an affect-incongruent (reversed instruction) condition. Behavioral and ERP analyses showed that cortisol enhanced congruency effects for angry faces in highly avoidant individuals only. The ERP effects involved an increase of both early (P150) and late (P3) positive amplitudes, indicative of increased processing of the angry faces in high avoidant subjects after cortisol administration. Together, these results suggest a context-specific effect of cortisol on processing of, and adaptive responses to, motivationally significant threat stimuli, particularly in participants highly sensitive to threat signals.

Anxiety, cortisol, and attachment predict plasma oxytocin.

Oxytocin and attachment seem to interact in suppressing subjective anxiety and physiological stress responses. In this study we investigated the relationships between individual differences in trait attachment scores, state and trait anxiety, plasma cortisol, and plasma oxytocin levels in healthy premenopausal women. Attachment proved to be a strong positive predictor of oxytocin levels, which were also positively predicted by cortisol levels and state and trait anxiety. The relationship between oxytocin and state anxiety was modulated by attachment scores. The present results may help interpreting seeming contradictions in the recent literature on oxytocin, attachment, and stress in humans, by suggesting that context effects determine which relationships are found in different studies: anxiolytic effects of oxytocin in a context of partner support versus stress- or cortisol-induced oxytocin responses in a context of distress or increased cortisol.

Individual differences in emotional expressivity predict oxytocin responses to cortisol administration: relevance to breast cancer?

Reduced emotional expression has been consistently related to susceptibility or fast progression of breast cancer. Breast cancer development and reduced emotional expression have both been related to rejection- and separation-related conditions. The neuropeptide oxytocin is low in response to rejection or separation. Recent results suggest that oxytocin may protect against the development of breast cancer and slow its progression. In the present study, we investigated if individual differences in emotional expressivity relate to basal or cortisol-stimulated plasma oxytocin. Healthy female subjects were treated with placebo or 35mg of cortisol orally in a double-blind within-subject study. Seventy minutes later, blood was sampled for determination of oxytocin and cortisol levels. We found an interaction between treatment condition and Emotional Expression-out scores: after cortisol treatment, oxytocin levels increased proportional to Emotion Expression-out score. These preliminary findings provide a potential mechanism for associations in the literature between emotional expressive behavior and breast cancer.

Acute cortisol administration reduces subjective fatigue in healthy women.

Treatment with cortisol has been found to decrease fatigue and increase feelings of vigor in both patients and healthy male subjects. We obtained self-reports of mood before 35 mg cortisol or placebo ingestion, 70 min later, and after the healthy female subjects performed cognitive tasks for 1 h in a double-blind within-subject study. Cortisol decreased fatigue, increased vigor, and tended to decrease tension. Effects on fatigue were largest after task performance, when fatigue had increased, suggesting that improvement of fatigue by cortisol is observed when subjects are fatigued. This is the first study to demonstrate improvements in fatigue in healthy female subjects; this is particularly relevant because of the high prevalence of hypocortisolimic fatigue syndromes in women and recent evidence that many psychiatric disorders may involve stress-induced hypocortisolemia that is responsive to cortisol replacement.

State-dependent regulation of cortical activity by cortisol: an EEG study.

In the present study we investigated the effects of cortisol administration on EEG activity in eight healthy volunteers. We administered 35 mg of cortisol in a within-subjects double-blind placebo-controlled design. Cortisol administration caused a global decrease in cortical activity except for an increase frontally at the left, resulting in a significant change in frontal asymmetry. This pattern of results is almost the exact mirror image of one of our previous studies. Comparing subjective activation measures from the present and previous study showed that activation was substantially higher in the present study that was performed in formal testing conditions involving venipuncture, compared to the previous EEG study that was performed in non-formal testing conditions. However, the direction of the present cortisolinduced change in frontal activity asymmetry is consistent with the cortisolinduced change in asymmetric rotation behavior that we recently reported in similar testing conditions. We also found indications that, in contrast to the effects on the EEG measures, effects of cortisol administration on subjective anxiety and plasma oxytocin levels may be sex-dependent. These results are preliminary because of the post-hoc nature and the small number of subjects in the present study. However, they are in line with recent findings by others, suggesting that the effects of cortisol on cortical activity and subjective activation are state dependent and are influenced by testing conditions.