Maternal distress during the COVID-19 outbreak: A socio-ecological perspective.

INTRODUCTION: Mothers faced an increased risk of adverse mental health outcomes during the COVID-19 pandemic compared to other populations. However, there is little data on the factors that placed mothers at increased risk of distress. AIMS: The present study explored a range of individual, familial, and environmental factors associated with psychological distress in mothers during the COVID-19 pandemic. METHOD: This repeated cross-sectional study was composed of a convenience sample of mothers who completed an online survey that included a demographic questionnaire, an emotion regulation questionnaire, and the Depression, Anxiety, and Stress scale. The survey was administered during the second and third lockdowns in Israel in 2020-2021. RESULTS: The study included 575 mothers (M age = 39). The findings of a hierarchical regression indicated that individual-level factors, composed of age and emotion regulation tendencies predicted psychological distress. The family-level factors of household income and number of children in the family also predicted distress. In terms of environmental-level factors, COVID-19-related media consumption and school status (open or closed) were also significant predictors of psychological distress. Importantly, the results showed that the most important predictors of psychological distress in mothers during the COVID-19 outbreak were school closures, household income, and the use of adaptive and maladaptive emotion regulation strategies. CONCLUSIONS: The findings highlight the intersection of individual, familial, and environmental factors in mothers' mental health during crises.

Negative and positive interpretations of emotionally neutral situations modulate the desire to eat personally craved foods.

Emotions play an important role in modulating food craving. Previous studies demonstrated that exposure to negative or positive stimuli can subsequently influence the desire to eat. However, in many daily situations, individuals self-generate their emotions, for example, by interpreting emotionally-neutral situations as positive or negative. So far, no studies have examined if and how positive and negative interpretations of emotionally-neutral situations modulate food craving. In this study, 65 healthy participants were asked to interpret emotionally-neutral images negatively or positively or observe the images naturally. Subsequently, participants rated their state negative/positive affect and their desire to eat their personally craved foods. The results demonstrate a lower desire to eat craved foods after negative interpretations and a higher desire to eat after positive interpretations, compared to an observe-naturally condition. Additionally, the impact of emotional interpretations on the desire to eat was mediated by participants' state negative/positive affect. These findings suggest that self-generated emotion as a result of negative/positive interpretations plays a significant role in modulating food craving. The results highlight the potential of modifying affective interpretations for the treatment of disorders that are characterized by both dysregulated food craving and emotion.

Boosting affective control with bifrontal transcranial direct current stimulation (tDCS): a proof-of-concept study in healthy individuals.

Affective control refers to the ability to regulate emotions and is considered a marker of mental health. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, holds promise to enhance affective control. In this between-subjects study in healthy individuals, we investigated the effects of bifrontal tDCS on core processes and higher-level markers of affective control. As such, we assessed direct tDCS effects on emotional interference during an affective control task and indirect effects on an instructed reappraisal task afterward. Results showed that the affective control task combined with active tDCS, compared to sham, resulted in enhanced cognitive emotion regulation. Specifically, participants in the active tDCS condition showed an increased propensity to use reappraisal and were more successful in doing so. Moreover, there was reduced vagally mediated heart rate variability indicative of attenuated emotion and self-regulation, in the sham, but not in the active condition. Surprisingly, there were no effects of tDCS on emotional interference during the affective control task, with Bayesian analyses showing extreme evidence against these effects. Nevertheless, there was a positive association between the emotional interference during the affective control task and participants' reappraisal success afterward for the active, but not the sham tDCS condition. The study offers valuable insights to guide future work on combined tDCS with affective control tasks or training on the ability to regulate emotions.

Understanding the benefits of extrinsic emotion regulation in depression.

Depression is a serious psychiatric illness that negatively affects people's feelings, thoughts, and actions. Providing emotion regulation support to others, also termed Extrinsic Emotion Regulation (EER), reduces depressive symptoms such as perseverative thinking and negative mood. In this conceptual review paper, we argue that EER may be especially beneficial for individuals with depression because it enhances the cognitive and affective processes known to be impaired in depression. Behavioral studies have shown that EER recruits processes related to cognitive empathy, intrinsic emotion regulation (IER), and reward, all impaired in depression. Neuroimaging data support these findings by showing that EER recruits brain regions related to these three processes, such as the ventrolateral prefrontal cortex which is associated with IER, the ventral striatum, which is associated with reward-related processes, and medial frontal regions related to cognitive empathy. This conceptual review paper sheds light on the mechanisms underlying the effectiveness of EER for individuals with depression and therefore offers novel avenues for treatment.

Working in corona-designated departments in a fortified underground hospital: Concerns about corona and predictors of job burnout.

Background: In August 2020 during Israel's second COVID-19 wave Rambam Medical Center opened the Sammy Ofer Fortified Underground Emergency Hospital. This was declared a regional Corona center in the north of Israel, receiving the most severe Corona patients from the region. Alongside the advanced inpatient capacity and technology within the underground facility, there was a severe shortage of trained medical and paramedical staff, as well as harsh working conditions. The current study examined the implications and effects of working in an underground facility on healthcare workers, focusing on emotion regulation tendencies and profession as predictors of job burnout. Methods: Seventy-six healthcare workers, who had worked in the underground hospital for a minimum continuous period of 2 weeks during the peak of the COVID-19 pandemic, and a control group of 40 healthcare workers from northern Israel were asked to fill out an online survey administered via Qualtrics (total sample 116). The survey comprised six questionnaires: a demographic survey questionnaire; a COVID-19 concerns questionnaire; a psychological distress questionnaire (DASS, Depression Anxiety Stress Scale); trait worry (PSWQ; Penn State Worry Questionnaire); emotion regulation (ERQ, Emotion Regulation Questionnaire), and burnout (SMBM, Shirom - Melamed Burnout Measure). Results: Independent-samples t-tests revealed no significant differences in psychological distress or burnout between Rambam Underground hospital workers and the control group. Conversely, COVID-19 concern scores were significantly different in the two groups, the Rambam hospital workers showing less concern (M = 2.9, SD = 0.73) than the control group (M = 3.47, SD = 0.76) [t (114) = -3.974, p < 0.001]. Hierarchical linear regression analysis identified the significant predictors of burnout among healthcare workers. Participants' profession (physician), psychological distress (total DASS score), and a personality trait of worry were statistically significant predictors for job burnout (p = 0.028, p < 0.001, p = 0.023, respectively). Concerns about COVID-19 marginally predicted job burnout (p = 0.09). Group (underground vs. control) and emotion regulation tendencies did not predict burnout. Conclusion: The two groups showed no significant differences in psychological distress nor in burnout. Being a physician, having an intrinsic trait of being overly worried and experiencing psychological distress were significant predictors for job burnout among healthcare workers, regardless of work environment (underground vs. control).

Cognitive Reappraisal Reduces the Influence of Threat on Food Craving.

Cognitive reappraisal is perhaps the most researched emotion regulation strategy. It involves reinterpreting emotional content to reduce its impact. While many studies have demonstrated that cognitive reappraisal reduces negative affect, the utility of cognitive reappraisal in buffering against the consequences of negative affect on subsequent behaviors and attitudes is not clear. To address this issue, the present study assessed whether cognitive reappraisal mitigates the influence of immediate threat on food craving. In Experiment 1, 80 women performed a novel combination of a cognitive reappraisal task with a food-rating task. Participants were exposed to threat-provoking or neutral images and were instructed to either reappraise or observe the images. Subsequently, they rated their desire to eat different types of foods. As expected, the desire to eat decreased after exposure to threat-provoking content. However, after reappraising the threat-provoking images, the desire to eat increased relative to when participants merely observed these images. These results were replicated in Experiment 2 (N = 46) which also showed that the effect of reappraisal on the desire to eat was fully mediated by the subjective emotional reactions to the threat-provoking content. These findings show that cognitive reappraisal can modulate links between emotion and food craving by buffering against the consequences of negative affect on basic human processes.

Reappraising negative emotions reduces distress during the COVID-19 outbreak.

In two studies, we examined the utility of intrinsic (i.e., self) versus extrinsic (i.e., other) reappraisal training for distress reduction during two consecutive COVID-19 lockdowns in Israel. In both Study 1 (n = 104) and Study 2 (n = 181), participants practiced the use of reappraisal for eight sessions across three weeks. Participants were trained to reappraise either a personal event (self-reappraisal group) or an incident presumably written by another participant (other-reappraisal group). Study 2 also included an untrained control group. Outcome measures were daily negative mood and psychological distress immediately at post-training and at a two-month follow-up. The results demonstrate a benefit for training compared to no training in lowering immediate post-training distress and daily negative emotions. However, this advantage disappeared at the two-month follow-up. In both studies, intrinsic reappraisal was associated with lower post-training distress than extrinsic reappraisal. Findings suggest reappraising negative experiences may lower distress at times of major contextual stress. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03642-6.

Emotion control training enhances reappraisal success among individuals with reported ADHD symptoms.

Previous research indicates that training individuals to recruit cognitive control before exposure to negative pictures can facilitate the propensity to use reappraisal and reappraisal success. Individuals with attention deficit hyperactivity disorder (ADHD) experience difficulties in cognitive control and emotion regulation, so they may especially benefit from such training. Individuals reporting high ADHD symptoms and controls were randomly assigned to one of two training conditions. In the high emotion control (H-EC) training condition, negative pictures were typically preceded by a stimulus that recruits cognitive control. In contrast, in the low emotion control (L-EC) training condition, negative pictures were typically preceded by a stimulus that does not recruit cognitive control. Participants were then asked to recall an adverse personal event and to reappraise the event. As predicted, instructed reappraisal was more effective in reducing negative mood in the H-EC training compared to the L-EC training. Furthermore, compared to controls, individuals with reported ADHD symptoms showed a greater propensity to use reappraisal after writing the event and a more considerable reduction in event significance and negativity following the instructed reappraisal assignment. We argue that employing cognitive control over emotional information has a causal role in reappraisal use and success among individuals with ADHD symptoms.

Job burnout among Israeli healthcare workers during the first months of COVID-19 pandemic: The role of emotion regulation strategies and psychological distress.

The current worldwide COVID-19 pandemic has elicited widespread concerns and stress. Arguably, healthcare workers are especially vulnerable to experience burnout during these times due to the nature of their work. Indeed, high prevalence of burnout was found among healthcare workers during the outbreak. However, the individual differences predicting burnout among healthcare workers during the pandemic have been understudied. The aim of the current study was, therefore, to identify risk and protective factors contributing to the severity of burnout among healthcare workers, above and beyond levels of current psychological distress. The survey was distributed online during the period April 13-28, 2020, approximately two months after the first COVID-19 case was identified in Israel. Ninety-eight healthcare workers completed an online survey administered cross-sectionally via the Qualtrics platform that included questionnaires assessing habitual emotion regulation strategies (i.e., trait worry, reappraisal, and suppression), psychological distress, COVID-19 related concerns, and burnout. A hierarchical linear regression analysis revealed that only trait worry and psychological distress were significant predictors of job burnout among healthcare workers. These findings highlight the role of maladaptive emotion regulation tendencies, specifically trait worry, in job burnout among healthcare workers. These findings have implications for both the assessment and treatment of healthcare workers. We discuss potential mechanisms and implications for practice.

The influence of inhibitory control on reappraisal and the experience of negative emotions.

Inhibitory control (IC) enables goal-directed behaviour by reducing the interference of irrelevant information. Studies have shown that IC can downregulate performance-based behavioural and physiological measures of emotional reactivity. This study examined whether transient recruitment of IC can modulate self-reported negative feelings after exposure to negative or neutral content. Furthermore, it was tested if triggering IC can improve the ability to reduce the negativity of unpleasant content by reinterpreting its meaning (cognitive reappraisal). For this purpose, a combined flanker and cognitive reappraisal task was performed by 49 participants. The flanker task was used to prime IC before participants reappraised or observed negative and neutral content. Priming IC before negative images reduced self-reported negative feelings compared to when IC was not primed. In contrast, priming IC before neutral images increased negative feelings. Priming IC had no influence on the ability to reappraise negative emotional content. Finally, trait rumination was associated with higher emotional reactivity only when IC was not primed. These results illustrate the importance of IC in decreasing emotional reactivity after being exposed to negative content. IC is revealed as a mechanism that can dynamically modulate subjective emotional reactivity as a function of emotional context.

The link between emotion regulation and size estimation of spiders pictures among women with fear of spiders.

Introduction: Fear is associated with perceptual biases. People who are afraid of spiders perceive spiders as larger than people without this fear. It is yet unclear, however, whether this effect can be influenced by using implicit (non-deliberate) emotion regulation (ER) processes and explicit (deliberate) ER strategies, such as reappraisal and suppression. Method: This study examined the link between implicit and explicit ER and size estimation among women afraid of spiders. After performing an implicit ER (cognitive control) task, participants rated the size and valence of spiders, wasps and butterflies shown in pictures. Participants' tendency to use reappraisal and suppression was assessed using the Emotion Regulation Questionnaire. Results: Results showed no effect of implicit ER on size and valence ratings. A greater tendency to use reappraisal was linked to reduced negative feelings on seeing the pictures of spiders. Greater use of suppression, however, was linked to increased size estimation of the spider stimuli. Discussion: These results highlight the role of ER in perceptual biases and offer avenues for future ER-based treatments for specific phobias.

Personalized cognitive training: Protocol for individual-level meta-analysis implementing machine learning methods.

Accumulating evidence suggests that cognitive training may enhance well-being. Yet, mixed findings imply that individual differences and training characteristics may interact to moderate training efficacy. To investigate this possibility, the current paper describes a protocol for a data-driven individual-level meta-analysis study aimed at developing personalized cognitive training. To facilitate comprehensive analysis, this protocol proposes criteria for data search, selection and pre-processing along with the rationale for each decision. Twenty-two cognitive training datasets comprising 1544 participants were collected. The datasets incorporated diverse training methods, all aimed at improving well-being. These training regimes differed in training characteristics such as targeted domain (e.g., working memory, attentional bias, interpretation bias, inhibitory control) and training duration, while participants differed in diagnostic status, age and sex. The planned analyses incorporate machine learning algorithms designed to identify which individuals will be most responsive to cognitive training in general and to discern which methods may be a better fit for certain individuals.

On the benefits and costs of extrinsic emotion regulation to the provider: Toward a neurobehavioral model.

Emotion regulation often takes place within interpersonal relationships. Prior research has focused mainly on the impact of extrinsic emotion regulation (EER) on the recipient. Yet EER may also have emotional and physical consequences for the provider. Understanding who benefits from helping others regulate their emotions and under what conditions is crucial in understanding the mechanisms that reinforce well-being and social ties. This conceptual review integrates existing literature into an interim working model of the benefits and costs of EER for the provider and of the underlying neural mechanisms. Inspired by a recent framework on the factors that underlie intrinsic emotion regulation, we suggest that the influence of EER on the provider depends on interactions among individual differences in salient psychological characteristics, situational factors and type of the emotion regulation strategy used. We further propose three pathways through which EER may influence the provider-stress regulation, reward and empathy-and connect each pathway to a distinct pattern of neural activation.

Prestimulus Activity in the Cingulo-Opercular Network Predicts Memory for Naturalistic Episodic Experience.

Human memory is strongly influenced by brain states occurring before an event, yet we know little about the underlying mechanisms. We found that activity in the cingulo-opercular network (including bilateral anterior insula [aI] and anterior prefrontal cortex [aPFC]) seconds before an event begins can predict whether this event will subsequently be remembered. We then tested how activity in the cingulo-opercular network shapes memory performance. Our findings indicate that prestimulus cingulo-opercular activity affects memory performance by opposingly modulating subsequent activity in two sets of regions previously linked to encoding and retrieval of episodic information. Specifically, higher prestimulus cingulo-opercular activity was associated with a subsequent increase in activity in temporal regions previously linked to encoding and with a subsequent reduction in activity within a set of regions thought to play a role in retrieval and self-referential processing. Together, these findings suggest that prestimulus attentional states modulate memory for real-life events by enhancing encoding and possibly by dampening interference from competing memory substrates.

CHAP: Open-source software for processing and analyzing pupillometry data.

Pupil dilation is an effective indicator of cognitive and affective processes. Although several eyetracker systems on the market can provide effective solutions for pupil dilation measurement, there is a lack of tools for processing and analyzing the data provided by these systems. For this reason, we developed CHAP: open-source software written in MATLAB. This software provides a user-friendly graphical user interface for processing and analyzing pupillometry data. Our software creates uniform conventions for the preprocessing and analysis of pupillometry data and provides a quick and easy-to-use tool for researchers interested in pupillometry. To download CHAP or join our mailing list, please visit CHAP's website: http://in.bgu.ac.il/en/Labs/CNL/chap .

A novel blink detection method based on pupillometry noise.

Pupillometry (or the measurement of pupil size) is commonly used as an index of cognitive load and arousal. Pupil size data are recorded using eyetracking devices that provide an output containing pupil size at various points in time. During blinks the eyetracking device loses track of the pupil, resulting in missing values in the output file. The missing-sample time window is preceded and followed by a sharp change in the recorded pupil size, due to the opening and closing of the eyelids. This eyelid signal can create artificial effects if it is not removed from the data. Thus, accurate detection of the onset and the offset of blinks is necessary for pupil size analysis. Although there are several approaches to detecting and removing blinks from the data, most of these approaches do not remove the eyelid signal or can result in a relatively large amount of data loss. The present work suggests a novel blink detection algorithm based on the fluctuations that characterize pupil data. These fluctuations ("noise") result from measurement error produced by the eyetracker device. Our algorithm finds the onset and offset of the blinks on the basis of this fluctuation pattern and its distinctiveness from the eyelid signal. By comparing our algorithm to three other common blink detection methods and to results from two independent human raters, we demonstrate the effectiveness of our algorithm in detecting blink onset and offset. The algorithm's code and example files for processing multiple eye blinks are freely available for download ( https://osf.io/jyz43 ).

From Surviving to Thriving in the Face of Threats: The Emerging Science of Emotion Regulation Training.

A key survival skill is the ability to regulate your emotions so as to respond adaptively to life's challenges. As such, it is essential to understand how we can improve this ability through training. While this is still a new area of research, to date, behavioral and brain studies have taken one of two approaches: either training individuals to implement strategies that directly impact current emotional responses, or training a cognitive control ability (like working memory, selective attention, response inhibition) to strengthen or tune control processes that can support regulation to subsequently encountered events. Behavioral data highlight the importance of tailoring training to an individual and their emotional situation. Brain data suggest that training impacts domain general cognitive control systems and their interaction with subcortical regions (mainly the amygdala). Future progress will depend on systematic examination of the mechanisms involved in training effectiveness and the populations that may benefit from training.

The interaction between emotion and executive control: Comparison between visual, auditory, and tactile modalities.

The reciprocal connections between emotion and attention are vital for adaptive behaviour. Previous results demonstrated that the behavioural effects of emotional stimuli on performance are attenuated when executive control is recruited. The current research studied whether this attenuation is modality dependent. In two experiments, negative and neutral pictures were presented shortly before a visual, tactile, or auditory target in a Simon task. All three modalities demonstrated a Simon effect, a conflict adaptation effect, and an emotional interference effect. However, the interaction between picture valence and Simon congruency was found only in the visual task. Specifically, when the Simon target was visual, emotional interference was reduced during incongruent compared to congruent trials. These findings suggest that although the control-related effects observed in the Simon tasks are not modality dependent, the link between emotion and executive control is modality dependent. Presumably, this link occurs only when the emotional stimulus and the target are presented in the same modality.

Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty.

PURPOSE: The aim of this study was to explore acute movement-evoked postoperative pain intensity trajectories over the first 5 days after total hip arthroplasty (THA) and to examine how these pain trajectories are associated with pain-related outcomes 6 weeks and 6 months later. METHODS: A total of 150 adult patients [72 women (48.0 %); mean age 60.0 ± 9.2 (standard deviation) years] completed pain questionnaires preoperatively, several times daily postoperatively until hospital discharge, and 6 weeks and 6 months after surgery. RESULTS: Results showed that the best model had four different acute postoperative pain trajectories and a significant quadratic term. The trajectories varied in terms of initial pain intensity levels and rates of decline/increase in pain over the first 4 postoperative days. Significant predictors of pain trajectory membership were preoperative pain disability and anxiety as well as cumulative morphine consumption 24 h following surgery. Pain trajectories were significantly associated with levels of pain intensity and anxiety at 6 weeks but not at 6 months postoperatively. CONCLUSION: This study showed that during the postoperative period patients differed in terms of pain intensity profiles and that these differences were associated with outcomes for up to 6 weeks following surgery. Pain trajectories were not predictive of persistent postoperative pain status at 6 months. Nonetheless, these results highlight the importance of patient heterogeneity in acute postoperative pain and pain-related outcomes months after THA.

Itsy bitsy spider?: Valence and self-relevance predict size estimation.

The current study explored the role of valence and self-relevance in size estimation of neutral and aversive animals. In Experiment 1, participants who were highly fearful of spiders and participants with low fear of spiders rated the size and unpleasantness of spiders and other neutral animals (birds and butterflies). We found that although individuals with both high and low fear of spiders rated spiders as highly unpleasant, only the highly fearful participants rated spiders as larger than butterflies. Experiment 2 included additional pictures of wasps (not self-relevant, but unpleasant) and beetles. The results of this experiment replicated those of Experiment 1 and showed a similar bias in size estimation for beetles, but not for wasps. Mediation analysis revealed that in the high-fear group both relevance and valence influenced perceived size, whereas in the low-fear group only valence affected perceived size. These findings suggest that the effect of highly relevant stimuli on size perception is both direct and mediated by valence.