Resting Heart Rate Variability (HRV) in Adolescents and Young Adults from a Genetically-Informed Perspective.

Reduced heart rate variability (HRV) is associated with cardiac morbidity, mortality, and negative psychopathology. Most research concerning genetic influences on HRV has focused on adult populations, with fewer studies investigating the developmental period of adolescence and emerging adulthood. The current study estimated the genetic and environmental contributions to resting HRV in a sample of twins using various HRV time domain metrics to assess autonomic function across two different time measurement intervals (2.5- and 10-min). Five metrics of resting HRV [mean interbeat interval (IBI), the standard deviation of normal IBIs (SDNN), root square mean of successive differences between IBIs (RMSSD), cardiac vagal index (CVI), and cardiac sympathetic index (CSI)] were assessed in 421 twin pairs aged 14-20 during a baseline electrocardiogram. This was done for four successive 2.5-min intervals as well as the overall 10-min interval. Heritability (h2) appeared consistent across intervals within each metric with the following estimates (collapsed across time intervals): mean IBI (h2 = 0.36-0.46), SDNN (h2 = 0.23-0.30), RMSSD (h2 = 0.36-0.39), CVI (h2 = 0.37-0.42), CSI (h2 = 0.33-0.46). Beyond additive genetic contributions, unique environment also was an important influence on HRV. Within each metric, a multivariate Cholesky decomposition further revealed evidence of genetic stability across the four successive 2.5-min intervals. The same models showed evidence for both genetic and environmental stability with some environmental attenuation and innovation. All measures of HRV were moderately heritable across time, with further analyses revealing consistent patterns of genetic and environmental influences over time. This study confirms that in an adolescent sample, the time interval used (2.5- vs. 10-min) to measure HRV time domain metrics does not affect the relative proportions of genetic and environmental influences.

Efficacy of a workbook to promote forgiveness: a randomized controlled trial with university students.

OBJECTIVE: The present study investigated the efficacy of a 6-hour self-directed workbook adapted from the REACH Forgiveness intervention. METHOD: Undergraduates (N = 41) were randomly assigned to either an immediate treatment or waitlist control condition. Participants were assessed across 3 time periods using a variety of forgiveness outcome measures. RESULTS: The 6-hour workbook intervention increased forgiveness, as indicated by positive changes in participants' forgiveness ratings that differed by condition. In addition, benchmarking analysis showed that the self-directed workbook intervention is at least as efficacious as the delivery of the REACH Forgiveness model via group therapy. CONCLUSION: A self-directed workbook intervention adapted from the REACH Forgiveness intervention provides an adjunct to traditional psychotherapy that could assist the mental health community to manage the burden of unforgiveness among victims of interpersonal harm.

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.

Does context matter in misophonia? A multi-method experimental investigation.

Introduction: Misophonia is a recently defined disorder in which certain aversive repetitive sounds and associated stimuli elicit distressing and impairing affective, behavioral, and physiological responses. The responses in misophonia may be stronger when the sound is produced by close friends and family, suggesting that the context in which a triggering cue occurs may have an important role in misophonia. As such, the goal of this study was to test experimentally whether the context of the sound source influences affective and psychophysiological responses to triggering stimuli in misophonia. Methods: Sixty one adults with misophonia and 45 controls listened to audio recordings (8 s) of human eating, animals eating, and human mouth smacking sounds (without eating). After a break, the same audio recordings were presented embedded within videos of human eating (congruent stimuli), animals eating (congruent stimuli), and, in the mouth smacking condition, with visually incongruent stimuli (hands playing in mud or in a bowl with a watery dough). Psychophysiological responses-skin conductance response (SCR) and heart rate (HR), and self-reported affective responses (valence, arousal, dominance) were gathered during the experiment in a laboratory. Results: Participants with misophonia assessed all the stimuli as more negative and arousing than the controls, and reported feeling less dominant with respect to the sounds. Animal and mouth smacking sounds were assessed by all the participants as less negative and arousing than human eating sounds, but only in the audio-video conditions. SCR data partially confirmed increased psychophysiological arousal in misophonia participants during an exposure to mouth sounds, but did not reflect the self-report changes in response to different contexts. Misophonia participants had deeper deceleration of HR than controls during human eating sound with congruent video stimuli, while there was no group difference during human mouth smacking with incongruent video stimuli. Conclusion: Results suggest that the context of mouth sounds influences affective experiences in adults with misophonia, but also in participants without misophonia. Presentation of animal eating sounds with congruent visual stimuli, or human mouth smacking sounds with incongruent stimuli, decreased self-report reaction to common misophonic triggers.

Detecting implicit racial bias in provider communication behaviors to reduce disparities in healthcare: Challenges, solutions, and future directions for provider communication training.

Since publication of Unequal Treatment by the Institute of Medicine in 2003, there has been a growing recognition of the role of provider implicit racial bias in patient care. Provider implicit racial bias has been consistently negatively associated with both care satisfaction and provider trust among racial/ethnic minority patients. This suggests provider implicit racial bias likely manifests through their communication behaviors, which in turn may offer a means of addressing racial disparities in healthcare and ultimately in health. However, identifying provider communication behaviors that mediate the links between provider implicit racial bias and patient outcomes is challenging. In this paper, we argue that identifying these provider communication behaviors requires (1) taking into account findings from social psychology research of implicit racial bias and (2) incorporating the perspectives of racial/ethnic minority patients into patient-provider communication research. We discuss the utility of mixed methods research designs as a framework for resolving this complex scientific question. Research that draws on social psychology research of implicit racial bias and incorporates the racial/ethnic minority patient perspectives can inform the development of communication skills training programs for students and residents in various healthcare fields. Such programs are one element of a broader effort to reduce racial/ethnic disparities in healthcare.

Assessing the coherence of narratives of traumatic events with latent semantic analysis.

OBJECTIVE: Memories of traumatic events are thought to be less coherent than memories for nontraumatic events, and expressive writing about traumatic events may help create more organized, coherent memories. Investigations of traumatic memories have been hampered by limitations in conceptualizing and measuring memory organization and coherence. The objective of this investigation was to compare the coherence of written narratives of trauma and neutral memories and examine changes in coherence of trauma narratives as a function of repeated expressive writing about the trauma using an atheoretical, computational method for assessing the coherence of text. METHOD: Participants (N = 246) wrote 3 times about either their daily activities (neutral condition) or the most traumatic event of their lives. Latent semantic analysis, a method of calculating meaning from text based on semantic association between words, was used to assess narrative coherence as the average semantic association between contiguous sentences. RESULTS: Neutral narratives were more coherent than trauma narratives overall, but neutral narratives decreased whereas trauma narratives increased in coherence from the first to the final session. CONCLUSIONS: These findings provide evidence that memories for trauma experiences are less coherent than neutral memories and suggest that writing helps to create a more coherent representation of a traumatic event, highlighting a potential mechanism for expressive writing's effects. Results demonstrate the utility of latent semantic analysis for examining coherence of memories of traumatic events. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trait anxiety, disgust sensitivity, and the hierarchic structure of fears.

This paper describes an evaluation of Taylor's (1998) hierarchic model of fears and its relationship to trait anxiety and disgust sensitivity (DS). In Study 1 (N=420), a confirmatory factor analysis supported a hierarchic structure of fears. Next, an analysis using structural equation modeling indicated that trait anxiety is associated with claustrophobic and social fears, whereas DS is associated with all four fear subtypes examined (claustrophobic, social, blood-injection-injury and animal). However, trait anxiety and DS did not account for all variance shared by fear subtypes. The addition of a generalized "fear factor" accounted for significant residual shared variance between the four fear subtypes, beyond that accounted for by trait anxiety and DS. Study 2 (N=213) generally replicated these results. Findings suggest that the hierarchic structural model of fears would benefit from inclusion of trait anxiety and DS as higher-order contributors to fearfulness.

Effect of expressive and neutral writing on respiratory sinus arrhythmia response over time.

BACKGROUND AND OBJECTIVES: Parasympathetic activity, as indexed by respiratory sinus arrhythmia (RSA), underlies key aspects of emotional and cognitive self-regulation. Examining time-varying RSA response during expressive writing about trauma may help inform theory about mechanisms of this intervention. The present study investigated changes in RSA during expressive writing. METHODS: Participants (N = 246, Mage = 21.5 years, 72% female) were randomly assigned to expressive or neutral writing conditions and wrote for three 20-min sessions. RSA was measured continuously during the first and third writing session. RESULTS: Linear mixed model analyses of RSA changes within and across sessions by writing groups found that neutral writers, but not expressive writers, exhibited change in RSA. The overall RSA changes during expressive and neutral writing are consistent with theory about the relationship between cognitive and emotional processing mechanisms and vagal activation. LIMITATIONS: As the present study was not a clinical sample selected on trauma exposure, findings should be considered preliminary. Additionally, engagement of affective and cognitive processes was only hypothesized, as manipulation checks were not performed. CONCLUSIONS: The present study illustrates the benefits of examining changes in RSA over time. Future work with clinical samples should include additional measures and tasks to better define these mechanisms and rule out alternative hypotheses.

Study protocol for investigating physician communication behaviours that link physician implicit racial bias and patient outcomes in Black patients with type 2 diabetes using an exploratory sequential mixed methods design.

INTRODUCTION: Patient-physician racial discordance is associated with Black patient reports of dissatisfaction and mistrust, which in turn are associated with poor adherence to treatment recommendations and underutilisation of healthcare. Research further has shown that patient dissatisfaction and mistrust are magnified particularly when physicians hold high levels of implicit racial bias. This suggests that physician implicit racial bias manifests in their communication behaviours during medical interactions. The overall goal of this research is to identify physician communication behaviours that link physician implicit racial bias and Black patient immediate (patient-reported satisfaction and trust) and long-term outcomes (eg, medication adherence, self-management and healthcare utilisation) as well as clinical indicators of diabetes control (eg, blood pressure, HbA1c and history of diabetes complication). METHODS AND ANALYSIS: Using an exploratory sequential mixed methods research design, we will collect data from approximately 30 family medicine physicians and 300 Black patients with type 2 diabetes mellitus. The data sources will include one physician survey, three patient surveys, medical interaction videos, video elicitation interviews and medical chart reviews. Physician implicit racial bias will be assessed with the physician survey, and patient outcomes will be assessed with the patient surveys and medical chart reviews. In video elicitation interviews, a subset of patients (approximately 20-40) will watch their own interactions while being monitored physiologically to identify evocative physician behaviours. Information from the interview will determine which physician communication behaviours will be coded from medical interactions videos. Coding will be done independently by two trained coders. A series of statistical analyses (zero-order correlations, partial correlations, regressions) will be conducted to identify physician behaviours that are associated significantly with both physician implicit racial bias and patient outcomes. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Virginia Commonwealth University IRB. Study results will be disseminated through publications in peer-reviewed journals and presentations at conferences. A novel Medical Interaction involving Black Patients Coding System from this project will be made publicly available.

Latent Semantic Analysis: A new measure of patient-physician communication.

RATIONALE: Patient-physician communication plays an essential role in a variety of patient outcomes; however, it is often difficult to operationalize positive patient-physician communication objectively, and the existing evaluation tools are generally time-consuming. OBJECTIVE: This study proposes semantic similarity of the patient's and physician's language in a medical interaction as a measure of patient-physician communication. Latent semantic analysis (LSA), a mathematical method for modeling semantic meaning, was employed to assess similarity in language during clinical interactions between physicians and patients. METHODS: Participants were 132 Black/African American patients (76% women, Mage = 43.8, range = 18-82) who participated in clinical interactions with 17 physicians (53% women, Mage = 27.1, range = 26-35) in a primary care clinic in a large city in the Midwestern United States. RESULTS: LSA captured reliable information about patient-physician communication: The mean correlation indicating similarity between the transcripts of a physician and patient in a clinical interaction was 0.142, significantly greater than zero; the mean correlation between a patient's transcript and transcripts of their physician during interactions with other patients was not different from zero. Physicians differed significantly in the semantic similarity between their language and that of their patients, and these differences were related to physician ethnicity and gender. Female patients exhibited greater communication similarity with their physicians than did male patients. Finally, greater communication similarity was predicted by less patient trust in physicians prior to the interaction and greater patient trust after the interaction. CONCLUSION: LSA is a potentially important tool in patient-physician communication research. Methodological considerations in applying LSA to address research questions in patient-physician communication are discussed.

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.

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.

Immediate antecedents of cigarette smoking in smokers with and without posttraumatic stress disorder: a preliminary study.

Using ambulatory methods for 1 day of monitoring, the authors of this study investigated the association between smoking and situational cues in 63 smokers with posttraumatic stress disorder (PTSD) and 32 smokers without PTSD. Generalized estimating equations contrasted 682 smoking and 444 nonsmoking situations by group status. Smoking was strongly related to craving, positive and negative affect, PTSD symptoms, restlessness, and several situational variables among PTSD smokers. For non-PTSD smokers, the only significant antecedent variables for smoking were craving, drinking coffee, being alone, not being with family, not working, and being around others who were smoking. These results are consistent with previous ambulatory findings regarding mood in smokers but also underscore that, in certain populations, mood and symptom variables may be significantly associated with ad lib smoking.

The effects of trauma recall on smoking topography in posttraumatic stress disorder and non-posttraumatic stress disorder trauma survivors.

Smoking topography was measured in trauma survivors with and without posttraumatic stress disorder (PTSD) after recalling trauma-related and neutral experiences. Analysis of covariance was performed on puff topography and mood measures using nicotine dependence scores and current major depressive disorder as covariates. Puff volumes were higher in the PTSD group than in the non-PTSD group. The PTSD group exhibited stable puff onset intervals while the non-PTSD group exhibited significantly shorter intervals following trauma recall. These findings support a "ceiling effect" hypothesis in which individuals with PTSD perpetually smoke in such a way as to maximize nicotine delivery, possibly reducing the potentially reinforcing effects of increased smoke delivery in negative affect-inducing situations.

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.

Magnitude and duration of cardiovascular responses to anger in Vietnam veterans with and without posttraumatic stress disorder.

This study investigated the cardiovascular responses to a relived anger task in 118 male Vietnam combat veterans (62 with posttraumatic stress disorder [PTSD] and 56 without PTSD). Participants completed standardized diagnostic measures, hostility measures, and a laboratory session in which they relived a self-chosen anger memory while heart rate (HR), systolic blood pressure, and diastolic blood pressure (DBP) were measured continuously using an Ohmeda Finapres monitor. Compared with veterans without PTSD, PTSD veterans took less time to feel anger, had greater mean HR and DBP response during relived anger, and reported greater anger and anxiety during the task. There was a significant relationship between covert hostility and anger response, during and after the anger task only in participants with PTSD.

Reactions to facial expressions: effects of social context and speech anxiety on responses to neutral, anger, and joy expressions.

Male and female participants (n=19) high or low in speech fear viewed pictures of faces posed in anger, neutral, and joyful expressions for 8s each. Zygomaticus major and corrugator supercilii EMG, skin conductance, and heart rate were measured during picture viewing, and subjective ratings were made after each picture. Compared to anger expressions, joy expressions were responded to with greater zygomatic EMG, less corrugator EMG, and greater heart rate and skin conductance. Physiological response to neutral expressions was similar to response to anger expressions. Expressions posed by women were responded to physiologically more negatively than expressions posed by men. More fearful participants exhibited more negative and less positive facial expressions, and skin conductance responses suggesting greater attention when viewing negative expressions. Results suggest that reactions to facial expressions are influenced by social context, and are not simple mimicry.

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.

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.

Effects of smoking on the acoustic startle response and prepulse inhibition in smokers with and without posttraumatic stress disorder.

RATIONALE: Cigarette smokers smoke in part because nicotine helps regulate attention. Prepulse inhibition (PPI) of the startle reflex is a measure of early attentional gating that is reduced in abstinent smokers and in groups with attention regulation difficulties. Attention difficulties are found in people with posttraumatic stress disorder (PTSD). OBJECTIVES: The aim of this study is to assess whether smoking and abstinence differentially affect the startle response and PPI in smokers with and without PTSD. METHODS: Startle response and PPI (prepulses at 60, 120, or 240 ms) were measured in smokers with (N = 39) and without (N = 61) PTSD, while smoking and again while abstinent. RESULTS: Participants with PTSD produced both larger magnitude and faster latency startle responses than controls. Across groups, PPI was greater when smoking than when abstinent. The PTSD and control group exhibited different patterns of PPI across prepulse intervals when smoking and when abstinent. Older age was associated with reduced PPI, but only when abstinent from smoking. CONCLUSIONS: The effects of PTSD on startle magnitude and of smoking on PPI replicate earlier studies. The different pattern of PPI exhibited in PTSD and control groups across prepulse intervals, while smoking and abstinent suggests that previous research on smoking and PPI has been limited by not including longer prepulse intervals, and that nicotine may affect the time course as well as increasing the level of PPI. The reduced PPI among older participants during abstinence suggests that nicotine may play a role in maintaining attention in older smokers, which may motivate continued smoking in older individuals.