Search

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., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Ruminative thinking about negative feelings has been prospectively associated with increases in depressive symptoms and heightened risk for new onsets of major depression. One putative pathophysiological mechanism underlying this link might be represented by autonomic nervous system dysfunction. The objective of this longitudinal study was to evaluate the interplay between rumination, autonomic function (as revealed by heart rate variability (HRV) analysis), and depressive symptoms in healthy young subjects, over a three-year period. Rumination and depressive symptoms were evaluated in twenty-two women and twenty men at three assessment points (Time 0, 1 and 2) by the score on the Ruminative Response Scale, and the Center for Epidemiological Studies Depression Scale, respectively. Vagally-mediated HRV was assessed in a laboratory session (Time 0) and in two ambulatory sessions at Time 1 and Time 2 (~13 and 34months after Time 0, respectively). Ruminative thinking was found to be (i) a stable trait characteristic, (ii) more prevalent in women than men, and (iii) positively correlated with depressive symptoms. Moreover, resting HRV was negatively correlated with both rumination and depressive symptoms. Finally, HRV at Time 1 mediated the relationship between rumination at Time 0 and depressive symptoms at Time 2. We conclude that autonomic dysfunction, specifically low vagal tone, may be prospectively implicated in the generation of depressive symptoms in a non-clinical setting., (Copyright © 2017 Elsevier B.V. All rights reserved.)

From a combined neurobiological and evolution-theoretical perspective, the stress response is a subcortically subserved response to uncertainty that is not 'generated' but 'default': the stress response is 'always there' but as long as safety is perceived, the stress response is under tonic prefrontal inhibition, reflected by high vagally mediated heart rate variability. Uncertainty of safety leads to disinhibiting the default stress response, even in the absence of threat. Due to the stress response's survival value, this 'erring on the side of caution' is passed to us via our genes. Thus, intolerance of uncertainty is not acquired during the life cycle, but is a given property of all living organisms, only to be alleviated in situations of which the safety is learned. When the latter is deficient, generalized unsafety ensues, which underlies chronic anxiety and stress and their somatic health risks, as well as other highly prevalent conditions carrying such risks, including loneliness, obesity, aerobic unfitness and old age., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Excessive cardiac responses to stressful events are a risk factor for morbidity and mortality. Adverse cardiac responses are usually attributed to conscious negative stress and emotions. Yet, cardiac responses might also be affected by emotions that are not consciously reported. Here we tested this hypothesis. Sixty participants were randomly allocated to an evaluated speaking stressor or control condition. Trait, state and implicit anxiety were assessed with the State Trait Anxiety Inventory, visual analog scales and the Implicit Association Test for assessing anxiety, with the latter two assessed before and after the stressor. Results showed that the stressor did not significantly affect implicit anxiety. Yet, participants with high implicit anxiety after the stressor had an overall enhanced heart rate and larger stressor-induced decreases in heart rate variability. These associations were independent of conscious anxiety. The implications of the results for a better understanding of excessive cardiac activity are discussed., (Copyright © 2014 Elsevier B.V. All rights reserved.)

The Penn State Worry Questionnaire (PSWQ) is a widely used self report scale to assess pathological worry. Several studies have shown that the paper-and-pencil version of the PSWQ shows satisfactory psychometric properties. Yet, it is unknown whether the PSWQ is suited to be administered on Internet. As the amount of assessments conducted online is vastly increasing, we examined the factor structure, predictive validity and reliability of the online version of the PSWQ in a large community sample (N = 1025). Confirmatory factor analyses demonstrated that the best fit to the data was provided by a one factor model wherein the reverse-worded items also loaded on a separate method factor. In a second part of the study a self-selected subsample of the total sample (n = 189) kept a log of the frequency and duration of worry episodes for six consecutive days. Worry frequency and worry duration were both predicted by the PSWQ, thereby lending support to its predictive validity. These findings provide preliminary evidence that the online version of the PSWQ possesses psychometric properties that are similar to the paper-and-pencil version., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

This study examined the psychological processes that may impede or facilitate cardiovascular recovery. It was hypothesized that cardiovascular recovery would be hampered by negative affect and rumination, and facilitated by positive affect. In an experimental study, stress was elicited by exposing participants (N=110) to a mental arithmetic task with harassment. After the stress task, affective levels were manipulated via a movie scene with negative, neutral, or positive emotional valence, or without an affect manipulation (control condition). During the entire experiment, heart rate and systolic and diastolic blood pressure levels were measured continuously. Results indicated that blood pressure recovery was hampered by the negative affect manipulation and by rumination. However, the positive affect manipulation did not facilitate blood pressure recovery. No effects were found on heart rate recovery. In sum, the findings emphasize the importance of negative affect and rumination in stress recovery., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. The understanding of the risk factors for CVD may yield important insights into the prevention, etiology, course, and treatment of this major public health concern. Autonomic imbalance, characterized by a hyperactive sympathetic system and a hypoactive parasympathetic system, is associated with various pathological conditions. Over time, excessive energy demands on the system can lead to premature aging and diseases. Therefore, autonomic imbalance may be a final common pathway to increased morbidity and mortality from a host of conditions and diseases, including cardiovascular disease. Heart rate variability (HRV) may be used to assess autonomic imbalances, diseases and mortality. Parasympathetic activity and HRV have been associated with a wide range of conditions including CVD. Here we review the evidence linking HRV to established and emerging modifiable and non-modifiable CVD risk factors such as hypertension, obesity, family history and work stress. Substantial evidence exists to support the notion that decreased HRV precedes the development of a number of risk factors and that lowering risk profiles is associated with increased HRV. We close with a suggestion that a model of autonomic imbalance may provide a unifying framework within which to investigate the impact of risk factors, including psychosocial factors and work stress, on cardiovascular disease., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.)

Slow cardiovascular (CV) recovery after stress is a predictor of adverse CV outcomes. Perseverative cognition (PC) about stress has been hypothesized to co-determine slow recovery. In the present study, it was investigated whether two types of trait PC, i.e. trait worry and trait rumination, predicted delayed cardiac recovery after a cognitive stressor. Furthermore, it was examined whether explicit state PC (i.e. negative intrusive thoughts) or implicit state PC (i.e. automatic vigilance) additionally predicted delayed cardiac recovery. Fifty-nine participants performed a stressful task, which consisted of an unsolvable synonym task. After a 6-minute recovery period, participants reported on their level of negative intrusive thoughts (i.e. explicit state PC), and performed a lexical decision task (LDT) to measure automatic vigilance for task-related information (i.e. implicit state PC). Cardiac activity was continuously measured using heart rate (HR) and heart rate variability (HRV). Trait worry and rumination were measured by the Penn State Worry Questionnaire (PSWQ) and the Ruminative Response Scale (RRS), respectively. The results showed that high trait worriers had a slower HR recovery from the cognitive stressor compared to low trait worriers. They also showed delayed HRV recovery, but only when the tendency to dwell upon one's negative mood (the 'brooding' subscale of the RRS) was low. Slow HR recovery was associated with high levels of negative intrusive thoughts and with automatic vigilance, but in the unexpected direction for the latter. These results provide evidence that delayed cardiac recovery is associated with trait as well as state PC, and suggest that brooding attenuates the HRV suppressing effect of high trait worry.

Appropriate regulation of emotions is an important component of health. The physiological effects of coping with anger are a topic of particular interest. In a pioneering series of studies Hokanson found that the mode of anger expression following anger instigation had differential effects on vascular recovery. These differential effects were thought to be a result of social learning of avoidance responses. The present study examined this hypothesis in the context of ethnic differences in cardiovascular recovery responses to anger instigation. Twenty-four African American (AA) and 26 European American (EA) males engaged in two debates, one racially themed and one non-racially themed, with an EA confederate. Cardiovascular measures were recorded at baseline, during the debates and during 10-minute recovery periods following each debate. Anger expression preceding the recovery period was manipulated such that half the participants could express their anger toward the confederate and half had to inhibit their anger toward the confederate. Results showed that both AA and EA participants that inhibited their anger had delayed total peripheral resistance recovery. Importantly, for the other dependent variables differential recovery responses were observed such that EA participants that expressed their anger recovered more quickly whereas AA participants that expressed their anger recovered more slowly. These results are consistent with Hokanson's social learning theory of recovery from anger instigation and have important implications for research on emotion regulation and health.

Stress and anxiety are risk factors for cardiovascular (CV) disease. Worry might be a mediator of their risks by prolonging their cognitive representation and concomitant CV activity. We hypothesized that daily stressors and worry, and trait anxiety and trait worry would be associated with high heart rate (HR) and low heart rate variability (HRV) during waking and the subsequent nocturnal sleep period, and that worry would mediate the effects of daily stressors. Low HRV and high HR are physiological risk factors for CV disease. Using an hourly diary, stressors, worry frequency and duration, and biobehavioral variables were measured during one day in 52 healthy subjects. During this time and the subsequent nocturnal sleep period, ambulatory ECG was measured. Stressors, worry and traits were related to higher HR and lower HRV during waking, and the effects of stressors and worry were extended into the sleeping period. Worry duration mediated the effects of stressors. The results were largely independent of biobehavioral variables including sleep quality. The results support the notion that worry, by prolonging CV activity, is a mediator of the CV risks of stress. They also imply a role for unconscious cognitive representation of stress.

Background: Depression is a major risk factor for cardiovascular disease. An important risk factor for cardiovascular disease, low heart rate variability, often has been found in depressed patients and has been associated with impulsivity. The present study investigated whether experimental lowering of serotonin would decrease heart rate variability and increase impulsivity in remitted depressed patients, in particular in those patients with disturbed impulse control., Methods: Nineteen patients in remission from depression received high-dose and low-dose acute tryptophan depletion in a randomized, counterbalanced, double-blind crossover design. Heart rate variability and impulsivity were assessed during each acute tryptophan depletion session and during a baseline session. Suicidal ideation during past depression was used as an index for individual differences in impulse control., Results: High-dose acute tryptophan depletion led to a larger increase in depressive symptoms than did low-dose acute tryptophan depletion. High-dose acute tryptophan depletion decreased heart rate variability and increased impulsivity and anxiety, but only in patients with a history of suicidal ideation. Symptom effects of high-dose acute tryptophan depletion correlated with low heart rate variability at baseline., Conclusions: Depressed patients who have problems with controlling impulsivity might be more at risk for developing cardiovascular disease, possibly related to increased vulnerability to impaired 5-hydroxytryptamine function.

Objective: Multiple genes and environmental factors play a role in the etiology of autoimmune thyroid disease (AITD). In Graves' hyperthyroidism, stress is such an environmental factor, but whether it plays a role in Hashimoto's hypothyroidism is unknown. We used validated questionnaires to evaluate an association between TPO antibodies, an early marker for AITD, and self-reported stress., Subjects and Methods: Recently Experienced Stressful Life Events, Daily Hassles, and mood (tendency to report positive and negative affects) were assessed in 759 euthyroid subjects., Results: TPO antibodies were found in 183/759 (24%) of subjects. The TPO-Ab positive subjects were older (39.7+/-12 vs. 34.2+/-12 years; p<.001) than the TPO-Ab negative subjects, but the number of daily hassles (24+/-14 vs. 25+/-14; p=.24), the number of stressful life events (10+/-6 vs. 11+/-6; p=.09), and the scores on the affect scales (22.1+/-7.4 vs. 22.2+/-7.3; p=.89 for negative affect and 38.2+/-5.1 vs. 38.3+/-5.3; p=.91 for positive affect) were similar in TPO-Ab positive and TPO- Ab negative subjects., Conclusions: We found no association between recently experienced stressful life events, daily hassles or mood and the presence of TPO antibodies in these euthyroid women.

Summary. Recent ambulatory findings showing comparable cardiovascular effects of positive and negative emotions are not consistent with the assumed etiological role of negative affect in stress-related diseases. We tested the hypothesis that regardless of initial reactivity, responses associated with negative emotions would be prolonged compared to responses associated with positive emotions. During 8 h, 33 healthy subjects from a general population reported their emotional arousal, emotional valence and physical activity and recorded their heart rates (HR) after a beep at each 60th min ('initial HR'; T0), followed by two 'prolonged activation' recordings, respectively 5 min later (T1) and 10 min later (T2). While emotional arousal and activity predicted initial HR, prolonged activation at T1 was solely predicted by emotional valence (negative affect) at T0, independent of emotional recovery. The results lend support to the hypothesis that cardiovascular activation after negative emotions last longer than after positive emotions. This finding is consistent with the view that prolonged activation, and not so much reactivity, might be a mechanism underlying the etiological role of negative emotions ('stress') in somatic disease. Perseverative cognition (worry, rumination) might be responsible for this prolonged activation.