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Background Saturated-fat intake and endotoxemia can impair cognition. However, their acute impact on cognitive performance is unknown. Objective This study assessed the impact of 2 high-fat meals and endotoxemia on attention. Methods In this double-blind, randomized crossover trial, 51 women (n =  32 breast cancer survivors, n  = 19 noncancer controls; mean ± SD age: 53 ± 8 y) completed the Continuous Performance Test (CPT) and had their blood drawn to assess endotoxemia markers LPS binding protein (LBP), soluble CD14 (sCD14), and the LBP to sCD14 ratio 1 h prior to eating either a high-saturated-fat meal or a high-oleic-sunflower-oil meal. Women again completed the CPT 5 h postmeal. At 1 to 4 wk later, women completed the same protocol but consumed the other meal. Results In adjusted models, women had more difficulty distinguishing target stimuli from distractors after consuming the high-saturated-fat meal than they did after the oleic-sunflower-oil meal (B =  4.44, SE  =  1.88, P =  0.02). Women with higher baseline LBP had less consistent response times (B =  0.002, SE  =  0.0008, P =  0.04). Those with higher LBP and LBP:sCD14 were less able to sustain their attention throughout the entire CPT, as reflected by their progressively slower (B =  0.002, SE  =  0.0006, P =  0.003; and B =  2.43, SE  =  0.090, P =  0.008, respectively) and more erratic (B =  0.003, SE  =  0.0008, P <  0.0001; and B =  3.29, SE  =  1.17, P =  0.006, respectively) response times. Additionally, women with higher baseline LBP or sCD14 were less able to maintain or increase response speeds at higher interstimulus intervals (B =  0.002, SE  =  0.0006, P =  0.02; and B =  0.006, SE  =  0.003, P =  0.03, respectively), indicating greater difficulty adapting to changing task demands. Significant meal type by LBP and LBP:sCD14 interactions emerged (P  < 0.05), such that high LBP and LBP:sCD14 erased between-meal cognitive differences, uniformly impairing performance. Conclusions These results suggest that higher LBP, sCD14, and LBP:sCD14 and saturated-fat intake individually and jointly influence attention. Endotoxemia may override the relative cognitive benefit of healthier oil choices. This trial is registered at clinicaltrials.gov as NCT04247763. [ABSTRACT FROM AUTHOR]

Emotion Regulation Therapy (ERT) has demonstrated efficacy in both open and randomized trials for generalized anxiety disorder (GAD) with and without co-occurring depression. An important goal in ERT is to teach clients adaptive emotion regulation, including healthier metacognitive abilities such as decentering and cognitive reappraisal. A few studies thus far have demonstrated a mediating role for these metacognitive abilities in other cognitive behavioral therapies (CBTs) for GAD. However, a drawback to most of these has been the ability to demonstrate a causal role for improved metacognitive abilities in outcome. In the present study, we utilized multilevel time-lagged segment analyses to explore the temporal dynamics between session-by-session changes in metacognition and anxiety outcomes from ERT. Thirty-one young adults diagnosed with GAD with and without co-occurring depression received 16 sessions of ERT. Prior to each session, participants completed questionnaires pertaining to metacognition (i.e., decentering and cognitive reappraisal) and anxiety symptoms (i.e., worry, trait anxiousness, and generalized anxiety). Changes in decentering temporally preceded changes in worry and trait anxiousness of a medium to large magnitude, and changes in cognitive reappraisal temporally preceded changes in all three outcomes of a medium to large magnitude. The reverse direction, where mediators were predicted by outcomes, was nonsignificant. These findings support the notion that adaptive metacognitive emotion regulation is involved in reducing worry and anxiety in GAD. Having a clearer understanding of the temporal dynamics between metacognitive abilities and symptoms of anxiety can inform and improve not only ERT but other CBTs for GAD, as well. [ABSTRACT FROM AUTHOR]

Emotion regulation therapy (ERT) promotes resilience in distress disorders by strengthening attentional and metacognitive capacities. Regulation skills are presented with the goal of ameliorating the perseverative negative thinking (PNT) that characterizes these disorders. This study tested ERT in a randomized controlled trial comparing the effectiveness of 16-session (ERT16) versus 8-session (ERT8) doses. Patients (N = 72) endorsing elevated worry and/or rumination and meeting diagnostic criteria for a distress disorder were randomized to ERT8 or ERT16. PNT, anxiety/depressive symptoms, functioning/quality of life, and treatment mechanisms (attention shifting, attention focusing, decentering, reappraisal) were measured at pre, mid, and post treatment. Clinical symptom severity was also assigned via diagnostic interview at each timepoint. ERT produced significant improvements across outcomes. ERT16 showed an advantage over ERT8 for distress disorder severity, worry, rumination, and attention shifting from pre-post treatment. Changes in ERT treatment mechanisms mediated changes in clinical improvement. These findings provide evidence of the effectiveness of two doses of ERT in reducing PNT and distress through improvements in regulation skills. NCT04060940. • Emotion regulation therapy (ERT) was tested in an 8-and 16-session format. • Distress-related outcomes and mechanisms were measured at pre, mid, and post treatment. • ERT improved mechanisms and distress-related outcomes through post treatment. • ERT16 was favorable compared to ERT8 across several outcomes. • Indices of attentional and metacognitive regulation mediated these changes. [ABSTRACT FROM AUTHOR]

Emotion regulation therapy (ERT) for generalized anxiety disorder (GAD) and accompanying major depressive disorder (MDD) is a theoretically derived, evidence-based treatment that integrates principles from traditional and contemporary cognitive-behavioral and experiential approaches with basic and translational findings from affect science to offer a blueprint for improving intervention by focusing on the motivational responses and corresponding self-referential regulatory characteristics. Preliminary evidence supports the efficacy of a 20-session version of ERT. However, previous trials of ERT and other traditional and contemporary cognitive-behavioral therapies have often utilized relatively homogeneous samples. Various contextual and demographic factors may be associated with challenges that increase risk for negative mental and social outcomes for young adults ages 18-29, particularly for individuals from diverse backgrounds. The aim of this pilot study was to examine the effectiveness of a briefer 16-session version of ERT in a racially and ethnically diverse sample of young adults. Participants (N = 31) were enrolled at an urban-based, commuter college who consented to treatment for anxiety, worry, or depression at an on-campus counseling center. Open-trial results demonstrate strong ameliorative changes in worry, rumination, self-reported and clinician-rated GAD and MDD severity, social disability, quality of life, attentional flexibility, decentering/distancing, reappraisal, trait mindfulness, and negative emotionality from pre- to posttreatment. These gains were maintained throughout a 3- and 9-month follow-up. These findings provide preliminary evidence for the efficacy of ERT in treating a racially and ethnically heterogeneous population. Further, this study highlights comparable effectiveness of a briefer 16-session version of ERT. [ABSTRACT FROM AUTHOR]

Dyadic stress theories and research suggest that couples' negative communication patterns threaten immune and emotional health, leaving partners vulnerable to illness. Spouses' relationship perceptions can also color how they see and react to marital discussions. To identify pathways linking distressed marriages to poor health, this study examined how self-reported typical communication patterns augmented discussion-based behavioral effects on spouses' blister wound healing, emotions, and discussion evaluations. Married couples completed two 24-hour in-person visits where they had their blood drawn to measure baseline interleukin-6 (IL-6), received suction blister wounds, reported their typical communication patterns (demand/withdraw strategies, mutual discussion avoidance, mutual constructive communication), and engaged in marital discussions. Discussions were recorded and coded for positive and negative behaviors using the Rapid Marital Interaction Coding System (RMICS). Immediately after the discussions, spouses rated their emotions and evaluated the discussion tone and outcome. Wound healing was measured for 12 days. Couples who reported typically using more demand/withdraw or mutual avoidance patterns had higher baseline IL-6, slower wound healing, greater negative emotion, lower positive emotion, and poorer discussion evaluations. In contrast, couples reporting more mutual constructive patterns reported more favorable discussion evaluations. Additionally, couples' more negative and less positive patterns exacerbated behavioral effects: Spouses had wounds that healed more slowly, reported lower positive emotion, and evaluated the discussions less positively if their typical patterns and discussion-based behaviors were more negative and less positive. Couples' typical communication patterns—including how often they use demand/withdraw, mutual avoidance, and mutual constructive patterns—may color spouses' reactions to marital discussions, amplifying the biological, emotional, and relational impact. These findings help explain how distressed marriages take a toll on spouses' health. • Married couples had blood draws, received blister wounds, and engaged in discussions. • Negative communication patterns augmented behavioral effects on wound healing. • Negative patterns and behaviors predicted more negative discussion emotions and evaluations. • Effects were stronger in women than men. • The findings highlight how distressed marriages take a toll on spouses' health. [ABSTRACT FROM AUTHOR]

Breast cancer survivors face a number of physical health threats including cardiovascular disease, the leading cause of death among breast cancer survivors. Low heart rate variability (HRV) represents one well-established risk factor for poor cardiovascular health. Among physically healthy adults and breast cancer survivors, distress disorders may contribute to lower HRV, enhancing morbidity and mortality. This study examined how a distress disorder history altered survivors' HRV trajectories during and after an experimental stressor. Breast cancer survivors (n = 178; mean age = 51.22) who finished treatment for stages 0-IIIa cancer within the past two years completed a diagnostic interview assessing lifetime presence of psychological disorders. They also participated in a Trier Social Stress Test (TSST). HRV data provided information on survivors' cardiovascular responses at baseline, during the TSST, and during recovery. HRV recovery data at 45 min and 120 min post-TSST was also collected. Survivors also completed questionnaires before and after the TSST assessing task performance, stress levels, ability to cope, and hopelessness. Covariates included body mass index, age, cancer stage, cardiovascular medications, exercise, menopause status, fatigue, current depressive and anxiety symptoms, and physical comorbidities. Women with a distress disorder history had significantly lower HRV before, during, and after the TSST compared to women without such a history. Survivors with distress disorders found the TSST to be more threatening, and reported feeling less control over their performance than those without distress disorders. Breast cancer survivors with a distress disorder history may have lower autonomic flexibility before, during, and after stress exposure. Distress disorder histories also heighten several stress-related risk perceptions leading up to and following the TSST. These findings highlight distress disorder histories as a unique correlate of poorer cardiovascular function among survivors. • Low HRV is a risk factor for cardiovascular disease. • Breast cancer survivors had HRV measured before, during, and after the TSST. • Survivors completed an interview to assess current and past distress disorders. • Distress disorder histories corresponded to lower HRV throughout the stressor. • Distress histories may therefore enhance cardiovascular disease risk for survivors. [ABSTRACT FROM AUTHOR]

• GAD is associated with painful physical symptoms. • Psychotherapy can ameliorate both psychological and physical distress. • Changes in anxiety and depression during treatment preceded reductions in gastric distress. • Findings highlight utility of using psychotherapy to help physical symptoms in GAD. Generalized anxiety disorder (GAD) is characterized, in part, by physical symptoms such as muscle tension and gastrointestinal (GI) distress. To date, little research has examined how changes in psychological symptoms associated with GAD may impact physical symptoms. This study investigated if reductions in worry, anxiety, and depression precede changes in muscle tension and GI distress throughout psychotherapy. Participants with GAD (N = 85) completed 20 weeks of emotion regulation therapy (ERT) in addition to assessments pre, mid, and post treatment. They completed a physical symptom questionnaire, evaluating muscle tension and GI distress. Participants also completed psychological symptoms questionnaires, including the State Trait Anxiety Inventory (STAI-7), Penn State Worry Questionnaire (PSWQ), and Beck Depression Inventory (BDI-II). Control participants (N = 44) completed these measures at baseline. Participants with GAD had significantly greater muscle tension (p <.001) and GI distress (p <.001) compared to control participants without GAD. Reductions in worry, depression, and trait anxiety did not precede changes in muscle tension (range of effect size (r):.05–.12). Reductions in both depression (p = 0.04) and trait anxiety (p < 0.01) preceded reductions in GI distress. Reductions in worry did not precede reductions in GI distress (p = 0.25). These data provide preliminary evidence for the temporal effect of reductions in psychological symptoms on reductions in GI distress in GAD, highlighting the potential of psychotherapy to improve physical outcomes. [ABSTRACT FROM AUTHOR]

• Participants completed experimental inductions of worry and relaxation • Participants had their blood drawn three times and heart rate variability was collected • Findings highlight how worry may dysregulate multiple biological systems • Relaxation may be used to buffer the biological implications of worrying • This is the first study to show the experimental impact of worry on inflammation Worry increases risk for long-term health issues by prolonging the physiological stress response. In contrast, relaxation may ameliorate the psychological and physiological burden resulting from worry. This study examined the impact of experimentally induced worry and relaxation on cortisol, heart rate variability (HRV), and inflammation. Participants (N = 80) completed both a worry and relaxation induction (presented in a fixed order) while HRV was collected continuously. Three blood samples were taken (at baseline, after the worry induction, and after the relaxation induction) to measure IL-6, IFN-γ, TNF-α and serum cortisol. There were significant changes in IL-6 (p < 0.001), IFN-γ (p < 0.01), HRV (p <.001), and cortisol (p <.001) but not in TNF-α (p = 0.65) across conditions. HRV decreased significantly from baseline to worry and then increased following relaxation. IL-6 was higher during relaxation compared to worry and baseline. Cortisol decreased significantly across conditions. Several patterns of covariance between inflammation and HRV and/or cortisol also emerged. These findings offer novel insight into how worry influences the immune system and emphasize the utility of a multi-methods approach to understanding the impact of worry on physical health. [ABSTRACT FROM AUTHOR]

• Breast cancer survivors provided blood samples at three visits to test for inflammation. • Survivors completed a measure of cancer-related distress at each visit. • Within-person fluctuations in cancer-related distress were linked to higher inflammation. • Between-person differences in cancer-related distress was not linked to inflammation. • We show how cancer-related distress may impact physical health among survivors. Among breast cancer survivors, elevated inflammation has been linked to greater recurrence risk. Psychological processes, such as cancer-related distress, can pose threats to a survivor's longevity and wellbeing. Although distress can heighten inflammation, little is known about how fluctuations in distress during and after treatment impact a woman's own inflammation – the primary question of this study. Breast cancer survivors (n = 165, stages 0-III) completed a baseline visit before treatment and two follow-up visits 6 and 18 months after. At each visit, women completed the Impact of Events Scale to assess cancer-related distress, and a blood sample was collected to measure proinflammatory cytokines IL-6, TNF-α, IL-1β, and IL-8. This longitudinal study related fluctuations in survivor's own cancer-related distress (i.e., within-person effects), as well as average effects of cancer-related distress between survivors (i.e., between-person effects) to inflammatory changes across visits. Women had elevated inflammation at visits where they expressed more cancer-related distress than what was typical. In contrast, the average cancer-related distress was not associated with inflammation. Larger increases in a women's cancer-related distress was linked with higher inflammation across visits. Comparing a survivor's own cancer-related distress to her average levels may prove useful in identifying links between distress and inflammation. [ABSTRACT FROM AUTHOR]

• Married couples provided 5 salivary cortisol samples during a 9.5 h visit. • Coding of couples' conflicts provided data on positive and negative behavior. • A stressed spouse was associated with slower declines in one's own cortisol. • Negative and less positive behaviors and a stressed spouse related to higher cortisol. • We show how partners "get under the skin" to influence stress-related health risk. Perceived stress can lead to dysregulated cortisol patterns, including blunted peaks and flatter slopes, which are associated with increased morbidity and mortality risks. Couples' interdependence provides a prime opportunity for partners' stress to disrupt a healthy cortisol pattern. This study examined how individuals' own perceived stress and their partners' perceived stress shape cortisol levels and slopes across the day, as well as how positive and negative behaviors during conflict discussions impact associations between stress and cortisol. Both partners of a married couple (n = 43 couples, 86 individuals) completed a full day in-person visit. Each partner completed the Perceived Stress Scale, and all couples engaged in a 20-min marital problem discussion which was recorded and later coded for positive and negative behaviors using the Rapid Marital Interaction Coding System (RMICS). Partners also provided five salivary cortisol samples across the day, two samples before the conflict and three after the conflict. The dyadic design and analyses provided a way to account for the interdependent nature of married couples' data, as well as to use the Actor-Partner Interdependence Model (APIM) to assess the mutual influence of spouses' stress on cortisol. Individuals with more stressed partners had flatter cortisol slopes than individuals with less stressed partners, who showed steeper and thus healthier declines across the day. Individuals' cortisol levels at the beginning of the day were similar regardless of their partners' perceived stress, but individuals with more stressed partners had higher cortisol levels 30-min, 1 h, and 4 h after the conflict discussion than those with less stressed partners. Couples' behavior during the conflict moderated the relationship between partner perceived stress and average cortisol; when couples used more negative and less positive behaviors, individuals with more stressed partners had higher average cortisol levels than those with less stressed partners. On a day couples experienced conflict, having a partner with higher perceived stress is associated with dysregulated cortisol patterns, including higher levels and flatter slopes, but having a partner with lower perceived stress is linked to steeper and thus healthier cortisol declines. A partner's stress was particularly consequential for one's own cortisol when couples used more negative and fewer positive behaviors during a conflict discussion. This research adds to the growing literature on pathways connecting marital interactions to important biorhythms and health. [ABSTRACT FROM AUTHOR]

• Breast cancer survivors completed visits before and 6 and 18 months after treatment. • When survivors were more satisfied with their relationship, they were less stressed. • In turn, feeling less stressed was related to lower inflammation levels. • Longitudinal examination demonstrated associations between and within survivors. • We show utility of within-person approaches to assess survivors' changes over time. Breast cancer survivors with elevated inflammation have a greater risk for cancer recurrence, premature mortality, and comorbid disease development. The psychological stress survivors experience when confronted with a breast cancer diagnosis and cancer treatment can heighten inflammation. Identifying factors that reduce stress and inflammation could lead to improvements in survivors' long-term health. Accordingly, this study examined the health-enhancing effects of romantic relationships—a key health determinant—on breast cancer survivors' stress and inflammation. Breast cancer survivors (n = 139, stages 0–IIIC) completed a baseline visit before treatment and two follow-up visits 6 and 18 months after treatment ended. Women completed self-report questionnaires assessing their romantic relationship satisfaction and perceived stress, and they provided a blood sample for serum markers of inflammation at each visit. The longitudinal design allowed for examination within and between survivors. We conducted multilevel mediation analyses to assess how changes in survivors' relationship satisfaction were related to changes in stress and inflammation from visit to visit (i.e., within-person effects), as well as how the average effects of relationship satisfaction were associated with average stress and inflammation levels throughout the study (i.e., between-person effects). At the within-person level, at visits in which survivors were more satisfied with their relationships, they also perceived less stress, which in turn was related to lower than their own average levels of serum C-reactive protein and proinflammatory cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-1β). At the between-person level, survivors who had greater relationship satisfaction throughout the study had lower perceived stress, which was linked to lower levels of inflammation. Breast cancer survivors in satisfying romantic relationships felt less stressed and in turn had lower inflammation throughout cancer treatment. This study illustrates the utility of a within-person approach to not only consider the average effects of relationship satisfaction, but also how changes in their own relationship satisfaction impact stress and inflammation over time. Our findings demonstrate important psychological and immunological pathways through which satisfying relationships may promote breast cancer survivors' long-term health. [ABSTRACT FROM AUTHOR]

The role of emotion dysregulation in the development and maintenance of transdiagnostic psychopathology is well established. Although behavioral acts often serve a regulatory function, there have been few systematic attempts to reliably measure multiple, functionally similarly forms of behavioral dysregulation via self-report. Using student (N = 776) and community (N = 494) samples, we examined the initial psychometric properties of a measure of behavioral emotion dysregulation, the Behavioral Dysregulation Scale (BDRS). Internal consistency was examined, and confirmatory factor analysis was used to confirm the presence of a rationally derived one-factor structure of the BDRS in both samples. Construct validity was assessed using bivariate correlations. We obtained a unidimensional, 13-item measure of behavioral dysregulation with adequate factor structure and good construct validity. Across both samples, a one-factor solution fit the data with acceptable to strong factor loadings. The BDRS was correlated with theoretically related but distinct constructs, including strong negative associations with measures of maladaptive cognitive emotion regulation and small to moderate positive associations with measures of adaptive cognitive emotion regulation. The results demonstrate preliminary support for the BDRS as a reliable and valid measure of behavioral emotion dysregulation with implications for better assessing the regulatory function of common maladaptive behaviors. • Emotion dysregulation is common in transdiagnostic psychopathology. • Behaviors often serve an emotion regulation function. • Psychometric properties of the Behavioral Dysregulation Scale (BDRS) were examined. • The BDRS demonstrated adequate factor structure and good construct validity. [ABSTRACT FROM AUTHOR]

Black breast cancer survivors have greater morbidity and mortality than White survivors. However, evidence comparing Black survivors' psychological symptoms with their White counterparts has been mixed. Prior studies have not compared Black and White survivor's distress-related symptom trajectories from pre- to post-treatment – the goal of the current study. At three annual visits from shortly after diagnosis to 6 and 18 months post-treatment, 195 women (n = 163 White; n = 32 Black) reported their cancer-related distress (intrusive thoughts and avoidance), perceived stress, anxiety and depressive symptoms, fatigue, and pain. Adjusting for age, educational attainment, income, treatment type, stage at diagnosis, and physical comorbidities, Black and White breast cancer survivors had different trajectories of cancer-related distress (p =.004), intrusive thoughts about cancer diagnosis and treatment (p =.002), perceived stress (p =.04), emotional fatigue (p =.01), and vigor (p =.02). Specifically, among White women, these distress-related symptoms improved from diagnosis to 6 months post-treatment (p s < 0.0001) and then remained stable between 6 and 18 months post-treatment, whereas Black women had persistently elevated distress – even 18 months after finishing treatment. Additionally, Black women reported more avoidance of cancer-related thoughts and emotions across visits (p =.047). Race was unrelated to the trajectories of anxiety and depressive symptoms, other fatigue subscales, or pain levels (p s > 0.08). Longitudinal assessment of the same breast cancer survivors from diagnosis to early survivorship revealed that Black and White survivors had divergent trajectories of psychological distress symptoms that were not reliably evident at a single timepoint. Overall, White women reported less psychological distress from pre- to post-treatment, but Black women's distress remained high from diagnosis to 18 months post-treatment. If left untreated, Black women's high distress levels may contribute to their poorer health throughout survivorship. • We compared Black and White breast cancer survivors' distress over two years. • White women's psychological distress declined from pre- to post-treatment. • In contrast, Black survivors had heightened and persistent psychological distress. • Results support the new clinical guideline to assess distress at each visit. [ABSTRACT FROM AUTHOR]