Lower Heart Rate Reactivity Research Articles

Heart rate reactivity during trauma recall as a predictor of treatment outcome in cognitive processing therapy for PTSD

Emotional engagement when recollecting a trauma memory is considered a key element of effective trauma-focused therapy. Research has shown that reduced physiological reactivity during trauma recall is associated with worse treatment outcomes for posttraumatic stress disorder (PTSD), but this has yet to be examined in a cognitively oriented treatment. This study examined whether pretreatment heart rate (HR) reactivity during trauma recall predicts PTSD symptom improvement and treatment dropout during Cognitive Processing Therapy (CPT) for PTSD. Participants were 142 women with PTSD secondary to interpersonal violence enrolled in one of two clinicals trials. HR reactivity reflected the mean increase in HR after listening to two 30-s scripts of the trauma memory prior to treatment. Linear mixed-effects models showed the effect of HR reactivity on change in total PTSD symptoms was not significant, but lower HR reactivity predicted less improvement in reexperiencing and avoidance and was associated with increased dropout. Findings suggest pretreatment physiological reactivity to the trauma memory may be a prognostic indicator of some elements of treatment response in CPT. Results tentatively support the importance of emotional activation during trauma recall in cognitive treatment of PTSD, though more research is needed to clarify how low HR reactivity impacts treatment.

Developmental connections between socioeconomic status, self-regulation, and adult externalizing problems.

Children from low socioeconomic status (SES) backgrounds are at particularly heightened risk for developing later externalizing problems. A large body of research has suggested an important role for self-regulation in this developmental linkage. Self-regulation has been conceptualized as a mediator as well as a moderator of these connections. Using data from the Child Development Project (CDP, N=585), we probe these contrasting (mediating/moderating) conceptualizations, using both Frequentist and Bayesian statistical approaches, in the linkage between early SES and later externalizing problems in a multi-decade longitudinal study. Connecting early SES, physiology (i.e., heart rate reactivity) and inhibitory control (a Stroop task) in adolescence, and externalizing symptomatology in early adulthood, we found the relation between SES and externalizing problems was moderated by multiple facets of self-regulation. Participants from lower early SES backgrounds, who also had high heart rate reactivity and lower inhibitory control, had elevated levels of externalizing problems in adulthood relative to those with low heart rate reactivity and better inhibitory control. Such patterns persisted after controlling for externalizing problems earlier in life. The present results may aid in understanding the combinations of factors that contribute to the development of externalizing psychopathology in economically marginalized youth.

Fight or flight: The effect of heart rate reactivity on acute stress-induced food intake

The ‘fight-or-flight-reaction’ describes the suppression of all irrelevant functions like food intake during the acute stress response. However, heart rate reactivity and food intake under acute stress has not been investigated. Therefore, the aim of this study was to investigate the effect of high and low heart rate reactivity on food intake following an acute laboratory stress paradigm in individuals with healthy weight. Fifty-six men and women with healthy weight (BMI: M = 21.82 ± 1.53 kg/m²) were categorized into high heart rate reactors (H-HRR) and low heart rate reactors (L-HRR). After the stress paradigm of the Trier Social Stress Test (TSST), total energy intake was measured in a standardized laboratory meal. H-HRR demonstrated a significantly lower appetite (z = -3.133, p≤ 0.01) and food intake (t(49.13) = 2.253, p≤ 0.05, d= 0.68) after the TSST compared to the L-HRR. No differences in the stress perception and cognitive appraisal could be found between the two reactor groups. These results suggest that the stress-induced heart rate reactivity might be a responsible factor in the stress-eating paradox. In view of the divergent results of stress-induced eating studies in laboratory setting with acute stressors, it is highly important to control the effect of the heart rate reactivity on food intake.

Lower Cardiovascular Reactivity is Associated with More Childhood Adversity and Poorer Midlife Health: Replicated Findings from the Dunedin and MIDUS Cohorts.

Cardiovascular reactivity has been proposed as a biomarker linking childhood adversity and poorer health. The current study examined the association of childhood adversity, cardiovascular reactivity, and health in the Dunedin (n=922) and MIDUS studies (n=1,015). In both studies, participants who experienced more childhood adversity had lower cardiovascular reactivity. In addition, people with lower cardiovascular reactivity had poorer self-reported health and greater inflammation. Dunedin participants with lower cardiovascular reactivity were aging biologically faster, and MIDUS participants with lower heart rate reactivity had increased risk of early mortality. Cardiovascular reactivity was not associated with hypertension in either study. Results were partially accounted for by greater reactivity among more conscientious, less depressed, and higher-functioning participants. These results suggest that people who experienced childhood adversity have a blunted physiological response, which is associated with poorer health. The findings highlight the importance of accounting for individual differences when assessing cardiovascular reactivity using cognitive stressor tasks.

Heart Rate Reactivity to Mental Stress in Athlete and Non-Athlete Children

Background. Research suggests that exercise training and/or physical fitness may be associated with lower heart rate reactivity and faster recovery from psychosocial stress. This relationship was rarely studied in children despite the potential protective role of physical activity in stress that may start in early life stages.
 Methods. In this laboratory investigation we examined 18 athlete and non-athlete children before, during and following exposure to mental stress which consisted of the Stroop Color Word Task and a mental arithmetic task, both distracted by classical music, in a counterbalanced research design.
 Results. The results based on absolute heart rate measures suggested that athletes exhibited lower heart rates in the stress-anticipation period as well as during the stress period than non-athletes. However, based on relative measures these differences vanished. The two groups of children did not differ in perceived arousal, perceived stressfulness of the mental tasks, and the self-reported feeling states before and after stress. Further, they did not differ in their performance on the two stress-eliciting active-coping tasks as indicated by the number of correct answers.
 Conclusion. These results appear to suggest that athletic status in children is unrelated to heart rate reactivity and other subjective psychological experiences before, during and after acute psychosocial stress. 
 Keywords: adolescent, exercise, fitness, physical activity, relative measures.

Heart Rate Reactivity, Neighborhood Disadvantage, and Antisocial Behavior

This article examines whether heart rate stress reactivity interacts with neighborhood disadvantage to predict antisocial behavior. Antisocial behavior was assessed in a community sample of 445 males and females ( Mage = 11.92 years), using respondent and parent measures of antisocial behavior. Heart rate stress reactivity interacted with neighborhood disadvantage to predict parent-reported antisocial behavior. Specifically, the relationship between neighborhood disadvantage and antisocial behavior was stronger among children with lower heart rate reactivity. This study is the first to find that heart rate stress reactivity interacts with the neighborhood environment to predict antisocial behavior. Findings demonstrate the importance of examining biological factors in conjunction with the broader environmental context to understand the development of antisocial behavior.

Improvement of Conflict Handling: Hand-Holding During and After Conflict Discussions Affects Heart Rate, Mood, and Observed Communication Behavior in Romantic Partners

Improved conflict handling is important to reduce relational discord. Touch potentially has beneficial effects on three important characteristics of conflict discussions, i.e., physiological reactivity, affect and communication behavior. We studied effects of hand-holding between partners during conflict discussions (N = 47 student couples) and after conflict discussions (N = 53 student and N = 45 clinical couples). During conflict discussions hand-holding caused lower heart rate reactivity, higher positive affect and improved communication in men, and in women lower positive affect but improved communication. After conflict discussions hand-holding resulted in lower heart rate reactivity and higher heart rate variability in student couples and higher positive affect in student and clinical couples. Touch seems a promising add-on intervention in couple therapy.

Autonomic nervous system activity and callous-unemotional traits in physically maltreated youth

BackgroundResearch into callous-unemotional (CU) traits often focuses exclusively on biological risk factors without integrating social factors. This gap exists despite a growing body of research showing that the social environment may actually impact physiological functioning, which could in turn affect behavior. ObjectiveThe current study addresses this limitation by examining physical maltreatment and heart rate stress reactivity as potential risk factors for CU traits. Participants and settingThis research was conducted in a community sample of Chinese youth (mean age = 11.83 years, 44.3 % female). MethodsEach child separately reported frequency of physical maltreatment experiences by his or her mother and father over the past 12 months. Children completed a self-report measure of CU traits. ResultsFrequency of maternal physical maltreatment was associated with uncaring traits in females, but not in males. Paternal physical maltreatment was associated with uncaring traits in both males and females and with callous traits in females only. While paternal physical maltreatment was associated with lower heart rate reactivity in females, maternal physical maltreatment was associated with higher heart rate reactivity in females. ConclusionFindings provide mixed support for a potential physiological pathway through which child maltreatment may impact callous traits and provide a multilevel, biosocial lens through which to understand CU traits.

Emotional responses to illness imagery in young adults: Effects of attention to somatic sensations and levels of illness anxiety

This study investigated the effect of interoceptive attention on emotional responses during illness imagery, and the moderating role of illness anxiety. 101 students (81 female; 18–35 years old) with low, moderate and high levels of illness anxiety had to imagine personally relevant illness scenarios and standardized fearful, joyful and neutral scenarios, after undergoing an attention manipulation to direct their attention towards interoceptive or exteroceptive stimuli. Emotional responses assessed included self-reports of arousal, valence and somatic sensations, and psychophysiological measures of heart rate reactivity and variability, skin conductance level, and facial electromyography. Findings showed increased reports of emotional arousal, negative affect and somatic symptoms, accompanied by negative emotion expressions, but a hypo-arousal physiological response pattern (i.e. low heart rate reactivity) during illness imagery after interoceptive attention, irrespective of illness anxiety levels. Under directed attention, the observed emotional response to illness imagery may increase the risk for developing and perpetuating illness anxiety.

Adolescent Girls’ Biological Sensitivity to Context: Heart Rate Reactivity Moderates the Relationship Between Peer Victimization and Internalizing Problems

The theory of biological sensitivity to context (BSC) suggests that heightened stress reactivity may reflect the potential for some children to develop negative mental health outcomes under adverse environmental conditions and gain resilience under supportive environments. This study investigated the interactive effects of heart rate (HR) reactivity on an understudied form of adverse environmental conditions in BSC models, peer victimization, on internalizing problems among 82 adolescents (44 girls and 38 boys; M age = 12.08 years). Participants were nominated by peers for internalizing problems and peer victimization. HR reactivity was assessed in response to a laboratory interpersonal stressor. For girls, peer victimization was associated with internalizing problems only if girls showed high HR reactivity; there was no effect for boys. This association was absent when girls showed low HR reactivity. Results suggest that HR reactivity serves as a marker of sensitivity to environmental influence, moderating the relationship of peer victimization to internalizing behaviors for adolescent girls.

Mindfulness-Based Relapse Prevention for Substance Use Disorders: Effects on Cardiac Vagal Control and Craving Under Stress.

Mindfulness-based relapse prevention (MBRP) is a therapy for addictive behaviors that incorporates cognitive-behavioral relapse prevention (RP) skills with mindfulness training to increase awareness and skillful action in high-risk situations. Stress is a common reason reported for substance use relapse, and using physiological measures to measure stress engagement may help us identify mechanisms of clinical improvement. Specifically, salutatory changes in HF-HRV post-treatment may serve as a marker of treatment efficacy. We investigated tonic and phasic heart rate variability (HRV) to a cognitive stressor (i.e., arithmetic challenge) following 8 weeks of RP, MBRP, or post-detox treatment known as treatment as usual (TAU; n = 34). MBRP was related to higher levels of tonic and phasic HF-HRV, lower levels of anxiety, and lower heart rate reactivity (than TAU only) compared to RP and TAU. This suggests that those who completed MBRP are engaging with stress, but perhaps in a more adaptive, flexible manner. MBRP is associated with higher cardiac vagal control and lower stress/anxious reactivity. Given that negative emotions are an important component of relapse, these results lend further support to say that mindfulness may be helpful for those with substance use disorders.

Clinical features and subjective/physiological responses to emotional stimuli in the presence of emotion dysregulation in attention-deficit hyperactivity disorder

ABSTRACTIntroduction: Emotion dysregulation (ED) has long been recognized in clinical descriptions of attention-deficit hyperactivity disorder (ADHD), but a renewed interest in ED has advanced research on the overlap between the two entities. Autonomic reactivity (AR) is a neurobiological correlate of emotion regulation; however, the association between ADHD and AR remains unclear. Our aim was to explore the clinical differences, AR, and subjective emotional responses to visual emotional stimuli in ADHD children with and without ED.Method: School-aged ADHD children with (n = 28) and without (n = 20) ED, according to the definition of deficiency in emotional self-regulation (DESR), and healthy controls (n = 22) were interviewed by using the Schedule for Affective Disorders and Schizophrenia for School Aged Children–Present and Lifetime version (K-SADS-PL) to screen frequent psychopathologies for these ages. All subjects were evaluated with Child Behavior Checklist 6–18 (CBCL), the Strengths and Difficulties Questionnaire (SDQ), the McMaster Family Assessment Device (FAD), the School-Age Temperament Inventory (SATI), and Conners’ Parent Rating Scale (CPRS-48), which were completed by parents. To evaluate emotional responses, the International Affective Picture System (IAPS) and the subjective and physiological responses (electrodermal activity and heart rate reactivity) to selected pictures were examined.Results: Regarding clinically distinctive features, the ADHD+ED group differed from the ADHD–ED and the control groups in terms of having higher temperamental negative reactivity, more oppositional/conduct problems, and lower prosocial behaviors. In the AR measures, children in the ADHD+ED group rated unpleasant stimuli as more negative, but they still had lower heart rate reactivity (HRR) than the ADHD–ED and control groups; moreover, unlike the two other groups, the ADHD+ED group showed no differences in HRR between different emotional stimuli.Conclusion: The presented findings are unique in terms of their ability to clinically and physiologically differentiate between ADHD children with and without ED.

How are neuroticism and depression related to the psychophysiological stress response to acute stress in healthy older people?

Neuroticism and depressive symptomatology have been related to a heightened and diminished physiological stress response, which may partly explain their negative relationship with health and wellbeing. Identifying factors that may increase disease vulnerability is especially relevant in older people, whose physiological systems decline. With this in mind, we investigated the influence of neuroticism and depression on the psychophysiological stress response in healthy older people (from 55 to 76years old). A total of 36 volunteers were exposed to a stressful task (Trier Social Stress Test, TSST), while 35 volunteers performed a control non-stressful task. The physiological stress response was assessed through measures of cortisol, alpha-amylase, heart rate (HR). Our results showed that, neuroticism was not related to physiological stress response. However, depression was related to higher cortisol response and lower HR reactivity in the stress condition. In summary, emotional states such as depressive mood seem to amplify the cortisol stress response and reduce the cardiovascular response, whereas more stable dispositions such as neuroticism did not affect stress response in older people. These findings confirm, in healthy older people, the adverse effects of depression, acting on different subsystems of the stress response.

Goal adjustment ability predicts magnitude of emotional and physiological responses to an unsolvable anagram task

Individuals differ in their ability to disengage from unattainable goals (goal disengagement, GD) and reengage in other activities (goal reengagement, GR). Existing studies examining GD and GR abilities are limited by cross-sectional design and reliance on self-reported measures. The present study employed an experimental paradigm using an anagram solving task to examine whether self-reported and behaviorally observed GD and/or GR abilities relate to emotional, heart-rate (HR) and blood pressure (BP) reactivity. Results show no significant association between self-reported GD and time to disengage from unsolvable anagrams. However, self-reported GR predicted persistence behavior during unsolvable anagrams. Higher self-reported GR ability and longer behavioral persistence on unsolvable trials related to more positive affect before and during the task. Self-reported GD was associated with higher baseline HR and a tendency towards lower HR reactivity in response to unsolvable anagrams. While findings did not provide criterion-related validity to the GD measure, they do show self-reported GD and GR abilities may be relevant in the emotional and physiological consequences experienced during challenging goal pursuits.

Cardiovascular Correlates of Misconduct in Children and Adolescents

Abstract: Prior literature reviews addressing cardiovascular correlates of misconduct have focused on resting heart rate (HR) and skin conductance (SC). The present paper is a quantitative review of studies that tested the relationship between child/adolescent misconduct and cardiovascular regulation. An additional selection criterion for the present review was that the study examined physiological variables beyond resting HR and SC (e.g., cardiovascular reactivity). Misconduct was related to low HR reactivity, low resting parasympathetic nervous system (PNS) control, and less withdrawal of PNS control during mental challenge. These findings expand on prior reviews that indicated resting sympathetic nervous system underarousal is associated with antisocial behavior/misconduct. Cardiovascular reactivity to stress and PNS control may also be important correlates of misconduct.

The association of cardiovascular reactivity to mental stress with mortality in patients with chronic heart failure

Objective: Psychological factors have been related to poor outcome in patients with heart failure. Pathophysiological mechanisms explaining this link may include the cardiovascular response to acute mental stress. The current study examined whether heart rate and blood pressure responses to acute mental stress predicted mortality in patients with chronic heart failure. Methods: Patients with HF (N=100, 26% female, mean age 65±12 years) underwent a public speech task, during which heart rate (HR) and blood pressure (BP) were recorded. Their all cause mortality status was assessed 4.8 years thereafter. Heart rate reactivity was recoded into high, low, and negative responsiveness based on the 25th (bpm ≤0) and 75th (>6 bpm) percentile. Blood pressure reactivity was recoded in high (>12.1 mmHg), medium (2.3-12.1 mmHg) and low (<2.3 mmHg) responsiveness based on the 25th and 75th percentile. The following covariates were added to the Cox proportional hazards regression: gender, left ventricular ejection fraction, use of beta blocking agents (HR), use of ACEi/ARB medication (BP), and presence of implanted devices. A p value of <.10 was considered of interest, due to the limited sample size. Results: At follow-up, 31 patients had died (31%), of whom 15 from cardiac causes. Results from the Cox proportional hazards regression showed that blunted HR reactivity (between 0.5-6 bpm; HR=2.3, 95% CI=0.9-6.2, p=.09) and low diastolic BP reactivity (HR=3.1, 95% CI=1.3-7.9, p=.02) were significantly associated with an increased risk of mortality in HF independent of included covariates (all ns, except ACEi/ARB use (HR=0.3, 95% CI=0.1-0.8, p=.02)). SBP reactivity was not significantly related to future mortality risk. Conclusion: In this preliminary study, low heart rate and diastolic blood pressure reactivity to acute mental stress were independent associates of all cause mortality in patients with chronic heart failure. The observed blunted autonomic and hemodynamic response to mental stress is in accordance with physical stress reactivity. These findings call for replication by larger studies that also should examine whether mental stress reactivity is a mediator in the relation between psychological risk factors and adverse cardiac outcomes.

Effects of family cohesion and heart rate reactivity on aggressive/rule-breaking behavior and prosocial behavior in adolescence: The Tracking Adolescents' Individual Lives Survey study

The biological sensitivity to context hypothesis posits that high physiological reactivity (i.e., increases in arousal from baseline) constitutes heightened sensitivity to environmental influences, for better or worse. To test this hypothesis, we examined the interactive effects of family cohesion and heart rate reactivity to a public speaking task on aggressive/rule-breaking and prosocial behavior in a large sample of adolescents (N = 679; M age = 16.14). Multivariate analyses revealed small- to medium-sized main effects of lower family cohesion and lower heart rate reactivity on higher levels of aggressive/rule-breaking and lower levels of prosocial behavior. Although there was some evidence of three-way interactions among family cohesion, heart rate reactivity, and sex in predicting these outcome variables, these interactions were not in the direction predicted by the biological sensitivity to context hypothesis. Instead, heightened reactivity appeared to operate as a protective factor against family adversity, rather than as a susceptibility factor. The results of the present study raise the possibility that stress reactivity may no longer operate as a mechanism of differential susceptibility in adolescence.

Linguistic markers of emotion regulation and cardiovascular reactivity among older caregiving spouses.

This study examined linguistic markers of emotion regulation and cardiovascular stress reactivity in spousal caregivers. Fifty-three individuals were audiotaped while they privately disclosed an instance of partner suffering and a typical partner interaction (i.e., a meal together). Systolic blood pressure, diastolic blood pressure, and heart rate (HR) were measured. Linguistic analysis determined emotion and cognitive processing word use. Results revealed that using more positive emotion words was associated with lower HR reactivity in each verbal account. Caregivers who used fewer cognitive processing words (e.g., think, realize, because) overall had the highest HR reactivity to talking about the partner's suffering. These findings have implications for interventions for all caregivers as well as distinguishing more resilient caregivers from those who may be at a higher risk for caregiver burden.

Associations between DNA methylation of a glucocorticoid receptor promoter and acute stress responses in a large healthy adult population are largely explained by lifestyle and educational differences

Glucocorticoids are the key regulators of the biological stress response and act by binding to glucocorticoid receptors (GR). Expression of GR is altered by DNA methylation. Methylation patterns in GR promoters have been shown to be highly variable between individuals, but little is known about the functional consequences of this variation for the acute stress response. The present study investigated associations between methylation status of the GR 1-C promoter and cortisol, cardiovascular and perceived stress responses to a psychosocial stress protocol in a large healthy adult population. A total of 725 overall healthy men and women, aged 55-60 years, participated in a standardized psychosocial stress protocol consisting of three different stressors. At different stages during the stress protocol, salivary cortisol levels, continuous blood pressure and heart rate (HR) levels as well as perceived stress were measured. Stress reactivity was calculated as the increase between basal and peak measurements. Methylation status of the GR 1-C promoter was assessed in DNA isolated from peripheral blood samples using a methylation sensitive PCR assay for 675 of the 725 participants. A decrease in methylation of the GR 1-C promoter was associated with a decrease in stress reactivity as indicated by lower cortisol and lower HR reactivity. A 1% decrease in GR 1-C methylation corresponded with a cortisol decrease by 0.14% (95% CI: 0.03-0.25, p=0.02) and an HR decrease by 0.10 bpm (0.03-0.16, p=0.003). Adjusting for sex, lifestyle and education largely abolished these associations. A decrease in methylation of the GR 1-C promoter was also associated with an increase in stress perception as indicated by higher perceived stress (0.03 points [0.00-0.06, p=0.05]), lower perceived performance (-0.03 points [-0.05 to -0.01], p=0.02), and lower perceived control (-0.03 points [-0.05 to 0.00], p=0.04). After adjusting for sex and educational level the associations were no longer statistically significant. GR 1-C methylation status was not associated with blood pressure responses to the stress protocol. Although effects were small, variation in methylation status in the GR 1-C promoter was associated with physical and perceived acute stress responses. Interestingly, these associations could largely be explained by differences in lifestyle and education.

Prospective associations between cardiovascular reactions to acute psychological stress and change in physical disability in a large community sample

Exaggerated haemodynamic reactions to acute psychological stress have been implicated in cardiovascular disease outcomes, while lower reactions have been considered benign. This study examined, in a large cohort, the prospective associations between stress reactivity and physical disability. Blood pressure and pulse rate were measured at rest and in response to a stress task. Physical disability was assessed using the OPCS survey of disability at baseline and five years later. Heart rate reactivity was negatively associated with change in physical disability over time, such that those with lower heart rate reactivity were more likely to deteriorate over the following five years. These effects remained significant following adjustment for a number of confounding variables. These data give further support to the recent argument that for some health outcomes, lower or blunted cardiovascular stress reactivity is not necessarily protective.