The worried mind: autonomic and prefrontal activation during worrying

Effects of A Brief Resonance Frequency Breathing Exercise on Heart Rate Variability and Inhibitory Control in the Context of Generalised Anxiety Disorder

Generalised anxiety disorder (GAD) is associated with cognitive and physiological symptoms including uncontrollable worry, inhibitory control deficits, and low heart rate variability (HRV). Literature linking HRV and inhibition in GAD is predominantly correlational. The present experiment investigated whether HRV has a causal role in maintaining inhibitory control. Participants (N = 135, 111 female) aged 18-37 reporting high levels of symptoms associated with GAD (GAD-7 scores ≥ 10; Penn State Worry Questionnaire scores ≥ 56) were assigned to an experimental or active control condition and completed baseline measures of HRV, respiration rate, and inhibitory control. The experimental condition completed resonance frequency breathing (RFB) training, and the control condition practiced breathing at their mean breathing rate before repeating the inhibitory control assessment. Participants also completed the breathing training before a behavioural worry task. The experimental condition was predicted to show increased HRV, alongside improved inhibitory control and better ability to stop worrying as compared to the control condition. HRV increased during the experimental condition, as compared to the control condition. However, there were no significant effects of RFB on inhibitory control or worry, or on HRV during the inhibitory control tasks. In conclusion, RFB can increase HRV in high GAD scorers, but further research is required to determine whether there is a relationship between increased HRV and symptoms of GAD in a single session experiment.

Affective bodily responses in monkeys predict subsequent pessimism, but not vice versa

Affect is a complex interplay of behaviour, physiology, cognition and subjective feelings. The James-Lange theory, which posits that affective bodily responses occur first and subsequently shape our affective experiences, has been extensively studied in humans but remains underexplored in non-human animals. This study employs a judgement bias test to explore the relationship between peripheral bodily responses, specifically self-scratching associated with negative affect, and shifts in cognitive information-processing modes (i.e. a 'pessimistic' judgement bias characterized by heightened anticipation of undesirable outcomes) in Japanese macaques (Macaca fuscata). Our findings support the hypothesis that bodily responses precede and influence changes in cognitive modes, demonstrating that self-scratching predicts subsequent pessimistic judgements, but not vice versa. This study provides comparative insights into the biological underpinnings of affect, highlighting that peripheral behaviours can shape cognitive processes in non-human primates. These results have broader implications for understanding the evolutionary continuity and adaptive significance of affective response systems across species.

A neural oscillatory signature of sustained anxiety

BACKGROUND

Anxiety is a sustained response to uncertain threats; yet few studies have explored sustained neurobiological activities underlying anxious states, particularly spontaneous neural oscillations. To address this gap, we reanalysed magnetoencephalographic (MEG) data recorded during induced anxiety to identify differences in sustained oscillatory activity between high- and low-anxiety states.

METHODS

We combined data from three previous MEG studies in which healthy adults (total N = 51) were exposed to alternating periods of threat of unpredictable shock and safety while performing a range of cognitive tasks (passive oddball, mixed-saccade or stop-signal tasks). Spontaneous, band-limited, oscillatory activity was extracted from middle and late intervals of the threat and safe periods, and regional power distributions were reconstructed with adaptive beamforming. Conjunction analyses were used to identify regions showing overlapping spectral power differences between threat and safe periods across the three task paradigms.

RESULTS

MEG source analyses revealed a robust and widespread reduction in beta (14-30 Hz) power during threat periods in bilateral sensorimotor cortices extending into right prefrontal regions. Alpha (8-13 Hz) power reductions during threat were more circumscribed, with notable peaks in left intraparietal sulcus and thalamus.

CONCLUSIONS

Threat-induced anxiety is underpinned by a sustained reduction in spontaneous beta- and alpha-band activity in sensorimotor and parietal cortical regions. This general oscillatory pattern likely reflects a state of heightened action readiness and vigilance to cope with uncertain threats. Our findings provide a critical reference for which to identify abnormalities in cortical oscillatory activities in clinically anxious patients as well as evaluating the efficacy of anxiolytic treatments.

Allostatic-interoceptive anticipation of social rejection

Anticipating social stress evokes strong reactions in the organism, including interoceptive modulations. However, evidence for this claim comes from behavioral studies, often with inconsistent results, and relates almost solely to the reactive and recovery phase of social stress exposure. Here, we adopted an allostatic-interoceptive predictive coding framework to study interoceptive and exteroceptive anticipatory brain responses using a social rejection task. We analyzed the heart-evoked potential (HEP) and task-related oscillatory activity of 58 adolescents via scalp EEG, and 385 human intracranial recordings of three patients with intractable epilepsy. We found that anticipatory interoceptive signals increased in the face of unexpected social outcomes, reflected in larger negative HEP modulations. Such signals emerged from key brain allostatic-interoceptive network hubs, as shown by intracranial recordings. Exteroceptive signals were characterized by early activity between 1-15 Hz across conditions, and modulated by the probabilistic anticipation of reward-related outcomes, observed over distributed brain regions. Our findings suggest that the anticipation of a social outcome is characterized by allostatic-interoceptive modulations that prepare the organism for possible rejection. These results inform our understanding of interoceptive processing and constrain neurobiological models of social stress.

Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review

Anxiety disorders are the most common group of mental disorders, but they are often underrecognized and undertreated in primary care. Dysfunctional breathing is a hallmark of anxiety disorders; however, mainstays of treatments do not tackle breathing in patients suffering anxiety. This scoping review aims to identify the nature and extent of the available research literature on the efficacy of breathwork interventions for adults with clinically diagnosed anxiety disorders using the DSM-5 classification system. Using the PRISMA extension for scoping reviews, a search of PubMed, Embase, and Scopus was conducted using terms related to anxiety disorders and breathwork interventions. Only clinical studies using breathwork (without the combination of other interventions) and performed on adult patients diagnosed with an anxiety disorder using the DSM-5 classification system were included. From 1081 articles identified across three databases, sixteen were included for the review. A range of breathwork interventions yielded significant improvements in anxiety symptoms in patients clinically diagnosed with anxiety disorders. The results around the role of hyperventilation in treatment of anxiety were contradictory in few of the examined studies. This evidence-based review supports the clinical utility of breathwork interventions and discusses effective treatment options and protocols that are feasible and accessible to patients suffering anxiety. Current gaps in knowledge for future research directions have also been identified.

Central and peripheral nervous system responses to chronic and paced hyperventilation in anxious and healthy subjects

The aim of the present study was to examine self-report, peripheral nervous system, and central nervous system correlates of naturally-occurring, chronic hyperventilation (HV, assessed by hypocapnia or low resting state low end-tidal CO2), and to examine the additional effect of acute, experimentally-induced HV in anxious and healthy participants. By identifying the biomarkers of anxiety-related chronic HV and examining responses to acute HV, we hope to identify meaningful, mechanistic targets for further treatment development. Seventy anxious patients and 34 healthy control participants completed electroencephalogram (EEG) and peripheral nervous system recording at baseline and following a paced breathing task. Diagnosis x baseline hypnocapnia group analyses indicated that anxious/hypocapnic patients exhibited greater nonspecific skin conductance response amplitude than did anxious/normocapnic patients, and the anxious group reported greater HV-related symptoms and anxiety sensitivity than did the control group. However, no EEG abnormalities were noted as a function of anxiety group or baseline hypocapnia status. Following paced HV, anxious patients (but not controls) exhibited an increase in left-frontal alpha 1 power. Hypocapnic, but not normocapnic, participants exhibited an increase in skin conductance levels. Anxious patients reported an increase in negative cognitive appraisals of HV symptoms, and anxious/hypocapnic participants reported an increase in affective responses to HV. Thus, chronic HV is associated with greater arousal, and increased self-reported and physiological sensitivity to paced HV. Patients who chronically hyperventilate appear to be more sensitive to respiratory distress, responding with higher levels of anxiety and poorer tolerance of the physiological sensations accompanying acute HV.

Impulsive and compulsive behaviors can be induced by opposite GABAergic dysfunctions inside the primate ventral pallidum

Introduction: The ventral pallidum (VP) is central in the limbic Basal Ganglia circuit, controlling both appetitive (approach) and aversive (avoidance) motivated behaviors. Nevertheless, VP involvement in pathological aspects remains unclear, especially in the behavioral expression of different motivational dysfunctions. This study aimed to investigate how the VP contributes to the expression of abnormal behaviors via opposite GABAergic dysfunctions. Methods: Opposite GABAergic dysfunctions were induced by injecting muscimol (a GABA_A agonist) and bicuculline (a GABA_A antagonist) into monkeys. We determined the effects of both substances on self-initiated behaviors in lab-chair and in free-moving home-cage contexts in six monkeys, and in two animals performing an approach-avoidance task in appetitive and aversive contexts. Results: While the self-initiated behaviors induced by bicuculline injections in VP were characterized by compulsive behaviors such as repetitive grooming and self-biting, muscimol injections induced impulsive behaviors including limb movements in a lab-chair context and exploration behaviors in a free-moving context. More specific behavioral effects were observed in the approach-avoidance task. The muscimol injections induced premature responses and erroneous screen touches, which characterize impulsive and attention disorders, while the bicuculline injections into the VP increased passive avoidance (non-initiated action) and task-escape in an aversive context, suggesting an anxiety disorder. Conclusions: These results show that activating or blocking GABAergic transmission in the VP impairs motivated behaviors. Furthermore, the behavioral expressions produced by these opposite disturbances show that the VP could be involved in anxiety-driven compulsive disorders, such as OCD, as well as in impulsive disorders motivated by attention deficits or reward-seeking, as seen in ADHD or impulse control disorders.

The effects of worry proneness on diurnal anxiety: An ecological momentary assessment approach

Existing theoretical models and empirical evidence suggest that worry proneness is associated with anxious responding. However, it is unknown how worry proneness may influence the experience of anxiety throughout the day. The present study addresses this gap in the literature by employing an ecological momentary assessment design to examine the impact of worry proneness on diurnal changes in anxiety reported in the morning, afternoon, and evening for one week in a sample of unselected adults (N = 136). Results indicated a significant reduction in anxiety from morning to evening. Further, this effect was moderated by worry proneness, such that a diurnal decline in anxiety was detectable among those with low and moderate levels of worry proneness, whereas those high in worry proneness reported increased momentary anxiety which was sustained throughout the day. These results replicate previous studies indicating anxiety is highest in the morning and lowest in the evening. Further, these findings suggest that worry proneness may override normative diurnal changes in anxiety and thereby maintain anxiety at elevated and consistent levels. The implications of these findings for the development and treatment of disorders characterized by excessive worry are discussed.

Acute effects of oral delta-9-tetrahydrocannabinol (THC) on autonomic cardiac activity and their relation to subjective and anxiogenic effects

Cannabis is the most commonly used psychotropic drug in the United States, after alcohol. Despite its apparent sedative and calming effects, cannabis and its main psychoactive constituent, ∆⁹ -tetrahydrocannabinol (THC) can produce serious adverse effects including tachycardia and anxiety. These effects can be especially pronounced in women, who remain underrepresented in clinical cannabinoid research. The present study is one of the first to characterize the effects of single doses of oral THC on autonomic nervous system function in healthy adult women. Occasional female cannabis users participated in three laboratory sessions in which they received oral THC (7.5 and 15 mg) and placebo. Autonomic measures included heart rate (HR), blood pressure (BP), pre-ejection period (PEP) a measure of cardiac sympathetic functioning, and high frequency heart rate variability (HF-HRV) a measure of parasympathetic cardiac control. Autonomic responses were examined in relation to subjective drug effects. THC dose-dependently increased HR, decreased HF-HRV, and increased ratings of feeling a drug effect, cannabis-like intoxication, and anxiety. Although the drug did not significantly affect BP or PEP, HR was negatively related to both PEP and HF-HRV. HF-HRV, the measure of parasympathetic activity, was significantly negatively related to subjective measures of cannabis intoxication (but not anxiety) at the 15 mg dose only. PEP was not significantly related to any subjective measure. These results extend our knowledge of the autonomic effects of THC in relation to subjective drug experience. This and future studies will help us to understand risk factors related to cannabis use.

Diverging patterns of EEG alpha asymmetry in anxious apprehension and anxious arousal

Anxious apprehension and anxious arousal are central transdiagnostic anxiety dimensions and have been linked to divergent patterns of frontal and parietal alpha asymmetry. The present study examined the relationship between alpha asymmetry and anxiety dimensions in 130 individuals whose electroencephalogram (EEG) was recorded at rest. We applied a 2 (anxious apprehension: low vs. high) × 2 (anxious arousal, low vs. high) design to contrast brain lateralization in four groups. Results revealed that anxious apprehension was associated with more left-than-right frontal brain activity in the lower alpha band, an effect driven by decreased right frontal activity. Exploratory analyses showed more left-than-right brain activity at central sites associated with anxious apprehension. Parietal activity was not lateralized as a function of anxiety dimensions. Taken together, the current results support that anxious apprehension is associated with more left-than-right frontal and central activity, and suggest a broader distribution of alpha asymmetries associated with anxious apprehension than previously thought.

Inducing empathy affects cardiovascular reactivity reflected in changes in high-frequency heart rate variability

Empathy represents an emotional trigger of prosocial emotions and social engagement behaviour as previous research demonstrates. Departing from literature indicating that parasympathetic mechanisms are associated with the preparation of social engagement behaviour, the present research investigates how feeling with another person affects empathising individuals' cardiovascular reactivity reflecting influences of parasympathetic mechanisms. Specifically, individuals' high-frequency heart rate variability (HF-HRV) while being instructed to feel with a target person in need reacting with a specific emotional response to a need-causing event (with anger or sadness) was investigated. Results of one experiment (N = 124) revealed that inducing empathy with needy target persons results in increases of HF-HRV - irrespective of their emotional reaction. No relation between cardiovascular indices and self-reported prosocial behaviour was found. Accordingly, these findings indicate that inducing empathy affects phasic vagal activity implied by parasympathetic mechanisms whereas the association of cardiovascular reactivity and social engagement behaviour needs further investigation.

Women with Major Depressive Disorder, Irrespective of Comorbid Anxiety Disorders, Show Blunted Bilateral Frontal Responses during Win and Loss Anticipation

BACKGROUND

Electroencephalography (EEG) studies suggest that major depressive disorder (MDD) is associated with lower left than right frontal brain activity (asymmetry), a pattern appearing stronger in women than men, and when elicited during emotionally-relevant paradigms versus an uncontrolled resting state. However, it is unclear whether this asymmetry pattern generalizes to the common presentation of MDD with co-occurring anxiety. Moreover, asymmetry may differ for anxiety subtypes, wherein anxious apprehension (AnxApp: worry characteristic of generalized anxiety disorder) appears left-lateralized, but anxious arousal (AnxAro: panic characteristic of social anxiety, posttraumatic stress, and panic disorders) may be right-lateralized.

METHODS

This analysis attempted to replicate frontal EEG asymmetry patterns using functional magnetic resonance imaging (fMRI). Participants completed clinical interviews and a monetary incentive delay (MID) task during fMRI recording. We compared five groups of right-handed women from the Tulsa 1000 study, MDD (n=40), MDD-AnxApp (n=26), MDD-AnxAro (n=34), MDD-Both (with AnxApp and AnxAro; n=26), and healthy controls (CTL; n=24), as a function of MID anticipation condition (no win/loss, win, loss) and hemisphere on frontal blood oxygen-level-dependent (BOLD) signal.

RESULTS

CTL exhibited higher bilateral superior, middle, and inferior middle frontal gyrus BOLD signal than the four MDD groups for high arousal (win and loss) conditions. However, frontal attenuations were unrelated to current depression/anxiety symptoms, suggestive of a trait as opposed to a state marker.

LIMITATIONS

This was a cross-sectional analysis restricted to women.

CONCLUSIONS

Reduced prefrontal cortex recruitment during processing of both positively and negatively valenced stimuli is consistent with the emotion context insensitivity theory of MDD.

Transdiagnostic preventative intervention for subclinical anxiety: Development and initial validation

Risk factors associated with the development of anxiety disorders have been identified; however, the development of preventive interventions targeting these risk factors is in the nascent stage. To date, preventive interventions have tended to target specific anxiety disorder symptoms (e.g., panic attacks). Although these interventions are effective at reducing risk for the targeted disorder (e.g., panic disorder), the focus of the intervention is narrow, thereby limiting the dissemination of these interventions. One approach that may broaden the scope of our prevention efforts is the development of a transdiagnostic intervention. Currently, transdiagnostic interventions have only been used in those with diagnosed conditions (e.g., anxiety disorders); however, it stands to reason that a transdiagnostic approach may also be helpful for those at-risk for developing anxiety disorders. The present study reported on the development and use of a brief preventative intervention for those with subclinical anxiety (i.e., worry, social anxiety). Participants were randomized into either a transdiagnostic preventative intervention, focused on reduction of safety aids, or a health focused control group. Participants consisted of sixty-nine individuals with subclinical levels of anxiety. Results revealed significant between group differences in the reduction of social anxiety, worry, and levels of impairment with the active intervention group relative to the control group. Further, change in safety aid utilization was a significant mediator in the association between intervention group and social anxiety and worry at Week 1; however, it was not a significant mediator at Month 1. Implications of these results and avenues for future research are discussed.

An evaluation of the distribution properties, factor structure, and item response profile of an assessment of emotion recognition

Many people with developmental disabilities, such as autism spectrum disorder and intellectual disability have emotion recognition (ER) difficulties compared with typically developing (TD) peers. Accurate assessment of the extent and nature of differences in ER requires an understanding of the response profiles to ER assessment stimuli. We analysed data from 504 TD individuals in response to an ER assessment in respect of distribution properties, factor structure, and item response profile. Eighteen emotion items discriminated better at lower levels of ER ability in TD participants. Neutral expressions were the hardest to interpret; surprise, anger, happy, and bored were easiest. The amount of contextual information in combination with the emotion being depicted also appeared to influence level of difficulty. Similar psychometric research is needed with people with developmental disabilities.

Types of Anxiety and Depression: Theoretical Assumptions and Development of the Anxiety and Depression Questionnaire

The present paper is addressed to (1) the validation of a recently proposed typology of anxiety and depression, and (2) the presentation of a new tool—the Anxiety and Depression Questionnaire (ADQ)—based on this typology. Empirical data collected across two stages—construction and validation—allowed us to offer the final form of the ADQ, designed to measure arousal anxiety, apprehension anxiety, valence depression, anhedonic depression, and mixed types of anxiety and depression. The results support the proposed typology of anxiety and depression and provide evidence that the ADQ is a reliable and valid self-rating measure of affective types, and accordingly its use in scientific research is recommended.

The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis

BACKGROUND

Some evidence suggests that heart rate variability (HRV) biofeedback might be an effective way to treat anxiety and stress symptoms. To examine the effect of HRV biofeedback on symptoms of anxiety and stress, we conducted a meta-analysis of studies extracted from PubMed, PsycINFO and the Cochrane Library.

METHODS

The search identified 24 studies totaling 484 participants who received HRV biofeedback training for stress and anxiety. We conducted a random-effects meta-analysis.

RESULTS

The pre-post within-group effect size (Hedges' g) was 0.81. The between-groups analysis comparing biofeedback to a control condition yielded Hedges' g = 0.83. Moderator analyses revealed that treatment efficacy was not moderated by study year, risk of study bias, percentage of females, number of sessions, or presence of an anxiety disorder.

CONCLUSIONS

HRV biofeedback training is associated with a large reduction in self-reported stress and anxiety. Although more well-controlled studies are needed, this intervention offers a promising approach for treating stress and anxiety with wearable devices.

Resting Heart Rate Variability, Facets of Rumination and Trait Anxiety: Implications for the Perseverative Cognition Hypothesis

The perseverative cognition hypothesis (PCH) posits that perseveration, defined as the repetitive or sustained activation of cognitive representations of a real or imagined stressor, is a primary mechanism linking psychological (or stress) vulnerability with poor health and disease. Resting vagally mediated heart rate variability (vmHRV) is an important indicator of self-regulatory abilities, stress vulnerability and overall health. Those with lower resting vmHRV are more vulnerable to stress, and thus more likely to engage in perseverative cognition and experience subsequent negative mental health outcomes such as anxiety. Recent research suggests that rumination—one of the core mechanisms underlying perseveration—is a construct containing (at least) two maladaptive (depressive and brooding) and one adaptive (reflective) types of rumination. However, to date, research has not examined how the association between resting vmHRV may differ between these three facets of rumination, in addition to these facets’ mechanistic role in linking lower resting vmHRV with greater trait anxiety. The current cross-sectional study explores these relationships in a sample of 203 participants (112 females, 76 ethnic minorities, mean age = 19.43, standard deviation = 1.87). Resting vmHRV was assessed during a 5-min-resting period using an Electrocardiogram (ECG). Both trait rumination (including the three facets) and anxiety were assessed via self-report scales. Significant negative associations were found between resting vmHRV and maladaptive, but not adaptive, forms of perseveration. Similarly, mediation analyses showed a significant indirect relationship between resting vmHRV and anxiety through maladaptive, but not adaptive, facets of rumination. Our findings support the PCH such that those with stress vulnerability, as indexed by lower resting vmHRV, are more likely to engage in maladaptive perseverative cognition and thus experience negative outcomes such as anxiety. Our data also lend a novel outlook on the PCH; resting vmHRV is not related to reflective rumination and thus, this facet of perseveration may be a neutral, but not beneficial, factor in the link between stress vulnerability and psychological well-being.

Cardiac vagal control as a marker of emotion regulation in healthy adults: A review

In the last two decades, a growing body of theory and research has targeted the role of cardiac vagal control (CVC) in emotional responding. This research has either focused on resting CVC (also denoted as cardiac vagal tone) or phasic changes in CVC (also denoted as vagal reactivity) in response to affective stimuli. The present paper is aimed at reporting a review of the papers published between 1996 and 2016, and focused on the results of 135 papers examining cardiac vagal control as a physiological marker of emotion regulation in healthy adults. The review shows that studies have employed a wide array of methodologies and measures, often leading to conflicting results. High resting CVC has been associated with better down-regulation of negative affect, use of adaptive regulatory strategies, and more flexible emotional responding. Concerning phasic changes, research has consistently found decreased CVC in response to stress, while CVC increases have been shown to reflect either self-regulatory efforts or recovery from stress. Despite conflicting results, we conclude that existing literature supports the use of CVC as a noninvasive, objective marker of emotion regulation.

The Effects of Worry and Relaxation on Flexibility During Cognitive Restructuring

Worry is associated with inflexibility in cognitive, emotional, and physiological functioning. In addition, worry’s negative valence and abstract level of construal are rigid characteristics that contribute to its nonadaptive consequences. Relaxation and cognitive therapy aim to increase flexibility in chronic worriers, and may have greater efficacy when administered in combination. We examined the extent to which relaxation enhances and/or worry inhibits cognitive flexibility during a cognitive restructuring exercise in which participants generated alternative predictions for their worries. Participants ( n = 189) were randomly assigned to engage in relaxation, worry, or neutral thinking prior to cognitive restructuring. We measured the number and perceived likelihood of alternative predictions generated by participants, and coded those alternative predictions for their degree of positive valence, negative valence, and level of construal (abstractness to concreteness). Worry and relaxation did not lead to different numbers or perceived likelihood of alternative predictions. However, compared with participants with minimal symptoms of generalized anxiety disorder (GAD), those with elevated symptoms of GAD who engaged in prior worry generated alternative predictions characterized by greater negative valence and more abstractness (i.e., less concreteness). We also found that greater negative valence of alternative predictions was associated with more abstractness, whereas greater positive valence of alternative predictions was associated with more concreteness. These findings suggest that after engaging in worry, individuals with GAD may be less able to flexibly shift from the use of nonadaptive characteristics (negative valence, abstractness) associated with feared outcomes to the use of more adaptive characteristics (positive valence, concreteness) when considering alternative predictions.

Prospective Investigation of the Contrast Avoidance Model of Generalized Anxiety and Worry

The factors that maintain generalized anxiety disorder (GAD) symptoms and worry over time are not entirely clear. The Contrast Avoidance Model (CAM) postulates that individuals at risk for pathological worry and GAD symptoms uniquely fear emotional shifts from neutral or positive emotions into negative emotional states, and consequently use worry to maintain negative emotion in order to avoid shifts or blunt the effect of negative contrasts. This model has received support in laboratory experiments, but has not been investigated prospectively in the naturalistic context of daily life. The present study tested the CAM in a longitudinal experience sampling study with a subclinical sample. Participants selected to represent a broad range of symptoms (N = 92) completed baseline measures of GAD and depression symptoms, and eight weekly assessments of worry, experiences of negative emotional contrasts during their worst event of the week, and situation-specific negative emotion. Consistent with the CAM, GAD symptoms prospectively predicted higher endorsement of negative contrast experiences as worst events, independent of depression symptoms. Unsurprisingly, higher negative contrasts predicted higher negative emotion. However, both higher baseline GAD symptoms and weekly worry uniquely moderated (reduced) this relationship, providing consistent support for the idea that worry may blunt the emotional effects of contrasts. Depression symptoms did not have the same moderating effect. These findings support the CAM in an ecologically valid context.

Ventral Pallidum Encodes Contextual Information and Controls Aversive Behaviors

Successful avoidance of aversive outcomes is crucial for the survival of animals. Although accumulating evidence indicates that an indirect pathway in the basal ganglia is involved in aversive behavior, the ventral pallidum (VP), which is an important component of this pathway, has so far been implicated primarily in appetitive behavior. In this study, we used single-cell recordings and bicuculline (GABAA antagonist) injections to elucidate the role of VP both in the encoding of aversive context and in active avoidance. We found 2 populations of neurons that were preferentially activated by appetitive and aversive conditioned stimuli (CSs). In addition, VP showed appetitive and aversive outcome anticipatory activities. These activity patterns indicate that VP is involved in encoding and maintaining CS-induced aversive contextual information. Furthermore, the disturbance of VP activity by bicuculline injection increased the number of error trials in aversive trials. In particular, the subjects released the response bar prematurely, showed no response at all, or failed to avoid the aversive outcome. Overall, these results suggest that VP plays a central role in controlling CS-induced negative motivation to produce avoidance behavior.

Heterogeneity in Autonomic Arousal Level in Perseverative Worry: The Role of Cognitive Control and Verbal Thought

One puzzle in high worry and generalized anxiety disorder (GAD) is the heterogeneity in the level of autonomic arousal symptoms seen among affected individuals. While current models agree that worry persists, in part, because it fosters avoidance of unpleasant internal experiences, they disagree as to whether worry does so by suppressing activation of autonomic arousal or by fostering persistent autonomic hyperarousal. Our Cognitive Control Model predicts that which pattern of autonomic arousal occurs depends on whether or not a worrier has sufficient cognitive control capacity to worry primarily in a verbal versus imagery-based manner. Because this model has been supported by only one study to date, the present study sought to replicate and extend that study’s findings. Results from an online survey in an unselected sample of over 900 college students provide further support for our model’s central tenet and initial support for its prediction that higher effortful control is associated with a higher percentage of verbal thought during worry. Finally, we report tentative evidence that autonomic arousal symptoms in worry and GAD vary as a function of individual differences in cognitive control capacity because higher capacity is linked to a greater predominance of verbal thought during worry.

The effect of verbal and imagery-based worry versus distraction on the emotional response to a stressful in-vivo situation

BACKGROUND AND OBJECTIVES

According to the Contrast Avoidance Model of worry, worrying induces prolonged negative affect and arousal and thereby suppresses sharp shifts in negative affect. The verbal and abstract nature of worry may be responsible for these effects as verbal thinking has been found to lead to less emotional and physiological responding than imagery. The present study was designed to test the Contrast Avoidance Model and to examine the role of verbal vs. imagery-based thinking during worrying..

METHODS

125 participants were exposed to a social-evaluative stressor. Before the stressor, they were randomized into three different groups (1) verbal worrying about the upcoming stressor, (2) imagery-based worrying, or (3) distraction. Self-reported affect and physiological arousal, as well as heart rate, respiratory sinus arrhythmia and skin conductance level (SCL) were monitored.

RESULTS

In line with the Contrast Avoidance Model, worrisome thinking (1) led to immediately increased self-reported negative affect and arousal as well as SCL, but (2) attenuated a further increase in self-reported negative affect and arousal in response to the stressor. No effect of style of worrying (verbal vs. imagery) was found..

LIMITATIONS

Effects were rather small and mostly confined to self-report data.

CONCLUSION

By and large, our findings support the Contrast Avoidance Model of worry with regard to self-report measures and extend earlier findings by using an in-vivo stressor. The role of thinking style on the contrast avoidance effect as well as the contrast avoidance effect on physiological measures need to be explored in more detail..

Patterns of alpha asymmetry in those with elevated worry, trait anxiety, and obsessive-compulsive symptoms: A test of the worry and avoidance models of alpha asymmetry

Some authors have argued that worry cues lateralization of frontal brain activity leftward, whereas other varieties of avoidance motivation cue lateralization of frontal brain activity rightward. By comparison, more right-than-left parietal activity correlates with anxious arousal. The purpose of the present report was to test two models of brain lateralization and anxiety: one model that proposed that worry correlates with more left-frontal activity and another model that proposed that avoidance motivation (including worry) correlates with more right-frontal activity. Undergraduate students were selected for worry, obsessive-compulsive symptoms, and trait anxiety using self-report questionnaires. A subset of participants also met DSM-IV criteria for Generalized Anxiety Disorder (GAD) or Obsessive-Compulsive Disorder (OCD). Alpha asymmetry and also a global-power-adjusted metric of alpha power were calculated from each participant's resting-state EEG. It was expected that participants with elevated worry and participants meeting criteria for GAD would show more left-than-right frontal activity. In contrast, participants with elevated trait anxiety, obsessive-compulsive symptoms, and those with an OCD diagnosis were expected to exhibit more right-than-left frontal activity. Participants with elevated worry, participants with a GAD diagnosis, and participants with elevated obsessive-compulsive symptoms, had more left frontal activity than low symptom individuals. Those with high scores on trait anxiety, but low worry, had greater right frontal and parietal activity compared to controls. The present results suggest that brain lateralization is not solely related to avoidance motivation, and suggest that facets of anxiety may cut across dimensions not well-represented by DSM-based categories.

Relative frontal brain asymmetry and cortisol release after social stress: The role of action orientation

Social evaluation is a potent stressor and consistently leads to an activation of the hypothalamic-pituitary-adrenal system. Here, we investigated whether individual differences in action orientation influence the relationship between the cortisol response to social-evaluative threat and relative left frontal electroencephalographic (EEG) alpha asymmetry as a brain marker of approach motivation. Forty-nine participants were exposed to a camera-based variant of the Trier Social Stress Task while salivary cortisol and resting EEG frontal alpha asymmetry were assessed before and after stress induction. Higher relative left frontal activity was associated with higher changes in cortisol levels as measured by the area under curve with respect to increase, particularly in individuals low in action orientation. We discuss the role of the left frontal cortex in coping, the potential role of oxytocin, and negative health consequences when the left-frontal coping process becomes overstrained.

Dissociation between the cognitive and interoceptive components of mindfulness in the treatment of chronic worry

OBJETIVES

Despite the increasing interest in mindfulness, the basic components and action mechanisms of mindfulness remain controversial. The present study aims at testing the specific contribution of two components of mindfulness -attention to cognitive experience (metacognition) and awareness of interoceptive sensations (metainteroception)- in the treatment of chronic worry.

METHOD

Forty five female university students with high scores in the Penn State Worry Questionnaire were split into three groups: a mindfulness cognitive training group, a mindfulness interoceptive training group, and a non-intervention control group. Participants were assessed before and after the intervention using physiological indices of autonomic regulation (skin conductance, heart rate, heart rate variability, and respiratory sinus arrhythmia) and self-report indices of mindfulness and clinical symptoms (chronic worry, depression, positive and negative affect, and perceived stress).

RESULTS

Both mindfulness training groups showed significant improvement after the intervention in self-report indices of mindfulness and clinical symptoms. However, the interoceptive training group was superior in also showing significant improvement in the physiological indices of autonomic regulation.

LIMITATIONS

The relatively small sample size may have increased the probabilities of type I and II errors. Our Intervention program was relatively short. The participants were all female.

CONCLUSIONS

These results support the hypothesis that, in the context of treating chronic worry, the interoceptive and cognitive components can be somewhat dissociated and that, when both components are applied separately, compared to a non-intervention condition, the interoceptive component is more effective.

Yoga for generalized anxiety disorder: design of a randomized controlled clinical trial

Generalized anxiety disorder (GAD) is a common disorder associated with significant distress and interference. Although cognitive behavioral therapy (CBT) has been shown to be the most effective form of psychotherapy, few patients receive or have access to this intervention. Yoga therapy offers another promising, yet under-researched, intervention that is gaining increasing popularity in the general public, as an anxiety reduction intervention. The purpose of this innovative clinical trial protocol is to investigate the efficacy of a Kundalini Yoga intervention, relative to CBT and a control condition. Kundalini yoga and CBT are compared with each other in a noninferiority test and both treatments are compared to stress education training, an attention control intervention, in superiority tests. The sample will consist of 230 individuals with a primary DSM-5 diagnosis of GAD. This randomized controlled trial will compare yoga (N=95) to both CBT for GAD (N=95) and stress education (N=40), a commonly used control condition. All three treatments will be administered by two instructors in a group format over 12 weekly sessions with four to six patients per group. Groups will be randomized using permuted block randomization, which will be stratified by site. Treatment outcome will be evaluated bi-weekly and at 6month follow-up. Furthermore, potential mediators of treatment outcome will be investigated. Given the individual and economic burden associated with GAD, identifying accessible alternative behavioral treatments will have substantive public health implications.

Trait and state anxiety reduce the mere exposure effect

The mere exposure effect refers to an affective preference elicited by exposure to previously unfamiliar items. Although it is a well-established finding, its mechanism remains uncertain, with some positing that it reflects affective processes and others positing that it reflects perceptual or motor fluency with repeated items. Here we examined whether individual differences in trait and state anxiety, which have been associated with the experience of emotion, influence the mere exposure effect. Participants' trait (Study 1) and state (Study 2) anxiety were characterized with the State-Trait Anxiety Inventory. Greater trait and state anxiety correlated with greater negative affect and lesser positive affect. In both experiments, greater anxiety was associated with a reduced mere exposure effect. Measures of fluency (response times at study and test) were unrelated to the mere exposure effect. These findings support the role of affective processes in the mere exposure effect, and offer a new insight into the nature of anxiety such that anxiety is associated with a reduced experience of positive affect typically associated with familiarity.

[Music-induced chills as a strong emotional experience]

While enjoying music and other works of art, people sometimes experience "chills," a strong emotional response characterized by a sensation of goose bumps or shivers. Such experiences differ from having goose bumps as a defense response or from shivering in reaction to cold temperatures. The current paper presents the phenomenon of music-induced chills and reviews the chill-related emotional response, autonomic nervous system activity, and brain activity. It also reviews the musico-acoustic features, listening contexts, and individual differences that cause chills. Based on the review, we propose a hypothetical model regarding the evocation of music-induced chills. Furthermore, we investigate the strong emotional response associated with chills by exploring the relationship between music-related chills and non-music-related chills, and discuss future research directions.

Cognitive, behavioral, and autonomic correlates of mind wandering and perseverative cognition in major depression

Autonomic dysregulation has been hypothesized to play a role in the relationships between psychopathology and cardiovascular risk. An important transdiagnostic factor that has been associated with autonomic dysfunction is perseverative cognition (PC), mainly present in Major Depressive Disorder (MDD) in the form of rumination. As the ability to adaptively let our mind wander without ruminating is critical to mental health, this study aimed to examine the autonomic concomitants of functional vs. dysfunctional intrusive thoughts in MDD. Ambulatory heart rate (HR) and variability (HRV) of 18 MDD subjects and 18 healthy controls were recorded for 24 h. Approximately every 30 min during waking hours subjects reported their ongoing thoughts and moods using electronic diaries. Random regression models were performed. Compared to controls, MDD subjects were more often caught during episodes of PC. In both groups, PC required more effort to be inhibited and interfered more with ongoing activities compared to mind wandering (MW) (ps < 0.0001). This cognitive rigidity was mirrored by autonomic inflexibility, as PC was characterized by lower HRV (p < 0.0001) compared to MW. A worse mood was reported by MDD patients compared to controls, independently of their ongoing cognitive process. Controls, however, showed the highest mood worsening during PC compared to being on task and MW. HRV during rumination correlated with self-reported somatic symptoms on the same day and several dispositional traits. MDD subjects showed lower HRV during sleep, which correlated with hopelessness rumination. Results show that PC is associated with autonomic dysfunctions in both healthy and MDD subjects. Understanding when spontaneous thought is adaptive and when it is not may clarify its role in the etiology of mood disorders, shedding light on the still unexplained association between psychopathology, chronic stress, and risk for health.

Respiratory sinus arrhythmia during worry forecasts stress-related increases in psychological distress

Respiratory sinus arrhythmia (RSA) has been conceptualized as an index of emotion regulation abilities. Although resting RSA has been associated with both concurrent and prospective affective responses to stress, the impact of RSA reactivity on emotional responses to stress is inconsistent across studies. The type of emotional stimuli used to elicit these phasic RSA responses may influence the adaptive value of RSA reactivity. We propose that RSA reactivity to a personally relevant worry-based stressor might forecast future affective responses to stress. To evaluate whether resting RSA and RSA reactivity to worry inductions predict stress-related increases in psychological distress, an academic stress model was used to prospectively examine changes in psychological distress from the well-defined low- and high-stress periods. During the low-stress period, 76 participants completed self-report mood measures and had their RSA assessed during a resting baseline, free worry period and worry catastrophizing interview. Participants completed another mood assessment during the high-stress period. Results indicated that baseline psychological distress predicted larger decreases in RSA during the worry inductions. Lower resting RSA and greater RSA suppression to the worry inductions at baseline prospectively predicted larger increases in psychological distress from the low- to high-stress period, even after accounting for the impact of baseline distress on RSA. These results provide further evidence that RSA may represent a unique index of emotion regulation abilities in times of stress.

Worry as an adaptive avoidance strategy in healthy controls but not in pathological worriers

The cognitive avoidance model of worry assumes that worry has the adaptive function to keep under control the physiological arousal associated with anxiety. This study aimed to test this model by the use of a fear induction paradigm in both pathological and healthy individuals. Thirty-one pathological worriers and 36 healthy controls accepted to be exposed to a fear induction paradigm (white noise) during three experimental conditions: worry, distraction, and reappraisal. Skin conductance (SCR) and heart rate variability (HRV) were measured as indices of sympathetic and parasympathetic nervous system functioning. Worriers showed increased sympathetic and decreased parasympathetic activation during the worry condition compared to non-worriers. There were no differences between groups for the distraction and reappraisal conditions. SCRs to the white noises during worry were higher in worriers versus controls throughout the entire worry period. Intolerance of uncertainty - but not metacognitive beliefs about worry - was a significant moderator of the relationship between worry and LF/HF-HRV in pathological worriers. Results support the cognitive avoidance model in healthy controls, suggesting that worry is no longer a functional attitude when it becomes the default/automatic and pathological response.

Yoga-enhanced cognitive behavioural therapy (Y-CBT) for anxiety management: a pilot study

Cognitive behavioural therapy (CBT) is an effective treatment for generalized anxiety disorder, but there is still room for improvement. The aim of the present study was to examine the potential benefit of enriching CBT with kundalini yoga (Y-CBT). Participants consisted of treatment resistant clients at a community mental health clinic. A total of 32 participants enrolled in the study and 22 completed the programme. After the Y-CBT intervention, pre-post comparisons showed statistically significant improvements in state and trait anxiety, depression, panic, sleep and quality of life. Results from this preliminary study suggest that Y-CBT may have potential as a promising treatment for those suffering from generalized anxiety disorder.

KEY PRACTITIONER MESSAGES

Yoga-enhanced cognitive behavioural therapy (Y-CBT) may be a promising new treatment for those suffering from generalized anxiety disorder. Y-CBT may also reduce depression in those suffering from generalized anxiety. Y-CBT may reduce depression and anxiety in a clinic population where clients suffer from multiple diagnoses including generalized anxiety disorder.