Childhood Maltreatment Influences Autonomic Regulation and Mental Health in College Students

Disorders of gut-brain interaction through the lens of polyvagal theory

This paper introduces a metric capable of tracking a hypothetical brainstem "switching" mechanism involved in regulating the afferent influence of blood pressure on the vagal efferent control of heart rate. In theory, this metric could be applied to evaluate the "efficiency" of brainstem pathways involved in common mechanisms of autonomic function involving the vagal influences on the gut as well as the heart. Thus, by exploring the dynamic "efficiency" of the brainstem feedback circuit linking heart rate to posture, a clinically relevant index of vagal flexibility might be extracted that would provide a generalizable window into the vagal regulation of both the heart and gut. Recent research supports this contention and has documented that this metric, VE, appears to covary with disorders of the gut. Clinical application of this metric might identify individual vulnerabilities that frequently reflect symptoms assumed to have features of a dysregulated autonomic nervous system (i.e., dysautonomia). If this is confirmed by additional research, then this objective measure of neural regulation of autonomic function might provide insight into the pathogenesis of disorders of gut-brain interaction.

Autonomic assessment at the intersection of psychosocial and gastrointestinal health

BACKGROUND

Wearable technology is increasingly used in clinical practice and research to monitor functional gastrointestinal symptoms and mental health.

AIMS

This article explores the potential of wearable sensors to enhance the understanding of the autonomic nervous system (ANS), particularly its role in linking psychological and gastrointestinal function. The ANS, facilitates brain-gut communication and is responsive to psychosocial conditions. It is implicated in disorders related to psychological stress and gut-brain interaction. Wearable technology enables tracking of the ANS in daily life, offering complementary and alternative methods from traditional lab-based measures. This review places focus on autonomic metrics such as respiratory sinus arrhythmia, vagal efficiency, and electrodermal activity as well as self-reports of autonomic symptoms.

DISCUSSION

Potential applications include use of wearable sensors for tracking autonomic activity in disorder of gut-brain interaction such as cyclic vomiting syndrome, in which ANS dysregulation may be triggered by psychosocial factors. Considerations for data interpretation and contextualization are addressed, acknowledging challenges such as situational confounders of ANS activity and accuracy of wearable devices.

Psychopathological Correlates and Psychosocial Functioning in Children and Adolescents with Syncope: A Systematic Review

Objective

Syncope is defined as a spontaneous and transient loss of consciousness and postural tone due to brief and reversible cerebral hypoperfusion. This review aimed to summarize the research findings regarding the psychological correlates associated with pediatric syncope. Moreover, the study aimed to deepen the understanding of the relationship between psychological disorders and the onset of syncopal episodes in childhood, focusing on clinical features and different clinical classifications.

Method

A systematic review was carried out from inception to January 2023, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using the CINAHL Plus, APA PsycArticles, APA PsycInfo, MEDLINE, and Psychology and Behavioral Sciences Collection databases. The study search and selection were based on the Population Intervention Comparison Outcome Study Design (PICOS) strategy and the Quality Assessment was carried out using Critical Appraisal Skills Programme (CASP) scales. A combination of keywords related to a) syncope; b) psycho*; and c) child* (Subjects) was used. Studies concerning epilepsy-related syncope were excluded.

Results

Overall, 912 records were identified. After excluding non-English, non-original, and duplicate studies, 579 records were selected for the title screening, 88 for the abstract screening, 37 full-text articles were assessed for eligibility and a total of 14 were included. The Risk of Bias in the included studies was assessed and 78,6% of the studies satisfied robustness quality criteria. The findings highlighted that children and adolescents with syncope showed a higher rate of psychopathology as compared to the healthy and clinical controls. Furthermore, patients reported social withdrawal and poor quality of life.

Conclusions

The findings suggest that there is a robust relationship between psychopathology and syncope. Children and adolescents with syncope frequently report clinical symptoms related to emotional, relational, and psychosomatic dysregulation. Psychological assessment should be routinely included in the integrated care to identify potential targets for treatment and improve early differential diagnosis.

Prenatal co-exposure to diisodecyl phthalate and ozone contribute to depressive behavior in offspring mice through oxidative stress and TWIST1 participation

Exposure to diisodecyl phthalate (DIDP) during early pregnancy may be a risk factor for depressive behavior in offspring. While ozone (O3) exposure also raises the probability of depressive behavior during the preceding DIDP-induced process. In the present study, we investigated the effects of prenatal exposure to DIDP and O3 on the development of depressive-like behavior in offspring mice. The study found that prenatal exposure to both DIDP and O3 significantly increased depressive-like behavior in the offspring mice compared to either DIDP or O3 alone. Prenatal exposure to DIDP and O3 obviously increased the levels of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH) and cortisol, and decreased the levels of brain-derived neurotrophic factor (BDNF), 5-hydroxytryptamine (5-HT), dopamine (DA) and norepinephrine (NE) in the brain tissues of offspring mice. Transcriptome analysis further revealed significant alterations in genes related to oxidative stress and TWIST1 (a helix-loop-helix transcription factor) in response to the combined exposure to DIDP and O3. HPA axis activation, dysregulation of neurodevelopmental factors, oxidative stress and TWIST1 involvement, collectively contributed to the development of depression-like behaviors in offspring mice following prenatal exposure to DIDP and O3. Moreover, the study also verified the potential role of oxidative stress using vitamin E as an antioxidant. The findings provide valuable evidence for the relationship between co-exposure to DIDP and O3 and depression, highlighting the importance of considering the combined effects of multiple environmental pollutants in assessing their impact on mental health outcomes.

A theoretical exploration of polyvagal theory in creative arts and psychomotor therapies for emotion regulation in stress and trauma

Polyvagal theory advocates for working with the body, becoming aware of the body and connecting with the senses. Similarly, paying attention to and influencing one's physical and sensory experience is a core aspect of the creative arts and psychomotor therapies. Polyvagal theory offers opportunities for strengthening resilience by treating emotion-regulation problems, stress, and trauma, as well as restoring regulation of the autonomic nervous system. Paying attention to and influencing physical and sensory experiences are core aspects of creative arts and psychomotor therapies. This theoretical paper explores how polyvagal theory can serve as a foundational theory and support the creative arts and psychomotor therapies for emotion regulation in stress and trauma. A number of pillars in polyvagal theory have links with arts therapies, such as an emphasis on physical and sensory experience in situations of safety or threat. This theory may offer insight into the role of the body in stressful situations, the role of co-and self-regulation, and thus the functioning of and the rationale for use of creative arts and psychomotor therapies. Through interventions focused on promoting healthy autonomic responses and regulating physiological responses, clients can learn to better regulate and process their emotional experiences. Although this could be broadly useful, it would seem particularly promising in therapies focused on stress and trauma. This article provides an introduction to polyvagal theory and outlines how it can serve as an explanatory, hypothetical model for the working mechanisms that underlie creative arts and psychomotor therapies. The application of PVT in creative arts and psychomotor therapies will be explored by describing techniques for "noticing and naming" and "learning to change," as well as by highlighting the role of PVT in the therapeutic relationship. It provides case examples and discusses the role of creative arts and psychomotor therapies for stress regulation and resilience conceptualized in line with the polyvagal theory.

The long-term impact of early adverse experience on adaptive functioning: a pilot study integrating measures of mental status, nonverbal communication, and heart rate variability

Background: Childhood maltreatment (CM) can disrupt the development of behavioural and physiological systems, increasing the risk of physical and psychological adverse outcomes across the lifespan. CM may cause interpersonal dysfunctions that impair social communication and lead to dysfunctional activation of the autonomic nervous system. The present exploratory study analyzed the long-term impact of CM from an integrated perspective through the simultaneous assessment of psychological symptoms, social and behavioural communication, and physiological regulation.

Methods: Participants were 55 healthy university students (9 males and 46 females; mean age ± SD = 25.26 ± 2.83 years), who filled out a battery of questionnaires to assess the presence of CM (Childhood Trauma Questionnaire) and psychopathological symptoms (Symptom Check-List-90 Item Revised). Participants were then subjected to a videotaped interview for the assessment of non-verbal behaviour (Ethological Coding System for Interviews) and measurement of tonic heart rate variability (HRV), a measure of physiological adaptability to the environment. We performed Pearson's correlation analysis to evaluate the associations between non-verbal behaviour, HRV, and CM variables. Multiple regression analysis was used to evaluate the independent associations between CM variables on HRV and nonverbal behaviour.

Results: We found an association between more severe CM, increased symptoms-related distress (ps < .001), less submissive behaviour (ps < .018), and decreased tonic HRV (ps < .028). As a result of multiple regression analysis, participants with a history of emotional abuse (R² = .18, p = .002) and neglect (R² = .10, p = .03) were more likely to display decreased submissive behaviour during the dyadic interview. Moreover, early experience of emotional (R² = .21, p = .005) and sexual abuse (R² = .14, p = .04) was associated with decreased tonic HRV.

Conclusion: Our preliminary findings show the utility of analyzing the long-term effects of adverse early experiences at different levels of ‘adaptive functioning’ (the capabilities needed to respond effectively to environmental demands).

Substantial traumatic experiences during childhood, such as emotional abuse, emotional neglect, and sexual abuse were associated with lower heart rate variability levels in a sample of young adults.

Young adults with a history of emotional abuse and neglect were more likely to display decreased submissive behaviour (ethological behaviour) during the dyadic interview.

Severe childhood maltreatment was associated with increased symptoms-related distress, less submissive behaviour (ethological behaviour), and decreased tonic heart rate variability in young adults.

Association of Self-Reported Autonomic Symptoms With Sensor-Based Physiological Measures

OBJECTIVE

Autonomic regulation of organ and tissues may give rise to disruptions of typical functions. The Body Perception Questionnaire Short Form (BPQ-SF) includes items that were developed to assess autonomic symptoms in daily life. This pair of studies aimed to establish previously unexplored psychometric properties of the BPQ-SF autonomic symptoms scale, develop normative values for clinical and research use, and assess the convergence of self-reports with sensor-based measures.

METHODS

Study 1 reports exploratory and confirmatory factor analysis on BPQ-SF autonomic symptom items from a large US population-based online study ( n = 2048). In study 2, BPQ-SF scores were examined for associations with heart period, respiratory sinus arrhythmia, and skin conductance during seated leg lifts in a community sample ( n = 62).

RESULTS

Study 1 results supported a two-factor supradiaphragmatic and subdiaphragmatic autonomic symptom solution (confirmatory factor analysis: root mean squared error of approximation = 0.040, Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99), although a one-factor solution also fit the data well (root mean squared error of approximation = 0.080, Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99). In study 2, heart period responses to leg lifts and rests were demonstrated at all autonomic symptom levels. However, low autonomic symptoms were associated with optimal autonomic nervous system patterns of activation and recovery to baseline levels. Moderate symptoms were associated with prolonged sympathetic activation. The highest symptom levels were associated with impaired autonomic nervous system coordination across activation and recovery.

CONCLUSIONS

Results support the utility of self-reports of autonomic symptoms in research and clinical applications, with higher symptoms likely indicating autonomic impairment.

The vagal paradox: A polyvagal solution

Although there is a consistent literature documenting that vagal cardioinhibitory pathways support homeostatic functions, another less frequently cited literature implicates vagal cardioinhibitory pathways in compromises to survival in humans and other mammals. The latter is usually associated with threat reactions, chronic stress, and potentially lethal clinical conditions such as hypoxia. Solving this 'vagal paradox' in studies conducted in the neonatal intensive care unit served as the motivator for the Polyvagal Theory (PVT). The paradox is resolved when the different functions of vagal cardioinhibitory fibers originating in two anatomically distinguishable brainstem areas are recognized. One pathway originates in a dorsal area known as the dorsal motor nucleus of the vagus and the other in a ventral area of the brainstem known as nucleus ambiguus. Unlike mammals, in all ancestral vertebrates from which mammals evolved, cardioinhibitory vagal fibers primarily originate in the dorsal motor nucleus of the vagus. Thus, in mammals the vagus nerve is 'poly' vagal because it contains two distinct efferent pathways. Developmental and evolutionary biology identify a ventral migration of vagal cardioinhibitory fibers that culminate in an integrated circuit that has been labeled the ventral vagal complex. This complex consists of the interneuronal communication of the ventral vagus with the source nuclei involved in regulating the striated muscles of the head and face via special visceral efferent pathways. This integrated system enables the coordination of vagal regulation of the heart with sucking, swallowing, breathing, and vocalizing and forms the basis of a social engagement system that allows sociality to be a potent neuromodulator resulting in calm states that promote homeostatic function. These biobehavioral features, dependent on the maturation of the ventral vagal complex, can be compromised in preterm infants. Developmental biology informs us that in the immature mammal (e.g., fetus, preterm infant) the ventral vagus is not fully functional and myelinization is not complete; this neuroanatomical profile may potentiate the impact of vagal cardioinhibitory pathways originating in the dorsal motor nucleus of the vagus. This vulnerability is confirmed clinically in the life-threatening reactions of apnea and bradycardia in human preterm newborns, which are hypothetically mediated through chronotropic dorsal vagal pathways. Neuroanatomical research documents that the distribution of cardioinhibitory neurons representing these two distinct vagal source nuclei varies among mammals and changes during early development. By explaining the solution of the 'vagal paradox' in the preterm human, the paper highlights the functional cardioinhibitory functions of the two vagal source nuclei and provides the scientific foundation for the testing of hypotheses generated by PVT.

Cardiac Vagal Regulation Is Impeded in Children With Cyclic Vomiting Syndrome

INTRODUCTION

The pathophysiology underlying cyclic vomiting syndrome (CVS) remains undefined. Scant data and distinct clinical features point to altered autonomic nervous system function. Autonomic signaling can be noninvasively assessed through cardiac indices of parasympathetic vagal regulation, which is reduced in children with disorders of gut-brain interaction. We aimed to examine dynamic cardiac vagal regulation in children with CVS compared with that in healthy controls (HC).

METHODS

A total of 31 children with CVS evaluated in a tertiary care CVS center and 66 HC (ages 8-18 years) underwent cardiac autonomic function assessment. Electrocardiogram recordings were conducted during 3-minute sit/stand/sit posture challenges. The electrocardiogram-derived variables heart period, respiratory sinus arrhythmia (RSA), and vagal efficiency (VE) were analyzed using linear regression and mixed-effects modeling.

RESULTS

After exclusion of medication confounders, 23 patients with CVS were included in analyses. Both groups were comparable in age, gender, and body mass index. Compared with HC, children with CVS had shorter heart period (standardized mean difference range: 1.15-1.22, all P values < 0.05) and lower RSA (SMD range: 0.66-0.88, all P values < 0.05). Patients with CVS had significantly lower VE during the entire course of posture shifts, compared with HC ( B = -19.87, SE = 6.95, t = -2.86, P = 0.005, SMD = 0.76).

DISCUSSION

Children with CVS have suboptimal parasympathetic autonomic regulation compared with HC, indexed by reduced RSA and VE, even during their interepisodic well phase. Abnormal vagal modulation may underlie CVS pathophysiology, comorbidities, and triggers. Assessing VE during posture stressors could inform therapeutic interventions.

Heart Rate Variability: A Personal Journey

Heart rate variabfility (HRV) has been a focal point throughout my academic history. To put into perspective, I have published studies spanning seven decades focusing on HRV (1969-2022). My interest in HRV started early in graduate school and continues to be an important portal informing my theoretical perspective. The current paper tracks some of this history, which started as an empirical observation and moved through several scientific stages including development of quantitative methods and investigations of neural mechanisms. Along this journey a variety of hypotheses were tested including the relative sensitivity of HRV metrics to neural mechanisms, psychological processes, and medical diagnoses. In addition, the research led to the identification of portal of intervention that have become strategies to optimize mental and physical health. These apparent disparate programs of inquiry have been tightly merged as the Polyvagal Theory evolved. In the sections below, I have shared my personal journey through these stages of scientific inquiry and my attempts to integrate the new knowledge in an expansive theoretical model.