Publications by authors named "Julian Koenig"

119 Publications

Maternal bonding impairment predicts personality disorder features in adolescence: The moderating role of child temperament and sex.

Personal Disord 2021 Feb 11. Epub 2021 Feb 11.

Research has shown associations between adverse parenting experiences and (borderline) personality disorder ([B]PD). A biopsychosocial model suggests that child characteristics and the environment interact in the development of symptoms. However, prospective data in this aspect are limited. This study focused on maternal bonding impairment (MBI; 2 weeks postpartum) and its interactions with child temperament (age 5) and child sex as predictors of BPD symptoms and general personality dysfunction in adolescence. Participants were 64 mother-child dyads from a community sample who took part in a 14-year longitudinal study. Higher MBI was a significant predictor of general personality dysfunction as defined in Criterion A of the alternative model for PD of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Interactions showed that the effect of MBI on general personality dysfunction was decreased for children higher in harm avoidance and increased for children higher in novelty seeking. There was also a negative main effect of harm avoidance on (B)PD features. Regarding BPD symptoms, the MBI × Child Sex interaction indicated differential susceptibility. Girls' but not boys' BPD symptoms were dependent on maternal bonding. Our results indicate that children at risk of developing personality pathology can be identified early in life. They stress the importance of early relationship disturbances in the development of personality pathology and refine the understanding of differential susceptibility factors in the context of MBI and PD symptom development. Our findings can be applied to target at-risk dyads for selective early prevention based on temperament and maternal bonding. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000433DOI Listing
February 2021

Autonomic nervous system activity and dialectical behavioral therapy outcome in adolescent borderline personality pathology.

World J Biol Psychiatry 2021 Feb 1:1-17. Epub 2021 Feb 1.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.

Objectives: We aimed to investigate whether pre-treatment cardiac autonomic nervous system (ANS) activity, indexed by heart rate (HR) and heart rate variability (HRV) predicts clinical outcome and therapy drop-outs in adolescents with borderline personality (BPD) pathology receiving dialectical behavioural therapy (DBT-A). We further tested for an association between changes in ANS function and clinical outcome over time. Traumatic experiences were considered as potential confounding factor.

Methods:  = 43 (95.4% female, M = 15.5 years) adolescents fulfilling at least sub-threshold criteria for BPD (≥3) were investigated before and after outpatient DBT-A as well as at follow-up.  = 10 patients dropped out of treatment (<50% of treatment sessions). Latent growth curve models were used for analyses.

Results: Greater pre-treatment resting HRV significantly predicted clinical improvement (decrease in BPD pathology/increase of global functioning) over time. Pre-treatment ANS activity was unrelated to treatment drop-out. Further, changes in ANS activity over treatment were associated with changes in clinical outcome.

Conclusion: This study is the first providing evidence that pre-treatment HRV predicts and is related to treatment response in adolescent borderline personality pathology. Implications for the use of ANS measures in clinical practice and directions for future research are discussed.
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http://dx.doi.org/10.1080/15622975.2020.1858155DOI Listing
February 2021

Lower values of a novel index of Vagal-Neuroimmunomodulation are associated to higher all-cause mortality in two large general population samples with 18 year follow up.

Sci Rep 2021 Jan 28;11(1):2554. Epub 2021 Jan 28.

Department of Psychological Science, The University of California, Irvine, CA, USA.

In recent clinical practice, a biomarker of vagal neuroimmunomodulation (NIM), namely the ratio of vagally-mediated heart rate variability (vmHRV) and CRP, was proposed to index the functionality of the cholinergic anti-inflammatory pathway. This study aims to transfer and extend the previous findings to two general population-based samples to explore the hypothesis that NIM-ratio is associated with all-cause mortality. Two large population studies (MIDUS 2: N = 1255 and Whitehall II wave 5: N = 7870) with complete data from a total of N = 3860 participants (36.1% females; average age = 56.3 years; 11.1% deaths, last exit 18.1 years post inclusion) were available. NIM indices were calculated using the vagally-mediated HRV measure RMSSD divided by measures of CRP (NIM) or IL-6 (NIM). The NIM-ratios were quartiled and entered into age, ethnicity and body mass index adjusted Cox proportional hazards models. For NIM the lowest quartile was 45% more likely to die during the observed period (max. 18 years follow-up) compared to the highest quartile (HR = 0.55 CI 0.41-0.73; p < .0001). NIM parallel these results. Here we show that an easily computable index of IL-6 inhibition is associated with all-cause mortality in two large general population samples. These results suggest that this index might be useful for risk stratification and warrant further examination.
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http://dx.doi.org/10.1038/s41598-021-82168-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844270PMC
January 2021

Calendar age and puberty-related development of regional gray matter volume and white matter tracts during adolescence.

Brain Struct Funct 2021 Jan 20. Epub 2021 Jan 20.

Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstr. 8, 69115, Heidelberg, Germany.

Background: Adolescence is a critical time for brain development. Findings from previous studies have been inconsistent, failing to distinguish the influence of pubertal status and aging on brain maturation. The current study sought to address these inconsistencies, addressing the trajectories of pubertal development and aging by longitudinally tracking structural brain development during adolescence.

Methods: Two cohorts of healthy children were recruited (cohort 1: 9-10 years old; cohort 2: 12-13 years old at baseline). MRI data were acquired for gray matter volume and white matter tract measures. To determine whether age, pubertal status, both or their interaction best modelled longitudinal data, we compared four multi-level linear regression models to the null model (general brain growth indexed by total segmented volume) using Bayesian model selection.

Results: Data were collected at baseline (n = 116), 12 months (n = 97) and 24 months (n = 84) after baseline. Findings demonstrated that the development of most regional gray matter volume, and white matter tract measures, were best modelled by age. Interestingly, precentral and paracentral regions of the cortex, as well as the accumbens demonstrated significant preference for the pubertal status model. None of the white matter tract measures were better modelled by pubertal status.

Limitations: The major limitation of this study is the two-cohort recruitment. Although this allowed a faster coverage of the age span, a complete per person trajectory over 6 years of development (9-15 years) could not be investigated.

Conclusions: Comparing the impact of age and pubertal status on regional gray matter volume and white matter tract measures, we found age to best predict longitudinal changes. Further longitudinal studies investigating the differential influence of puberty status and age on brain development in more diverse samples are needed to replicate the present results and address mechanisms underlying norm-variants in brain development.
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http://dx.doi.org/10.1007/s00429-020-02208-1DOI Listing
January 2021

Psychophysiological concomitants of personality pathology in development.

Curr Opin Psychol 2020 Dec 13;37:129-133. Epub 2020 Dec 13.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.

Psychophysiological research methods allow important insights into normative and pathological functioning of the human organism. This position paper briefly reviews existing studies, investigating the psychophysiological concomitants of personality pathology, with an emphasis on developmental aspects. Focussing on measures, indexing autonomic nervous system (ANS) activity at rest, and its reactivity to experimental challenge, the narrative synthesis of the literature highlights current challenges in the field. Findings on the psychophysiological concomitants of personality pathology are mixed. Inconsistencies among studies arise from differences between disorders and heterogeneity within distinct diagnostic categories. The majority of studies addressed borderline personality disorder, illustrating robust alterations in ANS function linked to severe experiences of early maltreatment and trauma, and associated symptoms of dissociation. However, important life-style and secondary health-related factors (i.e. physical activity, smoking) influencing ANS function are frequently neglected. Adapting a dimensional approach to personality pathology and longitudinal research designs seem promising to advance the filed in the years to come.
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http://dx.doi.org/10.1016/j.copsyc.2020.12.004DOI Listing
December 2020

Early life maltreatment and resting-state heart rate variability: A systematic review and meta-analysis.

Neurosci Biobehav Rev 2021 01 7;120:307-334. Epub 2020 Nov 7.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany. Electronic address:

Recent focus on the consequences of early life adversity (ELA) in neurobiological research led to a variety of findings suggesting alterations in several physiological systems, such as the cardiovascular system. In this systematic review and meta-analysis, we focused on the relationship between early life maltreatment (ELM), one form of ELA, and resting vagal activity indexed by resting-state heart rate variability (HRV). A systematic search of the literature yielded 1'264 hits, of which 32 studies reporting data for group comparisons or correlations were included. By quantitative synthesis of existing studies using random-effect models, we found no evidence for a relationship between ELM exposure and resting vagal activity in principal. Conducting meta-regression analyses, however, we found the relationship between ELM and resting vagal activity to significantly vary as a function of both age and the presence of psychopathology. In light of the current multitude of vastly unclear pathways linking ELM to the onset of disease, we emphasize the need for further research and outline several aspects to consider in future studies.
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http://dx.doi.org/10.1016/j.neubiorev.2020.10.026DOI Listing
January 2021

Resting state heart rate variability and false memories.

Int J Psychophysiol 2021 Jan 16;159:17-22. Epub 2020 Oct 16.

Department of Psychological Science, University of California, Irvine, USA; Department of Psychology, The Ohio State University Columbus, OH, USA.

Recent studies have shown higher resting-state vagally-mediated heart rate variability (vmHRV) to be related to greater memory retrieval. Research has not yet linked resting vmHRV with memory encoding and retrieval, as both are thought to play an important role in correctly distinguishing between true and false memories. The current study investigated this possible link in n = 71 undergraduate students. VmHRV was assessed during a 5-minute resting baseline period. Participants then completed the Deese-Roediger-McDermott (DRM) task, where they first viewed 6 word lists (12 words per list), and were later asked to identify previously shown words (true memories) and reject non-presented words. Results showed that participants with lower resting vmHRV were less able to discriminate true from false items. These data extend previous work on resting vmHRV and memory suggesting that resting vmHRV represents a psychophysiological pathway involved in both the proper encoding and retrieval of memories.
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http://dx.doi.org/10.1016/j.ijpsycho.2020.08.009DOI Listing
January 2021

Impaired vasodilation in pregnant African Americans: Preliminary evidence of potential antecedents and consequences.

Psychophysiology 2021 Jan 11;58(1):e13699. Epub 2020 Oct 11.

Department of Psychological Science, The University of California Irvine, Irvine, CA, USA.

Significant health disparities exist between African Americans (AA) and European Americans (EA) in hypertension and hypertension-related disorders. Evidence suggests that this is due to impaired vasodilation in AAs. Pregnancy is a potent systemic vasodilatory state. However, differences in vasodilation between AAs and EAs have not been investigated in pregnancy. We sought to examine the effects of pregnancy on vasodilation in AA and EA women and how this might be related to discrimination and low birth weight in their offspring. Hemodynamics [blood pressure (MAP), cardiac output (CO), total peripheral resistance (TPR)] and heart rate variability (HF-HRV) were examined at baseline in 40 pregnant AAs (n = 20) and EAs (n = 20) and matched nonpregnant women (n = 40). The Experiences of Discrimination scale and birth weight were also measured in the offspring of the pregnant participants. Whereas pregnancy was associated with decreased MAP independent of race, AAs showed impaired vasodilation independent of pregnancy status as indicated by greater TPR despite greater HF-HRV. In AAs, but not EAs, reports of fewer incidences of discrimination were associated with greater TPR. Finally, the HF-HRV of EA mothers was inversely related to the birth weight of their offspring but was uncorrelated in AAs. We report novel evidence of impaired vasodilation to an endogenous vasodilatory stimulus in AAs. Higher TPR was related to discrimination in AAs and higher HF-HRV was related to low birth weight in EAs. These findings have implications for understanding the intergenerational transmission of impaired vasodilation in AAs.
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http://dx.doi.org/10.1111/psyp.13699DOI Listing
January 2021

Cortical thickness and resting-state cardiac function across the lifespan: A cross-sectional pooled mega-analysis.

Psychophysiology 2020 Oct 10. Epub 2020 Oct 10.

Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting-state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12-87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS-or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between CT and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research.
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http://dx.doi.org/10.1111/psyp.13688DOI Listing
October 2020

Cortical thickness and resting-state cardiac function across the lifespan: A cross-sectional pooled mega-analysis.

Psychophysiology 2020 Oct 10. Epub 2020 Oct 10.

Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting-state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12-87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS-or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between CT and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research.
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http://dx.doi.org/10.1111/psyp.13688DOI Listing
October 2020

A plea for the sustained implementation of digital interventions for young people with mental health problems in the light of the COVID-19 pandemic.

J Child Psychol Psychiatry 2020 Sep 14. Epub 2020 Sep 14.

Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany.

The coronavirus disease 2019 pandemic and the consequent global lockdown posed a particular challenge for youths with mental health problems. Crucial interference with their everyday lives likely increased psychological distress while accessibility of conventional mental health care was limited. Ongoing online trials offer a unique opportunity to analyse mental health status and help-seeking behaviour of adolescents during the pandemic. The ProHEAD-online trial aims at improving help-seeking behaviour of children and adolescents with significant psychological impairment. From January to May 2020, 1,042 students had access to the ProHEAD-online platform providing information on mental illness, monitoring, peer support and professional counselling. In the week from 11 March, when schools were closed in Germany, a drastic (more than 2 standard deviations) but time-limited increase in utilization of the ProHEAD-online services became apparent. This may indicate a worsened mental health status and an increased help seeking via digital services during the lockdown. Although this finding is purely observational, it speaks to the importance of evidence-based online service in the field of mental health within the current crisis and beyond.
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http://dx.doi.org/10.1111/jcpp.13317DOI Listing
September 2020

A plea for the sustained implementation of digital interventions for young people with mental health problems in the light of the COVID-19 pandemic.

J Child Psychol Psychiatry 2020 Sep 14. Epub 2020 Sep 14.

Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany.

The coronavirus disease 2019 pandemic and the consequent global lockdown posed a particular challenge for youths with mental health problems. Crucial interference with their everyday lives likely increased psychological distress while accessibility of conventional mental health care was limited. Ongoing online trials offer a unique opportunity to analyse mental health status and help-seeking behaviour of adolescents during the pandemic. The ProHEAD-online trial aims at improving help-seeking behaviour of children and adolescents with significant psychological impairment. From January to May 2020, 1,042 students had access to the ProHEAD-online platform providing information on mental illness, monitoring, peer support and professional counselling. In the week from 11 March, when schools were closed in Germany, a drastic (more than 2 standard deviations) but time-limited increase in utilization of the ProHEAD-online services became apparent. This may indicate a worsened mental health status and an increased help seeking via digital services during the lockdown. Although this finding is purely observational, it speaks to the importance of evidence-based online service in the field of mental health within the current crisis and beyond.
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http://dx.doi.org/10.1111/jcpp.13317DOI Listing
September 2020

A plea for the sustained implementation of digital interventions for young people with mental health problems in the light of the COVID-19 pandemic.

J Child Psychol Psychiatry 2020 Sep 14. Epub 2020 Sep 14.

Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany.

The coronavirus disease 2019 pandemic and the consequent global lockdown posed a particular challenge for youths with mental health problems. Crucial interference with their everyday lives likely increased psychological distress while accessibility of conventional mental health care was limited. Ongoing online trials offer a unique opportunity to analyse mental health status and help-seeking behaviour of adolescents during the pandemic. The ProHEAD-online trial aims at improving help-seeking behaviour of children and adolescents with significant psychological impairment. From January to May 2020, 1,042 students had access to the ProHEAD-online platform providing information on mental illness, monitoring, peer support and professional counselling. In the week from 11 March, when schools were closed in Germany, a drastic (more than 2 standard deviations) but time-limited increase in utilization of the ProHEAD-online services became apparent. This may indicate a worsened mental health status and an increased help seeking via digital services during the lockdown. Although this finding is purely observational, it speaks to the importance of evidence-based online service in the field of mental health within the current crisis and beyond.
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http://dx.doi.org/10.1111/jcpp.13317DOI Listing
September 2020

Neuropsychological development in adolescents: Longitudinal associations with white matter microstructure.

Dev Cogn Neurosci 2020 10 30;45:100812. Epub 2020 Jun 30.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.

Important neuropsychological changes during adolescence coincide with the maturation of white matter microstructure. Few studies have investigated the association between neuropsychological development and white matter maturation longitudinally. We aimed to characterize developmental trajectories of inhibition, planning, emotion recognition and risk-taking and examine whether white matter microstructural characteristics were associated with neuropsychological development above and beyond age. In an accelerated longitudinal cohort design, n = 112 healthy adolescents between ages 9 and 16 underwent cognitive assessment and diffusion MRI over three years. Fractional anisotropy (FA) and mean diffusivity (MD) were extracted for major white matter pathways using an automatic probabilistic reconstruction technique and mixed models were used for statistical analyses. Inhibition, planning and emotion recognition performance improved linearly across adolescence. Risk-taking developed in a quadratic fashion, with stable performance between 9 and 12 and an increase between ages 12 and 16. Including cingulum and superior longitudinal fasciculus FA slightly improved model fit for emotion recognition across age. We found no evidence that FA or MD were related to inhibition, planning or risk-taking across age. Our results challenge the additional value of white matter microstructure to explain neuropsychological development in healthy adolescents, but more longitudinal research with large datasets is needed to identify the potential role of white matter microstructure in cognitive development.
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http://dx.doi.org/10.1016/j.dcn.2020.100812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352053PMC
October 2020

Ethnic Differences in Resting Total Peripheral Resistance: A Systematic Review and Meta-Analysis.

Psychosom Med 2020 Jul/Aug;82(6):548-560

From the Department of Psychology (Brownlow, Vasey), The Ohio State University, Columbus, Ohio; Department of Psychological Science (Williams, Thayer), University of California, Irvine, Irvine, California; Department of Pediatrics and Medicine (Kapuku), Georgia Prevention Institute, Augusta, Georgia; Department of Social Work and Nursing (Anderson), Florida State University, Tallahassee, Florida; Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg (Koenig), Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern (Koenig), Bern, Switzerland; and Department of Psychiatry and Behavioral Sciences, Behavioral Medicine, School of Medicine (Hill), Duke University, Durham, North Carolina.

Objective: Decades of research suggest that there may be important ethnic differences in the hemodynamic mechanisms that co-determine arterial blood pressure, the primary diagnostic index of hypertension. In general, studies have observed that, compared with European Americans (EAs), African Americans (AAs) exhibit higher total peripheral resistance (TPR), an important summative index of peripheral vascular constriction. In contrast, EAs have been reliably shown to exhibit greater cardiac output (CO), which is directly linked to left ventricle and overall cardiac blood flow. We have previously proposed that elevated basal TPR, in particular, represents one component of the cardiovascular conundrum, characterized, paradoxically, by elevated resting heart rate variability among AAs relative to EAs. The present meta-analysis and systematic review of the literature sought to extend this previous work by establishing the magnitude of the empirically implied ethnic differences in resting TPR and CO.

Methods: A search of the literature yielded 140 abstracts on differences in TPR between AAs and EAs; 40 were included. Sample sizes, means, and standard deviations for baseline TPR with samples that included EAs and AAs were collected, and Hedges g was computed.

Results: Findings indicated that AAs had higher baseline TPR than did EAs (Hedges g = 0.307, SE = 0.043, confidence interval= 0.224 to 0.391, p < .001). In addition, EAs had higher resting CO than did AAs (Hedges g = -0.214, SE = 0.056, confidence interval = -0.324 to -0.104, p < .001).

Conclusions: We discuss the present findings in the context of the role of elevated TPR in the deleterious effects of high blood pressure specifically for AAs.
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http://dx.doi.org/10.1097/PSY.0000000000000820DOI Listing
May 2020

Neural correlates of cue reactivity in individuals with smartphone addiction.

Addict Behav 2020 09 29;108:106422. Epub 2020 Mar 29.

Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Germany. Electronic address:

Popularity of smartphones has dramatically increased in the past years, accompanied by increased concerns regarding potentially adverse effects on physical and mental health. Addictive behavior associated with excessive smartphone use, frequently referred to as "smartphone addiction" (SPA), has attracted increased scientific interest. However the neural correlates of SPA are unknown. We used functional magnetic resonance imaging at 3T to investigate the neural correlates of cue reactivity (CR) in individuals with SPA (n = 21) compared to controls (n = 21). SPA was assessed using the Smartphone Addiction Inventory (SPAI), and neural activity was measured by a modified CR task. Contrasts of images of smartphones vs. neutral stimuli and stimuli including active vs. inactive smartphones (p < 0.001, uncorrected for height, followed by correction for spatial extent) were analyzed. In the first contrast, group differences in medial prefrontal (MPFC), occipital, temporal, and anterior cingulate (ACC) cortices, in temporoparietal regions, and cerebellum were found. For active vs. inactive smartphones, group differences were found in frontal operculum/anterior insula and precentral gyrus. Negative correlations were found between MPFC, ACC, precuneus, and precentral gyrus and specific SPAI subscores, i.e. compulsive behavior, functional impairment and withdrawal. This study suggests spatial similarities of CR-related brain activation between addictive smartphone use and other well-known addictive disorders.
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http://dx.doi.org/10.1016/j.addbeh.2020.106422DOI Listing
September 2020

[Indicated Stress Prevention for Adolescents in the Group Setting - A manual based on Acceptance- and Commitment-Therapy].

Prax Kinderpsychol Kinderpsychiatr 2020 May;69(3):183-202

Klinik für Kinder- und Jugendpsychiatrie Universitätsklinikum Heidelberg Blumenstraße 8 69115 Heidelberg Deutschland Klinik für Kinder- und Jugendpsychiatrie.

Stress in adolescence has become a topic of interest in recent years. Long-term exposure to stress can play a significant role in the development and maintenance of mental disorders. Previous studies have shown that especially the more severely stressed adolescents benefit from targeted interventions. However, evidence-based treatment concepts targeting this group are scarce. In this article we introduce the first German-language treatment manual for indicated stress prevention, addressing adolescents based on Acceptance and Commitment Therapy (ACT). ACT is part of the third wave of behavioral therapies, designed for treatment across disorders, which makes it suitable for the treatment of chronic stress symptoms. Previous studies show good efficacy of the ACT-approach in the treatment of adult stress and first promising successes in treatment of adolescents in non-German-speaking countries. The focus of our training lies in practical exercises based on ACT which are conveyed by the use of metaphors, art therapy techniques, role plays and group discussions. The concept is complemented by psychoeducation on stress, mindfulness exercises and training in problem solving. Worksheets and tasks for the week facilitate the transfer into everyday life. Alongside the presentation of the treatment manual, first experiences in the implementation of the program are discussed.
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http://dx.doi.org/10.13109/prkk.2020.69.3.183DOI Listing
May 2020

Lower Cardiac Vagal Activity Predicts Self-Reported Difficulties With Emotion Regulation in Adolescents With ADHD.

Front Psychiatry 2020 17;11:244. Epub 2020 Apr 17.

Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.

Objective: To investigate the relation between cardiac vagal activity (CVA), a measure of autonomic nervous system (ANS) flexibility, and self-reported emotion regulation (ER) difficulties in adolescents with attention-deficit/hyperactivity disorder (ADHD) and controls.

Methods: The sample comprised 11-17-year-old adolescents with ADHD (=34) and controls ( = 33). Multiple linear regression analyses investigated the relation between CVA, as indexed by high frequency heart rate variability (HF-HRV), and ER difficulties as assessed by the Difficulties in Emotion Regulation Scale (DERS). Supplemental analyses were performed in ADHD and control groups separately. Analyses assessed effects of body mass index (BMI), physical activity levels, and HF peak as a surrogate of respiration on CVA.

Results: Lower CVA was associated with ER difficulties, and specifically with limited access to effective ER strategies. When investigating the relation between CVA and ER in the ADHD and control groups separately, there was a tendency of lower CVA predicting limited access to effective ER strategies in the ADHD group, and not in the control group.

Conclusion: The results suggest that lower CVA, i.e., reduced ANS flexibility, in adolescents with ADHD and controls is associated with self-reported ER difficulties, and specifically with limited access to effective ER strategies. There was a tendency for lower CVA to predict limited ER strategies only in the adolescents with ADHD and not controls.
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http://dx.doi.org/10.3389/fpsyt.2020.00244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181562PMC
April 2020

Silence in the psychotherapy of adolescents with borderline personality pathology.

Personal Disord 2021 Mar 23;12(2):160-170. Epub 2020 Apr 23.

Child and Adolescent Psychiatric Research Department.

Silence in psychotherapy has been associated with different, sometimes opposing meanings. This study investigated silence during adolescent identity treatment in adolescent patients with borderline personality pathology. A more active therapeutic approach with less silence is advised in adolescent identity treatment. It was hypothesized that a session with more silence might be negatively perceived by adolescent patients. A total of 382 sessions that involved 21 female patients were analyzed. Silence was automatically detected from audio recordings. Diarization (segmenting an audio according to speaker identity) was performed. The patient's perception of the sessions was measured with the Session Evaluation Questionnaire. The amount of silence in the different speaker-switching patterns was not independent of one other. This finding supports the hypothesis of mutual attunement of patient and therapist concerning the amount of silence in a given session. Sessions with less silence were rated as being both smoother and better. The potential implications for clinical practice are discussed. The investigation of turn-taking and interpersonal temporal dynamics is relevant for psychotherapy research. The topic can be addressed efficiently using automated procedures. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000402DOI Listing
March 2021

Neurovisceral regulatory circuits of affective resilience in youth: Principal outline of a dynamic model of neurovisceral integration in development.

Authors:
Julian Koenig

Psychophysiology 2020 05 19;57(5):e13568. Epub 2020 Mar 19.

Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.

The Neurovisceral Integration Model (NIM) is one of the most influential psychophysiological models addressing the interplay between the autonomic (ANS) and central nervous system (CNS). In their groundbreaking conceptual work, integrating autonomic, attentional, and affective systems into a functional and structural network, Thayer & Lane laid the foundation for empirical research in the past two decades. The present paper provides a principal outline aiming to reflect and further elaborate on the model from a dynamic developmental perspective. The central question at hand is, how does neurovisceral integration develop (early in life)? By reviewing the existing evidence, it is illustrated that key components of the model, both, on a physiological and psychological level, undergo extensive change early in the course of life. This sensitive period of human development seems key for our understanding of the integrated action of the ANS and CNS in emotion across the lifespan. Early life events may interfere with the fine-tuned interplay of this shared neural circuitry resulting in long-term dysfunction and psychiatric illness. In the absence of longitudinal data covering the entire co-development of the ANS and CNS from early childhood to adolescence into early adulthood, it is suggested, that vagal activity and its normative increase in adolescence is a key premise for normative brain development on a structural and functional level, subsequent psychological functioning and adaptive regulation. Implications from this dynamic perspective and suggestions for future research in the field of developmental psychophysiology are discussed.
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http://dx.doi.org/10.1111/psyp.13568DOI Listing
May 2020

Neurovisceral regulatory circuits of affective resilience in youth: Principal outline of a dynamic model of neurovisceral integration in development.

Authors:
Julian Koenig

Psychophysiology 2020 05 19;57(5):e13568. Epub 2020 Mar 19.

Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.

The Neurovisceral Integration Model (NIM) is one of the most influential psychophysiological models addressing the interplay between the autonomic (ANS) and central nervous system (CNS). In their groundbreaking conceptual work, integrating autonomic, attentional, and affective systems into a functional and structural network, Thayer & Lane laid the foundation for empirical research in the past two decades. The present paper provides a principal outline aiming to reflect and further elaborate on the model from a dynamic developmental perspective. The central question at hand is, how does neurovisceral integration develop (early in life)? By reviewing the existing evidence, it is illustrated that key components of the model, both, on a physiological and psychological level, undergo extensive change early in the course of life. This sensitive period of human development seems key for our understanding of the integrated action of the ANS and CNS in emotion across the lifespan. Early life events may interfere with the fine-tuned interplay of this shared neural circuitry resulting in long-term dysfunction and psychiatric illness. In the absence of longitudinal data covering the entire co-development of the ANS and CNS from early childhood to adolescence into early adulthood, it is suggested, that vagal activity and its normative increase in adolescence is a key premise for normative brain development on a structural and functional level, subsequent psychological functioning and adaptive regulation. Implications from this dynamic perspective and suggestions for future research in the field of developmental psychophysiology are discussed.
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http://dx.doi.org/10.1111/psyp.13568DOI Listing
May 2020

Structural and functional correlates of smartphone addiction.

Addict Behav 2020 06 1;105:106334. Epub 2020 Feb 1.

Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Germany. Electronic address:

Popularity and availability of smartphones have dramatically increased in the past years. This trend is accompanied by increased concerns regarding potentially adverse effects of excessive smartphone use, particularly with respect to physical and mental health. Recently, the term "smartphone addiction" (SPA) has been introduced to describe smartphone-related addictive behavior and associated physical and psychosocial impairment. Here, we used structural and functional magnetic resonance imaging (MRI) at 3 T to investigate gray matter volume (GMV) and intrinsic neural activity in individuals with SPA (n = 22) compared to a control group (n = 26). SPA was assessed using the Smartphone Addiction Inventory (SPAI), GMV was investigated by means of voxel-based morphometry, and intrinsic neural activity was measured by the amplitude of low frequency fluctuations (ALFF). Compared to controls, individuals with SPA showed lower GMV in left anterior insula, inferior temporal and parahippocampal cortex (p < 0.001, uncorrected for height, followed by correction for spatial extent). Lower intrinsic activity in SPA was found in the right anterior cingulate cortex (ACC). A significant negative association was found between SPAI and both ACC volume and activity. In addition, a significant negative association between SPAI scores and left orbitofrontal GMV was found. This study provides first evidence for distinct structural and functional correlates of behavioral addiction in individuals meeting psychometric criteria for SPA. Given their widespread use and increasing popularity, the present study questions the harmlessness of smartphones, at least in individuals that may be at increased risk for developing smartphone-related addictive behaviors.
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http://dx.doi.org/10.1016/j.addbeh.2020.106334DOI Listing
June 2020

Effects of acute transcutaneous vagus nerve stimulation on emotion recognition in adolescent depression.

Psychol Med 2019 Dec 10:1-10. Epub 2019 Dec 10.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Stöckli, Bolligenstrasse 141c, 3000Bern 60, Switzerland.

Background: Transcutaneous vagus nerve stimulation (tVNS) is a promising therapeutic option for major depressive disorder (MDD) in adults. Alternative third-line treatments for MDD in adolescents are scarce. Here we aimed to assess the effects of acute tVNS on emotion recognition in adolescents with MDD.

Methods: Adolescents (14-17 years) with MDD (n = 33) and non-depressed controls (n = 30) received tVNS or sham-stimulation in a cross-sectional, case-control, within-subject cross-randomized controlled trial, while performing different tasks assessing emotion recognition. Correct responses, response times, and errors of omission and commission on three different computerized emotion recognition tasks were assessed as main outcomes. Simultaneous recordings of electrocardiography and electro dermal activity, as well as sampling of saliva for the determination of α-amylase, were used to quantify the effects on autonomic nervous system function.

Results: tVNS had no effect on the recognition of gradually or static expressed emotions but altered response inhibition on the emotional Go/NoGo-task. Specifically, tVNS increased the likelihood of omitting a response toward sad target-stimuli in adolescents with MDD, while decreasing errors (independent of the target emotion) in controls. Effects of acute tVNS on autonomic nervous system function were found in non-depressed controls only.

Conclusions: Acute tVNS alters the recognition of briefly presented facial expressions of negative valence in adolescents with MDD while generally increasing emotion recognition in controls. tVNS seems to specifically alter early visual processing of stimuli of negative emotional valence in MDD. These findings suggest a potential therapeutic benefit of tVNS in adolescent MDD that requires further evaluation within clinical trials.
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http://dx.doi.org/10.1017/S0033291719003490DOI Listing
December 2019

First Evaluation of an Index of Low Vagally-Mediated Heart Rate Variability as a Marker of Health Risks in Human Adults: Proof of Concept.

J Clin Med 2019 Nov 11;8(11). Epub 2019 Nov 11.

Department of Psychological Science, The University of California, Irvine, Irvine, CA 92697-7085, USA.

Multiple studies have demonstrated low vagally-mediated heart rate variability (HRV) being associated with a range of risk factors for heart disease and stroke, including inflammation, hyperglycemia, hyperlipidemia, and hypertension. Yet, no cut point exists that indicates elevated risk. In the present study we sought to identify a cut point-value for HRV that is associated with elevated risk across a range of known risk factors.

Methods: A total of 9550 working adults from 19 study sites took part in a health assessment that included measures of inflammation, hyperglycemia, hyperlipidemia, and hypertension and vagally-mediated HRV (Root mean square of successive differences between normal heartbeats (RMSSD)). Multiple age and sex adjusted logistic regressions were calculated per risk factor (normal versus clinical range), with RMSSD being entered in binary at different cut points ranging from 15-39 msec with a 2 msec increment.

Results: For daytime RMSSD, values below 25 ± 4 indicated elevated risk (odds ratios (OR) 1.5-3.5 across risk factors). For nighttime RMSSD, values below 29 ± 4 indicated elevated risk (OR 1.2-2.0).

Conclusion: These results provide the first evidence that a single value of RMSSD may be associated with elevated risk across a range of established cardiovascular risk factors and may present an easy to assess novel marker of cardiovascular risk.
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http://dx.doi.org/10.3390/jcm8111940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912519PMC
November 2019

Emotion dysregulation and resting-state autonomic function in adolescent borderline personality disorder-A multimodal assessment approach.

Personal Disord 2020 01 31;11(1):46-53. Epub 2019 Oct 31.

Section for Translational Psychobiology in Child and Adolescent Psychiatry.

Borderline personality disorder (BPD) is characterized by persistent emotion dysregulation (ED), and ED is one of the core features of BPD. In recent years, research aimed to identify distinct patterns of ED characteristic of patients with BPD. These efforts comprised translational approaches, including psychophysiological measures. Autonomic nervous system (ANS) dysfunction, indexed by reduced resting-state heart rate variability (HRV), is suggested to be a psychophysiological marker of ED. Reduced HRV is seen in patients with a variety of psychiatric disorders, including adolescents with depression and BPD. No previous study, to the best of our knowledge, addressed the association between ANS function and different measures of ED in adolescents with BPD. Here, we used a multimodal assessment of ED (self-reports, interviews, ambulatory assessment) in a sample of 43 adolescent patients (95.4% female, = 15.5 years), fulfilling at least 3 BPD criteria. Replicating earlier findings, greater BPD symptom severity was significantly related to reduced resting-state HRV and increased heart rate. However, other measures of ED and mean affect were unrelated to ANS function. Findings suggest that ANS dysfunction maps to symptom severity in general rather than specific symptomatology (such as ED) in adolescents with BPD. Implications for the use of ANS measures in clinical practice and directions for future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000367DOI Listing
January 2020

Emotion dysregulation and resting-state autonomic function in adolescent borderline personality disorder-A multimodal assessment approach.

Personal Disord 2020 01 31;11(1):46-53. Epub 2019 Oct 31.

Section for Translational Psychobiology in Child and Adolescent Psychiatry.

Borderline personality disorder (BPD) is characterized by persistent emotion dysregulation (ED), and ED is one of the core features of BPD. In recent years, research aimed to identify distinct patterns of ED characteristic of patients with BPD. These efforts comprised translational approaches, including psychophysiological measures. Autonomic nervous system (ANS) dysfunction, indexed by reduced resting-state heart rate variability (HRV), is suggested to be a psychophysiological marker of ED. Reduced HRV is seen in patients with a variety of psychiatric disorders, including adolescents with depression and BPD. No previous study, to the best of our knowledge, addressed the association between ANS function and different measures of ED in adolescents with BPD. Here, we used a multimodal assessment of ED (self-reports, interviews, ambulatory assessment) in a sample of 43 adolescent patients (95.4% female, = 15.5 years), fulfilling at least 3 BPD criteria. Replicating earlier findings, greater BPD symptom severity was significantly related to reduced resting-state HRV and increased heart rate. However, other measures of ED and mean affect were unrelated to ANS function. Findings suggest that ANS dysfunction maps to symptom severity in general rather than specific symptomatology (such as ED) in adolescents with BPD. Implications for the use of ANS measures in clinical practice and directions for future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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January 2020

Resting Cerebral Blood Flow and Ethnic Differences in Heart Rate Variability: Links to Self-Reports of Affect and Affect Regulation.

Neuroimage 2019 11 3;202:116154. Epub 2019 Sep 3.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany. Electronic address:

Reduced high-frequency heart rate variability (HF-HRV) is associated with a greater risk for cardiovascular disease (CVD). Although African Americans (AA) are at greater risk for CVD, they show greater HF-HRV compared to European Americans (EA). Previous studies suggest that differences in the association between regional cerebral blood flow (CBF) and HF-HRV in AA and EA may explain this surprising pattern of findings, termed the Cardiovascular Conundrum. Here we pooled data from a total of n = 452 EA and n = 102 AA, investigating differences in the association between CBF in 8 regions of interest (ROI), including the cingulate (anterior, mid, posterior), insula (anterior, posterior), and amygdala (basolateral, centromedial, superfical), with HF-HRV, mean heart rate (HR) and their Coefficient of Variation (CoV). Bayesian statistics illustrate that CBF - in particular in the anterior cingulate cortex (ACC) - is positively associated with HF-HRV and CoV in EA, but negatively associated in AA. Exploring the association between HF-HRV and CBF with self-reports of affect and affect regulation showed some differences as a function of ethnicity. The association between greater habitual use of reappraisal only showed a positive correlation with HF-HRV in AA. Similar, greater suppression or non-expression of angry emotions was associated with greater HF-HRV whereas greater outward direction of anger was associated with lower HF-HRV in AA only. Given the importance of the ACC in emotion and emotion regulation, we suggest that increased HF-HRV may serve a compensatory role in AA. Implications from these findings and suggestions for future studies are discussed.
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http://dx.doi.org/10.1016/j.neuroimage.2019.116154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819271PMC
November 2019

Resting Cerebral Blood Flow and Ethnic Differences in Heart Rate Variability: Links to Self-Reports of Affect and Affect Regulation.

Neuroimage 2019 11 3;202:116154. Epub 2019 Sep 3.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany. Electronic address:

Reduced high-frequency heart rate variability (HF-HRV) is associated with a greater risk for cardiovascular disease (CVD). Although African Americans (AA) are at greater risk for CVD, they show greater HF-HRV compared to European Americans (EA). Previous studies suggest that differences in the association between regional cerebral blood flow (CBF) and HF-HRV in AA and EA may explain this surprising pattern of findings, termed the Cardiovascular Conundrum. Here we pooled data from a total of n = 452 EA and n = 102 AA, investigating differences in the association between CBF in 8 regions of interest (ROI), including the cingulate (anterior, mid, posterior), insula (anterior, posterior), and amygdala (basolateral, centromedial, superfical), with HF-HRV, mean heart rate (HR) and their Coefficient of Variation (CoV). Bayesian statistics illustrate that CBF - in particular in the anterior cingulate cortex (ACC) - is positively associated with HF-HRV and CoV in EA, but negatively associated in AA. Exploring the association between HF-HRV and CBF with self-reports of affect and affect regulation showed some differences as a function of ethnicity. The association between greater habitual use of reappraisal only showed a positive correlation with HF-HRV in AA. Similar, greater suppression or non-expression of angry emotions was associated with greater HF-HRV whereas greater outward direction of anger was associated with lower HF-HRV in AA only. Given the importance of the ACC in emotion and emotion regulation, we suggest that increased HF-HRV may serve a compensatory role in AA. Implications from these findings and suggestions for future studies are discussed.
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http://dx.doi.org/10.1016/j.neuroimage.2019.116154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819271PMC
November 2019

Vagally mediated heart rate variability and safety learning: Effects of instructions and number of extinction trials.

Psychophysiology 2019 10 31;56(10):e13404. Epub 2019 May 31.

Department of Psychology, University of Greifswald, Greifswald, Germany.

Extinction of conditioned fear serves as a laboratory model for the mechanism of action underlying exposure treatment with patients suffering from anxiety disorders. Thus, an enhanced understanding of individual differences in extinction learning may help to improve exposure procedures by tailoring treatment plans to the specific needs of the patient. Vagally mediated heart rate variability (vmHRV) is a promising candidate to investigate individual differences in extinction learning because vmHRV is influenced by an inhibitory prefrontal-amygdala network that is similarly implied in extinction learning. Moreover, low levels of vmHRV were previously associated with a higher prevalence of anxiety disorders and a deficit in safety learning. Here, we report on two studies (Study 1: N = 48; Study 2: N = 120) in which we investigated the boundary conditions of the observed association between vmHRV and safety learning as indexed by startle potentiation during instructed or uninstructed extinction training. In Study 1 (conditional discrimination task), we found that low vmHRV levels are associated with higher CS+ potentiation during instructed extinction. In Study 2 (differential cue conditional task), we observed an association between individual vmHRV levels and defensive responding during CS- presentations and, in later instructed extinction trials, during intertrial intervals. These findings indicate an overactive defensive system in individuals with low levels of vmHRV that interferes with their ability to recognize safety and thus is associated with a general perception of unsafety.
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http://dx.doi.org/10.1111/psyp.13404DOI Listing
October 2019