Temperamental Change in Adolescence and Its Predictive Role on Anxious Symptomatology.

Growing evidence supports the hypothesis that temperamental traits are not static throughout adolescence. The known links between both reactive and regulatory temperament and anxiety symptoms should be investigated bearing this hypothesis in mind. This study collected self-reported data on behavioral inhibition system (BIS) sensitivity, attentional control (AC), and anxiety symptomatology, from 296 adolescents (64.2% girls; M = 12.96 years at the first assessment, SD = 0.47) every six months, four times over eighteen months. The relationships between temperament factors (AC and BIS sensitivity), considered longitudinally (by means of their trajectories) and anxiety symptoms were investigated using Multigroup Latent Growth Modeling (MLGM), as well as the mediating effect of sex on trajectories and anxiety. BIS sensitivity decreased over time and showed differential patterns across sexes. AC remained relatively stable and we found no sex influence on its trajectory. On the other hand, we observed that the BIS sensitivity trajectory was a significant predictor of anxiety symptomatology at age 15. In conclusion, temperamental changes between the ages of 13 and 15 seem to play a relevant role in explaining subsequent anxiety symptomatology, under the mediating influence of sex.

NoFumo+: A Clinical Trial of an mHealth for Smoking Cessation with Hospitalized Patients.

Smartphone applications (apps) improve accessibility to smoking cessation treatments. The NoFumo+ app administers a cognitive behavioral therapy program for smoking cessation. This study evaluates the efficacy of NoFumo+ for quitting smoking or reducing cigarette consumption versus the usual information-based treatment. A clinical trial was conducted with 99 hospitalized smokers, 54 pseudo-randomly assigned to the app treatment and 45 to the usual treatment. The two groups had homogeneous baseline characteristics to ensure comparability. Abstinence was evaluated at post-treatment (two months) and at a six-month follow-up. The results obtained indicate that participants who receive the usual treatment are 5.40 times more likely to continue smoking than those who undergo the app treatment (95% CI = [1.35; 20.15]). Participants who do not succeed in quitting smoking with the app manage to decrease their habitual consumption. Users who successfully complete treatment with NoFumo+ access all its contents and use the chat, but without requesting professional support. There is not enough empirical evidence to attribute this success to any specific element of the app. NoFumo+ achieves better abstinence rates than the usual information-based treatments, and the goal of generalizing its use to the non-hospitalized smoking population may be achievable in the future.

Sustained Anxiety Scores are Associated with the Fractal Dynamics of the Heartbeat in Early Adolescents.

The risk of suffering anxiety disorders is associated with sustained subthreshold symptoms of anxiety. This study evaluated the stability of anxiety scores (high, moderate or low) across a six-month period in early adolescents (N = 95). The associations between sustained anxiety, vagally-mediated heart rate variability (vmHRV), sympathetic activity, and heart rate fractal dynamics in everyday life conditions were analyzed. The anxiety scores from 71.50% of participants remained at the same level. The linear correlations between anxiety and cardiac measures were weak but a group-based approach revealed that the fractal dimension (FD) from stable-low anxiety participants was higher than the FD from participants with stable-moderate anxiety scores but not higher than the FD from the stable-high anxiety group. The short-term correlations' exponent a1 from the stable-high anxiety group was higher than the a1 from the stable-moderate anxiety group but not higher than the exponent from the stable-low anxiety group. No differences were found in the vmHRV nor sympathetic activity. The lack of a direct association between the complexity of the heart rate and the level of sustained anxiety suggests a nonlinear pattern of associations that would be in accordance with the optimum variability principle.

Impaired cardiac profile in adolescents with an increasing trajectory of anxiety when confronting an acute stressor.

Maladaptive patterns of cardiac adjustment to stress in adolescents may reveal their vulnerability to anxiety disorders (ADs). Traditional research in this field has focused on anxiety levels, whereas the time course of anxiety has rarely been considered. Nevertheless, since overall anxiety decreases as adolescence progresses, increasing time courses are clinically relevant and can be associated with maladaptive contextual adjustment. In this study, the cardiac pattern of adjustment to stress in adolescents with increasing anxiety was analysed. A sample of 44 adolescents (M = 14.88 years, SD = 0.53, 45.45% boys) were exposed to a socially relevant stress induction protocol, and their cardiac functioning was recorded. Participants with a trajectory of increasing anxious symptomatology over a 12-month period (n = 24) showed attenuated heart rate levels in the stage of maximum stress in comparison to their non-increasing anxious counterparts (p < 0.05), as well as a heightened pattern of sample entropy throughout the stress induction (p < 0.05). These findings suggest a loss of cardiac flexibility in those adolescents at risk of ADs when confronting an acute stressor.

Ecological assessment of heart rate complexity: Differences between high- and low-anxious adolescents.

Nonlinear measures can capture the complex structure of the heart beating, and recordings taken while the individual performs daily activities may help to understand the cardiac system's output in natural conditions. As healthy systems are characterized by having highly complex outputs, we hypothesized that the cardiac output from high anxious adolescents should be less complex than the output from their low anxious counterparts. In this study ECG was recorded for two hours in 50 adolescents while they performed regular school activities. Fractal dimension (FD), scaling exponents and multiscale entropy were calculated on the interbeat intervals time series. Both FD and entropy were significantly lower in the high-anxious group than the low-anxious group. These results suggest different heart-related regulation in adolescents who suffered from high anxious symptomatology.

Patient’s preferences regarding three computer-based exposure treatments for fear of flying / Preferencias de pacientes con miedo a volar sobre tres tratamientos de exposición con ordenador

This study analyses participants' preferences regarding three computeraided exposure treatments for fear of flying (FF): virtual reality exposure treatment assisted by a therapist (VRET), computer-aided exposure with a therapist present throughout exposure sessions (CAE-T), and self-administered computer-aided exposure (CAE-SA). Sixty participants with FF were randomly assigned to one of these treatments. At the end of a treatment, a demonstration of the other two treatment options was given and patients were asked to rate their preferences. At post-treatment, assessment data on treatment preferences were obtained from 48 participants (CAE-T n= 14; CAE-SA n= 16, and VRET n= 18). Participants favoured VRET as the most effective, the most recommended, but also they valued it as the most aversive. Attending to the specific treatment condition received by the participants, results showed that in VRET and CAE-T, participants assessed their own treatment as more preferred, more efficacious and more recommendable. Results suggest relevant features regarding the efficiency of computer-based treatments, and offer insights into improving computer-aided psychological interventions

Este estudio analiza las preferencias de los participantes sobre tres tratamientos de exposición basados en ordenador para el miedo a volar (MV): tratamiento de exposición mediante realidad virtual asistido por un terapeuta (RV), tratamiento de exposición asistido por ordenador con un terapeuta durante la exposición (CAFT-T) y tratamiento de exposición asistido por ordenador autoaplicado (CAFT-A). 60 participantes con MV fueron asignados aleatoriamente a uno de estos tratamientos. Al final del tratamiento, los participantes veían una demostración de las otras dos opciones y valoraban sus preferencias. En el posttratamiento, la evaluación de las preferencias se obtuvo para 48 participantes (CAFT-T n= 14; CAFT-A n= 16 y RV n= 18). Los participantes valoraron la RV como la más eficaz, más recomendada, pero también como la más aversiva. Atendiendo a la condición de tratamiento recibida, en las condiciones RV y CAFTT los participantes valoraron su propio tratamiento como el más preferido, más eficaz y más recomendable. Los resultados sugieren aspectos relevantes sobre la eficiencia de los tratamientos basados en ordenador y ofrecen ideas para mejorar las intervenciones psicológicas asistidas por ordenador

Attentional control, attentional network functioning, and emotion regulation styles.

Attentional network functioning in emotionally neutral conditions and self-reported attentional control (AC) were analysed as predictors of the tendency to engage in dysfunctional emotion regulation strategies. Diminished attentional orienting predicted an increased tendency to engage in brooding rumination, and enhanced alertness predicted a greater chance of suppression, beyond trait anxiety and self-reported AC, which were not predictive of either rumination or suppression. This is the first study to show that some forms of dysfunctional emotion regulation are related to the attentional network functioning in emotionally neutral conditions. Results are discussed in relation to regulatory temperament and anxiety-related attentional biases literature.

The Effortful Control Scale for adults: psychometric properties of the Catalan version and its relationship to cognitive emotion regulation / La Escala de Control Intencional para adultos: propiedades psicométricas de la versión catalana y sus relaciones con la regulación emocional cognitiva

Los objetivos del estudio fueron (a) examinar las propiedades psicométricas de la versión catalana de la Escala de Control Intencional del Cuestionario de Temperamento en Adultos (forma breve) y (b) analizar las relaciones entre control intencional (CI), afectividad negativa (AN) y el uso de estrategias de regulación emocional (RE) cognitiva negativa. En una muestra de 353 estudiantes universitarios, el instrumento muestra unos niveles aceptables de consistencia interna, estabilidad temporal y validez convergente; sin embargo, sus propiedades psicométricas son menos satisfactorias que las que presentan otras versiones de este instrumento. Los índices de ajuste del análisis factorial confirmatorio revelan poca adecuación al modelo teórico de tres factores. Por otro lado, los resultados indican que la tendencia a implicarse en estrategias de RE cognitiva negativas está relacionada, principalmente, con la presencia de niveles elevados de AN. Además, aunque tales tendencias también están influenciadas por la capacidad de CI, los datos muestran que el CI no modera la relación entre AN, ansiedad y el uso de estrategias de RE cognitiva negativas (AU)

The goals of this study were (a) to examine the psychometric properties of a Catalan version of the Effortful control scale of the Adult Temperament Questionnaire short-form and (b) to analyze the relationships among effortful control (EC), negative affectivity (NA), and the use of negative cognitive emotion regulation (ER) strategies. In a sample of 353 college students, the instrument presents acceptable internal consistency, temporal stability and convergent validity; however, in general, psychometric properties are poorer than those reported for other versions. Confirmatory factor analysis fit indices revealed an overall poor fit for the three-factor theoretical model. Additionally, it has been found that the proneness to engage in negative cognitive ER strategies was mainly related with exhibiting high NA. Further, although such tendencies were also influenced by EC capabilities, data did not show EC moderating the relationships among NA, anxiety, and the use of negative cognitive ER strategies (AU)

Complexity of everyday life heart rate dynamics and attentional control in healthy students.

Effective regulation of emotions requires the ability to voluntarily manage attention, i.e. attentional control (AC), which has been related to heart rate variability and vagal tone in laboratory based research. In this study, we calculated the correlation dimension (CD), the fractal-like properties (scaling exponents ?1 and ?2, and fractal dimension) and the sample entropy of heart rate time series obtained from ECG recordings (4 hours long each) taken from a sample of healthy students (n=47) during everyday activities. AC was assessed through a self-reported questionnaire. As expected, a linear positive correlation was found between AC scores and CD and entropy, but no associations were found between AC and ?1 and fractal dimension. The association between AC and ?2 was negative and marginally significant. No associations were found between AC and linear heart rate variability measures. These results show that nonlinear measures of long, everyday life, heart rate time series may provide useful information about the AC ability of healthy students.

Resting parietal EEG asymmetry and cardiac vagal tone predict attentional control.

The present study explores both resting cortical EEG asymmetry and vagally-mediated heart rate variability (HRV), as an index for vagal tone, as physiological correlates of self-reported attentional control in a sample of 53 healthy young adults. Regression analyses indicate that higher vagally-mediated HRV and lower right-sided parietal activity in the ß2 frequency range (20-30Hz) are significant predictors of larger attentional control. Results are in line with some of the basic features of the neurovisceral integration model and stress the role of parietal areas in attentional control capabilities, thus aiming to consider attentional control as a trait-like disposition.

Self-focused cognitive emotion regulation style as associated with widespread diminished EEG fractal dimension.

The cognitive regulation of emotions is important for human adaptation. Self-focused emotion regulation (ER) strategies have been linked to the development and persistence of anxiety and depression. A vast array of research has provided valuable knowledge about the neural correlates of the use of specific self-focused ER strategies; however, the resting neural correlates of cognitive ER styles, which reflect an individual's disposition to engage in different forms of ER in order to manage distress, are largely unknown. In this study, associations between theoretically negative ER style (self-focused or not) and the complexity (fractal dimension, FD) of the resting EEG at frontal, central, parietal, and occipital regions were investigated in 58 healthy volunteers. The Cognitive Emotion Regulation Questionnaire was used as the self-report measure of ER style. Results showed that a diminished FD over the scalp significantly correlated with self-focused ER style scores, even after controlling for negative affect, which has been also considered to influence the use of ER strategies. The lower the EEG FD, the higher were the self-focused ER style scores. Correlational analyses of specific self-focused ER strategies showed that self-blaming and rumination were negatively associated with diminished FD of the EEG, but catastrophizing and blaming others were not. No significant correlations were found for ER strategies more focused on situation or others. Results are discussed within the self-organized criticality theory of brain dynamics: The diminished FD of the EEG may reflect a disposition to engage in self-focused ER strategies as people prone to ruminate and self-blame show a less complex resting EEG activity, which may make it more difficult for them to exit their negative emotional state.

Efectos del temperamento y los estilos de regulación emocional en la determinación de estados emocionales negativos / Effects of temperament and emotion regulation styles in determining negative emotional states

Introducción. La interacción entre los procesos temperamentales reactivo y regulatorio resulta esencial para una mejor compresión de los trastornos emocionales. En este estudio exploramos la relación entre temperamento reactivo(afecto negativo), temperamento regulatorio (control intencional),estilos de regulación emocional negativos (rumiación y supresión) y el autorregistro en condiciones naturales de los niveles de ansiedad, preocupación y evitación. Método. Treinta y dos adultos jóvenes fueron, en primer lugar, evaluados mediante cuestionario en afecto negativo, control intencional y dos formas de regulación emocional negativa (rumiación y supresión). Posteriormente, registraron sus niveles de ansiedad, preocupación y evitación tres veces al día durante 50 días consecutivos a través de un diario electrónico accesible en línea. Resultados. Niveles elevados en afecto negativo y bajos en control intencional se asociaron a mayor ansiedad, preocupación y evitación (p<0,01). La asociación prospectiva entre afecto negativo y evitación estuvo moderada por el control intencional (R2 total=0,49) mientras que no se encontraron efectos de moderación del control intencional en la asociación entre afecto negativo, por una parte, y la ansiedad y preocupación por la otra. Además, la rumiación, en su componente de ensimismamiento, ejerció una mediación total de forma prospectiva en la asociación entre afecto negativo y ansiedad, con un efecto indirecto significativo (Efecto=0,30; Boot IC95%=0,09 a 0,69).Conclusiones. Los patrones de evitación se vieron significativamente determinados por la interacción entre afecto negativo y control intencional y la rumiación, en especial el ensimismamiento, medió totalmente la relación entre afecto negativo y ansiedad (AU)

Introduction. The interplay of reactive and regulatory temperamental processes appears to be essential for a better understanding of emotional states and disorders. In this study we explored the prospective relationship between reactive temperament (negative affect), regulatory temperament (effortful control), negative emotion regulation styles (rumination and suppression) and self-recorded anxiety, worry, and avoidance in naturalistic conditions. Method. Thirty-two young adults were first assessed through questionnaires on negative affectivity, effortful control, and two forms of negative emotion regulation (rumination and suppression). After this they recorded anxiety, worry, and avoidance three times a day over 50consecutive days through an on-line access electronic diary. Results. High levels of negative affect and low levels of effortful control were associated with higher levels of anxiety, worry, and avoidance (p<0.01). The prospective association between negative affectivity and avoidance was moderated by effortful control (Total R2=.49). Moreover, the brooding facet of rumination totally mediated the association between negative affect and anxiety with a significant indirect effect (Effect=0.30, Boot CI95%=0.09 to 0.69). Conclusions. Avoidance patterns are significantly determined by negative affect - effortful control interaction and rumination, especially brooding, totally mediates the relationship between negative affect and anxiety (AU)

Effects of temperament and emotion regulation styles in determining negative emotional states.

INTRODUCTION: The interplay of reactive and regulatory temperamental processes appears to be essential for a better understanding of emotional states and disorders. In this study we explored the prospective relationship between reactive temperament (negative affect), regulatory temperament (effortful control), negative emotion regulation styles (rumination and suppression) and self-recorded anxiety, worry, and avoidance in naturalistic conditions. METHOD: Thirty-two young adults were first assessed through questionnaires on negative affectivity, effortful control, and two forms of negative emotion regulation (rumination and suppression). After this they recorded anxiety, worry, and avoidance three times a day over 50 consecutive days through an on-line access electronic diary. RESULTS: High levels of negative affect and low levels of effortful control were associated with higher levels of anxiety, worry, and avoidance (p<.01). The prospective association between negative affectivity and avoidance was moderated by effortful control (Total R(2)=.49). Moreover, the brooding facet of rumination totally mediated the association between negative affect and anxiety with a significant indirect effect (Effect=.30, Boot CI95%=.09 to .69). CONCLUSIONS: Avoidance patterns are significantly determined by negative affect--effortful control interaction and rumination, especially brooding, totally mediates the relationship between negative affect and anxiety.

Heart rate variability profiles and exposure therapy treatment outcome in flight phobia.

The goal of this study was to explore why certain patients in a previous study on exposure therapy for flight phobia did not experience an improvement in their conditions. Participants from a treatment study (N = 45) were selected according to post-treatment results and divided into two groups: the unsatisfactory treatment outcome group (UTO, N = 10) and the satisfactory treatment outcome group (STO, N = 10). The differences between these two groups prior to receiving exposure therapy were analyzed at the behavioral, physiological, and cognitive levels. The UTO participants had been avoiding flying longer than the STO phobics. Following Thayer and Lane's neurovisceral model of emotion regulation, heart rate variability was analyzed at two levels: tonic and phasic. Low frequency and high frequency (HF) power were calculated in the frequency domain and Sample Entropy was computed in the time domain. The tonic HF power of the UTO group was higher than the STO group's tonic HF power. In the phasic level, while the STO group's HF power decreased under exposure and subsequently returned to baseline level, the UTO group demonstrated a more rigid pattern. Finally, the STO group reported higher emotional involvement than the UTO group when they were shown a sample of the therapy. Based on these results, the challenge of matching exposure therapy to each patient's profile is discussed.

Slope of change throughout exposure treatment for flight phobia: the role of autonomic flexibility.

This study tested the hypothesis that flight-phobic patients experience change at different rates even when they are receiving identical treatment. Faster within-session rates of change (WSRC) were expected for patients who required fewer exposure sessions. The study also tested the theoretical role of autonomic flexibility on WSRC. High flexibility should be associated with faster rates of change. Thirty-seven flight-phobic patients were successfully treated with a computer-assisted fear of flying treatment. A significant negative correlation was found between total number of sessions and WSRC: The fewer sessions patients attended, the faster their rate of change was. The role of autonomic flexibility was partially supported: A significant correlation between heart rate variability and WSRC revealed that flexible patients improved faster than less-flexible patients.

Virtual reality versus computer-aided exposure treatments for fear of flying.

Evidence is growing that two modalities of computer-based exposure therapies--virtual reality and computer-aided psychotherapy--are effective in treating anxiety disorders, including fear of flying. However, they have not yet been directly compared. The aim of this study was to analyze the efficacy of three computer-based exposure treatments for fear of flying: virtual reality exposure therapy (VRET), computer-aided exposure with a therapist's (CAE-T) assistance throughout exposure sessions, and self-administered computer-aided exposure (CAE-SA). A total of 60 participants with flying phobia were randomly assigned to VRET, CAE-T, or CAE-SA. Results indicate that the three interventions were effective in reducing fear of flying at posttreatment and at 1-year follow-up; furthermore, there were no significant differences between them in any of the outcome measure. Large within-group effect sizes were found for all three treatment conditions at both posttreatment and at follow-up. The results suggest that therapist involvement might be minimized during computer-based treatments and that CAE can be as effective as VRET in reducing fear of flying.

Linear and nonlinear analyses of EEG dynamics during non-painful somatosensory processing in chronic pain patients.

The aim of our study was to characterize brain dynamics of affective modulation of somatosensory processing in chronic pain. We hypothesized that chronic pain patients will show abnormal EEG activity under negative mood conditions compared to healthy controls. Nineteen patients with chronic pain and 21 healthy subjects participated in the experiment. Multiscale entropy, fractal dimension, event-related potentials, and fast Fourier transform were used to analyze EEG data. A significant enhancement of entropy was found in pain patients at P4 compared to P3. Analysis of fractal dimension also revealed significantly higher values at P4 than P3 when pain patients were viewing unpleasant pictures. By contrast, no significant differences due to hemisphere or affective condition were found on nonlinear measures for healthy controls. Analyses of somatosensory ERPs showed that P50 amplitudes elicited by pleasant pictures were more reduced in chronic pain patients than in healthy controls. Finally, we observed that EEG band power was lower in pain patients than in healthy controls, in particular for theta and beta bands over sensorimotor cortices and temporal regions when viewing pleasant images. These findings suggest that sustained pain seems to be accompanied by an abnormal activation and dynamic of brain networks related to emotional processing of somatosensory information in chronic pain. Furthermore, our findings suggest that both linear and nonlinear measures of EEG time series may contribute to the understanding of brain dysfunction in chronic pain.

Vagally mediated heart rate variability and heart rate entropy as predictors of treatment outcome in flight phobia.

In the present study a computer-assisted exposure-based treatment was applied to 54 flight phobics and the predictive role of vagally mediated heart rate (HR) variability (high frequency, 0.15-0.4 Hz band power) and heart rate entropy (HR time series sample entropy) on treatment outcome was investigated. Both physiological measures were taken under controlled breathing at 0.2 Hz and during exposure to a fearful sequence of audiovisual stimuli. Hierarchical regression analyses were conducted to assess the predictive power of these variables in these conditions on treatment self-report measures at the end of treatment and at 6 months follow-up, as well as on the behavioral treatment outcome (i.e. flying at the end of treatment). Regression models predicting significant amounts of outcome variance could be built only when HR entropy was added to the HR variability measure in a second step of the regression analyses. HR variability alone was not found to be a good predictor of neither self-reported nor behavioral treatment outcomes.

Fear induced complexity loss in the electrocardiogram of flight phobics: a multiscale entropy analysis.

In this study we explored the changes in the variability and complexity of the electrocardiogram (ECG) of flight phobics (N=61) and a matched non-phobic control group (N=58) when they performed a paced breathing task and were exposed to flight related stimuli. Lower complexity/entropy values were expected in phobics as compared to controls. The phobic system complexity as well as the heart rate variability (HRV) were expected to be reduced by the exposure to fearful stimuli. The multiscale entropy (MSE) analysis revealed lower entropy values in phobics during paced breathing and exposure, and a complexity loss was observed in phobics during exposure to threatening situations. The expected HRV decreases were not found in this study. The discussion is focused on the distinction between variability and complexity measures of the cardiac output, and on the usefulness of the MSE analysis in the field of anxiety disorders.

Sample entropy of ECG time series of fearful flyers: preliminary results.

Research within the framework of the nonlinear dynamical systems (NDS) in the field of anxiety disorders has shown that greater irregularity/complexity appears in the output from healthy systems. In this study we measured the Heart rate variability (HRV) and the sample sntropy (SampEn) of the ECG mV time series of fearful flyers (N = 15) and a matched control group (N = 15) when confronted with three combinations of feared stimuli (pictures, sounds, and pictures with sounds) as well as relaxing stimuli (pictures and sounds). Fearful flyers had lower SampEn than controls in all conditions, including baseline. Non-phobics showed significant entropy decreases from baseline in two out of three exposure conditions. No differences on HRV were found between groups, and HRV was not sensitive to condition changes. The main finding of the study is that the SampEn calculated on very short ECG mV recordings (10 to 60 seconds, easy to obtain in clinical settings) may be a useful diagnostic measure since it can distinguish fearful from non-fearful flyers.