Reduced approach disposition in familial risk for depression: Evidence from time-frequency alpha asymmetries.

Despite the promising role of alpha and delta power in reflecting reduced approach disposition in depression, to date, it is unclear whether these measures can be employed to identify at-risk individuals. Hence, the present study investigated affective disposition in 32 unaffected individuals with a family history of depression (23 F) and 30 individuals without a family history of depression (21 F) through a data-driven analysis of alpha and delta time-frequency power during the viewing of pleasant, neutral, and unpleasant pictures. Different patterns of posterior alpha asymmetry emerged within each group. Particularly, controls showed greater right posterior alpha desynchronization ~ 600 ms following emotional relative to neutral pictures presentation. Conversely, the group with a family history of depression showed greater posterior left alpha desynchronization only to unpleasant relative to neutral images in a later time window (> 900 ms). Hence, depression vulnerability seems to be characterized by a blunted reactivity to pleasant and delayed reactivity to unpleasant stimuli with a distinct posterior distribution relative to the controls. Finally, the two groups showed a comparable pattern of greater delta power to emotional relative to neutral cues. Overall, initial support was provided for the employment of time-frequency alpha power changes during affective processing in identifying blunted approach disposition in unaffected at-risk individuals.

Alcoholic Etiology, Severity of Liver Disease, and Post-Transplant Adherence Are Correlated with Worse Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in Liver Transplant Candidates.

Introduction: Psychosocial pre-transplant evaluation in patients undergoing liver transplantation (LT) could help identify those patients at higher risk of pharmacological non-adherence, organ rejection, and mortality. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated tool for assessing LT candidates' psychosocial well-being. Data on the ability of the SIPAT evaluation to predict post-transplant outcomes are sparse. Material and Methods: clinical and psychosocial data from a sample of 134 candidates for LT were analyzed. Moreover, the association between pre-transplant psychosocial evaluation and post-transplant clinical outcomes, including organ rejection, mortality, and immunosuppressant drug adherence, was calculated. Results: At the pre-transplant evaluation, patients who showed high SIPAT scores (77, 57%) also had more liver disease assessed by model for end-stage liver disease (MELD; F = 5.04; p < 0.05), alcoholic etiology (F = 35.80; p < 0.001), encephalopathy (F = 5.02; p < 0.05), and portal hypertension (F = 7.45; p < 0.01). Of the 51 transplant patients, those who had a high pre-transplant SIPAT score showed lower post-transplant immunosuppressive adherence, linked to more frequent immunological events. Conclusions: Patients with an alcoholic etiology of liver disease and more severe liver dysfunction are likelier to not adhere to medical prescriptions following transplantation. Current data suggests that this specific group of patients could benefit from early psychological pre-habilitation before undergoing liver transplantation.

Familial risk for depression is associated with reduced physical activity in young adults: evidence from a wrist-worn actigraphy study.

Depression is characterized by reduced physical activity and sleep-wake cycle disturbances, often considered important features of the disease. While a few studies have suggested that self-reported reduced physical activity and sleep-wake cycle disturbances might both be linked to depression vulnerability, actigraphy-based measures in vulnerable samples remain largely unexplored. This study relied on actigraphy-based parameters to test whether these disturbances characterize depression vulnerability. Seven-day actigraphy data were collected from 20 (13 female) university students with a high vulnerability to depression, which was determined by the presence of a family history of the condition but no current symptoms, and 32 (21 female) controls with neither a family history of depression nor current depressive symptoms. Daily physical activity, namely gross motor activity, was quantified as average daily acceleration and time spent engaging in moderate-vigorous physical activity (MVPA). The sleep-wake cycle and circadian rhythms were assessed as total sleep duration per night (in hours), sleep within sleep period time (in hours), sleep efficiency (%), and relative amplitude (i.e., the difference between the activity during the day and the night, which reflects circadian rhythms amplitude). Results showed that individuals with a familial risk for depression exhibited reduced daily acceleration and time spent in MVPA relative to the control group, particularly on the weekend during their free time away from scheduled activities. On the other hand, the two groups were comparable in terms of sleep estimates. Taken together, reduced physical activity, but not sleep-wake disturbances, seem to be associated with vulnerability to depression and might be a viable target for identification and prevention efforts.

Affective processing in dysphoria: Evidence from startle probe modulation of ERPs.

The hypoactivation of the appetitive and defensive motivational systems in the brain is a feature of depression and might also represent a vulnerability factor for the disorder. A measure that can be employed to investigate both motivational systems is the electroencephalographic response to an acoustic startle probe during affective processing. Particularly, the amplitude of auditory event-related potentials (ERPs) components to the startle probe is smaller when the emotional context is more arousing. Neural responses to an unattended startle probe during an emotional passive viewing task of pleasant, neutral, and unpleasant pictures was employed to assess the activation of the approach and defensive motivational systems in a sample of individuals with (n = 24, 23 females) vs. without (n = 24, 23 females) dysphoria. The group without dysphoria showed a reduced startle-elicited N200 only in the context of pleasant relative to neutral pictures, indicating that the affective processing of the appetitive context might reduce the attentional resources needed to orient attention toward unattended non-salient stimuli. Conversely, the N200 amplitude was not attenuated for pleasant relative to neutral and unpleasant contexts in the group with dysphoria. Moreover, no within- or between-group differences emerged in the P300 amplitude. Taken together, the results of this study showed that depression vulnerability is characterized by reduced attention to pleasant contexts, suggesting a blunted affective processing of appetitive emotional stimuli.

The moderating role of depressive symptoms in the association between heart rate variability and cognitive performance in cardiac patients.

INTRODUCTION: Coronary heart disease (CHD) is strongly associated with cognitive impairment, which is a core feature of depression, highly prevalent in patients with CHD. Interestingly, patients with CHD and individuals with depression display reduced heart rate variability (HRV), which proxies a complex network integrating autonomic and attentional systems. This study investigated the moderating role of depressive symptoms in the relation between reduced HRV and cognitive performance in patients with CHD. METHOD: The sample included 274 patients with CHD (mean [standard deviation] age = 62 [9.5] years; 13 % women) admitted to cardiac rehabilitation units. Visual attention and task switching were assessed through the Trail Making Test (TMT). Depressive symptoms were assessed with the Beck Depression Inventory-II (BDI-II). Resting electrocardiographic recordings were collected to compute HRV indices. RESULTS: Patients with more severe depressive symptoms displayed an inverse association between HRV and cognitive performance (TMT-A: b = -0.08, p = .022; TMTB: b = -0.07, p = .042), whereas patients with milder depressive symptoms showed no significant association (TMT-A: b = -0.00, p = .90; TMTB: b = -0.02, p = .44). CONCLUSIONS: Depressive symptoms may strengthen the relation between reduced HRV and poorer cognitive performance in cardiac patients. The presence of depressive symptoms may signal the dysfunction of a network subserving autonomic and cognitive function.

Familial risk for depression is associated with reduced P300 and late positive potential to affective stimuli and prolonged cardiac deceleration to unpleasant stimuli.

Despite evidence of abnormal affective processing as a key correlate of depression, specific attentional mechanisms underlying processing of emotions in familial risk for depression have yet to be investigated in a single study. To this end, the amplitude of the P300 and late positive potential (LPP) complex and cardiac deceleration were assessed during the passive viewing of affective pictures in 32 individuals who had family history of depression (without depressive symptoms) and in 30 controls (without depressive symptoms and family history of depression). Individuals with familial risk for depression revealed reduced P300-LPP amplitudes in response to pleasant and unpleasant stimuli relative to controls, and comparable P300-LPP amplitudes in response to pleasant and neutral stimuli. Controls, but not individuals with familial risk for depression, reported cardiac deceleration during the viewing of pleasant vs. neutral and unpleasant stimuli in the 0-3 s time window. Also, only individuals with familial risk for depression showed a prolonged cardiac deceleration in response to unpleasant vs. neutral stimuli. Overall, the present study provides new insights into the characterization of emotion-related attentional processes in familial risk for depression as potential vulnerability factors for the development of the disorder.

Rethinking the risk for depression using the RDoC: A psychophysiological perspective.

Considering that the classical categorical approach to mental disorders does not allow a clear identification of at-risk conditions, the dimensional approach provided by the Research Domain Criteria (RDoC) is useful in the exploration of vulnerability to psychopathology. In the RDoC era, psychophysiological models have an important role in the reconceptualization of mental disorders. Indeed, progress in the study of depression vulnerability has increasingly been informed by psychophysiological models. By adopting an RDoC lens, this narrative review focuses on how psychophysiological models can be used to advance our knowledge of the pathophysiological mechanisms underlying depression vulnerability. Findings from psychophysiological research that explored multiple RDoC domains in populations at-risk for depression are reviewed and discussed. Future directions for the application of psychophysiological research in reaching a more complete understanding of depression vulnerability and, ultimately, improving clinical utility, are presented.

Reduced heart rate variability and expressive suppression interact to prospectively predict COVID-19 pandemic-related post-traumatic stress symptoms.

The COVID-19 pandemic is a unique period of stress that, in some cases, led to post-traumatic stress symptoms (PTSSs). Emotion regulation strategies are known to modulate the emotional response to stressful events. Expressive suppression (ES) is a maladaptive strategy related to the exacerbation of the physiological stress response. Heart rate variability (HRV), an index of cardiac autonomic balance strictly related to ES, was also shown to predict PTSSs. This was the first study to investigate whether the pre-pandemic ES use and resting-state HRV predicted pandemic-related PTSSs. Before the pandemic, 83 (58 females) university students completed the Emotion Regulation Questionnaire (ERQ), self-report measures of anxiety and depressive symptoms, and a three-minute resting-state electrocardiogram recording. After 12 months, 61 (45 females) participants completed a self-report measure of pandemic-related PTSSs and repeated the self-report psychological measures. Pre-pandemic anxiety symptoms prospectively predicted greater PTSSs. Moreover, a significant interaction between HRV and ES in predicting PTSSs emerged, whereby those who had higher levels of ES and reduced HRV showed higher PTSSs. These findings suggest that an integrated assessment of HRV and ES might be useful for identifying individuals who are more vulnerable to the development of PTSSs during crises.

Depressive symptoms and cognitive control: the role of affective interference.

Depressive symptoms are characterised by reduced cognitive control. However, whether depressive symptoms are linked to difficulty in exerting cognitive control in general or over emotional content specifically remains unclear. To better differentiate between affective interference or general cognitive control difficulties in people with depressive symptoms, we employed a non emotional (cold) and an emotional (hot) version of a task-switching paradigm in a nonclinical sample of young adults (N = 82) with varying levels of depressive symptoms. Depressive symptoms were linked to greater difficulties in exerting cognitive control in complex situations (mixed-task blocks) compared to simple and semiautomatic situations (single-task blocks) in both task versions. Moreover, greater depressive symptoms were associated with longer latencies in the emotional version of the task across all trial types. Thus, the emotion-specific effect was not modulated by the degree of cognitive control required to perform the task. In sum, depressive symptoms were characterised by a general difficulty to exert cognitive control in both emotional and non emotional contexts and by greater difficulty in even simple attentional processing of emotional material. This study granted novel insights on the extent of cognitive control difficulties in emotional and non emotional contexts for people with depressive symptoms.

The impact of COVID-19-related quarantine on psychological outcomes in patients after cardiac intervention: a multicenter longitudinal study.

Mandatory quarantine during the COVID-19 pandemic had substantial negative consequences on psychological health in the general population. Depression, anxiety, and insomnia were reported to increase the morbidity and mortality risk in cardiac patients after cardiac interventions. Nonetheless, a gap in the evidence appeared regarding the effects of COVID-19-related quarantine on psychological outcomes in patients after cardiac interventions. The present study aimed to longitudinally investigate the effects of quarantine on depressive, anxiety, and insomnia symptoms in a group of patients who underwent cardiac intervention. Seventy-three patients admitted for cardiac rehabilitation completed a psychological assessment before and a reassessment after the quarantine and were included in the quarantine group. The control group included 76 patients who completed both evaluations before the quarantine. Depressive (Beck Depression Inventory-II; BDI-II), anxiety (Beck Anxiety Inventory-II; BAI), and insomnia (Sleep Condition Indicator; SCI) symptoms were evaluated in both groups at one (assessment) and eight (reassessment) months after cardiac intervention. The statistical analyses revealed that at reassessment, the quarantine group showed higher global depressive, anxiety, and insomnia symptoms than the control group and increased cognitive symptoms of depression. A higher presence of clinically relevant depressed patients was seen in the quarantine group. The present results showed that the COVID-19-related mandatory quarantine negatively affected psychological outcomes in patients after cardiac intervention, increasing the probability for these patients to be depressed. This, in turn, could influence patients' health in a critical period for morbidity and mortality risk. This underlines the priority of integrating and improving targeted mental health support as the pandemic continues, especially for cardiac patients.

Early indicators of vulnerability to depression: The role of rumination and heart rate variability.

BACKGROUND: Despite the evidence of increased levels of rumination and reduced heart rate variability (HRV) in depression, whether these measures can be considered early indicators of vulnerability to depression has yet to be investigated. Therefore, the present study aimed to investigate both levels of rumination and resting HRV in individuals with familial risk for depression that is the most reliable risk factor for the disorder. METHODS: Rumination and vagally-mediated HRV were assessed using the Ruminative Response Scale and a smartphone-based photoelectric volumetric pulse wave assay, respectively, in 25 individuals who had family history of depression (but did not report current depressive symptoms), 15 individuals who reported depressive symptoms (but had no family history of depression), and 25 controls (without depressive symptoms and family history of depression). RESULTS: Individuals with depressive symptoms and those with a family history of depression were characterized by higher levels of rumination and lower cardiac vagal control than controls. LIMITATIONS: Given the small sample size, this study should be used to design larger confirmatory studies; the cross-sectional nature of the study does not allow discussing the results in terms of cause-effect relationships. CONCLUSIONS: Our findings suggested that individuals at risk of developing depression, also in absence of depressive symptoms, are defined by defective self-regulation capacity that may lead to future depression episodes. Increased ruminative thoughts and reduced HRV may represent early indicators of vulnerability to depression. Effective prevention programs designed to reduce rumination and/or increase HRV may reduce the risk of developing a full-blown depressive episode.

EEG time-frequency analysis reveals blunted tendency to approach and increased processing of unpleasant stimuli in dysphoria.

To date, affective and cognitive processing of emotional information in individuals with depressive symptoms have been examined through peripheral psychophysiological measures, event-related potentials, and time-frequency analysis of oscillatory activity. However, electrocortical correlates of emotional and cognitive processing of affective content in depression have not been fully understood. Time-frequency analysis of electroencephalographic activity allows disentangling the brain's parallel processing of information. The present study employed a time-frequency approach to simultaneously examine affective disposition and cognitive processing during the viewing of emotional stimuli in dysphoria. Time-frequency event-related changes were examined during the viewing of pleasant, neutral and unpleasant pictures in 24 individuals with dysphoria and 24 controls. Affective disposition was indexed by delta and alpha power, while theta power was employed as a correlate of cognitive elaboration of the stimuli. Cluster-based statistics revealed a centro-parietal reduction in delta power for pleasant stimuli in individuals with dysphoria relative to controls. Also, dysphoria was characterized by an early fronto-central increase in theta power for unpleasant stimuli relative to neutral and pleasant ones. Comparatively, controls were characterized by a late fronto-central and occipital reduction in theta power for unpleasant stimuli relative to neutral and pleasant. The present study granted novel insights on the interrelated facets of affective elaboration in dysphoria, mainly characterized by a hypoactivation of the approach-related motivational system and a sustained facilitated cognitive processing of unpleasant stimuli.

The Influence of Emotion Regulation on the Association Between Depression and Heart Rate Variability in Cardiac Patients.

OBJECTIVE: Poor vagally mediated heart rate variability (vmHRV) is a mechanism linking depression to coronary heart disease (CHD). Reduced vmHRV is also considered an index of emotion dysregulation-the frequent use of maladaptive emotion regulation strategies, one of the most important being expressive suppression-which is a key component of depression. Therefore, this study aimed to investigate the moderating role of expressive suppression in the relation between depression and vmHRV in patients with CHD. METHODS: The sample included 235 patients with CHD (mean [standard deviation] age = 61.6 [9.8] years; 12% women) admitted to cardiac rehabilitation after a cardiac intervention. The Beck Depression Inventory-II was administered to assess depressive symptoms. Emotion regulation strategies based on either expressive suppression or cognitive reappraisal were assessed through the Emotion Regulation Questionnaire. Resting electrocardiographic recordings were collected for 5 minutes to compute HRV indices. RESULTS: Expressive suppression moderated the relation between depressive symptoms and vmHRV ( b = -0.03, p = .012). Patients with lower expressive suppression scores showed no association between depressive symptoms and vmHRV ( b = -0.00, p = .94), whereas those with higher expressive suppression scores showed a significant negative association between depressive symptoms and vmHRV ( b = -0.05, p = .015). CONCLUSIONS: The use of expressive suppression is likely to potentiate the relation between depressive symptoms and poor vmHRV, which could increase the cardiac risk in these patients. Targeting emotion regulation skills in cardiac rehabilitation programs may be useful for reducing the impact of depression in cardiac patients.

Reduced electrocortical responses to pleasant pictures in depression: A brief report on time-domain and time-frequency delta analyses.

BACKGROUND: The late positive potential (LPP) to pleasant content is an electrocortical indicator of blunted emotional reactivity in depression. A reduced time-frequency delta power has never been investigated in clinical samples. The present study examined time-frequency delta in depression and at investigated whether the combination of time-domain and time-frequency data would explain additional variance in the depression status. METHODS: The study was a secondary analysis of data collected during a passive viewing task of pleasant and neutral pictures in a community-based sample of 75 participants with a current depressive disorder and 42 controls. A time-frequency analysis on event-related changes within delta frequency band was conducted. RESULTS: Cluster-based statistics revealed a centro-parietal increase in delta power to pleasant relative to neutral pictures in the control group but not within the depression group. Moreover, a fronto-centro-parietal reduction in delta power to pleasant pictures emerged in depression relative to controls. Both a smaller LPP and delta power to pleasant pictures were related to depression status. The combination of LPP and delta power explained a greater amount of variance compared to the model where LPP was entered as the only predictor of depression status. CONCLUSIONS: These data suggest that delta power might be a promising electrocortical correlate of the hypoactivation of the approach-related motivational system in depression. Additionally, a blunted delta and LPP might reflect unique processes related to depression. A combination of these measures can be leveraged together to enhance clinical utility and to shed light on the underlying mechanisms associated with depression.

Emotional processing prospectively modulates the impact of anxiety on COVID-19 pandemic-related post-traumatic stress symptoms: an ERP study.

BACKGROUND: Considering that the elevated distress caused by the COVID-19 pandemic, in some cases, led to post-traumatic stress symptoms (PTSS), it has been proposed as a specific traumatic event. The present longitudinal study investigated pre-pandemic motivated attention to emotional stimuli, as indexed by Late Positive Potential (LPP) amplitude, in relation with the potential differential role of anxiety and depressive symptoms in predicting PTSS severity related to the COVID-19 pandemic. METHODS: A total of 79 university students initially completed self-report measures of depression and anxiety along with a passive viewing task of emotional (pleasant, unpleasant) and neutral pictures while electroencephaloghic activity was recorded. In December 2020, 57 participants completed a questionnaire assessing PTSS. RESULTS: Significant interactions between anxiety and LPP emerged in predicting pandemic-related PTSS, where greater anxiety symptoms predicted PTSS only in individuals with greater LPP to unpleasant or with reduced LPP to pleasant stimuli. LIMITATIONS: The prevalence of the female sex, the relatively young age of the participants, as well as the fact that they were all enrolled in a University course might not allow the generalization of the findings. CONCLUSIONS: Taken together, the present longitudinal study provided novel evidence on EEG predictors of pandemic-related PTSS that might be useful for the prevention and treatment of PTSS. Indeed, assessing anxiety symptoms and pre-trauma LPP to emotional stimuli might be a useful target for identifying individuals that are more vulnerable to the development of PTSS during times of crisis.

Disentangling emotional processing in dysphoria: An ERP and cardiac deceleration study.

The present study aimed to investigate emotional processing in dysphoria. To this end, the amplitude of the Late Positive Potential (LPP) and cardiac deceleration were assessed during the passive viewing of affective (pleasant, neutral, and unpleasant) pictures in 26 individuals with dysphoria and in 25 non-depressed controls. The group with dysphoria revealed a smaller LPP amplitude than the group without dysphoria in response to pleasant and neutral, but not unpleasant, stimuli at centro-parieto-occipital sites. Interestingly, whereas both groups showed cardiac deceleration when viewing pleasant compared to neutral pictures (3-6 s time window), only individuals with dysphoria showed a prolonged cardiac deceleration in response to unpleasant stimuli as compared with neutral ones. This study suggests that dysphoria is characterized by reduced motivated attentional allocation to positive information and by sustained intake of unpleasant information. Overall, the present findings provide novel insights into the characterization of valence-specific attentional processes in dysphoria as potential vulnerability factors for clinically significant depression.

Intensification of functional neural control on heartbeat dynamics in subclinical depression.

Subclinical depression (dysphoria) is a common condition that may increase the risk of major depression and leads to impaired quality of life and severe comorbid somatic diseases. Despite its prevalence, specific biological markers are unknown; consequently, the identification of dysphoria currently relies exclusively on subjective clinical scores and structured interviews. Based on recent neurocardiology studies that link brain and cardiovascular disorders, it was hypothesized that multi-system biomarkers of brain-body interplay may effectively characterize dysphoria. Thus, an ad hoc computational technique was developed to quantify the functional bidirectional brain-heart interplay. Accordingly, 32-channel electroencephalographic and heart rate variability series were obtained from 24 young dysphoric adults and 36 healthy controls. All participants were females of a similar age, and results were obtained during a 5-min resting state. The experimental results suggest that a specific feature of dysphoria is linked to an augmented functional central-autonomic control to the heart, which originates from central, frontopolar, and occipital oscillations and acts through cardiovascular sympathovagal activity. These results enable further development of a large set of novel biomarkers for mood disorders based on comprehensive brain-body measurements.

Depressed mood, brooding rumination and affective interference: The moderating role of heart rate variability.

Facilitated processing of negative information might contribute to the etiopathogenesis and maintenance of depressive symptoms. Cardiac vagal tone, indexed by heart rate variability (HRV), is believed to represent a proxy of the functional integrity of the neural networks implicated in brooding rumination, affective interference and depression. The present study examined whether HRV may moderate the relation between brooding rumination, affective interference and depressive symptoms in a sample of healthy individuals (n = 68) with different degrees of depressed mood. Self-report measures of depression and brooding were collected, whereas the emotional Stroop task was employed to measure affective interference. Three-minute resting-state electrocardiogram was recorded to obtain time- and frequency-domain vagally mediated HRV parameters. Stepwise linear regression analyses revealed that HRV was a significant moderator of the positive association between depression and brooding rumination, but not of the association between depression and affective interference. An integrated model is supported, in which vagally mediated HRV appeared to potentiate the positive link between depressive symptoms and brooding rumination. Considering that HRV and brooding rumination were found to have an interacting role in determining the severity of depressive symptoms, they may represent potential clinical targets in the prevention and treatment of depressive symptoms.

Increased functional connectivity within alpha and theta frequency bands in dysphoria: A resting-state EEG study.

BACKGROUND: The understanding of neurophysiological correlates underlying the risk of developing depression may have a significant impact on its early and objective identification. Research has identified abnormal resting-state electroencephalography (EEG) power and functional connectivity patterns in major depression. However, the entity of dysfunctional EEG dynamics in dysphoria is yet unknown. METHODS: 32-channel EEG was recorded in 26 female individuals with dysphoria and in 38 age-matched, female healthy controls. EEG power spectra and alpha asymmetry in frontal and posterior channels were calculated in a 4-minute resting condition. An EEG functional connectivity analysis was conducted through phase locking values, particularly mean phase coherence. RESULTS: While individuals with dysphoria did not differ from controls in EEG spectra and asymmetry, they exhibited dysfunctional brain connectivity. Particularly, in the theta band (4-8 Hz), participants with dysphoria showed increased connectivity between right frontal and central areas and right temporal and left occipital areas. Moreover, in the alpha band (8-12 Hz), dysphoria was associated with increased connectivity between right and left prefrontal cortex and between frontal and central-occipital areas bilaterally. LIMITATIONS: All participants belonged to the female gender and were relatively young. Mean phase coherence did not allow to compute the causal and directional relation between brain areas. CONCLUSIONS: An increased EEG functional connectivity in the theta and alpha bands characterizes dysphoria. These patterns may be associated with the excessive self-focus and ruminative thinking that typifies depressive symptoms. EEG connectivity patterns may represent a promising measure to identify individuals with a higher risk of developing depression.

Not All Competitions Come to Harm! Competitive Biofeedback to Increase Respiratory Sinus Arrhythmia in Managers.

Despite the positive impact on achievement, competition has been associated with elevated psychophysiological activation, potentially leading to a greater risk of cardiovascular diseases. Competitive biofeedback (BF) can be used to highlight the effects of competition on the same physiological responses that are going to be controlled through BF. However, it is still unknown whether competition could enhance the effects of respiratory sinus arrhythmia (RSA)-BF training in improving cardiac vagal control. The present study explored whether competitive RSA-BF could be more effective than non-competitive RSA-BF in increasing RSA in executive managers, who are at higher cardiovascular risk of being commonly exposed to highly competitive conditions. Thirty managers leading outstanding private or public companies were randomly assigned to either a Competition (n = 14) or a Control (n = 16) RSA-BF training lasting five weekly sessions. Managers in the Competition group underwent the RSA-BF in couples and each participant was requested to produce a better performance (i.e., higher RSA) than the paired challenger. After the training, results showed that managers in the Competition group succeeded in increasing cardiac vagal control, as supported by the specific increase in RSA (p < 0.001), the standard deviation of R-R wave intervals (SDNN; p < 0.001), and root mean square of the successive differences between adjacent heartbeats (rMSSD; p < 0.001). A significant increase in the percentage of successive normal sinus beat to beat intervals more than 50 ms (pNN50; p = 0.023; η2 p = 0.17), low frequency (p = ≤ 0.001; η2 p = 0.44), and high frequency power (p = 0.005; η2 p = 0.25) emerged independently from the competitive condition. Intriguingly, managers who compete showed the same reduction in resting heart rate (HR; p = 0.003, η2 p = 0.28), systolic blood pressure (SBP; p = 0.013, η2 p = 0.20), respiration rate (p < 0.001; η2 p = 0.46), and skin conductance level (SCL; p = 0.001, η2 p = 0.32) as non-competitive participants. Also, the same reduction in social anxiety (p = 0.005; η2 p = 0.25), state (p = 0.038, η2 p = 0.14) and trait anxiety (p = 0.001, η2 p = 0.31), and depressive symptoms (p = 0.023, η2 p = 0.17) emerged in the two groups. The present results showed that managers competing for increasing RSA showed a greater improvement in their parasympathetic modulation than non-competing managers. Most importantly, competition did not lead to the classic pattern of increased psychophysiological activation under competitive RSA-BF. Therefore, competition could facilitate the use of self-regulation strategies, especially in highly competitive individuals, to promote adaptive responses to psychological stress.