Links between physical fitness and cardiovascular reactivity and recovery to psychological stressors: A meta-analysis.

A meta-analysis of published studies with adult human participants was conducted to evaluate whether physical fitness attenuates cardiovascular reactivity and improves recovery from acute psychological stressors. Thirty-three studies met selection criteria; 18 were included in recovery analyses. Effect sizes and moderator influences were calculated by using meta-analysis software. A fixed effects model was fit initially; however, between-studies heterogeneity could not be explained even after inclusion of moderators. Therefore, to account for residual heterogeneity, a random effects model was estimated. Under this model, fit individuals showed significantly attenuated heart rate and systolic blood pressure reactivity and a trend toward attenuated diastolic blood pressure reactivity. Fit individuals also showed faster heart rate recovery, but there were no significant differences in systolic blood pressure or diastolic blood pressure recovery. No significant moderators emerged. Results have important implications for elucidating mechanisms underlying effects of fitness on cardiovascular disease and suggest that fitness may be an important confound in studies of stress reactivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived racism and cardiovascular reactivity and recovery to personally relevant stress.

This study evaluated cardiovascular responses (CVR) to an active speech task with blatantly discriminatory (BRC) versus neutral (NRC) stimuli and an anger recall task in a sample of Black men (N = 73; age 18 to 47). Diastolic blood pressure scores were higher for NRC versus BRC stimuli during anger recall (p = .05). Moreover, persons in the NRC group who perceived high levels of racism (vs. no racism or BRC group) during active speech showed larger increases in blood pressure across postspeech rest, anger recall, and subsequent rest (p = .03). The notable elevation in CVR in response to an ambiguous event extends current models of racism suggesting that subtle racism is a psychosocial stressor that erodes health through chronically elevated CVR. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cardiac autonomic reactivity and recovery in predicting carotid atherosclerosis: The cardiovascular risk in young finns study.

The present study examined the association of cardiac autonomic task-induced reactivity and recovery to preclinical atherosclerosis. Thirty-three men and 33 women aged 24-39 years participated in the ongoing epidemiological Cardiovascular Risk in Young Finns study. The authors measured heart rate (HR), respiratory sinus arrhythmia (RSA), and preejection period (PEP) during the mental arithmetic and speech tasks in 1999. Carotid atherosclerosis was assessed by measuring the thickness of the common carotid artery intima-media complex (IMT) with ultrasound in 2001. Higher HR, RSA, and PEP reactivity were associated with lower IMT values even after adjusting for cardiovascular risk factors (lipid levels, obesity, and blood pressure). In addition, better HR recovery after the mental arithmetic task was associated with lower IMT values, and this association persisted after all adjustments. Thus, higher task-induced cardiac autonomic reactivity and better HR recovery were related to less preclinical atherosclerosis. The authors concluded that cardiac pattern of reactivity and quick recovery may be associated with better cardiovascular health, and therefore all reactivity occurring in challenging situations should not automatically be considered as potentially pathological. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of emotion-specific appraisal, coping, and cardiovascular reactivity during an ongoing emotional episode.

The authors examined emotion-specific patterns of appraisal, coping, and cardiovascular reactivity during real ongoing emotional episodes. In this study, 109 participants performed a neutral opinion-expression task, where a confederate elicited anger, shame, or pride using verbal and nonverbal behavior. The authors assessed cognitive appraisals, emotional reactions, coping, outcomes (state self-esteem and outcome satisfaction), and cardiovascular reactivity. Results indicated substantial and theoretically consistent differences between the 3 emotions (and differences from a nonemotion condition) for cognitive appraisals, self-reported coping, behavioral coping, self-esteem, and cardiovascular reactivity. The results are discussed in relation to their implications for emotion theory and for psychological and physical health. Overall, the results suggest that researchers can study emotion-related issues using authentic emotional reactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sadness and amusement reactivity differentially predict concurrent and prospective functioning in major depressive disorder.

Depressed individuals often fail to react to emotionally significant stimuli. The significance of this pattern of emotional dysregulation in depression is poorly understood. In the present study, depressed and nondepressed participants viewed standardized neutral, sad, fear, and amusing films; and experiential, behavioral, and physiological responses to each film were assessed. Compared with nondepressed controls, depressed participants reported sadness and amusement in a flattened, context-insensitive manner. Those depressed participants who reported the least reactivity to the sad film exhibited the greatest concurrent impairment. Prospectively, the depressed participant who exhibited the least behavioral and heart rate reactivity to the amusing film were the least likely to recover from depression. Loss of the context-appropriate modulation of emotion in depression may reflect a core feature of emotion dysregulation in this disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cardiovascular reactivity to and recovery from psychological challenge as predictors of 3-year change in blood pressure.

The authors examined whether cardiovascular reactivity to and recovery from psychological challenge predict 3-year change in blood pressure (BP) among 216 initially normotensive, community-dwelling adults. Clinic BP assessments were conducted at baseline and follow-up. BP and heart rate (HR) readings were obtained before, during, and after 5 psychological tasks at baseline. Following adjustment for traditional predictors of BP and lifestyle factors, poorer systolic BP recovery across the tasks was associated with greater 3-year increases in clinic systolic and diastolic BP. Both diastolic BP recovery and HR recovery were also related to 3-year change in clinic BP, though cardiovascular reactivity measures were not. These findings suggest that the duration of stress-related cardiovascular responses may be important for predicting longitudinal changes in BP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conflict structure moderates associations between cardiovascular reactivity and negative marital interaction.

This study examined the role of marital conflict structure--who desires and requests change versus who responds to the change request--in spouses' cardiovascular responses to marital interactions. Forty-one couples discussed 2 marital topics: one in which the wife desired change in the husband, and one in which the husband desired change in the wife. Cardiovascular responses were assessed at 2-min intervals. Results indicated that marital conflict structure moderates cardiovascular reactivity during negative marital interactions: Husbands and wives whose interactions were characterized by high levels of negative behavior showed the most pronounced diastolic blood pressure reactivity, but only when they were in the role of desiring change in their spouses. Implications for gender differences in marital conflict physiology are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discrimination and unfair treatment: Relationship to cardiovascular reactivity among African American and European American women.

This study examined the relationship of cardiovascular reactivity to both interpersonal mistreatment and discrimination in a community-based sample of African American and European American women (N?=?363) in midlife. Subtle mistreatment related positively to diastolic blood pressure (DBP) reactivity for African American participants but not their European American counterparts. Moreover, among the African American participants, those who attributed mistreatment to racial discrimination exhibited greater average DBP reactivity. In particular, these women demonstrated greater DBP reactivity to the speech task, which bore similarities to an encounter with racial prejudice but not to a nonsocial mirror tracing task. These findings are consistent with the hypothesis that racial discrimination is a chronic stressor that can negatively impact the cardiovascular health of African Americans through pathogenic processes associated with physiologic reactivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of posttreatment decentering and cognitive reactivity to relapse in major depression.

Z. V. Segal et al. (2006) demonstrated that depressed patients treated to remission through either antidepressant medication (ADM) or cognitive-behavioral therapy (CBT), but who evidenced mood-linked increases in dysfunctional thinking, showed elevated rates of relapse over 18 months. The current study sought to evaluate whether treatment response was associated with gains in decentering-the ability to observe one's thoughts and feelings as temporary, objective events in the mind-and whether these gains moderated the relationship between mood-linked cognitive reactivity and relapse of major depression. Findings revealed that CBT responders exhibited significantly greater gains in decentering compared with ADM responders. In addition, high post acute treatment levels of decentering and low cognitive reactivity were associated with the lowest rates of relapse in the 18-month follow-up period. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recovery from major depressive disorder among female adolescents: A prospective test of the scar hypothesis.

This study examined the psychosocial consequences of experiencing major depressive disorder (MDD). In a 7-year longitudinal study of 496 female adolescents, the authors identified 49 girls who experienced their first episode of MDD and then recovered. They were compared with a randomly selected group of 98 never depressed participants on 13 psychological, social, psychiatric, and life events variables. None of the variables fit the scar pattern (i.e., a group difference that emerges during the first MDD episode and remains elevated post-recovery). All 13 variables were elevated before, during, and after the MDD episode, although some increased during the MDD episode. Results provide little support for the scar hypothesis among adolescent girls but instead suggest that many risk variables are elevated before and after the MDD episode. Interventions that modify these factors may help to reduce depression incidence and recurrence among female adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Appraisals of marital conflict and children's adjustment, health, and physiological reactivity.

Children's appraisals of marital conflict were examined as moderators and mediators of conflict and children's adjustment, physical health, and physiological reactivity. Mothers completed measures of marital conflict and children's adjustment and physical health, and elementary school children provided information on their parents' marital conflict, appraisals of perceived threat and self-blame in relation to parents' conflicts, and their internalizing symptomatology. Children's heart rate, systolic and diastolic blood pressure, and skin conductance response and level were examined during both a baseline and an interadult argument. Higher levels of both self-blame and perceived threat functioned as robust vulnerability factors for children exposed to higher levels of marital conflict in relation to internalizing behaviors, health problems, and higher levels of cardiovascular reactivity to the argument. Further, a higher level of perceived threat was a vulnerability factor for externalizing problems associated with exposure to marital conflict. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does depression interfere with effort mobilization? Effects of dysphoria and task difficulty on cardiovascular response.

On the basis of predictions of the mood-behavior model (G. H. E. Gendolla, 2000) and motivational intensity theory (J. W. Brehm & E. A. Self, 1989), the authors conducted 2 studies that critically tested the common assumption that dysphoria is associated with a motivational deficit. Dysphoric and nondysphoric undergraduates performed a cognitive task that was either easy or difficult. Effort intensity (i.e., resource mobilization) was assessed as performance-related cardiovascular reactivity. In support of the authors' predictions and in contrast to the popular view of a general motivational deficit, both studies found a crossover interaction between dysphoria and task difficulty: In the difficult condition, nondysphoric participants indeed showed stronger systolic blood pressure reactivity than dysphoric participants. But in the easy condition, dysphoric participants showed stronger systolic reactivity than nondysphoric participants. The findings are discussed with respect to motivational deficits in depression and possible underlying mechanisms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fibromyalgia: The role of sleep in affect and in negative event reactivity and recovery.

Objective: Fibromyalgia (FM) syndrome is a chronic pain condition characterized by diffuse muscle pain, increased negative mood, and sleep disturbance. Until recently, sleep disturbance in persons with FM has been modeled as the result of the disease process or its associated pain. The current study examined sleep disturbance (i.e., sleep duration and sleep quality) as a predictor of daily affect, stress reactivity, and stress recovery. Design and Measures: A hybrid of daily diary and ecological momentary assessment methodology was used to evaluate the psychosocial functioning of 89 women with FM. Participants recorded numeric ratings of pain, fatigue, and positive and negative affect 3 times throughout the day for 30 consecutive days. At the end of each day, participants completed daily diary records of positive and negative life events. In addition, participants reported on their sleep duration and sleep quality each morning. Results: After accounting for the effects of positive events, negative events, and pain on daily affect scores, it was found that sleep duration and quality were prospectively related to affect and fatigue. Furthermore, the effects of inadequate sleep on negative affect were cumulative. In addition, an inadequate amount of sleep prevented affective recovery from days with a high number of negative events. Conclusions: These results lend support to the hypothesis that sleep is a component of allostatic load and has an upstream role in daily functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blood pressure reactivity and cognitive function in the Baltimore Longitudinal Study of Aging.

Objective: Several blood pressure indexes of autonomic dysregulation, including stress-induced blood pressure responses (i.e., reactivity), have been associated previously with stroke, silent cerebrovascular disease, and decreased cognitive function. Design: The authors examined the cross-sectional relations among systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity and cognitive function in a sample of stroke- and dementia-free older adults (n = 73, 53% male, 72% Caucasian, mean age = 70.14 years) from the Baltimore Longitudinal Study of Aging. Main Outcome Measures: Age, education, baseline, and reactive blood pressure levels were regressed on cognitive test scores measuring the domains of attention, learning and memory, verbal functions/language skills, and perceptuo-motor speed. A Bonferroni correction was employed and results significant at the standard p     

Mastery is associated with cardiovascular disease mortality in men and women at apparently low risk.

Objective: We examine the prospective relationship between mastery, where limited mastery is defined as the inability to control negative emotions (and perceiving stressful experiences as beyond personal control), and cardiovascular disease (CVD) mortality particularly among individuals at apparently low CVD risk. Design: Prospective population-based study of 19,067 men and women, aged 41–80 years with no previous heart disease or stroke at baseline assessment. Main Outcome Measures: Primary outcome measure CVD mortality. Results: A total of 791 CVD deaths were recorded up to June 2009 during a median 11.3 person-years of follow-up. Limited perceived mastery over life circumstances was associated with an increased risk of CVD mortality, independently of biological, lifestyle, and socioeconomic risk factors (hazard ratio 1.11 per SD decrease in mastery score, 95% confidence interval 1.01–1.21). This association was more pronounced among those participants apparently at low CVD risk (p = .01 for test of interaction according to the number of CVD risk factors at baseline). Conclusions: Limited perceived control over life circumstances is associated with an increased risk of CVD mortality, independently of classical cardiovascular risk factors, and particularly among those at apparently low risk. Future attention should be given to this potentially modifiable personal characteristic, through the design of preliminary intervention studies, to reduce cardiovascular risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cancer patients with major depressive disorder: Testing a biobehavioral/cognitive behavior intervention.

Objective: In this Phase II trial, we evaluated a novel psychological treatment for depressed patients coping with the stresses of cancer. Effectiveness of a combined biobehavioral intervention (BBI) and cognitive behavior therapy (CBT) was studied. Method: Participants were 36 cancer survivors (mean age = 49 years; 88% Caucasian; 92% female) diagnosed with major depressive disorder. A single group pre–post design was used. Treatment consisted of up to 20 individual 75-min combined BBI/CBT sessions. Outcomes were change in interviewer (Hamilton Rating Scale for Depression; Williams, 1988) and self-rated depressive symptoms (Beck Depression Inventory—Second Edition; Beck, Steer, & Brown, 1996) as well as change in cancer relevant symptoms (Fatigue Symptom Inventory [Hann et al., 1998] and Brief Pain Questionnaire [Daut, Cleeland, & Flanery, 1983]) and quality of life (Medical Outcomes Study Short Form–36; Ware et al., 1995). Mixed-effects modeling, a reliability change index, and generalized linear models were used. All analyses were intent-to-treat. Results: Depressive symptoms significantly improved. In addition, 19 of 21 study completers met criteria for remission. Significant improvements were also noted in fatigue and mental health quality of life. Both concurrent anxiety disorders and high levels of cancer stress (Impact of Events Scale; Horowitz, Wilner, & Alvarez, 1979) were each associated with beginning and concluding treatment with greater depressive symptoms. Conclusions: CBT components were successfully incorporated into a previously efficacious intervention for reducing cancer stress. The BBI/CBT intervention warrants further research in evaluating its efficacy compared with well-established treatments for depression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A preliminary investigation of cognitive flexibility for emotional information in major depressive disorder and non-psychiatric controls.

Clinical research suggests that individuals with major depressive disorder (MDD) are cognitively inflexible, exhibiting ruminative, rigid, and automatic thoughts within a negative schema. However, existing neuropsychological research on cognitive flexibility in this population has not employed emotional stimuli. Because research suggests that the performance of individuals with MDD is modulated when emotional stimuli are used, this study investigates the impact of emotional stimuli on cognitive flexibility performance through a novel emotional modification of the Wisconsin Card Sorting Test. Controls were less flexible when stimuli were positive and individuals with MDD were less flexible when stimuli were negative relative to the controls. These divergent styles of responding to emotional information may contribute to the relative risk or protection from depressed mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health psychology and scientific consensus: The case of depression and cardiovascular disease.

Science proceeds, directly or indirectly, by consensus. Obtaining scientific consensus proactively when investigating the impact of depression on cardiovascular disease has been daunting, as the professions interested in this area include health psychology, psychiatry, cardiology, epidemiology, and others. Whereas consensus is at times difficult when sought within one specialty, it is almost inconceivable when attempted across disciplines. Therefore, we applaud a new trend, as the National Heart, Lung, and Blood Institute recently called for a working group to provide recommendations on the assessment and treatment of depression in patients with cardiovascular disease. The publication of this working group's report signals two important landmark accomplishments. First, it offers concrete recommendations for researchers interested in contributing to this field. Second, and perhaps more important, the publication of this report signifies a process through which interdisciplinary research areas can be proactive in fostering scientific consensus. Health psychology, an area and a field of research that is naturally interdisciplinary, may be one of the key benefactors of joining and creating stronger consensus processes for this type of science. Whether health psychologists will play a role in creating opportunities to promote consensus in areas of scientific interest remains to be seen. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resting cardiovascular levels and reactivity to interpersonal incivility among Black, Latina/o, and White individuals: The moderating role of ethnic discrimination.

Objective: The objective of this study was to examine cardiovascular responses among Black, non-Hispanic White, and Latina/o participants exposed to a potentially discriminatory situation. The study also examined the moderating role of prior history of discrimination on cardiovascular responses. Design: Black, Latina/o, and White participants engaged in a resting baseline and then interacted with an uncivil White research assistant. Main Outcome Measures: Two measures of prior exposure to discrimination were administered. Participants' blood pressure and heart rate (HR) were monitored throughout the protocol. The primary outcomes were resting cardiovascular function and cardiovascular reactivity to the uncivil interaction. Results: Past discrimination was related to higher resting systolic blood pressure (SBP) among Latina/o participants and lower resting SBP among White participants. Further, past discrimination was related to attenuated SBP and HR reactivity among Latina/o participants but was related to augmented HR reactivity among White participants. Discrimination was not related to resting levels or reactivity among Black participants. Conclusion: This study is the first to examine the relationship between discrimination and cardiovascular responses to interpersonal incivility among Black, Latina/o, and White individuals. Findings suggest that the relationship between discrimination and cardiovascular risk may differ by ethnicity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Major life events and major chronic difficulties are differentially associated with history of major depressive episodes.

Major life events have been found to precede onsets of a 1st lifetime episode of depression more commonly than subsequent recurrences. Despite general empirical support for this finding, few data directly address how the role of major life events may change over successive recurrences. Further, little research has examined major chronic difficulties in relation to a 1st lifetime episode versus a recurrence of depression. The present study tested the associations between major life events and major difficulties in relation to lifetime history of depressive episodes in a sample of 96 individuals diagnosed with major depression. Using investigator-based measures of life stress, the authors found that, whereas major life events were associated with fewer lifetime episodes, major chronic difficulties were related to more prior episodes. These findings are discussed in terms of underlying mechanisms that may account for the changing role of major life stress over successive recurrences of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)