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Metadata of Note
Type: 🌰 Seed [Nomenclature present here.]
Tags: #stress #health #literaturereview
Date: June 11th, 2022
If you’d like to read a comprehensive introduction to stress and how it impacts your body, check out this article.
Researchers have theorized that changing the way we think about our bodily responses can improve our physiological and cognitive reactions to stressful events. However, the underlying processes through which mental states improve downstream outcomes are not well-understood.
To this end, we examined whether reappraising stress-induced arousal could improve cardiovascular outcomes and decrease the attentional bias for emotionally-negative information. Participants were randomly assigned to either a reappraisal condition in which they were instructed to think about their physiological arousal during a stressful task as functional and adaptive or to one of two control conditions: attention reorientation and no instructions.
Relative to controls, participants instructed to reappraise their arousal exhibited more adaptive cardiovascular stress responses – increased cardiac efficiency and lower vascular resistance – and decreased attentional bias. Thus, reappraising arousal shows physiological and cognitive benefits. Implications for health and potential clinical applications are discussed. (Page 1)
The Biopsychosocial (BPS) Model of Challenge and Threat provides a theory of how appraisals shape stress responses (e.g., Blascovich, Mendes, Hunter, & Salomon, 1999). More specifically, this model posits that during active, goal-directed tasks, appraisals of situational demands interact with appraisals of available resources (see Blascovich & Mendes, 2010 for a review). When people believe they possess sufficient resources to cope with stressors they experience a challenging response, but when situational demands are seen as exceeding resources individuals experience threat. (Page 2)
Physiologically, the challenge is characterized by activation of the sympathetic-adrenal-medullary (SAM) axis, increased cardiac efficiency, and vasodilation; changes that signal an approach orientation and increase peripheral blood flow. The threat also activates the SAM axis, but the specific cardiovascular reactivity differs from a challenge and is associated with reduced cardiac efficiency and vasoconstriction; changes that signal an avoidance orientation and prepare the body for damage/defeat (Mendes, Blascovich, Hunter, Lickel, & Jost, 2007) (Page 2)
Whereas challenge typically is associated with positive outcomes (e.g., Blascovich et al., 1999; Deinstbier, 1989; Jamieson et al., 2010), threat impairs decision-making in the short-term and in the long-term is associated with accelerated “brain aging,” cognitive decline, and cardiovascular disease (Jefferson, Himali, Beiser, Au, Massaro, Seshardri, et al., 2010; Matthews, Gump, Block, & Allen, 1997).
In stressful situations, signs of increased arousal (e.g., racing heart) are frequently construed as anxiety, nervousness, or fear. These negative appraisals encourage people to perceive demands as exceeding resources, triggering a maladaptive threat response. Thus, modifying resource appraisals may help improve physiological responses. (Page 2)
Markers of threat responses have also been linked to increased attention to threat-related information, such as angry faces or emotionally-negative words (e.g., Roelofs, Bakvis, Hermans, van Pelt & van Honk, 2007; van Honk, Verbaten, Tuiten, van der Hout, Koppeschaar, et al., 1999).
Functionally, a bias for threat-related information facilitates the detection of danger and helps individuals respond effectively to potential threats. However, attentional bias also elicits and maintains feelings of anxiety and has been linked to a host of clinical conditions, including panic disorder (e.g., McNally, Amir, Lourro, Lukach, Riemann, & Calamari, 1994), posttraumatic stress disorder (e.g., Kaspi, McNally, & Amir, 1995), social anxiety (e.g., Mathews & MacLeod, 2002; 2005), and suicidal behavior (Cha, Najmi, Park, Finn, & Nock, 2010) (Page 2)
Method of Study
- To test the effects of reappraisal, participants were assigned to one of three conditions: (Page 3)
- Reappraisal—in which participants were instructed that arousal is functional and aids performance (e.g., Dienstbier, 1989; Jamieson et al., 2010)
- Ignore external cues—an attention reorientation control designed to rule out the possibility that any face-valid attentional intervention is sufficient to improve outcomes
- No-intervention control.
- Participants then completed a stressful public speaking task (Kirschbaum, Pirke, & Hellhammer, 1993) while their cardiovascular responses were recorded, followed by a test of attentional bias (MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, 2002). Because of the efficacy of CBT (e.g., Smits et al., 2004) and emotion regulation techniques (e.g., Gross, 1998), reappraisal participants were hypothesized to demonstrate improved acute cardiovascular functioning and reduced attentional bias for emotionally-negative information relative to ignore and no-intervention participants. (Page 3)
- Fifty participants (25 male, 25 female) were recruited from the Cambridge, MA area and compensated $25 or two-credit hours for participation (M age = 21.88 years). Participants were pre-screened for physician-diagnosed hypertension and a heart murmur, presence of a pacemaker, cardiac medications, and pregnancy. One participant wished to terminate the experiment and was excluded from the analysis (Page 3)
- The reappraisal manipulation educated participants about the functionality of physiological arousal during stress. More specifically, participants assigned to this condition were informed that increased arousal during stressful situations is not harmful. Instead, the instructions explained that our body’s responses to stress have evolved to help us successfully address stressors and that increased arousal actually aids performance in stressful situations. Thus, reappraisal participants were instructed to appraise arousal as functional and adaptive but were not encouraged to perceive the evaluative task as any less demanding or stressful. The “ignore external cues” condition instructed participants that the best way to reduce nervousness and improve outcomes is to ignore the source of stress. Thus, they were told to look at an “X” placed to the left of the evaluators. This attention reorientation paradigm was based on emotion-suppression techniques (e.g., Gross, 1998). (Page 3)
- Reactivity scores were computed by subtracting scores taken during the final minute of baseline (the “most relaxed” portion) from those collected during the first minute of the speech (the “most reactive” portion). We focused on two measures that provide the best distinction between challenge and threat states: cardiac output (CO) and total peripheral resistance (TPR).
- CO is the amount of blood ejected from the heart during one minute and is calculated by first estimating stroke volume (the amount of blood ejected during each beat) and multiplying that by heart rate. Increases in CO index improved cardiac efficiency.
- TPR is a measure of overall vasoconstriction/vasodilation. During threat states, the peripheral vasculature constricts so as to limit blood flow to the periphery. (Page 4)
- Taken together, the reappraisal condition was associated with lower TPR and greater CO, which indicates a more adaptive physiological response while engaged in a motivated performance task like the one used here (e.g., Blascovich et al., 1999) (Page 5)
- Planned contrasts revealed that participants instructed to reappraise arousal demonstrated less attentional bias for emotionally-negative information versus the ignore condition, F(1,45) = 6.75, p = .013, d = . 77, and with marginal significance compared to no-intervention controls, F(1,45) = 3.88, p = .055, d = .58, omnibus F (2,44) = 3.44, p = .040 (Figure 2). (Page 5)
- Individuals are better able to reappraise situations so as to decrease the emotional impact and exhibit more adaptive emotional and physiological responses to anger provocation (Mauss et al., 2007). Along these lines, the study presented here examined the physiological and cognitive benefits of reappraising arousal during acute evaluative stress. Data supported predictions: Participants instructed to reappraise or “rethink” arousal as functional exhibited increased perceptions of available resources, improved cardiovascular functioning, and less threat-related attentional bias. Thus, consistent with research on emotion regulation (Gross, 2002) and CBT (Hofmann & Smits, 2008), interpretations of bodily signals impact how the body and mind respond to acute stress. (Page 6)
- Although the reappraisal manipulation in this research builds on past work and shares similarities with cognitive restructuring, it differs in important ways from some other components of CBT such as mindfulness mediation (e.g., Rubia, 2009) and breathing retraining (e.g., Beck, Stanley, Baldwin, Deagle, & Averill, 1994). Unlike these approaches, reappraisal is not aimed at decreasing or dampening arousal, but rather at reshaping how that arousal is construed. For example, the experimental manipulation did not impact pre-ejection period (PEP) reactivity, F(2,46) = 1.42, p = .252, which indexes the contractile force of the heart and is related to sympathetic nervous system activation. (Page 6)
- It is our hope that disorders directly tied to the experience of acute social stress may benefit from reappraisal interventions. Also, although one must always exercise caution when comparing results across experiments, it is interesting to note that the effect of reappraisal on attentional bias observed here (reappraisal vs. attention reorientation, d = .59) is in-line with effects from studies with clinically anxious individuals (e.g., attention retraining vs. attention control, d = .42; Amir et al. 2008, Experiment 1). (Page 7)
- Given that adaptive responses to acute stress improve our ability to cope with future stressors (Dienstbier, 1989) health education programs might seek to educate students about the functionality of stress in an effort to break the link between physiological arousal and negative appraisals (Page 7)