Cross system autonomic balance and regulation: Associations with depression and anxiety symptoms

Abstract

The autonomic nervous system (ANS) has demonstrated utility for identifying alterations in emotion processing associated with common psychopathology, including depression and anxiety. To date though the majority of this ANS research has several limitations. Most studies have examined parasympathetic and sympathetic branches separately, requiring activity in the other branch be inferred. This is problematic as each branch may function independently. Composite indices such as cardiac autonomic balance (CAB) and cardiac autonomic regulation (CAR) which examine the relative input between respiratory sinus arrhythmia (RSA) and pre‐ejection period (PEP) should provide more comprehensive measures of autonomic functioning and thus stronger predictors of psychopathology. However, the sympathetic branch is driven by multiple neurotransmitter systems, thus PEP does not necessarily reflect overall SNS arousal. We propose two new metrics for assessing ANS functioning associated with psychopathology: parasympathetic effects on cardiac control (RSA) relative to sympathetic effects on the eccrine system (electrodermal activity, EDA), which we term cross‐system autonomic balance (CSAB) and regulation (CSAR). Eighty‐five women (18–37) completed a baseline physiological assessment with parasympathetic (RSA) and sympathetic indices (PEP, EDA), along with self‐reported depressive and anxiety symptoms. Lower CSAB, indicating sympathetic dominance driven by cholinergic neurotransmission, was associated with higher depressive and anxiety symptoms. Lower CAB indicating sympathetic dominance driven by beta‐adrenergic neurotransmission was associated specifically with depressive symptoms. CSAB was a more robust index than RSA. Results support the utility of assessing multiple composite ANS indices for identifying physiological substrates of alterations in emotion regulation associated with internalizing disorders.

A Close Examination of the Use of Systolic Time Intervals in the Calculation of Impedance Derived Cardiac Autonomic Balance and Regulation

“…Autonomic nervous system imbalance, or an increase in sympathetic activity coupled with a decrease in parasympathetic activity, has been associated with poorer physiological health outcomes including metabolic abnormalities (Licht et al, 2013) and cardiovascular disease risk factors (i.e., hypertension, diabetes) (Thayer et al, 2010b), as well as worse psychological outcomes, including anxiety (Friedman and Thayer, 1998), depression (Stone et al, 2020), and increased levels of daily stress (Mitchell et al, 2017). Due to its importance in health research, there have been several attempts to accurately measure cardiac autonomic balance and regulation over the years using various physiological measures.…”

“…CAB and CAR can be calculated using indices of parasympathetically mediated HRV (e.g., the root mean square of successive differences [RMSSD], HF-HRV) and impedance derived systolic time intervals (i.e., pre-ejection period [PEP]) as an index of sympathetic activity (Berntson et al, 2008;Williams et al, 2017). Both CAB and CAR have been used as indices of autonomic balance and activity in a myriad of studies, showing associations with affective responses (Kreibig et al, 2012), psychopathologies (Bylsma et al, 2015;Stone et al, 2020), stress (Gump et al, 2011;Mitchell et al, 2017), inflammatory markers (Singh et al, 2009;Alen et al, 2020), and physiological health (Berntson et al, 2008;Vrijkotte et al, 2015). For example, a history of myocardial infarctions and type 2 diabetes diagnoses are more likely to be linked to low levels of CAR and CAB, respectively (Berntson et al, 2008), while lower CAB has also been shown to be associated with increased levels of inflammatory cytokines such as interleukin-6 and tumor necrosis factor alpha (Alen et al, 2020).…”

Emotion context insensitivity in depression: Toward an integrated and contextualized approach

“…Typically, researchers interested in sympathetic activity assess either skin conductance (electrodermal activity, EDA), or PEP, as both are assumed to be relatively “pure” indices of sympathetic activity. However, recent work reveals that these indices may not even be significantly correlated (Stone et al., 2020) and may show differential relationships with parasympathetic activity and emotion regulation processes (Stone et al., 2020). This could be due to differences in temporal resolution in PEP and electrodermal measures (i.e., as electrodermal measures tend to have a slower onset and offset), or the fact that PEP is primarily driven by beta‐adrenergic neurotransmission, while electrodermal measures reflect primarily cholinergic neurotransmission (Stone et al., 2020; Stone et al., 2020).…”

“…However, recent work reveals that these indices may not even be significantly correlated (Stone et al., 2020) and may show differential relationships with parasympathetic activity and emotion regulation processes (Stone et al., 2020). This could be due to differences in temporal resolution in PEP and electrodermal measures (i.e., as electrodermal measures tend to have a slower onset and offset), or the fact that PEP is primarily driven by beta‐adrenergic neurotransmission, while electrodermal measures reflect primarily cholinergic neurotransmission (Stone et al., 2020; Stone et al., 2020). Further, skin conductance reactivity has been more associated with threat of punishment, while PEP reactivity is more sensitive to reward receipt or anticipation (Obradović & Boyce, 2012), suggesting that the nature of the stimuli and context may be particularly relevant.…”

Interoception Dysfunction Contributes to the Negative Emotional Bias in Major Depressive Disorder

“…To our knowledge, this study was the first to investigate the negative emotional bias in MDD from the aspect of internal-external information integration by interoception. With converging evidence reporting the intimate connections between the peripheral nervous system and emotion in MDD ( 55 , 56 ), the role of allostasis in depression pathological mechanism could not be ignored anymore. In the current study, we found that abnormal HEPs could predict aberrant LPP clusters in sad face trials only in the MDD group, indicating the possibility that aberrant interoception dysfunction has led to abnormal processing of sad faces in MDDs.…”