Trauma and Autonomic Dysregulation: Episodic—Versus Systemic—Negative Affect Underlying Cardiovascular Risk in Posttraumatic Stress Disorder

Abstract

Objective Posttraumatic stress disorder (PTSD) has been linked to elevated heart rate (HR) and reduced heart-rate variability (HRV) in cross-sectional research. Recent evidence suggests that this link may be driven by individual differences in autonomic arousal associated with momentary negative affect (NA). Using ecological momentary assessment (EMA) of NA and minute-to-minute HR/HRV monitoring, we examined whether NA-related HR/HRV mediated the association of PTSD symptom severity with 24-hour HRV and endothelial functioning. Methods One hundred ninety-seven young adults (18–39 years old), 93 with PTSD, underwent one day of Holter monitoring while concurrently reporting NA levels via EMA. Two non-invasive measures of endothelial functioning—flow-mediated dilation (FMD) and hyperemic flow—were also collected. Multilevel modeling was used to assess the associations of momentary NA with HR and low- (LF) and high-frequency (HF) HRV during the 5-minute intervals following each EMA reading. Latent variable modeling was then used to determine whether individual differences in these associations mediated the association of PTSD symptom severity with 24-hour HRV, FMD, and hyperemic flow Results PTSD symptom severity was positively associated with NA-related autonomic arousal (β = .21, p < .001), which significantly mediated the association of PTSD symptom severity with 24-hour HRV and hyperemic flow, accounting for 62% and 34% of their associations, respectively, while overshadowing the influence of smoking, lifetime alcohol dependence, sleep duration, mean NA, and episodes of acute NA. Conclusions Results suggest that NA-related autonomic arousal is both a primary factor driving cardiovascular risk in PTSD and a potential point of intervention.

The Association of Posttraumatic Stress Disorder With Clinic and Ambulatory Blood Pressure in Healthy Adults

“…Although laboratory studies have shown exaggerated physiological stress reactivity to trauma reminders and other stressors in participants with PTSD vs without, to our knowledge, this is the first study to test whether PTSD is associated with increased BP response to feelings of anxiety in participants’ daily lives. Our findings, along with others in the literature, 29,30 indicate that taking momentary measures of negative affect into consideration may help to better understand cardiovascular risk in individuals with PTSD.…”

Characterizing anger-related affect in individuals with posttraumatic stress disorder using ecological momentary assessment

“…Research has linked hostility in individuals with PTSD to physiological hyperarousal (Beckham et al, 2009, 2002; Vrana et al, 2009), and improved arousal regulation has been found to be the one of the primary mechanisms of change in anger management therapy for veterans with PTSD (Mackintosh et al, 2014a, 2014b). Considered in the context of these prior studies, our findings may suggest that directly targeting the PTSD-related physiological arousal (Beckham et al, 2009, 2002; Dennis et al, 2016, 2017; Mackintosh et al, 2014a, 2014b; Vrana et al, 2009) and hostile cognitions (Van Voorhees et al, 2016) that contribute to irritability and anger may be an important part of a holistic approach to minimizing the functional impact of the disorder. Current empirically support therapies specifically target the avoidance symptoms that are understood to maintain PTSD (Cahill et al, 2003; Foa et al, 2006; Resick et al, 2010), while less attention is given to directly targeting physiological arousal and hostile interpersonal attributions cued by trauma triggers.…”

The relationship of trauma exposure to heart rate variability during wake and sleep in midlife women

“…Our findings contribute importantly to the extant literature on relations of trauma to autonomic influences on the heart. While some evidence links trauma exposure to HRV, limitations of existing research include a focus on highly specific samples (e.g., bereaved older adults, military veterans) (Dennis et al, 2017;Fagundes et al, 2018), single categories of traumatic exposures (Buckley et al, 2012;Fagundes et al, 2018), laboratory measurements of HRV during waking hours only (Blechert et al, 2007;Fagundes et al, 2018;van Ockenburg, 2014), and failing to control for key factors that may influence HRV (Norte et al, 2013), This study included a large sample of nonsmoking women who underwent 24-hr ECG during both wake and sleep and who were free of clinical CVD. A range of traumatic experiences were assessed and considered.…”

“…However, in other studies this association did not persist over time (e.g., van Ockenburg, 2014). Existing work has key limitations, including a focus on highly specific samples (e.g., bereaved older adults, military veterans) (Dennis et al, 2017;Fagundes et al, 2018), single types of traumatic exposures considered (Buckley et al, 2012;Fagundes et al, 2018), laboratory measurements of HRV during waking hours only (Blechert, Michael, Grossman, Lajtman, & Wilhelm, 2007;Fagundes et al, 2018;van Ockenburg, 2014), and failing to control for factors that may influence HRV (e.g., age, smoking, medication usage) (Norte et al, 2013). Thus, whether traumatic experiences are related to reduced HF-HRV remains an open question.…”