Racial differences in stress-induced cardiovascular reactivity and hypertension: current status and substantive issues

Essential hypertension is perhaps the number-one health problem of Black Americans. Research has indicated that stress-induced cardiovascular hyperreactivity may be a significant contributor to essential hypertension. The high prevalence of hypertension among Blacks suggests that this group, in comparison with Whites, may be particularly susceptible to cardiovascular hyperreactivity. The first portion of this article reviews research to date that has examined racial differences in resting and stressor-induced cardiovascular activity. The second half of this article overviews some critical methodological and conceptual issues involved in the study of racial differences in reactivity. These issues include the effects of Black-White differences in plasma renin levels and sodium excretion, the effects of experimenter race, and differences in perceptions of the laboratory environment. Additionally, the issue of racial group classification and the implications this has for interpreting Black-White differences in reactivity is discussed. Two perspectives on racial group classification, the genetic and the sociocultural, are addressed in some detail, and the relevance of each to research on racial differences in stress reactivity is presented.     

Psychophysiological profiles of batterers: autonomic emotional reactivity as it predicts the antisocial spectrum of behavior among intimate partner abusers

On the basis of studies finding heart rate deceleration among severely violent (SV) batterers (J. M. Gottman et al., 1995) and unsuccessful psychopaths (S. S. Ishikawa, A. Raine, T. Lencz, S. Bihrle, & L. Lacasse, 2001), this study compares the physiological reactivity of SV batterers (n=35) with low-level violent (LLV) batterers (n=37) and nonviolent men (n=21) during 2 laboratory tasks. Men's heart rate and skin conductance level were recorded during baseline, a conflict discussion, and a standardized anger induction. Results suggest that autonomic hyporeactivity is a risk marker for antisocial features among SV men, whereas autonomic hyperreactivity is a risk marker among LLV men. Psychophysiological responding appears to be a stronger correlate of general antisocial behavior than of intimate partner abuse.     

Physiological hyperreactivity to stressors in physical child abusers and individuals at risk for being physically abusive

Research on the physiological reactivity of physical child abusers and individuals at risk for being physically abusive is summarized and critiqued. Several theorists have hypothesized that physical child abusers experience physiological hyperreactivity to stressors, particularly stressful child interactions associated with child rearing. The experimental evidence generally supports the physiological hyperreactivity hypothesis, although there are some contradictory and inconsistent results within individual studies and across studies. The research also indicates that the physiological hyperreactivity of physical child abusers and those at risk for being physically abusive occurs during a wide variety of stimulus situations, including aversive child-related stimuli, nonaversive child-related stimuli, aversive nonchild-related stimuli, and during periods when no overt stimulus is present (resting or baseline periods). Recommendations concerning procedural and methodological improvements are made in order to enable future researchers to better address unresolved issues related to the physiological hyperreactivity hypothesis.     

Does anxiety or cardiovascular reactivity have a causal role in hypertension?

Anxiety, stress, and cardiovascular reactivity (CVR) are variously believed to play a role in sustained hypertension. Although acute anxiety or stress elicits acute pressor responses, there is little support for their significant role in sustained hypertension. Anxiety correlates poorly with CVR, and blood pressure levels and anxiolytics do not sustain blood pressure lowering in subjects with hypertension-associated anxiety. Chronic anxiety disorders tend to be characterized by relatively low blood pressure and prevalence of sustained hypertension. Blood Pressure Regulation in hypertension is normal, and normo- and hypertensives have similar ambulatory blood pressure variability. Laboratory CVR fails to predict variability in natural environments, hyperreactors do not exhibit increased variability in natural environments, and the increased variability and ambulatory reactivity that is "accounted for" by laboratory responses is small. These findings do not support the belief that hypertension is related to a summation of heightened pressor responses over time. Antihypertensives normalize elevated blood pressures but do not alter CVR in the laboratory or variability in natural environments, probably because of a dual central regulation of resting and reactive blood pressures. Psychological stress responses result from selective neuronal activation rather than from generalized sympathetic neural responses or dysregulation. Differences in blood pressure responses during various emotions are only quantitative, with no specificity of sympathoadrenal or emotional responses to stressors. It may be time to regard reactive cardiovascular responses as physiological, rather than as psychological, and to require much stronger evidence to confirm causal roles of anxiety, stress, and reactivity in sustained hypertension.     

Are Large Physiological Reactions to Acute Psychological Stress Always Bad for Health?

How we react physiologically to stress has long been considered to have implications for our health. There is now persuasive evidence that individuals who show large cardiovascular reactions to stress are at increased risk of developing cardiovascular disease, particularly hypertension. By implication, low reactivity is protective or benign. However, there is recent evidence that low reactivity may predict elevated risk for a range of adverse health outcomes, such as depression, obesity, poor self-reported health and compromised immunity. In addition, low cortisol and cardiovascular reactivity may be a characteristic of individuals with addictions to tobacco and alcohol, as well as those at risk of addiction and those who relapse from abstinence. Our ideas about reactivity may have to be revised in the light of such findings.     

Autonomic stress reactivity and executive functions in successful and unsuccessful criminal psychopaths from the community

A significant gap in the psychopathy literature is the lack of studies comparing "successful," nonconvicted psychopaths with "unsuccessful," convicted psychopaths. This study tested the hypothesis that successful psychopaths show increased autonomic stress reactivity and better neuropsychological function compared with unsuccessful psychopaths. A total of 26 controls, 16 unsuccessful psychopaths, and 13 successful psychopaths were assessed on psychophysiological measures recorded during an emotional manipulation, the Wisconsin Card Sorting Test (WCST), Wechsler Memory Scale--Revised subtests, and childhood stressors. Compared with controls, unsuccessful psychopaths showed reduced cardiovascular stress reactivity. In contrast, successful psychopaths showed heightened reactivity, better WCST performance, and more parental absence than unsuccessful psychopaths and controls. The implications of these findings and the generalizability of existing psychopathy research are discussed.     

High blood pressure and marital discord: not being nasty matters more than being nice

Theories linking anger and blood pressure (BP) reactivity to cardiovascular disease must be able to identify naturally occurring stressors that arouse emotion with sufficient frequency to cause chronic physiologic stress. We examine the impact of normal family arguments on 43 patients (24 women, 19 men) with essential hypertension. Patients and their partners discussed a threatening disagreement for 10 min while BP and conversation were recorded. Discussing problems increased BP, but the causal pathways differed by sex. In women, hostile interaction and marital dissatisfaction were associated with increased BP; "supportive" or "neutral" exchanges were unrelated to BP. In men, BP fluctuations were related only to the patient's speech rate. These findings are consistent with other research on sex differences in communication and social problem-solving styles and implicate different mechanisms (frequent anger, active coping) through which marital discord could increase risk. Implications for intervention are considered.     

An evaluation of Woodard's theory of perceptually oriented hypnosis

This article evaluates Woodard's theory of Perceptually Oriented Hypnosis, a welcome addition to theories of hypnosis that emphasize the centrality of subjective experiences in understanding and studying hypnosis. With a focus on subjective experience. Woodard's account of perceptually oriented hypnosis is based on elements of humanistic, client-centered, and perceptual psychology. However, we contend that improvements in the operational clarity and coverage of the theory are necessary to optimize its utility and heuristic value. We also argue that it is important for Perceptually Oriented Hypnosis to address hypnotic phenomena, e.g., individual differences in suggestibility, involuntary responding to suggestions, stability of responding over time, widely recognized as essential to understanding hypnotic experience and responding. With these refinements, we believe that Woodard's theory would have a greater potential to enrich our understanding of both the unique experiences of individuals who undergo hypnosis and of hypnosis in general.     

Anticipatory threat and physical danger trait anxiety: A signal-detection analysis of effects on autonomic responding

The method of Signal-Detection Theory (SDT) was applied to the analysis of autonomic data in two experiments. In the first, apprehension surrounding the administration of loud tones was induced through preliminary information; in the second, it was increased by selecting subjects scoring high on a physical-danger trait anxiety scale. Despite enhanced autonomic reactivity, those in the first study who were led to believe that the tones would be extremely disturbing subsequently rated them as less disturbing than did their counterparts who were given comparatively benign expectations. The signal-detection analysis of heart rate and skin conductance suggested enhanced “preparedness of response” among the high-threat subjects; given the diminished subjective ratings, increased response readiness at the autonomic level may have reflected physiological activity assuaging subjective aversiveness of the tones. Contrary to the first study, the psychometrically designated threatened group in the second experiment produced both greater autonomic reactivity along with elevated subjective ratings of disturbance. The SDT analysis provided evidence of greater autonomic sensitivity to noxious stimulus properties. Results were discussed in terms of their implications for theories of anxiety; the comparative utilites of signal-detection theory and conventional methods of autonomic-response scoring were elaborated.     

Individual differences in the impact of attentional bias training on cardiovascular responses to stress in women

Experimental studies show that training people to attend to negative stimuli makes them more likely to respond with greater anxiety to stress. The present study investigated this effect in students using measures of cardiovascular responses to stress and examined whether individual differences influence the impact of attention training on stress responses. Using a standard dot probe task, 30 participants underwent negative attentional bias training and 34 participants underwent anti-negative training before completing a stressful speech task. Results indicated that, overall, participants exhibited acclimatization to the procedures (indicated by a dip in blood pressure post-training) and normal stress responding (indicated by elevated blood pressure in response to stress; p<.001). However, consideration of participants' scores for neuroticism/emotional-stability revealed important differences in how the intervention impacted on cardiovascular profiles (p=.008). For participants with high neuroticism scores, the negative attentional bias intervention elicited more exaggerated stress responding than the anti-negative intervention. For those with low neuroticism scores (i.e., emotionally stable participants), the anti-negative intervention was associated with elevated post-intervention blood pressure and higher blood pressure reactivity to stress. These findings provide evidence of the impact of attentional bias manipulation on physiological stress reactivity and suggest the effect is highly contingent on individual temperaments.     

情绪反应时间动力性的研究现状与展望

情绪反应的时间动力性系指情绪反应在时间方面的动力性质,是情感风格、情绪调节、情绪恢复等内容的重要特征,其研究对促进身心健康、完善情绪理论具有重要的理论和实践意义。文章阐述了情绪反应时间动力性的内涵与外延、相关理论,以及情绪反应时间动力性的各个参数及其影响因素的研究现状,并就未来研究增加自主生理反应指标、文化背景等因素予以展望     

Ego-involvement and the difficulty law of motivation: effects on performance-related cardiovascular response

Two experiments found that effort-related cardiovascular reactivity under ego-involvement follows the principles of motivational intensity theory. Experiment 1 manipulated ego-involvement and the difficulty of a memory task. Under high ego-involvement, cardiovascular reactivity during task performance increased with fixed task difficulty; an unfixed performance standard elicited the same high reactivity as a fixed high standard. Experiment 2 manipulated ego-involvement and administered a memory task with unfixed versus extremely high performance standards. High ego-involvement increased cardiovascular reactivity only when the performance standard was unfixed but not when success was obviously impossible. Both studies found associations between cardiovascular reactivity and achievement and controlled for emotional states. The findings clarify previous research and theorizing about ego-involvement and motivation.     

Cardiovascular reactivity and interpersonal influence: active coping in a social context

Previous studies have demonstrated that effortful attempts to secure positive outcomes or avoid negative outcomes produce significant increases in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Although these effects of active coping on cardiovascular reactivity are central in current psychosomatic theories, virtually all of the research to date has used impersonal, asocial tasks. Our two studies examined the cardiovascular effects of effortful attempts to influence other people. In Study 1, male subjects attempting to influence the opinions of their discussion partner to improve their own chances of winning money displayed significantly greater SBP, DBP, and HR reactivity. In Study 2, we obtained similar effects on SBP and DBP reactivity in men and women, while both preparing an influence attempt and making that attempt. Furthermore, reactivity levels were larger as the magnitude of incentive for successful persuasion increased. Implications of this interpersonal equivalent of active coping for the development of cardiovascular disease are discussed.     

Individual differences in the impact of attentional bias training on cardiovascular responses to stress in women

Abstract

Experimental studies show that training people to attend to negative stimuli makes them more likely to respond with greater anxiety to stress. The present study investigated this effect in students using measures of cardiovascular responses to stress and examined whether individual differences influence the impact of attention training on stress responses. Using a standard dot probe task, 30 participants underwent negative attentional bias training and 34 participants underwent anti-negative training before completing a stressful speech task. Results indicated that, overall, participants exhibited acclimatization to the procedures (indicated by a dip in blood pressure post-training) and normal stress responding (indicated by elevated blood pressure in response to stress; p<.001). However, consideration of participants’ scores for neuroticism/emotional-stability revealed important differences in how the intervention impacted on cardiovascular profiles (p=.008). For participants with high neuroticism scores, the negative attentional bias intervention elicited more exaggerated stress responding than the anti-negative intervention. For those with low neuroticism scores (i.e., emotionally stable participants), the anti-negative intervention was associated with elevated post-intervention blood pressure and higher blood pressure reactivity to stress. These findings provide evidence of the impact of attentional bias manipulation on physiological stress reactivity and suggest the effect is highly contingent on individual temperaments.     

Hemodynamic responses to active and passive coping tasks and the prediction of future blood pressure in Thai participants: A preliminary prospective cohort study

Cardiovascular responses to mental stress tests have been related to future blood pressure (BP) levels. However, most studies have been completed in North America and Europe; only one study has been conducted in Asia. Therefore, the study explored whether cardiovascular responses to mental stress predict future resting BP in Thailand. Hemodynamic measures were obtained from 101 healthy adults before, during and after mental arithmetic, a speech task, and a cold pressor task. A follow‐up assessment of resting BP was undertaken 1 year later. Results showed that Thais responded to standardized mental stress tasks with large and significant cardiovascular reactivity. Regression analyses indicated that, after adjustment for baseline BP and traditional risk factors, heightened systolic blood pressure (SBP) responses to mental arithmetic were associated with increased future SBP (ΔR² = .045). These findings suggest that BP reactivity predicts future BP and may play a role in the development of hypertension. In addition, Thais displayed large cardiovascular responses to standardized mental stress tasks, of a similar magnitude to previous studies of North Americans and Europeans.     

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.     

The lasting effect of words on feelings: words may facilitate exposure effects to threatening images

Previous studies have shown that mere words, particularly affective words, can dampen emotional responses. However, the effect of affective labels on emotional responding in the long term is unknown. The authors examined whether repeated exposure to aversive images would lead to more reduction in autonomic reactivity a week later if the images were exposed with single-word labels than without labels. In Experiment 1, healthy individuals were exposed to pictures of disturbing scenes with or without labels on Day 1. On Day 8, the same pictures from the previous week were exposed, this time without labels. In Experiment 2, participants were spider fearful and were exposed to pictures of spiders. In both experiments, although repeated exposure to aversive images (without labels) led to long-term attenuation of autonomic reactivity, exposure plus affective labels, but not nonaffective labels, led to more attenuation than exposure alone. Thus, affective labels may help dampen emotional reactivity in both the short and long terms. Implications for exposure therapy and translational studies are discussed.     

Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: a quantitative review of 30 years of investigations

This meta-analysis included 729 studies from 161 articles investigating how acute stress responsivity (including stress reactivity and recovery of hypothalamic-pituitary-adrenal [HPA] axis, autonomic, and cardiovascular systems) changes with various chronic psychosocial exposures (job stress; general life stress; depression or hopelessness; anxiety, neuroticism, or negative affect; hostility, aggression, or Type-A behavior; fatigue, burnout, or exhaustion; positive psychological states or traits) in healthy populations. In either the overall meta-analysis or the methodologically strong subanalysis, positive psychological states or traits were associated with reduced HPA reactivity. Hostility, aggression, or Type-A behavior was associated with increased cardiovascular (heart rate or blood pressure) reactivity, whereas anxiety, neuroticism, or negative affect was associated with decreased cardiovascular reactivity. General life stress and anxiety, neuroticism, or negative affect were associated with poorer cardiovascular recovery. However, regarding the sympathetic nervous system and parasympathetic nervous system, there were no associations between the chronic psychosocial factors and stress reactivity or recovery. The results largely reflect an integrated stress response pattern of hypo- or hyperactivity depending on the specific nature of the psychosocial background.     

Subjective, Autonomic, and Endocrine Reactivity during Social Stress in Children with Social Phobia

Reports of exaggerated anxiety and physiological hyperreactivity to social-evaluative situations are characteristic of childhood social phobia (SP). However, laboratory research on subjective, autonomic and endocrine functioning in childhood SP is scarce, inconsistent and limited by small sample sizes, limited breadth of measurements, and the use of non-standardized stressor tasks. We exposed 8–12-year-old children with DSM-IV SP (n = 41) and matched healthy control children (HC; n = 40) to the Trier Social Stress Test for Children (TSST-C) while measuring subjective anxiety, heart rate (HR) and salivary alpha-amylase (sAA) as well as salivary cortisol. The SP children showed heightened reactivity to the TSST-C on subjective anxiety compared to the HC children but not a heightened reactivity in HR, sAA or cortisol. However, the SP children showed chronically elevated HR levels throughout the whole laboratory session. Whereas subjective anxiety seems to respond specifically to social-evaluative stress in childhood SP, HR levels may be chronically elevated suggesting a more generalized autonomic hyperreactivity.     

Hemodynamic characteristics of young men at risk for hypertension at rest and during laboratory stressors.

Examined hemodynamic activity--at rest, during mental arithmetic, and during hand cold pressor--in young men varying in risk for hypertension. Classification into low-risk (n = 72), moderate-risk (n = 20), and high-risk (n = 13) groups was based on resting systolic blood pressure (SBP) and parental history of essential hypertension (PH). Dependent variables were SBP, diastolic BP (DBP), heart rate, and rate-pressure product (RPP). Progressively greater hemodynamic activity was seen across risk groups at rest and during the tasks. Risk groups differed significantly in SBP, DBP, and RPP at baseline (ps less than .003) and in size of response to mental arithmetic (ps less than .05) but not to cold pressor. These relationships were either absent or weaker when using either risk factor alone to form risk groups. These findings suggest that hemodynamic reactivity to mental stress is predicted better by a combination of resting SBP and PH than by either risk factor alone and that physiological reactivity may be an important accompaniment of increased risk for hypertension.