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1.  The neural correlates of trait resilience when anticipating and recovering from threat 
A facet of emotional resilience critical for adapting to adversity is flexible use of emotional resources. We hypothesized that in threatening situations, this emotional flexibility enables resilient people to use emotional resources during appropriately emotional events, and conserve emotional resources during innocuous events. We tested this hypothesis using functional magnetic resonance imaging in a repeated recovery from threat task with low- and high-trait resilient individuals (LowR and HighR, respectively, as measured by ER89). In an event-related design, 13 HighR and 13 LowR participants viewed ‘threat’ cues, which signaled either an aversive or neutral picture with equal probabilities, or ‘nonthreat’ cues, which signaled a neutral picture. Results show that when under threat, LowR individuals exhibited prolonged activation in the anterior insula to both the aversive and neutral pictures, whereas HighR individuals exhibited insula activation only to the aversive pictures. These data provide neural evidence that in threatening situations, resilient people flexibly and appropriately adjust the level of emotional resources needed to meet the demands of the situation.
PMCID: PMC2607054  PMID: 19015078
resilience; anticipation; recovery; emotion regulation; neuroimaging; threat
2.  Adapting to life’s slings and arrows: Individual differences in resilience when recovering from an anticipated threat 
Journal of research in personality  2008;42(4):1031-1046.
Following highly negative events, people are deemed resilient if they maintain psychological stability and experience fewer mental health problems. The current research investigated how trait resilience (Block & Kremen, 1996, ER89) influences recovery from anticipated threats. Participants viewed cues (‘aversive’, ‘threat’, ‘safety’) that signified the likelihood of an upcoming picture (100% aversive, 50/50 aversive/neutral, or 100% neutral; respectively), and provided continuous affective ratings during the cue, picture, and after picture offset (recovery period). Participants high in trait resilience (HighR) exhibited more complete affective recovery (compared to LowR) after viewing a neutral picture that could have been aversive. Although other personality traits previously associated with resilience (i.e., optimism, extraversion, neuroticism) predicted affective responses during various portions of the task, none mediated the influence of trait resilience on affective recovery.
PMCID: PMC2711547  PMID: 19649310
resilience; emotion regulation; recovery; relief; anticipation
3.  Affective circuitry and risk for alcoholism in late adolescence: Differences in frontostriatal responses between vulnerable and resilient children of alcoholic parents 
Children of alcoholics (COAs) are at elevated risk for alcohol use disorders (AUD), yet not all COAs will develop AUD. The two primary aims of this study were to identify neural activation mechanisms that may mark protection or vulnerability to AUD in COAs and to map the same activation patterns in relation to risk behavior (externalizing or internalizing behavior).
Twenty-two adolescent COAs were recruited from an ongoing community longitudinal study of alcoholic and matched control families. They were categorized as either vulnerable (n=11) or resilient (n=11) based on level of problem drinking over the course of adolescence. Six other adolescents with no parental history of alcoholism, and no evidence of their own problem drinking were recruited from the same study and labeled as low-risk controls. Valenced words were presented to the participants in a passive viewing task during functional magnetic resonance imaging. Activation to negative versus neutral words and positive versus neutral words were compared between groups. Behavior problems were assessed with the Youth Self-Report (YSR).
The resilient COA group had more activation of the orbital frontal gyrus, bilaterally, and left insula/putamen than the control and vulnerable groups, in response to emotional stimuli. In contrast, the vulnerable group had more activation of the dorsomedial prefrontal cortex and less activation of the ventral striatum and extended amygdala, bilaterally, to emotional stimuli than the control and resilient groups. The vulnerable group had more externalizing behaviors which correlated with increased dorsomedial prefrontal activation and decreased ventral striatal and extended amygdala activation.
These results are consistent with dissociable patterns of neural activation underlying risk and resiliency in COAs. We propose that the pattern observed in the resilient COAs represents an active emotional monitoring function, which may be a protective factor in this group. On the other hand, the vulnerable group displayed a pattern consistent with active suppression of affective responses, perhaps resulting in the inability to engage adaptively with emotional stimuli.
PMCID: PMC2593836  PMID: 18302724
Vulnerability; Resiliency; Ventral Striatum; Prefrontal Cortex; Orbitofrontal Cortex
4.  Purpose in Life Predicts Better Emotional Recovery from Negative Stimuli 
PLoS ONE  2013;8(11):e80329.
Purpose in life predicts both health and longevity suggesting that the ability to find meaning from life’s experiences, especially when confronting life’s challenges, may be a mechanism underlying resilience. Having purpose in life may motivate reframing stressful situations to deal with them more productively, thereby facilitating recovery from stress and trauma. In turn, enhanced ability to recover from negative events may allow a person to achieve or maintain a feeling of greater purpose in life over time. In a large sample of adults (aged 36-84 years) from the MIDUS study (Midlife in the U.S.,, we tested whether purpose in life was associated with better emotional recovery following exposure to negative picture stimuli indexed by the magnitude of the eyeblink startle reflex (EBR), a measure sensitive to emotional state. We differentiated between initial emotional reactivity (during stimulus presentation) and emotional recovery (occurring after stimulus offset). Greater purpose in life, assessed over two years prior, predicted better recovery from negative stimuli indexed by a smaller eyeblink after negative pictures offset, even after controlling for initial reactivity to the stimuli during the picture presentation, gender, age, trait affect, and other well-being dimensions. These data suggest a proximal mechanism by which purpose in life may afford protection from negative events and confer resilience is through enhanced automatic emotion regulation after negative emotional provocation.
PMCID: PMC3827458  PMID: 24236176
5.  Psychophysiological Assessment of Emotional Processing in Patients with Borderline Personality Disorder with and without Comorbid Substance Use 
Personality disorders  2012;4(3):203-213.
This study assessed physiological measures to study emotional dysregulation associated with borderline personality disorder (BPD). Two patient groups, individuals with BPD-only (n = 16) and individuals with BPD and co-occurring Substance Use Disorders (SUDs; n = 35), and a group of healthy controls (n = 45) were shown standardized pictures of varying valance and arousal levels while the affective modification of the startle eye-blink response, heart rate, facial electromyography (EMG; corrugator and zygomatic activity), and skin conductance responses were collected during picture presentation and during a brief recovery period. Startle data during picture presentation indicated a trend for the expected increase in startle magnitude to negative stimuli to be moderated by group status, with patients with BPD-SUD showing a lack of affective modification while the BPD-only group showing similar affective modification as controls. Heart rate data suggested lower reactivity to negative pictures for both patient groups. Differences in facial EMG responses did not provide a clear pattern and skin conductance responses were not significantly different between groups. The data did not suggest differences between groups in the recovery from the emotional stimuli. The startle and heart rate data suggest a possible hyporeactivity to emotional stimuli in BPD.
PMCID: PMC4086455  PMID: 23088207
Borderline Personality Disorder; Emotional dysregulation; Startle Reflex; Substance use; Psychophysiology
6.  Facial Expression Recognition, Fear Conditioning, and Startle Modulation in Female Subjects with Conduct Disorder 
Biological Psychiatry  2010;68(3):272-279.
Recent behavioral and psychophysiological studies have provided converging evidence for emotional dysfunction in conduct disorder (CD). Most of these studies focused on male subjects and little is known about emotional processing in female subjects with CD. Our primary aim was to characterize explicit and implicit aspects of emotion function to determine whether deficits in these processes are present in girls with CD.
Female adolescents with CD (n = 25) and control subjects with no history of severe antisocial behavior and no current psychiatric disorder (n = 30) completed tasks measuring facial expression and facial identity recognition, differential autonomic conditioning, and affective modulation of the startle reflex by picture valence.
Compared with control subjects, participants with CD showed impaired recognition of anger and disgust but no differences in facial identity recognition. Impaired sadness recognition was observed in CD participants high in psychopathic traits relative to those lower in psychopathic traits. Participants with CD displayed reduced skin conductance responses to an aversive unconditioned stimulus and impaired autonomic discrimination between the conditioned stimuli, indicating impaired fear conditioning. Participants with CD also showed reduced startle magnitudes across picture valence types, but there were no significant group differences in the pattern of affective modulation.
Adolescent female subjects with CD exhibited deficits in explicit and implicit tests of emotion function and reduced autonomic responsiveness across different output systems. There were, however, no differences in emotional reactivity. These findings suggest that emotional recognition and learning are impaired in female subjects with CD, consistent with results previously obtained in male subjects with CD.
PMCID: PMC2954286  PMID: 20447616
Conduct disorder; emotion; face recognition; female; psychopathy
7.  Self-Reported Trait Mindfulness and Affective Reactivity: A Motivational Approach Using Multiple Psychophysiological Measures 
PLoS ONE  2015;10(3):e0119466.
As a form of attention, mindfulness is qualitatively receptive and non-reactive, and is thought to facilitate adaptive emotional responding. One suggested mechanism is that mindfulness facilitates disengagement from an affective stimulus and thereby decreases affective reactivity. However, mindfulness has been conceptualized as a state, intervention, and trait. Because evidence is mixed as to whether self-reported trait mindfulness decreases affective reactivity, we used a multi-method approach to study the relationship between individual differences in self-reported trait mindfulness and electrocortical, electrodermal, electromyographic, and self-reported responses to emotional pictures. Specifically, while participants (N = 51) passively viewed pleasant, neutral, and unpleasant IAPS pictures, we recorded high-density (128 channels) electrocortical, electrodermal, and electromyographic data to the pictures as well as to acoustic startle probes presented during the pictures. Afterwards, participants rated their subjective valence and arousal while viewing the pictures again. If trait mindfulness spontaneously reduces general emotional reactivity, then for individuals reporting high rather than low mindfulness, response differences between emotional and neutral pictures would show relatively decreased early posterior negativity (EPN) and late positive potential (LPP) amplitudes, decreased skin conductance responses, and decreased subjective ratings for valence and arousal. High mindfulness would also be associated with decreased emotional modulation of startle eyeblink and P3 amplitudes. Although results showed clear effects of emotion on the dependent measures, in general, mindfulness did not moderate these effects. For most measures, effect sizes were small with rather narrow confidence intervals. These data do not support the hypothesis that individual differences in self-reported trait mindfulness are related to spontaneous emotional responses during picture viewing.
PMCID: PMC4352075  PMID: 25749431
8.  Affective engagement for facial expressions and emotional scenes: The influence of social anxiety 
Biological psychology  2012;91(1):103-110.
Pictures of emotional facial expressions or natural scenes are often used as cues in emotion research. We examined the extent to which these different stimuli engage emotion and attention, and whether the presence of social anxiety symptoms influences responding to facial cues. Sixty participants reporting high or low social anxiety viewed pictures of angry, neutral, and happy faces, as well as violent, neutral, and erotic scenes, while skin conductance and event-related potentials were recorded. Acoustic startle probes were presented throughout picture viewing, and blink magnitude, probe P3 and reaction time to the startle probe also were measured. Results indicated that viewing emotional scenes prompted strong reactions in autonomic, central, and reflex measures, whereas pictures of faces were generally weak elicitors of measurable emotional response. However, higher social anxiety was associated with modest electrodermal changes when viewing angry faces and mild startle potentiation when viewing either angry or smiling faces, compared to neutral. Taken together, pictures of facial expressions do not strongly engage fundamental affective reactions, but these cues appeared to be effective in distinguishing between high and low social anxiety participants, supporting their use in anxiety research.
PMCID: PMC3407306  PMID: 22643041
9.  Complexities of emotional responses to social and non-social affective stimuli in schizophrenia 
Background: Adaptive emotional responses are important in interpersonal relationships. We investigated self-reported emotional experience, physiological reactivity, and micro-facial expressivity in relation to the social nature of stimuli in individuals with schizophrenia (SZ).
Method: Galvanic skin response (GSR) and facial electromyography (fEMG) were recorded in medicated outpatients with SZ and demographically matched healthy controls (CO) while they viewed social and non-social images from the International Affective Pictures System. Participants rated the valence and arousal, and selected a label for experienced emotions. Symptom severity in the SZ and psychometric schizotypy in CO were assessed.
Results: The two groups did not differ in their labeling of the emotions evoked by the stimuli, but individuals with SZ were more positive in their valence ratings. Although self-reported arousal was similar in both groups, mean GSR was greater in SZ, suggesting differential awareness, or calibration of internal states. Both groups reported social images to be more arousing than non-social images but their physiological responses to non-social vs. social images were different. Self-reported arousal to neutral social images was correlated with positive symptoms in SZ. Negative symptoms in SZ and disorganized schizotypy in CO were associated with reduced mean fEMG. Greater corrugator mean fEMG activity for positive images in SZ indicates valence-incongruent facial expressions.
Conclusion: The patterns of emotional responses differed between the two groups. While both groups were in broad agreement in self-reported arousal and emotion labels, their mean GSR, and fEMG correlates of emotion diverged in relation to the social nature of the stimuli and clinical measures. Importantly, these results suggest disrupted self awareness of internal states in SZ and underscore the complexities of emotion processing in health and disease.
PMCID: PMC4373273  PMID: 25859230
electromyogram; negative symptoms; positive symptoms; schizotypal personality; arousal; valence; self awareness; alexithymia
10.  Resiliency in adolescents at high-risk for substance abuse: flexible adaptation via subthalamic nucleus and linkage to drinking and drug use in early adulthood 
The personality trait resiliency is the ability to flexibly adapt impulse control relative to contextual demand. Low resiliency has been linked to later alcohol/drug problems. The underlying psychological and neural mechanisms are unknown but neurocomputational models suggested relations between resiliency and working memory. Cortical-striatal connectivity has been proposed to underlie adaptive switches between cautious and risky behaviors.
Working memory was probed in sixty-seven 18–22 year olds from a larger community study of alcoholism, using the n-back task during functional magnetic resonance imaging. Functional connectivity between task-related regions was investigated with psychophysiological interaction analysis. Resiliency was measured in early teen years and related to early adulthood measures of drinking/drug use, task activation and connectivity. Relationships with risk factors, including family history, age of drinking onset and number of alcohol problems were also investigated.
Higher resiliency was related to lower levels of substance use, fewer alcohol problems and better working memory performance. Whole brain regression revealed resiliency negatively correlated with activation of subthalamic nucleus (STN) and pallidum during the n-back. High and Low resiliency quartile groups (n=17 each) differed in coupling strength between STN and median cingulate cortex, a region of reduced activation during working memory. The High resiliency group had later onset of drinking, fewer alcohol problems, had used fewer illicit drugs and were less likely to smoke cigarettes than their Low resiliency counterparts,
These findings suggest that resiliency in early adolescence may protect against alcohol problems and drug use, though the direction of this effect is currently unknown. This protective factor may relate to executive functioning as supported by the finding of a neural link shared between resiliency and working memory in basal ganglia structures. The STN, a key basal ganglia structure, may adaptively link flexible impulse control with cognitive processing, potentially modulating substance use outcomes.
PMCID: PMC3412943  PMID: 22587751
Resiliency; Substance Use; Working Memory; STN; fMRI; PPI
11.  Emotion Modulates Early Auditory Response to Speech 
Journal of cognitive neuroscience  2009;21(11):2121-2128.
In order to understand how emotional state influences the listener’s physiological response to speech, subjects looked at emotion-evoking pictures while 32-channel EEG evoked responses (ERPs) to an unchanging auditory stimulus (“danny”) were collected. The pictures were selected from the International Affective Picture System database. They were rated by participants and differed in valence (positive, negative, neutral), but not in dominance and arousal. Effects of viewing negative emotion pictures were seen as early as 20 msec (p = .006). An analysis of the global field power highlighted a time period of interest (30.4–129.0 msec) where the effects of emotion are likely to be the most robust. At the cortical level, the responses differed significantly depending on the valence ratings the subjects provided for the visual stimuli, which divided them into the high valence intensity group and the low valence intensity group. The high valence intensity group exhibited a clear divergent bivalent effect of emotion (ERPs at Cz during viewing neutral pictures subtracted from ERPs during viewing positive or negative pictures) in the time region of interest (rΦ = .534, p < .01). Moreover, group differences emerged in the pattern of global activation during this time period. Although both groups demonstrated a significant effect of emotion (ANOVA, p = .004 and .006, low valence intensity and high valence intensity, respectively), the high valence intensity group exhibited a much larger effect. Whereas the low valence intensity group exhibited its smaller effect predominantly in frontal areas, the larger effect in the high valence intensity group was found globally, especially in the left temporal areas, with the largest divergent bivalent effects (ANOVA, p < .00001) in high valence intensity subjects around the midline. Thus, divergent bivalent effects were observed between 30 and 130 msec, and were dependent on the subject’s subjective state, whereas the effects at 20 msec were evident only for negative emotion, independent of the subject’s behavioral responses. Taken together, it appears that emotion can affect auditory function early in the sensory processing stream.
PMCID: PMC2771613  PMID: 18855553
12.  The effects of tryptophan depletion on neural responses to emotional words in remitted depression 
Biological psychiatry  2009;66(5):441-450.
Major depressive disorder (MDD) has been associated with both dysfunction of the central serotonergic system and abnormal responses to emotional stimuli. We used acute tryptophan depletion (ATD) to investigate the effect of temporarily reducing brain serotonin synthesis on neural and behavioural responses to emotional stimuli in remitted MDD subjects (rMDD) and healthy controls.
Twenty controls and 23 rMDD subjects who had been unmedicated and in remission for ≥3 months completed the study. Following tryptophan or sham depletion, participants performed an emotional-processing task during functional magnetic resonance imaging. In addition, resting-state regional blood-flow was measured using arterial spin labelling.
Neither group exhibited significant mood-change following ATD. However, tryptophan depletion differentially affected the groups in terms of hemodynamic responses to emotional words in a number of structures implicated in the pathophysiology of MDD, including medial thalamus and caudate. These interactions were driven by increased responses to emotional words in the controls, with little effect in the patients under the ATD condition. Following ATD, habenula blood-flow increased significantly in the rMDD subjects relative to the controls, and increasing amygdala blood-flow was associated with more negative emotional bias score across both groups.
These data provide evidence for elevated habenula blood-flow and alterations in the neural processing of emotional stimuli following ATD in rMDD subjects, even in the absence of overt mood-change. However, further studies are required to determine whether these findings represent mechanisms of resilience or vulnerability to MDD.
PMCID: PMC2745906  PMID: 19539268
Depression; Serotonin; Acute Tryptophan Depletion; Functional Magnetic Resonance Imaging (fMRI); Emotional Processing; Affective Go/No-go (AGNG)
13.  Happiness Unpacked: Positive Emotions Increase Life Satisfaction by Building Resilience 
Emotion (Washington, D.C.)  2009;9(3):361-368.
Happiness – a composite of life satisfaction, coping resources, and positive emotions – predicts desirable life outcomes in many domains. The broaden-and-build theory suggests that this is because positive emotions help people build lasting resources. To test this hypothesis we measured emotions daily for one month in a sample of students (N=86) and assessed life satisfaction and trait resilience at the beginning and end of the month. Positive emotions predicted increases in both resilience and life satisfaction. Negative emotions had weak or null effects, and did not interfere with the benefits of positive emotions. Positive emotions also mediated the relation between baseline and final resilience, but life satisfaction did not. This suggests that it is in-the-moment positive emotions, and not more general positive evaluations of one’s life, that form the link between happiness and desirable life outcomes. Change in resilience mediated the relation between positive emotions and increased life satisfaction, suggesting that happy people become more satisfied not simply because they feel better, but because they develop resources for living well.
PMCID: PMC3126102  PMID: 19485613
happiness; life satisfaction; ego-resilience; broaden and build
14.  The ethology of empathy: a taxonomy of real-world targets of need and their effect on observers 
Empathy is inherently interpersonal, but the majority of research has only examined observers. Targets of need have been largely held constant through hypothetical and fictionalized depictions of sympathetic distress and need. In the real world, people's response to life stressors varies widely—from stoicism to resilience to complete breakdown—variations that should profoundly influence the prosocial exchange. The current study examined naturally-varying affect in real hospital patients with serious chronic or terminal illness during videotaped interviews about quality of life. Participants viewed each video while psychophysiological data were recorded and then rated each patient's and their own emotion. Patients displayed three major emotion factors (disturbed, softhearted, and amused) that were used to classify them into five basic types (distraught, resilient, sanguine, reticent, wistful). These types elicited four major emotions in observers [personal distress (PD), empathic concern (EC), horror, pleasure], two of which were never discovered previously with fictionalized targets. Across studies and measures, distraught targets usually received the greatest aid, but approximately as many observers preferred the positive and likeable resilient patients or the quietly sad wistful targets, with multiple observers even giving their greatest aid to sanguine or reticent targets who did not display distress or need. Trait empathy motivated aid toward more emotive targets while perspective taking (PT) motivated aid for those who did not overtly display distress. A second study replicated key results without even providing the content of patients' speech. Through an ecological examination of real need we discovered variation and commonality in the emotional response to need that interacts strongly with the preferences of observers. Social interactions need to be studied in ethological contexts that retain the complex interplay between senders and receivers.
PMCID: PMC3749372  PMID: 23986680
empathy; altruism; perception-action; prosocial; sympathy; compassion; helping
15.  Individual Differences in Heart Rate Variability Predict the Degree of Slowing during Response Inhibition and Initiation in the Presence of Emotional Stimuli 
Response inhibition is a hallmark of executive control and crucial to support flexible behavior in a constantly changing environment. Recently, it has been shown that response inhibition is influenced by the presentation of emotional stimuli (Verbruggen and De Houwer, 2007). Healthy individuals typically differ in the degree to which they are able to regulate their emotional state, but it remains unknown whether individual differences in emotion regulation (ER) may alter the interplay between emotion and response inhibition. Here we address this issue by testing healthy volunteers who were equally divided in groups with high and low heart rate variability (HRV) during rest, a physiological measure that serves as proxy of ER. Both groups performed an emotional stop-signal task, in which negative high arousing pictures served as negative emotional stimuli and neutral low arousing pictures served as neutral non-emotional stimuli. We found that individuals with high HRV activated and inhibited their responses faster compared to individuals with low HRV, but only in the presence of negative stimuli. No group differences emerged for the neutral stimuli. Thus, individuals with low HRV are more susceptible to the adverse effects of negative emotion on response initiation and inhibition. The present research corroborates the idea that the presentation of emotional stimuli may interfere with inhibition and it also adds to previous research by demonstrating that the aforementioned relationship varies for individuals differing in HRV. We suggest that focusing on individual differences in HRV and its associative ER may shed more light on the dynamic interplay between emotion and cognition.
PMCID: PMC3204574  PMID: 22059080
heart rate variability; response inhibition; individual differences; emotion regulation; stop-signal task
16.  Visual Complexity Attenuates Emotional Processing in Psychopathy: Implications for Fear-Potentiated Startle Deficits 
A long-standing debate is the extent to which psychopathy is characterized by a fundamental deficit in attention or emotion. We tested the hypothesis that the interplay of emotional and attentional systems is critical for understanding processing deficits in psychopathy. Sixty-three offenders were assessed using the Psychopathy Checklist: Screening Version. Event-related brain potentials (ERPs) and fear-potentiated startle (FPS) were collected while participants viewed pictures selected to disentangle an existing confound between perceptual complexity and emotional content in the pictures typically used to study fear deficits in psychopathy. As predicted, picture complexity moderated emotional processing deficits. Specifically, the affective-interpersonal features of psychopathy were associated with greater allocation of attentional resources to processing emotional stimuli at initial perception (visual N1) but only when picture stimuli were visually-complex. Despite this, results for the late positive potential indicated that emotional pictures were less attentionally engaging and held less motivational significance for individuals high in affective-interpersonal traits. This deficient negative emotional processing was observed later in their reduced defensive fear reactivity (FPS) to high-complexity unpleasant pictures. In contrast, the impulsive-antisocial features of psychopathy were associated with decreased sensitivity to picture complexity (visual N1) and unrelated to emotional processing as assessed by ERP and FPS. These findings are the first to demonstrate that picture complexity moderates FPS deficits and implicate the interplay of attention and emotional systems as deficient in psychopathy.
PMCID: PMC3326229  PMID: 22187225
psychopathy; fear-potentiated startle; visual complexity; emotion; ERP
17.  Relationship among Medical Student Resilience, Educational Environment and Quality of Life 
PLoS ONE  2015;10(6):e0131535.
Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL) and educational environment perceptions in medical students.
We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young’s resilience scale (RS-14), the Dundee Ready Educational Environment Measure (DREEM), the World Health Organization Quality of Life questionnaire – short form (WHOQOL-BREF), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI).
Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score ≥ 14 and STAI state or anxiety scores ≥ 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (β=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (β=-0.85; 95%CI=-1.25 to -0.45) QoL scores, environment (β=-6.48; 95%CI=-10.01 to -2.95), psychological (β=-22.89; 95%CI=-25.70 to -20.07), social relationships (β=-14.28; 95%CI=-19.07 to -9.49), and physical health (β=-10.74; 95%CI=-14.07 to -7.42) WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (β=-31.42; 95%CI=-37.86 to -24.98), learning (β=-7.32; 95%CI=-9.23 to -5.41), teachers (β=-5.37; 95%CI=-7.16 to -3.58), academic self-perception (β=-7.33; 95%CI=-8.53 to -6.12), atmosphere (β=-8.29; 95%CI=-10.13 to -6.44) and social self-perception (β=-3.12; 95%CI=-4.11 to -2.12) DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements.
Medical students with higher resilience levels had a better quality of life and a better perception of educational environment. Developing resilience may become an important strategy to minimize emotional distress and enhance medical training.
PMCID: PMC4486187  PMID: 26121357
18.  Contextual Modulation of Physiological and Psychological Responses Triggered by Emotional Stimuli 
A series of emotional events successively occur in temporal context. The present study investigated how physiological and psychological responses are modulated by emotional context. Skin conductance response (SCR), heart rate, corrugator activity, zygomatic activity, and subjective feelings during emotional picture viewing were measured. To create an emotional context, a unpleasant or pleasant picture was preceded by three types of pictures, i.e., unpleasant, pleasant, and neutral pictures, resulting in six pairings. The results showed that viewing an unpleasant picture attenuated pleasant feelings induced by the following pleasant picture. On the other hand, preceding pleasant pictures decreased SCR to the following pictures. The effects of contextual modulation on emotional responses might be due to the informative function of pre-existing feelings; unpleasant feelings signal a threatening environment, whereas pleasant feelings signal a benign environment. With respect to facial muscle activities, viewing a pleasant picture decreased corrugator activity in response to the preceding picture. These findings suggest several types of contextual modulation effects on psychological, autonomic, and somatic responses to emotional stimuli.
PMCID: PMC3650463  PMID: 23675359
emotional context; IAPS; skin conductance response; heart rate; facial electromyography
19.  Resilient Individuals Use Positive Emotions to Bounce Back From Negative Emotional Experiences 
Theory indicates that resilient individuals “bounce back” from stressful experiences quickly and effectively. Few studies, however, have provided empirical evidence for this theory. The broaden-and-build theory of positive emotions (B. L. Fredrickson, 1998, 2001) is used as a framework for understanding psychological resilience. The authors used a multimethod approach in 3 studies to predict that resilient people use positive emotions to rebound from, and find positive meaning in, stressful encounters. Mediational analyses revealed that the experience of positive emotions contributed, in part, to participants’ abilities to achieve efficient emotion regulation, demonstrated by accelerated cardiovascular recovery from negative emotional arousal (Studies 1 and 2) and by finding positive meaning in negative circumstances (Study 3). Implications for research on resilience and positive emotions are discussed.
PMCID: PMC3132556  PMID: 14769087
20.  Cut! that’s a wrap: regulating negative emotion by ending emotion-eliciting situations 
Little is known about the potentially powerful set of emotion regulation (ER) processes that target emotion-eliciting situations. We thus studied the decision to end emotion-eliciting situations in the laboratory. We hypothesized that people would try to end negative situations more frequently than neutral situations to regulate distress. In addition, motivated by the selection, optimization, and compensation with ER framework, we hypothesized that failed attempts to end the situation would prompt either (a) greater negative emotion or (b) compensatory use of a different ER process, attentional deployment (AD). Fifty-eight participants (18–26 years old, 67% women) viewed negative and neutral pictures and pressed a key whenever they wished to stop viewing them. After key press, the picture disappeared (“success”) or stayed (“failure”) on screen. To index emotion, we measured corrugator and electrodermal activity, heart rate, and self-reported arousal. To index overt AD, we measured eye gaze. As their reason for ending the situation, participants more frequently reported being upset by high- than low-arousal negative pictures; they more frequently reported being bored by low- than high-arousal neutral pictures. Nevertheless, participants’ negative emotional responding did not increase in the context of ER failure nor did they use overt AD as a compensatory ER strategy. We conclude that situation-targeted ER processes are used to regulate emotional responses to high-arousal negative and low-arousal neutral situations; ER processes other than overt AD may be used to compensate for ER failure in this context.
PMCID: PMC3937988  PMID: 24592251
situation selection; situation modification; attentional deployment; process model; emotion regulation; SOC-ERpt
21.  Seeding Stress Resilience through Inoculation 
Neural Plasticity  2016;2016:4928081.
Stress is a generalized set of physiological and psychological responses observed when an organism is placed under challenging circumstances. The stress response allows organisms to reattain the equilibrium in face of perturbations. Unfortunately, chronic and/or traumatic exposure to stress frequently overwhelms coping ability of an individual. This is manifested as symptoms affecting emotions and cognition in stress-related mental disorders. Thus environmental interventions that promote resilience in face of stress have much clinical relevance. Focus of the bulk of relevant neurobiological research at present remains on negative aspects of health and psychological outcomes of stress exposure. Yet exposure to the stress itself can promote resilience to subsequent stressful episodes later in the life. This is especially true if the prior stress occurs early in life, is mild in its magnitude, and is controllable by the individual. This articulation has been referred to as “stress inoculation,” reminiscent of resilience to the pathology generated through vaccination by attenuated pathogen itself. Using experimental evidence from animal models, this review explores relationship between nature of the “inoculum” stress and subsequent psychological resilience.
PMCID: PMC4736400  PMID: 26881112
22.  Trait anxiety modulates fronto-limbic processing of emotional interference in borderline personality disorder 
Previous studies of cognitive alterations in borderline personality disorder (BPD) have yielded conflicting results. Given that a core feature of BPD is affective instability, which is characterized by emotional hyperreactivity and deficits in emotion regulation, it seems conceivable that short-lasting emotional distress might exert temporary detrimental effects on cognitive performance. Here we used functional magnetic resonance imaging (fMRI) to investigate how task-irrelevant emotional stimuli (fearful faces) affect performance and fronto-limbic neural activity patterns during attention-demanding cognitive processing in 16 female, unmedicated BPD patients relative to 24 age-matched healthy controls. In a modified flanker task, emotionally negative, socially salient pictures (fearful vs. neutral faces) were presented as distracters in the background. Patients, but not controls, showed an atypical response pattern of the right amygdala with increased activation during emotional interference in the (difficult) incongruent flanker condition, but emotion-related amygdala deactivation in the congruent condition. A direct comparison of the emotional conditions between the two groups revealed that the strongest diagnosis-related differences could be observed in the dorsal and, to a lesser extent, also in the rostral anterior cingulate cortex (dACC, rACC) where patients exhibited an increased neural response to emotional relative to neutral distracters. Moreover, in the incongruent condition, both the dACC and rACC fMRI responses during emotional interference were negatively correlated with trait anxiety in the patients, but not in the healthy controls. As higher trait anxiety was also associated with longer reaction times (RTs) in the BPD patients, we suggest that in BPD patients the ACC might mediate compensatory cognitive processes during emotional interference and that such neurocognitive compensation that can be adversely affected by high levels of anxiety.
PMCID: PMC3585713  PMID: 23459637
borderline personality disorder; cognition-emotion interaction; anxiety; fMRI; amygdala; anterior cingulate cortex
23.  “I know it when I see it.” The complexities of measuring resilience among parents of children with cancer 
Promoting parent resilience may provide an opportunity to improve family-level survivorship after pediatric cancer; however, measuring resilience is challenging.
The “Understanding Resilience in Parents of Children with Cancer” was a cross-sectional, mixed-methods study of bereaved and non-bereaved parents. Surveys included the Connor-Davidson Resilience scale, the Kessler-6 psychological distress scale, the Post-Traumatic Growth Inventory, and an open-ended question regarding the on-going impact of cancer. We conducted content analyses of open-ended responses and categorized our impressions as “resilient,” “not resilient,” or “unable to determine.” “Resilience” was determined based on evidence of psychological growth, lack of distress, and parent-reported meaning/purpose. We compared consensus-impressions with instrument scores to examine alignment. Analyses were stratified by bereavement status.
Eighty-four (88%) non-bereaved, and 21 (88%) bereaved parents provided written responses. Among non-bereaved, 53 (63%) were considered resilient, 15 (18%) were not. Among bereaved, 11 (52%) were deemed resilient, 5 (24%) were not. All others suggested a mixed or incomplete picture. Rater-determined “resilient” parents tended to have higher personal resources and lower psychological distress (p=<0.001–0.01). Non-bereaved “resilient” parents also had higher post-traumatic growth (p=0.02). Person-level analyses demonstrated that only 50–62% of parents had all 3 instrument scores aligned with our impressions of resilience.
Despite multiple theories, measuring resilience is challenging. Our clinical impressions of resilience were aligned in 100% of cases; however, instruments measuring potential markers of resilience were aligned in approximately half. Promoting resilience therefore requires understanding of multiple factors, including person-level perspectives, individual resources, processes of adaptation and emotional well-being.
PMCID: PMC4264630  PMID: 24756554
Cancer; Oncology; Pediatrics; Parents; Resilience; Psychosocial Outcomes
24.  Age-related differences in affective responses to and memory for emotions conveyed by music: a cross-sectional study 
There is mounting evidence that aging is associated with the maintenance of positive affect and the decrease of negative affect to ensure emotion regulation goals. Previous empirical studies have primarily focused on a visual or autobiographical form of emotion communication. To date, little investigation has been done on musical emotions. The few studies that have addressed aging and emotions in music were mainly interested in emotion recognition, thus leaving unexplored the question of how aging may influence emotional responses to and memory for emotions conveyed by music. In the present study, eighteen older (60–84 years) and eighteen younger (19–24 years) listeners were asked to evaluate the strength of their experienced emotion on happy, peaceful, sad, and scary musical excerpts (Vieillard et al., 2008) while facial muscle activity was recorded. Participants then performed an incidental recognition task followed by a task in which they judged to what extent they experienced happiness, peacefulness, sadness, and fear when listening to music. Compared to younger adults, older adults (a) reported a stronger emotional reactivity for happiness than other emotion categories, (b) showed an increased zygomatic activity for scary stimuli, (c) were more likely to falsely recognize happy music, and (d) showed a decrease in their responsiveness to sad and scary music. These results are in line with previous findings and extend them to emotion experience and memory recognition, corroborating the view of age-related changes in emotional responses to music in a positive direction away from negativity.
PMCID: PMC3797547  PMID: 24137141
aging; musical emotions; emotional responses; facial muscle activity; incidental recognition; positivity effect
25.  Batting 300 is Good: Perspectives of Faculty Researchers and their Mentors on Rejection, Resilience, and Persistence in Academic Medical Careers 
Professional rejection is a frequent experience in an academic medical career. The authors sought to understand how rejection affects those pursuing such careers and why some individuals may be more resilient than others in a population of individuals with demonstrated ability and interest in research careers.
Between February 2010 and August 2011, the authors conducted semi-structured, in-depth telephone interviews with 100 former recipients of National Institutes of Health mentored career development awards and 28 of their mentors. Purposive sampling ensured a diverse range of viewpoints. Multiple analysts thematically coded verbatim transcripts using qualitative data analysis software.
Participants described a variety of experiences with criticism and rejection in their careers, as well as an acute need for persistence and resilience in the face of such challenges. Through their narratives, participants also vividly described a range of emotional and behavioral responses to their experiences of professional rejection. Their responses illuminated the important roles that various factors, including mentoring and gender, play in shaping the ultimate influence of rejection on their own careers and on the careers of those they have mentored.
Responses to rejection vary considerably, and negative responses can lead promising individuals to abandon careers in academic medicine. Resilience does not, however, appear to be immutable—it can be learned. Given the frequency of experiences with rejection in academic medicine, strategies such as training mentors to foster resilience may be particularly helpful in improving faculty retention in academic medicine.
PMCID: PMC3645975  PMID: 23425991

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