### 71) Abstract 1307

## COPING WITH MEDICAL PROCEDURES: INTRODUCTION OF A NEW INVENTORY

Sarah Sturmbauer, M.Sc., Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Bayern, Germany, Michael Hock, PhD, Psychology, Otto-Friedrich-University Bamberg, Bamberg, Bayern, Germany, Nicolas Rohleder, PhD, Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Bayern, Germany, Eva-Maria Rathner, M.Sc., Psychology, Ulm University, Ulm, Baden-Württemberg, Germany, Andreas Schwerdtfeger, PhD, Psychology, Bergische Universität Wuppertal, Wuppertal, Nordrhein-Westfalen, Germany

Past research has shown that anxiety is associated with higher reports of psychosomatic symptoms. Environments which cause anxiety for a lot of people are hospitals or doctor appointments. The question arises whether better coping with anxiety may improve psychosomatic symptoms. Hence, the assessment of how individuals cope with medical procedures may lead to a better understanding of the association of anxiety, coping and health in general. This study reports on the construction and empirical evaluation of a coping inventory focusing on medical settings.

The "Coping in Medical Situations" (German: "Angstbewältigungsinventar für medizinische Situationen", ABI-MS) was constructed based on the model of coping modes. It aims to assess vigilant and cognitive avoidant coping in potentially threatening medical scenarios, e.g. colonoscopy. It is organized as a stimulus-response inventory with forced-choice ratings (true/not true). To evaluate the factorial structure of the inventory, we conducted an online survey on a sample of n=471 individuals (345 women, 126 men) with a mean age of 28.4 years. Participants completed the ABI-MS and the Mainz Coping Inventory (MCI). Psychometric properties were examined and exploratory full-information factor analysis based on the item response theory were computed.

Four scenarios proved particularly suitable with good model fit indices (RMSEA and CFI) to assess vigilance (VIG), and cognitive avoidance (CAV): venipuncture, wound care of a cut injury, narcosis prior to surgery, and colonoscopy. Final factor structure revealed two factors for each of the scenarios, with 4 items each, resulting in a total of 32 items. Cronbach's alphas were satisfactory ranging between .74 and .77. Pearson correlations revealed convergent validity of the ABI-MS with significant correlations with the physical threat (VIG: r = .51, p < .001; CAV: r = .52, p < .001) and the ego threat sub scale (VIG: r = .35, p < .001; CAV: r = .32, p < .001) of the MCI. Taken together, results indicate that the newly developed questionnaire successfully detects behavior tendencies across situations. Results further show that the ABI-MS is a reliable and valid instrument to assess vigilant and cognitive avoidant coping in medical settings. Future research using this inventory will have to show whether better coping with anxiety will be predictive of better health outcomes.

### 72) Abstract 1141

## ADAPTATION OF MEANING CENTERED PSYCHOTHERAPY TO PORTUGUESE LANGUAGE

Guida Da Ponte, MD, Psychiatry and Mental Health, Centro Hospitalar Barreiro-Montijo, Barreiro, Lisbon, Portugal, Sílvia Ouakinin, MD, PhD, University Clinic of Medical Psychology and Psychiatry, Medical School of Lisbon, Lisbon, Lisbon, Portugal, William Brexitbart, MD, Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York

**Introduction:** Meaning Centered Psychotherapy (MCP) is a new modality of psychotherapy that specifically address loss of spiritual well-being or sense of meaning in life that often arise in patients with advanced cancer. It was developed by Breitbat Group, inspired in the work of Frankl. MCP is a structured psychotherapy involving a combination of didactic teaching, exercises and discussions.

**Methods:** We performed three discussion groups starting with an introduction to MCP and delivery of exercises handouts for discussion.

The groups were composed by two patients with breast and stomach cancers, three mental health professionals without MCP knowledge and three patients with breast and head and neck cancers. All the patients had about 50 years old and were in full remission; the majority was women and with jobs with average differentiation.

Between the second and third groups, the authors adapted the handouts content.

**Results:** Difficulties were felt with the concepts "historical/attitudinal/creative/experiential sources of meaning", with the necessity of clarification to "achieve meaning through our personal history/ attitude to life/capacity to create and build/life experiences". In the case of experiential sources of "love, beauty and humor" it was needed to ask examples of "memories, thoughts and emotions triggered by these sources". Other difficulties emerged with concepts of "disconnection connection (to meaning)" (clarified to "turn off/on"), "legacy" ("life as something that we received and transmit"), "transcendence" ("to cross certain barriers becoming superior to certain circumstances") and "good death" ("quiet death").

**Discussion:** The adaptation of MCP triggered some doubts about the core concepts. These questions seem more culturally determined and independent of patients' educational level, as the group with mental health professionals raised nearly the same issues.

Between the second and third group, authors did a clarification of the concepts, not eliminating the original text, what substantially improved the comprehensibility.

**Conclusions:** Despite group size limitation, it was clear that existential issues and "meaning" (of life) were difficult to understand. The authors conclude that MCP adaptation to portuguese patients need some clarifications, keeping in mind that thinking about ones' existence and meaning in life is culturally determined.

### 73) Abstract 1628

## POLYPHARMACY EN MENTAL HEALTH IN PRIMARY CARE

Huibert van Dis, MD, Jos A. Bosch, PhD, Ferdi de Jong, BA Sc, Psychology, University of Amsterdam, Amsterdam, NH, Netherlands, Burkhard Schmidt, PhD, College for International management, University of Heidelberg, Heidelberg, BW, Germany, Hans U. Wittchen, PhD, Psychology, Technische Universität Dresden, Dresden, S, Germany

**Introduction.** There are indications that polypharmacy, the i.e., the cumulative use of prescribed medications, may have serious psychological side effects but this issue received scant attention. The present analyses aimed to explore associations between polypharmacy and psychiatric diagnoses.

**Methods.** Participants were recruited among patients attending GP practices throughout Germany, as part of a larger nation-wide study on cardiovascular risk factors in primary care (The Detect Study). Primary physicians provided data on prescribed medication and ICD-09 psychiatric diagnoses (rated as none, possible, and probable). The number of different prescribed medications was categorized (0-2, 3-4, 5-6, 7 and more).

**Results.** Complete data was available on 3056 patients (59 % female; mean age 61years; range 19-95). The number of medications prescribed varied between 0 – 11. Cardiovascular diseases explained the majority of prescribed medications (e.g., beta-blockers, antihypertensive drugs, statins), followed by anti-diabetic medication. Regression analysis (adjusted for age and gender) showed consistent associations between cumulative medication use and depressive disorder (Beta = .150; p < .0001), pain disorder (Beta = .145; p < .0001), sexual disorder (Beta = .102; p < .0001) and sleep disorder (Beta = .084; p < .0001).

**Conclusion.** Based on these analyses we conclude that the possible psychological and psychiatric side effects of polypharmacy, and in particular polypharmacy related to cardiovascular diseases and their risk-factors, warrant further attention in research and clinical practice.
DISTRACTION COPING AFTER ACUTE PSYCHOSOCIAL STRESS PREDICTS STEEPER POST-STRESS CORTISOL DECLINE

Johanna Janson, MSc, Nicolas Rohleder, PhD, Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Bayern, Deutschland

Psychosocial stress represents an unavoidable and often long-lasting burden over the lifespan. While chronic exposure to stress is considered as antecedent of stress-related disease, individuals' ability to copeefficiently with everyday stress might also be necessary to prevent adverse health outcomes. Furthermore, designing interventions to promote healthy coping behavior requires a better understanding of the efficiency of state-dependent coping mechanisms in acute stress situations.

In order to assess the natural occurrence of state coping manifestations after psychosocial stress and to evaluate their differential stress-buffering impact on HPA axis activity, fifty-nine healthy adults (59.3% female, mean age = 22.93 years) underwent the Trier Social Stress Test (TSST) and provided salivary cortisol samples 1 min before as well as 1, 20, 30, 45, and 60 minutes after stress exposure. Self-reported coping responses were obtained immediately after TSST using a 42-item state coping questionnaire (SVF ak-42). Subsequent factor-analyses revealed three factors ("denial coping", "distraction coping" and "stressor-devaluation/self-comforting") whose relative importance on curve progressions of cortisol increase and decline was assessed using hierarchical linear modeling (HLM).

Independent of sex, age, BMI, chronic stress, and self-reported depressiveness, "denial coping" was related with higher baseline levels of cortisol (β = 0.0798, SE = 0.0381, p = 0.04) while "distraction coping" significantly predicted steeper recovery after stress (linear effect: β = -0.0430, SE = 0.0184, p = 0.02) and less pronounced curvature (quadratic effect: β = 0.0043, SE = 0.0017, p = 0.02). "Stressor-devaluation/self-comforting" was unrelated with cortisol response and recovery (all p's > 0.72).

The explorative assessment of state-dependent coping manifestations and their relative importance in the prediction of cortisol reactivity and recovery reveal better cortisol recovery among individuals with high capacity to distract from psychosocial stress. Since analysis of HPA axis activity alone is insufficient to provide evidence of this assumed health-promoting effect of distraction coping, future investigations linking distraction coping and inflammatory processes should shed further light on the relationship between cognitive coping and health.

ANXIETY SENSITIVITY MODERATES THE RELATIONSHIP BETWEEN STRESS AND PHYSICAL HEALTH

Julie K. Cremeans-Smith, Ph.D., Megan Huston, B.A., Psychological Sciences, Kent State University at Stark, N Canton, OH

The Shared Vulnerability Model states that psychological vulnerabilities (ie, anxiety sensitivity, AS), predispose individuals to disabling conditions (PTSD, chronic pain) following life events. Those high in AS fear anxiety-related symptoms, believing these to have serious health consequences. AS may amplify negative emotional reactions to stressful life events. The present study examines AS as a potential moderator of the relationship between stress and physical health. In accordance with the shared vulnerability model, we hypothesized that health consequences of stress would be most evident among those with high levels of AS.

Participants were 94 students enrolled in General Psychology at Kent State University Stark Campus (33 males and 61 females; ages 18-54; 87.5% Caucasian). Subjects completed surveys: Anxiety Sensitivity Index, Perceived Stress Scale, Traumatic Stress Schedule, and the Patient Health Questionnaire-15. Regression models controlled for demographic characteristics in step one. AS and stress variables were entered in step two, centered interaction terms in step three.

Participants who perceived more stress during the previous month reported more physical health symptoms (R²=.311, p<.001; β=.483, p<.001), with AS significantly moderating this relationship (R²=.030, p=.023; β=.196, p=.023). Decomposition analyses revealed the slope of perceived stress on physical health symptoms to be significant at both levels of the moderator (low AS t[90]=3.24, p<.01; high AS t[90]=6.56, p<.01). Results suggest the combination of high levels of AS and perceived stress is particularly toxic for physical health. Similarly, participants with a history of more traumatic stress reported more physical health symptoms (R²=.246, p<.001, β=.283, p=.001). AS significantly moderated this relationship (R²=.030, p=.034, β=-.182, p=.034). In decomposition analyses, the slope of traumatic stress on physical health symptoms was significant only at low levels of AS (t[90]=3.64, p<.01). Participants with low levels of both trauma history and AS reported the fewest physical symptoms, while those with high levels of AS reported greater physical symptoms regardless of traumatic stress burden. The present results support The Shared Vulnerability Model, suggesting that AS influences the relationship between life events and physical health.

INDUCING NEGATIVE AFFECTIVE STATES TO ELEVATE SOMATIC SYMPTOM REPORTS IN FUNCTIONAL SYNDROME PATIENTS: THE MODERATING EFFECT OF DIFFICULTY IDENTIFYING FEELINGS

Maaike Van Den Houte, MSc, Katleen Bogaerts, PhD, Health Psychology, Lukas Van Oudenhove, PhD, Clinical and Experimental Medicine, Ilse Van Diest, PhD, Omer Van den Bergh, PhD, Health Psychology, University of Leuven, Leuven, Vlaams-Brabant, Belgium.

**Background:** Previous research has shown that patients with functional syndromes, such as fibromyalgia (FM) or Chronic Fatigue Syndrome (CFS), and high habitual symptom reporters report more somatic symptoms after induction of negative affect, while healthy controls and low habitual symptom reporters do not. The goal of this study was to investigate the role of possible moderators of this effect within a patient group, with a focus on alexithymia, trait negative affectivity (NA), and somatization.

**Methods:** Patients with FM and/or CFS (N=66) and healthy controls (HC, N=35) watched one block of neutral, one block of positive and one block of negative affective pictures. After every picture series, participants filled out a somatic symptom checklist and rated emotions experienced during the picture series on valence, arousal and perceived control. Trait NA was measured with the trait version of the PANAS, Alexithymia was measured with the Toronto Alexithymia Scale (TAS) and somatization was measured with the PHQ-15.

**Results:** Participants reported more somatic symptoms after viewing negative pictures compared to the neutral and positive pictures. Patients reported more symptoms overall, but, in contrast to our expectation, did not report relatively more symptoms after negative picture viewing than HC (condition by group interaction, p = .114). However, the effect of negative pictures on symptom reporting was more pronounced in patients who scored high on the "difficulty identifying feelings (DIF)" subscale of the TAS (condition x DIF interaction, p = 0.004). Moreover, patients scoring high on DIF gave less positive valence ratings for neutral and positive pictures but higher arousal ratings for negative pictures and overall lower feelings of control. Other potential moderators (trait NA, total alexithymia, or somatization) did not significantly influence somatic symptom reporting in a negative affective state.

**Conclusion:** Both patients with FM/ CFS and healthy controls report more somatic symptoms after watching negative pictures compared to positive and neutral pictures. In patients, this effect is moderated by their self-reported difficulty to identify feelings (DIF): patients scoring high on this trait reported more somatic symptoms after negative, but not positive or neutral picture viewing.
Predicted symptom checklist score after viewing positive, neutral or negative affective pictures by Difficulty Identifying Feelings (patients only)

<figure><img src="image_11.png" /></figure>

Score on "Difficulty identifying feelings (DIF)" subscale of TAS

## 77) Abstract 1215

### AUTONOMIC AND AFFECTIVE CONCOMITANTS OF RUMINATION IN CHILDREN: MODERATING ROLE OF FAMILY FUNCTIONING AND PARENTS DISPOSITIONS

Cristina Ottaviani, PhD, Neuroimaging, Santa Lucia Foundation, Rome, Italy, Antonia Lonigro, PhD, Developmental & Social Psychology, Blu Cioffi, MSc, Psychology, Demetria Manzi, MSc, Fiorenzo Laghi, PhD, Roberto Baiocco, PhD, Developmental & Social Psychology, Sapienza University of Rome, Rome, Italy

Although rumination has been broadly investigated in adults, less is known about its developmental antecedents. In this study, family functioning assessment was combined with rumination induction and concomitant physiological assessment in children to shed light into the multiple factors involved in the origin of rumination. Forty children (20 girls, mean age = 9.8 years; 20 boys, mean age = 9.4 years) were asked to describe their tendency to ruminate about four prototypical situations depicted in a series of ad-hoc developed vignettes while the ECG was continuously recorded to derive heart rate (HR) and its variability (HRV). After the state rumination induction, children performed a low demanding task with thought probes. We hypothesized that episodes of rumination detected during the task would be associated with impaired attention (indexed by reaction times; RT) and decreased HRV. The associations between such markers of emotion regulation capacities and family functioning as well as with parents and children's dispositional tendencies to ruminate were examined. As expected, rumination was associated with higher HR (F = 14.28, p < .0001) and lower HRV (F = 45.8, p < .0001), mood worsening (F_s > 7.92, p_s < .01), and slower RT (F = 18.15, p < .0001) compared to being on task. These effects were moderated by family functioning (flexibility and cohesion) and parents' dispositions (trait rumination). Lastly, child's baseline levels of sadness (β = .50, p = .02) and levels of flexibility in the family (β = -.75, p = .03) predicted state rumination during the task. Findings help our understanding of the developmental origins of rumination by the use of an experimental paradigm and both subjective and objective measures of ruminative tendencies in children.

## 78) Abstract 1466

### ANXIETY CORRELATES WITH PSYCHOSOCIAL AND BIOLOGICAL FACTORS IN A PSYCHOTHERAPY TRIAL WITH DEPRESSED CAD PATIENTS (SPIRR-CAD)

Hans-Christian Deter, MD., Medical Clinic Psychosomatic, Charité Campus Benjamin Franklin, Berlin, Berlin, Germany, Melanie Merswolken, PhD., Outpatient unit, Fliedner Klinik, Berlin, Berlin, Germany, Kristina Orth-Gomér, MD., Clinical Neuroscience, Karolinska Institutet, Stockholm, Stockholm, Sweden, Matthias Michal, MD., Manfred Beutel, MD., Dept. of Psychosomatic Med. & Psychotherapy, University of Mainz, Mainz, Rheinland Pfalz, Germany, Christoph Herrmann-Lingen, m, Dept. of Psychosomatic Med. & Psychotherapy, Univ. of Goettingen Medical Center, Goettingen, Low-saxony, Germany, Christian Albus, MD., Dept. of Psychosomatic Med. & Psychotherapy, University of Cologne, Cologne, NRW, Germany, Cora S. Weber, MD., Medical Clinic Psychosomatic, Charité Campus Benjamin Franklin, Berlin, Berlin, Germany

**Introduction:** In addition to depression, anxiety seems to be an independent risk factor for CHD and cardiac mortality. Associations with depression and no.0. of PCI were demonstrated in a former study.

In the present examination we aimed to replicate these findings and to analyze the association of anxiety with psychosocial and clinical measures. **Methods:** In this trial, 450 men (78.9%) and 120 women (21.1%) with CAD (age 75 y) and mild to moderate depression (scoring 8 or higher on HADS), were randomized to a stepwise psychotherapy intervention (INT) or usual care (UC). Standard risk factors, EF, NYHA and psychological measures (HADS, DS14, Vital Exhaustion (VE), SF 36, MMPI hostility) were collected at baseline and at 18-months follow up. **Results:** High anxiety (HA, HADS > 10) patients were more depressed (HADS, r = .38, p < 0.001) and more exhausted (VE, r = .44, p < 0.001) than low anxiety (LA) patients. In a multivariate model, baseline anxiety was associated (cor r²=.06,) with gender (p=0.005), age (p < 0.001) and severity of heart disease (NYHA; p=0.034). Between baseline and 18 months there was a significant decrease of anxiety in the INT-(m:10.5 SD 3.7 to m:7.8 SD 4.1 and UC group (m:10.4 SD 3.7 to m:7.6 SD 3.7), but no significant differences between groups. In a separate analysis of the total sample, 291 patients showed a anxiety decrease (AD, -4.2) and 105 an anxiety increase (AI, +1.9) during the study. AD patients had higher baseline values in negative affectivity (DS14; AD m:15.8 AI m:14.5; p < 0.02), quality of life (physical sum scale, SF-36; AD m:39.0 AI.m: 35.5; p=0.004), and lower values in cynicism (MMPI; AD m: 11.9 AI. m:13.5; p=0.006). AD and AI predicted the course of VE (AD m: -5.7, AI m: +2.3., <0.001) as well as the number of cardiovascular events during the study (AD m: .57 AI. m .82; p < 0.05). **Conclusion:** HA patients showed higher psychosocial and cardiologic impairment than LA patients. In this CAD sample selected for depressive symptoms it was possible to replicate partly former results on CAD patients with HA. As in the former study, both groups significantly reduced their anxiety. In low anxiety patients at baseline and A-increase cardiovascular events were more detected. Psychosocial interventions in CAD, which focus on depression, need to differentiate also on anxiety. HA and LA individuals in those studies seem an interesting scope for the future.

## 79) Abstract 1274

### A COPING WEBSITE INCREASES SELF-EFFICACY AND DECREASES PERCEIVED BARRIERS TO DONATION AMONG FIRST-TIME BLOOD DONORS.

Janis L. France, PhD, Christopher R. France, PhD, Bruce W. Carlson, PhD, Psychology, Ohio University, Athens, Ohio, Victoria Frye, MPH DrPH, Community Health and Social Medicine, City College of New York / New York Blood Center, New York, New York, Louisa Duffy, BA, Debra A. Kessler, RN MS, Mark Rebosa, MBA, Beth H. Shaz, MD, New York Blood Center, New York, New York

Brochure and video interventions have been shown to enhance donation attitudes and intentions to give blood, particularly when the information provides specific suggestions for coping with donation-related concerns. Using a college student sample, positive changes in attitudes and intentions were also obtained when the coping material was presented via a website in a controlled laboratory environment. The present study examines whether similar effects can be achieved when a web-based coping intervention is provided to novice donors from a major blood center. First-time New York Blood Center whole blood donors (N = 161; 55% female; Mean Age = 21.3, SD = 2.2) were recruited one week after their initial donation and randomly assigned to either a donation coping website or no-website control condition. Participants completed online measures of donation self-efficacy, decisional balance, and anxiety at baseline (2 weeks post-donation), completed the website intervention if so assigned (3 weeks post-donation), and repeated the online measures (8 weeks post-donation). A series of 2 Group (website, control) x 2 Time (baseline, post-intervention) ANOVAs were conducted. A significant effect of Group x Time, F (1,159) = 4.12, p < 0.05, on action self-efficacy was observed, reflecting a significant increase in self-efficacy among the website group with no change in the no-website group. There was also a significant Group x Time effect on decisional balance - cons, F (1,159) = 3.96, p < 0.05, indicating a significant decrease in perceived
barriers among the website group with no change in the control group. No significant effects of Group, Time, or Group by Time were observed for decisional balance pros. Finally, a marginal effect of Group x Time was observed for anxiety, F (1,159) = 3.21, p = 0.07, reflecting a decrease in anxiety among the website group with no corresponding change in the control group. These findings indicate that first-time blood donors, who are known to be at high risk for not providing a repeat donation, may be motivated to return by a web-based intervention that addresses their donation-related concerns. Using New York Blood Center donor database records we are currently tracking all participants to determine whether the observed changes in self-efficacy and decisional balance will be associated with increased future donation behavior.

## 80) Abstract 1139

### LIVE, TELEPHONE, AND VIDEOCONFERENCED DELIVERY VENUES FOR GROUP-BASED STRESS MANAGEMENT IN CHRONIC FATIGUE SYNDROME PATIENTS

Michael H. Antoni, Ph.D., Psychology, University of Miami, Coral Gables, FLorida, Daniel Hall, M.S., Psychiatry, Harvard/MGH, Boston, MA, Sara Milrad, B.S., Devika Jutagir, M.S., Psychology, University of Miami, Coral Gables, Florida, Emily Lattie, Ph.D., Medicine, Northwestern University, Chicago, IL, Sara Czaja, Ph.D., Dolores Perdomo, Ph.D., Psychiatry, University of Miami School of Medicine, Miami, Florida, MaryAnn Fletcher, Ph.D., Nancy Klimas, M.D., Medicine, Nova Southeastern University, Davie, Florida

**INTRODUCTION.** The biobehavioral stress model of Chronic Fatigue Syndrome (CFS) holds that stress relates to physiological dysregulation and CFS symptom exacerbation. Cognitive behavioral stress management (CBSM) may offer benefit, but given the nature of CFS symptoms, patients face practical barriers to attending in-person CBSM, which may be reduced by technology-assisted delivery. **METHODS.** We present the highlights of separate randomized controlled trials (RCTs) of 3-month programs of weekly in-person group CBSM (IP-CBSM), and telephone-based group CBSM (T-CBSM), and then describe the development and preliminary results from a novel video-conferenced CBSM for patients and partners (V-CBSM). **RESULTS.** IP-CBSM involved weekly groups for patients to learn CBSM techniques and instructions to practice these between sessions. Those in IP-CBSM showed significant reductions in stress and symptoms over a 5-month follow-up vs controls. T-CBSM involved 10 weekly group conference calls on telephones with displays that allowed access to audiotape summaries of CBSM modules for review between sessions. While T-CBSM also reduced stress, direct comparisons revealed that IP-CBSM groups were more powerful in reducing stress and T-CBSM did not reduce CFS symptoms. We then created a videophone/tablet-driven videoconferenced CBSM intervention (V-CBSM) for patients and partners that features 10 weekly videoconferences attended by groups of CFS patient-partner dyads (up to 4 dyads). V-CBSM also provides access to downloadable videos covering weekly CBSM summaries; expert summaries on topics such as stress and coping, and changing cognitive appraisals; and demonstration videos for relaxation procedures. An RCT is comparing the effects of V-CBSM to a time-matched patient-partner health education control condition. Preliminary analyses show that patients in V-CBSM report increased perceived stress management skills (awareness of tension, coping, assertiveness) vs controls over 5 months suggesting that V-CBSM may be efficacious. **CONCLUSION.** Using videoconferenced CBSM may strike a balance between the intensity of in-person sessions with the convenience of home delivery in the context of partner support.

## 81) Abstract 1059

### A PERSONALIZED AND INTERACTIVE WEB-BASED INNOVATION TO ADVANCE THE QUALITY OF LIFE AND CARE IN PATIENTS WITH HEART FAILURE (ACQUIRE-HF): A FEASIBILITY STUDY

Susanne S. Pedersen, PhD, Psychology, Thomas Schmidt, PhD, Health Informatics, Søren Jensen, MSc, Psychology, Uffe K. Wiil, PhD, Health Informatics, University of Southern Denmark, Odense, Southern Denmark, Denmark, Kenneth Egstrup, MD, DMSc, Cardiology, Odense University Hospital & Svendborg Hospital, Svendborg, Southern Denmark, Denmark, Kim Smolderen, PhD, John Spertus, MD, PhD, Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri

Heart failure (HF) is a complex and debilitating condition, the end stage of most heart diseases, and comprises a global health and economic burden. Despite improved treatment options, hospitalization and mortality rates remain high. Thus, we are still searching for sustainable and successful care modalities to advance the quality of care for these patients. A multi-disciplinary, international team of experts together with end users will develop an innovative patient-centered ICT solution to empower patients to live a better and longer life with their disease. The clinical and economic impact of the innovation will be evaluated in a randomized controlled trial (RCT) design in 589 HF patients in Denmark. A full MAST (Model for ASsessment of Telemedicine) evaluation will be included. We now have data from focus group interviews and from the pilot study (n=26). Patients completed purpose-designed and standardized and validated questionnaires at baseline and at 3 months follow-up. Both patients (n=10) and nursing staff (n=3) from the outpatient HF clinic were interviewed post intervention with respect to feasibility and implementation. Patients' actual use of the platform, as indicated by the number of times that patients were logged on, varied considerably from 0-105 times during the 3 months follow-up period (total number of logins=1338; mean=58.2 ± 37.3 times; median = 71.0; IQR = 70). Three patients never logged on. Patients with higher expectations towards use of the platform at baseline reported a higher score with respect to their experiences after 3 months (Pearson's r = .41; p = .10), with expectations accounting for 17% of the variance in patients' experiences. Of the 26 patients, 19 patients had health status data at baseline and 3 months, with 8 patients deteriorating and 10 improving their health status. Of the 10 interviewed patients, 7 patients found the platform helpful, e.g. "I have been staying at home for many years. It was nice to have the platform to be able to monitor my own health. You gain knowledge about your disease and get a feeling that you are more involved in the process". ACQUIRE-HF represents an innovative and sustainable paradigm shift of HF care, with the first results showing promise both with respect to feasibility of use and impact on patients' lives, with recommendations based on the qualitative data shown in Table 1.
<figure><img src="image_12.png" /><figcaption>**Table 1.** Recommendations based on the results of the ACQUIRE-HF feasibility study</figcaption></figure>

## 82) Abstract 1574

# A PRELIMINARY STUDY ON THE ASSOCIATION BETWEEN VAGALLY MEDIATED HEART RATE VARIABILITY AND SELF-REPORTED DRUG ABUSE

Alexa D. Barton, B.S., Psychology, The Ohio State University, Columbus, Ohio, Cameron R. Wiley, B.S., Psychology, The Ohio University, Columbus, Ohio, DeWayne P. Williams, M.A., Psycholog, Derek P. Spangler, PhD, Psychology, The Ohio State University, Columbus, Ohio, Julian Koenig, Dr. sc. Hum, Psychology, Section for Translational Psychobiology in Child and Adolescent Psychiatry and the Department of Child and Adolescent Psychiatry, The Ohio State University, Centre for Psychosocial Medicine at University of Heidelberg, Heidelberg, Baden-Württemberg, Germany, Julian F. Thayer, PhD, Psychology, The Ohio University, Columbus, Ohio

Drug and alcohol abuse is a common issue in society, and has been linked with poorer executive brain function (e.g., prefrontal cortex), and thus poorer self-regulation and overall health. Similarly, resting vagally-mediated heart rate variability (vmHRV), an index of executive brain function and cardiac vagal tone, has also been linked with self-regulation and overall health. Specifically, lower resting vmHRV is associated with decreased executive brain function, lesser self-regulation abilities, and poorer overall health. Converging evidence has linked alcohol abuse with vmHRV reactivity (e.g., under task demands), however little research has been conducted on substance abuse and tonic (resting) vmHRV. Moreover, research has not yet linked vmHRV with general drug abuse tendencies. Therefore, the following preliminary analysis sought to examine the relationship between resting vmHRV and self-reported drug abuse tendencies in 32 college-age participants (mean age = 22; standard deviation = 5; 19 females). Subjects were attached to a 3-lead electrocardiogram (ECG) and first completed a 5-minute baseline-resting period. Participants then completed a set of self-report questionnaires, including the 28-item Drug Abuse Screening Test (DAST), with higher scores reflecting more drug abuse tendencies. High frequency heart rate variability was measured in accordance with Task Force (1996) guidelines and was regarded as the measure of vmHRV. Non-parametric (rho) correlations showed a significant negative relationship between resting vmHRV and DAST scores ($r_{rho} = -.375, p = .032$), such that a higher drug abuse tendencies was associated with lower resting vmHRV. These preliminary data both support the prior evidence on the link between substance abuse and vmHRV, and extend this notion into the domain of everyday drug abuse tendencies. In sum, these preliminary data

potentially assist in better understanding the neurophysiological contaminants of drug abuse, and subsequently, the complex relationship between drug abuse, self-regulation, and health.

## 83) Abstract 1103

# MOTIVATIONAL INTERVIEWING ENHANCES INTERNAL MOTIVATION FOR FUTURE DONATIONS AMONG RECENT FIRST-TIME BLOOD DONORS.

Christopher R. France, PhD, Janis L. France, PhD, Bruce W. Carlson, PhD, Psychology, Ohio University, Athens, Ohio, Victoria Frye, PhD, Community Health and Social Medicine, City College of New York / New York Blood Center, New York, NY, Louisa Duffy, BA, Donor Center Support, Debra A. Kessler, RN MS, Special Donor Services, Mark Rebosa, MBA, Data Management and Market Research & Analysis, Beth H. Shaz, MD, New York Blood Center, New York, NY

Self-determination theory (SDT) proposes that people are more likely to persist with behaviors that are internally-motivated, and that externally-motivated behavior can become internalized given the appropriate socio-environmental conditions. For example, SDT posits that motivation may become increasingly internalized and self-determined via satisfaction of the fundamental human need for autonomy (i.e., a sense of volitional control over one's behavior).

Consistent with this notion, among experienced blood donors it has been demonstrated that a telephone-delivered motivational interview that encourages autonomy in making future donation decisions enhances internal motivation and increases subsequent donations. Because many first-time blood donors do not go on to provide a second donation, the present study was designed to determine whether motivational interviewing could similarly enhance internal motivation for giving among new donors. First-time New York Blood Center donors (N=160; 45% female; Mean Age = 21.3, SD = 2.3) were recruited and randomly assigned to either a treatment-as-usual control group or a brief (~15 minute) telephone-delivered motivational interview conducted 3 to 6 weeks after their initial donation. Participants completed the Blood Donor Identity Survey at approximately 2 weeks post-donation and again at approximately 8 weeks post-donation, and this measure was used to compute subscale scores reflecting Amotivation, External Motivation, and Internal Motivation. There were no significant group differences on these motivation subscales at the initial administration. However, examination of change scores from the first to the second administration revealed that, relative to controls, participants who received the motivational interview showed greater increases in Internal Motivation, $F(1,159) = 4.80, p<0.05$. There were no significant differences with respect to changes in Amotivation, $F(1,159) = 0.50, p=0.48$, or External motivation, $F(1,159) = 0.83, p=0.36$. These findings indicate that a brief motivational interview promotes a sense of autonomy among first-time blood donors. Using New York Blood Center donor database records we are currently tracking all participants to determine whether, consistent with SDT, the observed increases in internal motivation will be associated with increased future donation behavior.

## 84) Abstract 1291

# EXAMINING ACCEPTABILITY FOR UTILIZING SMARTPHONES IN HEALTH BEHAVIOR CHANGE PROGRAMMING

Frank T. Materia, M.H.S., Biobehavioral Health, Danielle Symons Downs, Ph.D., Kinesiology and Obstetrics & Gynecology, Joshua M. Smyth, Ph.D., Biobehavioral Health and Medicine, The Pennsylvania State University, University Park, PA

Nearly two-thirds of adults in the US own smartphones; coupled with the expansive capabilities of smartphones to collect data and deliver content there is burgeoning interest in harnessing mobile technology to implement (either all or portions of) health promotion interventions. Yet, there is little research regarding the acceptability of utilizing a
smartphone for delivery of health behavior change programming, and if this varies across samples. **Purpose:** We investigated community perceptions about utilizing a smartphone as part of a health behavior change program in two independent studies. **Methods:** Study 1 sampled urban college students (n=130; M age=20; 47% Caucasian) via survey; study 2 was a focus group of rural adult women (n=40; M age=28; 93% Caucasian). Both samples answered similar items regarding smartphone ownership and rated acceptability of using the device for health behavior change (e.g., would having intervention content on the smartphone be useful; enjoyable; interesting; important; efficient). **Results:** 100% of urban student participants owned a smartphone, as did 85% of rural women. Smartphone intervention acceptability dimensions (1=not at all, 5=very much) were above the mean (i.e., 3=acceptable) for urban students: useful (M=3.9), enjoyable (M=3.2), interesting (M=3.4), important (M=3.3), efficient (M=3.7). Acceptability dimensions (1=not at all, 7=very much) were high (4=acceptable) for rural women: useful (M=6.3), enjoyable (M=5.9), interesting (M=5.3), important (M=5.7), efficient (M=5.8). **Conclusion:** Both groups exhibited high levels of device ownership. The majority in both studies reported the possibility of intervention content delivered via smartphone to be acceptable. Rural women expressed somewhat higher rates of acceptability than urban students for using the device as part of a health behavior change program, possibly due to greater salience of health behavior challenges. These results suggest using mobile technology for the delivery of health behavior interventions is widely accepted, supporting the feasibility of this approach. We also discuss the potential role of within group moderators of, and potential barriers to, acceptability (e.g., advanced age, design/content barriers).

## 85) Abstract 1585

### RESTING HIGH FREQUENCY HEART RATE VARIABILITY AND EVERYDAY MUSIC LISTENING TENDENCIES

Geoff D. Green II, Neuroscience, Psychology, The Ohio State University, Columbus, Ohio, Unites States, DeWayne P. Williams, Clinical Psychology, Lassiter F. Speller, Clinical Psychology, Nicholas Joseph, Clinical Psychology, Psychology, The Ohio State University, Columbus, Ohio, Julian Koenig, Neurobiology, Child and Adolescent Psychiatry, The Ohio State University/University of Heidelberg, Heidelberg, Germany, Europe, Derek P. Spangler, Clinical Psychology, Julian Thayer, PhD, Psychology, The Ohio State University, Columbus, Ohio

Research has compartmentalized everyday music listening tendencies into three main motivations, including cognitive (intellectual appreciation), emotional (emotional regulation), and background-stimulus (background noise) listening. Research has showed that listening to music can influence brain activity, including executive brain regions such as the prefrontal cortex, and has been linked with overall well-being. Interestingly, high-frequency heart rate variability (HF-HRV) is considered an index of both overall health and executive brain region activity, while lower HF-HRV is associated with lesser activity in executive brain regions, poorer overall health, and poorer self-regulation abilities (e.g. emotion regulation). However, to date, no study has linked HF-HRV with individuals' motivations to listen to music, as they may have consequences for both physical and psychological well-being. The following study sought to examine how HF-HRV under various conditions was associated with self-reported everyday music listening tendencies. In a sample of 36 college-aged participants (22 women), continuous heart rate data was collected via an electrocardiogram as participants first completed a 5-minute resting-baseline, followed by a physiological (standing) and psychological (memory) task, each followed by a 5-minute recovery period. During a subsequent questionnaire period, participants completed a 15-item questionnaire that assessed their music listening tendencies. Results showed a greater tendency to listen to music in an emotional manner was significantly associated with HF-HRV during the orthostatic (r = -.439, p < .01), orthostatic recovery (r = -.337, p < .05), and task

recovery (r = -.386, p < .05) phases. Additionally, results showed a greater tendency to listen to music in a cognitive manner was significantly associated with HF-HRV during the baseline (r = -.419, p < .05), orthostatic recovery (r = -.380, p < .05), and task recovery (r = -.355, p < .05) phases. However, no results were found regarding background music listening. These data are the first to examine how HF-HRV under various conditions is related to music listening tendencies. Overall, these data suggest that those with lower HF-HRV may seek external sources, such as music, for emotion regulation and cognitive purposes; important implications will be discussed.

## 86) Abstract 1383

### A 12-WEEK FITBIT-ASSISTED WALKING INTERVENTION IMPROVES BODY FUNCTION SATISFACTION IN OLDER WOMEN AND DECREASES PHYSICAL LIMITATIONS IN MIDDLE-AGED WOMEN

Idelle Vaynberg, B.S., Ashley M. Geiger, M.A., Claire Elling, M.A., William K. Goodman, M.A., Heather Sherman, B.A., Jutta M. Wolf, PhD, Psychology, Brandeis University, Waltham, MA

Background: Increasing age is associated with declines and often limitations in physical functions and recent studies further emphasize the accompanying declines in body function satisfaction. Exercise intervention studies suggest that increasing physical activity can lead to increases in body function satisfaction. However, little is known 1) as to whether increasing physical activity will be beneficial for older adults as well; 2) to what extent improvements in body function satisfaction are tied to decreases in physical limitations; and 3) whether potential physical benefits are accompanied by mental health benefits.
Method: To address these questions, 43 sedentary females (59±6.5yrs.) were enrolled in a 12-week physical activity intervention. Participants self-reported on physical function satisfaction (Body Esteem Scale) and physical ability (SF-36) and recorded daily steps with Fitbit step counting devices during weeks 1 and 12.

Results: Over the course of the intervention, participants showed increases in steps (F=26.93, p<.001), physical ability (F=3.97, p=.053) and physical function satisfaction (F=25.68, p<.001). However, while overall older females improved more than middle-aged females in terms of body function satisfaction (β=0.27, p=.073), satisfaction improvements were more dependent on physical ability improvements in middle-aged than older women (β=-0.34, p=.05). Furthermore, again just for middle-aged women, increases in physical ability and function satisfaction both translated into decreases in depressive symptoms (β=0.52, p=.003; β=0.31, p=.037, resp.).

Conclusions: The current walking intervention successfully increased participants' weekly steps, and particularly benefitted older women in terms of body function satisfaction increases. Interestingly, only for middle-aged women, however, changes in satisfaction appeared to be closely tied to increases in actual physical ability and both, in turn, were linked to improvements in depressive symptoms. The latter was again not true in older women. This may suggest that older women decouple mental health from physical functioning satisfaction and physical ability, which may be a beneficial strategy to compensate for present physical limitations. These findings provide insight into how the female aging process differentially affects physical activity benefits.

## 87) Abstract 1267

### MARIJUANA AND SYNTHETIC MARIJUANA (SM) OVERDOSE/WITHDRAWAL SYMPTOMS IN YOUNG ADULTS: APPLYING AND IMPLEMENTING STRICTER REGULATIONS ON USE: A CASE-REPORT

John S. Samaan, MD MPH, Boye Akinyemi, MD, Gerardo F. Ferrer, MD, Juan D. Oms, MD, Psychiatry Department, Larkin Community Hospital, South Miami, FL, Patricia Junquera, MD, Psychiatry Department, University of Miami Miller School of Medicine / Jackson Memorial Hospital, Miami, FL, Rhaisa Dumenigo, MD, Psychiatry Department, Marcos-Sanchez A. Gonzalez, MD PHD, Psychiatry
**Case Presentation:** The patient is an 18 year old Hispanic Male who lives with his parents. Patient voluntarily presented to our Hospital on 9/10/2015 to due to symptoms of psychosis, panic attacks (w/o agoraphobia), and paranoid ideations. Per mother, patient was exhibiting symptoms of panic attacks - including palpations, SOB, diaphoresis, tightness in chest, and numbness in his hands. Additionally, patient seemed impulsive, agitated, exhibiting slight delusional behavior, and mild psychosis. He also stated that he had been exhibiting suicidal thoughts. In this regard, patient mentioned that he started experiencing these suicidal thoughts about 4-5 days prior, which was the same time that he last used synthetic marijuana. The patient did admit he used marijuana habitually, but recently also started to use synthetic marijuana (~3 months prior) due to peer pressure and curiosity stating, "I just wanted to try it." Other culprits to patient's synthetic marijuana use included his recent breakup with his girlfriend, and the emotional distress he had to deal with the divorce of his parents. A Urine Drug Screen in the ED, did show he was positive for THC.

**Conclusion:** This case, as many others nationwide, exemplifies the impact of synthetic cannabinoid use and abuse in adolescents. Side effects and adverse health consequences of synthetic cannabinoid use warrants stricter regulations and policies in order to decrease psychiatric hospital admissions and associated healthcare costs. A table is attached below which points out the similarities & differences between the characteristics of synthetic cannabis and cannabis.

<table><caption>**Table 1: Cannabis Characteristic vs. Synthetic Marijuana (SM) Characteristics: Similarities and Differences**</caption><thead><tr><th>Topic of concern</th><th>Cannabis Characteristics</th><th>Synthetic Marijuana (SM) Characteristics</th></tr></thead><tbody><tr><td>Adverse side effects</td><td>According Karant (2004) the following effects occur with cannabis use – (1)<ul><li>Elevated Mood</li><li>Relaxation</li><li>Altered Perception of surrounding conditions</li><li>Symptoms of Psychosis (Delusions, disorganized thinking and detached from reality)</li><li>Cognitive deficits during acute intoxication</li><li>Precipitation of onset or relapse of schizophrenia</li><li>Cannabis dependence</li></ul></td><td>According to Freeman et al 2013 (2), the following side effects could occur with SM use:<ul><li>Ischemic stroke</li><li>Elevated mood</li><li>Relaxation</li><li>Altered Perception of surrounding conditions</li><li>Extreme Psychosis (Delusions, disorganized thinking and detached from reality to a great extent)</li><li>Violent behavior and suicidal thoughts</li><li>Tachycardia</li><li>Severe abdominal pain, nausea, vomiting that occurs over several months and resolves when SM use has been discontinued (known as synthetic cannabinoid hyperemesis syndrome)</li></ul></td></tr><tr><td>Mechanism of action</td><td>Binds to cannabinoid receptors in the brains and other organs as the endogenous ligand – anadamide. (3)</td><td>Binds to cannabinoid-like receptors in the brains and other organs as the endogenous ligand – anadamide (3)<ul><li>Synthetic cannabinoids and other identical products seem to have a similar mode of action as marijuana, in which these substances have affinity to various cannabinoid receptors (e.g. CB 1, CB2). (3)</li></ul>Synthetic cannabinoids ('Spice') fall into seven major structural groups:<br>Note that spice has high potency and high affinity for cannabinoid receptors this making it very efficacious (6).<ul><li>Naphthoylindoles (e.g. JWH-018, JWH-073 and JWH-398)</li><li>Naphthylmethylindoles</li><li>Naphthoylpyrroles</li><li>Naphthylmethylindenes</li><li>Phenylacetylindoles (i.e. benzoylindoles, e.g. JWH-250)</li></ul></td></tr></tbody></table>

<table><caption>**Table 1: Cannabis Characteristic vs. Synthetic Marijuana (SM) Characteristics: Similarities and Differences**</caption><tr><td></td><td><ul><li>Remains illegal in most parts of the united states. State laws determine the legality of marijuana. (5)</li><li>Available illegally in most US states.</li></ul></td><td><ul><li>Cyclohexylphenols (e.g. CP 47,497 and homologues of CP 47,497)</li><li>Classical cannabinoids (e.g. HU-210).</li></ul></td></tr><tr><td>Availability</td><td><ul><li>Remains illegal in most parts of the united states. State laws determine the legality of marijuana. (5)</li><li>Available illegally in most US states.</li></ul></td><td><ul><li>Readily available in the United States because manufacturers are able to bypass the law by changing chemical compounds that have been outlawed thus creating various cannabinoid-like substances which have not been studied for side effects (6).</li><li>In most countries around the world, including the United States, synthetic cannabis is illegal.</li><li>Cannabinoids are becoming more readily available in the United States due to articles and documentaries showing its benefits in regulating mood and also control of epileptiform activities (4).</li></ul></td></tr><tr><td>Screening & Detection</td><td><ul><li>THC compound can be detected consistently by simple serum, urine or oral swab tests (7)</li><li>Compound can be detected for up to 5-7 days depending on body fluid obtained and quantity of cannabis exposure (7)</li></ul></td><td><ul><li>Newly developed laboratory tests are able to successfully detect up to 20 synthetic cannabinoid substances. Due to the constant changes made to the compounds, it is difficult to have a single test determining the presence of synthetic cannabinoids in body fluids (7).</li><li>New advances have shown that liquid chromatography/tandem mass spectrometry (LC-MS/MS) and gas chromatography/mass spectrometry (GC/MS) can detect several metabolites of synthetic cannabinoid substances in the urine: JWH-018 and JWH-073, along with other various metabolites (7).</li><li>Compounds can be detected for up to 2-3 days based on immunoassay utilized and quantity of synthetic cannabinoid exposure (7).</li></ul></td></tr></table>

<caption>**Table 1: Cannabis Characteristic vs. Synthetic Marijuana (SM) Characteristics: Similarities and Differences**</caption>

### REFERENCES FOR TABLE 1:

1. Harold Karant (2004), Adverse effects of cannabis on health: an update of the literature since 1996. Progress in Neuro-Psychopharmacology and Biological Psychiatry Volume 28, Issue 5, August 2004, Pages 849-863

2. Melissa J. Freeman, MD, David Z. Rose, MD, Martin A. Myers, MD, Clifton L. Gooch, MD, Andrea C. Bozeman, MS, ARNP-C, and W. Scott Burgin, MD. (Dec 2013). Ischemic stroke after use of the synthetic marijuana "spice". American Academy of Neurology.

3. Vardakou I, Pistos C, Spiliopoulou ch 2010. Spice drugs as a new trend: mode of action, identification and legislation. Toxicology letters.1;197(3):157-62. doi: 10.1016/j.toxlet.2010.06.002

4. Evan C. Rosenberg1 & Richard W. Tsien & Benjamin J. Whalley & Orrin Devinsky (2015). Cannabinoid and Epilepsy. Neurotherapeutics. DOI 10.1007/s13311-015-0375-5

5. Gerald J. McKenna MD. (2014). The Current Status of Medical Marijuana in the United States. HAWAII JOURNAL OF MEDICINE & PUBLIC HEALTH, APRIL 2014, VOL 73, NO 4

6. Max Spaderna, Peter H Addy and Deepak Cyril D'Souza. (2013). Spicing thing up: Synthetic cannabinoids. NIH public access. Psychopharmacology (Berl). 2013 August; 228(4): 525-540. doi:10.1007/s00213-013-3188-4.

7. Ross H. Lowe, Tsadik T. Abraham, William D. Darwin, Ronald Herning, Jean Lud Cadet, and Marilyn A. Huestis. (2009). Extended Urinary Δ9-Tetrahydrocannabinol Excretion in Chronic Cannabis Users Precludes Use as a Biomarker of New Drug Exposure. NIH public access. Drug Alcohol Depend. 2009 November 1; 105(1-2): 24-32. doi:10.1016/j.drugalcdep.2009.05.027

Poster 88) WILL NOT BE PRESENTED
## 89) Abstract 1560

# TOWARD A BIOPSYCHOSOCIAL ECOLOGY OF THE HUMAN MICROBIOME AND HEALTH: CHARTING A DIRECTION FOR PSYCHOSOMATIC MEDICINE

Karl J. Maier, Ph.D., Psychology, Salisbury University, Salisbury, MD, Mustafa al'Absi, Ph.D., Duluth Medical Research Institute, University of Minnesota Medical School, Duluth, MN

Forty years ago, George Engel's (1977) advocacy for a new biopsychosocial (BPS) model initiated the evolution in Western medicine from a largely reductionist paradigm toward wide acceptance of biological, psychological, and social influences on health. Today, the rapidly growing literature on the human microbiome, and the gut microbiota in particular with its vast implications for health, suggests that medicine is again poised for significant evolution, or perhaps revolution. The development of applicable knowledge within this new area will likewise require a broad and inclusive paradigm, given the apparent sensitivity of the microbiota to perturbations across a cascade of BPS influences.

We propose a BPS ecological framework of the human microbiome and health that characterizes environmental and human factors as members of a global, dynamic set of interacting systems spanning BPS domains, levels of scale, and time - from the most immediate-level molecular, genetic, and neural processes to the most distal ecosystems. For example, in recent decades, shifts in biodiversity of the human gut and the rise of inflammatory and related diseases in industrialized societies parallel the proliferation of antibiotic use and resistance, as well as critical shifts in biodiversity observed at various scales globally. This likely reflects a dynamic interplay of biological, psychological/behavioral, and social systems at all levels of scale that ultimately interact with the gut microbiota, host systems, and their synergies. In turn, the host is integral to determining these systems.

The BPS ecological framework is aspirational, as was Engel's original BPS model, to more fully embody the reach of psychosomatic medicine through better reflecting the totality of interacting systems that determine health. Accordingly, it encourages replicable, generalizable research and practices through its broad consideration of the complex and dynamic systems that may otherwise be overlooked, studied within disciplinary silos, or understood out of context. A BPS ecological approach also bridges basic laboratory and clinical science, and transcends disciplines in ways that facilitate discovery. From a public health perspective, this paradigm may ultimately promote sustainable psychological, social, and bio-environmental systems that broadly support microbial-human health.

## 90) Abstract 1073

# INFLUENCES OF LIFESTYLE FACTORS ON CARDIAC AUTONOMIC NERVOUS SYSTEM ACTIVITY OVER TIME

Mandy Xian Hu, MSc, Femke Lamers, PhD, Psychiatry, VU University Medical Centre, Amsterdam, Noord-Holland, The Netherlands, Eco de Geus, PhD, Biological Psychology, VU University, Amsterdam, Noord-Holland, The Netherlands, Brenda Penninx, PhD, Psychiatry, VU University Medical Centre, Amsterdam, Noord-Holland, The Netherlands

Physical activity, alcohol use and smoking might affect cardiovascular disease through modifying autonomic nervous system (ANS) activity. We investigated: 1) whether there are consistent relationships between lifestyle factors and cardiac ANS activity over time, and 2) whether 2-year changes in lifestyle factors relate to 2-year changes in cardiac activity. Baseline (n=2618) and 2-year follow-up (n=2010) data of the Netherlands Study of Depression and Anxiety was combined. Lifestyle factors were habitual physical activity, frequency of sport activities, alcohol use, and smoking. Indicators of cardiac activity were heart rate (HR), respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP) (100 minutes recorded with the 'Vrije Universiteit Ambulatory Monitoring System'). The results showed that high physical activity (-1.8beats/min compared to low activity), high frequency of sport

activities ('couple of times/week':-2.5beats/min compared to 'almost never') and mild/moderate alcohol use (-1.2beats/min compared to non-drinking) were related to low HR. Heavy smoking was related to high HR (>30cigarettes/day:+5.1beats/min compared to non-smoking). High frequency of sport activities was associated with high RSA ('couple of times/week':+1.7ms compared to 'almost never') and moderate smoking with longer PEP (11-20cigarettes/day:+2.8ms compared to non-smoking). Associations were consistent across waves. Furthermore, 2-year change in frequency of sport activities and number of smoked cigarettes/day was accompanied by 2-year change in HR (β=-.076 and β=.101, respectively) and RSA (β=.046 and β=-.040, respectively). Our findings support consistent effects of lifestyle on HR and parasympathetic activity in the expected direction. Cardiac autonomic dysregulation may be partly mediating the relationship between lifestyle and subsequent cardiovascular health.

## 91) Abstract 1499

# PERSONALIZED INTERNET-BASED SELF-HELP FOR PATIENTS WITH MEDICALLY UNEXPLAINED SYMPTOMS: DESIGN OF AN INTERVENTION AND RANDOMIZED CONTROLLED TRIAL

Anne van Gils, MD, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, Groningen, Netherlands, Huib Burger, PhD, Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, Groningen, Nederland, Robert A. Schoevers, MD PhD, Judith G. Rosmalen, PHD, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, Groningen, Netherlands

**BACKGROUND:** Medically unexplained symptoms (MUS) constitute a major health problem because of their high prevalence, the suffering and disability they cause, and the increased use of healthcare resources that is associated. Internet-based interventions might provide an accessible and convenient tool for managing MUS. We developed a personalized internet-based self-help intervention for MUS in primary care. This intervention is part of a stepped-care program ('Master Your Symptoms') aiming to improve diagnosis, treatment, and referral of patients with MUS with the help of online tools. The design of the intervention and the randomized controlled trial assessing its effectiveness are discussed.

**METHODS:** The intervention starts with a number of online questionnaires concerning physical complaints, and possible triggers, consequences, and maintaining factors. Based on the results of these questionnaires, participants receive an automatically generated report and are offered a choice of personalized self-help advice exercises. These exercises are based on medical guidelines, self help books, and input of patients and health care providers.

200 adult patients with MUS will be recruited through primary care centers in the Netherlands. After eligibility assessment, participants will be randomly allocated to the intervention or control group. The control group will receive care as usual. Primary outcome will be quality of life (RAND-36). Secondary outcomes include physical symptoms, distress, depression, and anxiety (4DSQ), medical consumption and costs (iMCQ and iPCQ). Assessments will take place at baseline and at 3 and 6 months follow-up.

**DISCUSSION:** To our knowledge, this is the first study to combine the concepts of e-health, self-help, and personalized medicine in the treatment of MUS. This intervention has the potential to improve the quality of life of patients with MUS, reduce social and economical costs, and conserve scarce healthcare resources.
## 92) Abstract 1514

# EARLY MATERNAL SENSITIVITY, ADULT ATTACHMENT SECURITY, AND CARDIOMETABOLIC RISK: A PROSPECTIVE LONGITUDINAL STUDY

Allison K. Farrell, PhD, Psychology & Molecular Medicine and Genetic, Wayne State University, Detroit, MI, Jeffry A. Simpson, PhD, Psychology, University of Minnesota, Minneapolis, MN, Glenn I. Roisman, PhD, Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, Ethan S. Young, MS, Psychology, University of Minnesota, Minneapolis, MN, Theodore Waters, PhD, Psychology, NYU-Abu Dhabi, Abu Dhabi, N/A, UAE

Studies find that receiving high quality parenting is associated with better physical health in childhood, but do these effects remain into adulthood? The few studies that have tested these links have primarily relied on potentially biased retrospective reports. The mechanisms behind these effects are also unclear: Attachment security could be a key mechanism, as it stems from receiving high quality care and promotes less hypervigilance and better coping, but it has not been empirically tested. Using data from a 37-year prospective longitudinal study, we tested whether receiving sensitive maternal care in early childhood (as coded by trained observers at four timepoints) predicts cardiometabolic risk (assessed using CRP, BMI, MAP, and waist-to-hip ratio) in adulthood. Furthermore, we tested whether attachment orientations in adulthood (as assessed by the adult attachment interview) mediated the link between parenting and health. We find that receiving sensitive maternal care is associated with lower cardiometabolic risk in adulthood. Adult attachment partially mediated the link between early maternal sensitivity and adult cardiometabolic risk. These findings suggest that early parenting has enduring effects on health through pathways including (but not limited to) attachment.

## 93) Abstract 1485

# CARDIOVASCULAR MARKERS PREDICT PSYCHIATRIC MORBIDITY AND NEURODEVELOPMENTAL FEATURES IN A LARGE COHORT STUDY OF CHILDREN AND ADOLESCENTS IN THE UK

Jessica A. Eccles, BM BCh MRCPscyh PhD, Neil A. Harrison, MB BS MRCP MRCPsych PhD, Neuroscience, Kevin A. Davies, MD, Clinical and experimental medicine, Brighton and Sussex Medical School, Falmer, East Sussex, UK, Christopher J. Mathias, MBBS LRCP&SDPhil DSc FR, Institute of Neurology, University College London, London, London, UK, Hugo D. Critchley, MBChB DPhil FRCPsych, Neuroscience, Brighton and Sussex Medical School, Falmer, East Sussex, UK

**Background:** The Avon Longitudinal study of parents and children (ALSPAC) is a large population study of a birth cohort in the UK. There is growing interest in predictors of psychiatric morbidity in this population. To date the role of cardiovascular physiology in psychiatric morbidity in this large group has not been explored. In adults heart rate (HR) to blood pressure (BP) ratios can predict vulnerability to syncope, itself associated with psychiatric disorder

**Method:** The ALPSAC birth cohort was used. At Teen Focus 3 (TF3) (mean age 15.5 yrs) participants and their parents completed the Development and Well-being Assessment (DAWBA) which generates ICD-10 psychiatric diagnoses. HR and BP were recorded (n=4,254). At mean age 17.7 years (F17), they underwent psychiatric assessment (Clinical Interview Schedule (CIS-R)) and Anxiety Sensitivity Index: allowing identification of ICD-10 diagnoses of depression, and anxiety disorders as well as symptom quantification. HR and BP were recorded (n=4,236). The presence of neurodevelopmental disorders (e.g. autism spectrum, dyslexia) was determined from parent-completed questionnaires at child age 9 years. Linear regression models were independently used to explore relationships between cardiovascular physiology (HR, systolic BP, diastolic BP, HR to systolic BP ratio, HR to diastolic BP ratio and HR to pulse pressure ratio) and psychiatric diagnoses and rating scales, controlled for BMI and gender.

**Results:** Age 17, many aspects of HR and BP measurements predicted current depression and degree, presence of anxiety disorder and degree of anxiety. The strongest predictor was heart rate to pulse pressure ratio (all p=<0.001)(FIG 1); HR to pulse pressure ratio age 15, predicted presence of Hyperkinesis at 15 and historical presence of any neurodevelopmental disorder aged 9 (p=0.043, p=0.025)

**Discussion:** This is the first study to directly explore the relationship between cardiovascular markers and psychiatric symptomatology in a large group of children and adolescents, demonstrating that resting cardiovascular parameters can predict presence and degree of psychopathology. There is a substantial body of interest in the relationship between autonomic dysfunction and psychiatric disease and this study highlights the need for further evaluation of this link in children and adolescents.

<figure><img src="image_13.png" /></figure>

## 94) Abstract 1343

# PERSISTENTLY HIGH LIFE EVENT SEVERITY RATINGS ARE ASSOCIATED WITH PHYSICAL AND PSYCHOLOGICAL WELL-BEING ACROSS THE LIFESPAN

Hannah M. Schreier, PhD, Joshua M. Smyth, PhD, Jillian A. Johnson, PhD, Biobehavioral Health, Martin J. Sliwinski, PhD, Human Development and Family Studies, The Pennsylvania State University, University Park, PA

Exposure to negative life events has been linked to lower physical and psychological well-being. It is less clear whether the continued perception (following occurrence) of life events as highly negative influences well-being, and whether effects of perceived event severity differ across the life course.

A gender and age stratified community sample of 317 adults (mean age=49, range=19-83 years; 50% male; 37% Black) completed assessments of their cortisol awakening response (CAR), metabolic health (based on body mass index, body fat percentage, waist circumference, mean arterial pressure, and glycated hemoglobin), and self-reported health and well-being (Center for Epidemiological Studies-Depression Scale, SF-36v2 Health Survey). Participants indicated whether they had experienced each of 37 life events over the past 12 months; each endorsed event was rated for its negative impact at the time of occurrence and also at present. Analyses controlled for sex and race; only negative life events were included. We examined whether negative impact ratings at event occurrence, at present, and their interaction predicted outcomes, and whether age moderated the effect of perceived life event severity on well-being.

The interaction between life event severity at event occurrence and at present broadly predicted physical and psychological well-being beyond covariates and main effects. Specifically, persistently high ratings of life event severity were associated with worse metabolic
health (p=.041), worse self-rated global health (p=.004), worse overall mental health (p=.0001), greater depressive symptoms (p=.0002), and lower vitality (p=.003). There was no association with CAR, functional limitations, body pain, or social functioning. These associations did not vary by participant age, except that greater event severity was associated with lower vitality (p=.033) among older adults.

Although these associations are cross-sectional, they suggest that the continued perception of life events as highly negative is uniquely and adversely associated with physical and psychological well-being across a wide range of self-reported and metabolic health outcomes. Notably, these patterns appear to be largely similar across the adult lifespan.

## 95) Abstract 1454

### TIME DISCOUNTING PREDICTS INFLAMMATION IN LATER LIFE

Michael Daly, PhD, Behavioural Science Centre, Liam Delaney, PhD, Behavioural Science Centre & Economics Division, University of Stirling, Stirling, Stirlingshire, United Kingdom

Prominent economic and psychological models suggest that impatient individuals with high discount rates invest less in their health leading to adverse physiological consequences (Grossman, 1972; Hall & Fong, 2007). We examine the link between experimentally elicited discount rates and inflammation using a sample drawn from the population-based English Longitudinal Study of Ageing. Those who completed a preference module and provided blood plasma samples at two time-points for analysis were included in the study (n=389; Age=63.7 (SD=5.7); 52% Female). Discount rates were calculated from a set of 12 choices between smaller sooner and larger later rewards (e.g. £25 in two weeks or £30 in one month) where the participant won the value of a randomly selected choice (median reward £28). Our results indicate a substantial relationship between high discount rates and high levels of inflammation two years later as gauged by CRP (B =.16; p<.005) and fibrinogen (B =.13; p<.005) in analyses which adjusted for age, gender, race marital status, education, income, wealth and importantly prior inflammation levels. This pattern was robust to the inclusion of controls for BMI, cardiovascular disease, arthritis, other long-term illnesses, smoking, physical activity, and alcohol consumption. Further adjustment for cognitive functioning and the Big Five personality traits did not affect the associations observed. This study provides strong evidence that incentivised elicited discount rates robustly predict longitudinal changes in inflammation in a national sample.

## 96) Abstract 1590

### LEPTIN AND ADIPONECTIN AS PREDICTOR OF HEART RATE VARIABILITY CHANGE OVER TWO YEARS IN CHILDREN

Nathalie Michels, PhD, Roos Van De Wielle, MSc, Stefaan De Henauw, PhD, Public Health, Ghent University, Gent, OV, Belgium

**Background:** For early prevention of cardiovascular disease, early detection and risk factor insights are necessary. The autonomic balance reflects cardiovascular risk and can be measured by heart rate variability (HRV). Therefore, our purpose is to examine associations between HRV and the energy-related biomarkers leptin and adiponectin in children.

**Methods:** Participants of this study were Belgian children recruited for the longitudinal ChiBS study (year 2010-2012). HRV was measured and fasting blood samples were taken in 270 children at baseline (4.4-11.0y ) and 230 children at follow-up (6.7-12.2y). Cross-sectional and longitudinal linear regression analyses were separated by sex and adjusted for age, socio-economic status, body fat%, negative emotions, puberty and mean heart rate.

**Results:** Leptin was a negative cross-sectional and longitudinal predictor of parasympathetic activity in boys; while leptin in girls was cross-sectionally associated with higher LF and LF/HF suggesting sympathetic predominance. Adiponectin was a negative cross-sectional and longitudinal predictor of parasympathetic activity in boys; but

when adjusting for mean heart rate, this effect disappeared and adiponectin was a positive cross-sectional and longitudinal predictor of parasympathetic activity in girls. The other direction, HRV as predictor of leptin and adiponectin was not significant.

**Conclusion:** Results stress the importance of considering sex differences and adjustment for heart rate in testing HRV predictors. Leptin seemed disadvantageous for the autonomic balance (less parasympathetic in boys, more sympathetic in girls), while adiponectin seemed advantageous for the autonomic balance in girls only (more parasympathetic activity). More research is needed to see whether leptin and adiponectin are interesting in cardiovascular screening/prevention or in determining the cardiovascular gain during weight loss follow-up.

## 97) Abstract 1110

### EXPOSURE THERAPY IN PHOBIA - EFFECTS OF CARDIAC TIMING AND INTEROCEPTIVE ABILITY

David R. Watson, PhD, Neuroscience, Brighton & Sussex Medical School, Falmer, East Sussex, United Kingdom, Daniel Wilmott, MA, Psychology, University of Sussex, Falmer, East Sussex, United Kingdom, Frances Meeten, PhD, Clinical Psychology, Institute of Psychology, Psychology and Neuroscience, Kings College, London, Greater London, United Kingdom, Katherine Wong, MbChB, Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, Peoples Republic of China, Sarah N. Garfinkel, PhD, Hugo D. Critchley, DPhil., MRCPsych, FRCPsych, Neuroscience, Brighton and Sussex Medical School, Falmer, East Sussex, United Kingdom

Spider phobia is a specific phobia expressed as marked uncontrolled psychological and physiological fear reactions to spiders. Exposure therapy is an effective first line treatment which focuses on modifying the evoked fear response to the phobic stimulus. Fear is accompanied by bodily changes, notably cardiovascular arousal, which can intensify negative emotional experience. Arterial baroreceptors communicate centrally the state of cardiovascular arousal by signalling the timing and strength of individual heartbeats. Using heartbeat timing, a specific influence of baroreceptor afferent signalling on the processing of fear and threat stimuli has been identified. Further this influence appears to be mediated by an individual's interoceptive sensitivity which can be quantified from performance accuracy on tasks.

We studied 58 people with spider phobia (53 completed) in a computerised exposure protocol to see if heart timing/baroreceptor signalling could augment therapy benefits. Each participant underwent four sessions. In each session, 140 random spider images were shown (100 msec). Participants were assigned to one of three timing groups: Systole (shown during baroreceptor firing); Diastole (during baroreceptor quiescent interval); Random (not locked to cycle). Each participant was scored on measures of interoceptive accuracy. The Spider Phobia Questionnaire (SPQ) and Behavioural Avoidance Task (BAT) were used to assess the effects of exposure therapy. Behavioural and physiological (electrodermal activity, EDA) data was collected.

Spider phobia decreased with therapy, as measured using the SPQ (t = -5.808, p < 0.001) and BAT (t=6.460, p < 0.001). On the SPQ measure, Systole showed least overall benefit (F(2,44)=5.252, p=0.009) and an interaction with interoceptive ability (F(3,44)=4.158, p=0.011), where higher interoceptive accuracy was associated with the poorest outcome. EDA data closely paralleled these findings. Interestingly, in the BAT, the Random group remained most avoidant (F(2,44)=5.156, p=0.010), particularly individuals with higher interoceptive accuracy (F(3,44)=3.182, p=0.033).

Our findings demonstrate that interoception influences outcomes of exposure therapy. Understanding these mechanisms may help personalise approaches to anxiety treatment and reveal novel biobehavioural and psychopharmacological for targets intervention.
## ASSESSING COPING AND ADJUSTMENT IN CAREGIVERS: A SYSTEMATIC REVIEW

Tamsyn Hawken, MSc Health Psychology, Psychology, University of Bath, Bath, Somerset, United Kingdom, Julie Turner-Cobb, PhD, Psychology, Bournemouth University, Poole, Dorset, United Kingdom, Julie Barnett, PhD, Psychology, University of Bath, Bath, Somerset, United Kingdom

Increased awareness of the prevalence of informal caregiving has given rise to substantial growth in caregiver coping literature during recent decades. However, a synthesis of findings surrounding coping and adjustment is lacking. This systematic review assessed these factors in caregivers of all ages, in the context of methodological approaches taken and underlying theory. Three online databases were searched and reference lists and experts were consulted. Twenty-five empirical studies (13 quantitative; 12 qualitative) met inclusion criteria for the review. Results raised methodological issues including a wide variation of psychosocial measures, a range of theory and relative lack of research on young carers. Factors associated with adjustment and coping were identified. These included use of problem-focussed versus emotion-focussed coping, cognitive reappraisal strategies (acceptance, reframing and social comparison) and indicators of psychological adjustment (social support and resources). Caregivers predominantly utilised emotion-focussed coping but when problem-focussed coping was used it promoted positive adjustment. Finally, psychosocial predictors of physiological adaptation were identified, including trait anxiety, coping style and social support. Future work is called for that includes greater focus on young carers and employs more substantial use of theory driven approaches and physiological assessment in a mixed methods context. Findings inform future caregiver research and interventions.

## DIFFERENTIAL EFFICACY OF PSYCHOLOGICAL THERAPIES ON REDUCING DEMENTIA FAMILY CAREGIVERS' BLOOD PRESSURE

Andrés Losada, Ph.D., Medicine, Universidad Rey Juan Carlos, Madrid, Madrid, Spain, María Márquez-González, Ph.D., Psychology, Universidad Autónoma de Madrid, Madrid, Madrid, Spain, Rosa Romero-Moreno, Ph.D., Medicine, Universidad Rey Juan Carlos, Madrid, Madrid, Spain, Laura Gallego-Alberto, M.A., Carlos Vara-García, M.A., Psychology, Universidad Autónoma de Madrid, Madrid, Madrid, Spain

Caring for a relative with dementia is associated with negative consequences on caregivers' emotional and cardiovascular health. Even though the number of studies focused on psychological interventions for dementia family caregivers is growing in recent years, the effects of these interventions on caregivers' blood pressure is understudied. Participants in this study are 37 dementia family caregivers that were randomly allocated to four treatment conditions: control group (CG), Acceptance and Commitment therapy (ACT), cognitive behavioral therapy (CBT) and modular intervention guided by functional analysis (MIFA). In addition to mean arterial pressure (MAP), depressive and anxious symptoms were assessed through individual interviews. Results: Significant effects were observed for ACT in depression (p < .01; d = 1.14) and anxiety (p < .01; d = 1.29) but not for MAP (d = .12). Significant effects were found for CBT in depression (p < .01; d = 1.46), anxiety (p < .01; d = .79) and MAP (p < .05; d = 1.05). Similar findings were observed for MIFA in depression (p < .01; d = 1.24), anxiety (p < .05; d = .89) and MAP (p < .05; d = .70). No significant changes were found for CG. These findings suggest that psychological therapies are useful for reducing caregivers' blood pressure, especially those interventions focused on modification of caregivers' thoughts and behaviors.

## A SMARTPHONE-BASED ECOLOGICAL MOMENTARY ASSESSMENT APPROACH WITH OLDER AFRICAN-AMERICANS

Heather Fritz, PhD, Health Care Sciences and Institute of Gerontology, Malcolm P. Cutchin, PhD, Health Care Sciences, Wassim Tarraf, PhD, Health Care Sciences and Institute of Gerontology, Wayne State University, Detroit, Michigan

Smartphone-based Ecological Momentary Assessment (EMA) offers a relatively low-cost approach to collect data real time using participant self-reports about behaviors and psychosocial phenomena related to health and health behaviors in various contexts. The usefulness of an EMA approach depends primarily on a research participant's ability to appropriately use the technology involved and adhere to the data collection protocol. Little is known, however, about the feasibility of smartphone-based EMA with older populations. An EMA protocol can be challenging to employ with older adult samples, especially those who may have less formal education and less experience with smartphone technology. We present a study that used a smartphone-based EMA approach among a sample of older African-Americans living in Detroit, MI. One hundred older African-Americans (M = 72 years old) used an Android smartphone loaded with the Movisens XS application to provide data about their ongoing activities and perceived stress four times per day (representing current time and two hours prior) for seven consecutive days. Adherence to the EMA protocol was demonstrated with response completion rates of 92-98% on EMA measures, and no participant attrition was based on the EMA protocol. Although slightly less variable than might be expected, the average daily pattern of EMA stress reports was similar to the diurnal cortisol curve found in this and other samples. While a problem was encountered with obtaining global positioning system coordinates, our findings suggest using a smartphone-based EMA approach for data collection is feasible and acceptable among a sample of older African-Americans. Testing, training, monitoring, and adaptation of the EMA protocol most likely enhanced adherence, and input from older users was important. We discuss specific techniques in design and implementation that can help with the quality of data collection and adherence with smartphone-based EMA in similar populations.

## DO PLEASANT EVENTS AND ACTIVITY RESTRICTION MODIFY THE INFLUENCE OF CAREGIVING STRESS ON BLOOD PRESSURE?

Carlos Vara-García, M.A., Psychology, Universidad Autónoma de Madrid, Madrid, Madrid, Spain, Andrés Losada, Ph.D., Medicine, Universidad Rey Juan Carlos, Madrid, Madrid, Spain, María Márquez-González, Ph.D., Psychology, Universidad Autónoma de Madrid, Madrid, Madrid, Spain, Rosa Romero-Moreno, Ph.D., Medicine, Universidad Rey Juan Carlos, Madrid, Madrid, Spain, Laura Gallego-Alberto, M.A., Psychology, Universidad Autónoma de Madrid, Madrid, Madrid, Spain

Objective: Dementia caregiving has been described as a chronic stressful situation with adverse cardiovascular effects. Several variables may buffer the negative effect of caregivers' stress on cardiovascular health. Following the stress and coping and PEAR models, the objective of this study is to analyze the role of pleasant events and activity restriction in the explanation of caregivers' blood pressure. Method: Participants were 96 dementia family caregivers caring for a spouse or a parent. In addition to systolic and diastolic BP, caregivers' age, body mass index (BMI), physical exercise, frequency and distress associated with behavioral and psychological symptoms of dementia (BPSD), depressive symptoms, activity restriction and frequency of pleasant events were measured. Results: Two path analyses were analyzed with systolic and diastolic BP as dependent variables, respectively. Even though both models showed good fit indexes (Diastolic: $\chi^2$ = 31.59; p = .17; $\chi^2$/df = 1.26; IFI = .963; CFI = .985; RMSEA = .049; Systolic: $\chi^2$ = 35.07; p = .09; $\chi^2$/df = 1.40; IFI = .946;
CFI = .940; RMSEA = .061), the findings suggest that pleasant events and activity restriction play a significant role in the explanation of diastolic BP, acting as mediators in the relationship between BPSD and BP. The final model explains a 22% of the variance of diastolic BP. Conclusions: The results suggest that BPSD impact on caregivers' blood pressure by increasing their activity restriction and reducing their levels of pleasant activities. These effects also contribute to caregivers' depressive symptomatology. Future studies should analyze the psychological mechanisms involved in the association between BPSD and these changes in the pattern of pleasant activities.

## 102) Abstract 1408

### HIGHER LOCAL AND SYSTEMIC INFLAMMATION IN PERIODONTAL DISEASE DOES NOT ALTER HEALING RATES OR INFLAMMATORY RESPONSES TO ACUTE INJURY

Christopher G. Engeland, PhD, Biobehavioral Health, The Pennsylvania State University, University Park, PA, Andrew P. Monestero, DMD, Praveen K. Gajendrareddy, DMD, PhD, Periodontics, University of Illinois at Chicago, Chicago, IL, Jose M. Rocha, DDS, PhD, College of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil, Marc A. Manos, DMD, Periodontics, University of Illinois at Chicago, Chicago, IL

Past studies have linked higher inflammatory responses to both the pathogenesis of periodontal disease (periodontitis) and impaired healing of oral mucosal tissues. The relationship between these factors has not been investigated. Using a standardized model of wound healing, this study objectively examined differences in oral mucosal healing rates and local tissue inflammation in response to wounding between individuals with periodontitis and healthy controls. This study involved 20 systemically healthy, non-smoking, adult men (24-45 years); 10 individuals with untreated periodontitis and 10 healthy age-matched controls. Three excisional wounds were placed on the hard palate (roof of the mouth) under local anesthesia, and were standardized for size, location, depth, and time of placement. Importantly, wounds were placed in uninflamed tissues (unaffected by periodontitis). Oral mucosal healing rates were determined from the first wound using daily videographs. Tissue from the other wounds was biopsied at 6h or 24h post-wounding, from which inflammatory responses to injury were quantified using real-time PCR. Blood and saliva collected just prior to wounding were also analyzed. Inflammation was quantified based on pro-inflammatory cytokine levels. It was found that wounds healed at the same rates in systemically healthy men with and without periodontitis. Local tissue inflammation at baseline (0h) and after wounding (6h and 24h) did not differ between groups. Five men had more severe periodontitis and this subgroup exhibited higher inflammation in both blood and saliva compared to controls. However, both their healing rates and levels of inflammation in wounded tissue were comparable to controls, despite having higher levels of both local and systemic inflammation. These results suggest that periodontal disease and its associated inflammation does not affect acute inflammatory responses or healing in healthy oral tissues. These results have direct clinical implications on the timing and management of surgical procedures in patients with untreated periodontitis. Further, inflammatory responses and healing rates to acute oral injury do not appear affected by levels of either local or systemic inflammation. This has broader clinical implications regarding what constitutes risk factors for delayed healing in mucosal tissues.

## 103) Abstract 1136

### HIGH FREQUENCY HEART RATE VARIABILITY AND ART MAKING: WHAT DOES EMOTION HAVE TO DO WITH IT?

Shai Haiblum-Itskovich, MA, Johanna Czamanski-Cohen, PhD, Creative Arts Therapy, University of Haifa, Haifa, Israel, Giora Galili, PhD, Education and Psychology, Open University, Raanana, Israel

Background: Art Therapy involves the use of visual art-making within a therapeutic relationship. Different materials are used in Art Therapy to facilitate self-expression, and are posited to differentially affect the emotional response of the user, based on the material's level of fluidity. Cardiac vagal regulation, estimated by measures of Respiratory Sinus Arrhythmia (RSA), and specifically high frequency Heart Rate Variability (HF-HRV), has been theoretically and empirically related to emotion engagement and regulation. Aim: To examine the emotional self-reported and HF-HRV responses to art making with art materials characterized by differential levels of fluidity. We hypothesized that art making will elicit an emotional and HF-HRV response and the strength of the response will be affected by the fluidity of the materials. Methods: 50 adults (24 women) participated in a repeated measure experimental study. Each participant engaged in three art making sessions (Pencil, Oil pastels and Gouache paint). The order of art materials was randomized and balanced throughout the sample. Emotional response was measured using the Self-assessment manikin (SAM). HF-HRV measures were calculated based on ECG during art making and precipitating resting periods and recorded using a small wearable sensor (BioPatch™). Results: ANOVA indicated an interaction between art making and material, as well as a main effect for artmaking on HF-HRV which decreased during art making, compared to baseline ($\eta_p^2$=0.348). Artmaking with Pencil was associated with negative valance while Gouache was associated with positive valance. No differences were found in emotional arousal or control. HF-HRV and self-reported emotional responses were not found to be correlated. Conclusions: As theorized, art making differentially affects emotional response and HF-HRV. This has implications for the potential influence of art making on health and the application of art therapy in health care settings. Further research is required to examine the longitudinal effect of artmaking on health and the relationship between art making, emotions, HF-HRV and health.

<figure><img src="image_14.png" /></figure>

## 104) Abstract 1149

### SLEEP, PHYSICAL ACTIVITY, AND DIETARY INTAKE: ASSOCIATIONS WITH MOOD IN THIRD TRIMESTER WOMEN

Lin Shen, BA (Hons), Psychological Sciences, Michelle Blumfield, PhD, APD, Nutrition and Dietetics, Donna Neemia, BA (Hons), Catherine Fulgoni, DPsych (Clinical), Bei Bei, DPsych (Clinical), PhD, Psychological Sciences, Monash University, Melbourne, Victoria, Australia

**Background:** Despite the common portrait of joy and happiness, mood disturbances are common during pregnancy, with a range of contributing factors. These include modifiable lifestyle factors – sleep, physical activity, and dietary intake. In non-pregnant and postpartum populations, poor sleep, low levels of physical activity, and excessively
fatty diets are associated with poorer mood. In pregnant populations
however, these associations are less understood. The current study aims
to address this gap in literature, by investigating how these three factors
are associated with maternal depressive and anxiety symptoms.

**Methods:** A community sample of 91 healthy, third-trimester (~29 weeks gestation) first-time mothers ($M_{age}=33.22, SD_{age}=3.19$) completed self-report measures. Sleep duration and efficiency were assessed using the consensus sleep diary (modified), and daytime sleep-related impairments with the PROMIS Sleep-related Impairment-Short Form. Level of physical activity was measured using the Physical Activity Questionnaire, and dietary intake (energy intake and energy from fat) using the Australian Eating Survey. Depressive and anxiety symptoms were assessed with the PROMIS Depression and Anxiety-Short Form respectively. Hierarchical multiple regression analyses were undertaken, controlling for maternal age, mental health history, and pre-pregnancy Body Mass Index.

**Results:** In separate regression models, higher daytime sleep-related impairments uniquely contributed to significantly higher depressive and anxiety symptoms, while lower sleep efficiency uniquely contributed to higher anxiety symptoms. Sleep duration, level of physical activity and dietary intake were not significantly associated with either mood outcomes. When all three factors were examined collectively in one model, both higher daytime sleep-related impairment and lower level of physical activity made significant contributions to higher depressive symptoms, beyond the effects of covariates.

**Conclusion:** These results highlight the importance of perceived daytime consequences of poor sleep on new mothers' psychological wellbeing, and support sleep as a modifiable lifestyle factor for maternal mood disturbances. There is some evidence linking lower physical activity and higher depressive symptoms, and the associations between physical activity, dietary intake and mood require further investigation.

## 105) Abstract 1457

### DIFFERENTIAL STRESS EFFECTS ON SEXUAL EXPERIENCES IN MEN AND WOMEN

Charlotte Markert, M.Sc., Urs M. Nater, Dr., Psychology, University of Marburg, Marburg, Hesse, Germany

**Background:** Chronic stress and acute stress in everyday life are thought to influence the frequency and quality of sexual experiences. This notion, however, is not supported by empirical evidence. This study examines influences of both chronic and acute stress on sexual activity, sexual desire, and sexual arousal in everyday life. The study uses a combination of frequent time-based measurements as well as event-based measurements to maximize ecological validity.

**Methods:** The sample consisted of 60 young and healthy subjects (50% women) living in a romantic relationship for at least one year. Subjects reported the presence (yes, no) of sexual desire and sexual arousal at several fixed time points per day for fourteen consecutive days using iPods. Further time completed pre-programmed event-based brief surveys regarding sexual desire and arousal after having engaged in a sexual activity. Acute stress was measured on a 5-point Likert scale at the time-based measurements. Chronic stress was assessed using the TICS.

**Results:** Mean frequency of sexual activity was 6.10 (SD=3.16; range: 1-19). Men reported higher frequencies of masturbation than women (p<.001), whereas frequency of sexual intercourse and frequency of sexual desire or sexual arousal was equal. Correlations between chronic stress and frequency of sexual activity were not significant. Chronic stress negatively correlated with frequency of sexual arousal in women's everyday life (r=-.36; p<.05), but not in men. For men, higher levels of acute stress reduced the chance of experiencing sexual arousal in everyday life (OR=0.66; p<.001), whereas chronic stress was not a significant predictor. Sexual desire was not affected by either acute or chronic stress in men. In women, higher levels of chronic stress reduced the chance of experiencing sexual desire (OR=0.95; p<.05), whereas higher levels of acute stress (OR=0.86; p<.05) and chronic

stress (OR=0.94; p<.01) reduced the chance of experiencing sexual arousal in everyday life. During sexual activity, neither men's or women's sexual desire or arousal was affected by stress.

**Discussion:** The results indicate that stress differentially affects sexual experiences in men and women. Future research should examine how stress affects the sexual experience in chronically stressed subjects and subjects experiencing sexual problems.

## 106) Abstract 1545

### BODY SHAME AND SEXUAL SATISFACTION: A TEST OF MEDIATING FACTORS BASED ON OBJECTIFICATION THEORY

Suzanne L. Osman, PhD, Carolyn P. Merwin, Psychology, Salisbury University, Salisbury, MD

Objectification theory suggests that women objectify their own bodies from an observer's perspective as a result of cultural exposure to sexual objectification (Fredrickson & Roberts, 1997). This can result in body shame - felt when a woman believes her body does not conform to a set of internalized cultural standards for the ideal body - and diminished attention to somatic states that are important for sexual satisfaction. Accordingly, body shame has been associated with lower sexual satisfaction (Calogero & Thompson, 2009; Claudat & Warren, 2014). During sexual activity with a partner, objectification theory involves a woman's focus on how her partner may enjoy viewing her body. However, studies examining a woman's perceptions of her partner's attraction to and sexual satisfaction with her as explanatory factors are lacking. Theoretically, given the interpersonal nature of sexual activity and desire to be appealing, these perceptions should help explain the link between body shame and personal sexual satisfaction. College women in a relationship (n = 428; mean age 19.3, SD = 1.4; 79% European American) responded to the Body Shame Scale (BSS) (McKinley & Hyde, 1996), the Global Measure of Sexual Satisfaction (GMSEX) (Lawrance, Byers, & Cohen, 2011), and measures of perceptions of a partner's sexual satisfaction (PPSS) and attraction to oneself (PPA). As predicted, BSS was negatively related to GMSEX (r=-.12, p=.014), PPSS (r=-.13, p=.009), and PPA (r=-.13, p=.009). GMSEX was positively correlated with PPSS (r=.81, p<.0001) and PPA (r=.30, p<.0001). Tests of simple mediation using linear regression provide support for perceived partner sexual satisfaction and perceived partner attraction as mediators of the association between body shame and sexual satisfaction: The association between BSS and GMSEX ($R^2$=0.02, B=-.13, p=.008) was attenuated after including PPSS in the model (B=-.02, p=.58), and after including PPA in the model (B=-.09, p=.047).

A woman's body shame may influence perceptions of how her partner experiences her body, which in turn may impact her own sexual satisfaction. Perceptions of how others view one's body may be important to consider in future research on objectification theory and satisfaction. Future research may include men and non-college populations, and examine other theoretically related body constructs and mental health outcomes.

## 107) Abstract 1243

### MID-RANGE TRAIT CONSCIENTIOUSNESS IS ASSOCIATED WITH OPTIMAL CARDIOVASCULAR FUNCTIONING DURING ACUTE STRESS EXPOSURE

Amanda A. Sesker, BA, Psychology, National University of Ireland, Galway, Galway, Galway, Ireland, Siobhan Howard, PhD, Psychology, Mary Immaculate College, Limerick, Limerick, Ireland, Brian M. Hughes, PhD, Psychology, National University of Ireland, Galway, Galway, Galway, Ireland

Conscientiousness (C), a stable personality trait across the lifespan, is associated with positive health behaviours. Socio-behavioural mechanisms mediating this relationship have been proposed, but it is unclear whether direct psychosomatic mechanisms also contribute to the relationship between C and health. Little research includes
measurements of mid-range C, which may be more adaptive than high or low C during stress. This study examines whether mid-range C exhibits healthy, systematic associations with cardiovascular stress reactivity, and whether it should be considered in psychosomatic models of disease risk. Eighty-one female students underwent haemodynamic monitoring during a series of stress exposures and rest periods. C was assessed using self-report and analysed using ANOVA. Results indicated period × C interactions for systolic blood pressure (F[2, 78] = 4.73, *p* = .011) and diastolic blood pressure (F[2, 78] = 3.303, *p* = .042). High and low C displayed exaggerated reactivity and failed to adapt to stress across multiples exposures, while mid-range C showed lower reactivity overall. Mid-range C may be the most adaptive profile for coping with acute stress with long-term implications for future cardiovascular disease outcomes.

<figure><img src="image_15.png" /><figcaption>Figure 1. Illustration of SBP across phases for low ($n = 29$), mid ($n = 25$), and high ($n = 27$) conscientiousness</figcaption></figure>

## 108) Abstract 1132
### SYMPTOM SEVERITY AND PSYCHOLOGICAL STRESS ARE INDEPENDENT FROM LOW-GRADE INFLAMMATION IN IRRITABLE BOWEL SYNDROME

Gabriele Moser, MD, Univ.Klink für Innere Medizin III, Medical University, Vienna, Vienna, Austria, Johannes Peter, Mag, Lukas Knoblich, student, Univ.Klink für Innere Medizin III, Medical University of Vienna, Vienna, Vienna, Austria, Clemens Dejaco, MD, Univ.Klink für Innere Medizin III, Medical University, Vienna, Vienna, Austria

**Objective.** The role of underlying biological processes in Irritable Bowel Syndrome (IBS) is subject of ongoing discussion. Especially patients with post-infectious onset (PI-IBS) are supposed to have intestinal low-grade inflammation and possibly represent a subgroup with distinct pathophysiology.

**Aims of the study:** to investigate intestinal inflammation in IBS, with special regard to differences between IBS and PI-IBS, and to examine correlations with psychological variables and symptom burden.

**Methods.** N= 44 IBS patients with a mean age of 43,8 ± 15,3 years, 33 (75%) female, were examined in psychological variables (Perceived Stress PSQ, Resilience CD-RISC, Quality of life VAS, and Psychological Distress HADS), symptom severity (IBS-SSS), and faecal Calprotectin (fCal) as marker of intestinal inflammation. Obtained fCal values were classified into four categories of gastrointestinal inflammation: negative (<50 µg/g), marginal (50-100 µg/g), positive (100-250 µg/g), and severe (>250, to be excluded from further analysis).

**Results.** Two patients were exceeding the fCal threshold of 250 µg/g and excluded from further analysis. In the remaining n=42 disease onset was 9,6 ± 9,1 years ago, with 9 (21%) cases to be classified as PI-IBS. IBS was classified severe in 25 (60%), moderate in 14 (33%) and mild in 3 (7%) cases. 29 (69 %) showed negative, 9 (21 %) marginal, and 4 (10 %) positive signs of intestinal inflammation. In PI-IBS, distribution of fCal values was highly similar: 6 (67 %) negative, 2 (22 %) marginal, and 1 (11 %) positive. Correlations between psychological variables and fCal were small and nonsignificant (PSQ: .012; CD-RISC: -.204; HADS: .018;), except VAS (-.311, p<.05). Equally, IBS-SSS and fCal prove to be almost uncorrelated (.055).

Conclusions. Low-grade inflammation was present in about one third of patients, with no difference between PI-IBS and regular IBS. Psychological wellbeing and symptom severity seem to be largely independent from inflammation.

## 109) Abstract 1510
### PRELIMINARY EVIDENCE OF A POSITIVE RELATIONSHIP BETWEEN RESTING HEART RATE VARIABILITY AND TRAIT WORRY IN A SAMPLE OF WOMEN

Ebony T. Williams, Ms., Psychology, The Ohio State University, Columbus, Ohio, DeWayne P. Williams, Master of Arts, Psychology, The Ohio State University, Columbus, OH, Kristine E. Irwin, Ms., Psychology, The Ohio State University, Columbus, Ohio, Julian Koenig, Dr. sc. Hum, Section for Translational Psychobiology in Child and Adolescent Psychiatry and the Department of Child and Adolescent Psychiatry in the Centre for Psychosocial Medicine, SRH University Heidelberg, Heidelberg, Baden-Württemberg, Germany, Derek P. Spangler, PhD, Julian F. Thayer, PhD, Psychology, The Ohio State University, Columbus, OH

Resting high frequency heart rate variability (HF-HRV) is widely recognized as a psychophysiological index of emotion regulation and overall health. Lower resting HF-HRV is typically associated with both poorer emotion regulation and overall health, in addition to maladaptive psychological states including trait worry. Worry can be defined as the repetitive negative thinking of possible *future* outcomes or events. Interestingly, research has found that in women, the relationship between resting HF-HRV and negative psychological states can be positive. For example, one study found greater HF-HRV in depressed compared to non-depressed women, and found the opposite and more intuitive pattern in men. Another study found a similar pattern in women, such that anxious women showed greater higher HF-HRV compared to non-anxious women. However, studies have not yet examined the relationship between resting HF-HRV and worry in women. We sought to examine this relationship in a healthy college-aged sample of women (n = 56). Using an electrocardiogram (ECG), continuous heart rate data were measured as participants first completed a 5-minute resting period. HF-HRV was calculated in accordance with Task Force (1996) guidelines. Participants then completed several questionnaires, including the Penn State Worry Questionnaire (PSWQ), which measures an individual's self-reported everyday tendency to worry. Controlling for body mass index, age, and respiration, results showed a significant positive relationship between resting HF-HRV and PSWQ scores and (r = .311, p < .05), such that women with higher resting HF-HRV reported more trait worry. These data are counterintuitive, but are in line with findings regarding negative affect and resting HRV in women. Overall, the results highlight the importance of considering gender as a moderating factor in psychophysiological research. Future research will include a comparison group of men.

## 110) Abstract 1133
### EXAMINATION OF THE ROLE OF HYPERVENTILATION IN VASOVAGAL SYMPTOMS AMONG VOLUNTARY BLOOD DONORS

Johanna M. Harrison, MSc., Psychology, McGill University, Montreal, Quebec, Canada, Christopher R. France, PhD, Psychology, Ohio University, Athens, Ohio, Pierre M. Robillard, MD, Medical Affairs, Hema-Quebec, Montreal, Quebec, Canada, Thomas Ritz, PhD, Psychology, Southern Methodist University, Dallas, Texas, Blaine Ditto, PhD, Psychology, McGill University, Montreal, Quebec, Canada
Many studies have found that blood donors who experience unpleasant vasovagal reactions are less likely to donate again. While some
behavioral techniques such as applied muscle tension have been shown to helpful in reducing vasovagal reactions in the blood donation environment, the decrease in symptoms is often not clearly associated with exercise-related changes in blood pressure and heart rate. Recent research focusing on the contribution of hyperventilation-induced hypocapnia to vasovagal reactions suggests an additional possible mechanism in blood donation symptoms. The aim of the present study was to investigate the role of hyperventilation in vasovagal symptoms in the voluntary blood donation context.

**Method:** 304 generally inexperienced (X = 2.6 previous donations) blood donors were recruited at university and college clinics run by the provincial blood supply organization. Portable capnometers were used to monitor participant respiration rate and end-tidal carbon dioxide (ETCO₂), as a measure of hyperventilation, throughout the donation process, with mean values calculated for pre-donation (before arrival at the chair), donation (in the chair), and post-donation (recovery area). Heart rate and blood pressure were also measured pre- and post-donation. Vasovagal symptoms were assessed using the self-report Blood Donation Reaction Inventory (BDRI) and the presence or absence of nurse initiated treatment for vasovagal symptoms.

**Results:** Controlling for age, sex, and donation experience, donors who experienced symptoms generally displayed lower HR and DBP though the effects were due to baseline (pre-donation) influences. By contrast, consistent with the hyperventilation hypothesis, donors who were treated for symptoms had significantly greater decreases in ETCO₂ from pre-donation to the donation and post-donation periods. Similarly, participants who reported more symptoms on the BDRI experienced significantly greater drops in ETCO₂ during the donation and post-donation periods. Furthermore, of the physiological variables, only decrease in ETCO₂ level during the donation period predicted significant variance in rating of intention to donate again. **Conclusions:** Results suggest that hyperventilation-induced hypocapnia influences vasovagal symptoms in the blood donation context and may be associated with donor return rate.

## 111) Abstract 1579
RELATIONSHIP AMONG DEPRESSION SYMPTOMS, FACETS OF MINDFULNESS, AND PARASYMPATHETIC ACTIVITY IN PATIENTS WITH HF

Laura Redwine, PhD, Psychiatry, Merdith Pung, PhD, Kathleen Wilson, MS, Brandon Khuu, BS, Paul Mills, PhD, Family Medicine and Public Health, University of California, San Diego, La Jolla, California

Heart failure (HF) is a growing concern, with over 5.1 million cases in the United States alone and a 5-year mortality rate. Research shows that elevated depression symptoms are related to worse prognosis in patients with HF. Reduced parasympathetic activity is associated with elevated depression symptoms, as well as increased morbidity and mortality in HF, suggesting a potential mechanism affecting HF prognosis. In contrast, trait mindfulness is associated with increased parasympathetic activity. By discovering the relationships among depression symptoms, trait mindfulness, and autonomic activity, more focused treatments may be developed for HF patients. Methods: 115 Stage C heart failure patients (mean age = 65.69 +/- 8.23 and left ventricular ejection fraction (LVEF%) = 45.07% +/- 11.48%) were examined for depression symptoms using the Beck Depression Inventory (BDI), facets of mindfulness using the Five Facets of Mindfulness Scale (FFMS), and parasympathetic activity by examining heart rate recovery after bicycle ergometry. Results: Regression analyses adjusting for age, LVEF%, education, and antidepressant status revealed an association between lower heart rate at recovery from bicycle ergometry (signifying higher parasympathetic activity) and mindfulness facet, Nonreactivity to Inner Experience (change R2 = .11, p < .01). Whereas, increased heart rate at recovery was found in patients with elevated depression symptoms (change R2 = .046, p = .017). Finally, Nonreactivity to Inner Experience was negatively related to depression symptoms (change R2 = .10, p <.001). Conclusions:

Aspects of mindfulness that may promote increased parasympathetic activity in HF patients, in contrast to lower parasympathetic activity in HF patients with elevated depression symptoms. Through the understanding of the various facets of mindfulness, interventions may be developed that may improve physiological responses in patients with HF who have elevated depression symptoms, which may improve HF prognosis.

## 112) Abstract 1345
TEST-RETEST RELIABILITY OF PARAMETERS INDEXING CIRCADIAN VARIATION IN VAGAL ACTIVITY

Marc N. Jarczok, Dr. sc. hum., Institute of Medical Psychology, Julian Koenig, Dr., Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, BW, Germany, Corina Aguilar-Raab, Dr., Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Baden Württemberg, Germany, Marie-Luise Diepolder, B.Sc, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, BW, Germany, Claudia Traunmüller, Mag.rer.nat., Department of Psychology, University of Graz, Graz, ST, Austria, Julian F. Thayer, Dr., Department of Psychology, The Ohio State University, Columbus, OH, Beate Ditzen, Dr., Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, BW, Germany, Andreas Schwerdtfeger, degreeDr., School of Human and Social Sciences, University of Wuppertal, Wuppertal, NRW, Germany

**Background:** Vagal activity fluctuates in a pattern of diurnal variation with a maximum in the early morning. The diurnal variation in vagal activity can be expressed using methods of cosine estimation. The circadian variation patterns (CVP) are quantified by three parameters: MESOR – the rhythm adjusted 24h mean; Amplitude – the distance between MESOR and the maximum value of the cosine curve; and acrophase - the phase shift of the amplitude. While the MESOR indices of vagally mediated heart rate variability (HRV) parameters are thought to index overall vagal activity, the amplitude indices are thought to index day to night differences. However, no study has yet investigated the short- or long-term reproducibility of CVP parameters. We expected that differences in everyday life have greater impact on the amplitude, resulting in a lower short-term reliability compared to MESOR.

**Method:** Seventy-four men (age 41±7) had repeated 24h measures available (one day between measures). The holter monitor VarioPort (Becker Meditec, Karlsruhe, Germany) sampling at 512Hz was used. Vagal activity was indicated using estimates of HRV (RMSSD, pNN50, SDNN) as well as heart rate (HR). Between day associations were calculated using Pearson's correlation (PC). Short-term reliability was assessed using intra-class correlation (ICC) and Bland-Altman analysis (bias ± limits of agreement).

**Results:** The results demonstrate an excellent ICC (all >.82) and PC (all >.83) for the MESOR. Amplitude measures were good (ICC & PC >0.71) for RMSSD and pNN50, but fair (ICC & PC <.60) for SDNN & BPM. Acrophase measures were fair (ICC & PC all <.60). Bland-Altman plots show no systematic bias between measurement days.

**Discussion:** This study demonstrates high reliability for the rhythm adjusted 24h mean in primarily vagally mediated and mixed measures as well as heart rate in men. As hypothesized, lower but still good reliability was demonstrated for the amplitude but only in vagally mediated HRV measures and not in the mixed measure or HR. This indicates a higher day to day variability of the vagally mediated HRV amplitude parameters and more trait-like MESOR parameters. Future studies should expand to female samples, collect potential (time lagged) determinates of the diurnal variation using ecological momentary assessments and investigate the long term test-retest reliability.
## 113) Abstract 1452

### RELATING LIFE-TIME TRAUMATIC EVENTS AND POST-TRAUMATIC STRESS SYMPTOMS TO RESTING STATE CARDIAC VAGAL ACTIVITY IN YOUNG ADULTS

Nicole Feeling, M.A., DeWayne P. Williams, M.A., Psychology, The Ohio State University, Columbus, OH, Andrew H. Kemp, Ph.D., Psychology, Swansea University, Swansea, Wales, United Kingdom, Michael Kaess, PD Dr. med, Department of Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Heidelberg, Germany, Julian Thayer, Ph.D., Psychology, The Ohio State University, Columbus, OH, Julian Koenig, Dr. sc. hum., Department of Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Heidelberg, Germany

The present study sought to investigate how lifetime experience of trauma in a student population might relate to heart rate variability (HRV), while also assessing potential correlates of both post-traumatic stress disorder (PTSD) and HRV, such as emotion regulation and anxiety. Previous research has associated PTSD with reduced HRV, however, there is question as to the effect of trauma on HRV in individuals who report traumatic experiences, but do not develop PTSD. Relatedly, the association of PTSD and HRV has been primarily assessed in clinical populations; research in non-clinical populations is limited. In the present study resting state baseline measures of HRV were taken in undergraduate student volunteers (n=101), as well as an assessment of trauma history and relevant mood and anxiety disorder symptoms. As expected, individuals who reported a lifetime traumatic event also reported greater anxiety, worry, and difficulties in emotion regulation, compared to individuals who did not report a lifetime traumatic event. In addition, vagal activity indexed by HRV in traumatized individuals was inversely related to greater scores on the Trauma Screening Questionnaire ($r = -.325, p = .041$). Unexpectedly, individuals reporting a lifetime traumatic event showed greater resting state vagal activity compared to those not reporting a lifetime traumatic event ($t_{(86)} = 7.082, p = .009$). These differences were robust even after controlling for a host of covariates that are known to decrease HRV. Our findings suggest that trauma-exposure itself may have different implications than trauma exposure paired with a PTSD diagnosis. One interpretation is that these findings may indicate a critical, perhaps pre-existing difference between individuals who have experienced trauma, and the subset of those who then go on to develop PTSD. In accordance with research showing that active emotion regulation is associated with increase in HRV, our results suggest that the experience of a traumatic event might be associated with an up-regulation of vagal activity, needed to encounter everyday difficulties.

## 114) Abstract 1125

### THE HEMODYNAMIC PATTERN OF VASOVAGAL SYNCOPE MAY BE DEFINED BY THE INITIAL CARDIOVASCULAR RESPONSE TO HEAD-UP TILT

Saharnaz Balegh, PhD(C), Psychology, Julie Benoît, M.Sc., Neurology, Blaine Ditto, PhD, Psychology, Ronald Schondorf, MD, PhD, Neurology, McGill University, Montréal, Québec, Canada

Vasovagal syncope (VVS), a transient loss of consciousness provoked by emotive or orthostatic stress, is due to cerebral hypoperfusion caused by an abrupt decline in blood pressure (BP). In a related study, VVS was shown to be due to either an abrupt stroke volume (SV) or heart rate (HR) mediated decline in cardiac output (CO) or to an abrupt decline in total peripheral resistance (TPR). Specific patterns of hemodynamic response were related in part to the clinical triggers for VVS as well as to age and gender. Many have postulated that VVS is a simple reflex caused by “paradoxical” activation of cardiac afferents leading to cardioinhibitory or vasodepressor responses. Our data suggest that VVS is considerably more complex and subject specific. The goal of the present study was to examine whether the ultimate physiological strategy (decline in CO or TPR) underlying VVS could already be determined by the initial hemodynamic response to the simulated orthostatic stress of head-up tilt (HUT).

Beat-to-beat finger BP and EKG were continuously recorded from 58 healthy medication-free adults aged 17-61 (mean = $31 \pm 11$ years, 23 male), undergoing HUT testing for VVS. CO and TPR were derived from BP using Modelflo software. Data were divided into three periods: baseline, initial transition to HUT and end HUT (excluding presyncope). Nine 20-second averaged data segments comprised each period. Three-way Period (3) X Time (9) X Hemodynamic group (2) repeated-measures ANOVAs were performed on physiological data, controlling for the effects of Age and Sex. The two hemodynamic groups were CO and TPR fainters. The Period X Time X Hemodynamic group interaction effect was not significant for BP, but the profiles of the TPR and CO groups were significantly different for HR ($p=.036$), SV ($p=.008$), CO ($p<.001$) and TPR ($p<.001$). For example, in contrast to CO fainters, TPR fainters displayed a large increase in TPR initially following HUT that was maintained until presyncope. These findings remained significant even when the final period was excluded and only data from the initial two periods were analyzed. These results suggest that the strategy by which one initially maintains blood pressure during the orthostatic stress may define the strategy by which blood pressure is abruptly lost at VVS. Further work is needed to determine the underlying mechanisms defining this strategy.

## 115) Abstract 1205

### SOCIAL SUPPORT IN REAL LIFE IS ASSOCIATED WITH CARDIOVASCULAR RECOVERY FOLLOWING ACUTE STRESS EXPOSURE

Stephen Gallagher, PhD, Eoin Brown, BSc, Grace McMahon, BSc, Ann-Marie Creaven, PhD, Psychology, University of Limerick, Limerick, Limerick, Ireland

**Objective:** Recent experimental work examining the stress buffering role of social support has concentrated mainly on cardiovascular reactivity with less attention paid to cardiovascular recovery. Further, the quality of our social relationships, both positive and negative, on recovery indices still remain unclear.

**Methods:** Eighty-seven healthy young adults completed psychometric measures positive (e.g. friendship, emotional and tangible) social support and negative (e.g., hostile and rejection) support) in real life and participated in a standardised cardiovascular stress-testing protocol. Cardiovascular functioning as indexed by blood pressure (SBP, DBP), heart rate (HR), cardiac output (CO) and total peripheral resistance (TPR) was assessed before, during and after acute stress exposure.

**Results:** Social support, both positive and negative, was not associated with cardiovascular reactivity to stress. However, positive social support, in particular friendship ($B= .26, p = .01$) and emotional ($B= .25, p = .02$), was associated with SBP recovery, such that those reporting better social support had slower recovery from stress. A similar pattern was observed for friendship support for DBP ($B= .23, p = .03$). In contrast, hostile support was associated with faster DBP recovery DBP ($B= -.21, p = .04$). These associations withstood adjustment for a range of potential confounds (e.g. body mass index, age and sex).

**Conclusion:** The present study found positive social support in real life to be have an adverse impact on cardiovascular recovery from stress following stress exposure, whereas negative social support to have a positive impact on recovery. Our findings are at odds with some of the existing studies in the field but may be explained by contextual comparison, i.e. support not readily available at stress exposure.

## 116) Abstract 1368

### DISEASE CONTROL ASSOCIATED WITH CENTRAL NERVOUS SYSTEM AND AIRWAY INFLAMMATORY MARKERS IN ASTHMA PATIENTS

Juliet L. Kroll, B.A., Clinical Psychology, Southern Methodist University, Dallas, TX, 75206, Ashton Steel, PhD, Psychology, Southern Methodist University, Dallas, TX, Amy Pinkham, PhD,
*Psychology, University of Texas Dallas, Dallas, TX, Changho Choi, PhD, Physics, Dave Khan, MD, Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, TX, Sheenal Patel, MD, Justin Chen, MD, Allergy and Immunology, Sherwood Brown, MD, PhD, Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, Thomas Ritz, PhD, Psychology, Southern Methodist University, Dallas, Texas*

**Background:** Asthma impacts an estimated 300 million individuals worldwide (GINA, 2016). While prevalence rates continue to increase by nearly 15% in the US over the past decade, there is no cure for asthma (CDC, 2011). As such, the primary goal for the successful treatment patients is asthma control, which is frequently assessed with peripheral airway inflammation measured by the fraction of exhaled nitric oxide (FeNO). Central nervous system (CNS) pathways associated with airway inflammation are largely unknown; however, recent research indicates increased likelihood of mild cognitive impairments in older asthma patients compared to older healthy individuals.

**Methods:** We therefore tested, in twenty individuals with asthma, associations among left hippocampal metabolites with Magnetic Resonance Spectroscopy (MRS) and 1) asthma control with the Asthma Control Questionnaire (ACQ), Asthma Control Test (ACT) and 2) fraction of nitric oxide in exhaled breath (FeNO) with an electrochemical analyzer. After measurements of asthma control and airway inflammation, participants underwent a 3T MRS scan with volumes of interest placed in the left hippocampus. Total N-acetylaspartate (NAA), Myo-Inositol (MI), and Glutamate (Glu) concentrations were calculated in reference to Creatine (Cr) and water.

**Results:** Airway inflammation (FeNO) was negatively correlated with asthma control by ACT, r=-.72, p<.01 and ACQ, r=.68, p=.02, controlling for age and gender. The ratio of MI, a putative marker of glial inflammation, standardized to Cr, was positively correlated with FeNO, r=.56, p=.05, controlling for age and gender.

**Discussion:** These preliminary findings suggest that patients with lower asthma control have elevated levels of airway inflammation, which is associated with putative markers of hippocampal glial inflammation. Associations among both self-report and physiological markers of asthma control with hippocampal glial inflammation may indicate CNS consequences of poor asthma control. As hippocampal glial inflammation measured by MI is associated with mild cognitive impairment in other chronic diseases, future research is warranted to examine associations among asthma control, hippocampal MI, and cognitive function.

## 117) Abstract 1357

### ASSOCIATION OF TRAIT NEGATIVE AFFECT AND ASTHMA MORBIDITY IS MEDIATED BY SYMPTOM ATTRIBUTION AND TRIGGER IDENTIFICATION.

Thomas Janssens, PhD, Evelyne Van Aubel, BSc, Health Psychology, KU Leuven (University of Leuven), Leuven, -N/A, Belgium, Sibylle Petersen, PhD, INSIDE Reserach Group, Luxemburg University, Luxemburg, -N/A, Luxemburg, Omer Van den Bergh, PhD, Health Psychology, KU Leuven (University of Leuven), Leuven, -N/A, Belgium

The episodic nature of asthma symptoms such as wheeze, dyspnea, and cough can cause individuals to perceive their symptoms as unpredictable, and to be uncertain about the causes or triggers of their asthma symptoms. This may contribute to experiencing these symptoms as threatening, particularly in individuals scoring high on Trait Negative Affect (NA), a trait that is associated with excessive (overgeneral) identification of danger and deficient safety learning.

In asthma and other conditions, Trait Negative Affect (NA) is associated with morbidity and elevated symptom self-report. Furthermore, in asthma, NA is associated with increased attribution of symptoms to asthma (illness identity) or to attribution of symptoms to asthma medication. The aim of this study was to replicate and extend the relationship between NA and causal attribution by testing the association between NA and illness identity, and NA and asthma

trigger identification. Furthermore, we aimed to and test the role of these overgeneral attributions in explaining the relationship between NA and asthma morbidity.

We recruited individuals with asthma (n=186) from the community and secondary care clinics. Participants filled out an online survey, consisting of questions on asthma morbidity (asthma control test (ACT), asthma related-quality of life (AQLQ)), as well as questions on trait positive and negative affect (PANAS), illness identity (IPQ-R), and asthma trigger identification (ATI). We fitted different mediation models exploring the role of symptom attribution and trigger identification in explaining the association between NA, and ACT and AQLQ scores.

Higher levels of NA were associated with worse ACT (r= -.32, p<.001) and AQLQ (r= -.22, p=.004). Mediation models showed that associations between NA and asthma morbidity (ACT and AQLQ) were mediated by illness identity (IPQ-R), and asthma trigger Identification (ATI), showing no significant direct effects of NA in models that included these indirect effects.

Effects of NA on asthma control and quality of life are mediated by overgeneral causal attributions, which manifest both in increased illness identity, as well as increased asthma trigger identification. Further research into the development of these causal attributions as well as methods to prevent their occurrence may help to improve disease burden for individuals with asthma.

## 118) Abstract 1472

### INSOMNIA WITH OBJECTIVE SHORT SLEEP DURATION: IMPACT ON HYPERTENSION RISK AND INSOMNIA TREATMENT RESPONSE

Jack Edinger, Ph.D., Medicine, National Jewish Health, Denver, CO

**Introduction:** It has been proposed that insomnia with objective short sleep duration (< 6 hours/night) represent a severely ill phenotype with increased risk for cardio-metabolic morbidity and poor treatment response. The current series of studies was conducted to test these assumptions.

**Method:** Study 1 comprised a secondary analysis of data obtained from larger study testing the reliability/validity of insomnia diagnoses. The study sample consisted of 255 adult volunteers (n = 165 women; 64.7%) meeting current diagnostic criteria for insomnia disorder ($M_{Age}$ = 46.2 years, $SD_{Age}$ = 13.7 years). Logistic regressions assessed the odds ratios of having current hypertension among those insomnia patients with short sleep duration >6 h as determined by two nights of in lab polysomnography. Study 2 compared the responses of insomnia patients with actigraphically-determined short (<6 hours/night) or longer (>6 hours/night) sleep to a course of cognitive-behavioral insomnia therapy -CBTI. The study sample consisted of 60 (53% female; $M_{AGE}$=56.1±10.0 yrs.) who completed 1 to 8 therapist-guided. CBT sessions. Outcome measures included an insomnia symptom questionnaire, nightly actigraphy and sleep diaries completed before, during and 6 months after treatment.

**Results:** The logistic regression analyses conducted with participants in Study 1 showed that insomnia with short sleep duration >6 h was associated with a 3.59 increased risk of current hypertension compared with insomnia with sleep duration ≥6 h. In Study 2, mixed-effects models controlling for age, sex, number of CBT-I sessions offered, and treatment provider showed individuals with insomnia and normal sleep duration had significantly higher insomnia remission [ISQ<36.5; $X^2$(1, N=60) =44.72, P<.0001], and were more likely to have a normative sleep efficiency on actigraphy [SE>80%; $X^2$(1, N=60) =21, P<.0001], a normal level of MWASO 2(1, N=60) =37.85, P<.0001], and a >50% decline in MWASO [$X^2$(1, N=60) =60, P<.0001] by the study endpoint than were individuals with insomnia and short sleep duration.

**Conclusion:** Findings support the hypothesis that objective short sleep duration may be an important biomarker for a severe insomnia phenotype with enhanced risk for medical comorbidities and poor insomnia treatment response. Studies to reduce the comorbidity risk and enhance the treatment outcomes for such patients are needed.
## 119) Abstract 1109

### SLEEP DISTURBANCE OF DEPRESSIVE MEN WITH AND WITHOUT OBSTRUCTIVE SLEEP APNEA

Reiko Hori, Ph.D., M.D., Health and Psychosocial Medicine, Rhujiro Sasanabe, Ph.D., M.D., Toshiaki Shiomi, Ph.D., M.D., Sleep Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan

**Introduction:** Depression and obstructive sleep apnea (OSA) are known to be co-morbid. Patients with depression often visit sleep clinics for suspected OSA. The purpose of this study was to clarify clinical differences among male depressive patients with and without OSA.

**Methods:** The subjects were 127 male patients suffering from depression who were suspected to have OSA due to complaints of snoring, excessive daytime sleepiness and non-restorative sleep. They completed a semi-structured interview, including the Hamilton Depression Rating Scale polysomnography (PSG). Characteristics of the patients were analyzed as a function of the severity of OSA.

**Results:** Based on the apnea-hypopnea index (AHI) in the 127 male patients with depression, 49 patients (39%) were categorized as non-OSA (AHI<5), 51 patients (40%) as mild to moderate OSA (5≤AHI<30), and 27 patients (21%) as severe OSA (30≤AHI). Male patients with depression with severe OSA were more obese than those without OSA. Patients with mild to moderate OSA were older than patients without OSA. There were significantly more smokers among those with severe OSA and more ex-smokers among those with mild to moderate OSA. Dunnett's test adjusted for age, body mass index, and smoking showed that male depressive patients with severe OSA had less difficulty falling asleep at bedtime than those without OSA (non-OSA 0.5 ± 0.1, mild to moderate OSA 0.5 ± 0.1, severe OSA 0.1 ± 0.1). There was no significant difference in ESS score or HAM-D score across OSA severity groups.

**Conclusion:** Except for obese, less difficulty falling asleep at bedtime was a characteristic of male depressive patients with severe OSA.

## 120) Abstract 1474

### SLEEP ARCHITECTURE PROFILES IN INSOMNIA PATIENTS

William Wohlgemuth, Ph.D, Sleep Disorders Center, Miami VA, Miami, FL

**Introduction:** In the past few years interest in insomnia phenotypes has grown. However, little is known about the phenotypic presentation of sleep architecture in those with insomnia. Some investigators have used PSG as a method to identify those who complain of insomnia and also have objectively verified short sleep. Sleep stages have not been considered in this characterization. The objective of this study was to determine if unique sleep architecture profiles could be identified in those who complain of insomnia.

**Methods:** Data were obtained from a dual-site study testing the interrater reliability of the DSM-IV and ICSD-2 insomnia nosologies. As part of the study, all subjects had two consecutive nights of PSG recorded. This sample was comprised of 189 adults (69.2% women; M<sub>Age</sub>= 45.6 ±13.7 yrs.) who met research diagnostic criteria for insomnia. Participants were not excluded if they had sleep apnea. Latent profiles were extracted from the PSG data using Mplus with mixture modeling. Variables in the model included percent of stages N1, N2 and N3 and REM sleep. Covariates, also from PSG data, were the apnea-hypopnea index (AHI), average heart rate during sleep (AHR), and sleep efficiency (SE).

**Results:** A three class solution was the best fitting model. Sleep architecture Profile 1 (52% prevalence) had the following distribution: N1 (10%), N2 (62%), N3 (12%), and REM (16%). Profile 2 (42% prevalence) had an architecture distribution of: N1 (9%), N2 (47%), N3 (22%), and REM (22%) and Profile 3 (6% prevalence) had a distribution of: N1 (29%), N2 (42%), N3 (21%), and REM (8%). The first two profiles were distinguished from the final profile by a both a

higher sleep efficiency and higher average heart rate during sleep. There was a trend for a higher AHI to distinguish the final profile from the first two.

**Discussion:** Three sleep architecture profiles were extracted from this group of individuals with insomnia. The first profile had relatively more N2 and less N3 sleep than the other profiles. The second profile seemed to have a typical distribution of sleep stages. Profiles 1 and 2 were associated with a higher AHR rate and higher SE than Profile 3. The third profile had a higher percentage of light sleep (N1) and seemed to be associated with more severe sleep apnea.

## 121) Abstract 1438

### SOCIAL MEDIA TOOLS IN HEALTH CARE: ARE THEY EFFECTIVE?

Adriana S. Baban, Professor, Diana Taut, Senior Lecturer, Department of Health Psychology, Babes-Bolyai University, Cluj-Napoca, Cluj, ROMANIA

Despite their rapid growth in notoriety among patients and health care providers alike, little is known about the opportunities, mechanisms of actions and the pitfalls of using social media tools (SMTs) in health promotion. We conducted a systematic "review of reviews" comprising 11 existing meta-analyses and reviews of interventions, observational, qualitative and mixed methods studies that used SMTs (Facebook, Twitter, patients' websites and communities etc.) for various healthcare issues. The analyses revealed that there are certain advantages of using SMTs like: patient involvement, general positive perception of SMTs by patients, sharing of health-related content and patient empowerment. The disadvantages were more numerous and reffered to insufficient evidence of added effectiveness in interventions using SMTs, opportunity for fraud, doctor defamation and reduced health providers' control over information flow. While acknowledging the opportunities of SMTs use in health care, almost all reviews were moderated in showing enthusiasm for such an approach and point to a persistent need of rigorous studies and of a set of procedures to appropriately include SMTs in health care interventions.

## 122) Abstract 1172

### EFFECTS OF SOCIAL-EVALUATIVE THREAT AND COGNITIVE LOAD ON THE CORTISOL STRESS RESPONSE

Alex Woody, MS, Psychology, Ohio University, Athens, OH, Emily Hooker, BA, Psychology and Social Behavior, University of California, Irvine, Irvine, CA, Peggy Zoccola, PhD, Psychology, Ohio University, Athens, OH, Sally Dickerson, PhD, Psychology, Pace University, New York City, NY

Current evidence suggests that exposure to social-evaluative threat (SET) can elicit a physiological stress response, especially in cortisol, which is an important regulatory hormone. However, an alternative explanation of these findings is that socially-evaluative laboratory tasks are more difficult, or confer greater cognitive load, than non-evaluative tasks. Thus, the current experiment tested if SET, rather than CL, is truly an "active ingredient" in eliciting a cortisol responses to stressors. Healthy undergraduate students (n = 142, 65% female) were randomly assigned to one of four speech stressor conditions in a fully-crossed 2(SET: non-SET vs SET) by 2 (CL: low vs high) stressor manipulation. SET was manipulated by the presence (SET) or absence (non-SET) of two evaluators while CL was manipulated by the presence (high) or absence (low) of a tone-counting task during the speech stressor. After the stressor, participants rested in the laboratory. Salivary cortisol was collected at +0, +20, +30, +45, and +60 min relative to stressor onset and log-transformed for analyses.

Multi-level linear modeling, with within-person cortisol at level 1 and between-person participant at level 2, was used. As would be predicted if SET was the "active ingredient" in eliciting the cortisol stress response, there was a significant interaction between SET and time (γ=.02, t(141)=7.48, p<.001) and SET and time-squared (γ=-0.0002, t(141)=-6.78, p<.001). Follow-up analyses indicated that the
two SET conditions elicited the typical cortisol increase and decrease in
cortisol following the stressor while two non-SET conditions did not
elicit any changes in cortisol levels (see figure). CL did not have any
main effects (*p*=.58) or interact with time (*p*=.55), nor did it interact
with SET (*p*=.55). Results were not altered by the inclusion of gender,
BMI, start time, race, and ethnicity in the model.

These findings suggest that SET is a central aspect of stressors that
elicit a cortisol stress response, and additional difficulty or cognitive
load is not. This finding has implications for understanding the
qualities of stressful experiences in day-to-day life that may activate the
cortisol stress response and ultimately result in altered or dysfunctional
stress responding, with its concomitant risks of disease.

Cortisol Responses to Social-
Evaluative Threat and Cognitive
Load

<figure><img src="image_16.png" /></figure>

**123) Abstract 1381**

A FRIEND A DAY COULD KEEP POOR HEALTH AT BAY:
SOCIAL ENGAGEMENT AND ILLNESS SEVERITY AMONG
PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY
DISEASE

Aliza A. Panjwani, MA, Psychology, The Graduate Center, City University of New York, New York, NY, Joel Erblich, PhD, MPH, Tracey A. Revenson, PhD, MPH, Psychology, Hunter College, City University of New York, New York, NY, Hoda J. Badr, PhD, Medicine, Baylor College of Medicine, Houston, Texas, Alex D. Federman, MD, MPH, Juan P. Wisnivesky, MD, DrPH, General Internal Medicine, Mount Sinai Hospital, New York, NY

**Objective:** Although much research has examined the role of familial support on health outcomes, less is known about the impact of non-familial support on indicators of illness severity and physical functioning. The purpose of the current study of patients with chronic obstructive pulmonary disease (COPD) was to test whether social engagement with family and friends predicted lower illness severity, breathlessness and functional impairment. We also explored whether the combined effect of engagement with family and friends would have additive beneficial effects on these health outcomes.

**Methods:** Data were collected as part of a multi-site, multi-cohort study of adults with COPD and their caregivers. The 89 patients who reported having an informal caregiver were used for cross-sectional analyses. Caregivers were spouses/partners (49%), adult children (26%), other family members (19%) or close friends (7%). Participants completed measures of illness severity (e.g., COPD severity scale), pulmonary symptoms (MRC breathlessness) and functional impairment (ADLs), and social engagement (Lubben Social Network Scale). A series of multiple regression analyses tested the research questions.

**Results:** We found that support from friends significantly predicted lower illness severity and breathlessness (standardized beta weights ranged from -.32 to -.38, Ps < .01), but not functional impairment. Interestingly, engagement with family members had no significant effects on these health indicators. There were no additive effects of engagement with family and friends, indicating that engagement with friends uniquely contributed to positive health outcomes.

**Conclusions:** Our findings suggest that having a family caregiver or feeling socially engaged with family members may not be enough to maintain optimal health when living with COPD. Isolation from friends or one's broader social network could be a potential risk factor for greater illness severity and poorer lung functioning.

**124) Abstract 1465**

HUMAN RELATIONS OF TELEMARKETERS IN
PORTUGUESE CALL CENTERS

António Pedro, Phd, Psychology, Universidade Autonoma Lisboa,
Lisboa, Lisboa, Portugal

The current human relations of the so-called "relationship agents with clients", are characterized by job strain, loneliness and fear in call centers, the decrease of loving and family relationships and the non-participation in groups. This exploratory qualitative study was conducted among 12 telemarketers who work on average 10+ hours per day, in different companies, with a precarious bond system, and no established career. Three clinical interviews each were conducted. In verbal interactions with customers, telemarketers continuously answer messages and respond with timed and recorded scripts without intersubjective expression. They identify themselves with impersonal models, and reduce they're personal identity to outdoor images (Andy Wharol). The performance is evaluated individually, using quantitative methods. The climate is of maximum competition and minimal cooperation, including moral and sexual harassment, leaving each individual worker isolated. Two thirds of the interviewed isolate themselves outside work, living at they're parents, without romantic relationships or parenting projects. They do not participate in social organizations. Exhausted, angry, and most of them with physiological symptoms. When dominates the blame, they are depressed or with persecutory reactions. They suffer from sleep disorders, hearing impairment, visual, spine, skin, respiratory, cardiovascular, obesity, without medical or psychological care.

**Conclusion:** We hypothesized that this organization of work favors the surface identity pathology, leaving a part of the 60,000 portuguese telemarketers vulnerable to mental and somatic pathologies. Objectives: - Conduct a mixed study concurrent on the results, with a significant quantitative sample to test specific hypotheses, based on the following techniques: -The first interview about relationships and work organization, (Mendes-Pedro et Alls), bullying questionnaires (Gasparo and Pèze), sexual harassment questionnaire (Amassou et alls), validated questionnaire about attachment relationships (from M- Main AAI), Karolinska Exaustion Disorder Scale, Beck questionnaire and Somatic Symptom Disorder SS-D-12. - To promote the opening of a network of consultations on mental and somatic health in Portugal.
**125) Abstract 1639**

**OVERLAP OF ELECTRONIC AGGRESSION AND SCHOOL BULLYING IN NEW DELHI, INDIA**

Drishti Sharma, MD, Community Medicine- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India, Jugal Kishore, MD, PhD, Community Medicine, Vardhman Mahavir Medical College, New Delhi, New Delhi, India, Nandini Sharma, MD, MBA, Community Medicine, Maulana Azad Medical College, New Delhi, New Delhi, India, Mona Duggal, MD, MHS, Community Medicine- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, N/A = Not Applicable, India

**Background:** Violence has far reaching effects on mental and physical health of adolescents. With the changing milieu of social interaction, Internet has become the new arena for bullying. In this study we explore the self-reported acts of in-person bullying and fighting as well as the experience of bullying through electronic media. We also looked at the gender differences in bullying and victimization behavior.

**Methods:** A cross-sectional survey of eighth graders of two public schools in Delhi was conducted in July–September 2013. Self-reported bullying behavior of 174 students (13-15 years old) was measured using pretested questionnaire. We measured socio-demographic features, peer mediated acts of in-person bullying, fighting, victimization, experience of cyber harassment and its emotional and behavioral impact.

**Findings:** Out of the 174 students studied, two-thirds had heard about cyber harassment. Knowledge among girls was better than boys (85% vs 64%). Of total participants, 8% indulged in acts of aggression online and 17% report being victimized by them. Prevalence of in-person bullying, fighting and victimization by either was 16%, 12% and 17% respectively. Males were more likely to bully and fight in-person than females. They were also more likely to be the victims of both online and offline aggression. Though, the genders were comparable in case of cyber-bullying. School bullying and electronic forms of aggression were closely correlated. Also, it had an emotional and behavioral impact on children.

**Implications for Research and Policy:** The problem is complex with different type of bullying behavior being closely interwoven. Researchers, teachers, parents and administrators should gain better understanding of electronic aggression to ensure safe and appropriate applications of technology.

**126) Abstract 1495**

**PARTNER SUPPORT AS A MODERATOR OF THE RELATIONSHIP BETWEEN NEUROTICISM AND HPA AXIS FUNCTIONING**

Kimberly A. Dienes, PhD, Psychological Sciences, University of Manchester, Manchester, United Kingdom, Kristy Engel, MA, Psychology, Roosevelt University, Chicago, IL, Alison Wearden, PhD, Psychological Sciences, University of Manchester, Manchester, Manchester, United Kingdom

**Introduction:** Neuroticism has been shown to predict acute stress reactivity, including activation of the Hypothalamic-Pituitary-Adrenal axis and secretion of its end product cortisol, in both naturalistic and laboratory settings. Research findings to date on the relationship between neuroticism and elevated cortisol secretion across the Trier Social Stress Test (TSST: Kirschbaum et al., 1993) have been mixed (Oswald et al., 2006; Kirschbaum et al., 1992; Tyrka et al., 2007). Partner support may significantly reduce cortisol secretion across the TSST (Kirschbaum et al., 1995; Ditzen et al, 2008). In order to examine whether partner support would moderate the effects of neuroticism on acute stress reactivity, we compared two conditions, the standard TSST protocol, and a partner support modification of the TSST (PSTSST).

**Methods:** Condition 1 participants were 43 undergraduates (67.4% female), age 17 to 56 (M = 22.9, SD = 7.9). Condition 2 participants were 18 undergraduates (66.7% female), and their partners age 19 to 46

(M = 26.2, SD = 8.79). Cortisol was collected five times over 65 minutes during and after the stress tests. Cortisol outcome variables included Area Under the Curve with respect to ground and increase (AUCg and AUCi), and slope of rise and recovery. Neuroticism and its 6 facets (anxiety, anger, depression, self-consciousness, immoderation and vulnerability) were assessed using the IPIP-NEO (Goldberg et al., 2006; http). Total Neuroticism (TN) and study condition were regressed on the cortisol outcome variables.

**Results:** The interaction of TN and condition significantly predicted AUCg (B = -6.73, t(60) = -2.02, p = 0.048); TN explained 12.2% of the variance (p = 0.057). A similar pattern was found for recovery slope (p = 0.044). Anxiety and Depression interacted with condition to predict AUCg and rise (all p < .05). Depression and condition interacted to predict recovery (p = 0.010). Across all analyses, higher TN, Anxiety and Depression significantly predicted greater cortisol secretion across the TSST, but not across the PSTSST.

**Conclusion:** It is possible that partner support may moderate the impact of neuroticism on acute stress reactivity. Interventions targeting partner support may work to reduce the impact of neuroticism on stress reactivity.

**127) Abstract 1076**

**SMILE WHILE YOUR HEART IS BREAKING? THE PROTECTIVE CARDIOVASCULAR EFFECTS OF SMILING DURING SOCIAL EXCLUSION.**

Marie P. Cross, M.A., Amanda Acevedo, B.A., John F. Hunter, B.A., Sarah D. Pressman, Ph.D., Psychology and Social Behavior, University of California, Irvine, Irvine, CA

Smiling has been connected to numerous behaviors ranging from higher quality social interactions to better mental health. While little research has applied smiling to physical health, there is evidence that smiling alters physiological responses to stress and physical pain. Thus, this study sought to extend these findings by testing whether experimentally and covertly manipulated smiling would buffer the negative physiological effects of social pain, that is, the experience of rejection. Participants (N=334, 64.7% female, Mage=20.63) were randomized to hold chopsticks in their mouths in different orientations to manipulate their face into either a Duchenne smile (i.e., a "sincere" smile with both eye and cheek activation) or a neutral facial expression. A cover story obscured study hypotheses from participants by informing them that the study was focused on multitasking behavior. Participants were connected to Mindware physiological equipment to monitor heart rate throughout the study every minute and self-reports of felt rejection were taken immediately following the stressor. To manipulate rejection, half of the participants were randomized to be socially included or excluded while playing Cyberball, an online ball-tossing game reliably used for manipulation of exclusion. Results revealed that participants excluded during Cyberball reported feeling significantly more excluded, rejected, and disconnected (ps < .001) than included participants. Multi-level modeling revealed significantly different heart rate trajectories between groups (p < .001). Specifically, the rejected/neutral facial expression group had a steeper increase in heart rate following exclusion as compared to the rejected/Duchenne smiling group. These results suggest that Duchenne smiling during a painful social rejection dampens its negative physiological consequences. Future research should continue to investigate the mechanisms and reliability of this association.

**128) Abstract 1484**

**DETERMINANTS OF THE QUALITY OF ROMANTIC PARTNER INTERACTION - THE ROLE OF PERCEIVED RESPECT, RELATIONSHIP DURATION, AND RELATIONSHIP HAPPINESS**

Nadine Skoluda, M.Sc., Charlotte Markert, M.Sc., Urs M. Nater, Dr., Psychology, University of Marburg, Marburg, Hesse, Germany
**Objective:** Positive interactions between romantic partners in everyday life provide a valuable source for social support. It is conceivable that relationship characteristics such as relationship duration and overall relationship quality determine the quality of partner interaction. Perceived respect between partners, which is an understudied concept, may constitute another possible determinant of partner interaction as the lack of perceived respect may elicit stress and other negative emotional states. The aim of this study was to investigate determinants of the quality of romantic partner interaction in everyday life.

**Methods:** Using an ambulatory assessment design, 57 healthy participants (47% women) were investigated over a 14-day period. Participants completed a brief survey at 6 time points throughout the day (morning, 11 am, 2 pm, 5 pm, 8 pm, bedtime) using a pre-programmed electronic diary device. Participants were asked to evaluate the quality of partner interaction (VAS 0-100; negative – positive) and perceived respect (VAS 0-100) given by the partner whenever the partner was present at the time of the momentary assessment. In addition, participants provided information about relationship duration (M = 3yrs, SD = 2.9yrs, range: 1-18yrs), how happy they are in their relationship (single item from Marital Quality Questionnaire), and general perceived respect given by their partner (VAS 0-100).

**Results:** The partner was present at 26% of all measurement time points throughout the assessment period. Momentary positive partner interaction was positively predicted by momentary perceived respect as well as by relationship duration and relationship happiness. Interestingly, momentary perceived respect was unrelated to general perceived respect.

**Discussion:** These findings indicate that perceived respect may constitute an important component of the quality of romantic partner interaction in everyday life. Future research may further investigate the role of respect in interpersonal interactions and its role in social support.

## 129) Abstract 1143

### THE ASSOCIATIONS BETWEEN PSYCHOSOCIAL STRESSORS AND PERCEIVED POOR HEALTH DAYS IN SEXUAL MINORITIES LIVING IN AN UNDER-RESOURCED REGION OF THE SOUTHERN UNITED STATES

James A. Griffin, MS, Psychiatry & Health Behavior, Drescher F. Christopher, PhD, Psychiatry and Health Behavior, Toomey M. Thomas, BA, Educational Innovation Institute, Elizabeth D. Eldridge, PhD, Lara M. Stepleman, PhD, Psychiatry & Health Behavior, Medical College of Georgia, Augusta, Georgia

Lesbian, gay, and bisexual (LGB) men and women continue to share a disproportionate burden of physical and mental health conditions in the United States. In small, southern metropolitan areas of the US, there are greater perceived identity-related stressors and health disparities coupled with a general lack of resources to meet the health needs of the LGB community. Perception of health is a good indicator of such biomarkers as blood pressure, body mass index, metabolic and immune markers in underserved populations (Dowd & Zajacova, 2010) and predictive of disability and morbidity (Idler & Kasl, 1995). The present study assesses the associations between critical psychosocial stressors and self-perceptions of physical health. The current sample consists of 241 LGB individuals (74% White, 55% men) between the ages of 18 and 76 ($M_{age}$ = 36) from a larger sexual minority health needs assessment conducted in the Central Savannah River Area (CSRA) of Georgia and South Carolina. Participants completed a series of questions regarding discrimination, perceptions of safety, intimate partner violence, financial situation, and perceived health in the past 30 days. While each of the psychosocial stressors were related to perceived health in bivariate analyses, multiple regression (Adjusted $R^2$ = .084) indicated that perceived safety ($\beta$ = -.140, $p$ < .05), partner violence ($\beta$ = -.127, $p$ < .05), and financial situation ($\beta$ = -.173, $p$ < .05) were the significant independent predictors of perceived “bad health” days. These findings suggest that, while perceived

discrimination continues to be an important factor to address, physical safety and economic assurances may be more proximal stressors for the LGB community in under-resourced areas, such as the CSRA. These stressors impact perceptions of poor health, with the potential for detrimental health effects and increased healthcare costs. The fundamental needs of sexual minorities in under-resourced areas should be prioritized by health providers and advocates, while continuing to address systemic sources of sexual minority stress.

## 130) Abstract 1177

### PSYCHOSOCIAL AND HEALTH NEEDS OF LESBIAN WOMEN: AN ANALYSIS OF WITHIN GROUP DIFFERENCES AMONG SEXUAL MINORITIES

Elizabeth D. Eldridge, PhD, Psychiatry and Health Behavior, Jiby D. Yohannan, BS, Medicine, Medical College of Georgia, Augusta, GA, Joan Walker, BS, Educational Innovation Institute, Augusta University, Augusta, GA, Lara Stepleman, PhD, Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA

Women's health research has not routinely considered sexual orientation despite evidence that lesbian women (LW) may experience higher risk of health concerns, like obesity, compared to heterosexual women. The minority stress theory posits that minority group members face unique stressors related to stigma, which may contribute to higher rates of psychological distress, impacting overall health. Although discerning differences between heterosexuals and sexual minorities is useful, examining within-group differences among sexual minorities can shed light on unique risk factors for LW. The present study aimed to explore differences in health, psychological, and psychosocial factors between LW and gay men (GM), with a focus on LW.

This study uses data collected in 2016 as part of health assessment study of LGBT adults in the Central Savannah River Area of Georgia and South Carolina using a self-administered online survey (N = 436). The current study (n = 276) utilized a range of variables, including demographics, mental and physical health, healthcare utilization, and psychosocial constructs.

This study consisted of 109 LW (mean age = 38=; 63% Caucasian) and 167 GM (mean age = 37; 66% Caucasian). Compared to GM, LW reported worse levels of overall general health, $t(240) = -2.75, p = .01$, more days of poor physical health over the past 30 days), $t(151) = -2.59, p = .01.$, and higher BMI levels, $t(140) = -4.29, p < .01$. LW also reported experiencing higher rates of suicidal thoughts than GM, $t(154) = 2.37, p = .02$. LW more frequently endorsed not seeing a mental health provider, $t(164) = 2.38, p = .02$, and not filling prescriptions, $t(175) = 1.94, p = .05$, despite need. LW reported significantly more concern about lack of LGBT employment opportunities, $t(237) = 2.24, p = .03$, and higher levels of discomfort disclosing sexual orientation to family, $t(100) = 1.93, p = .05$, and healthcare providers, $t(179) = 2.38, p = .02$.

Results indicate that LW may experience unique health concerns compared to GM. Higher levels of BMI reported by LW may help explain the reported worse physical health and more days of poor health of LW. LW also experience higher rates of suicidality and unique stressors related to employment, disclosure, and health care access. More research focus is warranted to better understand the unique risk factors impacting LW.

## 131) Abstract 1048

### TECHNOLOGY-ASSISTED COGNITIVE-BEHAVIORAL THERAPY INTERVENTION FOR END-STAGE KIDNEY DISEASE

Karen P. Jakubowski, MS, Psychology, Manisha Jhamb, MD, MPH, Jonathan Yabes, PhD, Medicine, Swathi Gujral, MS, Lauren E. Oberlin, MS, Psychology, Filitsa Bender, MD, Medicine, Jennifer Steel, PhD, Surgery, University of Pittsburgh, Pittsburgh, PA

**Methods:** Participants were receiving dialysis at a local HD facility for end-stage kidney disease. Patients were screened for clinically-elevated
levels of depressive symptoms, pain and/or fatigue (i.e., ≥3 on the PHQ-2 or ≥4 on the BPI or ≥24 on the FACIT-F). For 8-10 weeks, patients met with a therapist for approximately one hour a week during regularly scheduled HD sessions via a secure, HIPAA compliant, video-conferencing platform (Vidyo). Patients used a study tablet equipped with headphones and microphone. The intervention included CBT modules that have been empirically tested to treat depression, fatigue, and pain, such as identifying and changing maladaptive thought patterns and coping. Participants completed psychosocial and health questionnaires before starting the intervention (baseline) and at 3 months follow-up. Data will also be collected at 6- and 12-months.

**Results:** Out of 11 patients initially enrolled, 3 dropped out (1 moved to a different HD unit, 1 withdrew consent, 1 was found to be ineligible after enrollment due to cognitive impairment). The resulting sample included 8 adults (mean age=58.7; 50% female; 50% African American). At baseline, frequency of elevated symptoms was as follows: (1) 25% of patients had elevated depressive symptoms (CES-D≥16); (2) 75% had elevated pain (BPI average pain≥3); (3) 75% had high levels of fatigue (FACIT-F≥24); and (4) 10% had elevations in all three symptoms. Patient acceptability, satisfaction, and adherence with the video-conferencing sessions was high; more than 95% completed all 8 prescribed sessions. The intervention was also well received by renal providers. No significant changes in depression, fatigue, or pain were observed at 3 months (Figure 1), although there was small improvement in SF-36 Physical Component Summary score [mean change=3±3, p=0.04]. Relevant lessons were learned from this pilot study, including how to improve screening, technology, and facilitation of the intervention.

**Conclusion:** Our technology-assisted CBT intervention for end-stage kidney disease patients was feasible, well-accepted and required minimal additional resources in the outpatient HD setting. Although our study was not powered to examine effectiveness of the intervention, we observed improvements in some patient-reported outcomes, which warrants further evaluation in larger clinical trials.

<figure><img src="image_17.png" /><figcaption>Figure 1. Individual change in depression, pain, and fatigue symptoms from baseline to 3-month follow-up (N=8)</figcaption></figure>

*Note.* Month 0=baseline (data collected before patients started the intervention). For each panel, the horizontal dashed line indicates elevated levels of symptoms: (1) CES-D≥16, (2) BPI average pain≥3, and (3) FACIT-F≥24.

## 132) Abstract 1286
RACE DIFFERENCES IN RESTING AND STRESS-RELATED HEART RATE VARIABILITY IN PATIENTS WITH HEART FAILURE

LaBarron K. Hill, PhD, Lana L. Watkins, PhD, Andrew Sherwood, PhD, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina

African Americans experience a significantly greater incidence of heart failure (HF), with an earlier age of onset, greater rates of cardiovascular co-morbidities and a higher prevalence of left ventricular dysfunction, compared to Whites. Autonomic nervous system impairment, characterized by low heart rate variability (HRV), has been associated with increased mortality risk in patients with HF. Intriguingly, studies in healthy populations have noted that African Americans tend to exhibit higher resting HRV, which is putatively cardio-protective. In contrast, other work has suggested that African Americans show attenuated task-related changes in HRV, or HRV reactivity, which may reflect diminished autonomic flexibility. Despite these indications, the clinical significance of racial differences in HRV and HRV reactivity remains unknown. The goals of the present study were to examine whether ethnic differences in HRV, 1) persist in the context of significant cardiac impairment, and 2) extend beyond resting conditions to periods of psychological stress. The study sample was comprised of 154 patients (49% African American) recruited from the heart failure programs of two academic medical centers in the Southeast US. Heart rate was assessed continuously via ECG during a 10 minute resting baseline period and during the completion of three mental stress tasks (i.e. Mirror Trace, a speech preparation period, and a public speaking task). A global HRV reactivity score was obtained by averaging change (i.e. task – baseline) scores across all stressor tasks. Separate general linear models revealed a significant main effect for ethnicity on both baseline HRV and HRV reactivity. African Americans exhibited significantly higher resting HRV (p < .01), and greater HRV reactivity (p < .05) compared to Whites. These effects remained robust even after accounting for established adverse predictors of HF disease severity and low HRV (i.e. left ventricular ejection fraction, N-terminal pro b-type natriuretic peptide, hypertension, diabetes, depressive symptoms). These data are the first to demonstrate that the paradox of higher HRV in African Americans remains evident in the context of HF and persists beyond resting conditions.

## 133) Abstract 1099
EMA-ASSESSED MOMENTARY POSITIVE RACIAL IDENTIFICATION AND AMBULATORY BLOOD PRESSURE IN AFRICAN AMERICAN YOUNG ADULTS

Nataria T. Joseph, PhD, Psychology, Pepperdine University, Malibu, California, Laurel M. Peterson, PhD, Psychology, Bryn Mawr, Bryn Mawr, PA, Thomas W. Kamarck, PhD, Psychology, Psychiatry, Rebecca C. Thurston, PhD, Psychiatry, Clinical and Translational Science, Epidemiology and Psychology, University of Pittsburgh, Pittsburgh, PA

**Background:** Ecological momentary assessment (EMA) has been shown to capture psychosocial factors in a way that strongly relates to cardiovascular outcomes. Global reports of racial identity (specifically, positive identification with one's racial group) have shown mixed associations with health-related outcomes. EMA might have utility here given that there is evidence that one's identification with a group and the extent to which one feels positively about this group identity might fluctuate. Whether EMA-assessed racial identity is associated with ambulatory blood pressure (AmBP) in African-American young adults has not yet been examined. **Objective:** The purpose of the study was to determine whether EMA-assessed racial identity is associated with AmBP. **Methods:** 55 healthy, African American young adults with valid data were included in analyses (mean age 23 years, range 18-30 years; 75% female). Racial identity was assessed using hourly EMA for 2 consecutive days during waking hours using 2 items adapted for EMA from the Multidimensional Inventory of Black Identity (Sellers, 1997), i.e., "Right now, I am proud to be Black" (positive private regard) and "Right now, being Black is an important part of my self-image" (racial centrality). AmBP was assessed using Oscar2 monitors worn for 2 consecutive days and nights and automatically inflated
**Results:** An interclass correlation (ICC) indicated that within-participant variation accounted for approximately 36% of the total variation in momentary racial identity scores. In a mixed model adjusted for age, sex, income, body mass index (BMI), and momentary biobehavioral and psychosocial covariates (momentary smoking, physical activity, body temperature, talking, and posture), higher momentary positive private regard for one's race was significantly associated with lower diastolic AmBP, $F(1,904) = 4.32, p < .05, b = -1.58$. **Conclusions:** EMA-assessed positive identification with one's racial group (positive private regard) fluctuated within individuals and was associated with AmBP. Potential mechanisms, such as positive emotions and social connections, need to be explored. Findings extend the literature that suggests that positive racial identification has health implications as well as the literature suggesting that EMA has utility for examining connections between psychosocial factors and cardiovascular health.

## 134) Abstract 1606

### LIFE EVENT VALENCE AND BREAST CANCER RISK: THE PROMOTING EFFECT OF NEGATIVE VALENCE LIFE EVENTS

Avital Fischer, B.Sc., Argyrios Ziogas, Ph.D., Hoda Anton-Culver, Ph.D., Epidemiology, University of California, Irvine, School of Medicine, Irvine, California

**Background:** The influence of stress on breast cancer risk remains unknown. The goal of this study was to determine the effect of stress in the form of salient positive and negative valence (+/-) life events (LEs) on primary invasive breast cancer risk. We hypothesized that salient (-) LEs increase breast cancer risk, while salient (+) LEs attenuate this increased risk. **Methods:** A case-control design including 664 cases identified through the Cancer Surveillance Program of Orange County (CSPOC) and 203 population-based controls was used. Participants completed a risk factor questionnaire, which included a life event section. Fourteen salient LEs of positive or negative valence were used to quantify stress exposure. A baseline model was constructed and odds ratios (ORs) calculated using multivariate unconditional logistic regression. **Results:** (-) LEs were associated with increased breast cancer risk. The OR for 4 (-) LEs showed a 2.81 fold increase in breast cancer risk (OR=2.81, 95% CI=1.47-5.36). A significant dose-response relationship between lifetime (-) valence LEs and breast cancer risk was found. Previous personal illness increased breast cancer risk by 3.6 fold (OR=3.60, 95% CI=2.50-5.20). Conversely, abortion was associated with a 45% decrease in breast cancer risk (OR=0.55, 95% CI=0.34-0.89). Salient (+) LEs did not have a significant effect on breast cancer risk. However, they seemed to buffer the adverse effect of salient (-) LEs on breast cancer risk. **Conclusion:** This study supports the role of salient (-) LEs in promoting breast cancer development with a possible buffering effect of salient (+) life events.

<table><caption>**Table 4:** Univariate and multivariate odds ratios for lifetime negative valence life event sum</caption><thead><tr><th rowspan="2"></th><th colspan="2">Cases (N=664)</th><th colspan="2">Controls (N=203)</th><th rowspan="2">OR</th><th rowspan="2">95% CI</th><th rowspan="2">Adj OR*</th><th rowspan="2">95% CI</th></tr><tr><th>N</th><th>%</th><th>N</th><th>%</th></tr></thead><tbody><tr><td>0 events</td><td>25</td><td>12.32</td><td>38</td><td>5.72</td><td>1</td><td></td><td></td><td></td></tr><tr><td>1 event</td><td>30</td><td>14.78</td><td>108</td><td>16.27</td><td>2.37</td><td>1.24</td><td>4.52</td><td>2.26</td><td>1.11</td><td>4.59</td></tr><tr><td>2 events</td><td>44</td><td>21.67</td><td>103</td><td>15.51</td><td>1.54</td><td>0.83</td><td>2.85</td><td>1.74</td><td>0.88</td><td>3.44</td></tr><tr><td>3 events</td><td>39</td><td>19.21</td><td>125</td><td>18.83</td><td>2.11</td><td>1.14</td><td>3.92</td><td>2.20</td><td>1.11</td><td>4.35</td></tr><tr><td>4+ events</td><td>65</td><td>32.02</td><td>290</td><td>43.67</td><td>2.94</td><td>1.66</td><td>5.20</td><td>2.81</td><td>1.47</td><td>5.36</td></tr></tbody><tfoot><tr><td colspan="10"><em>P trend**</em></td><td colspan="2">P=0.0065</td><td colspan="2">P=0.0334</td></tr></tfoot></table>

status, family history of breast cancer, HRT use, smoking history, education level, race/ethnicity and physical activity

** *P trend* computed by incorporating negative valence LE sum in the logistic regression model as a continuous variable

<figure><img src="image_18.png" /></figure>

Initiation

Promotion

Breast Cancer

## 135) Abstract 1046

### DAILY STRESS DURING CHEMOTHERAPY: ASSOCIATIONS WITH CHANGES IN QUALITY OF LIFE, DEPRESSION, AND INFLAMMATION

Carissa A. Low, PhD, Medicine, University of Pittsburgh, Pittsburgh, PA, Sangwon Bae, PhD, Human-Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, PA, Denzil Ferreira, PhD, Center for Ubiquitous Computing, University of Oulu, Oulu, Northern Ostrobothnia, Finland, Thomas Kamarck, PhD, Psychology, Weijing Sun, MD, Medicine, University of Pittsburgh, Pittsburgh, PA, Anind K. Dey, PhD, Human-Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, PA

**Background:** Adjuvant cancer treatment can be a time of significant psychological stress, but little is known about implications of daily stressors during chemotherapy for mental and physical health.

**Methods:** Patients undergoing chemotherapy for gastrointestinal cancer used a smartphone application to complete end-of-day diaries describing each day's most stressful situation and rating it from 1 (not at all stressful) to 4 (extremely stressful). Participants also completed standardized questionnaires to assess depressive symptoms (CES-D) and quality of life (FACT) prior to and at the end of the four-week smartphone data collection and provided blood samples for complete blood counts as part of their routine clinical care. Neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, was computed by dividing absolute neutrophils by absolute lymphocytes (M = 3.87, SD = 2.71).

**Results:** 14 patients (M = 59.7 years old, range 40-74, 43% female) provided data for 15 to 36 days, and daily stressor ratings were averaged for each participant (M = 2.03, SD = .74; M = 13.35 ratings, range 1-29 ratings). Mean daily stressor rating was significantly correlated with mean neutrophil-to-lymphocyte ratio (NLR) during study participation (r(14) = 0.55, p = .044), indicating higher levels of inflammation in patients reporting greater stress. Mean daily stressor rating also predicted significant decreases in FACT quality of life (β = -.25, ΔR² = .04, p = .045) and significant increases in CES-D depressive symptom scores (β = .43, ΔR² = .16, p = .009) at the end of the study, adjusting for baseline values of self-report measures.

**Conclusions:** Higher daily stressor ratings during chemotherapy were associated with higher levels of systemic inflammation and predicted decreases in quality of life and increases in depressive symptoms over time. These preliminary data are consistent with the hypothesis that reducing daily stress during cancer treatment may have implications for both psychological and biological outcomes. Future analyses of these data will also examine whether passively sensed data such as location,

<footnote>* Adjusted for reference age, age at first full term pregnancy, menopausal</footnote>
activity, and heart rate permit real-time detection of daily stress during chemotherapy, which could enable just-in-time adaptive stress management interventions.

## 136) Abstract 1045

### FITBIT STEP COUNTS AS A PREDICTOR OF POSTOPERATIVE RECOVERY: LINKS TO READMISSION AND PATIENT-REPORTED FUNCTION AFTER CANCER SURGERY

Carissa A. Low, PhD, Medicine, Dana H. Bovbjerg, PhD, Psychiatry, Steven Ahrendt, MD, M. Haroon Choudry, MD, Matthew Holtzman, MD, Heather L. Jones, PA-C, James F. Pingpank, Jr., MD, Herbert J. Zeh III, MD, Amer H. Zureikat, MD, David L. Bartlett, MD, Surgery, University of Pittsburgh, Pittsburgh, PA

**Background:** Mobility is encouraged after surgery but is rarely monitored systematically or linked to clinical or subjective outcomes. Commercial activity trackers such as Fitbit devices permit passive quantification of mobility and may identify patients at risk for poor postoperative outcomes.

**Methods:** Patients diagnosed with metastatic peritoneal cancer and scheduled for curative surgical resection with intraperitoneal chemotherapy were enrolled at their preoperative clinic visit. Quality of life was assessed using the FACT before surgery and at three-month follow-up. Fitbit devices were placed on patients' wrists upon transfer from the ICU and worn for the duration of the inpatient stay. Information about readmission to any hospital within 30 and 60 days of discharge was extracted from electronic medical records.

**Results:** Fifty patients provided Fitbit data for analyses (mean age = 57.97, range = 31-81 years; 46% female; 47% with pseudomyxoma peritonei and 35% with colorectal cancer). Means steps per inpatient recovery day were computed for each patient (mean = 984 steps/day, range = 0-3186 steps/day). 42% of patients were readmitted within 30 days, and 46% were readmitted within 60 days. QOL decreased from baseline to 3 month follow-up, with the largest declines seen for Functional Well-Being (FWB; M reduced from 18.85 to 17.62). Older patients were more likely to be readmitted within 30 and 60 days of discharge and also took fewer steps during inpatient recovery. In unadjusted analyses, taking more steps was significantly associated with lower risk of 30-day (t(40) = 2.10, p = .042) and 60-day readmission (t(40) = 2.53, p = .015) and predicted improved FWB from baseline to 3 months after surgery (β = .26, p = .054). After adjusting for age, neither age nor steps was significantly associated with readmission risk, while steps continued to predict improved FWB (β = .32, p = .031).

**Conclusions:** Passively sensed step counts during inpatient recovery predicted risk of 30- and 60-day readmission and functional quality of life 3 months after cancer surgery. Older age confounded the association between steps and readmission, but steps predicted improved functional well-being even after adjustment for age. Although preliminary, results suggest that passively monitoring perioperative activity may identify patients at risk for poor postoperative outcomes.

## 137) Abstract 1489

### RELATIONSHIPS AMONG SLEEP, ADVERSE DRUG REACTION, AND QUALITY OF LIFE IN NON-METASTATIC BREAST CANCER PATIENTS RECEIVING POSTOPERATIVE ADJUVANT CHEMOTHERAPY

Dooyoung Jung, MD, PhD, Human Factors Engineering, Ulsan National Institute of Science and Technology, Ulsan, Ulsan, Korea, Bong-Jin Hahm, MD, PhD, Neuropsychiatry, Seoul National University Hospital, Seoul, Seoul, Korea

Many patients with cancer experience a range of side effects while receiving chemotherapy. Among them, chemotherapy-induced nausea and vomiting are a significant burden. Cancer patients are known to

experience psychological difficulties such as sleep and mood from cancer diagnosis itself.

We collected data from 198 patients who received highly emetogenic chemotherapy after surgery for breast cancer. We used questionnaires to measure morningness, sleep quality, insomnia, daytime sleepiness, anxiety, depression, cancer-related symptoms, and quality of life prior to the administration of chemotherapy, after the first cycle of chemotherapy, and one year later. Significant nausea and vomiting were defined according to a numeric rating scale (0 to 10) as follows: ≥3, nausea; ≥1, vomiting. To evaluate the adverse effects of chemotherapy, we compared the severity of cancer-related symptoms after the first cycle to that at the baseline. We evaluated the changes in quality of life to assess the long-term quality of life. We performed paired t-tests for the changes in time, logistic regression analysis for the risk factors of chemotherapy-induced nausea and vomiting, and multiple linear regression for the predictive factors related to the quality of life.

The symptoms showing the greatest change following initiation of chemotherapy were nausea and vomiting. The occurrence of chemotherapy-induced nausea was associated with poor sleep quality (odds ratio [OR] = 2.48, 95% confidence interval [CI] 1.13–5.46; P = 0.024) and pre-treatment nausea (OR = 4.81, 95% CI 1.84–12.62; P = 0.015). Likewise, chemotherapy-induced vomiting was associated with poor sleep quality and pre-treatment nausea. The menopausal transition was found to be a risk factor in the secondary analysis based on hormonal change. After the initiation of chemotherapy, insomnia exacerbated significantly and maintained through one year. Insomnia and daytime sleepiness were significant predictors of the quality of life after one year of treatment.

Poor sleep quality before the initiation of chemotherapy was found to be associated with chemotherapy-induced nausea and vomiting. Menopausal transition, which is related to the change in sleep and mood, was also found to be a risk factor. Insomnia and sleepiness found in the post 1-year period of chemotherapy were significant predictors of quality of life.

## 138) Abstract 1122

### SCIENTIFIC BASED CONSTRUCTION OF A PSYCHO-EDUCATIONAL GROUP FOR CANCER PATIENTS

Guida Da Ponte, MD, Psychiatry and Mental Health, Jorge Espírito Santo, MD, Oncology, Centro Hospitalar Barreiro-Montijo, Barreiro, Lisbon, Portugal, Sílvia Ouakinin, MD, PhD, University Clinic of Medical Psychology and Psychiatry, Medical School of Lisbon, lisboa, Lisbon, Portugal

**Introduction:** It's well established that psychoeducational groups (PEG) in cancer patients enhance self-management and quality of life. Currently, these groups cover a myriad of topics and are becoming an integral part of service delivery, but although it's proven effectiveness literature is scarce relatively to construction methodology.

**Methods:** The model of Fur and Fulkerson (1982) entails two phases of development of a PEG: conceptual (purpose, goals and objectives) and operational (selection of content, exercises and evaluation).

The purpose was defined as enhance management of cancer and chemotherapy (CT). For selection of content, it was constructed questionnaires, according to a Likert scale, based on educational site "American Cancer Society".

This study was conducted in Portugal, a catholic caucasian population, and it was used a convenience sample.

**Results:** The sample was composed by 20 patients (mean age 59,95 years; 60% female), 14 doctors (43,5 years; 50% male) and 21 nurses (37,43 years; 95% female).

All were consensual in giving more importance to manage side effects and how CT works. Only doctors gave more importance to the role of the patient in their treatment and only nurses to explanation of cancer treatments. Patients had their own concerns as survival rates and medical exams.
**Conclusions:** The primary concern is CT side effects, but differences emerged: doctors believe that patients should have a more active role and patients need more technical information.

## 139) Abstract 1630

### MODERATING ROLE OF MINDFULNESS ON DAILY AFFECT AND CORTISOL IN LUNG CANCER PATIENTS

Lauren A. Zimmaro, M.A., Psychological and Brain Sciences, University of Louisville, Louisville, KY, Suzanne Segerstrom, Ph.D., Psychology, University of Kentucky, Lexington, KY, Elizabeth Cash, Ph.D., Otolaryngology-HNS and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, Chelsea Siwik, B.A., Kala Phillips, B.A., Psychological and Brain Sciences, University of Louisville, Louisville, KY, Whitney Rebholz, Ph.D., Otolaryngology-HNS and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, Sandra E. Sephton, Ph.D., Psychological and Brain Sciences, University of Louisville, Louisville, KY

The physical and emotional complexities of the lung cancer journey may be met with daily fluctuations in positive (PA) and negative affect (NA), which may impact stress biology (e.g., HPA axis). However, mindfulness may ameliorate associations between affect and stress responses. We explored the between-subjects effect of mindfulness on cortisol regulation among lung cancer patients. We then examined the role of mindfulness in moderating within-subjects relationship between daily PA, NA and cortisol.

Lung cancer patients (N=40) completed a mindfulness questionnaire (FFMQ) and provided daily assessments of mood (PANAS) and salivary cortisol (waking, bedtime) over 10 days. Multi-level models were explored, with participants at Level 2 (between-subjects) and days at Level 1 (within-subjects) for three outcomes: waking log cortisol, bedtime log cortisol, diurnal cortisol slope. Waking cortisol was predicted from Level 1 variables assessed on the previous day; bedtime and diurnal cortisol slope were predicted from Level 1 variables on the same day. PA was tested as a mean across days (Level 2) and daily deviation from mean (Level 1). NA was tested as mean across all days (Level 2) and presence vs. absence of NA (Level 1). Main effects of mindfulness and interactions between mindfulness and between-person (Level 2) and within-person (Level 1) PA and NA predictors were tested. Models adjusted for age, gender, and early/late stage.

Between-subjects tests showed that mindfulness had no main effect on mean cortisol outcomes. A interaction between mindfulness and NA emerged as a trend: For days on which NA was not experienced, higher waking cortisol was observed on the following morning, and this effect was marginally stronger in patients with higher innate mindfulness (p=.08). No significant findings with PA were observed.

In within-subjects tests, patients who endorsed no NA on a given day showed more rhythmic (i.e., higher) waking cortisol levels, and this effect was more pronounced in those who were more mindful. Innate mindfulness may play a protective role in the relationship between negative affect and stress biology. These data suggest plausible affective pathways by which mindfulness-based behavioral interventions may exert beneficial effects on physiological stress-response systems among lung cancer patients. Further examination in a larger sample is warranted.

## 140) Abstract 1126

### NOREPINEPHRINE INFLUENCES EARLY ATEROSCLEROTIC EVENTS IN CULTURED HUMAN AORTIC ENDOTHELIAL CELLS AND THP-1 MONOCYTES

Jesica S. West, B.A., Psychology, University of Miami, Miami, FL, Armando J. Mendez, PhD, Medicine, University of Miami Miller School of Medicine, Miami, FL, Angela Szeto, PhD, Philip M. McCabe, PhD, Psychology, University of Miami, Miami, FL

**Objective:** The progression of atherosclerosis may be exacerbated by exposure to emotional stress. These effects appear to be mediated by catecholamines, but mechanisms have not been elucidated.

Catecholamines have been linked to immune and inflammatory processes relevant to atherosclerosis, including leukocyte trafficking, chemotaxis, and adhesion molecule expression. However, it is not clear how catecholamines might affect these processes in atherosclerosis. The present study will investigate how the catecholamine, norepinephrine, influences the proximal atherosclerotic events of monocyte (MO) migration and MO adhesion to vascular endothelial cells (EC).

**Methods:** To evaluate cellular adhesion, cultured human aortic ECs (HAEC) and fluorescently labeled THP-1 monocytes (THP) were separately incubated with or without norepinephrine (NE, 10 nM – 1 µM) for 6 hours. THP were added to HAEC monolayers for 30-60 minutes, and non-adherent cells removed by washing. Adhesion was quantified as the number of fluorescent THP cells bound/mm² of HAEC area. The effect of NE (10 pM – 1 µM) on THP migration was evaluated using a Transwell assay. After 2 or 4 hours, the number of migrated cells on the basal side of the membrane was quantified by light microscopy.

**Results:** Pre-treatment of HAEC with NE increased adhesion of THP to HAEC cell surface. Pre-treatment of THP had no effect on adhesion. Moreover, similar doses of NE increased migration of THP into the Transwell membrane.

**Conclusions:** Exposure of HAEC, but not THP, to physiological levels of NE increased adhesion of THP to HAEC in an *in vitro* assay. These results indicate that catecholamines may increase adhesion of MO through their action on EC, promoting the infiltration of MO into the vessel wall. Furthermore, similar concentrations of NE stimulated migration of THP *in vitro*, indicating that catecholamines may act on MO through a different mechanism to promote recruitment of these cells to developing atherosclerotic lesions. These findings suggest two mechanisms by which emotional stress, mediated by catecholamines, may influence proximal atherosclerotic events, and could explain why adrenergic antagonism is an effective treatment for early cardiovascular disease. Future experiments will assess the adrenergic receptor subtypes responsible for effects on adhesion and migration.

Supported by HL116387 and HL04726.

## 141) Abstract 1218

### PREVALENCE AND PREDICTORS OF SLEEP PROBLEMS IN PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICDS)

Mirela Habibovic, PhD, Liza Mudde, MSc, Dounya Schoormans, PhD, Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands, Jos Widdershoven, MD, PhD, Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, Noord-Brabant, The Netherlands, Susanne S. Pedersen, PhD, Psychology, University of Southern Denmark, Odense, Odense, Denmark, Johan Denollet, PhD, Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands

**Background:** Although sleep disturbances are highly prevalent and associated with poor health outcomes in the cardiac population, to date little research has focused on their assessment and management. Therefore, the current study focuses on the prevalence and predictors of sleep problems in patients with an Implantable Cardioverter Defibrillator (ICD). In addition, we examined the impact of sleep disturbance on health related quality of life.

**Methods:** Data were collected as part of the WEB-based distress program for ICD patients (WEBCARE) trial. ICD patients completed questionnaires at time of implantation, 3-, 6-, and 12 months afterwards. Sleep problems were assessed with the corresponding item #3 of the Patient Health Questionnaire 9 (PHQ-9). A total of 195 patients was included in the analyses.

**Results:** Mean age of the sample was 60 years with majority of the patients being male (82%). The prevalence rates of sleep problems were 67%, 58%, 54%, and 57% at baseline, 3-, 6-, and 12 months post implant respectively. Multivariable logistic regression revealed that a younger age (OR=0.96, 95%CI 0.92-0.99; p=.012) and high Negative
Affect (OR=4.47, 95%CI 1.52-13.17; *p*=.007) were associated with more sleep problems. However, sleep problems were not associated with an impaired health related quality of life at 12 months.

**Conclusions:** Sleep problems are highly prevalent in ICD patients. Negative Affect and younger age predicted sleep problems one year after implantation independent of demographic, clinical, and psychological variables. Due to the negative effects of sleep disturbances on cardiac health, identifying patients who are at risk could contribute to better health outcomes.

## 142) Abstract 1231

### SOCIAL INHIBITION AND NEGATIVE AFFECTIVITY ELICIT DIFFERENT EMOTIONAL AND PHYSIOLOGICAL RESPONSES TO SOCIAL STRESS IN CARDIAC PATIENTS - THE PSYCHE STUDY

Stefanie Duijndam, MSc, Nina Kupper, PhD, Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands

**Background:** Type D personality is related to poor cardiovascular prognosis. The interaction between the two Type D components, social inhibition (SI) and negative affectivity (NA) likely is responsible for these adverse effects. However, physiological and psychological mechanisms relating these two components to poorer cardiovascular outcomes are largely unknown. Therefore, we examined the associations of NA and SI with physiological and emotional responses to social stress in patients with coronary artery disease.

**Method:** From an ongoing study (PSYCHE) we used data from 44 participants (Mean age=66±12, 83% male) for this preliminary analysis. Participants underwent the Trier Social Stress Test (TSST) while an ECG and ICG were recorded to obtain RMSSD and the pre-ejection period (PEP) to gauge parasympathetic and sympathetic cardiac drive. Patients reported perceived negative emotional states pre and post stress. We analyzed negative emotions with high (e.g., tense) and low (e.g., sad) cortical arousal separately. SI and NA were assessed by the DS14.

**Results:** Opposite autonomic responses were observed for SI and NA. While SI was related to a hyperreactive sympathetic stress response, NA was associated with a blunted sympathetic response (see Figure 1a). NA was related to a less active and SI to a more active parasympathetic tone throughout. Parasympathetic reactivity was low, with a higher withdrawal response to the speech task for patients with high SI and a larger response to the math task in patients with high NA (see Figure 1b). Emotional and physiological responses correlated only minimally (RMSSD: $r=-.05/r=.09$; PEP: $r=-.12/r=.15$) with low and high cortical arousal emotions. Higher levels of NA were significantly associated with an increased response on both low and high cortical arousal negative emotions. In comparison, for SI, emotional reactivity was generally more dampened.

**Conclusion:** These preliminary findings suggest that SI and NA are characterized by different autonomic and emotional stress responses. This implies that the mechanisms connecting NA and SI to cardiovascular outcomes via stress reactivity may work through distinctly different pathways. While the increased sympathetic reactivity might play a mechanistic role towards cardiovascular prognosis for SI, for NA the low parasympathetic tone and response may serve as an intermediate risk marker.

<figure><img src="image_19.png" /><figcaption>Figure 1. PEP (A) and RMSSD (B) measurements</figcaption></figure>

## 143) Abstract 1111

### EFFECTS OF NT-PRO BNP ON ANXIETY IN DEPRESSED PATIENTS WITH CORONARY ARTERY DISEASE (CAD)

Stella V. Fangauf, M.Sc. Psych., Thomas Meyer, PhD, MD, Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Lower Saxony, Germany, Christian Albus, MD, Department of Psychosomatics and Psychotherapy, University of Cologne, Cologne, North Rhine-Westphalia, Germany, Karl-Heinz Ladwig, MD, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany, Matthias Michal, MD, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany, Joram Ronel, MD, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany, Wolfgang Söllner, MD, Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Bavaria, Germany, Christoph Herrmann-Lingen, MD, Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Lower Saxony, Germany

Patients with CAD have an increased prevalence for depression, anxiety and distress, which are most likely not only influenced by psychological adaptation, but also modulated by neurobiological processes. Natriuretic peptides may be involved in such mechanisms as they are increased in heart disease and seem to have an anxiolytic-like function. Negative correlations with anxiety were found for (pro-)ANP and recently also for (NT-pro)BNP. However, longitudinal associations of NT-proBNP and anxiety have yet to be assessed.

We therefore used data from the Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD) trial from baseline to 24 months follow-up to study the association of baseline NT-proBNP with anxiety. Linear regression was calculated to assess the correlation of NT-proBNP (N=506) with baseline anxiety (HADS). In repeated-measures ANOVA (N=309) baseline NT-proBNP was used to predict anxiety at baseline and 1, 6, 12, 18 and 24 months follow-up.