Neural mechanisms of enhancing emotion regulation in bereaved spouses

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Project Summary / Abstract The loss of a spouse is a profoundly stressful life event associated with significantly increased morbidity and mortality risk in bereaved spouses. Bereavement stress is often manifested in emotional reactions such as despair, dejection, guilt, and other symptoms of depression. Acute suffering stemming from the above reactions is highly prevalent, especially during the early stages of bereavement (i.e., within the first 1-2 years), with substantial dysphoria in everyday life activities often persisting even longer (up to 4 years or more post- loss). Bereavement is also associated with low respiratory sinus arrhythmia (RSA), a psychophysiological biomarker of adaptive cardiac vagal tone and a strong predictor of all-cause mortality. Emotion regulation skills represent an ideal target for psychological intervention to promote healthy coping in bereaved spouses. Despite clear evidence that the emotional stress of bereavement is associated with negative health outcomes, existing cognitive-behavioral intervention approaches for bereavement are frequently overall ineffective; involve training in disparate intervention strategies, obscuring knowledge about which strategies are most effective; impose substantial time/cost burdens; and—crucially—operate via neurobiological mechanisms that remain to be elucidated. The objective of this proposal is to use an experimental medicine approach to evaluate the basic psychological, psychophysiological, and neural mechanisms underlying a novel cognitive emotion regulation intervention aimed at improving psychological outcomes (i.e., reducing depressive symptoms and grief rumination) in bereaved spouses. Cognitive reappraisal (i.e. the ability to modify the trajectory of an emotional response by thinking about and appraising emotional information in an alternative, more adaptive way) represents a highly promising target for psychological intervention in bereavement. Reappraisal can be operationalized via two primary tactics: psychological distancing (i.e. appraising an emotional stimulus as an objective, impartial observer) and reinterpretation (i.e. imagining a better outcome than what initially seemed apparent). The proposed project builds upon promising preliminary work to investigate the effectiveness and underlying neurobiological mechanisms of a novel, five-session cognitive reappraisal intervention in bereaved spouses. Recently-bereaved participants (i.e. approximately 6 months post-spousal loss) will be randomly assigned to receive training in either distancing or reinterpretation, with five sessions occurring every 1-3 days, with longitudinal collection of affective, psychophysiological, and functional magnetic resonance imaging (fMRI) data. The proposed study aims to mechanistically relate changes in psychological, psychophysiological, and neural function during a novel emotion regulation intervention never before implemented in this stressed, high risk group.