Training Reappraisal under Stress

Stressful life events have a major impact on our mental health. Despite this
high clinical relevance and associated societal costs, successful and
cost-efficient treatment options and preventative measures are still sparse.
Many of the symptoms of stress-related psychopathologies, including overly
strong attention toward and processing of negative information as well as
excessive fear responding, are at least partly driven by stress-induced
impairments in effective emotion regulation abilities and the use of
maladaptive emotion regulation strategies may pose an important risk factor for
the development of several psychopathologies. Cognitive reappraisal has been
proposed as a key mechanism for resilience. Stress-induced impairments in
reappraisal likely result from the high cognitive demands that this strategy
imposes on prefrontal cortex (PFC) functioning. A potential solution to this
problem is repeated training which is known to cause cognitive processes to
become more efficient and less dependent on PFC regions, and therefore less
sensitive to the effects of stress. Earlier research indeed showed that four
sessions of guided reappraisal practice improved downregulation of
self-reported negative affect.

The aim of this experiment is to investigate whether training reappraisal will
prevent stress-induced impairments in effective emotion regulation, and if this
training effect is associated with reduced negative effects of acute stress on
PFC functioning during emotion regulation.

In this functional MRI (fMRI) experiment we use a randomized between subjects
design with the between subjects factors training (training vs. no training)
and stress (stress induction vs. control).

To reduce the burden on participants, instead of inviting them regularly to the
lab to do the training, we will use a smartphone-based training that
participants can easily follow in their daily lives. Participants will use an
adapted version of the original ReApp (Reappraisal Application), a
smartphone-based training developed by the University of Zürich(Marciniak et
al, in preparation). Their study showed that ReApp is feasible to offer short
trainings to students in their daily lives (Marciniak et al, in preparation).
User adherence and commitment, as well as user experience were very high in
this study. During this training, participants are asked to challenge and
reinterpret negative thoughts they may have had about an actual, hypothetical,
or future event. Participants do this 3x per day and are instructed to trigger
the training themselves whenever they experience negative thoughts. The study
from Zürich (Marciniak et al., in preparation) showed that mean adherence was
34 out of 21 notifications (166% of the planned trainings), meaning that
participants liked to trigger the training in addition to the required 3x per
day. This also shows that the burden for the participants is very low.
To test the effectiveness of the training in preventing stress-induced
impairments in effective emotion regulation, participants will be exposed to a
laboratory stress induction (a combination of the Socially Evaluative Cold
Pressor Test [SECPT] and the ScanSTRESS) or a control procedure before
performing an emotion regulation task inside the MRI. These are very common
procedure to increase acute stress levels.

The estimated burden and risks of this study are negligible. Subjects may
experience slight discomfort when filling in mood questionnaires, collecting
saliva samples and when being exposed to the laboratory stress induction. Also,
participants may experience the daily time investment of the training as
burdensome. However, since a previous study showed that participants even
invested more time in the training than was required, this is not expected.
Loud noise in the scanner and lying in a small confined space may lead to
discomfort in some participants. These procedure are widely used in humans and
are completely save.