Interoceptive awareness and perceived control moderate the relationship between cognitive reappraisal, self-esteem, and cardiac activity in daily life

International Journal of Psychophysiology 141 (2019) 84–92

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Full Length Article

Interoceptive awareness and perceived control moderate the relationship between cognitive reappraisal, self-esteem, and cardiac activity in daily life

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Andreas R. Schwerdtfegera, , Sabine Heeneb, Eva-Maria Messnerc a

Institute of Psychology, Health Psychology Unit, University of Graz, Austria Department of Family and Family Policies, German Youth Institute of Munich, Germany c Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany b

A R T I C LE I N FO

A B S T R A C T

Keywords: Emotion regulation Heart rate variability Interoception Reappraisal Self-esteem

Cognitive reappraisal has been discussed to dampen emotional experience and foster health and well-being. Recent theorizing suggests that the benefits of reappraisal might depend on the feasibility to exert control in a given situation and the ability of an individual to sensitively attend to organismic cues (interoception). This study examined the interplay of habitual reappraisal, interoceptive awareness and perceived control on psychological (self-esteem) and physiological (heart rate variability) adjustment in daily life. A sample of 111 participants was monitored throughout 12 h. Habitual reappraisal was assessed via the emotion regulation questionnaire and interoception via a heartbeat detection task (method of constant stimuli). An ecological momentary assessment protocol was used to record short-term heart rate variability (HRV) as an indicator of cardiac vagal tone, self-esteem and perceived control in daily life. Higher use of reappraisal was associated with higher self-esteem particularly in good heartbeat detectors when perceived control in daily life was low. Conversely, habitual reappraisal was unrelated to momentary self-esteem in poor heartbeat detectors. Moreover, habitual reappraisal predicted higher HRV in daily life when perceived control was low, and reappraisal tended to be positively related with HRV in good, but not in poor heartbeat detectors. Together the findings suggest that the benefits of habitual reappraisal in daily life may depend on perceived control and interoceptive accuracy, thus supporting the assumption that the effects of reappraisal in daily life are more complex.

Reappraisal is thought to impact an individual's emotional experience at an early stage in the emotional process by cognitive regulation, hence constituting an antecedent-focused strategy (e.g., Gross and Thompson, 2007). More specifically, reappraisal refers to an alternating way to think of a potentially negative situation or stimulus by cognitive re-interpretation. Numerous experimental studies examined the effects of reappraisal on psychological adjustment and found that reappraising the emotional stimulus proved particularly effective in reducing the emotional response (for meta-analyses see, Aldao et al., 2010; Webb et al., 2012). Habitual use of reappraisal has also been found to predict positive affect and higher self-esteem in daily life (e.g., Gross and John, 2003; Nezlek and Kuppens, 2008), thus facilitating psychological adjustment and well-being (e.g., Gross, 2007; Hu et al., 2014). The findings on self-esteem are particularly interesting, because self-esteem has been found to constitute a reasonable proxy measure for well-being (e.g., Diener et al., 1999) and its relevance for emotion regulation has been demonstrated in previous research (e.g., Diener et al., 1999; Nezlek, 2005; Nezlek and Kuppens, 2008). Taken together, reappraisal

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has been suggested to constitute an adaptive strategy to downregulate negative emotions and foster both psychological well-being (including self-esteem) and health. In line with this reasoning, neurobiological research could identify considerable overlap in brain regions being involved in both cognitive emotion regulation (reappraisal) and trait self-esteem, involving regions of the medial prefrontal cortex, cuneus, anterior cingulate cortex, and hippocampus (Agroskin et al., 2014; Dixon et al., 2017; Pan et al., 2016). Other research found evidence that reappraisal involves activation of cognitive control regions in the brain that downregulate the amygdala via modulation of semantic representations (e.g., Buhle et al., 2014), thus modulating the processing of negative stimuli by attenuating their salience. Accordingly, it could be assumed that cognitive reappraisal should also dampen the physiological consequences of stress. Specifically, reappraising a stressful situation such that it can be regarded rather neutral or even positive should bolster self-esteem and buffer physiological responding. However, with respect to the physiological underpinnings of reappraisal findings appear inconsistent. In

Corresponding author at: Institute of Psychology, University of Graz, Universitaetsplatz 2/III, A-8010 Graz, Austria. E-mail address: [email protected] (A.R. Schwerdtfeger).

https://doi.org/10.1016/j.ijpsycho.2019.04.003 Received 29 October 2018; Received in revised form 26 February 2019; Accepted 5 April 2019 Available online 06 April 2019 0167-8760/ © 2019 Elsevier B.V. All rights reserved.

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resulted in less psychological impact of ostracism, thus suggesting a more efficient emotion regulation in individuals with better interoceptive accuracy. Indeed, it has been hypothesized that interoceptive accuracy may allow for a fine-tuned feedback of emotional arousal from the body, thus facilitating psychological adjustment (Critchley and Garfinkel, 2017). Correspondingly, bodily feedback is assumed to be a prerequisite to sensitively adapt to emotion-eliciting circumstances (e.g., Craig, 2004; Seth, 2013). In this respect, Füstös et al. (2013) could observe that a better cardiac awareness (as assessed via a heartbeat detection task) facilitated the downregulation of affect and could also be a prerequisite for fine-tuned behavior regulation (Herbert et al., 2007). Hence, one aim of the present research was to examine the interplay of reappraisal and interoceptive awareness on psychophysiological adjustment. A second factor potentially moderating the effects of emotion regulation is perceived control. A large body of research documents that perceived control is health protective when the current situation or behavior in principle allows control (e.g., Karasek, 1998; Lachman et al., 2011; Steptoe and Wardle, 2001). Conversely, in situations with little opportunities for control high control beliefs may backfire and lead to poorer adjustment (e.g., Heidemeier and Göritz, 2013; Thompson et al., 1993). In such situations other cognitive strategies might be better suited (e.g., Lachman et al., 2011). In line with this reasoning, a person-situation-fit model has been proposed, suggesting that the effects of reappraisal should be more robust when individuals have no control over the situation (Troy et al., 2016). These authors could show that reappraisal was particularly adaptive when applied in contexts with little perceived control. Conversely, when reappraisal was used during highly controllable stress, it was associated with worse mental health (i.e., depressive symptoms). Taken together, the aim of this study was to examine interoceptive accuracy and perceived control as moderators of the psychological (selfesteem) and physiological effects (HRV) of reappraisal in daily life. Therefore, a momentary assessment study protocol was implemented. Of note, contrary to many experimental studies on emotion regulation, we were particularly interested in the effects of habitual use of these strategies in daily life. We decided on habitual reappraisal use, because asking about momentary use of reappraisal multiple times a day could pose a mental challenge within each situation and might further stimulate/sensitize the individual toward the use of such strategies. It was hypothesized that interoceptive accuracy and perceived control should moderate the relationship between cognitive reappraisal and both selfesteem and cardiac activity such that a more accurate interoception and a rather low level of perceived momentary control would be accompanied by a stronger positive relationship between habitual reappraisal and momentary self-esteem, as well as momentary HRV.

principal, such studies assessed emotion regulation as a state variable either by instructing participants to reappraise the upcoming stimuli or by asking about the actual tendency to reappraise a given situation. Several studies could not find reliable effects of state reappraisal on skin conductance, heart rate, blood pressure, or cortisol (e.g., Gross, 2002). For example, Egloff et al. (2006) found that spontaneous reappraisal during a public speaking task was not associated with electrodermal activity, finger temperature, finger pulse amplitude, or heart rate. On the other hand, Denson et al. (2014) reported that reappraisal rather increased cortisol reactivity to a socially-evaluative speech and a cold pressor task, while there was no effect for heart rate. Other studies focused on hemodynamic responses while participants were instructed to use reappraisal and found a more beneficial physiological response (i.e., higher cardiac output and lower peripheral resistance, e.g., Pavlov et al., 2014; Sammy et al., 2017). Taken together, the heterogeneity of the findings suggest that individual differences might moderate this relationship. It is rather surprising that the variability of beat-to-beat changes in heart rate (so-called heart rate variability; HRV) has seldom been studied with respect to reappraisal. HRV is influenced by both sympathetic and parasympathetic (i.e., vagal) nerve fibers and can be divided into short-term, respiratory-related components (e.g., respiratory sinus arrhythmia) and longer-term components. Importantly, short-term HRV has been found to be mainly under parasympathetic (i.e., vagal) control (e.g., Berntson et al., 1997), thus allowing the organism to rapidly adapt (within milliseconds) to changing environmental demands by releasing the vagal brake (e.g., Thayer and Lane, 2009). Due to its sensitive responding, short-term HRV (as indicated by both time domain and frequency domain measures) has been associated with psychological variables that are considered relevant for the dynamic adjustment to environmental changes (e.g., Appelhans and Luecken, 2006). Specifically, a higher short-term HRV has been associated with better attentional regulation and executive functioning (e.g., Schwerdtfeger and Derakshan, 2010; Thayer et al., 2009), social safety (e.g., Porges, 2007), more efficient self-regulation (e.g., Zahn et al., 2016), and more adaptive emotion regulation (e.g., Thayer et al., 2009). Furthermore, research suggests threat-buffering effects for both HRV and self-esteem, thus implying that both variables might share similar health-protective mechanisms (e.g., Martens et al., 2010; Martens et al., 2008; Schwerdtfeger and Scheel, 2012). Of note, there is also increasing evidence that reappraisal and HRV are interrelated. A recently published study found that habitual reappraisal use was associated with elevated resting HRV (Cai et al., 2019). A similar finding for individuals low in worry was reported by Knepp et al. (2015). Other research could observe a buffering role of state reappraisal on the heart as indicated by elevated short-term HRV (Ottaviani et al., 2014; vanOyen Witvliet et al., 2011), and studies on both adults and children found that cognitive reappraisal resulted in elevated vagally-mediated HRV while watching emotional film clips (Davis et al., 2016; Denson et al., 2011). Taken together, these findings suggest that both habitual and state reappraisal might exert a calming effect on the heart, thus supporting the hypothesis that short-term HRV could index an individual's cognitive emotion regulation capacity. Importantly, meta-analytic evidence suggests that the health-related benefits of reappraisal are small to medium in size (Aldao et al., 2010; Webb et al., 2012) and a diverse set of moderators has been found (e.g., emotion to be regulated, emotional stimulus material, methodological design, participant's sex, reappraisal success; Ford et al., 2017; Webb et al., 2012). Of note, recent research identified two meaningful factors that may modulate the effect of emotion regulation: First, the benefits of reappraisal might depend on the individual's ability to attend to bodily changes (so-called interoception; e.g., Craig, 2004). Noteworthy, Kever et al. (2015) could demonstrate that better interoceptive accuracy was associated with more use of habitual emotion regulation strategies, a finding that was supported by Pollatos et al. (2015). Moreover, these latter authors found that interoceptive accuracy

1. Methods 1.1. Participants Overall, 131 individuals participated in this study. They were recruited via flyers and announcements among employees at the university campus and at the local city center. Sampling strategy was based on the idea of a more heterogeneous, non-student sample in order to allow sufficiently large variance in the measures. There were 66 women and 65 men and n = 31 (24%) were smokers. Participants were screened prior to the study for medication use and cardiovascular diseases by means of an online questionnaire. Only individuals without self-reported cardiovascular diseases (hypertension, ischemic heart disease, cardiopulmonar disease, cerebrovascular disease) and mental disorders (including anxiety and major depression) and without cardiovascular and psychoactive medication were eligible for study participation. The data of 11 participants could not be used due to excessive artifacts in the electrocardiogram (ECG; poor signal quality, frequent ectopic beats), technical failure (n = 2), or withdrawal from the study 85

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(500 ms delay). After each trial, participants were requested to rate via button press (forced-choice) whether auditory feedback was perceived synchronous or asynchronous with their heartbeats. Task duration was 10 min. In order to quantify interoceptive accuracy the signal-detection performance measure d-prime (d′) was used (e.g., MacMillan and Creelman, 2005) with higher scores indicating better interoceptive accuracy (d′ = z[Hits] − [False Alarms]). Of note, this statistic allows for a continuous quantification of interoceptive accuracy with higher scores indicating better performance (high sensitivity) and lower scores poor performance (e.g., Fairclough and Goodwin, 2007). Values around zero indicate performance by chance. Mean d′ in this sample was 0.62 (SD = 1.51), thus suggesting on average above chance performance. The heartbeat detection task was performed after an adaptation period to assure validity of the task, because high heart rates (120 BPM) would transform the asynchronous trials into nearly synchronous (note that a 500 ms delay corresponds to 120 BPM). Mean heart rate during this task was 72.09 BPM (SD = 11.38) and no participant exceeded 112 BPM. Of note, heart rate and d′ were unrelated to each other (r = −0.15, p > .10).

(n = 4). Finally, 3 participants were skipped from analysis because they showed no variation in neither perceived control and used the highest rating on each EMA. Thus, a total of 111 participants (60 women) were included in the analyses. Mean age was 37.30 years (SD = 7.82), spanning a range from 30 to 60 years. 1.2. Research design Of note, a previously published data set on the relationship between repressive coping and the discrepancy between autonomic activity and negative affect was used (Schwerdtfeger and Rathner, 2016), which, however, did neither analyze reappraisal, self-esteem, HRV, nor interoception. The study was part of a larger research project on coping, emotion regulation and health, including a laboratory stress protocol, a sonographic assessment of the carotid arteries, a blood sample, and a 12-h ambulatory assessment, which will be described in more detail. Specifically, physiological and psychological variables were recorded throughout one weekday via ecological momentary assessment (EMA). Participants were equipped with ambulatory monitoring devices to record the electrocardiogram (ECG) and bodily movement to control for metabolically relevant changes in HRV (e.g., Laborde et al., 2017). In addition, participants were repeatedly asked to provide ratings of their current location, smoking (if smokers), perceived control, and momentary self-esteem (e.g., Schwerdtfeger and Scheel, 2012) via electronic devices (iPOD touch 4 GB, Apple Inc.). Participants were also instructed to fill out a questionnaire to assess habitual emotion regulation and demographic as well as lifestyle variables (e.g., regular physical exercise, smoking status), and completed a heartbeat detection task prior to the ambulatory protocol in order to assess interoceptive accuracy.

1.4. EMA 1.4.1. Psychological variables iPODs were programmed with the software iDialogPad App by G. Mutz (University of Cologne, Germany) to assess perceived control, momentary self-esteem, momentary smoking, and situational characteristics in everyday-life (i.e., location). Reports were made contingent on signals participants received between 9 am and 9 pm following an acoustic signal, which was initialized about every 45 min ( ± 10 min). The interval between two alarms could therefore vary between 35 and 55 min to prevent anticipatory behavioral adjustments. Participants rated their self-esteem (“how was your self-esteem”) and perceived control (“to what extend do you feel you had control over the situation?”) during the 5 min prior to each alarm. Self-esteem was generally defined as a sense of self-worth and personal value (e.g., being proud of oneself or feeling inferior), which can fluctuate across situations. Self-esteem and control were rated on 6-point Likert scales with the poles 1 (low) and 6 (high). The mean control score across all entries and participants was 5.14 (SD = 0.96, MIN = 1, MAX = 6), for self-esteem it was 4.33 (SD = 0.79, MIN = 1, MAX = 5), documenting rather high levels of perceived control and self-esteem in everyday-life. Additionally, participants were asked to report their location (work, home, outside, vehicle) and whether they engaged in smoking during the last 5 min (only if smokers; no vs. yes) and whether they consumed caffeinated beverages (e.g., coffee, energy drinks). As it turned out in later analyses, caffeine intake was not significantly associated with neither self-esteem nor RMSSD, thus this variable was not included in further analyses in order to reduce complexity. About 22% of the prompts were filled out during work, 9% during leisure time, 15% on the go and 53% at home. With respect to location, being at home was contrasted with all other locations because previous research has unveiled substantially lower cardiovascular activation and negative affect when individuals were at home as compared to other locations (e.g., Gump et al., 2001; Schwerdtfeger and Friedrich-Mai, 2009). Moreover, momentary smoking has been found to impact ANS function (e.g., Karakaya et al., 2007; Schwerdtfeger and Gerteis, 2014). Importantly, each EMA assessment was supplied with a time stamp to permit precise matching with the corresponding physiological signals (i.e., ECG traces, bodily movement). Overall, 2753 valid EMA entries were obtained, averaging to approximately 25 entries for each participant across the 12-h recording period.

1.3. Measures and instruments 1.3.1. Demographic and lifestyle variables Demographic (age, sex, family status) and lifestyle variables (smoking, physical exercise) were assessed by means of a self-constructed questionnaire. Waist to hip-ratio (WHR) was assessed objectively via an elastic centimeter belt. These variables were included because they could substantially impact cardiac activity. WHR for women was 0.75 (SD = 0.06) and for men M = 0.86 (SD = 0.08), thus suggesting rather normative values (e.g., WHO, 2011). Applying common cut-off scores to assess abdominal obesity (≥0.85 for women and ≥0.90 for men) resulted in 9% of women and 30% of men being obese. Physical exercise was assessed by asking participants whether they engaged regularly in exercising or sporting activities accompanied by increased heart rate, respiration and sweating (0 = no, 1 = yes; 68% of the sample agreed). 1.3.2. Emotion regulation questionnaire (ERQ; German version by Abler and Kessler, 2009) The reappraisal subscale of the ERQ was used, which comprises 5 items to be rated on a 7-point Likert scale. Reliability of the scale was satisfactory (Cronbach's alpha = 0.79). The mean score was 4.83 (SD = 1.09), thus indicating above average use of cognitive reappraisal strategies. 1.3.3. Interoceptive accuracy: heartbeat detection paradigm Heartbeat detection was assessed via the method of constant stimuli (e.g., Brener et al., 1993; Fairclough and Goodwin, 2007; Wiens and Palmer, 2001). In this paradigm heartbeats are continuously recorded via ECG and acoustically transmitted to the participant. Auditory feedback is given either concordant with the heartbeat (a 200 ms delay is usually perceived as concordant; Wiens et al., 2000) or severely delayed (500 ms delay). In this study 60 trials with 10 consecutive heartbeats each were presented in pseudorandomized order. Of the 60 trials 30 were synchronous (200 ms delay) and 30 asynchronous

1.4.2. Physiological monitoring Physiological variables (ECG, bodily movement) were recorded by means of a lightweight ambulatory monitoring device (Varioport-b, Becker Meditec Karlsruhe, Germany). This device is capable of 86

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calculated in milliseconds for each minute. Extraordinarily strong successive IBI variations were corrected by a moving average procedure if they differed by more than a multiplier of 1.5 or 0.7 from the previous IBI. Minutes with > 5 erroneous IBIs were discarded. Short-term HRV was quantified in the time-domain by calculating the root mean squares of successive differences (RMSSD). Importantly, RMSSD is a sensitive indicator of vagal cardiac control that reflects parasympathetic efference (Goedhart et al., 2007; Task Force Guidelines, 1996). Of note, the myelinated vagus nerve innervates the heart via milliseconds, thus allowing a rapid adaptation to changing environmental demands (Thayer and Lane, 2009). It has proven to be a reliable index of vagal activity especially suited for ambulatory assessment (Goedhart et al., 2007) with higher values indicating stronger vagal influence. Due to its skewed distribution, RMSSD was log-transformed using the natural logarithm prior to analyses (ln ms). Bodily movement was also calculated across the 5 min prior to each iPOD entry. The signal was quantified by integrating each of the axes of the accelerosensors and calculating the mean across axes. Prior to integration, the signal was detrended by subtracting the DC-component from the AC-component. Integrals were subsequently square root transformed.

recording up to 16 physiological channels with 16 bit resolution. It is lightweight (170 g), and the dimensions are 12 (length) × 6.5 (width) × 2.2 cm (height). It is worn on the right side of the chest via a chest belt. Cardiac activity was recorded by means of an ECG by applying a chest lead, and participants were grounded on the lower right rib cage. Disposable tap electrodes (Ambu® Blue Sensor VL) were used for signal transduction. The ECG signal was scanned with 512 Hz and sampled with 256 Hz on a memory card. In addition, bodily movement was recorded by means of two accelerosensors in order to control for metabolically relevant changes in cardiac activity. Thus, decreases in HRV reflecting metabolic adjustments to increased muscle activity could be controlled for. A uni-dimensional accelerometer (Becker Meditec®, Karlsruhe, Germany) was attached on the left thigh (above the knee) to measure leg movements, and a three-dimensional accelerometer was located inside the VARIOPORT-b. The sensitivity of the accelerometers is 0.2 m Gs. Signals from each sensor were sampled at 16 Hz and stored on a memory card for further offline processing. 1.5. Procedure Participants were invited to the laboratory and filled out the informed consent sheet. Then waist and hip circumference were measured, the electrodes (ECG for the heartbeat detection task) were attached, and signal quality was checked. During this time period participants were handed over newspapers to adapt to the environment. Then the heartbeat detection task was initiated. Afterwards participant worked on questionnaires on demographic variables, emotion regulation and other subjects unrelated to this study's aim. The EMA was initiated at the end of the laboratory session to record 12 h of data in everyday life. Study participants were instructed beforehand to arrange the scheduling such that the EMA following the laboratory session captured a typical day. Upon arrival, participants were made familiar with the study protocol and the technical equipment. Subsequently, the electrodes were attached and signal quality was checked. An acoustic signal was initialized, and participants were instructed to provide ratings of self-esteem, control, current smoking (if applicable), and location on the iPOD following each alarm (as referred to a time-interval of 5 min prior each alarm). Special care was taken to familiarize participants with the procedure (i.e., acoustic signal, iPOD entries). Items were introduced and explained when necessary by the experimenter. Participants were explicitly informed about the possibility of muting or ignoring a prompt if necessary (e.g., while driving a car or attending a meeting), and to initialize an assessment manually later on. However, it was emphasized that participants should make every effort to respond to the acoustic prompts and that manual assessment initiation was meant to be an exception. Participants were asked to detach the electrodes after 22 h and to return the equipment to the laboratory the next day. In this study, only 12 h of data were used, thus excluding nocturnal recordings. On account of the sensitive technical equipment, they were not allowed to engage in intense aerobic training, bathing, or showering during the recording period. Participants were compensated with up to 100 Euros for participating in the research project. The study was approved by the institutional ethics review board and was therefore performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

1.7. Statistical analyses Data were analyzed using multilevel analysis using the statistical software R (ver. 3.4.3, R Core Team, 2017) with the package “nlme” (ver. 3.1-137, Pinheiro et al., 2017) to account for the different levels of measurement (multiple assessments within-person: body motion, current smoking, perceived control, location; single assessment betweenperson: age, sex, WHR, habitual reappraisal, interoceptive accuracy). Two models were calculated, one for predicting self-esteem, and one for predicting lnRMSSD. The model for self-esteem included several control variables as fixed effects: sex, age (grand mean centered), concurrent smoking (0 = no, 1 = yes), and current location (0 = home, 1 = not at home). We decided to control for smoking and current location, because smoking has frequently been related to self-esteem (e.g., Hale et al., 2015) and contextual factors could diminish or enhance self-esteem depending on the availability of external or internal factors (e.g., Campbell et al., 2010). Importantly, skipping these predictors from the model did not change the main results. Likewise, including WHR and physical activity as predictors for self-esteem did not change any of the main findings. For reasons of parsimony, we skipped these variables from the corresponding analysis. Habitual reappraisal (grand mean centered), perceived control (mean centered), and interoceptive accuracy (grand mean centered) were included as the variables of interest. In accordance with the hypotheses interactions between these variables were analyzed. Centering was performed in accordance with recently published guidelines (Wang and Maxwell, 2015). The model for lnRMSSD included several control variables as fixed effects: body motion to control for metabolic changes in HRV (grand mean centered), sex, age (grand mean centered), WHR (grand mean centered), physical exercise (0 = no, 1 = yes), concurrent smoking (0 = no, 1 = yes), and current location (0 = home, 1 = not at home). Finally, the following variables were included as fixed effects: Habitual reappraisal, perceived control, and interoceptive accuracy. Again, interactions between these variables were analyzed. Both models included a random intercept to account for heteroscedasticity with respect to location for each participant. Models including location as a random effect proved superior with respect to AIC and BIC (self-esteem: Log likelihood ratio = 17.32, p < .001; RMSSD: Log likelihood ratio = 16.05, p < .001) as compared to a random intercept model. A continuous autoregressive error structure was specified (Schwartz and Stone, 1998), because of nonstationary repeated assessments. Of note, model fit considerably improved with inclusion of the autoregressive error structure for both self-esteem (phi = 0.43, likelihood-ratio test, p < .001), and for lnRMSSD (phi = 0.54,

1.6. Parameterization of RMSSD and bodily movement The ECG was analyzed by means of a semi-automatic peak detection software (written with LABVIEW® 6.0i; National Instruments). Segments were extracted out of the 12-h recording according to the time stamps identified on the iPOD. The ECG was analyzed for 5 min prior to each EMA entry on a minute-by-minute basis. Previous to parameterization, the ECG was low-pass filtered with 30 Hz to overcome gross movement artifacts. Interbeat intervals (IBIs) were then 87

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likelihood-ratio test, p < .001). Regression coefficients (B, absolute effect size), standard errors (SE), their ratio (t statistic), as well as pvalues are reported. The level of significance was fixed at p < .05 (twotailed). 2. Results 2.1. Preliminary analyses Means and standard deviations of the psychological variables have already been reported in the Methods section. Interoceptive accuracy and cognitive reappraisal were unrelated to each other (r = 0.04, p = .66). Perceived control (aggregated across situations for each individual) and interoceptive accuracy were also not significantly correlated (r = 0.18, p = .06). However, perceived control and reappraisal were significantly positively associated (r = 0.28, p < .01), meaning that a higher habitual use of reappraisal was associated with an elevated perception of control. Because of the moderate interrelations, analysis for moderation seemed justified. 2.2. Self-esteem First, an unconditional model was calculated resulting in an ICC type 1 (Bliese, 2000) of 0.56, suggesting that 56% of the variance in self-esteem could be ascribed to interindividual (between-person) differences. In a next step, predictor variables were entered as specified in the Methods section. The final model is depicted in Table 1. There was a main effect for location (b = −0.102, p < .001), documenting lower levels of self-esteem at home as compared to other locations. Both cognitive reappraisal and perceived control were associated with higher self-esteem (reappraisal: b = 0.146, p = .006; perceived control: b = 0.212, p < .001). Moreover, the interaction of interoceptive accuracy and perceived control was significant (b = 0.030, p = .002), suggesting that the relationship between perceived control and selfesteem increased with higher interoceptive accuracy. Of note, this interaction was further qualified by a significant three-way interaction of reappraisal, interoceptive accuracy, and perceived control (b = −0.056, p < .001). Follow-up analyses were conducted with reappraisal, interoceptive accuracy and perceived control, respectively, centered at the standard deviation in order to arrive at single slopes. Importantly, this kind of analysis makes use of the whole sample size,

Fig. 1. Three-way interaction between habitual reappraisal, heartbeat detection ability (HBD), and perceived control for predicting self-esteem (a). Reappraisal was associated with increasing self-esteem when perceived control was low and interoceptive accuracy high. Figure b) depicts the significant twoway interaction between reappraisal and perceived control on HRV (lnRMSSD). Note: Values represent predicted values derived from the linear mixed effects model. Standard errors were approximated using the delta method.

Table 1 Hierarchical linear Model relating self-esteem to level 1 and level 2 predictors. Random effects

SD

Corr

Intercept Location Residual

0.60 0.19 0.47

Intercept −0.32

Fixed effects Parameter Interceptb Fixed effects Age Sex (women vs. men) Location (home vs. not at home) Momentary smoking (yes vs. no) Reappraisal Interoceptive accuracy Perceived control Reappraisal × interocept. acc. Reappraisal × perceived control Interocept. acc. × perceived control Reappraisal × interocept. acc. × perceived control

Estimatea (SE)

df

4.291 (0.096) 0.0001 0.047 −0.102 −0.073 0.146 0.018 0.213 0.037 0.020 0.029 −0.056

(0.007) (0.113) (0.029) (0.048) (0.052) (0.039) (0.012) (0.034) (0.011) (0.010) (0.009)

* indicates significant effects (p < .01) 88

t

p

2636

44.89

< .001

105 105 105 2636 105 105 2636 105 2636 2636 2636

0.13 0.41 −3.55 1.53 2.82 0.46 17.65 1.09 1.58 3.08 −6.21

.897 .679 < .001 .126 .006 .647 < .001 .280 .114 .002 < .001

*

* * *

* *

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perceived control was high. The interaction is depicted in Fig. 1b. Moreover, there was a marginally significant interaction of reappraisal and interoceptive accuracy (b = 0.043, p = .053). Single slope analyses revealed a significant positive association between habitual reappraisal and RMSSD in good heartbeat detectors (b = 0.09, p = .036), but not in poor heartbeat detectors (b = −0.035, p = .49). Thus, being able to attend sensitively to bodily cues seemed to have facilitated the effects of cognitive reappraisal on HRV.

thus retaining the same statistical power as the previous models. Analyses revealed that for good heartbeat detectors as compared to poor heartbeat detectors the association between habitual reappraisal and self-esteem was particularly strong in situations with low perceived control (good heartbeat detectors: b = 0.246, p < .001; poor heartbeat detectors: b = 0.017, p = .83). Moreover, the relationship between reappraisal and self-esteem was significantly positive for both good heartbeat detectors (b = 0.153, p = .02) and poor heartbeat detectors (b = 0.170, p = .03) in situations with high perceived control. The three-way interaction is depicted in Fig. 1a. It is interesting to note that self-esteem was particularly low in good heartbeat detectors in situations with low perceived control when they did not tend toward the use of reappraisal. Taken together, the findings document that reappraisal success seems to be impacted by interoceptive awareness only in the absence of perceived control, whereas interoceptive awareness seems to be no moderator during high control.

3. Discussion The aim of this research was to examine the interplay of habitual reappraisal, interoceptive accuracy, and perceived control on self-esteem and HRV in daily life. Applying an ambulatory assessment protocol it was shown that the relationship between habitual reappraisal and momentary self-esteem was dependent on the level of perceived control and interoceptive accuracy. Specifically, when control was low and interoceptive accuracy high, then the habitual use of reappraisal predicted higher self-esteem. This finding corroborates previous research suggesting that the relationship between reappraisal and psychological well-being is more complex (e.g., Ford et al.; Troy et al., 2016). In particular, it seems that organismic feedback could facilitate emotion regulation when environmental circumstances are beyond one's control. It should be emphasized that irrespective of perceived control the habitual use of reappraisal was unrelated to self-esteem when interoceptive awareness was low. Importantly, this finding is in line with an extensive body of research relating psychological function to bodily cues (embodiment; Niedenthal, 2007; Seth, 2013). Specifically, it has been suggested that the perception of bodily cues allows for a fine-grained regulation of emotion and adjustment to environmental challenges. Hence, the psychological benefits of reappraisal as a strategy to regulate emotions could be facilitated by learning to attend to organismic changes. The finding of lower self-esteem at home as compared to other locations deserves some further discussion. Sources of self-esteem are manifold and comprise agency, mastery and competence (e.g., Deci and Ryan, 1995), as well as both internal (independent thinking, productive projects) and external (approval by friends, getting one's success recognized by others, competitive social comparison) factors (e.g.,

2.3. HRV The unconditional model for lnRMSSD resulted in an ICC of 0.49, suggesting that 49% of the variance could be attributed to interindividual differences. The final model is depicted in Table 2. Several confounds could be identified. Bodily movement and older age were accompanied by lower RMSSD (bodily movement: b = −0.024, p < .001; age: b = −0.023, p < .001) and regular physical exercise by higher RMSSD (b = 0.200, p = .02). Furthermore, being at home as compared to other locations predicted higher RMSSD (b = 0.131, p < .001) and momentary smoking predicted lower RMSSD (b = −0.119, p < .001). Importantly, there was no significant threeway interaction of reappraisal, interoceptive accuracy, and perceived control. However, a significant two-way interaction of reappraisal and perceived control (b = −0.021, p = .02) was found. Single slope analyses (as specified above) revealed that the relationship between perceived control and HRV was significantly negative for individuals reporting high levels of habitual reappraisal (b = −0.036, p = .01) and positive, although not significant, for individuals with low habitual reappraisal use (b = 0.011, p = .378). This finding indicates that a high level of habitual reappraisal was associated with elevated RMSSD in situations with low control and with comparably low RMSSD when

Table 2 Hierarchical linear Model relating short-term heart rate variability (lnRMSSD) to level 1 and level 2 predictors. Random effects

SD

Corr

Intercept Location Residual

0.39 0.15 0.38

Intercept −0.41

Fixed effects Parameter b

Intercept Fixed effects Bodily movement Waist to hip-ratio (WHR) Age Physical exercise Sex (men vs. women) Location (home vs. not at home) Momentary smoking (yes vs. no) Perceived control Reappraisal Interoceptive accuracy Reappraisal × perceived control Interocept. acc. × perceived control Reappraisal × interocept. acc. Reappraisal × interocept. acc. × perceived control

Estimatea (SE)

df

3.092 (0.099) −0.024 −0.063 −0.023 0.200 0.112 0.131 −0.119 −0.012 0.028 −0.007 −0.022 0.005 0.043 −0.003

(0.001) (0.547) (0.005) (0.087) (0.092) (0.024) (0.036) (0.009) (0.034) (0.025) (0.009) (0.007) (0.022) (0.007)

* indicates significant effects (p < .01) 89

t

p

2633

31.39

< .001

*

2633 103 103 103 103 2633 2633 2633 103 103 2633 2633 103 2633

−24.34 −0.12 −4.48 2.29 1.23 5.53 −3.27 −1.30 0.83 −0.26 −2.50 0.68 1.95 −0.50

< .001 .909 < .001 .024 .222 < .001 .001 .195 .410 .794 .012 .494 .053 .618

* * * * *

* †

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reappraisal in daily life on psychological and physiological adjustment. Momentary reappraisal was not assessed in the present study in order to keep assessments short and to minimize cognitive load. Nonetheless, the findings of this study corroborate the ecological validity of habitual reappraisal. Second, participants in this study exhibited rather high levels of both self-esteem and perceived control in daily life, thus challenging the generalizability of the findings to other populations. It should be noted though that irrespective of the limited variance in these measures, findings seemed reliable and robust, thus suggesting that a similar pattern of results might emerge when more diverse samples are examined. Nonetheless, further studies are certainly needed in order to verify the interplay of reappraisal, perceived control and interoceptive accuracy in other populations. Third, self-esteem and perceived control were assessed via single items measures, thus questioning reliability. Single items were preferred because multiple items may increase burden and decrease adherence with the study protocol. Moreover, previous research could show that single item measures for assessing self-esteem are valid and useful (e.g., Robins et al., 2001; Schwerdtfeger and Scheel, 2012). Nonetheless, we would recommend to include a measure of trait self-esteem in future studies in order to verify the validity of the state measure. Fourth, this study focused exclusively on cognitive reappraisal as one antecedent strategy to regulate emotions. It should be noted that the other major strategy that has frequently been related with physiological responding is emotional suppression (e.g., Aldao et al., 2010; Webb et al., 2012). We decided to exclusively focus on reappraisal, because of its widely established positive effects on health and well-being (Gross, 2007; Haga et al., 2009; McRae et al., 2012) and because previous research found that it is more frequently used in daily life (e.g., Nezlek and Kuppens, 2008). However, because emotional suppression has been associated with elevated physiological arousal in laboratory research (e.g., Egloff et al., 2006; Gross, 2002) it would be interesting to analyze the psychophysiological effects of suppression in everyday-life in future studies. Fifth, although we aimed to control for various confounders, like WHR, current smoking, bodily movement etc., other variables potentially biasing associations were not assessed (e.g., momentary alcohol and food consumption, water ingestion, bladder and gastric distension etc. (see, Quintana and Heathers, 2014). Future ambulatory research should aim to control for such potential confounds. Finally, it should be mentioned that this study applied a correlational design, thus precluding causal interpretations. Although laboratory research suggests that reappraisal causally impacts psychological well-being, it could also be assumed that the momentary level of self-esteem triggers the use of reappraisal in situations perceived as less controllable, depending on interoceptive awareness. Alternatively, perceived control could be influenced by the level of self-esteem such that high self-esteem may trigger a higher sense of control. Furthermore, hidden third variables could have influenced the variables in this study. For example, associations might reflect shared genetic variance. Certainly, further research is needed to verify causality and test alternative models. Irrespective of the above mentioned limitations, the findings of the present study add to previous research suggesting that the beneficial health effects of reappraisal are more complex (e.g., Ford et al., 2017; Troy et al., 2017; Troy et al., 2016). Among others, its effects on psychological (i.e., self-esteem) and physiological (i.e., HRV) variables seem to depend on the perception of control an individual has in a given situation and his/her sensitivity to detect bodily changes. Therefore, it could be assumed that organismic feedback represents a prerequisite to successfully regulate emotional experience and that effects are more likely when perceived control is low.

Campbell et al., 2010). Other research identified social well-being (e.g., social connectedness, support and competence) as a major source of self-esteem (Williams and Galliher, 2006). Together these findings imply that self-esteem might be more easily fostered when increasing the likelihood for positive feedback, which might be higher outside home (success at work, meeting with friends). With respect to HRV, the expected three-way interaction between habitual reappraisal, interoceptive accuracy, and perceived control could not be supported. However, perceived control moderated the relationship with habitual reappraisal. In particular, when control in a given situation was considered low then individuals with higher habitual reappraisal use showed higher HRV. Interestingly, HRV was lower in individuals with high reappraisal use when perceived control was high, thus indicating lower vagal efference. This finding is concordant with the person-by-situation model of reappraisal as proposed by Troy et al. (2016), who found adverse effects of reappraisal when stress was regarded controllable, thus suggesting that reappraisal is a maladaptive strategy in such situations, thereby increasing stress. However, it should be noted that perceived control was positively associated with momentary self-esteem in individuals with higher reappraisal use, thus challenging the interpretation of higher stress. An alternative interpretation might be that individuals who tend toward higher use of reappraisal invested more effort in situations with elevated perceived control, thus indicating behavioral activation/engagement and vagal withdrawal (Porges, 2007). In line with this reasoning it has been found that individuals habitually engaging in reappraisal are behaviorally faster than individuals with low habitual reappraisal use (e.g., Vanderhasselt et al., 2013). Certainly, further studies are needed to verify – or falsify – the hypothesis of a positive relationship between habitual reappraisal and behavioral activation when the person is able to exert control. Another finding worth mentioning is the marginally significant interaction of interoceptive accuracy and habitual reappraisal on HRV in daily life. In particular, good heartbeat detectors with a higher use of reappraisal strategies tended to show elevated HRV as compared to individuals with lesser use of reappraisal. Of note, this finding was independent of perceived control, and is compatible with the hypothesis that sensitivity to organismic feedback could facilitate the health-protective effect of reappraisal (e.g., Füstös et al., 2013). However, because this finding was marginally significant, further research is certainly needed in order to substantiate or dismiss this assumption. The findings of this study have several implications. First, when examining the effects of habitual reappraisal in daily life researchers are advised to consider the specific context (see also Troy et al., 2016; Troy et al., 2017). Unlike in the laboratory, which allows rigorous control of emotional stimuli and contextual factors, situations in daily life severely differ within person with respect to perceived controllability. The possible influence an individual is able to exert in a given situation seems crucial though for the adaptability of cognitive reappraisal. Second, interoceptive awareness seems to modulate the effects of reappraisal on both psychological and – subject to replications – physiological outcomes, thus supporting embodiment theories of emotion (e.g., Niedenthal, 2007). This study is among the first to provide evidence that the ability to attend sensitively to organismic cues affects psychological adjustment outside the laboratory in daily life in individuals who predominantly use cognitive reappraisal, thus suggesting ecological validity of previous research. Hence, it might be speculated that learning to attend to bodily signals (e.g., via body awareness training; Sze et al., 2010) could foster health and well-being among those who tend toward habitual reappraisal. Certainly, there are also some limitations of the findings that need to be discussed. First, reappraisal was assessed via a trait questionnaire and not as a momentary state. Although previous research could show that habitual tendencies to regulate emotions are stable and related to daily functioning (e.g., Gross and John, 2003; Meyer et al., 2012), further research is needed to verify the beneficial role of momentary

Acknowledgements We are grateful to Michaela Hiebler, Bianca Würger, Regina Pabst, Elisa Maier, and Bernadette Hofer for their help in data collection and data parametrization and Rebecca Koller for valuable comments on an 90

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earlier draft of this manuscript. This research was funded by the German Research Foundation (DFG; Grant No. SCHW 1188/5-1).

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