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72 Somatization and Headaches in people with insomnia during the COVID-19 Pandemic: the benefit of exercise.
- Kymberly Henderson-Arredondo, Samantha Jankowski, Emmett Suckow, Shivani Desai, Melissa Reich-Fuehrer, Lindsey Hildebrand, William D.S. Killgore
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 581-582
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Objective:
Stress is well known to increase the severity of somatization and insomnia. A recent major stressor that could have influenced the severity of these presentations was world-wide COVID-19 Pandemic. Somatization is the physical expression of stress and emotional distress that can manifest itself throughout various corporal domains and can be a comorbidity to insomnia. Headaches represent some of the most common complaints associated with brain injuries and neurological disorders but are common in somaticized disorders as well. In large survey study we examined whether exercise was associated with severity of somatization and headaches. We hypothesized that both healthy individuals and those with insomnia who exercised during the pandemic would report less severe somatic symptoms and headaches than those who did not.
Participants and Methods:A large survey was sent out to 4,073 individuals to measure their experience in numerous domains during the COVID-19 pandemic. This survey included a short symptom questionnaire used to measure somatization and the Insomnia Scale Index to measure insomnia. These questionnaires were administered along with a “yes or no” question on whether the participants exercised regularly in that period. A univariate ANOVA was performed to analyze the data to determine if exercise during the pandemic was beneficial in the reduction of somatic symptoms and headache severity. Furthermore, these tests were run to determine if the effect was greater on those with insomnia.
Results:The effect of insomnia and exercise on total somatic symptoms were significant at F(1, 3445)=650.5, p<0.001 and F(1, 3445)=26.1, p<0.001, respectively. For reported headache severity, there was a significant effect of exercise F(1, 4073)=14.5, p<0.001 and insomnia F(1, 4073)=160.5, p<0.001; therefore, those who exercised reported less severe headaches and those who suffered from insomnia reported more severe somatic symptoms. This meant that those who exercised reported less severe somatization and headaches than those who didn’t and those with insomnia reported more severe somatization and headaches than healthy individuals. However, the interaction between exercise and insomnia on overall somatization severity was not significant at F(1, 3445)=3.4, p=0.066 nor for reported headache severity F(1, 4073)=0.81, p=0.370. Despite there not being a significant interaction, the benefit of exercise was slightly greater on healthy individuals than those with insomnia.
Conclusions:Those with insomnia reported more severe headaches and overall somatic symptoms than non-insomniacs regardless of whether they exercised or not. Exercise did make a difference on the reported severity of headaches and somatization in both groups; however, the benefit of exercise on headaches and somatization was greater in individuals who do not suffer from insomnia. Thus, exercise was noted to be beneficial to those in the general population and those suffering from insomnia as it can potentially reduce the severity of somatization and headaches. Of course, this research was cross sectional and correlational, so the directionality of the effects cannot be inferred. For future research, it would be instrumental to use experimental methods to help determine the duration and type of exercise that may optimize its potential benefits on headaches and somatic symptoms.
58 Sex Differences in the Relationship Between Sleep Disruption and Depressive Symptoms During Acute and Chronic Stages of Mild Traumatic Brain Injury (mTBI)
- Melissa J Reich-Fuehrer, Lindsey Hildebrand, Shivani Desai, Kymberly Henderson-Arredondo, William D.S. Killgore
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 163-164
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Objective:
mTBI is trauma to the brain due to a blow or other mechanical force affecting the head. Prior research has established that common symptoms of mTBI include decreased sleep quality and onset/worsening of emotional dysregulation. However, there is little published research investigating how sleep disruption and depressive symptoms are experienced at varying stages of mTBI. We hypothesized that sleep disruption would change with differing time since injury, and that depressive symptoms should accordingly. Additionally, since females tend to have higher rates of depression, we predicted that there would be a significant difference between the sexes at different stages post-mTBI.
Participants and Methods:This study included 145 healthy adults, split into six groups, comparing healthy controls consisting of 15 males (Mage=23.67, SD=5.066) and 17 females (Mage=25.35, SD=7.035) to individuals who had mTBI, 41 males (Mage=26.88, SD=8.509) and 72 females (Mage=23.79, SD=6.898) at five points post-mTBI: 2 weeks and 1, 3, 6, and 12 months. The Pittsburgh Sleep Quality Index (PSQI) global score was used to assess individual sleep quality and disturbances; higher scores indicated poorer sleep quality. The Beck Depression Index (BDI-II) was used to assess characteristics and symptoms of depression. We adjusted the score to exclude item 16, which measures changes in sleep. Higher scores indicate more severe depressive symptoms. We conducted a multivariate analysis of variance and Pearson correlation to examine whether there were significant differences in sleep and depression at different stages of mTBI for each sex.
Results:We discovered that sleep quality was worse at chronic stages of mTBI (i.e, 12M, p=<.001), than at acute stages (2W, p=.049), and compared to healthy controls. There were also significant differences in depression scores compared to healthy controls at 2W, p=.008, 3M, p=<.001, and 6M, p=.012, but not 12M, p=.313, suggesting that depressive symptoms resolved by 12M in those with mTBI. To explain this, we investigated sex differences, as males tend to experience fewer depressive disorders than females. However, females reported fewer depressive symptoms than males at chronic stages of mTBI. This finding was not statistically significant as females had a Mbdi_total=6.84, SD=7.98 and males had a Mbdi_total=5.38, SD=6.078; still, this could be due to the low statistical power of the study, and with a larger sample size, could produce statistically significant differences between the sexes. Despite this, there is a statistically significant difference in the depression score for females between 2W and 12M post-mTBI (p=.046; effect size of d=.99). Comparatively, males showed no significant divergence between depression and sleep scores.
Conclusions:Sleep disruption and depressive symptoms were correlated in individuals with mTBI in both acute and chronic stages; however, at 12M, there was a decrease in this correlation due to females exhibiting fewer depressive symptoms in combination with greater sleep disruption in the chronic phase of mTBI. Further research investigating the relationship between depression and sleep quality by looking at females with a much larger sample size would be helpful in clarifying these associations.
70 Daily Routine and Psychological Resilience.
- Emmett J Suckow, Kymberly Henderson-Arredondo, Lindsey Hildebrand, Samantha R Jankowski, William D.S Killgore
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 579-580
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Objective:
Resiliency has been shown to attenuate and even protect against cognitive impairment from mental and physical stressors. Recently, it has been demonstrated that individuals who score high in psychological resilience tend to have less impairment following a mTBI.The COVID-19 pandemic proved to be an uncertain time for many. Periods of isolation, unemployment, and of course, sickness, meant more time at home. The partial or complete breakdown of an individual’s day-to-day routine paired with the stress of the pandemic has reinforced the need for psychological resilience. This analysis investigates the relationship between self-reported routine adherence and an individual’s corresponding psychological resilience. We hypothesize that individuals who maintained a structured daily routine during the pandemic will have higher levels of psychological resilience, enabling them to better handle periods of extreme stress.
Participants and Methods:8963 English-speaking adults (18-92 years old; 59.5% female) from across the U.S. completed an online, monthly cross-sectional (∼1000 participants per month), battery of questions that included the Connor-Davidson Resilience Scale (CD-RISC), and a self-reported sleep and routine rating(s) between June 2020 and April 2021. We measured the level of an individual’s routine by adding the self-reported survey scores of waking at the same time and maintaining a routine throughout the day. Both questions were scored 0-4 (Likert-style) for a score range of 0 to 8; higher scores indicated a higher adherence to a daily structure. Weeknight sleep (Sun-Thurs) was a self-reported average of the hours of sleep obtained over the past 4 weeks. A two-way ANCOVA was used to analyze the effects that routine had on subsequent psychological resilience scores while controlling for average sleep duration.
Results:A significant main effect routine on psychological resilience was found F(8,8953) =227, p=<.00001 after controlling for average reported weeknight sleep. An independent t-test was performed to determine the differences between those who fall above and below the average score (M= 5.1) for routine adherence. Individuals who were above average in adherence (M=71.1, SD=15.5) had significantly higher CD-RISC scores than individuals who did not (M=59.2, SD=16.7); t(9166)=35.1, p <0.001.
Conclusions:Individuals who maintained a more structured day throughout the pandemic were more likely to score higher on psychological resilience assessments than those who did not. Chronic stress is known to contribute to the development and exacerbation of many common psychiatric conditions like anxiety and depression. These results suggest that having a regular routine may have positive effects on an individual’s ability to bounce back from stressful cognitive and psychological events. This relationship should be further investigated in clinical populations as a potential intervention or adjunctive treatment for common neuropsychiatric conditions.
58 Examining the Link Between Self-Reported Anxiety and Aggressive Behaviors
- Shivani Desai, Lindsey Hildebrand, Melissa Reich-Feuhrer, Kymberly Henderson-Arredondo, William D.S. Killgore
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 843-844
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Objective:
It is well known that there are differences between men and women in anxiety and aggression. Moreover, prior research has shown an association between anxiety and aggression but the strength of these associations in males and females has not been well characterized, and it remains unclear whether such associations are driven by comorbid disorders such as posttraumatic stress disorder (PTSD) or substance abuse. Therefore, we examined these associations in a large sample of males and females, and statistically controlled for the aforementioned potential confounding variables.
Participants and Methods:A total of 13,313 adults completed the survey on Amazon Mechanical Turk between April 2020 and April 2021, including 5,598 females (Mage=36.4, SD=11.9) and 7,654 males (Mage=37.81, SD=12.7). Aggression was measured using the Buss Perry Aggression Questionnaire (BPAQ), while the Generalized Anxiety Disorders (GAD-7) scale was used to gauge anxiety levels. PTSD was assessed with the PC-PTSD scale, and alcohol misuse was assessed with the Alcohol Use Disorders Inventory (AUDIT). Data were analyzed with zero-order correlations and linear regression to control for the effects of PTSD and alcohol misuse. Lastly, we used a Fisher r-to-z transformation to compare the correlations between males and females for both physical and verbal aggression with anxiety.
Results:Higher aggression (i.e., BPAQ) was correlated with greater anxiety (i.e., GAD; r(13213)=0.482, p<0.0001)). This association between anxiety and aggression held even when other potential confounders were controlled, such as PTSD (p<0.0001), and alcohol misuse, p<0.0001. Additionally, the correlation between anxiety and physical aggression was significantly stronger in males than females (z=5.02, p<0.0001), a pattern that was also true for the association between anxiety and verbal aggression (z=4.13, p<0.0001).
Conclusions:Our findings suggest that there is a linear relationship between the severity of anxiety and the severity of both verbal and physical aggression, that these associations tend to be stronger among males, and are not accounted for by associated conditions such as PTSD or alcohol misuse. This data augments existing research on the factors that contribute to aggression and further suggest that anxious feelings are more directly associated with aggression in males. These findings raise the possibility that interventions that target anxiety may prove helpful in reducing aggressive behavior among males. It may be fruitful for future work to identify neural systems that are associated with both anxiety and aggression and which are also modulated by sex. While measures of neurochemistry were not collected here, prior research has suggested that there are sex differences in brain systems that rely on serotonergic neurotransmission and arginine vasopressin, which could provide a target for future work.
79 Continuous Theta Burst Stimulation (cTBS) over the Inferior Parietal Cortex Decreases Default Mode Connectivity and Improves Overnight Sleep in People with Insomnia
- William D. S. Killgore, Samantha Jankowski, Kymberly Henderson-Arredondo, Christopher Trapani, Heidi Elledge, Daniel Lucas, Andrew Le, Emmett Suckow, Lindsey Hildebrand, Michelle Persich, Brianna Zahorecz, Cohelly Salazar, Tyler Watson, Camryn Wellman, Deva Reign, Yu-Chin Chen, Ying-Hui Chou, Natalie S. Dailey
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 587-588
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Objective:
Chronic insomnia is a highly prevalent disorder affecting approximately one-in-three Americans. Insomnia is associated with increased cognitive and brain arousal. Compared to healthy individuals, those with insomnia tend to show greater activation/connectivity within the default mode network (DMN) of the brain, consistent with the hyperarousal theory. We investigated whether it would be possible to suppress activation of the DMN to improve sleep using a type of repetitive transcranial magnetic stimulation (rTMS) known as continuous theta burst stimulation (cTBS).
Participants and Methods:Participants (n=9, 6 female; age=25.4, SD=5.9 years) meeting criteria for insomnia/sleep disorder on standardized scales completed a counterbalanced sham-controlled crossover design in which they served as their own controls on two separate nights of laboratory monitored sleep on separate weeks. Each session included two resting state functional magnetic resonance imaging (fMRI) sessions separated by a brief rTMS session. Stimulation involved a 40 second cTBS stimulation train applied over an easily accessible cortical surface node of the DMN located at the left inferior parietal lobe. After scanning/stimulation, the participant was escorted to an isolated sleep laboratory bedroom, fitted with polysomnography (PSG) electrodes, and allowed an 8-hour sleep opportunity from 2300 to 0700. PSG was monitored continuously and scored for standard outcomes, including total sleep time (TST), percentage of time various sleep stages, and number of arousals.
Results:Consistent with our hypothesis, a single session of active cTBS produced a significant reduction of functional connectivity (p < .05, FDR corrected) within the DMN. In contrast, the sham condition produced no changes in functional connectivity from pre- to post-treatment. Furthermore, after controlling for age, we also found that the active treatment was associated with meaningful trends toward greater overnight improvements in sleep compared to the sham condition. First, the active cTBS condition was associated with significantly greater TST compared to sham (F(1,7)=14.19, p=.007, partial eta-squared=.67). Overall, individuals obtained 26.5 minutes more sleep on the nights that they received the active cTBS compared to the sham condition. Moreover, the active cTBS condition was associated with a significant increase in the percentage of time in rapid eye movement (REM%) sleep compared to the sham condition (F(1,7)=7.05, p=.033, partial eta-squared=.50), which was significant after controlling for age. Overall, active treatment was associated with an increase of 6.76% more of total sleep time in REM compared to sham treatment. Finally, active cTBS was associated with fewer arousals from sleep (t(8) = -1.84, p = .051, d = .61), with an average of 15.1 fewer arousals throughout the night than sham.
Conclusions:Overall, these findings suggest that this simple and brief cTBS approach can alter DMN brain functioning in the expected direction and was associated with trends toward improved objectively measured sleep, including increased TST and REM% and fewer arousals during the night following stimulation. These findings emerged after only a single 40-second treatment, and it remains to be seen whether multiple treatments over several days or weeks can sustain or even improve upon these outcomes.
58 Preliminary Development of a Virtual Reality Neuropsychological Assessment System
- William D. Killgore, Kymberly Henderson-Arredondo, Natalie S. Dailey, Jason Zhang, Samantha Jankowski, Ao Li, Huayu Li, Deva Reign, Emmett Suckow, Lindsey Hildebrand, Camryn Wellman, Jerzy Rozenblit, Janet Roveda
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 735-736
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Objective:
While there exist numerous validated neuropsychological tests and batteries to measure cognitive and behavioral capacities, the vast majority of these are time intensive and difficult to administer and score outside of the clinic. Moreover, many existing assessments may have limited ecological validity in some contexts (e.g., military operations). Therefore, we have been developing a novel approach to administering neuropsychological assessment using a virtual reality (VR) “game” that will collect simultaneously acquired multidimensional data that is synthesized by machine learning algorithms to identify neurocognitive strengths and weaknesses in a fraction of the time of typical assessment approaches. For our initial pilot project, we developed a preliminary VR task that involved a brief game-like military “shoot/no-shoot” task that collected data on hits, false alarms, discriminability, and response times under a context-dependent rule set. This prototype task will eventually be expanded to include a significantly more complex set of tasks with greater cognitive demands, sensor feeds, and response variables that could be modified to fit many other contexts. The objective of this project was to construct a rudimentary pilot version and demonstrate whether it could predict outcomes on standard neuropsychological assessments.
Participants and Methods:To demonstrate proof-of-concept, we collected data from 20 healthy participants from the general population (11 male; age=24.8, SD=7.8) with high average intelligence (IQ = 112, SD=10.7). All participants completed the Wechsler Abbreviated Scale of Intelligence-II (WASI-II), and several neuropsychological tests including the ImPACT, the Attention and Executive Function modules of the Neuropsychological Assessment Battery (NAB), and the VR task. Initially, we used a prior dataset from 359 participants (n=191 mild traumatic brain injury; n=120healthy control; n=48 sleep deprived) to serve as a training sample for machine learning models. Based on these outcomes, we applied machine learning, as well as standard multiple regression approaches to predict neuropsychological outcomes in the 20 test participants.
Results:In this limited study, the machine learning approach did not converge on a meaningful prediction due to the instability of the small sample. However, standard multiple linear regression using stepwise entry/deletion of the VR task variables significantly predicted neuropsychological performance. The VR task predicted WASI-II vocabulary (R=.457, p=.043), NAB Attention Index (R=.787, p=.001), and NAB Executive Function Index (R=.715, p=.002). Interestingly, these performances were generally as good or better than the predictions resulting from the ImPACT, a commercially available neuropsychological test battery, which correlated with WASI-II vocabulary (R=.557, p=.011), NAB Attention Index (R=.574, p=.008), and NAB Executive Function Index (R=.619, p=.004).
Conclusions:Our pilot VR task was able to predict performances on standard neuropsychological assessment measures at a level comparable to that of a commercially available computerized assessment battery, providing preliminary evidence of concurrent validity. Ongoing work is expanding this rudimentary task into one involving greater complexity and nuance. As multivariate data integration models are incorporated into the tasks and extraction features, future work will collect data on much larger samples of individuals to develop and refine the machine learning models. With additional work this approach may provide an important advance in neuropsychological assessment methods.
76 Investigating the Severity of Insomnia Comorbidities Between the Sexes
- Shivani Desai, Lindsey Hildebrand, Melissa Reich-Feuhrer, Kymberly Henderon-Arredondo, William D.S. Killgore
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 584-585
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Objective:
Previous research indicates that women tend to struggle with insomnia at higher rates both prior to and during the global COVID-19 pandemic; however, not much research has investigated the extent to which insomnia correlates with comorbid problems, including aggression, depression, anxiety, PTSD severity, and alcohol use between the sexes. On a neurobiological level, insomnia could be associated with those mood disorders due to the effects of sleep disturbance on serotonergic and GABA neurotransmission, and males might experience such associations at a lower frequency due to their increased rates of serotonin synthesis. Consequently, we hypothesized that women would demonstrate higher prevalence of the aforementioned comorbidities during COVID than males due to higher rates of insomnia reported in women during COVID.
Participants and Methods:We surveyed a total of 13,313 adults, with 5,598 females (Mage=36.4, SD=11.9) and 7,654 males (Mage=37.81, SD=12.7) using Amazon Mechanical Turk between April 2020 and April 2021. Insomnia was measured using the Insomnia Severity Index (ISI), while levels of depression, anxiety, PTSD severity, and alcohol use, and aggression were assessed through Patient Stress Questionnaires (PSQs) and the Buss Perry Aggression Questionnaire (BPAQ).
Results:As expected, there were significant positive correlations between ISI and BPAQ (r(13306)=0.364, p<0.0001), PSQ Depression (r(13300)=0.694, p<0.0001), PSQ Anxiety (r(13211)=0.627, p<0.0001), PSQ PTSD (r(13305)=0.444, p<0.0001), and PSQ Alcohol (r(12915)=0.218, p<0.001). The strength of these associations was significantly higher in males than females in almost all categories: aggression (z=4.27, p<0.0001), depression (z=2.41, p=0.016), anxiety (z=3.16, p=0.0016), and alcohol use (z=5.89, p<0.0001) - not significant for PTSD severity (z=1.48, p=0.14).
Conclusions:We found that insomnia was more strongly correlated with comorbid emotional and behavioral problems among males than females. This stands in contrast to our initial hypothesis, as the findings suggest that men who suffer from greater insomnia are more likely to experience those four comorbidities than females. This suggests that sex may play a role in the association between sleep disturbances and other clinical presentations relevant to neuropsychology. Further work will be necessary to identify the neurobiological mechanisms that drive the sex differences in these associations. While the present findings cannot determine the causal direction of the association, it will be crucial to determine the directionality of these associations and the mechanisms that lead to differences in expression between the sexes.
40 Sex Differences in Emotional Intelligence Ability and Risk-Taking Behavior
- Lindsey Hildebrand, William D. S. Killgore
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 828-829
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Objective:
People differ in their propensity to engage in risky behaviors. Numerous factors such as cognition and personality have been utilized in predicting risk-taking, but little is known about the influence of stable emotional competencies, such as Emotional Intelligence (EI), in risk-taking. EI is defined as the ability and capacity to understand, perceive, and manage one's own, as well as others', emotions. However there has been little published research on the effect of ability emotional intelligence in engaging in risk- taking behavior. We hypothesized that those with higher emotional intelligence ability scores would demonstrate higher and more optimal risk-taking propensity. Furthermore, as prior research has demonstrated that males engage in more risk-taking behaviors, we accounted for sex differences within our analysis.
Participants and Methods:One-hundred and twelve healthy adults completed this study, including 56 females (Mage=21.7, SD=5.8) and 56 males (Mage=21.5, SD=3.2). The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) was used to assess total EI ability while the Balloon Analog Risk Task (BART) was used to assess risk-taking propensity. We specifically analyzed adjusted number of pumps on unexploded balloons throughout the BART to account for the increased risk. We conducted Pearson correlations and a multiple regression to assess the if ability emotional intelligence and gender significantly predicted risk-taking propensity.
Results:There was a significant correlation between total emotional intelligence ability score and adjusted number of pumps on the BART for females, r(55)=.362, p = .006, but not for males r(55)=.053, p=.701, suggesting that females who score higher in emotional intelligence ability also had a higher risk-taking propensity. Due to these findings, we conducted a multiple regression to assess if ability emotional intelligence and gender significantly predict risk-taking propensity on the BART. The results of the regression indicated the two predictors explained 9.0% of the variance (R2 =.09, F(2,108)=5.32, p<.01). However, it was found that ability emotional intelligence significantly predicted risk-taking propensity (β = .23, p<.05), but not sex (β = -.17, p=.06). There was no sex x EI interaction.
Conclusions:Higher ability emotional intelligence was significantly related to greater risk-taking propensity, but this was only observed for females. However, the lack of significance of sex in significantly predicting risk-taking may just be due to lower statistical power in the study. Importantly, the adjusted number of pumps for the participants in this sample was generally far below the mid-point for popping balloons, suggesting that the higher scores observed here represent more optimal decision performance rather than just greater risk. Thus, greater EI may reflect greater capacity to learn from reward and punishment feedback and apply that learning to optimize performance. Future research should look at the effect of emotional intelligence training in improving optimal risk-taking, particularly for populations known for engaging in risky behaviors such as those with mTBI.