Heart rate variability, trait anxiety, and perceived stress among physically fit men and women

Gender differences in alcohol-cue-induced craving and heart-rate variability in hazardous drinkers

Alcohol use disorder (AUD) has risen more rapidly in women than men in recent decades. While previous studies identified gender differences in AUD, the mechanisms remain unclear. This study examined gender differences in alcohol cue-induced craving and heart rate variability (HRV) in 114 people who engage in heavy drinking (61 women) using an alcohol-cue reactivity task. We predicts that men will show stronger cue-induced reward cravings, women will have more intense relief cravings. Additionally, it is expected that the relationship between cue-induced craving and HRV will differ by gender: reward craving in men will correspond with increased HRV, whereas relief craving in women will correlate with decreased HRV. The alcohol cue-reactivity task began with a 75-second relaxation exercise, followed by 30-second presentations of alcohol-related pictures and imagery, and a 120-second session of handling an alcohol beverage. Craving was assessed before and after using the desire for alcohol questionnaire (DAQ), and HRV was continuously recorded via electrocardiograph throughout the task. Repeated measures ANOVAs showed significant increases in both relief (p < .05) and reward craving (p < .001) after the alcohol cue-reactivity task, with no gender differences. Exploratory analysis found that HRV decreased in response to alcohol cues for both genders, with men showing a significantly greater decline during the picture phase (p < .05). Additionally, those with higher relief craving had lower HRV during the imagery phase compared to the picture phase, regardless of gender (p = .20). The current study suggests that gender differences in alcohol cue reactivity are more pronounced in HRV than in subjective responses.

The intricate brain-heart connection: The relationship between heart rate variability and cognitive functioning

In the last years, there has been a growing interest in the brain-heart connection. A core aspect of this connection appears to be the autonomic nervous system, particularly through the vagus nerve. Accordingly, vagally mediated heart rate variability (vmHRV) is currently considered as an index of top-down control processes involved in cognition and emotion regulation. Recent evidence indicates that higher vmHRV is associated with enhanced cognitive performance across multiple domains, such as executive functions, memory, attention, and language skills. From this premises, this study examined the relationship between cardiac vagal tone, as indicated by heart rate variability (vmHRV), and cognitive functions. A sample of 143 healthy young adults completed a comprehensive neuropsychological battery. The results revealed a strong correlation between resting vmHRV and cognitive functions, particularly in executive processes. Participants with higher resting vagal tone showed superior cognitive performance in tasks requiring cognitive control, motor and cognitive inhibition, cognitive flexibility, and working memory in comparison to those with lower resting vagal tone. Furthermore, vagal-mediated heart rate variability was also found to be associated with memory, attention, and executive performance. The current research provides new insights into the interactions between cognitive and autonomic systems, further supporting evidence for body-brain interactions.

Exploring the mechanisms influencing psychological adaptation in athletes in high-risk sports: a moderated mediation model

This study explores the impact of state and trait anxiety on perceived stress in athletes in high-risk sports, focusing on the mediating role of cognitive reappraisal and the moderating effect of sports psychological skills. Data were collected from athletes in sports like Boxing, Sanda, Mixed Martial Arts, Freestyle Skiing, and Ski Jumping. The analysis, conducted using the PROCESS macro revealed that both state and trait anxiety significantly predict perceived stress (β = 0.331, p < 0.001; β = 0.500, p < 0.001). Cognitive reappraisal strategies negatively mediate this relationship (β = -0.117, p < 0.001; β = -0.176, p < 0.001). Sports psychological skills moderate the relationship between anxiety and cognitive reappraisal (β = -0.094, p < 0.001; β = -0.091, p < 0.001). Female athletes reported higher levels of anxiety and stress, whereas male athletes were more likely to use cognitive reappraisal. Greater injury severity was associated with increased anxiety and stress, but cognitive reappraisal and sports psychological skills remained stable across injury levels. These findings contribute to an understanding of psychological adaptation in high-risk sports athletes and have implications for targeted psychological interventions.

Effects of Tai Chi and Qigong on Heart Rate Variability: A Systematic Review and Meta-Analysis

Background:

Intervention studies examining meditative movement (MM) often demonstrate benefits on physiological and psychological health. A potential mechanism associated with these outcomes is heart rate variability (HRV), an important neurophysiological biomarker of optimal and resilient health and functioning.

Objective:

We aimed to synthesize existing literature on the effects of two related forms of MM, Tai Chi (TC) and Qigong (QG) on HRV parameters in adult populations.

Methods:

Following PRISMA guidelines and Cochrane Collaboration recommendations, four databases (MEDLINE, Google Scholar, Academic Search Premier, and PubMed) were searched for articles (through December 15, 2023) that included TC and/or movement-based QG intervention versus any control condition (active or inactive) and reported at least one HRV outcome. Two reviewers independently completed study selection, data extraction, and risk-of-bias assessment.

Results:

We identified 148 for potential inclusion. After removing 61 duplicates, 87 full-text reviews yielded 23 articles, and 16 qualified for meta-analysis based on common HRV outcomes. Meta-analyses indicated a significant overall effect of TC/QG interventions on high-frequency power and standard deviation of the beat-to-beat intervals (SDNN), two critical HRV parameters, compared with control conditions: for HF power, standardized mean difference (SMD) = 0.29, P = 0.003, 95% Confidence interval (CI) [0.10, 0.48]; heterogeneity: I 2 = 46%, χ2 (8) = 14.89, P = 0.06; and for SDNN: SMD = 0.83, P = 0.02, 95% CI [0.16, 1.51]; heterogeneity: I 2 = 90%, χ2 (7) = 71.62, P < 0.001. Other HRV parameters did not demonstrate significant changes upon meta-analyses, but overall effect sizes showed a trend toward the expected direction.

Conclusion:

Based on the strength of the evidence, we conclude TC/QG interventions may shift HRV parameters toward improved health status and resilience. In addition, we offer suggestions to improve the design and measurement of future TC/QG research interventions exploring HRV.

Orienteering Is More than Just Running! Acute Effect of Competitive Pressure on Autonomic Cardiac Activity among Elite Orienteering Athletes

Background and Objectives: Orienteering is a sport characterized by high physical exertion and intense mental demands, which increase susceptibility to errors. Understanding the impact of such errors on psychophysiological responses, particularly on heart rate variability (HRV), is essential. This study aimed to investigate the relationship between psychophysiological indicators and checkpoint errors made by elite orienteers during official competition. Materials and Methods: Fifty-three orienteers participated in this study, and their performance was continuously monitored and recorded by using a global positioning system (GPS) and HRV data. Errors made during the orienteering events were identified and analyzed. HRV data were examined in three temporal segments: before, during, and after the identified and standardized errors. Results: The analyses indicated that errors significantly impacted HRV indices across multiple domains: the time domain, frequency domain, and nonlinear domain. Additionally, a significant effect of sex on the normalized the root mean square of successive differences (r-MSSD) before and after the error was observed. Conclusions: The findings of this study underscore the significant impact of errors made by orienteers on cardiovascular responses, as evidenced by measurable alterations in HRV metrics. Cardiovascular activity, represented by the HRV, can provide useful information for coaches and sport psychologists to adopt effective training programs for athletes.

Update: factors influencing heart rate variability-a narrative review

Objective

Heart rate variability (HRV) is an important non-invasive marker for the assessment of an organism's autonomic physiological regulatory pathways. Lower HRV has been shown to correlate with increased mortality. HRV is influenced by various factors or diseases. The aim of this narrative review is to describe the current state of knowledge on factors influencing HRV and their significance for interpretation.

Methods

The narrative review only included reviews, meta-analyses, and cohort studies which were published until 2021. HRV confounders were grouped into four categories (non-influenceable physiological factors, diseases, influenceable lifestyle factors and external factors).

Results

The review found that HRV was decreased not only in non-influenceable physiological factors (e.g., age, gender, ethnicity) but also in connection with various number of acute and chronic diseases (e.g., psychiatric diseases, myocardial infarction, heart failure), influenceable lifestyle factors (e.g., alcohol abuse, overweight, physical activity), and external factors (e.g., heat, noise, shift work, harmful- and hazardous substances).

Conclusion

In order to improve the quality of HRV studies and to ensure accurate interpretation, it is recommended that confounders be taken into account in future diagnostic measurements or measurements in the workplace (e.g., as part of health promotion measures) in order to counteract data bias.

The Impact on Autonomic Nervous System Activity during and Following Exercise in Adults: A Meta-Regression Study and Trial Sequential Analysis

Background and Objectives: Exercise enhances cardiovascular health through various mechanisms, including the modulation of autonomic nervous system activity. This study aimed to systematically examine the impact of exercise on heart rate variability (HRV) in adults during and within one hour after exercise (WHAE). Materials and Methods: A comprehensive literature review was conducted using the MEDLINE, Embase, Cochrane Library, Scopus, and PubMed databases to identify published studies that reported the impact of exercise on autonomic nervous system activity in adults. The studies measured the absolute power of the low-frequency band (0.04-0.15 Hz) to the absolute power of the high-frequency band (0.015-0.4 Hz) (LF/HF ratio) to assess sympathetic activity and the root mean square of successive differences between normal heartbeats (RMSSD) to assess parasympathetic activity. Results: A total of 3329 studies were screened for relevance, and finally, 10 articles that utilized methods for measuring autonomic nervous system activity, such as the LF/HF ratio and RMSSD, covering 292 adult patients, were included for meta-analysis. In the current meta-analysis, we observed a significant decrease in parasympathetic activity during and after exercise, as indicated by RMSSD, compared to pre-exercise levels (mean difference [MD] = -4.96, 95% confidence interval [CI]: -8.00 to -1.91, p = 0.003). However, sympathetic activity after exercise, represented by the LF/HF ratio, showed a borderline significant increase compared to pre-exercise levels (MD = 1.06, 95% CI: -0.01 to 2.12, p = 0.052). The meta-regression model found that factors associated with RMSSD included mean age, male gender, and duration post-exercise. Additionally, the factor associated with the LF/HF ratio was the healthy condition of participants. The trial sequential analysis provided robust evidence of a decrease in RMSSD and an increase in the LF/HF ratio during and WHAE. Conclusions: Given the limitations of the current study, the findings suggest that a significant decrease in parasympathetic activity and a borderline significant increase in sympathetic activity in adults during and WHAE, as confirmed by trial sequential analysis. Meta-regression analysis indicated that parasympathetic activity was negatively associated with participant age and male gender, but positively associated with duration post-exercise. Additionally, increased sympathetic activity was linked to the healthy conditions of participants. This study suggests that exercise might differentially affect autonomic balance in individuals with chronic conditions compared to healthy individuals. This highlights the potential need for tailored exercise interventions to improve autonomic function across different populations.

Compassionate mind training for people with Parkinson's disease: A pilot study and predictors of response

INTRODUCTION

People with Parkinson's disease (PD) often present with disabling neuropsychiatric symptoms. Compassionate mind training (CMT) is a psychological approach effective in reducing stress and promoting psychological well-being. Heart rate variability (HRV), a measure reflecting sympathovagal balance, has been associated with psychological well-being and a compassionate attitude.

AIM

To assess the feasibility and effectiveness of CMT in enhancing the quality of life and psychological well-being in PD patients. Additionally, we evaluated HRV as a physiomarker for assessing the CMT outcomes.

METHODS

Twenty-four PD patients participated in the study. A 6-week online CMT intervention was delivered on a weekly basis. At baseline and post-intervention patients completed questionnaires assessing depression, anxiety and quality of life. In a subsample of 11 patients, HRV was measured at baseline and post-intervention in three conditions: at rest, during stress and after 3 min of deep breathing.

RESULTS

The attendance rate was 94.3%. Quality of life and perceived stigma improved post-intervention as compared with baseline (p = 0.02 and p = 0.03 for PD Questionnaire-39 total score and Stigma subscore, respectively). After CMT, patients presented better physiological regulation to stress, as measured by higher HRV as compared with baseline (p = 0.005). Notably, patients who were more resilient to stress at baseline (less decrease in HRV during stress) experienced a more substantial reduction in anxiety and depression following CMT.

CONCLUSIONS

CMT is feasible and can improve quality of life and stigma in PD patients. HRV emerges as a promising physiomarker for predicting and measuring the outcomes of psychological interventions in PD.

Absence of Monotony and Strain Effects on Referees' Physical Performance During International Basketball Federation World Cup Basketball Competition

PURPOSE

The study aimed to conduct a comparative analysis of physical performance indicators and assess the levels of performance monotony and strain experienced by basketball referees.

METHODS

The study involved the participation of 12 basketball referees (mean age: 40.0 [4.9] y) affiliated with the International Basketball Federation. The investigation was carried out throughout 2 density tournaments, wherein the maximum heart rate, average heart rate, performance monotony, and performance strain were documented for 3 variables.

RESULTS

The findings indicated significant variations in the mean heart rate, maximum heart rate, total distance monotony, total distance strain, the total number of sprints monotony, the total number of sprints strain, calories monotony, and calories strain (P < .05). Decreasing the density of elite-level basketball competitions has been observed to reduce the monotony and strain experienced by referees. However, this action does not increase motion distance or speed zones.

CONCLUSIONS

The environmental stressors experienced by senior-level athletes (World Cup) differ from those encountered by younger athletes (World Cup Under 19). Further investigation is required to ascertain the potential effects of competition monotony and strain on decision-making processes and the overall quality of refereeing.

Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science

This updated guideline replaces the "Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science" first published in 2014. Based on the older version of the guideline, the authors have reviewed and evaluated the findings on the use of heart rate (HR) and heart rate variability (HRV) that have been published in the meantime and incorporated them into a new version of this guideline.This guideline was developed for application in clinical practice and research purposes in the fields of occupational medicine and occupational science to complement evaluation procedures with respect to exposure and risk assessment at the workplace by the use of objective physiological workload indicators. In addition, HRV is also suitable for assessing the state of health and for monitoring the progress of illnesses and preventive medical measures. It gives an overview of factors influencing the regulation of the HR and HRV at rest and during work. It further illustrates methods for measuring and analyzing these parameters under standardized laboratory and real workload conditions, areas of application as well as the quality control procedures to be followed during the recording and evaluation of HR and HRV.

Stress Response Pattern of Heart Rate Variability in Patients with Functional Somatic Syndromes

Functional somatic syndromes (FSSs) represent a clinically important group of disorders that are often stress-related. Their autonomic pathophysiology, including reduced heart rate variability (HRV), has been reported. However, the response pattern to mental stress and recovery in FSSs remains unclear. Thus, we aimed to clarify the pattern of autonomic stress response and recovery to mental arithmetic stress in patients with FSS compared to that in healthy controls. This cross-sectional study included 79 patients with FSS who visited the Department of Psychosomatic Medicine at a university hospital in Japan and 39 healthy controls. Following a mood questionnaire and obtaining epidemiologic information, HRV was measured during three periods (5 min each): relaxation baseline resting, stress (mental arithmetic task), and post-stress recovery period. The HRV analysis included inter-beat interval, low frequency power, and high frequency power. Compared to healthy controls, patients with FSS exhibited significantly higher scores on the mood questionnaire, prolonged duration of illness, and decreased functionality in daily activities. While the healthy control group showed a pronounced stress response pattern with a significant decrease in vagal HRV and recovery, the FSS group showed a "flat" vagal stress response pattern, and the HRV in the FSS group was lower at relaxation baseline, remained low during the stress, and did not change post stress. Patients with severe FSS exhibit an altered stress response pattern. Our results could provide significant clues for the diagnosis and treatment of such patients, as well as useful insights into the relationship between stress and illness.

Visually assessing work performance using a smartwatch via day-to-day fluctuations in heart rate variability

Objective

To optimize workplace health promotion, a simple method for quantifying allostatic load response is needed. This study examines the feasibility of optimizing objective anxiety and presenteeism monitoring using daily smartwatch-measured ultra-short heart rate variability (HRV).

Methods

Office workers without diagnosed disease prospectively performed 30 s HRV self-measurement each morning for two months and responded to the State-Trait Anxiety Inventory (STAI) and Work Limitation Questionnaire (WLQ). Logistic regression analysis examined daily HRV parameters in the high-trait anxiety group (HTA, STAI ≥ 40) using mean and variance HRV, age, self-reported gender, and body mass index (BMI). The ideal cutoff value enabled comparison of WLQ using the Mann-Whitney U test. Heart rate variability data were collected for 279 participants (male ratio, 83.9%; age, 42 ± 10 years) who completed questionnaires and monitored HRV for 30+ days.

Results

Compared to the low-trait anxiety group, HTA exhibited higher variance of the log-transformed coefficient of component variance of high-frequency component (LnccvHF) and low-frequency per HF (Lnccv L/H), in addition to differences in the means of these HRV parameters. In addition to BMI (odds ratio [OR] = 0.92, p = 0.02) and mean LnccvL/H (OR = 10.75, p < 0.01), the variance of Lnccv L/H was an independent predictor of HTA (OR = 2.39E + 8, p = 0.011). The daily Lnccv L/H dispersion group had a lower WLQ productivity loss score (p = 0.02, r = 0.17).

Conclusions

By focusing on HRV dispersion status, this simple and instantly applicable daily HRV monitoring system enables optimized quantitative monitoring of anxiety and productivity.

Cardioautonomic lability assessed by heart rate variability changes in Royal Canadian Mounted Police cadets during the cadet training program

Objective

The current study examined variations in cardioautonomic lability during the Royal Canadian Mounted Police (RCMP) Cadet Training Program (CTP) between cadets starting their training who did or did not screen positive for one or more mental health disorders (i.e., posttraumatic stress disorder [PTSD], major depressive disorder [MDD], social anxiety disorder [SAD], generalized anxiety disorder [GAD], panic disorder [PD], alcohol use disorder [AUD]).

Methods

Electrocardiogram (ECG) signals integrated into Hexoskin garments were used to record ECG and heart rate Over the 26-week CTP. There were 31 heart rate variability (HRV) parameters calculated using Kubios Premium HRV analysis software. Mann-Whitney U-tests were used to perform groupwise comparisons of participant raw values and HRV during the CTP.

Results

A total of 157 cadets (79% male) were screened for any mental disorder using self-report surveys and then grouped by positive and negative screening. Analyses indicated a statistically significant (p < 0.05) decrease in low frequency (LF): High Frequency (HF) variability during CTP, but only for cadets who endorsed clinically significant anxiety symptoms on the GAD-7 at the start of their training. There were no other statistically significant groupwise differences.

Conclusion

The results indicate the participants have excellent cardiac health overall and suggest potentially important differences between groups, such that cadets who endorsed clinically significant anxiety symptoms on the GAD-7 showed less variability in the LF:HF ratio over the course of the CTP. The relatively lower variability suggests decreased parasympathetic tone in those without clinically significant anxiety symptoms. The results also have important implications for future investigations of cardioautonomic dysfunction and chronic hypothalamic pituitary adrenal (HPA) axis deviations in policing populations with anxiety disorders; specifically, cardioautonomic inflexibility related to cardiovascular morbidity and mortality. In any case, the current results provide an important baseline for future cardiac research with cadets and serving officers.

Evaluating Drivers of the Patient Experience Triangle: Stress, Anxiety, and Frustration

Patient experience is a widely used indicator for assessing the quality-of-care process during a patient's journey in hospital. However, the literature rarely discusses three components: patient stress, anxiety, and frustration. Furthermore, little is known about what drives each component during hospital visits. In order to explore this, we utilized data from a patient experience survey, including patient- and provider-related determinants, that was administered at a local hospital in Abu Dhabi, UAE. A machine-learning-based random forest (RF) algorithm, along with its embedded importance analysis function feature, was used to explore and rank the drivers of patient stress, anxiety, and frustration throughout two stages of the patient journey: registration and consultation. The attribute 'age' was identified as the primary patient-related determinant driving patient stress, anxiety, and frustration throughout the registration and consultation stages. In the registration stage, 'total time taken for registration' was the key driver of patient stress, whereas 'courtesy demonstrated by the registration staff in meeting your needs' was the key driver of anxiety and frustration. In the consultation step, 'waiting time to see the doctor/physician' was the key driver of both patient stress and frustration, whereas 'the doctor/physician was able to explain your symptoms using language that was easy to understand' was the main driver of anxiety. The RF algorithm provided valuable insights, showing the relative importance of factors affecting patient stress, anxiety, and frustration throughout the registration and consultation stages. Healthcare managers can utilize and allocate resources to improve the overall patient experience during hospital visits based on the importance of patient- and provider-related determinants.

Effects of a Stress Management Training in Patients With Lymphedema and Obesity During Rehabilitation

Abstract: Background: Evidence for behavioral weight loss interventions demonstrates promising effects, but stress management training for weight loss and stress reduction in patients with lymphedema and obesity during rehabilitation has not been investigated yet. Aim: This study aims to examine innovative psychological treatment options for weight loss and stress management through a multifaceted approach in patients with lymphedema and obesity. Method: Seventy-one patients with lymphedema and obesity participating in an existing rehabilitation took part in this clinical trial. Half of them ( n = 36) were allocated to an additional stress management intervention. At the beginning of rehabilitation and the end (after 3 weeks; n = 66) participants’ weight, physical fitness, heart rate variability (HRV), and perceived stress were assessed. After around 8 months ( n = 28) chronic and perceived stress were evaluated again. Results: Irrespective of group allocation, rehabilitation had a positive, but short-term effect on perceived stress ( d = 0.60). Although patients receiving the additional stress management training did neither show a decrease in perceived stress nor an increase of HRV from pre- to post-assessment, they lost more weight and improved physical fitness at post-assessment as compared to the control group. Limitations: A stress-reducing effect of the training was not found, thus questioning the underlying mechanism of the applied intervention. Conclusions: Findings suggest a clinically relevant impact of psychological interventions in patients with lymphedema and a promising pathway for further research.

Does heart rate variability mediate the association between chronic stress, cardiorespiratory fitness, and working memory in young adults?

Young adulthood is a demanding development phase rendering individuals at risk for high levels of stress. While chronic stress may impair working memory maintenance, cardiorespiratory fitness is suggested to have a protective effect. Heart rate variability (HRV) contributes to this cognitive domain, but also retaliates to stress and aerobic exercise. Therefore, the present study investigated the mediating role of resting HRV on the association between chronic stress, cardiorespiratory fitness, and working memory maintenance in young healthy adults. Healthy participants (N = 115, 48% female) aged 18-35 years (M = 24.1, SD = 3.8) completed the Åstrand test on a bicycle ergometer to estimate maximal oxygen consumption [ V ̇ O 2 max $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\max } $$ (ml/min/kg)]. In addition, working memory maintenance was assessed using the modified Sternberg task with low (three items) and high cognitive load (six items). Using electrocardiography, HRV was recorded and the LF/HF ratio was extracted for mediation analyses. Path analysis revealed that cardiorespiratory fitness was significantly associated with accuracy on high cognitive load trials (β = 0.19, p = 0.035), but not on trials with low cognitive load. Perceived levels of chronic stress failed to show a significant association with working memory maintenance, independently of cognitive load. The pattern of results remained unchanged after introduction of HRV as a mediator (β = 0.18, p = 0.045). In conclusion, higher cardiorespiratory fitness is associated with better maintenance of verbal information in working memory. However, this association cannot be explained by vagal influences on memory processing driven by the autonomic nervous system.

Practices and Applications of Heart Rate Variability Monitoring in Endurance Athletes

Heart rate variability reflects fluctuations in the changes in consecutive heartbeats, providing insight into cardiac autonomic function and overall physiological state. Endurance athletes typically demonstrate better cardiac autonomic function than non-athletes, with lower resting heart rates and greater variability. The availability and use of heart rate variability metrics has increased in the broader population and may be particularly useful to endurance athletes. The purpose of this review is to characterize current practices and applications of heart rate variability analysis in endurance athletes. Important considerations for heart rate variability analysis will be discussed, including analysis techniques, monitoring tools, the importance of stationarity of data, body position, timing and duration of the recording window, average heart rate, and sex and age differences. Key factors affecting resting heart rate variability will be discussed, including exercise intensity, duration, modality, overall training load, and lifestyle factors. Training applications will be explored, including heart rate variability-guided training and the identification and monitoring of maladaptive states such as overtraining. Lastly, we will examine some alternative uses of heart rate variability, including during exercise, post-exercise, and for physiological forecasting and predicting performance.

A Training Programme for Developing Social and Personal Resources and Its Effects on the Perceived Stress Level in Adults in Daily Life-Study Protocol for a Prospective Cohort Study

Persistent stress and insufficient coping strategies have negative consequences for physical and mental health. Teaching adults the skills needed to sustainably improve stress-buffering aspects of their character could contribute to the prevention of stress-related diseases. In this non-randomised, observational, prospective cohort study, participants of a training programme for developing social and personal skills, to which they previously self-assigned, are assessed. The 12-month training programme focuses on improving perceived stress level (primary outcome), health behaviour, presence of common somatic symptoms, satisfaction with life, quality of social relationships, and wellbeing by addressing life goals, meaning in life, sense of coherence, social and personal resources, and transcendence. Study participants are recruited from the training groups via the training organiser. Companions, persons with whom they share a close relationship, are recruited to assess the interpersonal diffusion effects of the training. Matched individuals not participating in the training are the control group. Parameter assessment follows a pre-, post-, and follow-up (6 months) design. Designed to improve health-related outcomes in adults by addressing personality characteristics and using Lozanov's superlearning principles to improve learning efficiency, this training programme is, to the study team's knowledge, the first of its kind. From a research perspective, the outcomes of this study can provide new insights into primary prevention of stress-related diseases and how the effects of these measures are passed on through common personal interaction. The trial has been pre-registered (registration number: NCT04165473).

Beyond tingles: An exploratory qualitative study of the Autonomous Sensory Meridian Response (ASMR)

This qualitative exploratory study investigated the embodied experiences and the meanings of Autonomous Sensory Meridian Response (ASMR) from the viewer's perspective. ASMR research has been sparse and largely quantitative, assuming it to be a predominantly fixed physiological response of "tingles", despite the acronym being rooted in pseudoscience. A qualitative research design was adopted to facilitate the exploratory nature of the study in this under-researched area. In contrast to the mostly survey-based research on ASMR, this study employed semi-structured interviews as a means to understand the lived experience of ASMR and to promote participant agency. Six self-identifying ASMR consumers were recruited using a mixture of snowball and opportunity sampling. Semi-structured interviews were conducted both in person and using Skype to facilitate transnational data collection. Interview transcripts were analysed using an inductive, data-driven approach to thematic analysis. The analysis suggests that ASMR is felt to provide a social environment of comfort rather than a solely physiological-based experience. Three key themes emerged: who and what defines ASMR? (reflecting the variety of what was classed as ASMR and what content was consumed to produce the response); "real" intimacy tailored to me (reflecting the idiosyncratic perception of intimacy made possible through ASMR); and emotional relief on my terms (reflecting the role of ASMR in self-soothing). The present data reflect a rich, complex experience of the ASMR consumer, pointing to potential wider applications and informing further research.

Stress in surgical educational environments: a systematic review

BACKGROUND

The effects of stress on surgical residents and how stress management training can prepare residents to effectively manage stressful situations is a relevant topic. This systematic review aimed to analyze the literature regarding (1) the current stress monitoring tools and their use in surgical environments, (2) the current methods in surgical stress management training, and (3) how stress affects surgical performance.

METHODS

A search strategy was implemented to retrieve relevant articles from Web of Science, Scopus, and PubMed. The 787 initially retrieved articles were reviewed for further evaluation according to the inclusion/exclusion criteria (Prospero registration number CRD42021252682).

RESULTS

Sixty-one articles were included in the review. The stress monitoring methods found in the articles showed heart rate analysis as the most used monitoring tool for physiological parameters while the STAI-6 scale was preferred for psychological parameters. The stress management methods found in the articles were mental-, simulation- and feedback-based training, with the mental-based training showing clear positive effects on participants. The studies analyzing the effects of stress on surgical performance showed both negative and positive effects on technical and non-technical performance.

CONCLUSIONS

The impact of stress responses presents an important factor in surgical environments, affecting residents' training and performance. This study identified the main methods used for monitoring stress parameters in surgical educational environments. The applied surgical stress management training methods were diverse and demonstrated positive effects on surgeons' stress levels and performance. There were negative and positive effects of stress on surgical performance, although a collective pattern on their effects was not clear.

Stressors Length and the Habituation Effect-An EEG Study

The research described in this paper aimed to determine whether people respond differently to short and long stimuli and whether stress stimuli repeated over time evoke a habituation effect. To meet this goal, we performed a cognitive experiment with eight subjects. During this experiment, the subjects were presented with two trays of stress-inducing stimuli (different in length) interlaced with the main tasks. The mean beta power calculated from the EEG signal recorded from the two prefrontal electrodes (Fp1 and Fp2) was used as a stress index. The main results are as follows: (i) we confirmed the previous finding that beta power assessed from the EEG signal recorded from prefrontal electrodes is significantly higher for the STRESS condition compared to NON-STRESS condition; (ii) we found a significant difference in beta power between STRESS conditions that differed in length-the beta power was four times higher for short, compared to long, stress-inducing stimuli; (iii) we did not find enough evidence to confirm (or reject) the hypothesis that stress stimuli repeated over time evoke the habituation effect; although the general trends aggregated over subjects and stressors were negative, their slopes were not statistically significant; moreover, there was no agreement among subjects with respect to the slope of individual trends.

Alignment Between Heart Rate Variability From Fitness Trackers and Perceived Stress: Perspectives From a Large-Scale In Situ Longitudinal Study of Information Workers

BACKGROUND

Stress can have adverse effects on health and well-being. Informed by laboratory findings that heart rate variability (HRV) decreases in response to an induced stress response, recent efforts to monitor perceived stress in the wild have focused on HRV measured using wearable devices. However, it is not clear that the well-established association between perceived stress and HRV replicates in naturalistic settings without explicit stress inductions and research-grade sensors.

OBJECTIVE

This study aims to quantify the strength of the associations between HRV and perceived daily stress using wearable devices in real-world settings.

METHODS

In the main study, 657 participants wore a fitness tracker and completed 14,695 ecological momentary assessments (EMAs) assessing perceived stress, anxiety, positive affect, and negative affect across 8 weeks. In the follow-up study, approximately a year later, 49.8% (327/657) of the same participants wore the same fitness tracker and completed 1373 EMAs assessing perceived stress at the most stressful time of the day over a 1-week period. We used mixed-effects generalized linear models to predict EMA responses from HRV features calculated over varying time windows from 5 minutes to 24 hours.

RESULTS

Across all time windows, the models explained an average of 1% (SD 0.5%; marginal R2) of the variance. Models using HRV features computed from an 8 AM to 6 PM time window (namely work hours) outperformed other time windows using HRV features calculated closer to the survey response time but still explained a small amount (2.2%) of the variance. HRV features that were associated with perceived stress were the low frequency to high frequency ratio, very low frequency power, triangular index, and SD of the averages of normal-to-normal intervals. In addition, we found that although HRV was also predictive of other related measures, namely, anxiety, negative affect, and positive affect, it was a significant predictor of stress after controlling for these other constructs. In the follow-up study, calculating HRV when participants reported their most stressful time of the day was less predictive and provided a worse fit (R2=0.022) than the work hours time window (R2=0.032).

CONCLUSIONS

A significant but small relationship between perceived stress and HRV was found. Thus, although HRV is associated with perceived stress in laboratory settings, the strength of that association diminishes in real-life settings. HRV might be more reflective of perceived stress in the presence of specific and isolated stressors and research-grade sensing. Relying on wearable-derived HRV alone might not be sufficient to detect stress in naturalistic settings and should not be considered a proxy for perceived stress but rather a component of a complex phenomenon.

Serotonin Modulates the Correlations between Obsessive-compulsive Trait and Heart Rate Variability in Normal Healthy Subjects: A SPECT Study with [123I]ADAM and Heart Rate Variability Measurement

Objective

The impact of serotonergic system on obsessive-compulsive disorder (OCD) is well studied. However, the correlation between OC presentations and autonomic nervous system (ANS) is still unclear. Furthermore, whether the correlation might be modulated by serotonin is also uncertain.

Methods

We recruited eighty-nine healthy subjects. Serotonin transporter (SERT) availability by [¹²³I]ADAM and heart rate variability (HRV) tests were measured. Symptoms checklist-90 was measured for the OC presentations. The interaction between HRV and SERT availability were calculated and the correlation between HRV and OC symptoms were analyzed after stratified SERT level into two groups, split at medium.

Results

The interactions were significant in the factors of low frequency (LF), high frequency (HF), and root mean square of successive differences (RMSSD). Furthermore, the significantly negative correlations between OC symptoms and the above HRV indexes existed only in subjects with higher SERT availability.

Conclusion

OC symptoms might be correlated with ANS regulations in subjects with higher SERT availability.

Improving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol

INTRODUCTION

COVID-19 required healthcare systems to iteratively adapt for safe and up-to-date care as knowledge of the disease rapidly evolved. Rates of COVID-19 infections continue to fluctuate and patients without COVID-19 increasingly return to the emergency department (ED) for care. This leads to new challenges and threats to patient and clinician safety as suspected patients with COVID-19 need to be quickly detected and isolated among other patients with non-COVID-19-related illnesses. At the front lines, emergency physicians also face continued personal safety concerns and increased work burden, which heighten stress and anxiety, especially given the prolonged course of the pandemic. Burnout, already a serious concern for emergency physicians due to the cumulative stresses of their daily practice, may present as a longer-term outcome of these acute stressors.

METHODS AND ANALYSIS

We will implement a rapidly adaptive simulation-based approach to understand and improve physician preparedness while decreasing physician stress and anxiety. First, we will conduct semi-structured qualitative interviews and human factor observations to determine the challenges and facilitators of COVID-19 preparedness and mitigation of physician stress. Next, we will conduct a randomised controlled trial to test the effectiveness of a simulation preparedness intervention on physician physiological stress as measured by decreased heart rate variability on shift and anxiety as measured by the State-Trait Anxiety Inventory.

ETHICS AND DISSEMINATION

The protocol was reviewed and approved by the Agency for Healthcare Research and Quality for funding, and ethics approval was obtained from the Yale University Human Investigation Committee in 2020 (HIC# 2000029370 and 2000029372). To support ongoing efforts to address clinician stress and preparedness, we will strategically disseminate the simulation intervention to areas most impacted by COVID-19. Using a virtual telesimulation and webinar format, the dissemination efforts will provide hands-on learning for ED and hospital administrators as well as simulation educators.

TRIAL REGISTRATION NUMBER

NCT04614844.

Effects of Changes in Environmental Color Chroma on Heart Rate Variability and Stress by Gender

With increasing time spent indoors during the coronavirus disease pandemic, occupants are increasingly affected by indoor space environmental factors. Environmental color stimulates human vision and affects stress levels. This study investigated how changing environmental color chroma affected heart rate variability (HRV) and stress. The HRV of nine males and fifteen females was measured during exposure to 12 color stimuli with changes in chroma under green/blue hues and high/low-value conditions, and a stress assessment was performed. The effect of chroma on the HRV of males and females was verified, but the interaction effect between chroma and gender was not. ln(LF) and RMSSD were valid parameters. ln(LF) of males and females decreased as chroma increased under the green hue and low-value conditions; RMSSD was reduced as chroma increased in the blue hue and low-value conditions. ln(LF) decreased as chroma increased under blue hue and high-value conditions in males. Color–stress evaluation revealed that the higher chroma under high-value conditions, the more positive the stress emotion, and the lower the chroma under low-value conditions, the more negative the stress emotion. As chroma increased under low-value conditions, color is a stress factor; for men, this effect was more evident in the blue hue.

Heart rate variability, mood and performance: a pilot study on the interrelation of these variables in amateur road cyclists

Objective

The present study seeks to explore the relationship between measures of cycling training on a given day and the heart rate variability (HRV) and mood states obtained the following morning. The association between HRV and mood state is also studied, as is the relationship between internal and external measures of training.

Methods

During a 6-week period, five recreational road cyclists collected 123 recordings of morning HRV and morning mood, and 66 recordings of training power and rate of perceived exertion (RPE). Training power was used as an external measure of performance and RPE as an internal measure of performance. The HRV parameters used in the study were the mean of RR intervals (mean RR) and the standard deviation of all RR intervals (SDNN) as time domain analysis, and the normalized high frequency band (HFnu), normalized low frequency band (LFnu) and the ratio between low and high frequency bands, as frequency domain analysis. Mood was measured using a 10-point cognitive scale.

Results

It was found that the higher the training power on a given day, the lower the HFnu and the higher LF/HF were on the following morning. At the same time, results showed an inverse relationship between training and mood, so the tougher a training session, the lower the mood the following day. A relationship between morning HRV and mood was also found, so that the higher mean RR and HFnu, the more positive the mood (r = 0.497 and r = 0.420 respectively; p < 0.001). Finally, RPE correlated positively with external power load variables (IF: r = 0.545; p < 0.001).

Conclusion

Altogether, the results indicate a relationship between training of cyclists on a given day and their morning HRV and mood state on the following day. Mood and HRV also seem positively related. It is argued that developing a monitoring system that considers external and internal training loads, together with morning mood, could help understand the state of the individual, enabling feedback to athletes to facilitate the adaptation to training and to prevent problems associated with overtraining. However, more research is needed to further understand the association between the different variables considered.

Respiration rate during a stress task moderates neuroticism and perceived stress in older adults

BACKGROUND

Research suggests that respiration rate is related to psychological factors such as neuroticism and perceived stress in addition to physiological factors. However, it is unclear how respiration rate during a laboratory stress task relates to the relationship between neuroticism and perceived stress.

PARTICIPANTS AND PROCEDURE

This cross-sectional secondary analysis examined respiration rate during a stress task in moderating the relationship between neuroticism and perceived stress in a sample of generally healthy older adults (n = 64). Respiration data were collected during an auditory oddball paradigm and the Portland Arithmetic Stress Task (PAST), a laboratory-based cognitive stressor.

RESULTS

The results indicated that respiration rate during the PAST significantly moderated the relationship between neuroticism and perceived stress (p = .031), such that participants who exhibited a very low (-1.78 SD) respiration rate showed a non-significant relationship between neuroticism and perceived stress, whereas participants with average (mean; p < .001) and elevated respiration rates (+1 SD; p < .001) exhibited a significant positive relationship between neuroticism and perceived stress.

CONCLUSIONS

These findings add to a body of literature suggesting that stress reactivity is an important link between personality factors and negative outcomes. However, this is the first study to our knowledge to examine the role of physiological stress reactivity in buffering this relationship. The results suggest that individuals higher in neuroticism may attenuate the relationship between stress vulnerability and perceived stress through decreased physiological stress reactivity, particularly by exhibiting slow breathing during a stressor.

Correlating Personal Resourcefulness and Psychomotor Skills: An Analysis of Stress, Visual Attention and Technical Metrics

Modern surgical education is focused on making use of the available technologies in order to train and assess surgical skill acquisition. Innovative technologies for the automatic, objective assessment of nontechnical skills are currently under research. The main aim of this study is to determine whether personal resourcefulness can be assessed by monitoring parameters that are related to stress and visual attention and whether there is a relation between these and psychomotor skills in surgical education. For this purpose, we implemented an application in order to monitor the electrocardiogram (ECG), galvanic skin response (GSR), gaze and performance of surgeons-in-training while performing a laparoscopic box-trainer task so as to obtain technical and personal resourcefulness' metrics. Eight surgeons (6 nonexperts and 2 experts) completed the experiment. A total of 22 metrics were calculated (7 technical and 15 related to personal resourcefulness) per subject. The average values of these metrics in the presence of stressors were compared with those in their absence and depending on the participants' expertise. The results show that both the mean normalized GSR signal and average surgical instrument's acceleration change significantly when stressors are present. Additionally, the GSR and acceleration were found to be correlated, which indicates that there is a relation between psychomotor skills and personal resourcefulness.

Effect of Apartment Community Garden Program on Sense of Community and Stress

Apartment housing has become a dominant form of urban residence. High dwelling density in apartment complexes causes frequent conflicts and disputes. To counter this, it is necessary to promote a sense of community among residents with programs such as a customized horticultural program for the introduction of a community garden in an apartment complex. This study was conducted to investigate the effect of a community garden program in an apartment complex in fostering residents’ sense of community and reducing stress. Experiments were performed in three groups: a group participating in the program based on the sense of community theory (SCG; n = 11), a group participating with a focus on horticultural education (HEG; n = 11), and a non-participation group (NPG; n = 10). The experimental results revealed that the sense of community was significantly higher in the SCG than in the HEG and NPG. The results suggest that the SCG positively affected the sense of community, overall energy, ratio between sympathetic and parasympathetic nervous systems, and stress resistance. Considering these results, community garden programs with appropriate interventions to promote a sense of community are more effective in improving community life and reducing stress than programs based on horticultural education.

Effects of High-Intensity Interval Exercise and Acute Partial Sleep Deprivation on Cardiac Autonomic Modulation

Sleep deprivation in healthy adults has been associated with disrupted autonomic nervous system function, which in turn has been linked to cardiovascular health. High-intensity interval exercise (HIIE) may affect both sleep and cardiac autonomic modulation. Purpose: To investigate the impact of acute partial sleep deprivation on autonomic cardiac regulation before and after an acute bout of HIIE and the length of time for the autonomic system to return to resting levels. Methods: Fifteen healthy males with body mass index (BMI) of 25.8 ± 2.7 kg·m^-2 and age 31 ± 5 y participated in a reference sleep (~9.5 hr) with no HIIE (RS), a reference sleep with HIIE (RSX), and an acute partial sleep deprivation (~3.5 hr) with HIIE (SDX). HIIE was performed in 3:2 intervals at 90% and 40% of VO₂ reserve. Autonomic regulation through HRV selected time and frequency domain indices were recorded the night before, the morning of the next day, 1 hr-, 2 hr-, 4hr-, and 6-hr post-exercise. Results: HIIE performed in a 3:2 W:R ratio decreased the HRV (p < .05) at 1-hr post exercise and it took up to 4 hr to return to baseline levels. Parasympathetic related HRV indices increased the morning of the next day for SDX (p < .05). Acute partial sleep deprivation and HIIE did not modify the HRV responses compared to reference sleep and HIIE. Conclusion: HRV disturbance typically seen in responses to an acute episode of HIIE is not influenced by acute partial sleep deprivation.

Cortisol Awakening Response and Heart Rate Variability in the Menstrual Cycle of Sportswomen

Purpose: This study aimed to examine the activities of heart rate variability (HRV) and cortisol secretion as markers of the autonomous nervous system (ANS) and the hypothalamic-pituitary-adrenal axis (HPA) during the menstrual cycle in female athletes. Method: Saliva samples of the participants (n = 28) were collected successively at 0, 15, 30, and 60 min after awakening to assess cortisol awakening response (CAR) during each of four phases of the menstrual cycle (the menstruation, ovulation, luteal, and premenstrual phases). Diurnal saliva samples were collected at noon, in the evening (17:00) and 22:00 for cortisol analysis. HRV was measured in the menstrual and premenstrual phases at rest (12:00-14:00). Results: There was no difference between CAR parameters in the menstrual phases. CAR parameters and diurnal cortisol levels were significantly correlated with each other throughout the menstrual cycle. Mean cortisol was a strong predictor of the area under the curve (AUC: S = 0.042; R-Sq = 98.4%). Time-dependent parameters of HRV (standard deviation of the N-N interval [SDNN; P = .049] and the root mean square of the successive R-R differences [rMSSD; P = .038]) were significantly higher in the menstrual phase. There were no correlations between CAR and HRV parameters. Conclusions: We suggest that the hypothalamic-pituitary-adrenal axis activity and the autonomic nervous system work in a separate manner that is not affected by the menstrual phases in sportswomen. The present study contributed to a better understanding of the relationship between the dynamics of cortisol release and the autonomic nervous system in different phases of the menstrual cycle in female athletes.

The Relationship Between Psychological Stress and Anxiety with Gastrointestinal Symptoms Before and During a 56 km Ultramarathon Running Race

Background

This study assessed relationships and sex differences between psychological state (recovery, stress, anxiety, and self-confidence) and gastrointestinal symptoms (GIS) prior to and during a 56 km ultramarathon running race and identified predictive factors of race GIS. Forty-four (26 males, 18 females) ultramarathon competitors completed anxiety, recovery, stress and GIS questionnaires for three days prior to the race and immediately pre-race. Race GIS were assessed immediately post-race. Spearman’s rank order, Mann–Whitney U tests and regression analyses were used to determine correlations and identify sex differences between psychological state and GIS and determine predictors of race GIS.

Results

Race GIS were significantly correlated with recovery (r_s =  − 0.381, p = 0.011), stress (r_s = 0.500, p = 0.001) and anxiety (r_s = 0.408, p = 0.006), calculated as the mean of the three days preceding the race and on race morning. The correlation between anxiety and GIS was strongest in the 24 h immediately prior to the race (all r_s > 0.400, and all p < 0.05), but unclear patterns were identified for stress and recovery. Regression analyses showed 36% and 40% of variation in the severity and number of race GIS was accounted for by body mass and measures of stress, anxiety, and GIS over the three days preceding the race and on race morning (both p < 0.001). There were no sex differences in the number and severity of GIS leading up to or during the race (all p > 0.05), however, females reported greater state anxiety (p = 0.018) and lower self-confidence than males (p = 0.006) over the three days preceding the race and on race morning.

Conclusion

Endurance athletes that experience GIS during competition should investigate elevated stress and/or anxiety as a potential contributor and identify if management strategies can reduce the occurrence and severity of GIS.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-021-00389-5.

Real-Time Stress Level Feedback from Raw Ecg Signals for Personalised, Context-Aware Applications Using Lightweight Convolutional Neural Network Architectures

Human stress is intricately linked with mental processes such as decision making. Public protection practitioners, including Law Enforcement Agents (LEAs), are forced to make difficult decisions during high-pressure operations, under strenuous circumstances. In this respect, systems and applications that assist such practitioners to take decisions, are increasingly incorporating user stress level information for their development, adaptation, and evaluation. To that end, our goal is to accurately detect and classify the level of acute, short-term stress, in real time, for the development of personalized, context-aware solutions for LEAs. Deep Neural Networks (DNNs), and in particular Convolutional Neural Networks (CNNs), have been gaining traction in the field of stress analysis, exhibiting promising results. Furthermore, the electrocardiogram (ECG) signals, have also been widely adopted for estimating levels of stress. In this work, we propose two CNN architectures for the stress detection and 3-level (low, moderate, high) stress classification tasks, using ultra short-term raw ECG signals (3 s). One architecture is simple and with a low memory footprint, suitable for running in wearable edge-computing nodes, and the other is able to learn more complex features, having more trainable parameters. The models were trained on the two publicly available stress classification datasets, after applying pre-processing techniques, such as data pruning, down-sampling, and data augmentation, using a sliding window approach. After hyperparameter tuning, using 4-fold cross-validation, the evaluation on the test set demonstrated state-of-the-art accuracy both on the 3- and 2-level stress classification task using the DriveDB dataset, reporting an accuracy of 83.55% and 98.77% respectively.

Yoga as an Integrative Therapy for Mental Health Concerns: An Overview of Current Research Evidence

Background: Because the prevalence of mental health concerns is high and access or full responsiveness to pharmacological or psychotherapeutic treatment for many individuals is low, there has been increased interest in yoga as a potential therapy for many mental health concerns. Approach: We synthesize and critique current research on the efficacy of yoga relative to pharmacological approaches for anxiety disorders, mood disorders, posttraumatic stress disorder, obsessive-compulsive disorder, and eating disorders. Results: Yoga has been tested mostly as a complementary treatment to standard psychiatric and psychotherapeutic approaches. Findings from efficacy trials largely support the notion that yoga can help reduce symptoms of many psychiatric conditions, including anxiety, depression, and PTSD symptoms, above and beyond the effects achieved by standard pharmacological treatments alone; however, most evidence is of poor to moderate quality. Plausible transdiagnostic bottom-up and top-down mechanisms of yoga’s therapeutic effects have been advanced but remain untested. Conclusions: While results should be considered preliminary until more rigorous evidence is available, yoga appears to have the potential to provide many people suffering with psychiatric symptoms additional relief at relatively little cost. Yoga may be a viable complementary therapy to psychiatric and psychotherapeutic approaches for people with mental health challenges.

Prediction of GABA receptor antagonist-induced convulsion in cynomolgus monkeys by combining machine learning and heart rate variability analysis

Drug-induced convulsion is a severe adverse event; however, no useful biomarkers for it have been discovered. We propose a new method for predicting drug-induced convulsions in monkeys based on heart rate variability (HRV) and a machine learning technique. Because autonomic nervous activities are altered around the time of a convulsion and such alterations affect HRV, they may be predicted by monitoring HRV. In the proposed method, anomalous changes in multiple HRV parameters are monitored by means of a convulsion prediction model, and convulsion alarms are issued when abnormal changes in HRV are detected. The convulsion prediction model is constructed based on multivariate statistical process control (MSPC), a well-known anomaly detection algorithm in machine learning. In this study, HRV data were collected from four cynomolgus monkeys administered with multiple doses of pentylenetetrazol (PTZ) and picrotoxin (PTX), which are GABA receptor antagonists, as convulsant agents. In addition, low doses of pilocarpine (PILO) were administered as a negative control. Twelve HRV parameters in three hours after drug administration were monitored by means of the prediction model. The number and duration of convulsion alarms from HRV increased at medium and high doses of PTZ and PTX (1/3 or 1/4 of convulsion dose). On the other hand, the frequency of convulsion alarms did not increase with PILO. Although vomiting was observed in all drugs, convulsion alarms were not associated with the vomiting. Thus, convulsion alarms can be used as a biomarker for convulsions induced by GABA receptor antagonists.

Evaluation of Mindfulness State for the Students Using a Wearable Measurement System

Purpose

This study aimed to develop and evaluate the feasibility and preliminary efficiency of a methodology to measure the mindfulness state using a wearable device ("Cap") capable of monitoring students' levels of full attention by means of real-time measured heart rate variability (HRV).

Methods

The device was developed to export the data to the user's smartphone via Bluetooth, which in turn stores the securely accessible data in the cloud. The autonomous wearable device consists of electronic boards of the Arduino platform that detect the period in milliseconds between two subsequent referential R peaks of the QRS complex wave through infrared oxygenation sensor.

Results

In a population of 13 subjects (8 female, 5 male, age 16.1 years ± 0.58 ), the Z-test ( p < 0.05 ) using rMSSD (root mean squared successive differences) and the Toronto Mindfulness (Curiosity) Scale within two 50 min windows, shows that increased HRV values converge to high values for the mindfulness state when the time difference between R n and R n + 1 samples is greater than 88 ms.

Conclusion

The device proved to be viable and potentially effective for measuring the state of mindfulness. Thus, further studies should be conducted to test it on a large scale as well as in real classroom situations.

Is the Association Between Education and Sympathovagal Balance Mediated by Chronic Stressors?

Background

This study investigated whether raised chronic stress in low education groups contributes to education differences in cardiovascular disease by altering sympathovagal balance.

Methods

This study included cross-sectional data of 10,202 participants from the multi-ethnic, population-based HELIUS-study. Sympathovagal balance was measured by baroreflex sensitivity (BRS), the standard deviation of the inter-beat interval (SDNN) and the root mean square of successive differences between normal heartbeats (RMSSD). The associations between chronic stressors (work, home, psychiatric, financial, negative life events, lack of job control and perceived discrimination) in a variety of domains and BRS, SDNN and RMSSD were assessed using linear regression, adjusted for age, ethnicity, waist-to-hip ratio and pack-years smoked. Mediation analysis was used to assess the contribution of chronic stress to the association between education and sympathovagal balance.

Results

Modest but significant associations were observed between financial stress and BRS and SDNN in women, but not in RMSSD nor for any outcome measure in men. Women with the highest category of financial stress had 0.55% lower BRS (ms/mmHg; β = -0.055; CI = -0.098, -0.011) and 0.61% lower SDNN (ms; β = -0.061; CI = -0.099, -0.024) than those in the lowest category. Financial stress in women contributed 7.1% to the association between education and BRS, and 13.8% to the association between education and SDNN.

Conclusion

No evidence was found for the hypothesized pathway in which sympathovagal balance is altered by chronic stress, except for a small contribution of financial stress in women.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12529-021-10027-9.

Capturing Interactive Work for Nurses-First Validation of the German IWDS-N as a Multidimensional Measure

The theoretical framework of interactive work provides a multi-dimensional perspective on the interpersonal demands of nurses in nurse-patient interactions. It is defined by four dimensions: emotional labor directed to the self and others, cooperative work, and subjective acting. While the framework stems from qualitative research, the aim of the current study is to translate it into a quantitative scale to enable measurement of the high interpersonal demands that so often remain implicit. For this reason, we conducted an online survey study (N = 157; 130 women, 25 men, 2 divers) among professional nurses in Germany (spring 2021) to test the derived items and subscales concerning interactive work, which resulted in a 4-factor model that was verified with confirmatory factor analysis (CFA). The survey further captured additional information on established constructs concerning job-related well-being (e.g., burn out, meaningfulness), job characteristics (e.g., work interruptions, time pressure) and individual resources (coping strategies) that are supposed to correlate with interactive work demand scales for nurses (IWDS-N), to determine the quantitative nature of their relations. The results show that the subscales of the IWDS-N have adverse effects on indicators of work-related well-being. Moreover, negative job characteristics, such as time pressure, are positively correlated with subscales of the IWDS-N and are therefore problem-focused coping strategies as an individual resource. The results emphasize that a multidimensional consideration of self-regulatory processes is useful to capture the subtle and complex nature of the interactive work demands of nurses. The current study is the first that developed a quantitative, multi-dimensional measure for interactive work demands, which can help make implicit demands in service work explicit.

Does Eligibility Classification Matter? Tracking Cardiac Autonomic Function during a Collegiate Soccer Season

The current study examined differences in heart rate (HR) variability (HRV) across student-athlete eligibility classifications within a men’s soccer team. The study also aimed to identify any differences in HRV while competing at home or away. Data collection covered an entire collegiate season, commencing in the preseason and concluding upon elimination from the NCAA Soccer tournament. Comparisons of HR and HRV, paired with self-reported subjective measures, were documented between student-athlete eligibility classifications, home versus away games, and based on soccer position (forward, midfielder, defender, goalkeeper). HR and HRV were similar based on student-athlete eligibility. Heart rate exhibited a small, but statistically significant decrease (β = −1.7 bpm (95% CI: −2.9, 0.57), p = 0.003) for the away games relative to home. HRV showed a statistically significant increase in the away game setting (β = 2.1 (95% CI: 0.78, 3.38), p = 0.002). No difference in HRV was observed across eligibility classification. This lack of difference may be attributed to a different perception of stress amongst male athletes. Athletes also exhibited a reduced HRV at home, likely as an indication of their readiness to compete paired with an increased self-confidence, given there was no difference in any subjective measures of mood or stress or between games played away or at home.

Gender Matters: Nonlinear Relationships Between Heart Rate Variability and Depression and Positive Affect

Vagally mediated heart rate variability (vmHRV), a measure of the parasympathetic nervous system's control over the heart, is often negatively related to maladaptive emotional outcomes. Recent work suggests that quadratic relationships involving these factors may be present; however, research has not investigated gender differences in these nonlinear functions. To address this gap, the current study tested for quadratic relationships between resting vmHRV and depression and positive affect while investigating gender differences in these relationships. Significant quadratic effects were found between resting vmHRV and reports of both depression symptoms and positive affect in women but not men. Specifically, the lowest levels of depression and the highest levels of positive affect were found at moderate vmHRV in women. These results suggest that examinations of vmHRV's nonlinear associations require the consideration of gender. Our findings are interpreted based on proposed differential neuropsychological mechanisms of vmHRV in men versus women.

Exposure therapy in a virtual environment: Validation in obsessive compulsive disorder

Exposure and response prevention (ERP) is the current first-line psychological treatment for Obsessive-compulsive disorder (OCD). However, substantial inter-individual variability exists in treatment outcomes, including inadequate symptom improvements, and notable refusal and attrition rates. These are driven, in part, by impracticalities in simulating intrusive thoughts within clinical settings. Virtual reality (VR) offers the potential of overcoming these limitations in a manner that allows for finely controlled anxiety-provoking scenarios to be created within supportive clinical settings. To validate the potential of VR for treating contamination-based OCD, 22 patients undertook a VR ERP session and a matched session of the current gold-standard of in vivo ERP. In VR, patients were immersed within a contamination environment that permitted flexible delivery of customisable, graded exposure tasks. The VR environment utilised HTC Vive hardware, to allow for patients to both interact with, and physically move through the environment. Subjective and objective measures of distress were recorded, including heart and respiration rates. These measures indicate virtual and in vivo ERP sessions provoke consistent anxiety profiles across an exposure hierarchy. Virtual exposure was advantageous for engagement and adherence to tasks, and the therapeutic alliance was upheld. VR is a promising mechanism for ERP in contamination OCD.

Physiological Reactions in the Therapist and Turn-Taking during Online Psychotherapy with Children and Adolescents with Autism Spectrum Disorder

This study aims to analyze the relationship between the sociocognitive skills of a group of children and adolescents with autism spectrum disorder (ASD) at verbal level 1, the variability of the therapist's heart rate (HRV), and the conversational turn-taking during online psychotherapy sessions. Initially, we assessed the intelligence, narrative, and behavioral characteristics of the participants. We videotaped the online sessions and recorded the therapist's HRV via a smart wireless sensor. Finally, we analyzed the video sessions using an observation system and the therapist's HRV using the Poincaré technique. The results show that the patients' communicative intention was related to their narrative, intellectual and social competencies. Furthermore, the turn-taking between the therapist and the participant was associated with the patient's emotional and behavioral difficulties. On the other side, the therapist's heart rate variability (HRV) was related to the synchrony between the therapist and the participant with more significant stress on the therapist, when he shared and expanded the conversation with the patient, and when the patient broadened and shared the conversation with the therapist.

Eligibility Classification as a Factor in Understanding Student-Athlete Responses to Collegiate Volleyball Competition

The current study examined differences in heart rate variability (HRV) across student-athletes of different eligibility classifications and analyzed differences in HRV when competing at home or away. Fourteen female collegiate volleyball players volunteered for the study. Data collection encompassed an entire collegiate season, with comparisons in HRV made between home and away games, as well as pre-gameday, gameday, and post-gameday recordings for the whole squad. Comparisons were also made between student-athlete eligibility classification, with self-reported measures of sleep quality, fatigue, muscle soreness, stress, and mood recorded at the time of HRV measurement. Freshman athletes reported a significantly (p < 0.05, η² = 0.17) lower HRV (80.3 ± 9.7) compared to sophomore (85.7 ± 7.2), junior (91.2 ± 8.3), and senior (86.5 ± 7.2) athletes, while junior athletes had a significantly higher HRV when compared to sophomore and senior athletes. All athlete classifications reported similar HRV for home and away games, and there was no difference in HRV for any athlete classification group when comparing pre-gameday, gameday, and post-gameday measures. Freshman athletes reported significantly (p < 0.05, η² = 0.23) worse mood states compared to the other eligibility classifications, while self-reported stress was significantly (p < 0.05) worse in junior and senior athletes. Results suggest that monitoring the workload of student-athletes based on their eligibility classification holds merit. Collegiate coaching and support staff should be aware of the academic and competitive demands placed on their student-athletes. In particular, freshman athletes adjusting to the increased demands placed on them as collegiate student-athlete may warrant additional support.

Stress and anxiety in nursing students between individual and peer simulations

BACKGROUND

The use of high-fidelity simulation practice as an educational tool is becoming increasingly prevalent in nursing education. Despite the learning effects of simulation practice, students have been shown to experience high levels of stress and anxiety during simulation. In recent years, peer learning has been defined as an acquisition of knowledge and skills through active support and support among equal or equal peers and has been shown to be an effective educational intervention for clinical health science students.

AIM

The purpose of this study was to incorporate peer learning into simulation learning and to clarify the differences between stress and anxiety during personal and peer simulations.

METHOD

Third-grade undergraduate students in a four-year course at two nursing universities participated in this study. In this study, the simulated patient was a 53-year-old man who had undergone gastrectomy for the treatment of gastric cancer. The scenario was that the patient had completely recovered consciousness in the operating room, and his tracheal tube had been removed one hour before the students examined him. Stress while simulation training was evaluated with heart rate variability. Anxiety was evaluated by the STAI after the simulations were complete.

RESULTS

Personal simulation practice (personal group; n = 50) and peer simulation practice (peer group, n = 59) was conducted. The personal group included 7 male students, and the peer group included 12 male students; the difference in male proportion was not significant. At the first patient assessment phase, stress of heart rate variability components at the peer group significantly increased relative to that of the personal. In addition, the personal had a significantly higher state anxiety score after simulation than the peer.

CONCLUSION

This study shows that in the face-to-face scene involving vital sign measurements, the presence of peers did not objectively alleviate stress.

Cardiac Autonomic Nervous System Activity during Slow Breathing in Supine Position

The purpose of this study is to clarify cardiac autonomic nervous system activity during slow breathing exercises in a supine position. Eighteen healthy young males were participated. Heart rate variability was measured for 5 minutes at rest, 5 minutes at slow breathing, and then 5 minutes at rest. As a result, the LF/HF ratio increased with slow breathing, but HF value did not change. We suggest that the increased LF/HF ratio may be due to increased airway resistance. Cardiac autonomic nervous system activity during slow breathing in the supine position was revealed.

Impact of Cognitive Tasks on CO2 and Isoprene Emissions from Humans

The human body emits a wide range of chemicals, including CO₂ and isoprene. To examine the impact of cognitive tasks on human emission rates of CO₂ and isoprene, we conducted an across-subject, counterbalanced study in a controlled chamber involving 16 adults. The chamber replicated an office environment. In groups of four, participants engaged in 30 min each of cognitive tasks (stressed activity) and watching nature documentaries (relaxed activity). Measured biomarkers indicated higher stress levels were achieved during the stressed activity. Per-person CO₂ emission rates were greater for stressed than relaxed activity (30.3 ± 2.1 vs 27.0 ± 1.7 g/h/p, p = 0.0044, mean ± standard deviation). Isoprene emission rates were also elevated under stressed versus relaxed activity (154 ± 25 μg/h/p vs 116 ± 20 μg/h/p, p = 0.041). The chamber temperature was held constant at 26.2 ± 0.49 °C; incidental variation in temperature did not explain the variance in emission rates. Isoprene emission rates increased linearly with salivary α-amylase levels (r² = 0.6, p = 0.02). These results imply the possibility of considering cognitive tasks when determining building ventilation rates. They also present the possibility of monitoring indicators of cognitive tasks of occupants through measurement of air quality.

Cold Water Immersion After a Handball Training Session: The Relationship Between Physical Data and Sensorial Experience

The aim of this study was to examine the relationship between the physiological data from subjects and their reported sensory experiences during two types of recovery methods following a handball training session. Female handball players (average age: 21.4 ± 1.3 years; weight: 59.2 ± 3.3 kg; height: 158 ± 3 cm; body mass index, 23.4 ± 2.0 kg.m⁻²) carried out an athletic training session (rating of perceived exertion RPE: 14.70 ± 0.89) with either a passive recovery (PR) period or cold water immersion (CWI) for 14 min) (cross-over design). Physiological data were collected during the recovery period: CWI had a greater effect than PR on heart rate (HR; bpm), the higher frequencies (HF) of heart rate variability (HRV: 46.44 ± 21.50 vs. 24.12 ± 17.62), delayed onset muscle soreness (DOMS: 1.37 ± 0.51 vs. 2.12 ± 1.25), and various reported emotional sensations. Spectrum HRV analysis showed a significant increase in HF during CWI. Sensorial experiences during the recovery periods were gathered from verbatim reports 24 h later. Players' comments about CWI revealed a congruence between the physiological data and sensorial reports. They used words such as: “thermal shock,” “regeneration,” “resourcefulness,” “dynamism,” and “disappearance of pain” to describe their sensations. In conclusion, this study demonstrated the link between physiological and experiential data during CWI and we propose that action of the parasympathetic system on the autonomic nervous system can, at least in part, explain the observed correlations between the corporeal data measured and the sensorial experiences reported.