Autonomic Nervous System Response Patterns of Test-Anxious Individuals to Evaluative Stress

The stress-immune system axis: Exploring the interplay between stress and immunity

The chapter talks about how our body and mind respond to stress and how it affects our immune system. Stress reactions, especially the fight-or-flight reaction, are helpful at first but can be harmful if they last too long. Long-term stress, caused by hormones like cortisol and adrenaline, weakens the immune system and makes people more likely to get sick. Important brain chemicals like serotonin and norepinephrine help control how our immune system works. Also, the connection between our gut and brain is an important way that mental health affects how our immune system functions. Getting older and experiencing stress early in life can affect how our immune system works. Inflammation caused by stress is connected to health issues like heart disease, depression, and autoimmune diseases. There are ways to manage stress, like being mindful and having support from friends, are important for keeping your immune system healthy and lessening harm caused by stress.

Intricate mechanism of anxiety disorder, recognizing the potential role of gut microbiota and therapeutic interventions

Anxiety is a widespread psychological disorder affecting both humans and animals. It is a typical stress reaction; however, its longer persistence can cause severe health disorders affecting the day-to-day life activities of individuals. An intriguing facet of the anxiety-related disorder can be addressed better by investigating the role of neurotransmitters in regulating emotions, provoking anxiety, analyzing the cross-talks between neurotransmitters, and, most importantly, identifying the biomarkers of the anxiety. Recent years have witnessed the potential role of the gut microbiota in human health and disorders, including anxiety. Animal models are commonly used to study anxiety disorder as they offer a simpler and more controlled environment than humans. Ultimately, developing new strategies for diagnosing and treating anxiety is of paramount interest to medical scientists. Altogether, this review article shall highlight the intricate mechanisms of anxiety while emphasizing the emerging role of gut microbiota in regulating metabolic pathways through various interaction networks in the host. In addition, the review will foster information about the therapeutic interventions of the anxiety and related disorder.

Insight of autonomic dysfunction in CLN3 disease: a study on episodes resembling paroxysmal sympathetic hyperactivity (PSH)

BACKGROUND

Recurrent non-epileptic episodes resembling paroxysmal sympathetic hyperactivity (PSH) have been observed in adolescents with Juvenile Ceroid Lipofuscinosis (CLN3-disease) and a possible association to an autonomic dysfunction has been suggested. The objective of the present study was to investigate the dynamics of the autonomic activity up to, during, and in the time after individual attacks. We include all seven suitable CLN3 patients in Denmark ≥ 15 years of age. HRV parameters were assessed from continuous heart rate monitoring during seven consecutive days and a particular focus of HRV parameters was obtained in close temporal context to clinically recurrent PSH-like episodes. In addition, the likelihood of PSH was assessed by caregiver's description and by video documentation.

RESULTS

Respectively eight and five episodes were recorded in two patients (18 and 20 years of age). The episodes were all safely superior to the cut off values of the clinical assessment score to be considered PSH-like episodes. During all 13 episodes, HRV revealed a statistically significant decrease in root mean square of successive differences (RMSSD) and standard deviation of the Poincaré-Plot interval (SD1) in the minutes prior to the clinical onset of the episodes, both indicating a sudden decrease in parasympathetic activity in advance of the onset. The reduced activity remained low during the episodes, and 15-30 min following the attack cessation, the parasympathetic activity had returned to pre-attacks levels. The sympathetic HRV parameters were unchanged resulting in a sympathetic overactivity during the episodes. In a third participant (32 years of age), in whom severity of PSH-like episodes had been gradually reduced during the last years, five episodes were registered. A similar temporally related reduction of the parasympathetic activity was found, but because the sympathetic activity decreased as well, no sympathetic dominance developed, which most reasonable is the reason to the clinically reduced expression of the episodes.

CONCLUSION

The documented transient withdrawal of parasympathetic activity leading to a paroxysmal unbalanced sympathetic hyperactivity most probably accounts for the PSH-like episodes occurring in post-adolescent CLN3 patients. The findings shed new light on both aetiology and possible preventative and therapeutic measures.

Comfort evaluation and physiological effects/autonomic nervous system response of inflatable deep pressure vest in reducing anxiety

Background

Deep pressure therapy treats anxiety by triggering physiological responses and promoting calmness. Moreover, measuring user comfort can improve product quality.

Objective

To investigate the physiological effects and subjective comfort level of inflatable deep pressure vests to enhance their calming effect.

Methods

Experimental research was conducted with a one-group pretest-posttest design for physiological effects using pulse oximetry for peripheral pulse rate and a one-shot case study for three subscale parameters that help evaluate comfort (pressure, touch, and mobility) using the Numerical Rating Scale (NRS). Deep pressure intervention using the Inflatable Vest was performed for three sessions, each lasting 5 min.

Results

This study was conducted with 46 participants (24 males, 22 females) aged 17-20 (19.52 ± 0.78). Although pulse rate consistently decreased in all sessions, session 1 showed a significant decrease (p = 0.014*, d = 0.379), whereas sessions 2 (p = 0.274, d = 0.163) and 3 (p = 0.597, d = 0.078) demonstrated non-significant decreases with small effect sizes. The pressure comfort subscale showed that 87.0 %, 4.3 %, and 8.7 % of the participants, and the touch comfort subscale test revealed that 82.6 %, 8.7 %, and 73.9 % of the participants rated it as comfortable, very comfortable, and less comfortable, respectively. The mobility subscale test showed that 73.9 % of the participants rated no limitation, 17.4 % rated somewhat limited, and only 8.7 % rated limitation. Decreased pulse rate and pressure comfort were significantly positively correlated (r = 0.282**, p < 0.01), whereas touch pressure and mobility were not (r = 0.160, p > 0.05; and r = 0.121, p > 0.05, respectively). Decreased pulse rate was also positively correlated with the overall score for the three aspects (r = 0.201*, p < 0.05).

Conclusions

A comfortable inflatable deep pressure vest provides a physiologically calming effect for therapeutic modalities.

Evaluating Perceptions of Test Anxiety Among Student Pharmacists and Faculty Members: A Pilot Study

OBJECTIVE

The purpose of this study was to determine student perceptions versus actual level of test anxiety, as measured by the Cognitive Test Anxiety Scale-2 (CTAS-2), and student and faculty perceptions of test anxiety with regard to prevalence, impact, ease of treatment, and importance in pharmacy education.

METHODS

Two independent Qualtrics questionnaires were distributed via email to all students and faculty in the professional pharmacy program (years 1-4) at the University of Mississippi. The first questionnaire evaluated pharmacy students' perceptions of test anxiety and self-awareness of personal test anxiety. The second questionnaire evaluated faculty members' perceptions of student test anxiety. The questionnaires had 50 and 21 questions, respectively, and were developed from validated, reliable questionnaires used in Cognitive Test Anxiety (CTA) research.

RESULTS

Questionnaires were completed by 123 students and 19 faculty. Overall, 46 % of students had a self-perception of "high test anxiety", with 28 % having a CTAS-2 score that correlated to severe test anxiety. A majority of faculty respondents (84 %) believed severe test anxiety affects 30 % or less of pharmacy students and may be associated with poor academic performance.

CONCLUSION

Student pharmacists' self-perception of test anxiety and perception of difficulty mitigating test anxiety may be overestimated. Overall, faculty accurately estimated the degree of test anxiety, felt confident in being able to help students, and believed it should receive attention from both faculty and the university.

Evaluation of driver stress intervention with guided breathing and positive comments

While many methods have been proposed to detect driver stress with high accuracy, few studies have explored how to mitigate stress during driving effectively. This study proposed and evaluated two driver stress intervention methods, i.e., auditory Positive Comments w/o haptic Breathing guidance (BPC and PC). Sixty drivers were randomly assigned to four groups (i.e., no stress, stressful but no intervention-NI, PC, and BPC) and completed a simulated driving task with their physiological, psychological, and behavioral data collected. Driver stress was effectively induced by challenging simulated driving events. Haptic guidance provided by smartwatches efficiently regulated the breathing rate to the target. Engaging in the intervention was associated with increased RMSSD and did not worsen driving performance. Participants perceived moderate to large comfort effects. The complexity of driving scenarios should be considered for choosing interventions. Breathing intervention was less effective when complex maneuvers were required than normal driving. The findings provided implications regarding the design of in-vehicle stress intervention systems for intelligent transportation.

The impact of virtual reality scenes on stress response characteristics of individuals with different personality traits

Virtual reality based physical stress (VRPS) paradigms could eliminate the influence of social factors on participants, and it may be a desirable tool to explore the impact of personality traits on stress levels. In this study, we attempt to explore the effects of VRPS on stress response among individuals with different personality traits. Forty male participants with an average age of 22.79 ± 0.41 years were divided into two groups based on Harm Avoidance (HA) scores of Tridimensional Personality Questionnaire (TPQ), referred to as the Low-HA group and the High-HA group. The stress levels of the participants were assessed using salivary α-amylase (sAA) activity and heart rate variability (HRV) indices pre- and post-stress. The influence of personality traits on stress response among different groups was analyzed. VRPS significantly affected the sAA activity and HRV indicators of both groups. During and after stress, there were significant differences in sAA activity and HRV indicators between the two groups. The sAA levels and HRV indices of the Low-HA group were lower than those of the High-HA group. Furthermore, sAA levels and HRV indices were correlated with the scores of TPQ. VRPS scenarios elicit different stress responses on individuals with different harm avoidance personality traits. Stress evaluation based on VR scenarios presents potential in personality trait assessments, particularly for distinguishing between individuals with low and high HA tendencies.

Stress reappraisal improves the autonomic nervous system response of test anxious individuals: Evidence from heart rate variability

BACKGROUND

Stress belief plays an important role in stress response. This study investigated whether individuals with high test anxiety/low test anxiety (HTA/LTA) held different stress belief, and tested the effect of stress reappraisal on reducing test anxiety related autonomic nervous system (ANS) response.

METHODS

51 HTA students and 49 LTA students were recruited using the Test Anxiety Scale (TAS). They completed a 10-min intelligence test (including preparation, test, and recovery phases), then were randomly assigned to reappraisal group and control group to complete the test again. Heart rate variability (HRV) was recorded throughout the protocol. Beliefs about Stress Scale was obtained before and after the experiment. Stress belief were manipulated using a 2-min film clip that orienting participant to the enhancing nature of stress. Emotional changes were assessed.

RESULTS

HTA individuals held more negative stress beliefs and showed greater emotional arousal during the test than the LTA individuals. Their negative stress belief was associated with higher TAS score and worse HRV response. (2) When facing an exam, LTA individuals exhibited increased low-frequency HRV and stable high-frequency HRV, while HTA individuals showed stable low-frequency HRV and decreased high-frequency HRV. (3) HTA individuals who underwent reappraisal showed a reduction in test anxiety and in low-frequency/high-frequency HRV ratio.

CONCLUSIONS

The ANS activity of HTA individuals is imbalanced in the test situations. Stress belief is a meaningful variable in anxiety related ANS activity. Stress reappraisal can effectively reduce test anxiety and improve the balance of ANS activity of HTA individuals.

Gender moderates the association between resting vagally mediated heart rate variability and attentional control

Background

Women typically exhibit weaker attentional control ability than men. Lower resting vagally mediated heart rate variability (vmHRV) is thought to reflect the poorer function of the neurophysiological pathways underlying attentional control and thus, poorer attentional control ability. However, existing findings are inconsistent regarding the relationship between vmHRV and attentional control. Gender may be an important moderator.

Objective

To examine whether gender moderates the relationship between resting vmHRV and attentional control, and to provide neurophysiological evidence for elucidating gender differences in attentional control ability.

Methods

Two hundred and twenty college students completed the Attentional Control Scale to evaluate their attentional control ability. Resting vmHRV was assessed during a 5 min baseline period using an electrocardiographic amplifier (ECG100C) of the Biopac MP150 physiological recorder.

Results

(1) There was no significant difference in the total scores of the Attentional Control Scale between men and women (t = 0.498, p > 0.05), but the scores of the attentional shifting dimension of women were significantly lower than those of men (t = 1.995, p < 0.05); (2) Resting vmHRV was significantly negatively correlated with attentional control in women(r = -0.233, p < 0.01), whereas the correlation was not significant in men; (3) Gender significantly moderated the relationship between resting vmHRV and attentional control (B = -3.088, 95% boot CI [-5.431, -0.745], t = -2.598, p < 0.05); (4) Among participants with lower resting vmHRV, there was no significant difference in attentional control between men and women (B = 2.284, 95% boot CI [-0.748, 5.310], p > 0.05), but among participants with higher resting vmHRV, men scored significantly higher than women in attentional control (B = -3.377, 95% boot CI [-6.406, -0.348], p < 0.05).

Conclusion

Gender moderates the relationship between resting vmHRV and attentional control, with higher resting vmHRV in women reflecting a compensatory response to deficits in attentional control.

Etiology of anxious and fearful behavior in juvenile neuronal ceroid lipofuscinosis (CLN3 disease)

Background

Juvenile neuronal ceroid lipofuscinosis (JNCL, CLN3) is a childhood-onset neurodegenerative disease with prominent symptoms comprising a pediatric dementia syndrome. As in adult dementia, behavioral symptoms like mood disturbances and anxiety are common. In contrast to in adult dementia, however, the anxious behavioral symptoms increase during the terminal phase of JNCL disease. In the present study, the current understanding of the neurobiological mechanisms of anxiety and anxious behavior in general is addressed as will a discussion of the mechanism of the anxious behavior seen in young JNCL patients. Based on developmental behavioral points of view, known neurobiological mechanisms, and the clinical presentation of the anxious behavior, a theory of its etiology is described.

Result and discussion

During the terminal phase, the cognitive developmental age of JNCL patients is below 2 years. At this stage of mental development individuals act primarily from a concrete world of consciousness and do not have the cognitive ability to encounter a normal anxiety response. Instead, they experience the evolutionary basic emotion of fear, and as the episodes typically are provoked when the adolescent JNCL patient is exposed to either loud sounds, is lifted from the ground, or separated from the mother/known caregiver, the fear can best be perceived as the developmental natural fear-response that appears in children 0-2 years of age. The efferent pathways of the neural fear circuits are mediated through autonomic, neuroendocrine, and skeletal-motor responses. The autonomic activation occurs early, is mediated through the sympathetic and parasympathetic neural systems, and as JNCL patients beyond puberty have an autonomic imbalance with a significant sympathetic hyperactivity, the activation of the autonomic nervous system results in a disproportionate high sympathetic activity resulting in tachycardia, tachypnea, excessive sweating, hyperthermia, and an increased atypical muscle activity. The episodes are thus phenotypically similar to what is seen as Paroxysmal Sympathetic Hyperactivity (PSH) following an acute traumatic brain injury. As in PSH, treatment is difficult and so far, no consensus of a treatment algorithm exists. Use of sedative and analgesic medication and minimizing or avoiding provocative stimuli may partly reduce the frequency and intensity of the attacks. Transcutaneous vagal nerve stimulation might be an option worth to investigate rebalancing the sympathetic-parasympathetic disproportion.

Effects of Expressive Writing on "Choking under Pressure" in High Test-Anxious Individuals

(1) Background: High test-anxious students often fail to perform at their actual level and are prone to choking under pressure (CUP). The aim of the present study was to investigate whether expressive writing (EW) can help high test-anxious individuals reduce the degree of the CUP effect, and whether the intervention effects were different in people with different working memory capacities. (2) Methods: High test-anxious participants wrote expressively (EW group) or neutrally (control group) according to guidance, and then completed a modular arithmetic (MA) task under a high-stress condition. (3) Results: The state anxiety score of the control group was significantly higher than that of the EW group in the high-pressure situation, indicating that the EW intervention was helpful to alleviate the state anxiety. Subjects with high working memory capacity in the control group performed the complex MA task significantly less accurately in the high-stress situation than in the low-stress situation, showing the CUP effect. There was no significant difference in complex MA task scores between high- and low-stress situations for subjects with high working memory capacity in the EW group, indicating that the EW intervention can reduce the degree of the CUP effect. (4) Conclusions: EW intervention was effective in reducing state anxiety levels and attenuating the detrimental effects of test stress on cognitive processing in test-anxious individuals with high working memory capacity.

Effects of Music Therapy in the Reduction of Pre-Meal Anxiety in Patients Suffering from Anorexia Nervosa

Literature reviews appear to indicate that Music Therapy (MT) may instil a sense of empowerment and generate feelings of renewed self-confidence, distracting subjects who follow this type of intervention from negative thoughts and, generally, helping patients suffering from Anorexia Nervosa (AN) to redevelop or rediscover their identity. The purpose of the study reported in this paper is to investigate whether MT proposed before an evening meal is capable of decreasing pre-meal anxiety in adolescents suffering from AN who follow the Day-hospital Treatment Programme at the San Bortolo Hospital of Vicenza (Italy). A total of 24 patients participated voluntarily in once-weekly sessions of group-based MT conducted by a qualified music therapist over a period of six months. Before evening meals on Monday, Tuesday and Wednesday, pre-meal anxiety was measured using a self-report scale, and the MT group session occurred every Wednesday before the evening meal was consumed. MT activities were both active and receptive. It has been found that with respect to Mondays and Tuesdays, pre-meal anxiety was significantly lower on Wednesdays following participation in the MT group. MT is evidently capable of reducing pre-meal anxiety and may be adopted as a supportive element in treatment plans relating to patients with AN in a day-hospital treatment programme.

Reducing Test Anxiety by Device-Guided Breathing: A Pilot Study

Test anxiety remains a challenge for students and has considerable physiological and psychological impacts. The routine practice of slow, Device-Guided Breathing (DGB) is a major component of behavioral treatments for anxiety conditions. This paper addresses the effectiveness of using DGB as a self-treatment clinical tool for test anxiety reduction. This pilot study sample included 21 healthy men and women, all college students, between the ages of 20 and 30. Participants were randomly assigned to two groups: DGB practice (n = 10) and wait-list control (n = 11). At the beginning and the end of 3-weeks DGB training, participants underwent a stress test, followed by measures of blood pressure and reported anxiety. Anxiety reduction in the DGB group as compared to controls was not statistically significant, but showed a large effect size. Accordingly, the clinical outcomes suggested that daily practice of DGB may lead to reduced anxiety. We assume that such reduction may lead to improved test performance. Our results suggest an alternative treatment for test anxiety that may also be relevant for general anxiety, which is likely to increase due to the ongoing COVID-19 pandemic.