A Review on the Role of the Neuroscience of Flow States in the Modern World

Psychometric Properties of the Turkish Version of the Learning Flow in Clinical Simulation Scale

BACKGROUND

Students must be able to accept the unrealistic aspects of clinical simulations to ensure these simulations are effective learning tools. As the flow during simulation must be measured to determine simulation learning effectiveness, a reliable measurement tool is needed.

PURPOSE

This study was carried out to translate the Learning Flow in Clinical Simulation Scale (LFCSS) into Turkish and then to validate it on a sample of nurses in Turkey.

METHODS

A methodological research approach was used, and 135 nursing students with prior experience engaging with clinical simulations were recruited and enrolled as participants. The data were collected using two forms, i.e., the Student Information Form, LFCSS (Turkish version) and The Simulation Effectiveness Tool-Modified. Content validity was evaluated using a content validity index (CVI) based on expert opinions. The correlation between the two forms was calculated using the equivalent (parallel) forms method, and reliability and internal consistency were examined using the Cronbach alpha coefficient and item analysis. The construct validity of the scale was determined using factor analysis with varimax rotation.

RESULTS

The Cronbach alpha coefficient was .93 for the entire LFCSS, with item-total score correlations ranging between .922 and .745. In terms of equivalent (parallel) forms reliability, a low correlation (r = .389) was found with the Flow Scale in Clinical Simulation and Prebriefing subdimension of the Simulation Effectiveness Tool-Modified, and a moderate correlation (r = .467, r = .584, r = .447) was found with the Learning, Confidence, and Debriefing subdimensions of the same. The factor analysis showed a four-factor structure explaining 74.13% of the total variance, which is similar to the original scale. The Kaiser-Meyer-Olkin value was .890 and the Bartlett's test chi-square value was 1455.35 with a p < .001 significance level.

CONCLUSIONS

The findings indicate the Turkish version of the LFCSS is a reliable and valid tool for assessing level of student/participant flow in clinical simulation.

Flow and intuition: a systems neuroscience comparison

This paper explores the relationship between intuition and flow from a neurodynamics perspective. Flow and intuition represent two cognitive phenomena rooted in nonconscious information processing; however, there are clear differences in both their phenomenal characteristics and, more broadly, their contribution to action and cognition. We propose, extrapolating from dual processing theory, that intuition serves as a rapid, nonconscious decision-making process, while flow facilitates this process in action, achieving optimal cognitive control and performance without [conscious] deliberation. By exploring these points of convergence between flow and intuition, we also attempt to reconcile the apparent paradox of the presence of enhanced intuition in flow, which is also a state of heightened cognitive control. To do so, we utilize a revised dual-processing framework, which allows us to productively align and differentiate flow and intuition (including intuition in flow). Furthermore, we draw on recent work examining flow from an active inference perspective. Our account not only heightens understanding of human cognition and consciousness, but also raises new questions for future research, aiming to deepen our comprehension of how flow and intuition can be harnessed to elevate human performance and wellbeing.

Practicing Emotional Self-awareness to Build Surgeon Resilience

As surgeons, we work in a high-stress, high-stakes environment to take care of our patients. In this setting, it is not uncommon for us to experience microaggressions-subtle or indirect actions or statements that communicate a demeaning or exclusionary message, often unintentionally. Microaggressions can bring us down, taking away from the fulfillment that attracted many of us to this profession. In this article, we introduce the Institute for Professional Excellence in Coaching energy leadership framework as a tool to understand and address microaggressions. We then apply it to real-life scenarios surgeons may encounter, demonstrating how this framework can help us to build resilience and recover our joy for our profession.

Doing good well (Karma Yoga, the path of selfless action): Psychotherapeutic lessons from the East

The tripartite classification of mental faculties into cognition, affect, and conation (motivation and action) continues to be the edifice on which the mind and the methods to address mental afflictions are studied. Eastern spiritual traditions offer insights into mental health as it pertains to each of these domains. Following up on our previous paper on the cognition path to psychotherapy (Knowing oneself, or Jnana Yoga), we herein focus on the path of selfless action (Karma Yoga). We review eastern concepts on the nature of karma and the approaches to optimal action (the will to do things, doing the right things, and doing them well). We then place these eastern insights in the context of emerging concepts in psychology on motivation and action. Current psychological concepts such as autonomy and intrinsic motivation, mastery, flow and growth mindset, higher purpose and value driven self-less action, equanimity and balance are convergent with ancient eastern concepts. We also review current neuroscientific underpinnings (such as neural circuitries, neurotransmitter systems and epigenetics and how these facilitate neural plasticity) relevant to karma, including free will, focused action, prosocial behaviors, extrinsic and intrinsic and motivation. These concepts have significant implications for psychotherapeutic models, especially in the areas of positive psychology and preventive psychiatry.

Temporal Changes in Depressive Symptoms Among Goodville Farm Game Players: A 6-Week Observational Study

Aim of the Study: The primary objective was to evaluate the potential impact of the Goodville farm game on depressive symptoms. Methods: The Goodville game, characterized by its unique farming features, incorporates elements of emotional well-being and various mental health assessment tools, enabling players to monitor and improve their emotional state. Using self-reported Patient Health Questionnaire-8 (PHQ-8) data from 1717 US and UK players, changes were monitored weekly over a 6-week period. The study focused on the game's ability to integrate emotional well-being elements and various mental health assessments to facilitate self-monitoring and improvement of players' emotional states. Results: There was a significant overall time effect (F = 154.498, df = 1711, P < 0.001), indicating a moderate-to-large effect size, with progressive decreases in PHQ-8 scores throughout the period. About 60% of players reported reduced depressive symptom severity, with around 35% experiencing complete symptom relief. More significant improvements were observed in players with higher initial severity. No correlations were found between symptom changes and demographic data or the number of active playing days. Conclusion: Goodville demonstrates potential as a digital mental health intervention in reducing depressive symptoms through its specific characteristics designed to improve emotional well-being. The study emphasizes the need to consider baseline severity and highlights the therapeutic promise of authentic farming game features. Despite the absence of a control group, the findings contribute meaningful insights into digital interventions for mental health care and set a direction for future studies to validate and expand upon these results.

Psycho-physio-neurological correlates of qualitative attention, emotion and flow experiences in a close-to-real-life extreme sports situation: low- and high-altitude slackline walking

It has been indicated that extreme sport activities result in a highly rewarding experience, despite also providing fear, stress and anxiety. Studies have related this experience to the concept of flow, a positive feeling that individuals undergo when they are completely immersed in an activity. However, little is known about the exact nature of these experiences, and, there are still no empirical results to characterize the brain dynamics during extreme sport practice. This work aimed at investigating changes in psychological responses while recording physiological (heart rate-HR, and breathing rate-BR) and neural (electroencephalographic-EEG) data of eight volunteers, during outdoors slackline walking in a mountainous environment at two different altitude conditions (1 m-low-walk- and 45 m-high-walk-from the ground). Low-walk showed a higher score on flow scale, while high-walk displayed a higher score in the negative affect aspects, which together point to some level of flow restriction during high-walk. The order of task performance was shown to be relevant for the physiological and neural variables. The brain behavior during flow, mainly considering attention networks, displayed the stimulus-driven ventral attention network-VAN, regionally prevailing (mainly at the frontal lobe), over the goal-directed dorsal attention network-DAN. Therefore, we suggest an interpretation of flow experiences as an opened attention to more changing details in the surroundings, i.e., configured as a 'task-constantly-opened-to-subtle-information experience', rather than a 'task-focused experience'.

A framework for neurophysiological experiments on flow states

Csikszentmihalyi's concept of the "flow state" was initially discovered in experts deeply engaged in self-rewarding activities. However, recent neurophysiology research often measures flow in constrained and unfamiliar activities. In this perspective article, we address the challenging yet necessary considerations for studying flow state's neurophysiology. We aggregate an activity-autonomy framework with several testable hypotheses to induce flow, expanding the traditional "challenge skill balance" paradigm. Further, we review and synthesise the best methodological practices from neurophysiological flow studies into a practical 24-item checklist. This checklist offers detailed guidelines for ensuring consistent reporting, personalising and testing isolated challenge types, factoring in participant skills, motivation, and individual differences, and processing self-report data. We argue for a cohesive approach in neurophysiological studies to capture a consistent representation of flow states.

Forgetting ourselves in flow: an active inference account of flow states and how we experience ourselves within them

Flow has been described as a state of optimal performance, experienced universally across a broad range of domains: from art to athletics, gaming to writing. However, its phenomenal characteristics can, at first glance, be puzzling. Firstly, individuals in flow supposedly report a loss of self-awareness, even though they perform in a manner which seems to evince their agency and skill. Secondly, flow states are felt to be effortless, despite the prerequisite complexity of the tasks that engender them. In this paper, we unpick these features of flow, as well as others, through the active inference framework, which posits that action and perception are forms of active Bayesian inference directed at sustained self-organisation; i.e., the minimisation of variational free energy. We propose that the phenomenology of flow is rooted in the deployment of high precision weight over (i) the expected sensory consequences of action and (ii) beliefs about how action will sequentially unfold. This computational mechanism thus draws the embodied cognitive system to minimise the ensuing (i.e., expected) free energy through the exploitation of the pragmatic affordances at hand. Furthermore, given the challenging dynamics the flow-inducing situation presents, attention must be wholly focussed on the unfolding task whilst counterfactual planning is restricted, leading to the attested loss of the sense of self-as-object. This involves the inhibition of both the sense of self as a temporally extended object and higher-order, meta-cognitive forms of self-conceptualisation. Nevertheless, we stress that self-awareness is not entirely lost in flow. Rather, it is pre-reflective and bodily. Our approach to bodily-action-centred phenomenology can be applied to similar facets of seemingly agentive experience beyond canonical flow states, providing insights into the mechanisms of so-called selfless experiences, embodied expertise and wellbeing.

Creative flow as optimized processing: Evidence from brain oscillations during jazz improvisations by expert and non-expert musicians

Using a creative production task, jazz improvisation, we tested alternative hypotheses about the flow experience: (A) that it is a state of domain-specific processing optimized by experience and characterized by minimal interference from task-negative default-mode network (DMN) activity versus (B) that it recruits domain-general task-positive DMN activity supervised by the fronto-parietal control network (FPCN) to support ideation. We recorded jazz guitarists' electroencephalograms (EEGs) while they improvised to provided chord sequences. Their flow-states were measured with the Core Flow State Scale. Flow-related neural sources were reconstructed using SPM12. Over all musicians, high-flow (relative to low-flow) improvisations were associated with transient hypofrontality. High-experience musicians' high-flow improvisations showed reduced activity in posterior DMN nodes. Low-experience musicians showed no flow-related DMN or FPCN modulation. High-experience musicians also showed modality-specific left-hemisphere flow-related activity while low-experience musicians showed modality-specific right-hemisphere flow-related deactivations. These results are consistent with the idea that creative flow represents optimized domain-specific processing enabled by extensive practice paired with reduced cognitive control.

The effect of music tempo on movement flow

There has been much controversy over the effects of music tempo on movement flow. In this study, a single-factor repeated-measurement design was used to explore the effect of music tempo (fast, slow, and no music control) on movement flow by measuring both subjective experiences and objective electroencephalographic (EEG) characteristics during brisk walking. In the experiment, 20 college students walked briskly on a treadmill using EEG equipment. Each participant walked for 10 min on three different days. Their brain waves were recorded during brisk walking on a treadmill. After each walk, the participants completed a form of short flow state scale-2 (S FSS-2), which covered nine major aspects of flow. The results showed that music tempo had a significant effect on subjective experiences and objective physiological characteristics; that is, a higher subjective flow level for fast-tempo music in brisk walking and a significant enhancement of mean power values in the subconscious brain waves of the delta, theta, alpha, and beta bands for fast tempo music were observed. A fast tempo facilitated the movement flow. The findings of this study can be instructive for the use of music in exercises to improve sports training outcomes.

Siddha Self-Inquiry for Flow, Bliss, and Uvagai: Mindfulness for Intuitive Lifestyle in Complex Cardiac Disease

Cardiovascular disease (CVD) and mental health disorders contribute to significant healthcare expenses. Lifestyle approaches that empower and enable patients to participate in their recovery are needed with the increasing complexity of cardiac patients. Traditional Tamil medical practice of Siddha self-inquiry meditation targets holistic health through intuitive lifestyle transformation. We describe 4 complex cardiac patients who explored Siddha based Hunger Gratitude Experience (HUGE) mindful eating and reported elevated levels of optimism and deeper experience of life as outlined by the 5000-year-old secular Siddha medical tradition. We cannot exclude the role of suggestion and placebo effect in descriptive series. However, the simultaneous improvement in physical health and emotional wellbeing along with demonstrated resilience against unforeseen adversities suggests this is Uvagai, the true essence of Siddha higher consciousness. Uvagai is extreme happiness and may be accessible universally with little formal training and targets positive psychology to improve wellbeing. While flow and bliss states are transient transcendental experiences, Uvagai may be more profound and therapeutic in CVD despite age and comorbidities. Seeking Uvagai can potentially overcome health disparities, including rural, minority, and underprivileged populations for better health. HUGE allows CVD patients to safely engage in Uvagai, experience higher consciousness and intuitively sustain lifestyle transformation.

First few seconds for flow: A comprehensive proposal of the neurobiology and neurodynamics of state onset

Flow is a cognitive state that manifests when there is complete attentional absorption while performing a task. Flow occurs when certain internal as well as external conditions are present, including intense concentration, a sense of control, feedback, and a balance between the challenge of the task and the relevant skillset. Phenomenologically, flow is accompanied by a loss of self-consciousness, seamless integration of action and awareness, and acute changes in time perception. Research has begun to uncover some of the neurophysiological correlates of flow, as well as some of the state's neuromodulatory processes. We comprehensively review this work and consider the neurodynamics of the onset of the state, considering large-scale brain networks, as well as dopaminergic, noradrenergic, and endocannabinoid systems. To accomplish this, we outline an evidence-based hypothetical situation, and consider the flow state in a broader context including other profound alterations in consciousness, such as the psychedelic state and the state of traumatic stress that can induce PTSD. We present a broad theoretical framework which may motivate future testable hypotheses.

Advancing the Study of “Goals of Best Practice”: Toward Achieving Optimal Best – Educational Implications to Developments in Flow Research and Positive Optimal Psychology

The paradigm of positive psychology is significant in introducing positive psychological concepts such as “flourishing,” “optimal best,” and “a state of flow.” In terms of research development of positive psychology, the researchers of this article have made extensive theoretical, empirical, and methodological contributions by advancing the study of optimal best. One aspect of this research, notably, consists of advancement of the psychological process of optimization. Optimization, in brief, provides a theoretical account into the “optimization” of a person’s state of functioning. Non-academically, a Buddhist nun’s seeking to successfully achieve an optimal state of enlightenment or, academically, a first-year student’s seeking to achieve an A grade in Psych 101 would require some form of optimization. Recent research development has, interestingly, considered a related concept known as “goals of best practice” (GsBP), which may co-exist with the process of optimization and/or assist to account for the optimization of learning experiences. This conceptual analysis article, by utilizing the paradigm of philosophical psychology, advances the study of optimal best practice by focusing on three major aspects: (i) to consider conceptually and philosophically how and/or the extent to which GsBP could, in fact, relate to the nature of flow, flourishing, and optimal best; (ii) to consider a methodological account, which could help to measure and assess the concept GsBP; and (iii) to consider the potential practicality of GsBP in educational contexts, which may assist to facilitate and motivate the achievement of optimal best. These three aspects, we firmly believe, are of significance as they provide grounding for implementation and continuing research development into the area of best practice.