A Review on Mental Stress Assessment Methods Using EEG Signals

Continuous real-time assessment of acute cognitive stress from cardiac mechanical signals captured by a skin-like patch

The inability to objectively quantify cognitive stress in real-time with wearable devices is a crucial unsolved problem with serious negative consequences for dementia and mental disability patients and those seeking to improve their quality of life. Here, we introduce a skin-like, wireless sternal patch that captures changes in cardiac mechanics due to stress manifesting in the seismocardiogram (SCG) signals. Judicious optimization of the device's micro-structured interconnections and elastomer integration yields a device that sufficiently matches the skin's mechanics, robustly yet gently adheres to the skin without aggressive tapes, and captures planar and longitudinal SCG waves well. The device transmits SCG beats in real-time to a user's device, where derived features relate to the heartbeat's mechanical morphology. The signals are assessed by a series of features in a support vector machine regressor. Controlled studies, compared to gold standard cortisol and following the validated imaging test, show an R-squared correlation of 0.79 between the stress prediction and cortisol change, significantly improving over prior works. Likewise, the system demonstrates excellent robustness to external temperature and physical recovery status while showing excellent accuracy and wearability in full-day use.

Uninterrupted real-time cerebral stress level monitoring using wearable biosensors: A review

Stress is the major unseen bug for the health of humans with the increasing workaholic era. Long periods of avoidance are the main precursor for chronic disorders that are quite tough to treat. As precaution is better than cure, stress detection and monitoring are vital. Although there are ways to measure stress clinically, there is still a constant need and demand for methods that measure stress personally and in an ex vitro manner for the convenience of the user. The concept of continuous stress monitoring has been introduced to tackle the issue of unseen stress accumulating in the body simultaneously with being user-friendly and reliable. Stress biosensors nowadays provide real-time, noninvasive, and continuous monitoring of stress. These biosensors are innovative anthropogenic creations that are a combination of biomarkers and indicators like heart rate variation, electrodermal activity, skin temperature, galvanic skin response, and electroencephalograph of stress in the body along with machine learning algorithms and techniques. The collaboration of biological markers, artificial intelligence techniques, and data science tools makes stress biosensors a hot topic for research. These attributes have made continuous stress detection a possibility with ease. The advancement in stress biosensing technologies has made a great impact on the lives of human beings so far. This article focuses on the comprehensive study of stress-indicating biomarkers and the techniques along with principles of the biosensors used for continuous stress detection. The precise overview of wearable stress monitoring systems is also sectioned to pave a pathway for possible future research studies.

A deep learning-based approach for distinguishing different stress levels of human brain using EEG and pulse rate

In today's world, people suffer from many fatal maladies, and stress is one of them. Excessive stress can have deleterious effects on the health, brain, mind, and nervous system of humans. The goal of this paper is to design a deep learningbased human stress level measurement technique using electroencephalogram (EEG), and pulse rate. In this research, EEG signals and pulse rate of healthy subjects are recorded while they solve four different question sets of increasing complexity. It is assumed that the subjects undergo through four different stress levels, i.e., 'no stress', 'low stress', 'medium stress', and 'high stress', while solving these question sets. An attention mechanism-based CNN-TLSTM (convolutional neural network-tanh long short-term memory) model is proposed to detect the mental stress level of a person. An attention layer is incorporated into the designed TLSTM network to increase the classification accuracy of the CNN-TLSTM model. The CNN network is used for the automated extraction of intricate features from the EEG signals and pulse rate. Then TLSTM is used to classify the stress level of a person into four different categories using the CNNextracted features. The obtained average accuracy of the proposed CNN-TLSTM model is 97.86%. Experimentally, it is found that the designed stress level measurement technique is highly effective and outperforms most existing state-of-the-art techniques. In the future, functional Near-Infrared Spectroscopy (fNIRS), ECG, and Galvanic Skin Response (GSR) can be employed with EEG and pulse rate to increase the effectiveness of the designed stress level measurement technique.

Mental stress recognition on the fly using neuroplasticity spiking neural networks

Mental stress is found to be strongly connected with human cognition and wellbeing. As the complexities of human life increase, the effects of mental stress have impacted human health and cognitive performance across the globe. This highlights the need for effective non-invasive stress detection methods. In this work, we introduce a novel, artificial spiking neural network model called Online Neuroplasticity Spiking Neural Network (O-NSNN) that utilizes a repertoire of learning concepts inspired by the brain to classify mental stress using Electroencephalogram (EEG) data. These models are personalized and tested on EEG data recorded during sessions in which participants listen to different types of audio comments designed to induce acute stress. Our O-NSNN models learn on the fly producing an average accuracy of 90.76% (σ = 2.09) when classifying EEG signals of brain states associated with these audio comments. The brain-inspired nature of the individual models makes them robust and efficient and has the potential to be integrated into wearable technology. Furthermore, this article presents an exploratory analysis of trained O-NSNNs to discover links between perceived and acute mental stress. The O-NSNN algorithm proved to be better for personalized stress recognition in terms of accuracy, efficiency, and model interpretability.

Nonlinear Features from Multi-Modal Signals for Continuous Stress Monitoring

Continuous monitoring of stress in individuals during their daily activities has become an inevitable need in present times. Unattended stress is a silent killer and may lead to fatal physical and mental disorders if left unidentified. Stress identification based on individual judgement often leads to under-diagnosis and delayed treatment possibilities. EEG-based stress monitoring is quite popular in this context, but impractical to use for continuous remote monitoring.Continuous remote monitoring of stress using signals acquired from everyday wearables like smart watches is the best alternative here. Non-EEG data such as heart rate and ectodermal activity can also act as indicators of physiological stress. In this work, we have explored the possibility of using nonlinear features from non-EEG data such as (a) heart rate, (b) ectodermal activity, (c) body temperature (d) SpO2 and (e) acceleration in detecting four different types of neurological states; namely (1) Relaxed state, (2) State of Physical stress, (3) State of Cognitive stress and (4) State of Emotional stress. Physiological data of 20 healthy adults have been used from the noneeg database of PhysioNet.Results: We used two machine learning models; a linear logistic regression and a nonlinear random forest to detect (a) stress from relaxed state and (4) the four different neurological states. We trained the models using linear and nonlinear features separately. For the 2-class and 4-class problems, using nonlinear features increased the accuracy of the models. Moreover, it is also proved in this study that by using nonlinear features, we can avoid the use of complex machine learning models.

Classification of Mental Stress Levels using EEG Connectivity and Convolutional Neural Networks

Classifying mental stress is important as it helps in identifying the type and severity of stress, which can inform the most appropriate treatment or intervention. In this study, we propose utilizing electroencephalography (EEG) signals with convolutional neural networks (CNNs) to classify four mental states: rest, control-alert, stress and stress mitigation. The mental stress state was induced using Stroop color word test (SCWT) with time constrains and was then mitigated using 16 Hz Binaural beat stimulation (BBs). We quantified the four mental states using the reaction time (RT) to stimuli, accuracy of target detection, subjective score, and functional connectivity images of EEG estimated by Phase Locking Value (PLV). Our results show that, the SCWT reduced the accuracy of target detection by 70% with (F= 24.56, p = .00001), and the BBs improved the accuracy by 28% (F= 4.54, p = .00470). The functional connectivity network showed different patterns between the frontal/occipital and parietal regions, under the four mental states. The proposed CNNs with PLV images differentiated between the four mental states with highest classification performance at beta frequency band with 80.95% accuracy, 80.36% sensitivity, 94.75% specificity, 83.63% precision and 81.96% F-score. The overall results suggest that 16 Hz BBs can be used as an effective method to mitigate stress and the proposed CNNs with EEG-PLV images as a promising method for classifying different mental states.

Mental Stress Detection and Mitigation using Machine Learning and Binaural Beat Stimulation

Stress is an inevitable problem experienced by people worldwide. Continuous exposure to stress can greatly impact mental activity as well as physical health thereby leading to several diseases. In this study, we investigate the effectiveness of audio binaural beat stimulation (BBs) in mitigating mental stress. We developed an experimental protocol to induce four mental states: rest, control, stress, and stress mitigation. The stress was induced by utilizing Stroop Color Word Test (SCWT) with time constraints and mitigated, by listening to 16 Hz of BBs. The four mental states were assessed using behavioral responses (accuracy of target detection), a perceived stress state questionnaire (PSS-10), and electroencephalography (EEG). The mean spectral power of four frequency bands was estimated using Power Spectral Density (PSD), and five different machine learning classifiers were used to classify the four mental states. Our results show that SCWT reduced the detection accuracy by 59.58% while listening to 16-Hz BBs significantly increased the accuracy of detection by 27.08%, (p = .00392). Furthermore, the support vector machine (SVM) significantly outperformed other classifiers achieving the highest accuracy of 82.5 ± 2.0 % using the beta band information. Similarly, the PSD topographical maps showed different patterns between the four mental states, where the temporal region's PSD was mostly affected by stress. Nevertheless, under mitigation, there was a noticeable restoration in the temporal activity. Overall, our results demonstrate that BBs at 16 Hz can be used to mitigate stress levels.

Effects of acute psychosocial stress on source level EEG power and functional connectivity measures

The usage of EEG to uncover the influence of psychosocial stressors (PSSs) on neural activity has gained significant attention throughout recent years, but the results are often troubled by confounding stressor types. To investigate the effect of PSSs alone on neural activity, we employed a paradigm where participants are exposed to negative peer comparison as PSS, while other possible stressors are kept constant, and compared this with a condition where participants received neutral feedback. We analyzed commonly used sensor level EEG indices (frontal theta, alpha, and beta power) and further investigated whether source level power and functional connectivity (i.e., the temporal dependence between spatially seperated brain regions) measures, which have to our knowledge not yet been used, are more sensitive to PSSs than sensor level-derived EEG measures. Our results show that on sensor level, no significant frontal power changes are present (all p's > 0.16), indicating that sensor level frontal power measures are not sensitive enough to be affected by only PSSs. On source level, we find increased alpha power (indicative of decreased cortical activity) in the left- and right precuneus and right posterior cingulate cortex (all p's < 0.03) and increased functional connectivity between the left- and right precuneus (p < 0.001), indicating that acute, trial based PSSs lead to decreased precuneus/PCC activity, and possibly indicates a temporary disruption in the self-referential neural processes of an individual.

Cognitive tasks and combined statistical methods to evaluate, model, and predict mental workload

Mental workload (MWL) is a concept that is used as a reference for assessing the mental cost of activities. In recent times, challenges related to user experience are determining the expected MWL value for a given activity and real-time adaptation of task complexity level to achieve or maintain desired MWL. As a consequence, it is important to have at least one task that can reliably predict the MWL level associated with a given complexity level. In this study, we used several cognitive tasks to meet this need, including the N-Back task, the commonly used reference test in the MWL literature, and the Corsi test. Tasks were adapted to generate different MWL classes measured via NASA-TLX and Workload Profile questionnaires. Our first objective was to identify which tasks had the most distinct MWL classes based on combined statistical methods. Our results indicated that the Corsi test satisfied our first objective, obtaining three distinct MWL classes associated with three complexity levels offering therefore a reliable model (about 80% accuracy) to predicted MWL classes. Our second objective was to achieve or maintain the desired MWL, which entailed the use of an algorithm to adapt the MWL class based on an accurate prediction model. This model needed to be based on an objective and real-time indicator of MWL. For this purpose, we identified different performance criteria for each task. The classification models obtained indicated that only the Corsi test would be a good candidate for this aim (more than 50% accuracy compared to a chance level of 33%) but performances were not sufficient to consider identifying and adapting the MWL class online with sufficient accuracy during a task. Thus, performance indicators require to be complemented by other types of measures like physiological ones. Our study also highlights the limitations of the N-back task in favor of the Corsi test which turned out to be the best candidate to model and predict the MWL among several cognitive tasks.

Machine learning for the detection of social anxiety disorder using effective connectivity and graph theory measures

Introduction

The early diagnosis and classification of social anxiety disorder (SAD) are crucial clinical support tasks for medical practitioners in designing patient treatment programs to better supervise the progression and development of SAD. This paper proposes an effective method to classify the severity of SAD into different grading (severe, moderate, mild, and control) by using the patterns of brain information flow with their corresponding graphical networks.

Methods

We quantified the directed information flow using partial directed coherence (PDC) and the topological networks by graph theory measures at four frequency bands (delta, theta, alpha, and beta). The PDC assesses the causal interactions between neuronal units of the brain network. Besides, the graph theory of the complex network identifies the topological structure of the network. Resting-state electroencephalogram (EEG) data were recorded for 66 patients with different severities of SAD (22 severe, 22 moderate, and 22 mild) and 22 demographically matched healthy controls (HC).

Results

PDC results have found significant differences between SAD groups and HCs in theta and alpha frequency bands (p < 0.05). Severe and moderate SAD groups have shown greater enhanced information flow than mild and HC groups in all frequency bands. Furthermore, the PDC and graph theory features have been used to discriminate three classes of SAD from HCs using several machine learning classifiers. In comparison to the features obtained by PDC, graph theory network features combined with PDC have achieved maximum classification performance with accuracy (92.78%), sensitivity (95.25%), and specificity (94.12%) using Support Vector Machine (SVM).

Discussion

Based on the results, it can be concluded that the combination of graph theory features and PDC values may be considered an effective tool for SAD identification. Our outcomes may provide new insights into developing biomarkers for SAD diagnosis based on topological brain networks and machine learning algorithms.

[Assessment method of cognitive load and stress inducer factors of surgeons and anesthetists in the operating room]

INTRODUCTION

For many years, surgeons and anesthetists have recognized that stress can be present in their daily professional practice. The goal of this study was to identify tools for assessing stress and cognitive load in the operating room.

MATERIAL AND METHODS

We conducted a literature review in the PubMed database of scientific articles published on the subject without date limit using the keywords anesthesia, surgery, surgeon, cognitive workload, definition, pathophysiology, physiological measurement, objective, subjective, stress.

RESULTS

Nineteen articles were selected, focusing on cardiac surgery, gastrointestinal surgery, vascular surgery and urology. No publications concerning ophthalmology were found through the literature search. The means of measurement found were either subjective, such as questionnaires, or objective, such as the study of heart rate variability (HRV), reaction time, eye movements, electrical conductivity of the skin, biological markers and electroencephalogram. Of all these measurement tools, the NASA-TLX questionnaire, used in four articles, and the HRV study, used in eight articles, appear to be the most widely used and are strongly correlated with stress.

CONCLUSION

The articles reviewed use only some of the available tools for assessment of stress and cognitive load. The main objective is to improve the quality of care and the quality of life of caregivers. It would be interesting to develop other methods to identify and better characterize the risk factors that increase stress and cognitive load.

Dynamic fluctuations in ascending heart-to-brain communication under mental stress

Dynamical information exchange between central and autonomic nervous systems, as referred to functional brain-heart interplay, occurs during emotional and physical arousal. It is well documented that physical and mental stress lead to sympathetic activation. Nevertheless, the role of autonomic inputs in nervous system-wise communication under mental stress is yet unknown. In this study, we estimated the causal and bidirectional neural modulations between electroencephalogram (EEG) oscillations and peripheral sympathetic and parasympathetic activities using a recently proposed computational framework for a functional brain-heart interplay assessment, namely the sympathovagal synthetic data generation model. Mental stress was elicited in 37 healthy volunteers by increasing their cognitive demands throughout three tasks associated with increased stress levels. Stress elicitation induced an increased variability in sympathovagal markers, as well as increased variability in the directional brain-heart interplay. The observed heart-to-brain interplay was primarily from sympathetic activity targeting a wide range of EEG oscillations, whereas variability in the efferent direction seemed mainly related to EEG oscillations in the γ band. These findings extend current knowledge on stress physiology, which mainly referred to top-down neural dynamics. Our results suggest that mental stress may not cause an increase in sympathetic activity exclusively as it initiates a dynamic fluctuation within brain-body networks including bidirectional interactions at a brain-heart level. We conclude that directional brain-heart interplay measurements may provide suitable biomarkers for a quantitative stress assessment and bodily feedback may modulate the perceived stress caused by increased cognitive demand.

A narrative review of the interconnection between pilot acute stress, startle, and surprise effects in the aviation context: Contribution of physiological measurements

Aviation remains one of the safest modes of transportation. However, an inappropriate response to an unexpected event can lead to flight incidents and accidents. Among several contributory factors, startle and surprise, which can lead to or exacerbate the pilot's state of stress, are often cited. Unlike stress, which has been the subject of much study in the context of driving and piloting, studies on startle and surprise are less numerous and these concepts are sometimes used interchangeably. Thus, the definitions of stress, startle, and surprise are reviewed, and related differences are put in evidence. Furthermore, it is proposed to distinguish these notions in the evaluation and to add physiological measures to subjective measures in their study. Indeed, Landman's theoretical model makes it possible to show the links between these concepts and studies using physiological parameters show that they would make it possible to disentangle the links between stress, startle and surprise in the context of aviation. Finally, we draw some perspectives to set up further studies focusing specifically on these concepts and their measurement.

Spontaneity matters! Network alterations before and after spontaneous and active facial self-touches: An EEG functional connectivity study

BACKGROUND

Despite humans frequently performing spontaneous facial self-touches (sFST), the function of this behavior remains speculative. sFST have been discussed in the context of self-regulation, emotional homeostasis, working memory processes, and attention focus. First evidence indicates that sFST and active facial self-touches (aFST) are neurobiologically different phenomena. The aim of the present analysis was to examine EEG-based connectivity in the course of sFST and aFST to test the hypotheses that sFST affect brain network interactions relevant for other than sensorimotor processes.

METHODS

To trigger spontaneous FST a previously successful setting was used: 60 healthy participants manually explored two haptic stimuli and held the shapes of the stimuli in memory for a 14 min retention interval. Afterwards the shapes were drawn on a sheet of paper. During the retention interval, artifact-free EEG-data of 97 sFST by 32 participants were recorded. At the end of the experiment, the participants performed aFST with both hands successively. For the EEG-data, connectivity was computed and compared between the phases before and after sFST and aFST and between the respective before-and the after-phases.

RESULTS

For the before-after comparison, brainwide distributed significant connectivity differences (p < .00079) were observed for sFST, but not for aFST. Additionally, comparing the before- and after-phases of sFST and aFST, respectively, revealed increased similarity between the after-phases than between the before-phases.

CONCLUSION

The results support the assumption that sFST and aFST are neurobiologically different phenomena. Furthermore, the aligned network properties of the after-phases compared to the before-phases indicate that sFST serve self-regulatory functions that aFST do not serve.

Prediction of exam scores using a multi-sensor approach for wearable exam stress dataset with uniform preprocessing

BACKGROUND

Physiological signals, such as skin conductance, heart rate, and temperature, provide valuable insight into the physiological responses of students to stress during examination sessions.

OBJECTIVE

The primary objective of this research is to explore the effectiveness of physiological signals in predicting grades and to assess the impact of different models and feature selection techniques on predictive performance.

METHODS

We extracted a comprehensive feature vector comprising 301 distinct features from seven signals and implemented a uniform preprocessing technique for all signals. In addition, we analyzed different algorithmic selection features to design relevant features for robust and accurate predictions.

RESULTS

The study reveals promising results, with the highest scores achieved using 100 and 150 features. The corresponding values for accuracy, AUROC, and F1-Score are 0.9, 0.89, and 0.87, respectively, indicating the potential of physiological signals for accurate grade prediction.

CONCLUSION

The findings of this study suggest practical applications in the field of education, where the use of physiological signals can help students cope with exam stress and improve their academic performance. The importance of feature selection and the use of appropriate models highlight the importance of engineering relevant features for precise and reliable predictions.

EEG Signal Processing for Biomedical Applications

Electroencephalography (EEG) signals are used widely in clinical and research settings [...].

EEG-based spatial elements optimisation design method

In the field of digital design, a recent hot topic is the study of the interaction between spatial environment design and human factors. Electroencephalogram (EEG) and eye tracking can be used as quantitative analysis methods for architectural space evaluation; however, conclusions from existing studies on improving the quality of spatial environments based on human factors tend to remain qualitative. In order to realise the quantitative optimisation design of spatial elements from human physiological data, this research used the digital space optimisation method and perceptual evaluation research. In this way, it established an optimisation method for built space elements in real-time using human psychological indicators. Firstly, this method used the specific indicators of the Meditation value and Attention value in the human EEG signal, taking the ThinkGear AM (TGAM) module as the optimisation objective, the architectural space colour and the window size as the optimisation object, and the multi-objective genetic algorithm as the optimisation tool. Secondly, this research combined virtual reality scenarios and parametric linkage models to realise this optimisation method to establish a tool platform and workflow. Thirdly, this study took the optimisation of a typical living space as an example and recruited 50 volunteers to participate in an optimisation experiment. The results indicated that with the iterative optimisation of the multi-objective genetic algorithm, the specific EEG index decreases significantly and the standard deviation of the in-dex fluctuates and decreases during the iterative process, which further indicates that the optimisation method established in this study with the specific EEG index as the optimisation objective is effective and feasible. In addition, this study laid the foundation for more EEG indicators and more complex spatial element opti-misation research in the future.

Capacity of Autonomous Sensory Meridian Response on the Reduction of Mental Stress

In a social environment, various types of stress can be overwhelming. Humans frequently encounter these stressful situations in social life. Stress is divided into physical stress and mental stress; the latter is induced by heavy mental workloads and has become a huge social problem, leading to mental disorders and possibly suicide in the worst scenario. Investigations into monitoring mental stress and reducing stressful conditions are, therefore, important for its prevention. In the present study, we focused on autonomous sensory meridian response (ASMR) sound, which is known to improve the human mental condition through its comforting and relaxing effects. We investigated the effect of ASMR on the mental workload induced by mental tasks by the evaluation of EEG activation patterns in normal subjects. Our results showed a significant decrease in alpha-band activity and a significant increase in gamma (high beta)-band activity under the induction of mental workload by mental tasks compared to the resting condition. When applying ASMR sound, alpha- and gamma-band activity under the induction of mental workload by mental tasks was restored to the level of the resting condition. In conclusion, these results indicate that ASMR sound reduces the mental stress induced by mental workload.

Feasibility study of personalized speed adaptation method based on mental state for teleoperated robots

The teleoperated robotic system can support humans to complete tasks in high-risk, high-precision and difficult special environments. Because this kind of special working environment is easy to cause stress, high mental workload, fatigue and other mental states of the operator, which will reduce the quality of operation and even cause safety accidents, so the mental state of the people in this system has received extensive attention. However, the existence of individual differences and mental state diversity is often ignored, so that most of the existing adjustment strategy is out of a match between mental state and adaptive decision, which cannot effectively improve operational quality and safety. Therefore, a personalized speed adaptation (PSA) method based on policy gradient reinforcement learning was proposed in this paper. It can use electroencephalogram and electro-oculogram to accurately perceive the operator’s mental state, and adjust the speed of the robot individually according to the mental state of different operators, in order to perform teleoperation tasks efficiently and safely. The experimental results showed that the PSA method learns the mapping between the mental state and the robot’s speed regulation action by means of rewards and punishments, and can adjust the speed of the robot individually according to the mental state of different operators, thereby improving the operating quality of the system. And the feasibility and superiority of this method were proved. It is worth noting that the PSA method was validated on 6 real subjects rather than a simulation model. To the best of our knowledge, the PSA method is the first implementation of online reinforcement learning control of teleoperated robots involving human subjects.

Improving EEG-Based Driver Distraction Classification Using Brain Connectivity Estimators

This paper discusses a novel approach to an EEG (electroencephalogram)-based driver distraction classification by using brain connectivity estimators as features. Ten healthy volunteers with more than one year of driving experience and an average age of 24.3 participated in a virtual reality environment with two conditions, a simple math problem-solving task and a lane-keeping task to mimic the distracted driving task and a non-distracted driving task, respectively. Independent component analysis (ICA) was conducted on the selected epochs of six selected components relevant to the frontal, central, parietal, occipital, left motor, and right motor areas. Granger-Geweke causality (GGC), directed transfer function (DTF), partial directed coherence (PDC), and generalized partial directed coherence (GPDC) brain connectivity estimators were used to calculate the connectivity matrixes. These connectivity matrixes were used as features to train the support vector machine (SVM) with the radial basis function (RBF) and classify the distracted and non-distracted driving tasks. GGC, DTF, PDC, and GPDC connectivity estimators yielded the classification accuracies of 82.27%, 70.02%, 86.19%, and 80.95%, respectively. Further analysis of the PDC connectivity estimator was conducted to determine the best window to differentiate between the distracted and non-distracted driving tasks. This study suggests that the PDC connectivity estimator can yield better classification accuracy for driver distractions.

Assessing Electroencephalography as a Stress Indicator: A VR High-Altitude Scenario Monitored through EEG and ECG

Over the last decade, virtual reality (VR) has become an increasingly accessible commodity. Head-mounted display (HMD) immersive technologies allow researchers to simulate experimental scenarios that would be unfeasible or risky in real life. An example is extreme heights exposure simulations, which can be utilized in research on stress system mobilization. Until recently, electroencephalography (EEG)-related research was focused on mental stress prompted by social or mathematical challenges, with only a few studies employing HMD VR techniques to induce stress. In this study, we combine a state-of-the-art EEG wearable device and an electrocardiography (ECG) sensor with a VR headset to provoke stress in a high-altitude scenarios while monitoring EEG and ECG biomarkers in real time. A robust pipeline for signal clearing is implemented to preprocess the noise-infiltrated (due to movement) EEG data. Statistical and correlation analysis is employed to explore the relationship between these biomarkers with stress. The participant pool is divided into two groups based on their heart rate increase, where statistically important EEG biomarker differences emerged between them. Finally, the occipital-region band power changes and occipital asymmetry alterations were found to be associated with height-related stress and brain activation in beta and gamma bands, which correlates with the results of the self-reported Perceived Stress Scale questionnaire.

EEG Evaluation of Stress Exposure on Healthcare Workers During COVID-19 Emergency: Not Just an Impression

Psychological distress among healthcare professionals, although already a common condition, was exacerbated by the COVID-19 pandemic. This effect has been generally self-reported or assessed through questionnaires. We aimed to identify potential abnormalities in the electrical activity of the brain of healthcare workers, operating in different roles during the pandemic. Cortical activity, cognitive performances, sleep, and burnout were evaluated two times in 20 COVID-19 frontline operators (FLCO, median age 29.5 years) and 20 operators who worked in COVID-19-free units (CFO, median 32 years): immediately after the outbreak of the pandemic (first session) and almost 6 months later (second session). FLCO showed higher theta relative power over the entire scalp (FLCO = 19.4%; CFO = 13.9%; p = 0.04) and lower peak alpha frequency of electrodes F7 (FLCO = 10.4 Hz; CFO = 10.87 Hz; p = 0.017) and F8 (FLCO = 10.47 Hz; CFO = 10.87 Hz; p = 0.017) in the first session. FLCO parietal interhemispheric coherence of theta (FLCO I = 0.607; FLCO II = 0.478; p = 0.025) and alpha (FLCO I = 0.578; FLCO II = 0.478; p = 0.007) rhythms decreased over time. FLCO also showed lower scores in the global cognitive assessment test (FLCO = 22.72 points; CFO = 25.56; p = 0.006) during the first session. The quantitative evaluation of the cortical activity might therefore reveal early signs of changes secondary to stress exposure in healthcare professionals, suggesting the implementation of measures to prevent serious social and professional consequences.

Evaluation of a New Lightweight EEG Technology for Translational Applications of Passive Brain-Computer Interfaces

Technologies like passive brain-computer interfaces (BCI) can enhance human-machine interaction. Anyhow, there are still shortcomings in terms of easiness of use, reliability, and generalizability that prevent passive-BCI from entering real-life situations. The current work aimed to technologically and methodologically design a new gel-free passive-BCI system for out-of-the-lab employment. The choice of the water-based electrodes and the design of a new lightweight headset met the need for easy-to-wear, comfortable, and highly acceptable technology. The proposed system showed high reliability in both laboratory and realistic settings, performing not significantly different from the gold standard based on gel electrodes. In both cases, the proposed system allowed effective discrimination (AUC > 0.9) between low and high levels of workload, vigilance, and stress even for high temporal resolution (<10 s). Finally, the generalizability of the proposed system has been tested through a cross-task calibration. The system calibrated with the data recorded during the laboratory tasks was able to discriminate the targeted human factors during the realistic task reaching AUC values higher than 0.8 at 40 s of temporal resolution in case of vigilance and workload, and 20 s of temporal resolution for the stress monitoring. These results pave the way for ecologic use of the system, where calibration data of the realistic task are difficult to obtain.

Causal Symbolic Information Transfer for the Assessment of functional Brain-Heart Interplay through EEG Microstates Occurrences: a proof-of-concept study

Electroencephalography (EEG) microstates analysis provides a sequence of topographies representing the scalp-related electric field over time, and each microstate is synthetically represented by a symbol. Despite recent advances on functional brain-heart interplay (BHI) assessment, to our knowledge no methodology takes EEG microstates into account to relate the causal heartbeat dynamics. Moreover, standard BHI methods are tailored to a single EEG-channel analysis, neglecting the comprehensive information associated with a multichannel cluster or a whole-brain activity. To overcome these limitations, we devised a novel methodological frame-work for the assessment of functional BHI that exploits the symbolic representation of both EEG microstates and heart rate variability (HRV) series. Directional BHI quantification is then performed through Kullback-Leibler Divergence (KLD) and Transfer Entropy. The proposed methodology is here preliminarily tested on a dataset gathered from healthy subjects undergoing a resting state and a mental arithmetic task. Except for the KLD in the from-brain-to-heart direction, all other estimates showed significant differences between the two experimental conditions. We conclude that the proposed frame-work may promisingly provide novel insights on brain-heart phenomena through a whole-brain symbolic representation.

Methods and Measures for Mental Stress Assessment in Surgery: A Systematic Review of 20 Years of Literature

Real-time mental stress monitoring from surgeons and surgical staff in operating rooms may reduce surgical injuries, improve performance and quality of medical care, and accelerate implementation of stress-management strategies. Motivated by the increase in usage of objective and subjective metrics for cognitive monitoring and by the gap in reviews of experimental design setups and data analytics, a systematic review of 71 studies on mental stress and workload measurement in surgical settings, published in 2001-2020, is presented. Almost 61% of selected papers used both objective and subjective measures, followed by 25% that only administered subjective tools - mostly consisting of validated instruments and customized surveys. An overall increase in the total number of publications on intraoperative stress assessment was observed from mid-2010 s along with a momentum in the use of both subjective and real-time objective measures. Cardiac activity, including heart-rate variability metrics, stress hormones, and eye-tracking metrics were the most frequently and electroencephalography (EEG) was the least frequently used objective measures. Around 40% of selected papers collected at least two objective measures, 41% used wearable devices, 23% performed synchronization and annotation, and 76% conducted baseline or multi-point data acquisition. Furthermore, 93% used a variety of statistical techniques, 14% applied regression models, and only one study released a public, anonymized dataset. This review of data modalities, experimental setups, and analysis techniques for intraoperative stress monitoring highlights the initiatives of surgical data science and motivates research on computational techniques for mental and surgical skills assessment and cognition-guided surgery.

Mental Stress and Cardiovascular Health-Part I

Epidemiological studies have shown that a substantial proportion of acute coronary events occur in individuals who lack the traditional high-risk cardiovascular (CV) profile. Mental stress is an emerging risk and prognostic factor for coronary artery disease and stroke, independently of conventional risk factors. It is associated with an increased rate of CV events. Acute mental stress may develop as a result of anger, fear, or job strain, as well as consequence of earthquakes or hurricanes. Chronic stress may develop as a result of long-term or repetitive stress exposure, such as job-related stress, low socioeconomic status, financial problems, depression, and type A and type D personality. While the response to acute mental stress may result in acute coronary events, the relationship of chronic stress with increased risk of coronary artery disease (CAD) is mainly due to acceleration of atherosclerosis. Emotionally stressful stimuli are processed by a network of cortical and subcortical brain regions, including the prefrontal cortex, insula, amygdala, hypothalamus, and hippocampus. This system is involved in the interpretation of relevance of environmental stimuli, according to individual’s memory, past experience, and current context. The brain transduces the cognitive process of emotional stimuli into hemodynamic, neuroendocrine, and immune changes, called fight or flight response, through the autonomic nervous system and the hypothalamic–pituitary–adrenal axis. These changes may induce transient myocardial ischemia, defined as mental stress-induced myocardial ischemia (MSIMI) in patients with and without significant coronary obstruction. The clinical consequences may be angina, myocardial infarction, arrhythmias, and left ventricular dysfunction. Although MSIMI is associated with a substantial increase in CV mortality, it is usually underestimated because it arises without pain in most cases. MSIMI occurs at lower levels of cardiac work than exercise-induced ischemia, suggesting that the impairment of myocardial blood flow is mainly due to paradoxical coronary vasoconstriction and microvascular dysfunction.

Stress management using fNIRS and binaural beats stimulation

In this study, we investigate the effectiveness of binaural beats stimulation (BBs) in enhancing cognitive vigilance and mitigating mental stress level at the workplace. We developed an experimental protocol under four cognitive conditions: high vigilance (HV), vigilance enhancement (VE), mental stress (MS) and stress mitigation (SM). The VE and SM conditions were achieved by listening to 16 Hz of BBs. We assessed the four cognitive conditions using salivary alpha-amylase, behavioral responses, and Functional Near-Infrared Spectroscopy (fNIRS). We quantified the vigilance and stress levels using the reaction time (RT) to stimuli, accuracy of detection, and the functional connectivity metrics of the fNIRS estimated by Phase Locking Values (PLV). We propose using the orthogonal minimum spanning tree (OMST) to determine the true connectivity network patterns of the PLV. Our results show that listening to 16-Hz BBs has significantly reduced the level of alpha amylase by 44%, reduced the RT to stimuli by 20% and increased the accuracy of target detection by 25%, (p < 0.001). The analysis of the connectivity network across the four different cognitive conditions revealed several statistically significant trends. Specifically, a significant increase in connectivity between the right and left dorsolateral prefrontal cortex (DLPFC) areas and left orbitofrontal cortex was found during the vigilance enhancement condition compared to the high vigilance. Likewise, similar patterns were found between the right and left DLPFC, orbitofrontal cortex, right ventrolateral prefrontal cortex (VLPFC) and right frontopolar PFC (prefrontal cortex) area during stress mitigation compared to mental stress. Furthermore, the connectivity network under stress condition alone showed significant connectivity increase between the VLPFC and DLPFC compared to other areas. The laterality index demonstrated left frontal laterality under high vigilance and VE conditions, and right DLPFC and left frontopolar PFC while under mental stress. Overall, our results showed that BBs can be used for vigilance enhancement and stress mitigation.

Improved Cognitive Vigilance Assessment after Artifact Reduction with Wavelet Independent Component Analysis

Vigilance level assessment is of prime importance to avoid life-threatening human error. Critical working environments such as air traffic control, driving, or military surveillance require the operator to be alert the whole time. The electroencephalogram (EEG) is a very common modality that can be used in assessing vigilance. Unfortunately, EEG signals are prone to artifacts due to eye movement, muscle contraction, and electrical noise. Mitigating these artifacts is important for an accurate vigilance level assessment. Independent Component Analysis (ICA) is an effective method and has been extensively used in the suppression of EEG artifacts. However, in vigilance assessment applications, it was found to suffer from leakage of the cerebral activity into artifacts. In this work, we show that the wavelet ICA (wICA) method provides an alternative for artifact reduction, leading to improved vigilance level assessment results. We conducted an experiment in nine human subjects to induce two vigilance states, alert and vigilance decrement, while performing a Stroop Color-Word Test for approximately 45 min. We then compared the performance of the ICA and wICA preprocessing methods using five classifiers. Our classification results showed that in terms of features extraction, the wICA method outperformed the existing ICA method. In the delta, theta, and alpha bands, we obtained a mean classification accuracy of 84.66% using the ICA method, whereas the mean accuracy using the wICA methodwas 96.9%. However, no significant improvement was observed in the beta band. In addition, we compared the topographical map to show the changes in power spectral density across the brain regions for the two vigilance states. The proposed method showed that the frontal and central regions were most sensitive to vigilance decrement. However, in this application, the proposed wICA shows a marginal improvement compared to the Fast-ICA.

Validation of a Light EEG-Based Measure for Real-Time Stress Monitoring during Realistic Driving

Driver’s stress affects decision-making and the probability of risk occurrence, and it is therefore a key factor in road safety. This suggests the need for continuous stress monitoring. This work aims at validating a stress neurophysiological measure—a Neurometric—for out-of-the-lab use obtained from lightweight EEG relying on two wet sensors, in real-time, and without calibration. The Neurometric was tested during a multitasking experiment and validated with a realistic driving simulator. Twenty subjects participated in the experiment, and the resulting stress Neurometric was compared with the Random Forest (RF) model, calibrated by using EEG features and both intra-subject and cross-task approaches. The Neurometric was also compared with a measure based on skin conductance level (SCL), representing one of the physiological parameters investigated in the literature mostly correlated with stress variations. We found that during both multitasking and realistic driving experiments, the Neurometric was able to discriminate between low and high levels of stress with an average Area Under Curve (AUC) value higher than 0.9. Furthermore, the stress Neurometric showed higher AUC and stability than both the SCL measure and the RF calibrated with a cross-task approach. In conclusion, the Neurometric proposed in this work proved to be suitable for out-of-the-lab monitoring of stress levels.

Complex Pearson Correlation Coefficient for EEG Connectivity Analysis

In the background of all human thinking—acting and reacting are sets of connections between different neurons or groups of neurons. We studied and evaluated these connections using electroencephalography (EEG) brain signals. In this paper, we propose the use of the complex Pearson correlation coefficient (CPCC), which provides information on connectivity with and without consideration of the volume conduction effect. Although the Pearson correlation coefficient is a widely accepted measure of the statistical relationships between random variables and the relationships between signals, it is not being used for EEG data analysis. Its meaning for EEG is not straightforward and rarely well understood. In this work, we compare it to the most commonly used undirected connectivity analysis methods, which are phase locking value (PLV) and weighted phase lag index (wPLI). First, the relationship between the measures is shown analytically. Then, it is illustrated by a practical comparison using synthetic and real EEG data. The relationships between the observed connectivity measures are described in terms of the correlation values between them, which are, for the absolute values of CPCC and PLV, not lower that 0.97, and for the imaginary component of CPCC and wPLI—not lower than 0.92, for all observed frequency bands. Results show that the CPCC includes information of both other measures balanced in a single complex-numbered index.

Enhancing EEG-Based Mental Stress State Recognition Using an Improved Hybrid Feature Selection Algorithm

In real-life applications, electroencephalogram (EEG) signals for mental stress recognition require a conventional wearable device. This, in turn, requires an efficient number of EEG channels and an optimal feature set. This study aims to identify an optimal feature subset that can discriminate mental stress states while enhancing the overall classification performance. We extracted multi-domain features within the time domain, frequency domain, time-frequency domain, and network connectivity features to form a prominent feature vector space for stress. We then proposed a hybrid feature selection (FS) method using minimum redundancy maximum relevance with particle swarm optimization and support vector machines (mRMR-PSO-SVM) to select the optimal feature subset. The performance of the proposed method is evaluated and verified using four datasets, namely EDMSS, DEAP, SEED, and EDPMSC. To further consolidate, the effectiveness of the proposed method is compared with that of the state-of-the-art metaheuristic methods. The proposed model significantly reduced the features vector space by an average of 70% compared with the state-of-the-art methods while significantly increasing overall detection performance.

The Influence of an Alpha Band Neurofeedback Training in Heart Rate Variability in Athletes

Neurofeedback training is a technique which has seen a widespread use in clinical applications, but has only given its first steps in the sport environment. Therefore, there is still little information about the effects that this technique might have on parameters, which are relevant for athletes' health and performance, such as heart rate variability, which has been linked to physiological recovery. In the sport domain, no studies have tried to understand the effects of neurofeedback training on heart rate variability, even though some studies have compared the effects of doing neurofeedback or heart rate biofeedback training on performance. The main goal of the present study was to understand if alpha-band neurofeedback training could lead to increases in heart rate variability. 30 male student-athletes, divided into two groups, (21.2 ± 2.62 year 2/week protocol and 22.6 ± 1.1 year 3/week protocol) participated in the study, of which three subjects were excluded. Both groups performed a pre-test, a trial session and 12 neurofeedback sessions, which consisted of 25 trials of 60 s of a neurofeedback task, with 5 s rest in-between trials. The total neurofeedback session time for each subject was 300 min in both groups. Throughout the experiment, electroencephalography and heart rate variability signals were recorded. Only the three sessions/week group revealed significant improvements in mean heart rate variability at the end of the 12 neurofeedback sessions (p = 0.05); however, significant interaction was not found when compared with both groups. It is possible to conclude that neurofeedback training of individual alpha band may induce changes in heart rate variability in physically active athletes.

EEG Mental Stress Assessment Using Hybrid Multi-Domain Feature Sets of Functional Connectivity Network and Time-Frequency Features

Exposure to mental stress for long period leads to serious accidents and health problems. To avoid negative consequences on health and safety, it is very important to detect mental stress at its early stages, i.e., when it is still limited to acute or episodic stress. In this study, we developed an experimental protocol to induce two different levels of stress by utilizing a mental arithmetic task with time pressure and negative feedback as the stressors. We assessed the levels of stress on 22 healthy subjects using frontal electroencephalogram (EEG) signals, salivary alpha-amylase level (AAL), and multiple machine learning (ML) classifiers. The EEG signals were analyzed using a fusion of functional connectivity networks estimated by the Phase Locking Value (PLV) and temporal and spectral domain features. A total of 210 different features were extracted from all domains. Only the optimum multi-domain features were used for classification. We then quantified stress levels using statistical analysis and seven ML classifiers. Our result showed that the AAL level was significantly increased (p < 0.01) under stress condition in all subjects. Likewise, the functional connectivity network demonstrated a significant decrease under stress, p < 0.05. Moreover, we achieved the highest stress classification accuracy of 93.2% using the Support Vector Machine (SVM) classifier. Other classifiers produced relatively similar results.