Role-played interpersonal interaction: ecological validity and cardiovascular reactivity

ACACIAS 1: The physiological and subjective impacts of high fidelity simulation of the breaking of bad news

STUDY OBJECTIVE

Breaking bad news (BN) is difficult and necessitates targeted training. To be effective, training may call for High Fidelity Simulation (HFS). This prospective study was conducted to objectively assess the impact of HFS as a tool conducive to the development of clinical competence in situations involving the delivery of bad news.

METHODS

This feasibility study was conducted from January to May 2021 and included students in medical oncology and digestive surgery. The subjective and objective impacts of HFS were evaluated by means of a self-administered questionnaire and a wristband, Affect-tag, which recorded several indicators: emotional power (EP), emotional density (DE) and cognitive load (CL) in students undergoing training.

RESULTS

Forty-six (46) students with a median age of 25 years (21-34 years) were included. While the participants were effectively and emotionally involved in the HFS training, they were not completely overwhelmed by their emotions, a possible occurrence in this type of program. After two training programs, the students presented with lower EP (P<0.001) and higher DE (P=0.005), while their CL remained stable (P=0.751). The information given in the self-administered questionnaires and the evaluations by outside professionals (actor, nurse, psychologist…) highlighted improved skills.

CONCLUSION

Taking into account the emotional parameters observed and the questionnaires collected, HFS can be considered as a suitable and effective tool in the breaking of bad news.

Sex differences in the psychophysiological response to an intergroup conflict

Conflict induces psychophysiological responses, but less is known about responses to intergroup conflict. Intergroup relationships activate social processes, adding complexity to people's physiological responses. This study analyzes the psychophysiological responses to intergroup conflict considering sex differences. Thus, 150 young people were distributed in 50 groups in two conditions (conflict vs. non-conflict). Conflict was created in the interaction between two groups (three people each) in the laboratory. Their responses were compared to a control group. Mood, heart rate variability, cortisol, and testosterone were measured. Results showed that intergroup conflict induced a less pronounced decrease in negative and positive mood, and a reduction in parasympathetic activity (RMSSD of IBI). Moreover, women in conflict showed lower testosterone levels than men in conflict and control women. Finally, women's conflict perception correlated with their psychophysiological response. Results suggest that intergroup conflict induces emotional, cardiovascular, and endocrine responses, and that men and women interpret conflict differently.

Effects of glucose ingestion on autonomic and cardiovascular measures during rest and mental challenge

BACKGROUND

High levels of dietary sugar consumption may result in dysregulated glucose metabolism and lead to elevated cardiovascular disease risk via autonomic nervous system and cardiovascular dysfunction. Altered cardiovascular function can be examined using perturbation tasks such as mental challenge. This study examined the effects of controlled glucose intake on cardiovascular measures at rest and in responses to mental challenge in a laboratory setting.

METHOD

Using a double blind within-subjects design, participants were monitored at baseline, following ingestion of a glucose or taste-control solution, during structured speech (SS), anger recall (AR) and recovery (N=24, 288 repeated measures; age = 21±2 years). Pre-ejection period (PEP), heart rate (HR), stroke index (SI), cardiac index (CI), blood pressure and total peripheral resistance (TPR) were measured throughout the protocol.

RESULTS

Glucose resulted in sustained decreased PEP levels compared to control condition (Δ=11.98±9.52 vs. 3.27±7.65 m·s, P<.001) and transient increases in resting HR (P=.011), CI (P=.040) and systolic blood pressure (P=.009). Glucose did not result in increased cardiovascular reactivity to mental challenge tasks, but was associated with a delayed HR recovery following AR (P=.032).

CONCLUSION

Glucose intake resulted in a drop in PEP indicating increased sympathetic nervous system activity. No evidence was found for glucose-related exaggerated cardiovascular responses to mental challenge. Dysregulated glucose metabolism may result in elevated cardiovascular disease risk as a result of repeated glucose-induced elevations of sympathetic nervous system activity.

Hostile behavior links negative childhood family relationships to heart rate reactivity and recovery in young adulthood

Prior research has demonstrated that vulnerability to stress is influenced by early life experiences. This study evaluates the impact of negative childhood family relationships on cardiovascular stress reactivity in young adulthood. Participants (age 18-22) from families characterized by negative (n=39) or positive relationships (n=36) engaged in a role-play conflict task. Hostile/aggressive verbal behaviors during the task were observed, and blood pressure (BP) and heart rate (HR) responses were measured before, during, and after the task. Participants from negative families engaged in more hostile/aggressive verbal behavior during the task and showed attenuated HR reactivity. Hostile/aggressive verbal behavior predicted attenuated HR reactivity and recovery. Path analyses linked negative family relationships to more hostile verbal behavior during the task, and attenuated HR reactivity and recovery. These results support the development of hostile/aggressive behavior in social situations as a pathway linking childhood adversity to stress vulnerability across the lifespan.

Nonlinear Heart Rate Variability features for real-life stress detection. Case study: students under stress due to university examination

Background

This study investigates the variations of Heart Rate Variability (HRV) due to a real-life stressor and proposes a classifier based on nonlinear features of HRV for automatic stress detection.

Methods

42 students volunteered to participate to the study about HRV and stress. For each student, two recordings were performed: one during an on-going university examination, assumed as a real-life stressor, and one after holidays. Nonlinear analysis of HRV was performed by using Poincaré Plot, Approximate Entropy, Correlation dimension, Detrended Fluctuation Analysis, Recurrence Plot. For statistical comparison, we adopted the Wilcoxon Signed Rank test and for development of a classifier we adopted the Linear Discriminant Analysis (LDA).

Results

Almost all HRV features measuring heart rate complexity were significantly decreased in the stress session. LDA generated a simple classifier based on the two Poincaré Plot parameters and Approximate Entropy, which enables stress detection with a total classification accuracy, a sensitivity and a specificity rate of 90%, 86%, and 95% respectively.

Conclusions

The results of the current study suggest that nonlinear HRV analysis using short term ECG recording could be effective in automatically detecting real-life stress condition, such as a university examination.

The psychophysiology of medical communication. Linking two worlds of research

OBJECTIVE

Medical communication is goal oriented behavior. As such, it can be modeled as a chain of decisions, resulting from cognitive and emotional processes each potentially associated with psychophysiological reactions. Psychophysiological may be helpful to detect small changes in affect or arousal in the course of a consultation that would be difficult to detect by other evaluations of the process, like self-reports. The question is how psychophysiological communication research should be modeled for unraveling in more detail the cognitive, emotional and interpersonal processes which underlie physician and patient behavior.

METHODS

In the world of medical communication research the six-function model of medical communication reveals a number of fundamental perceptual, cognitive and emotional processes which may evoke psychophysiological responses. The world of psychophysiological research encompasses domains of perception, mental imagery, anticipation and action which all have close connections with fundamental tasks in communication.

CONCLUSION

This paper discusses ten methodological issues in linking continuous psychophysiological data to verbal and nonverbal events in a medical consultation observed with the Verona coding system.

PRACTICE IMPLICATIONS

When linking the two worlds of research, the methodological challenges discussed need to be solved to obtain a valid and reliable application of psychophysiological measures in medical communication research.

Relationship between malocclusion and heart rate variability indices in young adults: a pilot study

OBJECTIVES

Heart rate variability (HRV) has been used to assess sympathetic and parasympathetic modulation of heart rate. Chronic stress relates to reduced HRV. Malocclusion has effects on quality of life, which can lead to chronic stress. Therefore, we hypothesized that malocclusion, as chronic stress, may contribute to reduced HRV. The aim of this study was to investigate the relationship between malocclusion and HRV indices in healthy young adults.

METHODS

Thirty-seven non-smoking healthy subjects, aged 22 to 25 years, were examined. Malocclusion was defined by Angle classification. HRV indices included root mean square of successive differences, low frequency (LF), high frequency (HF) and ratio of LF to HF. The effects of malocclusion on quality of life and mental health were assessed using self-reported questionnaires, the condition-specific Oral Impacts on Daily Performances index (CS-OIDP) and the Hopkins Symptoms Checklist (HSCL), respectively.

RESULTS

Significantly lower score of HF and higher heart rate (HR) level and CS-OIDP score were observed in subjects with malocclusion (n = 17) compared to those in the control subjects (n = 20) ( P <0.05). There was a positive correlation between HR and score of "anxiety" in HSCL ( P <0.05).

CONCLUSIONS

The data showed an association between malocclusion and lower HRV. Based on our results, orthodontic treatment might contribute not only to improvement of oral esthetic and functional problems but also to improvement of stress and HRV indices.

Negative relationships in the family-of-origin predict attenuated cortisol in emerging adults

Negative childhood family environments have been associated with stress-related physical and psychological health consequences across the lifespan. The present study examined the relation between adverse relationships in the family of origin and physiological stress response, as measured by salivary cortisol, in emerging adulthood. Seventy-six university students (age range=18-22) selected from intact married families-of-origin characterized by either negative (n=39) or positive (n=37) relationship quality engaged in a challenging role play task. Results from multilevel models indicated that those from negative families exhibited significantly lower salivary cortisol across the task than those from positive families. This relation did not change in strength or direction after controlling for experiences with abuse or recent anxiety or depressive symptoms. These findings suggest the significance of early family relationships on the long-term activity of the HPA axis.

Effects of stress on heart rate complexity--a comparison between short-term and chronic stress

This study examined chronic and short-term stress effects on heart rate variability (HRV), comparing time, frequency and phase domain (complexity) measures in 50 healthy adults. The hassles frequency subscale of the combined hassles and uplifts scale (CHUS) was used to measure chronic stress. Short-term stressor reactivity was assessed with a speech task. HRV measures were determined via surface electrocardiogram (ECG). Because respiration rate decreased during the speech task (p<.001), this study assessed the influence of respiration rate changes on the effects of interest. A series of repeated-measures analyses of covariance (ANCOVA) with Bonferroni adjustment revealed that short-term stress decreased HR D2 (calculated via the pointwise correlation dimension PD2) (p<.001), but increased HR mean (p<.001), standard deviation of R-R (SDRR) intervals (p<.001), low (LF) (p<.001) and high frequency band power (HF) (p=.009). Respiratory sinus arrhythmia (RSA) and LF/HF ratio did not change under short-term stress. Partial correlation adjusting for respiration rate showed that HR D2 was associated with chronic stress (r=-.35, p=.019). Differential effects of chronic and short-term stress were observed on several HRV measures. HR D2 decreased under both stress conditions reflecting lowered functionality of the cardiac pacemaker. The results confirm the importance of complexity metrics in modern stress research on HRV.

Type C coping, alexithymia, and heart rate reactivity are associated independently and differentially with specific immune mechanisms linked to HIV progression

The maladaptive Type C coping style has been linked to disease progression in HIV and other immunologically mediated disorders. We hypothesized that strong Type C coping, higher levels of alexithymia, and greater cardiovascular (particularly heart rate) responses to, and prolonged recovery from stress would be associated with poorer functioning of immune parameters previously linked to HIV pathogenesis and progression: (1) antigen-stimulated production of the beta (beta)-chemokines MIP-1 alpha and MIP-1 beta, which bind to the HIV co-receptor CCR5 and block HIV entry into CD4(+) lymphocytes; and (2) antigen-stimulated production of the proinflammatory cytokine interleukin-6 (IL-6), which synergizes immune activation associated with HIV replication. We examined relations among psychological, cardiovascular, and immune variables in a baseline sample of 200 HIV-infected, predominantly African American outpatients attending an HIV primary care clinic in inner-city Baltimore. In regression analyses adjusted for CD4(+) count and age, strong Type C coping was associated with significantly higher IL-6 production, as predicted. The theoretically related construct of alexithymia was correlated with significantly lower stimulated production of HIV-inhibiting MIP-1 alpha. Independent of alexithymia, greater heart rate reactivity, and poorer heart rate recovery in response to experimental stressors were also significantly associated with lower production of MIP-1 alpha, adjusted for cardiovascular medications, methadone use, CD4(+) count, and age. These findings support our primary set of hypotheses that maladaptive Type C coping, alexithymia, and heart rate reactivity/recovery are associated with disturbances in two key immune parameters implicated in HIV pathogenesis. Our secondary hypothesis, that dysregulated heart rate reactivity may mediate the connections between Type C coping and/or alexithymia and IL-6/ MIP-1 alpha was not confirmed. The finding that Type C coping, alexithymia, and heart rate reactivity/recovery are associated independently and differentially with specific aspects of relevant immune functioning may reflect distinct biobehavioral pathways that contribute to HIV progression.

Religious orientation, aging, and blood pressure reactivity to interpersonal and cognitive stressors

BACKGROUND

Research on religion and health suggests general health benefits for those who are more religiously involved. Particular aspects of religiosity that may influence this finding, however, have not been sufficiently investigated.

PURPOSE

This study was designed to explore the relationship between religious orientation (intrinsic, extrinsic) and blood pressure reactivity among older (over 60 years) and younger (18-24 years) adults exposed to two qualitatively different laboratory stressors (cognitive, interpersonal).

METHODS

Participants were categorized as exhibiting either a predominantly intrinsic or extrinsic religious orientation based on scores on the Religious Orientation Scale. They were subsequently exposed (in counterbalanced order) to two laboratory stressors that varied in terms of whether an interpersonal confrontation was involved. Measures of blood pressure were obtained at baseline and during stressor presentation.

RESULTS

Analyses indicated that older extrinsically religious individuals demonstrated exaggerated reactivity compared to younger participants and older intrinsically religious individuals. Older intrinsically religious participants did not differ from younger persons. Similar results were found for analysis of baseline data. Extrinsic participants had greater reactivity during the interpersonal confrontation condition than did intrinsic individuals.

CONCLUSIONS

These findings suggest that religious orientation may be an important variable to study regarding cardiovascular reactivity in, particularly, older adults.

Relation of cognitive appraisal to cardiovascular reactivity, affect, and task engagement

The relation of primary cognitive appraisals to cardiovascular reactivity, affect, task engagement, and perceived stress was examined in 56 men (ages 18-29). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, preejection period, stroke index, cardiac index, and total peripheral resistance were assessed at rest and during performance of a computerized mental arithmetic task. Extending on prior investigations, threat and challenge appraisals were assessed independently from one another and from secondary appraisals. Positive and negative affect, task engagement, and levels of perceived stress were also assessed. Results indicated that threat (R2 =.08, p =.01), challenge (R2 =.14, p =.003), and their interaction (R2 =.11, p =.006) independently predicted DBP reactivity; DBP responses were greatest among participants with a high threat/low challenge pattern of appraisal. Threat appraisals predicted greater negative affect (R2 =.32) and perceived stress (R2 =.48), whereas challenge appraisals were related to greater positive affect (R2 =.44) and task engagement (R2 =.40, ps <.0001). Greater positive affect was correlated with increased SBP and DBP reactivity, and greater levels of task engagement with increased DBP response (ps < or = .002). Results suggest that primary cognitive appraisals are more potent predictors of affect and task engagement than cardiovascular reactivity.

Dissociated autonomic regulation during stress and physical complaints

OBJECTIVE

In order to evaluate the relevance of individual differences in the regulation of autonomic subsystems to psychosomatic processes, reactivity of the autonomic nervous system to an emotional stressor was related to the occurrence of physical complaints. In contrast to most other studies, the measures were related to the degree of actually experienced stress.

METHODS

In a large sample (n=111), electrodermal activity (EDA) and heart rate variability (HRV) were obtained at rest and during emotional stress. Physical complaints were assessed by a standardized symptom checklist providing subscales for different physiological systems.

RESULTS

Subjects who were actually stressed by the stress induction procedure but showed only weak reactivity of EDA, and subjects who were only slightly stressed but showed a marked EDA response reported a high amount of gastrointestinal complaints. A greater decrease of high-frequency HRV from the rest to the stress condition was associated with reports of relatively more cardiovascular complaints.

CONCLUSION

Findings indicate that the link between regulation of EDA and gastrointestinal functions has to be localized in higher brain structures and support the hypothesis that minor autonomic dysregulation may represent one pathway linking negative affect and the development of physical disorders.

The Yale Interpersonal Stressor (YIPS): affective, physiological, and behavioral responses to a novel interpersonal rejection paradigm

Given links between interpersonal functioning and health as well as the dearth of truly interpersonal laboratory stressors, we present a live rejection paradigm, the Yale Interpersonal Stressor (YIPS), and examine its effects on mood, eating behavior, blood pressure, and cortisol in two experiments. The YIPS involves one or more interaction(s) between the participant and two same-sex confederates in which the participant is made to feel excluded and isolated. In Experiment 1, 50 female undergraduates were randomly assigned to the YIPS or a control condition. Participants in the YIPS condition experienced greater negative affect and less positive affect than did those in the control condition. Further, restrained eaters ate more following the YIPS than did nonrestrained eaters. In Experiment 2, 25 male and female undergraduates completed the YIPS. The YIPS induced significant increases in tension, systolic blood pressure (SBP), and diastolic blood pressure (DBP) from baseline, while significantly decreasing positive affect. The YIPS appeared particularly relevant for women, resulting in significantly greater increases in cortisol and SBP for women compared to men. The YIPS, then, provides an alternative to traditional, achievement-oriented laboratory stressors and may allow for the identification of individuals most vulnerable to interpersonal stress.

The effects of racial stressors and hostility on cardiovascular reactivity in African American and Caucasian men

This study examined the effects of race-related stressors and hostility on cardiovascular reactivity in 31 African American and 31 Caucasian men. Participants viewed 3 film excerpts that depicted neutral, anger-provoking (but race-neutral), and racist situations. Participants exhibited significantly greater diastolic blood pressure reactivity to anger-provoking and racist stimuli compared with neutral stimuli. In addition, high hostility was associated with higher recovery systolic and diastolic blood pressure levels after exposure to the films. Although the results failed to confirm previous reports of greater reactivity to racism in African Americans, the findings suggest that diastolic blood pressure levels may remain elevated after exposure to racist stimuli. These results indicate that even indirect exposure to interpersonal conflict elicits significant reactivity, which can persist after exposure to the stressor, especially among high-hostile men.

Postural effects on hemodynamic response to interpersonal interaction

Laboratory studies of stress-induced cardiovascular reactivity have been conducted predominantly with participants in a seated posture. This procedure may contribute to limited laboratory-field generalization of cardiovascular response. The present study examined hemodynamic adjustments underlying pressor responses, in addition to heart rate and systolic time intervals, during seated and standing role-played, interpersonal interaction in 60 young adults. Irrespective of gender or race, blood pressure responses to the seated and standing interactions were comparable. However, seated interactions yielded a significantly greater increase in heart rate, shortened preejection period and decreased stroke index as compared to standing. Alternatively, interacting while standing yielded a significantly increased left ventricular ejection time and total peripheral resistance in comparison to sitting. These results suggest that hemodynamic adjustments during stressful interpersonal interaction vary as a function of posture, with somewhat greater cardiac influences apparent while seated and a more pronounced vascular response while standing.