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Makaracı M, Makaracı Y, Zorba E, Lautenbach F. Effects of Ten Biofeedback Sessions on Athletes' Physiological, Psychological, and Cognitive Functioning: A Randomized Controlled Trial with International Tennis Players. Percept Mot Skills 2024:315125241274834. [PMID: 39149880 DOI: 10.1177/00315125241274834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Our aim in this study was to test the effect of 10 sessions of biofeedback (BFB) on physiological, psychological, and cognitive functioning of international tennis players. In this randomized controlled trial, we recruited 16 international tennis players (11 male, 5 female; Mage = 17.31, SD = 0.87 years), who were randomly assigned to either an intervention group (IG; n = 8) or a control group (CG; n = 8). Those in the IG received 10 multimodal BFB sessions over four weeks, while those in the CG received no intervention. We assessed physiological, psychological, and cognitive parameters before and after the intervention and found a positive effect for skin temperature, state anxiety, and cognitive performance in the IG versus the CG. We provide preliminary data that 10 sessions of multimodal BFB improved cognitive functions and reduced anxiety symptoms in international tennis players. Future investigators should consider increasing sample size, incorporating an active CG, and studying these effects across diverse athletic disciplines.
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Affiliation(s)
- Melek Makaracı
- Department of Physical Education and Sports Teaching, Faculty of Sports Sciences, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Yücel Makaracı
- Department of Coaching Education, Faculty of Sports Sciences, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Erdal Zorba
- Department of Recreation, Faculty of Sports Sciences, Gazi University, Ankara, Turkey
| | - Franziska Lautenbach
- Institute of Sport Science, Sport Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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Orgil Z, Karthic A, Bell NF, Heisterberg LM, Williams SE, Ding L, Kashikar-Zuck S, King CD, Olbrecht VA. Feasibility and Acceptability of Biofeedback-Based Virtual Reality System Use in Children and Adolescents Undergoing Surgery: Phase 1 of a Pilot Observational Study. JMIR Perioper Med 2024. [PMID: 38742940 DOI: 10.2196/48959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Biofeedback-based virtual reality (VR-BF) is a novel, nonpharmacologic method for teaching patients how to control their breathing, which in turn increases heart rate variability (HRV) and may reduce pain. Unlike traditional forms of biofeedback (BF), VR-BF is delivered through a gamified virtual reality environment, increasing the accessibility of BF. This is the first study to systematically integrate VR-BF use in the pediatric perioperative setting, with the ultimate goal of evaluating the efficacy of VR-BF to reduce pain, anxiety, and opioid consumption once feasibility and acceptability has been established. OBJECTIVE The primary objective was to develop a clinical trial protocol for VR-BF use in the pediatric perioperative setting, including preoperative education/training and postoperative application of VR-BF in children undergoing surgery. A secondary objective was to evaluate the patient/parent experience with VR-BF. METHODS A total of 23 patients (12-18 years of age) scheduled for surgery at Nationwide Children's Hospital were recruited using purposive sampling. Following training, participants independently completed a daily, 10-minute VR-BF session for seven days before surgery and during their inpatient stay. Participants could use VR-BF up to two weeks after hospital discharge. Patient and session-level data of VR-BF usage and achievement of target HRV parameters were measured to identify the optimal frequency and duration of sessions before and after surgery for this population. Standardized questionnaires and semi-structured interviews were conducted to obtain qualitative information about patients' experiences with VR-BF. RESULTS Patient-level data indicated that the highest odds of achieving 1 session under target HRV parameters was after 4 sessions (OR 4 vs. 3 sessions=5.1, 95% CI 1.3-20.6; OR 3 vs. 2 sessions=16.6, 95% CI 1.2-217.0). Session-level data showed that a session duration of 9 to 10 minutes provided the greatest odds of achieving 1 session under target HRV parameters (OR 9 vs. 8 minutes=1.3, 95% CI 1.1-1.7; OR 8 vs. 7 minutes=1.4, 95% CI 1.1-1.8; OR 10 vs. 9 minutes=1.0, 95% CI 0.9-1.2). Qualitative data revealed patient satisfaction with the VR-BF technology, particularly in managing perioperative stress (n=17, 85%). Few patients reported VR-BF as beneficial for pain (n=8, 40%). CONCLUSIONS Children and adolescents undergoing surgery successfully learned behavioral strategies with VR-BF with once-daily 10-minute sessions for 5 days. To integrate VR-BF as a therapeutic intervention in a subsequent clinical trial, patients will be instructed to complete three 10-minute sessions a day for 7 days after surgery. CLINICALTRIAL ClinicalTrials.gov; NCT04943874; https://clinicaltrials.gov/ct2/show/NCT04943874.
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Affiliation(s)
- Zandantsetseg Orgil
- Department of Clinical Research Services, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, US
| | - Anitra Karthic
- The Ohio State University College of Medicine, Columbus, US
| | - Nora F Bell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, US
| | | | - Sara E Williams
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, US
| | - Lili Ding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, US
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, US
| | - Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, US
- Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, US
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, US
- Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, US
| | - Vanessa A Olbrecht
- Department of Anesthesiology & Perioperative Medicine, Nemours Children's Health, Delaware Valley, 1600 Rockland Road, Wilmington, US
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Jeong H, Yoo JH, Goh M, Song H. Deep breathing in your hands: designing and assessing a DTx mobile app. Front Digit Health 2024; 6:1287340. [PMID: 38347886 PMCID: PMC10860399 DOI: 10.3389/fdgth.2024.1287340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
Digital Therapeutics (DTx) are experiencing rapid advancements within mobile and mental healthcare sectors, with their ubiquity and enhanced accessibility setting them apart as uniquely effective solutions. In this evolving context, our research focuses on deep breathing, a vital technique in mental health management, aiming to optimize its application in DTx mobile platforms. Based on well-founded theories, we introduced a gamified and affordance-driven design, facilitating intuitive breath control. To enhance user engagement, we deployed the Mel Frequency Cepstral Coefficient (MFCC)-driven personalized machine learning method for accurate biofeedback visualization. To assess our design, we enlisted 70 participants, segregating them into a control and an intervention group. We evaluated Heart Rate Variability (HRV) metrics and collated user experience feedback. A key finding of our research is the stabilization of the Standard Deviation of the NN Interval (SDNN) within Heart Rate Variability (HRV), which is critical for stress reduction and overall health improvement. Our intervention group observed a pronounced stabilization in SDNN, indicating significant stress alleviation compared to the control group. This finding underscores the practical impact of our DTx solution in managing stress and promoting mental health. Furthermore, in the assessment of our intervention cohort, we observed a significant increase in perceived enjoyment, with a notable 22% higher score and 10.69% increase in positive attitudes toward the application compared to the control group. These metrics underscore our DTx solution's effectiveness in improving user engagement and fostering a positive disposition toward digital therapeutic efficacy. Although current technology poses challenges in seamlessly incorporating machine learning into mobile platforms, our model demonstrated superior effectiveness and user experience compared to existing solutions. We believe this result demonstrates the potential of our user-centric machine learning techniques, such as gamified and affordance-based approaches with MFCC, which could contribute significantly to the field of mobile mental healthcare.
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Affiliation(s)
- Harim Jeong
- Department of Interaction Science, SungKyunKwan University, Seoul, South Korea
- Department of Artificial Intelligence, SungKyunKwan University, Suwon, South Korea
| | - Joo Hun Yoo
- Department of Artificial Intelligence, SungKyunKwan University, Suwon, South Korea
- Hippo T&C, Suwon, South Korea
| | - Michelle Goh
- Department of Interaction Science, SungKyunKwan University, Seoul, South Korea
| | - Hayeon Song
- Department of Interaction Science, SungKyunKwan University, Seoul, South Korea
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Blaser BL, Weymar M, Wendt J. The effect of a single-session heart rate variability biofeedback on attentional control: does stress matter? Front Psychol 2023; 14:1292983. [PMID: 38034309 PMCID: PMC10687403 DOI: 10.3389/fpsyg.2023.1292983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Vagally mediated heart rate variability is an index of autonomic nervous system activity that is associated with a large variety of outcome variables including psychopathology and self-regulation. While practicing heart rate variability biofeedback over several weeks has been reliably associated with a number of positive outcomes, its acute effects are not well known. As the strongest association with vagally mediated heart rate variability has been found particularly within the attention-related subdomain of self-regulation, we investigated the acute effect of heart rate variability biofeedback on attentional control using the revised Attention Network Test. Methods Fifty-six participants were tested in two sessions. In one session each participant received a heart rate variability biofeedback intervention, and in the other session a control intervention of paced breathing at a normal ventilation rate. After the biofeedback or control intervention, participants completed the Attention Network Test using the Orienting Score as a measure of attentional control. Results Mixed models revealed that higher resting baseline vagally mediated heart rate variability was associated with better performance in attentional control, which suggests more efficient direction of attention to target stimuli. There was no significant main effect of the intervention on attentional control. However, an interaction effect indicated better performance in attentional control after biofeedback in individuals who reported higher current stress levels. Discussion The results point to acute beneficial effects of heart rate variability biofeedback on cognitive performance in highly stressed individuals. Although promising, the results need to be replicated in larger or more targeted samples in order to reach stronger conclusions about the effects.
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Affiliation(s)
- Berenike L. Blaser
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
- Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Julia Wendt
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
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Kluge MG, Maltby S, Kuhne C, Walker N, Bennett N, Aidman E, Nalivaiko E, Walker FR. Evaluation of a Virtual Reality Platform to Train Stress Management Skills for a Defense Workforce: Multisite, Mixed Methods Feasibility Study. J Med Internet Res 2023; 25:e46368. [PMID: 37930751 PMCID: PMC10659241 DOI: 10.2196/46368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Psychological stress-related injuries within first-responder organizations have created a need for the implementation of effective stress management training. Most stress management training solutions have limitations associated with scaled adoption within the workforce. For instance, those that are effective in civilian populations often do not align with the human performance culture embedded within first-responder organizations. Programs involving expert-led instructions that are high in quality are often expensive. OBJECTIVE This study sought to evaluate a tailored stress management training platform within the existing training schedule of the Australian Defense Force (ADF). The platform, known as Performance Edge (PE), is a novel virtual reality (VR) and biofeedback-enabled stress management skills training platform. Focusing on practical training of well-established skills and strategies, the platform was designed to take advantage of VR technology to generate an immersive and private training environment. This study aimed to assess the feasibility of delivering the VR platform within the existing group-based training context and intended training population. In this setting, the study further aimed to collect data on critical predictors of user acceptance and technology adoption in education, including perceived usability, usefulness, and engagement, while also assessing training impacts. METHODS This study used a mixed methods, multisite approach to collect observational, self-reported, and biometric data from both training staff and trainers within a real-world "on-base" training context in the ADF. Validated scales include the Presence Questionnaire and User Engagement Scale for perceived usefulness, usability, and engagement, as well as the State Mindfulness Scale and Relaxation Inventory, to gain insights into immediate training impacts for specific training modules. Additional surveys were specifically developed to assess implementation feedback, intention to use skills, and perceived training impact and value. RESULTS PE training was delivered to 189 ADF trainees over 372 training sessions. The platform was easy to use at an individual level and was feasible to deliver in a classroom setting. Trainee feedback consistently showed high levels of engagement and a sense of presence with the training content and environment. PE is overall perceived as an effective and useful training tool. Self-report and objective indices confirmed knowledge improvement, increased skill confidence, and increased competency after training. Specific training elements resulted in increased state mindfulness, increased physical relaxation, and reduced breathing rate. The ability to practice cognitive strategies in a diverse, private, and immersive training environment while in a group setting was highlighted as particularly valuable. CONCLUSIONS This study found the VR-based platform (PE) to be a feasible stress management training solution for group-based training delivery in a defense population. Furthermore, the intended end users, both trainers and trainees, perceive the platform to be usable, useful, engaging, and effective for training, suggesting end-user acceptance and potential for technology adoption.
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Affiliation(s)
- Murielle G Kluge
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Steven Maltby
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Caroline Kuhne
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, Australia
| | - Nicole Walker
- Army School of Health, Australian Defence Force, Canberra, Australia
| | - Neanne Bennett
- Joint Health Command, Department of Defence, Canberra, Australia
| | - Eugene Aidman
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- Human and Decision Sciences Division, Defence Science & Technology Group, Edinburgh, Australia
| | - Eugene Nalivaiko
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Frederick Rohan Walker
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
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Makaracı Y, Makaracı M, Zorba E, Lautenbach F. A Pilot Study of the Biofeedback Training to Reduce Salivary Cortisol Level and Improve Mental Health in Highly-Trained Female Athletes. Appl Psychophysiol Biofeedback 2023; 48:357-367. [PMID: 37204539 DOI: 10.1007/s10484-023-09589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
Biofeedback (BFB) training can provide a useful resource for athletes to cope with stress. However, the effects of BFB training on acute and chronic endocrine stress responses, parasympathetic activity, and mental health in competitive athletes have not been explored yet. This pilot study examined the effects of a 7-week BFB training on psychophysiological parameters in highly trained female athletes. Six highly trained female volleyball players (mean age: 17.50 ± 1.05 years) volunteered to participate in the study. Athletes individually attended 21-session heart rate variability (HRV)-BFB training consisting of six minutes for 7 weeks. A BFB device (Nexus 10) was used to measure the athletes' physiological responses reflecting HRV. To assess the cortisol awakening response (CAR), saliva samples were collected immediately after awakening and 15 min, 30 min, and 60 min post-awakening. The Depression Anxiety Stress Scale-21 was filled out before and after the intervention to assess mental health. Furthermore, athletes provided saliva samples during eight sessions pre- and immediately post-session. Mid-day cortisol levels decreased significantly after the intervention. No significant change was observed in CAR and physiological responses after the intervention. A significant decrease in cortisol level was observed in BFB sessions in which cortisol level was assessed, except for two sessions. We concluded that short sessions of 7-week HRV-BFB training could be used as an effective method to control autonomic functions and stress of female athletes. Although the present study provides strong evidence for the psychophysiological well-being of athletes, further investigations with larger samples are needed.
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Affiliation(s)
- Yücel Makaracı
- Faculty of Sports Sciences, Karamanoğlu Mehmetbey University, Karaman, Turkey.
| | - Melek Makaracı
- Faculty of Sports Sciences, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Erdal Zorba
- Faculty of Sports Sciences, Gazi University, Ankara, Turkey
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Four Sessions of Combining Wearable Devices and Heart Rate Variability (HRV) Biofeedback are Needed to Increase HRV Indices and Decrease Breathing Rates. Appl Psychophysiol Biofeedback 2023; 48:83-95. [PMID: 36350478 DOI: 10.1007/s10484-022-09567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/11/2022]
Abstract
Heart rate variability biofeedback (HRVB) is a behavioral intervention that uses resonance frequency breathing to synchronize the heart rate and breathing patterns. This study aimed to explore how many sessions of wearable HRVB devices are needed to increase the HRV index and decrease breathing rates and to compare the HRVB protocol with other psychological intervention programs in HRV indices and breathing rates. Sixty-four participants were randomly assigned to either the HRVB or relaxation training (RT) group. Both groups received interbeat intervals (IBIs) and breathing rates measurement at the pre-training baseline, during training, and post-training baseline from weeks 1 to 4. IBIs were transformed into HRV indices as the index of the autonomic nervous system. The Group × Week interaction effects significantly in HRV indices and breathing rates. The between-group comparison found a significant increase in HRV indices and decreased breathing rates in the HRVB group than in the RT group at week 4. The within-session comparison in the HRVB group revealed significantly increased HRV indices and decreased breathing rates at weeks 3 and 4 than at weeks 1 and 2. There was a significant increase in HRV indices and a decrease in breathing rates at mid- and post-training than pre-training in the HRVB group. Therefore, 4 weeks of HRVB combined with a wearable device are needed in increasing HRV indices and decrease breathing rates compared to the relaxation training. Three weeks of HRVB training are the minimum requirement for increasing HRV indices and reducing breathing rates compared to the first week of HRVB.
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Orgil Z, Johnson L, Karthic A, Williams SE, Ding L, Kashikar-Zuck S, King CD, Olbrecht VA. Feasibility and acceptability of perioperative application of biofeedback-based virtual reality versus active control for pain and anxiety in children and adolescents undergoing surgery: protocol for a pilot randomised controlled trial. BMJ Open 2023; 13:e071274. [PMID: 36697053 PMCID: PMC9884985 DOI: 10.1136/bmjopen-2022-071274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Current clinical applications of virtual reality (VR) provide patients with transient pain relief during acutely painful events by redirecting attention. Biofeedback (BF) is a mind-body therapy that effectively produces sustained pain reduction, but there are obstacles to its routine use. Combined, BF-based VR (VR-BF) may increase accessibility while enhancing the benefits of BF. VR-BF has yet to be employed in perioperative care, and as such, no defined treatment protocol for VR-BF exists. The primary aim of this study is to assess the feasibility of the perioperative use of VR-BF in children and adolescents. The secondary aims are to assess the acceptability of VR-BF and to collect pilot efficacy data. METHODS AND ANALYSIS This is a single-centre, randomised controlled pilot clinical trial. A total of 70 patients (12-18 years) scheduled for surgery anticipated to cause moderate to severe pain with ≥1 night of hospital admission will be randomised to one of two study arms (VR-BF or control). Participants randomised to VR-BF (n=35) will use the ForeVR VR platform to engage their breathing in gamified VR applications. Participants randomised to control (n=35) will interact with a pain reflection app, Manage My Pain. The primary outcome is feasibility of VR-BF use in adolescents undergoing surgery as assessed through recruitment, enrolment, retention and adherence to the protocol. Secondary outcomes are acceptability of VR-BF and pilot efficacy measures, including pain, anxiety and opioid consumption. ETHICS AND DISSEMINATION The protocol was approved by the Nationwide Children's Hospital Institutional Review Board (IRB #STUDY00002080). Patient recruitment begins in March 2023. Written informed consent is obtained for all participants. All information acquired will be disseminated via scientific meetings and published in peer-reviewed journals. Data will be available per request and results will be posted on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04943874).
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Affiliation(s)
- Zandantsetseg Orgil
- Department of Clinical Research Services, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leah Johnson
- Department of Clinical Research Services, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Anitra Karthic
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sara E Williams
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lili Ding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Vanessa A Olbrecht
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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Zhu B, Zhou Y, Weng Q, Luo W, He X, Jin L, Wang Q, Gao B, Harb AKA, Wang J. Effects of biophilic virtual reality on cognitive function of patients undergoing laparoscopic surgery: study protocol for a sham randomised controlled trial. BMJ Open 2022; 12:e052769. [PMID: 35803619 PMCID: PMC9272097 DOI: 10.1136/bmjopen-2021-052769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Virtual reality (VR) is already being used for cognitive or emotional rehabilitation. However, its role in postoperative cognitive dysfunction (POCD) has not been fully recognised. Due to the lack of an effective postoperative follow-up system, the incidence of POCD in China is not clear, and although many drugs have been proposed to improve POCD in the animal study, their clinical applications are limited, while VR provides an innovative method to provide non-pharmacological management. METHODS AND DESIGN This is a single-centre, randomised, double-blind, sham-controlled clinical trial. In this study, 600 patients over 55 years old undergoing laparoscopic surgery will be recruited. Participants will be randomly assigned to receive biophilic VR or sham VR (1:1 ratio), all patients have 20 min of exposure per day during the hospital stay. The primary outcome is the impact of VR on the incidence of POCD. Secondary outcomes include perioperative anxiety and instrumental activities of daily living. Changes in the performance of the neurocognitive batteries are measured by a local resident doctor. Serum samples will be collected on the day before surgery and 7 days after surgery. ETHICS AND DISSEMINATION This trial has ethical approval from the Medical Ethics Committee of the Affiliated Hospital of Medical School of Ningbo University (KY20210302). The study is sponsored by Ningbo University and Ningbo Science and Technology Bureau. CONTACT Dr. Mao Haijiao, Chair of the hospital medical Ethics committee (ndfylunli@126.com). Trial results will be submitted for publication in peer-reviewed journals, patient recruitment began in April 2021. Written informed consent is obtained for all participants. All information acquired will be disseminated via national or international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2000040919.
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Affiliation(s)
- Binbin Zhu
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Yanling Zhou
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Qiuyan Weng
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Wenjun Luo
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Xiuchao He
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Lufei Jin
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Qinwen Wang
- Ningbo Key Lab of Behavior Neuroscience, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Bin Gao
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | | | - Jianhua Wang
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
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Conlon A, Arnold R, Preatoni E, Moore LJ. Pulling the Trigger: The Effect of a 5-Minute Slow Diaphragmatic Breathing Intervention on Psychophysiological Stress Responses and Pressurized Pistol Shooting Performance. JOURNAL OF SPORT & EXERCISE PSYCHOLOGY 2022; 44:206-219. [PMID: 35468589 DOI: 10.1123/jsep.2021-0213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
This study examined the effect of slow diaphragmatic breathing on psychophysiological stress responses and pressurized performance. Sixty-seven participants (40 female; Mage = 20.17 ± 2.77 years) were randomly assigned to either a diaphragmatic-breathing, paced-breathing, or control group. Participants completed a nonpressurized shooting task and then received instructions about a pressurized version. Next, the diaphragmatic group was told to breathe at 6 breaths/min, the paced group at 12 breaths/min, and the control group received no instructions. Following a 5-min intervention period, participants completed the pressurized task while performance was assessed. Psychophysiological stress responses (e.g., cognitive anxiety, heart rate) were recorded throughout. Results revealed that diaphragmatic breathing had mixed effects on stress responses, with some unaffected (e.g., heart rate) and others reduced (e.g., cognitive anxiety), and little effect on performance. Findings suggested that slow diaphragmatic breathing might not aid pressurized performance but could benefit psychological stress responses.
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Affiliation(s)
- Aodhagán Conlon
- Department for Health, University of Bath, Bath,United Kingdom
| | | | | | - Lee J Moore
- Department for Health, University of Bath, Bath,United Kingdom
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Wearne TA, Logan JA, Trimmer EM, Wilson E, Filipcikova M, Kornfeld E, Rushby JA, McDonald S. Regulating emotion following severe traumatic brain injury: a randomized controlled trial of heart-rate variability biofeedback training. Brain Inj 2021; 35:1390-1401. [PMID: 34487459 DOI: 10.1080/02699052.2021.1972337] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND While difficulties regulating emotions are almost ubiquitous after traumatic brain injury (TBI), remediation techniques are limited. Heart-rate variability (HRV) is a physiological measure of emotion regulation and can be modified using biofeedback training. The aim of the current study was to evaluate the efficacy of repeated biofeedback training for improving emotion regulation difficulties following TBI. DESIGN Fifty adults with severe TBI were allocated to either biofeedback or waitlist conditions. Treatment consisted of six biofeedback sessions whereby participants were taught to breathe at their resonant frequency. Outcomes included changes in physiological and subjective reactivity to anger-induction, emotional well-being, and physiology at rest, together with symptoms of psychological distress and sleep disturbances (ACTRN12618002031246). RESULTS While biofeedback led to reduced skin conductance, it did not affect any other objective or subjective response to the mood induction procedure. Biofeedback led to fewer sleep disturbances, and reduced negative mood valence and depression during follow-up. CONCLUSIONS HRV biofeedback training is a feasible technique following TBI that transfers to improved symptoms of general emotional well-being, psychological distress, and sleep. Biofeedback does not transfer to a laboratory-based emotional provocation task. HRV biofeedback training may represent a novel adjunct for generalized emotional difficulties following injury.
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Affiliation(s)
- T A Wearne
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - J A Logan
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - E M Trimmer
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - E Wilson
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - M Filipcikova
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - E Kornfeld
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - J A Rushby
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - S McDonald
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
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Schlatter S, Guillot A, Schmidt L, Mura M, Trama R, Di Rienzo F, Lilot M, Debarnot U. Combining proactive transcranial stimulation and cardiac biofeedback to substantially manage harmful stress effects. Brain Stimul 2021; 14:1384-1392. [PMID: 34438047 DOI: 10.1016/j.brs.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have identified the dorsolateral prefrontal cortex (dlPFC) as a core region in cognitive emotional regulation. Transcranial direct current stimulations of the dlPFC (tDCS) and heart-rate variability biofeedback (BFB) are known to regulate emotional processes. However, the effect of these interventions applied either alone or concomitantly during an anticipatory stress remains unexplored. OBJECTIVE The study investigated the effect of anodal tDCS and BFB, alone or combined, on psychophysiological stress responses and cognitive functioning. METHODS Following a stress anticipation induction, 80 participants were randomized into four groups and subjected to a 15-min intervention: neutral video viewing (ctrl), left dlPFC anodal tDCS (tdcs), heart-rate variability biofeedback (bfb), or a combined treatment (bfb + tdcs). Participants were then immediately confronted with the stressor, which was followed by an assessment of executive functions. Psychophysiological stress responses were assessed throughout the experiment (heart rate, heart-rate variability, salivary cortisol). RESULTS The tdcs did not modulate stress responses. Compared with both ctrl and tdcs interventions, bfb reduced physiological stress and improved executive functions after the stressor. The main finding revealed that bfb + tdcs was the most effective intervention, yielding greater reduction in psychological and physiological stress responses than bfb. CONCLUSIONS Combining preventive tDCS with BFB is a relevant interventional approach to reduce psychophysiological stress responses, hence offering a new and non-invasive treatment of stress-related disorders. Biofeedback may be particularly useful for preparing for an important stressful event when performance is decisive.
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Affiliation(s)
- Sophie Schlatter
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France; Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation centre), SAMSEI, Lyon, France.
| | - Aymeric Guillot
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Laura Schmidt
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation centre), SAMSEI, Lyon, France.
| | - Mathilde Mura
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Robin Trama
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Franck Di Rienzo
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Departments of Anaesthesia and Intensive Care, University Claude Bernard Lyon 1, Lyon, France; Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation centre), SAMSEI, Lyon, France.
| | - Ursula Debarnot
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France; Institut Universitaire de France, France.
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Lin FV, Heffner K, Gevirtz R, Zhang Z, Tadin D, Porsteinsson A. Targeting autonomic flexibility to enhance cognitive training outcomes in older adults with mild cognitive impairment: study protocol for a randomized controlled trial. Trials 2021; 22:560. [PMID: 34425878 PMCID: PMC8381519 DOI: 10.1186/s13063-021-05530-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Importance Cognitive training with components that can further enhance the transferred and long-term effects and slow the progress of dementia is needed for preventing dementia. Objective The goal of the study is to test whether improving autonomic nervous system (ANS) flexibility via a resonance frequency breathing (RFB) training will strengthen the effects of a visual speed of processing (VSOP) cognitive training on cognitive and brain function, and slow the progress of dementia in older adults with mild cognitive impairment (MCI). Design Stage II double-blinded randomized controlled trial. The study was prospectively registered at ClinicalTrials.gov, with registration approved on 21 August 2020 (No. NCT04522791). Setting Study-related appointments will be conducted on-site at University of Rochester Medical Center locations. Data collection will be conducted from August 2020 to February 2025. Participants Older adults with MCI (n = 114) will be randomly assigned to an 8-week combined intervention (RFB+VSOP), VSOP with guided imagery relaxation (IR) control, and a IR-only control, with periodical booster training sessions at follow-ups. Mechanistic and distal outcomes include ANS flexibility, measured by heart rate variability, and multiple markers of dementia progress. Data will be collected across a 14-month period. Discussion This will be among the first RCTs to examine in older persons with MCI a novel, combined intervention targeting ANS flexibility, an important contributor to overall environmental adaptation, with an ultimate goal for slowing neurodegeneration. Trial registration ClinicalTrials.gov NCT04522791. Registered on 21 August 2020 Protocol version: STUDY00004727; IRB protocol version 2, approved on 30 July 2020.
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Affiliation(s)
- Feng V Lin
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, USA.,Wu Tsai Neuroscience Institute, Stanford University, Stanford, USA.,Elaine C. Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, USA.,Department of Brain and Cognitive Sciences, University of Rochester, Rochester, USA
| | - Kathi Heffner
- Elaine C. Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, USA. .,Department of Medicine, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, USA. .,Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, USA.
| | | | - Zhengwu Zhang
- University of North Carolina-Chapel Hill, Chapel Hill, USA
| | - Duje Tadin
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, USA.,Department of Neuroscience, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, USA
| | - Anton Porsteinsson
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, USA
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14
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Belli F, Felisatti A, Fischer MH. "BreaThink": breathing affects production and perception of quantities. Exp Brain Res 2021; 239:2489-2499. [PMID: 34117890 PMCID: PMC8196292 DOI: 10.1007/s00221-021-06147-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/31/2021] [Indexed: 01/21/2023]
Abstract
Cognition is shaped by signals from outside and within the body. Following recent evidence of interoceptive signals modulating higher-level cognition, we examined whether breathing changes the production and perception of quantities. In Experiment 1, 22 adults verbally produced on average larger random numbers after inhaling than after exhaling. In Experiment 2, 24 further adults estimated the numerosity of dot patterns that were briefly shown after either inhaling or exhaling. Again, we obtained on average larger responses following inhalation than exhalation. These converging results extend models of situated cognition according to which higher-level cognition is sensitive to transient interoceptive states.
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Affiliation(s)
- Francesco Belli
- Cognitive Sciences Division, Psychology Department, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany.
| | - Arianna Felisatti
- Cognitive Sciences Division, Psychology Department, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Martin H Fischer
- Cognitive Sciences Division, Psychology Department, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
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Ratajczak E, Hajnowski M, Stawicki M, Duch W. Novel Methodological Tools for Behavioral Interventions: The Case of HRV-Biofeedback. Sham Control and Quantitative Physiology-Based Assessment of Training Quality and Fidelity. SENSORS 2021; 21:s21113670. [PMID: 34070475 PMCID: PMC8197468 DOI: 10.3390/s21113670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/15/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022]
Abstract
Scientific research on heart rate variability (HRV) biofeedback is burdened by certain methodological issues, such as lack of consistent training quality and fidelity assessment or control conditions that would mimic the intervention. In the present study, a novel sham HRV-biofeedback training was proposed as a credible control condition, indistinguishable from the real training. The Yield Efficiency of Training Index (YETI), a quantitative measure based on the spectral distribution of heart rate during training, was suggested for training quality assessment. A training fidelity criterion derived from a two-step classification process based on the average YETI index and its standard deviation (YETISD) was suggested. We divided 57 young, healthy volunteers into two groups, each subjected to 20 sessions of either real or sham HRV-biofeedback. Five standard HRV measures (standard deviation of the NN (SDNN), root mean square of the standard deviation of the NN (RMSSD), total power, low-frequency (LF), and high-frequency (HF) power) collected at baseline, after 10 and 20 sessions were subjected to analysis of variance. Application of a training fidelity criterion improved sample homogeneity, resulting in a substantial gain in effect sizes of the group and training interactions for all considered HRV indices. Application of methodological amendments, including proper control conditions (such as sham training) and quantitative assessment of training quality and fidelity, substantially improves the analysis of training effects. Although presented on the example of HRV-biofeedback, this approach should similarly benefit other behavioral training procedures that interact with any of the many psychophysiological mechanisms in the human body.
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Affiliation(s)
- Ewa Ratajczak
- Institute of Psychology, Faculty of Philosophy and Social Sciences, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland
- Department of Informatics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland;
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Toruń, Wileńska 4, 87-100 Toruń, Poland;
- Correspondence:
| | - Marcin Hajnowski
- Institute of Information and Communication Research, Faculty of Philosophy and Social Sciences, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland;
| | - Mateusz Stawicki
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Toruń, Wileńska 4, 87-100 Toruń, Poland;
| | - Włodzisław Duch
- Department of Informatics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland;
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Toruń, Wileńska 4, 87-100 Toruń, Poland;
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Blase K, Vermetten E, Lehrer P, Gevirtz R. Neurophysiological Approach by Self-Control of Your Stress-Related Autonomic Nervous System with Depression, Stress and Anxiety Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073329. [PMID: 33804817 PMCID: PMC8036915 DOI: 10.3390/ijerph18073329] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Heart Rate Variability Biofeedback (HRVB) is a treatment in which patients learn self-regulation of a physiological dysregulated vagal nerve function. While the therapeutic approach of HRVB is promising for a variety of disorders, it has not yet been regularly offered in a mental health treatment setting. AIM To provide a systematic review about the efficacy of HRV-Biofeedback in treatment of anxiety, depression, and stress related disorders. METHOD Systematic review in PubMed and Web of Science in 2020 with terms HRV, biofeedback, Post-Traumatic Stress Disorder (PTSD), depression, panic disorder, and anxiety disorder. Selection, critical appraisal, and description of the Random Controlled Trials (RCT) studies. Combined with recent meta-analyses. RESULTS The search resulted in a total of 881 studies. After critical appraisal, nine RCTs have been selected as well as two other relevant studies. The RCTs with control groups treatment as usual, muscle relaxation training and a "placebo"-biofeedback instrument revealed significant clinical efficacy and better results compared with control conditions, mostly significant. In the depression studies average reduction at the Beck Depression Inventory (BDI) scale was 64% (HRVB plus Treatment as Usual (TAU) versus 25% (control group with TAU) and 30% reduction (HRVB) at the PSQ scale versus 7% (control group with TAU). In the PTSD studies average reduction at the BDI-scale was 53% (HRV plus TAU) versus 24% (control group with TAU) and 22% (HRVB) versus 10% (TAU) with the PTSD Checklist (PCL). In other systematic reviews significant effects have been shown for HRV-Biofeedback in treatment of asthma, coronary artery disease, sleeping disorders, postpartum depression and stress and anxiety. CONCLUSION This systematic review shows significant improvement of the non-invasive HRVB training in stress related disorders like PTSD, depression, and panic disorder, in particular when combined with cognitive behavioral therapy or different TAU. Effects were visible after four weeks of training, but clinical practice in a longer daily self-treatment of eight weeks is more promising. More research to integrate HRVB in treatment of stress related disorders in psychiatry is warranted, as well as research focused on the neurophysiological mechanisms.
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Affiliation(s)
- Kees Blase
- National Centre Stress Management, Innovational and Educational Centre HartFocus, 1231 NC78 Loosdrecht, The Netherlands
- Correspondence:
| | - Eric Vermetten
- Department Psychiatry, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Paul Lehrer
- Rutgers Medical School, Rutgers University, Monmouth Junction, NJ 08852, USA;
| | - Richard Gevirtz
- California School of Professional Psychology, Alliant International University, San Diego, CA 92131, USA;
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Schlatter S, Schmidt L, Lilot M, Guillot A, Debarnot U. Implementing biofeedback as a proactive coping strategy: Psychological and physiological effects on anticipatory stress. Behav Res Ther 2021; 140:103834. [PMID: 33743384 DOI: 10.1016/j.brat.2021.103834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 01/10/2023]
Abstract
Anticipating a stressful situation involves psychophysiological reactions before the occurrence of the overt stress event. The current challenge in the stress domain is to characterize anticipatory stress reactions and how to effectively modulate them. The present study aimed to characterize the anticipation period and evaluate the benefits of a heart-rate variability biofeedback (BFB) intervention designed to manage anticipatory stress. Healthy participants were exposed to an anticipation stress period (15 min) during which they either practised BFB (stress + bfb, n = 15) or watched a neutral video (stress + video, n = 14). Anticipatory stress was effectively induced by the Trier Social Anticipatory Stress (TSAS) protocol, specifically designed for this study. Control participants, without anticipation stress, practised BFB for an equivalent time (ctrl + bfb, n = 15). Subsequently, all participants performed a set of cognitive tasks assessing executive functions. Heart-rate variability (cardiac coherence, standard deviation of the R-R intervals, root mean square of successive difference measure) and the evolution of the perceived psychological state were measured during the anticipation period. Self-reported judgements of how the intervention influenced stress and performance were further assessed. The main result showed that BFB is a relevant proactive stress-coping method. Compared with the stress + video group, participants who practised BFB attained higher cardiac coherence scores. Post-intervention self-reported measures revealed that BFB contributed to reduce psychological stress and increase perceived levels of performance. Together, these findings provide practical guidelines for examining the stress anticipation period by means of the TSAS protocol.
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Affiliation(s)
- Sophie Schlatter
- Univ. Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, F-69622, Villeurbanne, France.
| | - Laura Schmidt
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Marc Lilot
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hôpital Louis Pradel, Hospices Civils de Lyon, Departments of Anaesthesia and Intensive Care, Lyon, France; Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, medical simulation centre), University Claude Bernard Lyon 1, 69003, Lyon, France
| | - Aymeric Guillot
- Univ. Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, F-69622, Villeurbanne, France
| | - Ursula Debarnot
- Univ. Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, F-69622, Villeurbanne, France; Institut Universitaire de France, France.
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18
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Kluge MG, Maltby S, Walker N, Bennett N, Aidman E, Nalivaiko E, Walker FR. Development of a modular stress management platform (Performance Edge VR) and a pilot efficacy trial of a bio-feedback enhanced training module for controlled breathing. PLoS One 2021; 16:e0245068. [PMID: 33529187 PMCID: PMC7853514 DOI: 10.1371/journal.pone.0245068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
This paper describes the conceptual design of a virtual reality-based stress management training tool and evaluation of the initial prototype in a pilot efficacy study. Performance Edge virtual-reality (VR) was co-developed with the Australian Defence Force (ADF) to address the need for practical stress management training for ADF personnel. The VR application is biofeedback-enabled and contains key stress management techniques derived from acceptance and commitment and cognitive behavioural therapy in a modular framework. End-user-provided feedback on usability, design, and user experience was positive, and particularly complimentary of the respiratory biofeedback functionality. Training of controlled breathing delivered across 3 sessions increased participants' self-reported use of breath control in everyday life and progressively improved controlled breathing skills (objectively assessed as a reduction in breathing rate and variability). Thus the data show that a biofeedback-enabled controlled breathing protocol delivered through Performance Edge VR can produce both behaviour change and objective improvement in breathing metrics. These results confirm the validity of Performance Edge VR platform, and its Controlled Breathing module, as a novel approach to tailoring VR-based applications to train stress management skills in a workplace setting.
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Affiliation(s)
- Murielle G. Kluge
- Centre for Advanced Training Systems, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Steven Maltby
- Centre for Advanced Training Systems, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Nicole Walker
- Army School of Health, Latchford Barracks, Bonegilla, VIC, Australia
| | | | - Eugene Aidman
- School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Land Division, Defence Science & Technology Group, Edinburgh, SA, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Eugene Nalivaiko
- Centre for Advanced Training Systems, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Frederick Rohan Walker
- Centre for Advanced Training Systems, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, The University of Newcastle, Callaghan, NSW, Australia
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Rose S, Cacho F, Wiersma L, Magdaleno A, Anderson N, Statler T. Efficacy of a Brief Biofeedback Intervention on Mood, Arousal, Mental Workload, Movement Time, and Biofeedback Device Preference. Appl Psychophysiol Biofeedback 2021; 46:205-214. [PMID: 33387096 DOI: 10.1007/s10484-020-09500-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 11/27/2022]
Abstract
Biofeedback (BF) training has been utilized with performers for years. Previous literature highlights the effectiveness of multi-week intervention protocols, but there is a lack of evidence for abbreviated interventions using portable devices and the performer's preference of these devices. Therefore, we investigated the effects of a brief BF intervention on mental workload, mood, arousal, and movement time and BF device preference. Participants (N = 40) were randomly assigned to one of two heart rate variability (HRV) BF interventions or a control group. Although the brief intervention did not have a significant effect on mood, movement time, or mental workload, it did significantly and positively impact perceived arousal. Overall, 12 participants (48%) preferred the EmWave™ desktop device, eight (32%) preferred the Inner Balance™ device, and five (20%) preferred the EmWave2™ portable device. Results support limited effectiveness of a brief HRV BF protocol, although the dose-response effectiveness should continue to be explored.
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Affiliation(s)
- Seth Rose
- Department of Movement Sciences, University of Idaho, Moscow, ID, USA
- Performance Psychology Laboratory, Department of Kinesiology, California State University, Fullerton, Fullerton, USA
| | - Frances Cacho
- Department of Educational Psychology, Florida State University, Tallahassee, FL, USA
- Performance Psychology Laboratory, Department of Kinesiology, California State University, Fullerton, Fullerton, USA
| | - Lenny Wiersma
- Department of Kinesiology, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA, 92834-3599, USA.
- Performance Psychology Laboratory, Department of Kinesiology, California State University, Fullerton, Fullerton, USA.
| | - Anthony Magdaleno
- Department of Kinesiology, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA, 92834-3599, USA
- Performance Psychology Laboratory, Department of Kinesiology, California State University, Fullerton, Fullerton, USA
| | - Nicholas Anderson
- Department of Kinesiology, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA, 92834-3599, USA
- Performance Psychology Laboratory, Department of Kinesiology, California State University, Fullerton, Fullerton, USA
| | - Traci Statler
- Department of Kinesiology, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA, 92834-3599, USA
- Performance Psychology Laboratory, Department of Kinesiology, California State University, Fullerton, Fullerton, USA
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Olbrecht VA, Williams SE, O'Conor KT, Boehmer CO, Marchant GW, Glynn SM, Geisler KJ, Ding L, Yang G, King CD. Guided relaxation-based virtual reality versus distraction-based virtual reality or passive control for postoperative pain management in children and adolescents undergoing Nuss repair of pectus excavatum: protocol for a prospective, randomised, controlled trial (FOREVR Peds trial). BMJ Open 2020; 10:e040295. [PMID: 33380482 PMCID: PMC7780540 DOI: 10.1136/bmjopen-2020-040295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Virtual reality (VR) offers an innovative method to deliver non-pharmacological pain management. Distraction-based VR (VR-D) using immersive games to redirect attention has shown short-term pain reductions in various settings. To create lasting pain reduction, VR-based strategies must go beyond distraction. Guided relaxation-based VR (VR-GR) integrates pain-relieving mind-body based guided relaxation with VR, a novel therapy delivery mechanism. The primary aim of this study is to assess the impact of daily VR-GR, VR-D and 360 video (passive control) on pain intensity. We will also assess the impact of these interventions on pain unpleasantness, anxiety and opioid and benzodiazepine consumption. The secondary aim of this study will assess the impact of psychological factors (anxiety sensitivity and pain catastrophising) on pain following VR. METHODS AND ANALYSIS This is a single centre, prospective, randomised, clinical trial. Ninety children/adolescents, aged 8-18 years, presenting for Nuss repair of pectus excavatum will be randomised to 1 of 3 study arms (VR-GR, VR-D and 360 video). Patients will use the Starlight Xperience (Google Daydream) VR suite for 10 min. Patients randomised to VR-GR (n=30) will engage in guided relaxation/mindfulness with the Aurora application. Patients randomised to VR-D (n=30) will play 1 of 3 distraction-based games, and those randomised to the 360 video (n=30) will watch the Aurora application without audio instructions or sound. Primary outcome is pain intensity. Secondary outcomes include pain unpleasantness, anxiety and opioid and benzodiazepine consumption. ETHICS AND DISSEMINATION This study follows Standard Protocol Items: Recommendations for Interventional Trials guidelines. The protocol was approved by the Cincinnati Children's Hospital Medical Center's institutional review board. Patient recruitment began in July 2020. Written informed consent will be obtained for all participants. All information acquired will be disseminated via scientific meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04351776.
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Affiliation(s)
- Vanessa A Olbrecht
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sara E Williams
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Keith T O'Conor
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chloe O Boehmer
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gilbert W Marchant
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susan M Glynn
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kristie J Geisler
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lili Ding
- Divsion of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gang Yang
- Divsion of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher D King
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Brinkmann AE, Press SA, Helmert E, Hautzinger M, Khazan I, Vagedes J. Comparing Effectiveness of HRV-Biofeedback and Mindfulness for Workplace Stress Reduction: A Randomized Controlled Trial. Appl Psychophysiol Biofeedback 2020; 45:307-322. [PMID: 32556709 PMCID: PMC7644531 DOI: 10.1007/s10484-020-09477-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Psychophysiological disorders due to work-related stress continue to be highly costly for health systems and approaches for cost-effective and easily accessible interventions are much needed. Both heart rate variability-biofeedback (HRV-Bfb) and mindfulness-based interventions (MBI) have been empirically shown to reduce stress. This study compares these two interventions in the work context to a wait-list-control-group (WLC). In this three-armed randomized controlled trial (RCT), 69 healthy adults employed in the same organization were randomized to participate in HRV-Bfb, MBI or the WLC. Participants were assessed for psychophysiological parameters of stress (stress perception, coping, HRV parameters and cortisol) and stress related symptoms (depressive symptoms, psychological wellbeing, mindfulness and self-compassion). Participants trained using either HRV-Bfb or MBI for 6 weeks on a daily basis. Outcomes were assessed at baseline, after the intervention and at follow-up 12 weeks later. Results did not show any statistically significant differences between HRV-Bfb and MBI groups, and neither of the intervention groups (IGs) differed from the WLC. Findings suggest an overall reduction in stress for all groups, including the WLC, with mostly small to medium effect sizes. However, it is important to note that participants with higher baseline stress levels might benefit more from mindfulness and biofeedback-based stress reduction interventions. The results have to be interpreted with caution due to the relatively small sample size. MBI might have a slightly stronger effect on stress reduction in comparison to HRV-Bfb, as suggested by the effect sizes. This study highlights issues and challenges of the implementation of such interventions in corporate health management.
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Affiliation(s)
- Amelie Edith Brinkmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Tuebingen, 72070, Tübingen, Germany.
- ARCIM Institute for Academic Research in Complementary and Integrative Medicine, 70794, Filderstadt, Germany.
| | - Sophia Antonia Press
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Tuebingen, 72070, Tübingen, Germany
- ARCIM Institute for Academic Research in Complementary and Integrative Medicine, 70794, Filderstadt, Germany
| | - Eduard Helmert
- ARCIM Institute for Academic Research in Complementary and Integrative Medicine, 70794, Filderstadt, Germany
| | - Martin Hautzinger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Tuebingen, 72070, Tübingen, Germany
| | | | - Jan Vagedes
- ARCIM Institute for Academic Research in Complementary and Integrative Medicine, 70794, Filderstadt, Germany.
- Department of Neonatology, University Hospital Tuebingen, 72070, Tübingen, Germany.
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22
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Chelidoni O, Plans D, Ponzo S, Morelli D, Cropley M. Exploring the Effects of a Brief Biofeedback Breathing Session Delivered Through the BioBase App in Facilitating Employee Stress Recovery: Randomized Experimental Study. JMIR Mhealth Uhealth 2020; 8:e19412. [PMID: 33055072 PMCID: PMC7596654 DOI: 10.2196/19412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 12/25/2022] Open
Abstract
Background Recovery from stress is a predictive factor for cardiovascular health, and heart rate variability (HRV) is suggested to be an index of how well people physiologically recover from stress. Biofeedback and mindfulness interventions that include guided breathing have been shown to be effective in increasing HRV and facilitating stress recovery. Objective This study aims to assess the effectiveness of a brief app-based breathing intervention (BioBase) in enhancing physiological recovery among employees who were induced to cognitive and emotional stress. Methods In total, we recruited 75 full-time employees. Interbeat (RR) intervals were recorded continuously for 5 min at baseline and during cognitive and emotional stress induction. The session ended with a 5-min recovery period during which participants were randomly allocated into 3 conditions: app-based breathing (BioBase), mindfulness body scan, or control. Subjective tension was assessed at the end of each period. Results Subjective tension significantly increased following stress induction. HRV significantly decreased following the stress period. In the recovery phase, the root mean square of successive RR interval differences (P=.002), the percentage of successive RR intervals that differed by >50 ms (P=.008), and high frequency (P=.01) were significantly higher in the BioBase breathing condition than in the mindfulness body scan and the control groups. Conclusions Biofeedback breathing interventions digitally delivered through a commercially available app can be effective in facilitating stress recovery among employees. These findings contribute to the mobile health literature on the beneficial effects of brief app-based breathing interventions on employees’ cardiovascular health.
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Affiliation(s)
- Olga Chelidoni
- Evolution, Behaviour and Environment, School of Life Sciences, University of Sussex, Brighton, United Kingdom
| | - David Plans
- Initiative in the Digital Economy, Department of Science, Innovation, Technology, and Entrepreneurship, University of Exeter, Exeter, United Kingdom.,Social Cognition Lab, Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,BioBeats Group Ltd, London, United Kingdom
| | | | - Davide Morelli
- BioBeats Group Ltd, London, United Kingdom.,Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Mark Cropley
- Faculty of Health and Medical Sciences, School of Psychology, University of Surrey, Guildford, United Kingdom
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23
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Rab SL, Admon R. Parsing inter- and intra-individual variability in key nervous system mechanisms of stress responsivity and across functional domains. Neurosci Biobehav Rev 2020; 120:550-564. [PMID: 32941963 DOI: 10.1016/j.neubiorev.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
Exposure to stressful events is omnipresent in modern human life, yet people show considerable heterogeneity in the impact of stress exposure(s) on their functionality and overall health. Encounter with stressor(s) is counteracted by an intricate repertoire of nervous-system responses. This narrative review starts with a brief summary of the vast evidence that supports heart rate variability, cortisol secretion, and large-scale cortical network interactions as kay physiological, endocrinological, and neural mechanisms of stress responsivity, respectively. The second section highlights potential sources for inter-individual variability in these mechanisms, by focusing on biological, environmental, social, habitual, and psychological factors that may influence stress responsivity patterns and thus contribute to heterogeneity in the impact of stress exposure on functionality and health. The third section introduces intra-individually variability in stress responsivity across functional domains as a novel putative source for heterogeneity in the impact of stress exposure. Challenges and future directions are further discussed. Parsing inter- and intra-individual variability in nervous-system mechanisms of stress responsivity and across functional domains is critical towards potential clinical translation.
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Affiliation(s)
- Sharona L Rab
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Roee Admon
- Department of Psychology, University of Haifa, Haifa, Israel; The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel.
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Lin IM, Wang SY, Fan SY, Peper E, Chen SP, Huang CY. A Single Session of Heart Rate Variability Biofeedback Produced Greater Increases in Heart Rate Variability Than Autogenic Training. Appl Psychophysiol Biofeedback 2020; 45:343-350. [PMID: 32767160 DOI: 10.1007/s10484-020-09483-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Heart rate variability biofeedback (HRV-BF) has been confirmed to increase heart rate variability (HRV) and cardiac outflows by baroreflex in healthy populations and clinical patients. Autogenic training (AT) is common used in the psychological intervention. This study integrates a single-session of HRV-BF and AT into a high-technology mobile application (app), and examines the effects on HRV indices, breathing rates, and subjective relaxation scores. Healthy college students were recruited and assigned to the single-session HRV-BF group or AT group. Participants in the HRV-BF group received HRV-BF combined with paced breathing training, which gradually stepped down their breathing rates from 12, to 8, to 6 breaths/per min; and received feedback of HRV indices from the app. Participants in the AT group received autogenic training and feedback of heart rate from the app. A chest belt Zephyr BioHarness was connected through Bluetooth to a Zenfone5 mobile phone, it collected the signals of interbeat intervals and breathing rates at pre-training, mid-training, and post-training stages. The Kubios HRV software was used to analyze HRV indices. The results reveal higher HRV indices and lower breathing rates during mid-training and post-training in the HRV-BF group compared to the AT group. There were higher high-frequency of HRV at post-training than pre-training in the AT group. Participants of both groups increased their subjective relaxation scores after training. The HRV-BF protocol increased cardiac outflows by baroreflex and decreased breathing rates, and the AT protocol increased high-frequency of HRV. These high-technology wearable devices combined with psychological interventions will apply to various populations in the future.
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Affiliation(s)
- I-Mei Lin
- Department of Psychology, Kaohsiung Medical University, No 100, Shih-Chuan 1 st Rd, Kaohsiung, 80708, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Pervasive Artificial Intelligence Research (PAIR) Labs, Hsinchu, Taiwan.
| | - San-Yu Wang
- Department of Psychology, Kaohsiung Medical University, No 100, Shih-Chuan 1 st Rd, Kaohsiung, 80708, Taiwan
| | - Sheng-Yu Fan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Erik Peper
- Institute for Holistic Health Studies, San Francisco State University, San Francisco, CA, USA
| | - Sui-Pi Chen
- Geographic Information Systems Research Center, Feng Chia University, Taichung, Taiwan
| | - Ching-Yu Huang
- Industrial Technology Research Institute, Hsinchu, Taiwan
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25
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[Caring for the caregiver: The emotional impact of the coronavirus epidemic on nurses and other health professionals]. ENFERMERIA CLINICA 2020; 31:S35-S39. [PMID: 32425487 PMCID: PMC7229967 DOI: 10.1016/j.enfcli.2020.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022]
Abstract
La crisis sanitaria provocada por la pandemia del virus COVID-19 ha vuelto a destacar el papel de los profesionales sanitarios como elemento clave para su contención, que sufren una alta tensión marcada por la presión asistencial y la falta de medios de protección. Ante esta tensión, resulta relevante analizar el impacto emocional en los profesionales sanitarios de la pandemia de coronavirus y los recursos de afrontamiento para disminuir o atenuar este impacto. Destacan el estrés, los trastornos del sueño y los síntomas depresivos. Se ofrecen algunas estrategias que han sido utilizados por profesionales que anteriormente han sufrido la presión del COVID-19 y les han sido de utilidad. Por último, se señalan algunas recomendaciones cuya eficacia es conocida para el manejo del impacto emocional.
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26
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Kuula L, Halonen R, Kajanto K, Lipsanen J, Makkonen T, Peltonen M, Pesonen AK. The Effects of Presleep Slow Breathing and Music Listening on Polysomnographic Sleep Measures - a pilot trial. Sci Rep 2020; 10:7427. [PMID: 32366866 PMCID: PMC7198497 DOI: 10.1038/s41598-020-64218-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/08/2020] [Indexed: 02/04/2023] Open
Abstract
Knowledge on efficient ways to reduce presleep arousal and, therefore, improve sleep, is scanty. We explored the effects of presleep slow breathing and music listening conditions on sleep quality and EEG power spectral density in young adults in a randomized, controlled trial with a crossover design. Participants’ (N = 20, 50% females) sleep was measured on two consecutive nights with polysomnography (40 nights), the other night serving as the control condition. The intervention condition was either a 30-minute slow breathing exercise or music listening (music by Max Richter: Sleep). The intervention and control conditions were placed in a random order. We measured heart rate variability prior to, during and after the intervention condition, and found that both interventions increased immediate heart rate variability. Music listening resulted in decreased N2 sleep, increased frontal beta1 power spectral density, and a trend towards increased N3 sleep was detected. In the slow breathing condition higher central delta power during N3 was observed. While some indices pointed to improved sleep quality in both intervention groups, neither condition had robust effects on sleep quality. These explorative findings warrant further replication in different populations.
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Affiliation(s)
- Liisa Kuula
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Risto Halonen
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kristiina Kajanto
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Lipsanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tommi Makkonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Miina Peltonen
- Department of oral and maxillofacial diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anu-Katriina Pesonen
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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27
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Abstract
Brain-computer interfaces and wearable neurotechnologies are now used to measure real-time neural and physiologic signals from the human body and hold immense potential for advancements in medical diagnostics, prevention, and intervention. Given the future role that wearable neurotechnologies will likely serve in the health sector, a critical state-of-the-art assessment is necessary to gain a better understanding of their current strengths and limitations. In this chapter we present wearable electroencephalography systems that reflect groundbreaking innovations and improvements in real-time data collection and health monitoring. We focus on specifications reflecting technical advantages and disadvantages, discuss their use in fundamental and clinical research, their current applications, limitations, and future directions. While many methodological and ethical challenges remain, these systems host the potential to facilitate large-scale data collection far beyond the reach of traditional research laboratory settings.
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28
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Chang WL, Lee JT, Li CR, Davis AHT, Yang CC, Chen YJ. Effects of Heart Rate Variability Biofeedback in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial. Biol Res Nurs 2019; 22:34-44. [PMID: 31635477 DOI: 10.1177/1099800419881210] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Autonomic dysfunction, cognitive impairment, and psychological distress are associated with poorer prognosis in patients with acute ischemic stroke (AIS). Heart rate variability (HRV) biofeedback (BF) improves autonomic dysfunction, cognitive impairment, and psychological distress in other patient populations, but its effect in patients with AIS is still unclear. OBJECTIVE This study investigated the effects of an HRVBF intervention on autonomic function, cognitive impairment, and psychological distress in patients with AIS. METHOD In this randomized, controlled, single-blind trial, patients with AIS were randomly assigned to the experimental or control group. The experimental group received four HRVBF training sessions. The control group received usual care. Repeated measures of HRV, mini-mental status examination (MMSE), and Hospital Anxiety and Depression Scales (HADS) were collected prior to and at 1 and 3 months postintervention. RESULTS A total of 35 patients completed the study (19 experimental, 16 control). HRV and HADS significantly improved in the experimental group (p < .001) but not in the control group. Likewise, only the experimental group showed significant improvements in HRV, MMSE, and HADS over time (p < .05). CONCLUSION HRVBF is a promising intervention for improving autonomic function, cognitive impairment, and psychological distress in patients with AIS. More studies of HRVBF interventions are needed to further optimize the effects of HRVBF on autonomic, cognitive, and psychological function in patients with AIS.
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Affiliation(s)
- Wan-Ling Chang
- Department of Nursing, Fu Jen Catholic University Hospital, New Taipei City
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Chi-Rong Li
- Department of Teaching and Research, Taichung Hospital, Ministry of Health and Welfare, Taichung
| | - Amy H T Davis
- College of Health and Society, Hawaii Pacific University, Kaneohe, HI, USA
| | - Chia-Chen Yang
- School of Nursing, National Defense Medical Center, Taipei
| | - Yu-Ju Chen
- School of Nursing, National Defense Medical Center, Taipei
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29
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Zargari Marandi R, Madeleine P, Omland Ø, Vuillerme N, Samani A. An oculometrics-based biofeedback system to impede fatigue development during computer work: A proof-of-concept study. PLoS One 2019; 14:e0213704. [PMID: 31150405 PMCID: PMC6544207 DOI: 10.1371/journal.pone.0213704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/18/2019] [Indexed: 12/19/2022] Open
Abstract
A biofeedback system may objectively identify fatigue and provide an individualized timing plan for micro-breaks. We developed and implemented a biofeedback system based on oculometrics using continuous recordings of eye movements and pupil dilations to moderate fatigue development in its early stages. Twenty healthy young participants (10 males and 10 females) performed a cyclic computer task for 31–35 min over two sessions: 1) self-triggered micro-breaks (manual sessions), and 2) biofeedback-triggered micro-breaks (automatic sessions). The sessions were held with one-week inter-session interval and in a counterbalanced order across participants. Each session involved 180 cycles of the computer task and after each 20 cycles (a segment), the task paused for 5-s to acquire perceived fatigue using Karolinska Sleepiness Scale (KSS). Following the pause, a 25-s micro-break involving seated exercises was carried out whether it was triggered by the biofeedback system following the detection of fatigue (KSS≥5) in the automatic sessions or by the participants in the manual sessions. National Aeronautics and Space Administration Task Load Index (NASA-TLX) was administered after sessions. The functioning core of the biofeedback system was based on a Decision Tree Ensemble model for fatigue classification, which was developed using an oculometrics dataset previously collected during the same computer task. The biofeedback system identified fatigue with a mean accuracy of approx. 70%. Perceived workload obtained from NASA-TLX was significantly lower in the automatic sessions compared with the manual sessions, p = 0.01 Cohen’s dz = 0.89. The results give support to the effectiveness of integrating oculometrics-based biofeedback in timing plan of micro-breaks to impede fatigue development during computer work.
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Affiliation(s)
- Ramtin Zargari Marandi
- Department of Health Science and Technology, Sport Sciences, Aalborg University, Aalborg, Denmark
- Univ. Grenoble Alpes, AGEIS, Grenoble, France
| | - Pascal Madeleine
- Department of Health Science and Technology, Sport Sciences, Aalborg University, Aalborg, Denmark
| | - Øyvind Omland
- Department of Health Science and Technology, Sport Sciences, Aalborg University, Aalborg, Denmark
- Aalborg University Hospital, Clinic of Occupational Medicine, Danish Ramazzini Center, Aalborg, Denmark
| | - Nicolas Vuillerme
- Department of Health Science and Technology, Sport Sciences, Aalborg University, Aalborg, Denmark
- Univ. Grenoble Alpes, AGEIS, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Afshin Samani
- Department of Health Science and Technology, Sport Sciences, Aalborg University, Aalborg, Denmark
- * E-mail:
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30
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De Couck M, Caers R, Musch L, Fliegauf J, Giangreco A, Gidron Y. How breathing can help you make better decisions: Two studies on the effects of breathing patterns on heart rate variability and decision-making in business cases. Int J Psychophysiol 2019; 139:1-9. [DOI: 10.1016/j.ijpsycho.2019.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 01/26/2023]
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31
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Frazier SE, Parker SH. Measurement of physiological responses to acute stress in multiple occupations: A systematic review and implications for front line healthcare providers. Transl Behav Med 2019. [PMID: 29522140 DOI: 10.1093/tbm/iby019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Optimizing performance of individuals in acutely stressful work-related situations requires a deeper understanding of the interaction between the demands of the stimuli and an individual's associated physiological response. Identifying these responses is particularly germane for healthcare professionals, who experience episodes of acute stress on a regular basis. The purpose of this review was to examine and synthesize empirical literature to identify studies assessing physiological responses to acute stress, determine common methods for measuring acute stress in near real-time, and identify common research designs employed across industries. A modified PRISMA approach was followed. Systematic searches were conducted of four databases (PsycINFO, Medline, PubMed, and Turning Research into Practice [TRIP]) to access eligibility. Reference list searches and a hand search were also conducted to identify other articles suitable for inclusion. Studies selected examined an acute physiological response while participants were engaged in a stress-inducing task. Twenty-two articles were included. Fifteen (68.2%) were centered on the human service industry while only three (13.6%) focused on healthcare professionals. Half of the studies incorporated a simulation into the research design while only two (9.1%) articles looked at physiological responses in real-world settings. Heart rate and cortisol emerged as the most common physiological measures collected. This review demonstrates that acute stress is primarily assessed retrospectively, and that there is a pragmatic gap in methodological approach, with many data collection methods inappropriate for the healthcare environment. Future research should capitalize on advancements in sensor technology to passively examine acute stress in healthcare professionals.
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Affiliation(s)
- Sarah E Frazier
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, VA, USA.,Graduate Program in Translational, Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA.,Carilion Clinic, Roanoke, VA, USA
| | - Sarah H Parker
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, VA, USA.,Carilion Clinic, Roanoke, VA, USA.,Department of Biomedical Sciences, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Department of Psychology, Virginia Tech, Blacksburg, VA, USA
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Rauch HGL, Hume DJ, Howells FM, Kroff J, Lambert EV. Food Cue Reactivity and the Brain-Heart Axis During Cognitive Stress Following Clinically Relevant Weight Loss. Front Nutr 2019; 5:135. [PMID: 30662897 PMCID: PMC6328490 DOI: 10.3389/fnut.2018.00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/11/2018] [Indexed: 12/05/2022] Open
Abstract
Successful weight loss maintainers are more vulnerable to stress induced eating. The aim of our study was to determine what effect an attention-demanding cognitive performance task had on brain-heart reactivity to visual food cues in women who maintained clinically relevant weight loss vs. women who had never weight cycled. A clinical weight loss group (CWL, n = 17) and a BMI-matched control group (CTL, n = 23) completed modified Stroop tasks that either included high calorie food pictures (Food Stroop) or excluded food cues (Office Stroop). ECG, breathing rate, and EEG were recorded. CWL participants: The Eating Restraint scores (Three Factor Eating Questionnaire) of the CWL participants correlated negatively with their heart rates recorded during the Food Stroop task (r = 0.62, p < 0.01). There was no such relationship in CTL participants. The P200 latencies in CWL participants evoked by the Stroop color-word cues at the C3 electrode were positively correlated to the log high frequency power in their cardiac spectrograms during the Food Stroop (r = 0.63, p < 0.02). There were no such relationships in the Office Stroop task nor in CTL participants. Combined Groups: Participants' heart rates were significantly lower (p < 0.05) and their RMSSD values and the log Total Power in their cardiac spectrograms were significantly greater during the Food Stroop vs. Office Stroop (p < 0.01, Bonferroni corrected). In conclusion Eating Restraint scores in CWL participants correlated with their Stroop heart rates, while the P200 latencies evoked by the Stroop cues correlated with the log high frequency power in their cardiac spectrograms (marker of cardiac vagal activation) during the Food Stroop task. This provides evidence that even 12 months after successful weight loss maintenance the cardiac ANS reactivity to food cues while completing a cognitive performance test was still different to that in individuals of normal weight who never weight cycled. Across all participants the cardiac ANS reactivity evoked by performing the Stroop task was lowered by food cues suggesting that the dampening effect of food cues on cardiac ANS reactivity may be one of the drivers of ‘stress induced' eating.
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Affiliation(s)
- Henri G Laurie Rauch
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - David J Hume
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Fleur M Howells
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jacolene Kroff
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Estelle Victoria Lambert
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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33
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Smets E, De Raedt W, Van Hoof C. Into the Wild: The Challenges of Physiological Stress Detection in Laboratory and Ambulatory Settings. IEEE J Biomed Health Inform 2018; 23:463-473. [PMID: 30507517 DOI: 10.1109/jbhi.2018.2883751] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Stress and mental health have become major concerns worldwide. Research has already extensively investigated physiological signals as quantitative and continuous markers of stress. In recent years, the focus of the field has shifted from the laboratory to the ambulatory environment. We provide an overview of physiological stress detection in laboratory settings with a focus on identifying physiological sensing priorities, including electrocardiogram, skin conductance, and electromyogram, and the most suitable machine learning techniques, of which the choice depends on the context of the application. Additionally, an overview is given of new challenges ahead to move toward the ambulant environment, including the influence of physical activity, lower signal quality due to motion artifacts, the lack of a stress reference, and the subject-dependent nature of the physiological stress response. Finally, several recommendations for future research are listed, focusing on large-scale, longitudinal trials across different population groups and just-in-time interventions to move toward disease prevention and interception.
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Kangas P, Tikkakoski A, Uitto M, Viik J, Bouquin H, Niemelä O, Mustonen J, Pörsti I. Metabolic syndrome is associated with decreased heart rate variability in a sex-dependent manner: a comparison between 252 men and 249 women. Clin Physiol Funct Imaging 2018; 39:160-167. [PMID: 30307694 DOI: 10.1111/cpf.12551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022]
Abstract
Impaired heart rate variability (HRV) is associated with increased risk of cardiovascular disease, but evidence regarding alterations of HRV in metabolic syndrome (MetS) remains elusive. In order to examine HRV in MetS, we subjected 501 volunteers without atherosclerosis, diabetes or antihypertensive medication, mean age 48 years, to passive head-up tilt. The subjects were divided to control men (n = 131), men with MetS (n = 121), control women (n = 191) and women with MetS (n = 58) according to the criteria by Alberti et al. (Circulation, 2009, 120, 1640). In unadjusted analyses (i) men and women with MetS had lower total power and high-frequency (HF) power of HRV than controls whether supine or upright (P<0·05 for all). (ii) Supine low-frequency (LF) power of HRV was lower in men (P = 0·012) but not in women (P = 0·064) with MetS than in controls, while men and women with MetS had lower upright LF power of HRV than controls (P <0·01 for both). (iii) The LF:HF ratio did not differ between subjects with and without MetS. After adjustment for age, smoking habits, alcohol intake, height, heart rate and breathing frequency, only the differences in upright total power and HF power of HRV between women with MetS and control women remained significant (P<0·05). In conclusion, reduced total and HF power of HRV in the upright position may partially explain why the relative increase in cardiovascular risk associated with MetS is greater in women than in men. Additionally, the present results emphasize that the confounding factors must be carefully taken into consideration when evaluating HRV.
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Affiliation(s)
- Pauliina Kangas
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Antti Tikkakoski
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Marko Uitto
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Jari Viik
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Heidi Bouquin
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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35
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Yu B, Funk M, Hu J, Wang Q, Feijs L. Biofeedback for Everyday Stress Management: A Systematic Review. ACTA ACUST UNITED AC 2018. [DOI: 10.3389/fict.2018.00023] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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36
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McAusland L, Addington J. Biofeedback to treat anxiety in young people at clinical high risk for developing psychosis. Early Interv Psychiatry 2018; 12:694-701. [PMID: 27573093 PMCID: PMC5376371 DOI: 10.1111/eip.12368] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/01/2016] [Accepted: 06/12/2016] [Indexed: 12/19/2022]
Abstract
AIM Anxiety is a common presenting concern for individuals at clinical high risk (CHR) for psychosis. Treatment for CHR is still in the early stages and has focused on transition to psychosis and positive symptom reduction, but little is known about what may be effective in reducing anxiety for these young people. One treatment that may be effective for anxiety is heart rate variability (HRV) biofeedback. The aim of this study was to test the efficacy and feasibility of using HRV biofeedback to reduce anxiety and distress in those at CHR. METHODS Twenty participants who met minimum scores for anxiety and distress completed 4 weeks of an HRV biofeedback intervention and received pre- and post-intervention assessments. Repeated measures were used to examine changes in scores over time. RESULTS There was a significant decrease in impaired ability to tolerate normal stressors (P ≤ 0.001) and dysphoric mood (P ≤ 0.001) over time. There was no change on self-reported measures of anxiety and distress. However, when two outliers were removed there was a trend towards improvement in self-reported anxiety (P = 0.07). These results were not impacted by including usage time as a covariate. Feedback and adherence were significant. CONCLUSIONS HRV biofeedback may be a feasible treatment option for individuals at CHR who have concerns with impaired stress tolerance and dysphoric mood. Future studies with a randomized controlled trial design will be necessary to further determine efficacy.
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Affiliation(s)
- Laina McAusland
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jean Addington
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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37
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Positive Effects of Diaphragmatic Breathing on Physiological Stress Reactivity in Varsity Athletes. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2018. [DOI: 10.1123/jcsp.2016-0041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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38
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Inhibiting the Physiological Stress Effects of a Sustained Attention Task on Shoulder Muscle Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010115. [PMID: 29324693 PMCID: PMC5800214 DOI: 10.3390/ijerph15010115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/29/2022]
Abstract
Objective: The objective of this study was to investigate if a breathing technique could counteract the effects of hyperventilation due to a sustained attention task on shoulder muscle activity. Background: The trend towards higher levels of automation in industry is increasing. Consequently, manufacturing operators often monitor automated process for long periods of their work shift. Prolonged monitoring work requires sustained attention, which is a cognitive process that humans are typically poor at and find stressful. As sustained attention becomes an increasing requirement of manufacturing operators’ job content, the resulting stress experienced could contribute to the onset of many health problems, including work related musculoskeletal disorders (WRMSDs). Methods: The SART attention test was completed by a group of participants before and after a breathing intervention exercise. The effects of the abdominal breathing intervention on breathing rate, upper trapezius muscle activity and end-tidal CO2 were evaluated. Results: The breathing intervention reduced the moderation effect of end-tidal CO2 on upper trapezius muscle activity. Conclusions: Abdominal breathing could be a useful technique in reducing the effects of sustained attention work on muscular activity. Application: This research can be applied to highly-automated manufacturing industries, where prolonged monitoring of work is widespread and could, in its role as a stressor, be a potential contributor to WRMSDs.
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Zauszniewski J, Musil C, Herbell K, Givens S. Biofeedback in Grandmothers Raising Grandchildren: Evaluating Intervention Parameters. Issues Ment Health Nurs 2017; 38:493-499. [PMID: 28605245 DOI: 10.1080/01612840.2016.1277410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined the six critical parameters for evaluating interventions, including necessity, acceptability, feasibility, safety, fidelity, and effectiveness, of a heart rate variability (HRV) biofeedback training intervention in a sample of 20 grandmothers who were the primary caregivers of their grandchildren. After the grandmothers completed the HRV biofeedback training, they answered open-ended questions to provide data on the six parameters during face-to-face interviews. The findings of the study provided evidence for the necessity, acceptability, feasibility, safety, fidelity, and effectiveness of the HRV biofeedback intervention for reducing the stress experienced by grandmothers in raising their grandchildren.
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Affiliation(s)
- Jaclene Zauszniewski
- a Frances Payne Bolton School of Nursing , Case Western Reserve University , Cleveland , Ohio , USA
| | - Carol Musil
- b Bolton School of Nursing , Case Western Reserve University , Cleveland , Ohio , USA
| | - Kayla Herbell
- b Bolton School of Nursing , Case Western Reserve University , Cleveland , Ohio , USA
| | - Sarah Givens
- b Bolton School of Nursing , Case Western Reserve University , Cleveland , Ohio , USA
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40
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Christmann CA, Hoffmann A, Bleser G. Stress Management Apps With Regard to Emotion-Focused Coping and Behavior Change Techniques: A Content Analysis. JMIR Mhealth Uhealth 2017; 5:e22. [PMID: 28232299 PMCID: PMC5344985 DOI: 10.2196/mhealth.6471] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/03/2017] [Accepted: 02/03/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic stress has been shown to be associated with disease. This link is not only direct but also indirect through harmful health behavior such as smoking or changing eating habits. The recent mHealth trend offers a new and promising approach to support the adoption and maintenance of appropriate stress management techniques. However, only few studies have dealt with the inclusion of evidence-based content within stress management apps for mobile phones. OBJECTIVE The aim of this study was to evaluate stress management apps on the basis of a new taxonomy of effective emotion-focused stress management techniques and an established taxonomy of behavior change techniques. METHODS Two trained and independent raters evaluated 62 free apps found in Google Play with regard to 26 behavior change and 15 emotion-focused stress management techniques in October 2015. RESULTS The apps included an average of 4.3 behavior change techniques (SD 4.2) and 2.8 emotion-focused stress management techniques (SD 2.6). The behavior change technique score and stress management technique score were highly correlated (r=.82, P=.01). CONCLUSIONS The broad variation of different stress management strategies found in this sample of apps goes in line with those found in conventional stress management interventions and self-help literature. Moreover, this study provided a first step toward more detailed and standardized taxonomies, which can be used to investigate evidence-based content in stress management interventions and enable greater comparability between different intervention types.
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Affiliation(s)
- Corinna Anna Christmann
- Junior research group wearHEALTH, Department of Computer Science, University of Kaiserslautern, Kaiserslautern, Germany
| | - Alexandra Hoffmann
- Junior research group wearHEALTH, Department of Computer Science, University of Kaiserslautern, Kaiserslautern, Germany
| | - Gabriele Bleser
- Junior research group wearHEALTH, Department of Computer Science, University of Kaiserslautern, Kaiserslautern, Germany
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41
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Attenuating Physiological Arousal Through the Manipulation of Simple Hand Movements. Appl Psychophysiol Biofeedback 2017; 42:39-50. [PMID: 28188383 DOI: 10.1007/s10484-017-9350-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current study tests whether manipulating simple motor movements can regulate one's physiological reactivity to negative images. Healthy college age participants were randomly assigned to no tapping, steady tapping, or slow tapping conditions and viewed two sets of 15 negative images from the international affective picture system. Participants viewed the first image set without manipulation. During the second image set, they were instructed to tap at a steady pace, a slow pace or not at all. Steady tapping suppressed the vagal component of the cardiovascular defense response, and produced a significant increase in respiration rate and skin conductance level (SCL). Slow tapping suppressed the sympathetic and enhanced the vagal components of the cardiovascular defensive response, and produced a decrease in heart rate, SCL and skin conductance responses to negative images. Results suggest that manipulating simple motor movements is an effective way to both up-regulate and more importantly, down-regulate one's physiological response to negative affective images. Manipulation of slow and simple motor movements may be an effective means to attenuate autonomic arousal.
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42
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Russell MEB, Scott AB, Boggero IA, Carlson CR. Inclusion of a rest period in diaphragmatic breathing increases high frequency heart rate variability: Implications for behavioral therapy. Psychophysiology 2016; 54:358-365. [PMID: 27925652 DOI: 10.1111/psyp.12791] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 10/06/2016] [Indexed: 01/22/2023]
Abstract
Heart rate variability (HRV) is associated with positive physiological and psychological effects. HRV is affected by breathing parameters, yet debate remains regarding the best breathing interventions for strengthening HRV. The objective of the current study was to test whether the inclusion of a postexhalation rest period was effective at increasing HRV, while controlling for breathing rate. A within-subject crossover design was used with 40 participants who were assigned randomly to a breathing pattern including a postexhalation rest period or a breathing pattern that omitted the postexhalation rest period. Participants completed training on each breathing pattern, practiced for 6 min, and sat quietly during a 5-min washout period between practices. Participants were given instructions for diaphragmatic breathing at a pace of six breaths/minute with or without a postexhalation rest period. Recordings of heart rate, breathing rate, HF-HRV, RMSSD, LF-HRV, and SDNN were collected before and during each of the breathing trials. HRV indices were derived from Lead 1 ECG recordings. Pairwise contrasts showed that inclusion of a postexhalation rest period significantly decreased heart rate (p < .001) and increased HF-HRV (p < .05). No differences were found for breathing rates (p > .05), RMSSD (p > .05), and SDNN (p > .05). Results indicated that omission of the postexhalation rest period resulted in higher LF-HRV (p < .05). A postexhalation rest period improves HF-HRV, commonly associated with self-regulatory control, yet the importance of a postexhalation rest period requires further exploration.
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Affiliation(s)
| | - April B Scott
- Psychology Department, University of Kentucky, Lexington, Kentucky, USA
| | - Ian A Boggero
- Psychology Department, University of Kentucky, Lexington, Kentucky, USA
| | - Charles R Carlson
- Psychology Department, University of Kentucky, Lexington, Kentucky, USA.,College of Dentistry, Division of Orofacial Pain, University of Kentucky, Lexington, Kentucky, USA
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43
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A randomized-controlled trial of heart rate variability biofeedback for psychotic symptoms. Behav Res Ther 2016; 87:207-215. [PMID: 27768984 DOI: 10.1016/j.brat.2016.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 10/03/2016] [Accepted: 10/10/2016] [Indexed: 01/19/2023]
Abstract
Arousal and the way it is coped with are relevant to the emergence of psychotic symptoms. Heart rate variability (HRV) stems from autonomic responses to environmental demands such as stress and is an index of physiological arousal, adaptability, and homeostatic reflexes forming autonomic balance. A randomized-controlled between-subjects trial that compared HRV-biofeedback (BF) to an active relaxation and to a waiting control condition was conducted in a sample with attenuated subclinical psychotic symptoms (N = 84). A 20-min intervention was preceded and followed by repeated assessments of stress responses. Change scores of the post-stress periods were analyzed using ANOVAs for HRV, subjective stress, perceived control, and state paranoia. As expected, BF participants showed greater improvements in perceived control than waiting controls (p = 0.006). However, no group differences occurred in HRV, paranoid symptoms or subjective stress. In exploratory analyses in a subset of participants who were breathing per protocol, the expected effects were found for total HRV and state paranoia. Thus, this trial of HRV-BF for people with attenuated psychotic symptoms indicates that the intervention may hold potential if conducted per protocol. To reach this, longer training might be inevitable. Future studies are needed to further elucidate efficacy and applicability of HRV-BF in clinical samples.
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44
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Koya K, Sice P, Rauch L. An enactive perspective on comprehending leadership: A comparative case study approach. HUMAN SYSTEMS MANAGEMENT 2016. [DOI: 10.3233/hsm-160869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kushwanth Koya
- Department of Computers and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle City Campus, Newcastle-upon-Tyne, United Kingdom
| | - Petia Sice
- Department of Computers and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle City Campus, Newcastle-upon-Tyne, United Kingdom
| | - Laurie Rauch
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, University of Cape Town, Sports Science Institute of South Africa, Newlands, Cape Town, South Africa
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45
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Kim JH, Bae HS, Park SS. The Effects of Breath-Counting Meditation and Deep Breathing on Heart Rate Variability. ACTA ACUST UNITED AC 2016. [DOI: 10.13048/jkm.16019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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46
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Abbreviated Resonant Frequency Training to Augment Heart Rate Variability and Enhance On-Demand Emotional Regulation in Elite Sport Support Staff. Appl Psychophysiol Biofeedback 2016; 41:263-74. [DOI: 10.1007/s10484-015-9330-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Meier NF, Welch AS. Walking versus biofeedback: a comparison of acute interventions for stressed students. ANXIETY STRESS AND COPING 2015; 29:463-78. [DOI: 10.1080/10615806.2015.1085514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Nathan F. Meier
- Department of Kinesiology, College of Human Sciences, Iowa State University, Ames, IA, USA
| | - Amy S. Welch
- Department of Environmental & Health Sciences, Johnson State College, Johnson, VT, USA
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Evans S, Seidman LC, Tsao JC, Lung KC, Zeltzer LK, Naliboff BD. Heart rate variability as a biomarker for autonomic nervous system response differences between children with chronic pain and healthy control children. J Pain Res 2013; 6:449-57. [PMID: 23788839 PMCID: PMC3684221 DOI: 10.2147/jpr.s43849] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Studies in adults have demonstrated a relationship between lowered heart rate variability (HRV) and poor health. However, less is known about the role of autonomic arousal in children’s well-being. The aim of the current study was to examine resting HRV in children with chronic pain compared to healthy control children and, further, to examine children’s HRV following a series of acute experimental pain tasks in both groups. Participants included 104 healthy control children and 48 children with chronic pain aged 8–17 years. The laboratory session involved a 5-minute baseline electrocardiogram followed by four pain induction tasks: evoked pressure, cold pressor, focal pressure, and a conditioned pain modulation task. After the tasks were complete, a 5-minute post-task electrocardiogram recording was taken. Spectral analysis was used to capture high-frequency normalized power and the ratio of low-to-high frequency band power, signifying cardiac vagal tone and sympathetic balance, respectively. Results revealed that children with chronic pain had significantly lower resting HRV (signified by low high-frequency normalized power and high ratio of low-to-high frequency band power) compared to healthy children; moreover, a significant interaction between groups and time revealed that children with chronic pain displayed a static HRV response to the pain session compared to healthy children, whose HRV was reduced concomitant with the pain session. These findings suggest that children with chronic pain may have a sustained stress response with minimal variability in response to new acute pain stressors.
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Affiliation(s)
- Subhadra Evans
- Pediatric Pain Program, University of California, Los Angeles, CA, USA
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