Cardiovascular reactivity in real life settings: measurement, mechanisms and meaning

Individual differences in parasympathetic nervous system reactivity in response to everyday stress are associated with momentary emotional exhaustion

Acute stressors (e.g., time pressure) can provoke psychological and physiological stress responses, and the magnitude of such responses is called stress reactivity. However, stress reactivity levels can differ considerably among individuals, with exaggerated levels being associated with adverse outcomes (e.g., emotional exhaustion). Previous studies have primarily investigated psychological stress reactivity or physiological stress reactivity induced in the laboratory. Physiological stress reactivity, especially concerning heart rate variability (HRV), has rarely been examined so far in real life. We addressed this research gap in a sample of 394 adults who participated in 2- to 4-day ecological momentary assessments. Individuals answered self-reports on perceived time pressure and emotional exhaustion multiple times a day and simultaneously wore electrocardiogram sensors. Based on 4,009 total situations and 3-16 situations per participant, individual differences in HRV reactivity to time pressure were computed as random slopes from multilevel models. Consistent with preregistered hypotheses, increased time pressure was associated with reduced HRV, and increased stress reactivity was associated with increased emotional exhaustion. The findings highlight the detrimental effects of everyday demands and physiological reactivity and emphasize the relevance of practical coping strategies. This study contributes to research on dynamic inter- and intraindividual stress regulation using ambulatory, psychophysiological methods.

Reduced heart rate variability is related to fluctuations in psychological stress levels in daily life

Laboratory-based studies have shown that psychological stress caused by response to various stressors triggers acute changes in the cardiovascular system. A better understanding is needed of the emerging evidence on temporal associations between psychological stress and cardiovascular responses in natural settings. This study examined the association of psychological stress and heart rate variability (HRV) in daily life, at high resolution over 2 weeks, taking the effect of physical activity into account. Participants (n = 34) completed ecological momentary assessments (EMA) 6 times per day, reporting levels of perceived stress, low-arousal negative affect (LNA), and high-arousal negative affect. Chest-mounted heart-rate monitors were worn to assess HRV. Multilevel models were used to examine the association between psychological stress levels and preceding/subsequent HRV. Reduced time domain HRV measures (mean and standard deviation of R-wave to R-wave intervals) during the prior hour predicted higher levels of perceived stress. Frequency domain HRV measures higher low to high frequency (LF/HF) and lower HF to total power (HF nu) ratios during the preceding 10 min predicted higher perceived stress levels, suggesting the dominance of sympathetic nervous system activity. EMA reports of higher perceived stress levels were associated with reduced time domain HRV measures during the following 10 min. On the other hand, higher LNA were related to increased HRV measures, such as lower LF/HF and higher HF nu during the following hour. The dynamic associations observed may have therapeutic implications for 'just-in-time' interventions in the management of daily stress and cardiovascular health.

Stress and cardiovascular disease: an update

Psychological stress is generally accepted to be associated with an increased risk of cardiovascular disease (CVD), but results have varied in terms of how stress is measured and the strength of the association. Additionally, the mechanisms and potential causal links have remained speculative despite decades of research. The physiological responses to stress are well characterized, but their contribution to the development and progression of CVD has received little attention in empirical studies. Evidence suggests that physiological responses to stress have a fundamental role in the risk of CVD and that haemodynamic, vascular and immune perturbations triggered by stress are especially implicated. Stress response physiology is regulated by the corticolimbic regions of the brain, which have outputs to the autonomic nervous system. Variation in these regulatory pathways might explain interindividual differences in vulnerability to stress. Dynamic perturbations in autonomic, immune and vascular functions are probably also implicated as CVD risk mechanisms of chronic, recurring and cumulative stressful exposures, but more data are needed from prospective studies and from assessments in real-life situations. Psychological assessment remains insufficiently recognized in clinical care and prevention. Although stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, more data from randomized trials are needed.

Cardiovascular reactivity to acute psychological stress is associated with generalized self-efficacy and self-efficacy outcomes during adventure challenges

Outdoor adventure challenges are commonly used to enhance self-efficacy, but the physiological mechanisms involved remain unexplored. Additionally, while studies have documented the influence of self-efficacy on stress management, general self-efficacy has yet to be fully understood in the context of cardiovascular stress reactivity (CVR). This study investigated the influence of self-efficacy beliefs on CVR during acute psychological stress tasks. Additionally, it explored whether CVR serves as a novel mechanism underlying the outcomes of outdoor adventure challenges. As part of a wider randomized controlled trial, participants (n = 55) were invited to complete a laboratory session to assess CVR to an active (paced auditory serial addition test (PASAT)) and a passive (cold pressor test (CPT)) stress task. Randomized participants (n = 33) to the experimental condition also engaged in a high ropes challenge course after the laboratory session. It was found that greater self-reported self-efficacy was associated with larger CVR during the CPT and positively associated with perceived engagement and performance during the PASAT. Secondly, participants reporting positive change in self-efficacy post-intervention were associated with greater CVR and greater CVR was associated with higher ratings of intervention engagement and perceived challenge. This study provides preliminary evidence suggesting that greater efficacy beliefs may heighten CVR to passive acute psychological stressors. Habitual stress reactivity may represent a novel mechanism involved in outdoor and adventure-based interventions. Future research should continue to explore the impact of psychological variables on stress physiology and examine CVR as a potential mechanism in adventure experiences.

Stress-Induced Autonomic Dysfunction is Associated With Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease

BACKGROUND

Mental stress-induced myocardial ischemia (MSIMI) is associated with adverse cardiovascular outcomes in individuals with coronary artery disease, but the mechanisms underlying this phenomenon are unknown. We examined the relationship between stress-induced autonomic dysfunction, measured by low heart rate variability (HRV) in response to stress, and MSIMI in patients with stable coronary artery disease. We hypothesized that stress-induced autonomic dysfunction is associated with higher odds of MSIMI.

METHODS

In 735 participants with stable coronary artery disease, we measured high- and low-frequency HRV in 5-minute intervals before and during a standardized laboratory-based speech stressor using Holter monitoring. HRV at rest and stress were categorized into low HRV (first quartile) versus high HRV (second to fourth quartiles); the low category was used as an indicator of autonomic dysfunction. Multivariable logistic regression models were used to examine the association of autonomic dysfunction with MSIMI.

RESULTS

The mean age was 58 (SD, ±10) years, 35% were women, 44% were Black participants, and 16% developed MSIMI. Compared with high HRV during stress, low HRV during stress (both high and low frequencies) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors (odds ratio for high-frequency HRV, 2.1 [95% CI, 1.3-3.3]; odds ratio for low-frequency HRV, 2.1 [95% CI, 1.3-3.3]). Low-frequency HRV at rest was also associated with MSIMI but with slightly reduced effect estimates.

CONCLUSIONS

In individuals with coronary artery disease, mental stress-induced autonomic dysfunction may be a mechanism implicated in the causal pathway of MSIMI.

Anxiety and heart rate in a real-life class test in undergraduates choosing real-time or prerecorded oral presentations

Most studies on acute stress stem from works conducted under artificial laboratory conditions. Inducing stress for experimental scrutiny is problematic and can be unethical. In this study, a 'research methods' course's curriculum included a demonstration study testing anxiety and heart rate responses to the midterm test. Fifty-four university students (35 males and 19 females) presented a research topic in-person (n = 14) or prerecorded while being present (n = 40). Students selected a test format they could change until the week before the midterm test. The measures were trait anxiety, test anxiety, state anxiety, heart rate (HR), the last two being measured before and after examination, and grades. All students manifested decreased state anxiety and increased HR from before to after the test. Females exhibited higher HR and state anxiety than males. Real-time presentations were associated with higher HRs but not higher state anxiety. Those who changed their planned presentation mode from in-person to prerecorded exhibited higher test anxiety but not trait anxiety than those who presented as planned. Students who presented in-person obtained lower grades than those who prerecorded their presentations. Grades were negatively correlated with state anxiety after the test, but test anxiety did not significantly mediate the grades. Pre-test state anxiety was positively associated with both trait anxiety and test anxiety. The findings suggest that test anxiety is unlikely to affect grades, but test-anxious students need more control over academic evaluation. A choice in test format could be helpful in this regard.

Do friends get under the skin?: Everyday social encounters and cardiovascular functioning among Black and White adults in the United States

OBJECTIVE

Studies have shown that contact with friends enhances emotional health, but little is known about whether friends influence cardiovascular health. This study investigated (a) whether encounters with friends and the quality of these encounters were associated with cardiovascular reactivity in everyday life and (b) whether these associations varied by race.

METHOD

Participants were from the Stress and Well-being in Everyday Life Study which included Black (n = 76; aged = 34-76) and White (n = 87, aged = 34-91) adults residing in the United States. Participants provided background and social network information in a baseline interview, followed by a 4-day ecological momentary assessment in which they reported social encounters every 3 hr. Concurrently, participants wore an electrocardiogram monitor which collected physiological data in real time. To assess cardiovascular reactivity, heart rate variability (HRV) was analyzed.

RESULTS

Multilevel models revealed that at times when individuals encountered friends (particularly positive encounters), they exhibited a momentary reduction in HRV (within-person association). But those with more friend encounters during the study period (particularly positive encounters) had higher HRV than those with fewer friend encounters during the study period (between-person association). These links were observed only among Black adults, but not among White adults.

CONCLUSIONS

This study contributes to the conceptual model of social integration and enriches the literature on racial disparities in cardiovascular health from a social perspective. Findings highlight the implications of engagement with friends for momentary cardiovascular reactivity and suggest that friends may be more salient for Black adults' cardiovascular health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comparison of the Perceived Stress Reactivity Scale with physiological and self-reported stress responses during ecological momentary assessment and during participation in a virtual reality version of the Trier Social Stress Test

Valid approaches to conveniently measure stress reactivity are needed due to the growing evidence of its health-impairing effects. This study examined whether the Perceived Stress Reactivity Scale (PSRS) predicts cardiovascular and psychological responses to psychosocial stressors during daily life and during a virtual reality (VR) Trier Social Stress Test (TSST). Medical students answered a standardized baseline questionnaire to assess perceived stress reactivity by the PSRS. The PSRS asks participants to rate the intensity of their typical affective responses to common stressors during daily life. They were further asked to participate in a VR-TSST and in an ecological momentary assessment (EMA) over a period of three consecutive workdays during daily life. Blood pressure and self-reported stress were repeatedly, heart rate variability (HRV) continuously measured during the VR-TSST and EMA. Furthermore, participants repeatedly assessed task demands, task control and social conflict during the EMA. Data was analysed using multilevel analysis and multiple linear regression. Results indicate that the PSRS moderates associations between blood pressure (but not HRV) and demands and control during daily life. Furthermore, the PSRS directly predicted self-reported stress, but did not moderate associations between self-reported stress and demands, control and social conflict. The PSRS did not predict physiological and self-reported stress responses to the VR-TSST. This study partly confirmed convergent validity of the PSRS to stress reactivity in daily life. Furthermore, the lack of association between the PSRS and stress responses to the VR-TSST calls for future studies to search for reliable and valid ways to assess stress reactivity.

Acute and Chronic Stress Associations With Blood Pressure: An Ecological Momentary Assessment Study on an App-Based Platform

OBJECTIVE

This study examined the within- and between-person associations of acute and chronic stress with blood pressure (BP) and heart rate (HR) using an app-based research platform.

METHODS

We examined data from 31,964 adults (aged 18-90 years) in an app-based ecological momentary assessment study that used a research-validated optic sensor to measure BP.

RESULTS

Within-person associations revealed that moments with (versus without) acute stress exposure were associated with higher systolic (SBP; b = 1.54) and diastolic BP (DBP; b = 0.79) and HR ( b = 1.53; p values < .001). During moments with acute stress exposure, higher acute stress severity than usual was associated with higher SBP ( b = 0.26), DBP ( b = 0.09), and HR ( b = 0.40; p values < .05). During moments without acute stress, higher background stress severity than usual was associated with higher BP and HR (SBP: b = 0.87, DBP: b = 0.51, HR: b = 0.69; p values < .001). Between-person associations showed that individuals with more frequent reports of acute stress exposure or higher chronic stress severity had higher SBP, DBP, and HR ( p values < .05). Between-person chronic stress severity moderated within-person physiological responses to stress such that individuals with higher chronic stress severity had higher average BP and HR levels but showed smaller responses to momentary stress.

CONCLUSIONS

Technological advancements with optic sensors allow for large-scale physiological data collection, which provides a better understanding of how stressors of different timescales and severity contribute to momentary BP and HR in daily life.

Appropriate Circadian-Circasemidian Coupling Protects Blood Pressure from Morning Surge and Promotes Human Resilience and Wellbeing

Background

Blood pressure (BP) variability is involved in the appraisal of threat and safety, and can serve as a potential marker of psychological resilience against stress. The relationship between biological rhythms of BP and resilience was cross-sectionally assessed by 7-day/24-hour chronobiologic screening in a rural Japanese community (Tosa), with focus on the 12-hour component and the "circadian-circasemidian coupling" of systolic (S) BP.

Subjects and Methods

Tosa residents (N = 239, 147 women, 23-74 years), free of anti-hypertensive medication, completed 7-day/24-hour ambulatory BP monitoring. The circadian-circasemidian coupling was determined individually by computing the difference between the circadian phase and the circasemidian morning-phase of SBP. Participants were classified into three groups: those with a short coupling interval of about 4.5 hours (Group A), those with an intermediate coupling interval of about 6.0 hours (Group B), and those with a long coupling interval of about 8.0 hours (Group C).

Results

Residents of Group B who showed optimal circadian-circasemidian coordination had less pronounced morning and evening SBP surges, as compared to residents of Group A (10.82 vs 14.29 mmHg, P < 0.0001) and Group C (11.86 vs 15.21 mmHg, P < 0.0001), respectively. The incidence of morning or evening SBP surge was less in Group B than in Group A (P < 0.0001) or Group C (P < 0.0001). Group B residents showed highest measures of wellbeing and psychological resilience, assessed by good relation with friends (P < 0.05), life satisfaction (P < 0.05), and subjective happiness (P < 0.05). A disturbed circadian-circasemidian coupling was associated with elevated BP, dyslipidemia, arteriosclerosis and a depressive mood.

Conclusion

The circadian-circasemidian coupling of SBP could serve as a new biomarker in clinical practice to guide precision medicine interventions aimed at achieving properly timed rhythms, and thereby resilience and wellbeing.

Heart rate variability predicts outcome of short-term psychotherapy at the workplace

The bio-psycho-social model highlights intra-individual and inter-individual interactions, including psychotherapy. The processing of these interactions within a person takes place, among others, in the central autonomic network (CAN). The CAN's autonomic output to the periphery can be indexed by heart rate variability (HRV), representing individual adaptive capacity. Further, the CAN influences the hypothalamus-pituitary-adrenal axis with its product cortisol. The aim consisted in investigating HRV and cortisol as well as their relation to symptom course in response to short-term psychotherapy. A single-arm, uncontrolled, explorative study was conducted at an outpatient psychotherapeutic consultation in the workplace offered to employees with mental or psychosomatic complaints. Questionnaires included symptoms of depression, irritation and functional impairment. Circadian profile of HRV and salivary cortisol concentrations collected pre and post short-term psychotherapeutic intervention (4-12 sessions) were assessed. Multilevel-linear mixed regressions were calculated. Out of 29 participants (mean age 42; 72% female), 24% were on sick leave from work. Cortisol concentrations were neither affected by intervention nor by symptom course. The proportion of individuals showing a vagally mediated HRV in the range of the lowest quartile assessed for age- and sex-matched healthy controls was reduced at follow-up (pre 34%, post 22%; p = .017). Higher vagally mediated HRV at baseline predicted lower symptom burden at follow-up. Thus, the results support the assumption that HRV reflects the capability of an organism to adapt and recover. Patients with reduced HRV might need additional psychotherapeutic sessions to achieve the same symptom improvements than patients with retained HRV.

Effects of Olfactory Stimulation with Aroma Oils on Psychophysiological Responses of Female Adults

This study investigated the effects of olfactory stimulation with aroma oils on the psychophysiological responses in women. Ten aromatic oils (lavender, rosemary, rose, eucalyptus, jasmine, geranium, chamomile, clary sage, thyme, and peppermint) were used on 23 women aged between 20 and 60 years. They inhaled the scent for 90 s through a glass funnel attached to their lab apron, 10 cm below their nose, while the pump was activated. Electroencephalography, blood pressure, and pulse rate were measured before and during inhalation of the aroma oils. The relative alpha (RA) power spectrums indicating relaxation and resting state of the brain significantly increased when lavender, rosemary, eucalyptus, jasmine, chamomile, clary sage, and thyme oils were inhaled compared to those of before olfactory stimulation. The ratio of alpha to high beta (RAHB), an indicator of brain stability and relaxation, significantly increased when rosemary, jasmine, clary sage, and peppermint oils were inhaled. The relative low beta (RLB) power spectrum, an indicator of brain activity in the absence of stress, significantly increased when stimulated with lavender, rosemary, rose, and geranium scents. Further, systolic blood pressure significantly decreased after introduction of all 10 types of aromatic oils, which indicates stress reduction. Thus, olfactory stimulation with aroma oil had a stabilizing effect on the prefrontal cortex and brain activity and decreased systolic blood pressure.

Changes in vitality in response to acute stress: an investigation of the role of anxiety and physiological reactivity

Background: Feeling alive and invigorated, or vitality, is examined within the framework of a stress paradigm. The current study investigated whether endocrine and cardiovascular responses to acute psychological stress predict declines in vitality.Methods: A sample of 90 undergraduate students completed an in-lab stressor. We measured anxiety, state vitality, cortisol levels, heart rate, and blood pressure before the task, and measured changes in state vitality, cortisol, heart rate, and blood pressure in response to the stressor. We investigated whether pre-task anxiety predicted changes in state vitality, and whether such changes were explained by physiological responses.Results: Results indicate that cognitive and somatic anxiety preceding a stressor predict changes in vitality, which is mediated by the magnitude of diastolic (95% CI [0.017, 0.517]; [0.006, 0.454]) and systolic (95% CI [0.038, 0.705]) blood pressure responses to the task. Cortisol reactivity was associated with somatic anxiety (F(6, 83) = 3.34, p < .01, β = 0.401) but was not related to changes in vitality.Conclusions: Together, these results contribute to the understanding of how physiological reactivity to a stressor can deplete vitality.

A Pilot Study of Temporal Associations Between Psychological Stress and Cardiovascular Response

Psychological stress (PS) in daily life can trigger acute changes in cardiovascular function and may lead to increased risk of cardiovascular problems. Prior laboratory-based studies provide little evidence on temporal changes in the associations between PS and cardiovascular responses in natural settings. We hypothesized that daily PS would be associated with higher heart rate (HR) and lower heart rate variability (HRV). Using smartphones, ten participants (four females, 21.1±1.1 years) completed ecological momentary assessment (EMA) 6 times a day for two weeks regarding their current affective state. Participants rated levels of PS, as well as 3 high-arousal negative affect (HNA: Anxious, Annoyed, and Upset), and 3 low-arousal negative affect (LNA: Sluggish, Bored, and Sad) states. They also wore a chest-mounted heart-rate monitor and a wrist accelerometer to monitor cardiovascular response and physical activity, respectively. HR and HRV variables in the time intervals (5, 30, 60 min) before and after EMA were used as indicators of cardiovascular response. Multilevel modeling was used to examine the association between affect and HR/HRV, controlling for physical activity. Higher HR and lower HRV were related to subsequent greater feelings of stress at the 5 and 30-min time intervals. No significant associations were observed between cardiovascular parameters and subsequent affective states, suggesting that the acute exaggerated cardiovascular responses occurred due to PS. Higher LNA was related to antecedent/subsequent lower HR or higher HRV within 2 hours, while HNA was unrelated to HR or HRV for all time intervals, suggesting that both high/low arousal NA were not related to exaggerated cardiovascular response. Understanding psychological feelings of stress and LNA may be helpful in the management of daily cardiovascular health.

A Matter of the Heart: Daytime Relationship Functioning and Overnight Heart Rate in Young Dating Couples

BACKGROUND

Although past longitudinal research demonstrates that romantic partners affect one another's health outcomes, considerably less is known about how romantic experiences "get under the skin" in everyday life.

PURPOSE

The current study investigated whether young couples' naturally occurring feelings of closeness to and annoyance with each other during waking hours were associated with their overnight cardiovascular activity.

METHODS

Participants were 63 heterosexual young adult dating couples (Mage = 23.07). Using ecological momentary assessments, couples reported their hourly feelings of closeness to and annoyance with their partners across 1 day; subsequent overnight heart rate was captured through wearable electrocardiogram biosensors. Actor-partner interdependence models tested whether individuals' overnight heart rate varied as a function of (a) their own daytime feelings of closeness and annoyance (actor effects) and (b) their partner's daytime feelings of closeness and annoyance (partner effects) while controlling for daytime heart rate.

RESULTS

Although young adults' feelings of romantic closeness and annoyance were unrelated to their own overnight heart rate (i.e., no actor effects), gender-specific partner effects emerged. Young men's nocturnal heart rate was uniquely predicted by their female partner's daytime relationship feelings. When women felt closer to their partners during the day, men exhibited lower overnight heart rate. When women felt more annoyed with their partners during the day, men exhibited heightened overnight heart rate.

CONCLUSIONS

The findings illustrate gender-specific links between couple functioning and physiological arousal in the everyday lives of young dating couples, implicating physiological sensitivity to partner experiences as one potential pathway through which relationships affect health.

What Can We Learn From More Than 140,000 Moments of Ecological Momentary Assessment-Assessed Negative Emotion and Ambulatory Blood Pressure? A Systematic Review and Meta-Analysis

OBJECTIVE

Two decades of research has examined within-person associations between negative emotion states and ambulatory blood pressure (ABP) using ecological momentary assessment (EMA), but no meta-analysis has been conducted. We conducted this systematic review and meta-analysis to quantify the magnitude of this association and identify moderators, review strengths and weaknesses in conceptual and measurement approaches, and provide recommendations.

METHODS

We searched databases (PsycINFO, PubMed), identified 15 studies, and obtained data from 13 studies (n = 2511; 142,307 observations).

RESULTS

Random-effects meta-analyses demonstrated small effect r values between momentary negative emotions and systolic ABP (r = 0.06) and diastolic ABP (r = 0.05; p values < .001). Meta-regressions found that effects were larger among studies focused on anxiety, multidimensional negative emotions, predominantly female samples, or less observations of each participant (p values from .003 to .049). A qualitative review found that few studies examined moderators contributing to the substantial interindividual differences in this association.

CONCLUSIONS

The small association between momentary negative emotion and ABP extends laboratory findings on the association between the experiential and physiological aspects of emotion to the daily, natural emotional experiences of individuals. This literature could be strengthened by determining interindividual and intraindividual moderators of this association (e.g., trait negative emotion and state positive emotion), examining differential associations of different negative emotions with ABP, and standardizing EMA protocols. Although the effect is small, to the extent that repeated emotion-related cardiovascular reactivity may contribute to cardiovascular disease risk, identifying daily life triggers of emotion is important.

Eveningness, depression and cardiovascular reactivity to acute psychological stress: A mediation model

The psychological pathways linking depression to blunted cardiovascular reactivity (CVR) are still being elucidated. The purpose of the present study was to test whether the association between eveningness, a diurnal/sleep-wake preference and CVR would be mediated by depressive symptoms. One hundred and eighty-two healthy young adults completed measures of morningness/eveningness (the Morningness-Eveningness Questionnaire; MEQ-SA), depressive symptoms (Hospital Anxiety and Depression Scale; HADS) and had their blood pressure and heart rate monitored throughout a standardised stress testing protocol. Results indicated that depressive symptoms were negatively associated with systolic blood pressure (SBP) but not diastolic blood pressure (DBP) or heart rate (HR) reactions to the stress task. Eveningness was also negatively associated with both SBP and DBP, but not HR. As such, those who reported increased depressive symptomology, and higher scores on eveningness displayed a more blunted cardiovascular response. Furthermore, the latter relationship was mediated by depressive symptoms such that those reporting higher scores on eveningness also reported increased depressive symptomology and this resulted in blunted CVR for SBP. These findings withstood adjustment for several confounding factors including time of testing. In conclusion, the present findings highlight the importance of considering eveningness when looking at the depression-blunted CVR relationship.

Associations between positively valenced affect and health behaviors vary by arousal

Evidence is mixed with regard to whether positively valanced affect (PA) is associated with engagement in health behaviors. Both affective arousal (activated/deactivated) and level of analysis (between and within-person) may influence such associations. Adults (N = 121; 25-65 years) completed ambulatory assessments of affect and daily reports of sleep, diet, and physical/sedentary activity. Patterns of association were generally consistent at between and within-person levels, although associations varied by arousal. Activated PA was positively associated with action tendencies (i.e., higher physical activity, lower sedentary activities) and riskier behaviors (such as poor diet) whereas deactivated PA was positively associated with engaging in satiety and rest (i.e., better diet, better sleep quality, and more sedentary activity). Results were maintained when covarying for indicators of relative socioeconomic advantage and neuroticism. Overall, arousal appears to be related to the nature of the associations between PA and health behaviors, highlighting the importance of assessing and evaluating a range of arousal states.

Attenuation of stress-induced cardiovascular reactivity following high-intensity interval exercise in untrained males

Exaggerated cardiovascular (CV) reactivity to stress is associated with negative cardiovascular outcomes. This study aimed to investigate the effects of acute high-intensity interval exercise (HIIE) and moderate-intensity exercise (MIE) on CV reactivity in response to a stress challenge in untrained males. Thirteen, normotensive males (age: 22.8 ± 2 years, BMI: 21.9 ± 3.6 kg/m²) underwent three conditions in counterbalanced order: HIIE (bodyweight exercises; 80-90% HRR), MIE (treadmill-jog; 55-60% HRR) and seated rest (CON) separated by 7-10 days. Thirty minutes after performing HIIE, MIE or CON, subjects underwent a 2-min cold pressor task (CPT). Blood pressure (BP) and heart rate (HR) were measured before, during, and after CPT. CV reactivity, i.e., the change in BP and HR responses were compared across conditions. Systolic BP reactivity were attenuated following HIIE (-60%, p = 0.015) and MIE (-42%, p = 0.033) compared to CON, but no differences were observed between HIIE and MIE. HR reactivity was not different across all conditions. We conclude that performing HIIE or MIE 30 minutes prior to acute stress exposure lowers BP reactivity compared to rest in untrained males. These findings highlight the potential benefits of HIIE in lowering stress-induced elevations in blood pressure.

Efficient methods for acute stress detection using heart rate variability data from Ambient Assisted Living sensors

BACKGROUND

Using Ambient Assisted Living sensors to detect acute stress could help people mitigate the harmful effects of everyday stressful situations. This would help both the healthy and those affected more by sudden stressors, e.g., people with diabetes or heart conditions. The study aimed to develop a method for providing reliable stress detection based on heart rate variability features extracted from portable devices.

METHODS

Features extracted from portable electrocardiogram sensor recordings were used for training various classification algorithms for stress detection purposes. Data were recorded in a clinical trial with 7 participants and two stressors, the Trier Social Stress Test and the Stroop colour word test, both validated by standardised questionnaires. Different heart rate variability feature sets (all, time-domain and non-linear only, frequency-domain only) were tested to investigate how classification performance is affected, in addition to various time window length setups and participant-wise training sessions. The accuracy and F1 score of the trained models were compared and analysed.

RESULTS

The best results were achieved with models using time-domain and non-linear heart rate variability features with 5-min-long overlapping time windows, yielding 96.31% accuracy and 96.26% F1 score. Shorter overlapping windows had slightly lower performance, with 91.62-94.55% accuracy and 91.77-94.55% F1 score ranges. Non-overlapping window configurations were less effective, with both accuracy and F1 score below 88%. For participant-wise learning, average F1 scores of 99.47%, 98.93% and 96.1% were achieved for feature sets using all, time-domain and non-linear, and frequency-domain features, respectively.

CONCLUSION

The tested stress detector models based on heart rate variability data recorded by a single electrocardiogram sensor performed just as well as those published in the literature working with multiple sensors, or even better. This suggests that once portable devices such as smartwatches provide reliable hear rate variability recordings, efficient stress detection can be achieved without the need for additional physiological measurements.

Mastery Imagery Ability Is Associated With Positive Anxiety and Performance During Psychological Stress

Mastery imagery (i.e., images of being in control and coping in difficult situations) is used to regulate anxiety. The ability to image this content is associated with trait confidence and anxiety, but research examining mastery imagery ability's association with confidence and anxiety in response to a stressful event is scant. The present study examined whether trait mastery imagery ability mediated the relationship between confidence and anxiety, and the subsequent associations on performance in response to an acute psychological stress. Participants (N = 130; 55% male; M_age = 19.94 years; SD = 1.07 years) completed assessments of mastery imagery ability and engaged in a standardized acute psychological stress task. Immediately prior to the task, confidence, cognitive and somatic anxiety intensity, and interpretation of anxiety symptoms regarding the task were assessed. Path analyses supported a model whereby mastery imagery ability mediated the relationship between confidence and cognitive and somatic anxiety interpretation. Greater mastery imagery ability and confidence were both directly associated with better performance on the stress task. Mastery imagery ability may help individuals experience more facilitative anxiety and perform better during stressful tasks. Improving mastery imagery ability by enhancing self-confidence may help individuals successfully cope with anxiety elicited during stressful situations.

Emotional valence sensing using a wearable facial EMG device

Emotion sensing using physiological signals in real-life situations can be practically valuable. Previous studies have developed wearable devices that record autonomic nervous system activity, which reflects emotional arousal. However, no study determined whether emotional valence can be assessed using wearable devices. To this end, we developed a wearable device to record facial electromyography (EMG) from the corrugator supercilii (CS) and zygomatic major (ZM) muscles. To validate the device, in Experiment 1, we used a traditional wired device and our wearable device, to record participants’ facial EMG while they were viewing emotional films. Participants viewed the films again and continuously rated their recalled subjective valence during the first viewing. The facial EMG signals recorded using both wired and wearable devices showed that CS and ZM activities were, respectively, negatively and positively correlated with continuous valence ratings. In Experiment 2, we used the wearable device to record participants’ facial EMG while they were playing Wii Bowling games and assessed their cued-recall continuous valence ratings. CS and ZM activities were correlated negatively and positively, respectively, with continuous valence ratings. These data suggest the possibility that facial EMG signals recorded by a wearable device can be used to assess subjective emotional valence in future naturalistic studies.

Effect of Fragrant Primula Flowers on Physiology and Psychology in Female College Students: An Empirical Study

Indoor plants can positively impact physical and mental health in daily life. However, the benefits of viewing indoor plants may be enhanced if the plants emit a fragrant aroma. In this crossover-design study, we measured the physiological and psychological effects of fragrant and non-fragrant Primula plants on 50 female college students, and explored whether aroma stimulation had additive benefits for this group. Non-fragrant Primula malacoides Franch was used as a control stimulus, and Primula forbesii Franch, which has a floral fragrance, was used as an experimental stimulus. We measured blood pressure, pulse rate, and electroencephalogram (EEG) to evaluate physiological responses, and used a mood state profile and the semantic differential (SD) method to evaluate psychological responses. We found that mean blood pressure and pulse rate decreased significantly after the experiment in both conditions. EEGs showed that the mean values of high alpha waves, high beta waves, and relaxation scores were significantly higher in the experimental vs. control condition. The average scores on each subscale of the psychological questionnaire improved after the experiment in both conditions, and the vitality (V) subscale and total emotional state scores were significantly better in the experimental vs. control condition. The results of the SD method showed that the sense of relaxation and comfort were significantly higher in the experimental vs. control condition. Compared with the non-fragrant Primula, the fragrant Primula induced relatively better physiological and psychological effects.

Heightened Stress Reactivity in Response to an Attachment Related Stressor in Patients With Medically Treated Primary Hypertension

Background: A heightened stress reactivity to mental stress tasks has been shown in hypertensive patients and might contribute to a higher disease risk. We investigated this hyperreactivity with regard to an attachment related stressor that focuses on emotions instead of performance and we examined whether this effect can also be found in patients on antihypertensive drugs. Materials and Methods: Fifty patients with primary hypertension, treated with at least one antihypertensive drug, were compared with 25 healthy individuals. After 10 min of rest, they participated in an attachment-related interview (Adult Attachment Projective picture system, AAP) and were exposed to an attachment-related stressor (Separation Recall, SR), a short-time stressor which activates attachment-related emotions and thoughts by talking 5 min about a personal experience of loneliness. Blood samples to measure adrenocorticotrope hormone (ACTH), cortisol, norepinephrine, epinephrine, and dopamine were taken. Blood pressure, heart rate and arterial stiffness were measured at rest, after AAP, after SR and 10 min after recovery. Standard deviation of normal-to-normal intervals (SDNN) and root mean square of successive differences (RMSSD) were calculated. Parameters were compared using Mann Whitney U-test and linear mixed-effects regression models controlling for age and body mass index (BMI) after logarithmic transformation if appropriate. Results: Healthy test persons were younger and had lower BMI than patients. Comparing the two groups there were no significant differences in blood pressure and heart rate at rest. Both stressors provoked a significant response in almost all parameters. Results of the post-estimation of contrasts from linear mixed-effects regression models showed a steeper rise in systolic BP and arterial stiffness as well as a more pronounced decline in SDNN in hypertensive patients than in healthy controls. Levels of cortisol rose earlier and higher in hypertensive patients than in healthy controls. Conclusion: Vascular, autonomic, and hypothalamic pituitary adrenal axis response is heightened in medicated subjects with hypertension in response to attachment-focused stressors compared to healthy subjects. We conclude that the remaining hyper-reactivity even with sufficient antihypertensive medication still poses a substantial risk for affected patients. New ways to diminish this risk should be developed.

Forgiveness: protecting medical residents from the detrimental relationship between workplace bullying and wellness

Bullying of medical residents is associated with numerous negative psychological and physiological outcomes. As bullying within this demographic grows, there is increased interest in identifying novel protective factors. Accordingly, this research investigated whether interpersonal forgiveness buffers the relationship between two forms of workplace bullying and indices of well-being. Medical residents (N = 134, 62% males) completed measures assessing person and work-related bullying victimization, dispositional forgiveness, and depressive symptoms and underwent a series of cardiovascular assessments during which cardiovascular reactivity was induced by a 3-min serial subtraction math task. It was hypothesized that the tendency to forgive would be negatively related to bullying victimization and that forgiveness would reduce the association of bullying with psychological distress (i.e. depressive symptoms), cognition errors (i.e. incorrect serial subtraction computations), and exaggerated cardiovascular reactivity and recovery. Findings show that forgiveness reduced the harmful relationship between the two forms of workplace bullying and depressive symptoms, serial subtraction errors, and cardiovascular reactivity and recovery for systolic blood pressure (SBP). Study results suggest that forgiveness may serve as an effective means for reducing the outcomes of bullying for medical residents. Implications for forgiveness interventions are discussed. Lay summary This research demonstrated that forgiveness reduced the harmful relationship between bullying victimization and negative outcomes (i.e. depressive symptoms, subtraction errors, and exaggerated cardiovascular reactivity and recovery for SBP) in medical residents. This study suggests that forgiveness may serve as a protective factor and provide an effective means for reducing the negative association between workplace bullying and negative outcomes.

Testing the cross-stressor hypothesis under real-world conditions: exercise as a moderator of the association between momentary anxiety and cardiovascular responses

The cross-stressor adaptation hypothesis of exercise training has not been investigated under real-life conditions. Using ecological momentary assessment, we tested whether usual exercise level moderates the relationship of self-reported anxiety to concurrent ambulatory heart rate (HR) and systolic/diastolic blood pressure (SBP/DBP). Participants (N = 832) completed 24-h ambulatory monitoring of HR/BP, using a brachial BP cuff that took readings at 28-min intervals. Anxiety levels were concurrently reported on a visual analog scale (VAS) using a Palm Pilot. Usual exercise behavior was assessed by a self-report questionnaire. Random coefficients linear regression models predicting momentary HR/BP readings from time-matched anxiety scores were estimated, yielding the average within-person effect (slope) of anxiety. The interaction of exercise level (i.e., no weekly exercise, 1-149, and ≥ 150 min/week; a between-person factor) with anxiety was added to the model in order to estimate the average anxiety slope for participants in each exercise category. The relationship of HR/BP to anxiety did not differ significantly among exercise categories, hence not providing evidence for the cross-stressor hypothesis. In an exploratory analysis of the difference in HR/BP between occasions when anxiety was in the top versus bottom person-specific quintiles of responses, the difference in HR (but not SBP or DBP) varied significantly by exercise level (F(2,625) = 4.92, p = 0.008). Though our pre-specified analysis did not support the hypothesis, we provide some post hoc evidence supporting the cross-stressor hypothesis of exercise training for the HR response to anxiety.

The Impact of the Associated Pathology in Acute Coronary Events

Acute coronary events (ACE) are one of the main concerns for both clinical medicine and prophylaxis. The study aims to follow the frequency of the pathology associated with ACE and to establish its association with the occurrence of ACE. The study included 865 adult participants between the ages of 19-86. Subjects completed a complex questionnaire that included questions about health status. The study was conducted by applying the subjects to an anonymous questionnaire, in three family medicine practices between November 2018 to May 2019 and targeted healthy people. The frequencies of the following types of associated pathologies were evaluated: high blood pressure (HBP), hypercholesterolemia, stroke, diabetes, depression, stress. In hypertensive patients the prevalence of ACE was 6,99% (N=11) and in those not diagnosed with HBP of only 0,29% (N=2). The risk of ACE was 20 times higher than in those without HBP (RR=20,93; p<0.001). The prevalence of ACE was high among subjects with high cholesterol levels (21,43%) compared with those with normal values (3,03%; N=22), the risk of ACE being 7 times higher (RR=7,06; p<0.001). The prevalence of diabetes was more than four times higher in subjects with ACE (17,3%; N=9) compared with those without ACE (3,9%; N=32). Among those affected by diabetes, the prevalence of ACE was 21,95% (9/41), and risk of ACE in people with diabetes was four times higher (RR=4,21; p<0.001). Although cardiovascular disease is the most common pathology in the contemporary world, a number of comorbidities arise as ACE generators (hypertension, hypercholesterolemia, diabetes), along with psycho-emotional disorders such as depression, anxiety or stress, which outline, ensures, contributes or accelerates the progression to ACE.

Effects of Aerobic Exercise on Cortisol Stress Reactivity in Response to the Trier Social Stress Test in Inpatients with Major Depressive Disorders: A Randomized Controlled Trial

Physical activity is associated with a favourable (blunted) cortisol stress reactivity in healthy people. However, evidence from experimental study and with psychiatric patients is missing. This study examines whether exercise training impacts on cortisol stress reactivity in inpatients with major depressive disorder (MDD). These new insights are important because the stress reactivity of healthy people and patients with severe symptoms of depression might differ. Methods: The study was designed as a randomized controlled trial (trial registration number: NCT02679053). In total, 25 patients (13 women, 12 men, mean age: 38.1 12.0 years) completed a laboratory stressor task before and after a six-week intervention period. Nine samples of salivary free cortisol were taken before and after the Trier social stress test (TSST). Fourteen participants took part in six weeks of aerobic exercise training, while 11 patients were allocated to the control condition. While the primary outcome of the study was depressive symptom severity, the focus of this paper is on one of the secondary outcomes (cortisol reactivity during the TSST). The impact of aerobic exercise training was examined with a repeated-measures analysis of variance. We also examined the association between change in depression and cortisol response via correlational analysis. Cortisol reactivity did not change from baseline to post-intervention, either in the intervention or the control group. Participation in six weeks of aerobic exercise training was not associated with participants' cortisol reactivity. Moreover, depressive symptom change was not associated with change in cortisol response. Aerobic exercise training was not associated with patients' stress reactivity in this study. Because many patients initially showed a relatively flat/blunted cortisol response curve, efforts might be needed to find out which treatments are most efficient to promote a normalization of HPA axis reactivity.

Stress-Recovery State in Fibromyalgia Patients and Healthy People. Relationship with the Cardiovascular Response to Stress in Laboratory Conditions

The current study´s objective was to determine the relationship between stress-recovery state and cardiovascular response to an acute stressor in a sample of female fibromyalgia patients in comparison with a control group of healthy participants. The laboratory procedure was completed by 36 participants with fibromyalgia and by 38 healthy women who were exposed to an arithmetic task with harassment while blood pressure and heart rate were measured during task exposure.

Associations Among Emotional State, Sleep Quality, and Resting-State EEG Spectra: A Longitudinal Study in Graduate Students

University students are routinely influenced by a variety of natural stressors and experience irregular sleep-wake cycles caused by the necessity to trade sleep for studying while dealing with academic assignments. Often these factors result in long-term issues with daytime sleepiness, emotional instability, and mental exhaustion, which may lead to difficulties in the educational process. This study introduces the Daily Sampling System (DSS) implemented as a smartphone application, which combines a set of self-assessment scales for evaluating variations in the emotional state and sleep quality throughout a full academic term. In addition to submitting the daily sampling scores, the participants regularly filled in the Depression, Anxiety, and Stress Scales (DASS) reports and took part in resting-state EEG data recording immediately after report completion. In total, this study collected 1835 daily samples and 94 combined DASS with EEG datasets from 18 university students (aged 23-27 years), with 79.3± 15.3% response ratio in submitting the daily reports during an academic semester. The results of pairwise testing and multiple regression analysis demonstrate that the daily level of self-perceived fatigue correlates positively with stress, daytime sleepiness, and negatively with alertness on awakening, self-evaluated sleep quality, and sleep duration. The spectral analysis of the EEG data reveals a significant increase in the resting-state spectral power density across the theta and low-alpha frequency bands associated with increased levels of anxiety and stress. Additionally, the state of depression was accompanied by an intensification of high-frequency EEG activity over the temporal regions. No significant differences in prefrontal alpha power asymmetry were observed under the described experimental conditions while comparing the states of calmness and emotional arousal of the participants for the three conditions of depression, anxiety, and stress.

Ambulatory Assessment of Psychological and Physiological Stress on Workdays and Free Days Among Teachers. A Preliminary Study

Objective

Teachers are affected by high levels of job stress, leading to one of the highest rates of burnout. The purpose of our pilot study was to investigate the diurnal course of teachers’ psychological and physiological stress responses [cortisol levels, alpha-amylase, heart rate (HR), and heart rate variability (HRV)]. Another aim of the project was to test the applicability of ambulatory assessment methods in daily teaching situations.

Methods

In a non-clinical sample of eight primary school teachers (mean age = 43, SD = 15.22, 6 females) in Switzerland, continuous biopsychological data on two workdays and a free day were assessed. The teachers’ HRs and HRV were measured continuously using an ambulatory ECG. Additionally, eight saliva samples were collected from the teachers repeatedly throughout the day to determine the diurnal course of salivary cortisol and alpha-amylase (sAA). Perceived stress and anger ratings were assessed simultaneously.

Results

As hypothesized, the teachers’ morning cortisol levels, perceived stress, and anger levels were significantly higher, and their overall HRV was significantly lower on workdays than on a free day. Conversely, sAA levels and HRs showed no significant differences between working and free days. Salivary markers exhibited the expected diurnal course, with decreasing cortisol and increasing sAA levels over the course of the day, while self-rated stress reached the maximum at midday during working days.

Conclusion

The results of the present explorative study show that physiological and psychological parameters differ within working and free days for teachers. A comparison between working and free days resulted in differences in morning cortisol levels, HRV as well as stress and anger levels. The ambulatory assessment method was found to be applicable in daily teaching situations.

Failures of executive function when at a height: Negative height-related appraisals are associated with poor executive function during a virtual height stressor

It is difficult to maintain cognitive functioning in threatening contexts, even when it is imperative to do so. Research indicates that precarious situations can impair subsequent executive functioning, depending on whether they are appraised as threatening. Here, we used virtual reality to place participants at ground level or at a virtual height in order to examine the impact of a threat-related context on concurrent executive function and whether this relationship was modulated by negative appraisals of heights. Executive function was assessed via the Go/NoGo and N-Back tasks, indexing response inhibition and working memory updating respectively. Participants with negative appraisals of heights exhibited impaired executive function on both tasks when performing at a virtual height (i.e., a threat-related context) but not at ground-level, demonstrating the importance of considering the cognitive consequences of individual differences in negative interpretations of emotionally-evocative situations. We suggest that a virtual reality approach holds practical benefits for understanding how individuals are able to maintain cognitive ability when embedded within threatening situations.

Does Cardiorespiratory Fitness Buffer Stress Reactivity and Stress Recovery in Police Officers? A Real-Life Study

High levels of cardiorespiratory fitness have the potential to buffer against physical and mental health impairments, which can result from exposure to occupational stress. Police officers are especially at risk of high psychosocial stress; therefore, effective intervention strategies are warranted. Given this background, the purpose of the present study was to examine whether police officers with different levels of cardiorespiratory fitness differ with regard to their (a) physiological stress reactivity during acute real-life stress situations, and (b) physiological recovery related to acute and chronic work stress. In total, 201 police officers took part in this study (M = 38.6 years, SD = 10.1, 35.8% females). Officers were contacted eight times on a smartphone during their workday, and asked to report their current level of positive and negative affect, as well as feelings of stress and anger. Physiological stress responses and recovery (heart rate variability) were assessed using Movisens EcgMove3 devices. The Åstrand bicycle ergometer test was used to assess participants' cardiorespiratory fitness. Chronic work stress was assessed using the effort-reward imbalance model and the job strain model. Multilevel modeling was used to test buffering effects of cardiorespiratory fitness on physiological stress reactivity. Linear regression was applied to test stress-buffering effects of cardiorespiratory fitness on physiological recovery. Results showed lowered physiological stress reactivity to acute work stress in officers with higher levels of cardiorespiratory fitness. However, these results were not consistent, with no effects occurring for feelings of anger, positive affect, and negative affect. Chronic work stress (effort-reward imbalance) was related to lower physiological recovery. Cardiorespiratory fitness was positively related to physiological recovery. Data did not support interactions between work stress and cardiorespiratory fitness on physiological recovery. To some extent, cardiorespiratory fitness seems to have the potential to buffer stress reactivity in police officers in acute stress situations. Therefore, we encourage promoting fitness programs which aim to enhance cardiorespiratory fitness in stressful occupations such as law enforcement. Improvements in cardiorespiratory fitness might further enhance physiological recovery from chronic work stress, which is thought to improve cardiovascular health.

Relational Savoring Reduces Physiological Reactivity and Enhances Psychological Agency in Older Adults

The benefits of savoring interventions for improving mental health have recently been demonstrated with older adults. Using a randomized controlled design involving N = 63 adults (aged 60-90 years), we explore whether relational savoring, a targeted intervention in which participants savor (intensify and prolong) positive emotions associated with the connection experienced with another person, particularly those involving the provision of safe haven/secure base attachment care, is associated with a state of lower cardiovascular reactivity (lower heart rate) during its enactment, as well as greater agency and lower passivity in a post-savoring advice-giving task. We compare all outcomes to participants randomized to a control condition utilized in prior investigations of relational savoring. Results suggest that relational savoring results in lower reactivity and greater agency and passivity. Although preliminary and obtained within a small sample, these findings provide early evidence of the potential of this approach with this population.

Stressing the accuracy: Wrist-worn wearable sensor validation over different conditions

Wearable sensors are promising instruments for conducting both laboratory and ambulatory research in psychophysiology. However, scholars should be aware of their measurement error and the conditions in which accuracy is achieved. This study aimed to assess the accuracy of a wearable sensor designed for research purposes, the E4 wristband (Empatica, Milan, Italy), in measuring heart rate (HR), heart rate variability (HRV), and skin conductance (SC) over five laboratory conditions widely used in stress reactivity research (seated rest, paced breathing, orthostatic, Stroop, speech task) and two ecological conditions (slow walking, keyboard typing). Forty healthy participants concurrently wore the wristband and two gold standard measurement systems (i.e., electrocardiography and finger SC sensor). The wristband accuracy was determined by evaluating the signal quality and the correlations with and the Bland-Altman plots against gold standard-derived measurements. Moreover, exploratory analyses were performed to assess predictors of measurement error. Mean HR measures showed the best accuracy over all conditions. HRV measures showed satisfactory accuracy in seated rest, paced breathing, and recovery conditions but not in dynamic conditions, including speaking. Accuracy was diminished by wrist movements, cognitive and emotional stress, nonstationarity, and larger wrist circumferences. Wrist SC measures showed neither correlation nor visual resemblance with finger SC signal, suggesting that the two sites may reflect different phenomena. Future studies are needed to assess the responsivity of wrist SC to emotional and cognitive stress. Limitations and implications for laboratory and ambulatory research are discussed.

Female Volleyball Players Are More Prone to Cortisol Anticipatory Stress Response than Sedentary Women

Background and Objectives: Top-level sports performance places heavy physical and psychological demands on elite-level athletes, which can be a source of increased levels of stress. Therefore, high-level volleyball players may present altered cardiovascular and endocrinological stress response during stressful events. Although many previous studies have examined the response to stress on athletes, most of them regarded only males, while the impact of the female menstrual cycle has rarely been taken into account. We aimed to study psychophysiological response to anticipatory stressor through analysis of heart rate, self-reported anxiety level, and salivary cortisol in healthy young female athletes by minimalizing the effect of confounders. Materials and Methods: A total of 55 females (25 members of the best league for female volleyball players in Poland and 30 sedentary-lifestyle control subjects) in the follicular phase of their menstrual cycle were exposed to mental arithmetic tasks as an experimental imitation of the stressor. Volleyball players were significantly taller than sedentary individuals (177.1 ± 3.4 cm vs. 173.3 ± 3.4 cm, respectively, p = 0.034), but did not differ in weight (73.6 ± 5.2 kg vs. 70 ± 4.23 kg, respectively, p = 0.081), body mass index (BMI) (23.5 ± 1.13 vs. 24.1 ± 1.45, respectively, p = 0.060), and age (22 ± 1.11 vs. 23 ± 1.14 years, respectively, p = 0.2). Their stress responses were assessed through self-reported anxiety levels and physiological measurements of salivary cortisol concentrations and heart rate (HR). Results: For HR, significant effects of time (F_(2,120) = 21.34, p < 0.001, η² = 0.26) were found, but not for training status (F_(1,60) = 2.69, p = 0.106, η² = 0.04). For cortisol levels, the analysis showed the main effects of time (F_(3,180) = 11.73, p < 0.001, η² = 0.16) and training status (F_(1,60) = 4.69, p = 0.034, η² = 0.07) and a significant interaction between training status and time (F_(3,180) = 3.07, p = 0.029, η² = 0.05). Post-hoc analyses showed higher cortisol concentrations among volleyball players following the math task (all p < 0.001), as well as higher cortisol concentrations in S2, S3, and S4 compared to S1 in volleyball players (all p < 0.001). We observed also a significant increase in state anxiety in both groups (all p < 0.001), but no differences in state anxiety levels between groups. Conclusion: Female volleyball players may not differ in subjective graduation of stressors; however, exposure to training-based stressors seems to promote cortisol response to the anticipated stressor.

Cardiovascular Responses of Women with Fibromyalgia to a Laboratory Stressor: Does Post-traumatic Stress Disorder Comorbidity Matter?

OBJECTIVES

This study compared cardiovascular responses to a laboratory trauma-unrelated stressor of two groups of women diagnosed with fibromyalgia (FM), one of them with comorbid post-traumatic stress disorder (PTSD), with a group of healthy controls in order to detect the possible existence of differences linked to comorbidity.

DESIGN

Case-controls.

METHODS

Eighteen women diagnosed with FM and comorbid PTSD, 18 women diagnosed with FM and no PTSD, and 38 healthy women were exposed to an arithmetic task with harassment while blood pressure and heart rate were measured during task exposure and recovery.

RESULTS

Although heart rate response evidenced a general blunted reactivity for both groups of FM patients, only those with comorbid PTSD presented lower levels of reactivity in terms of their systolic blood pressure response. In addition, systolic blood pressure response was sensitive to the presence of depression in both groups of FM patients and controls. Finally, although both groups of FM patients showed significantly slower rates of recovery, their final recovery state was not worse after twelve minutes of recording.

CONCLUSIONS

Results of this study point to comorbid PTSD as a significant contributor to the blunted cardiovascular reactivity observed in FM patients, which may be dependent to a great extent on depressive symptomatology. As some degree of cardiovascular response to stress is functional in that it mobilizes energy and triggers the necessary compensatory mechanisms to manage stressors, this study supports the well-recognized clinical strategies of detection and treatment of PTSD and concomitant depression in the management of FM.

Measurement of physiological responses to acute stress in multiple occupations: A systematic review and implications for front line healthcare providers

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.

Comparison and Efficacy of Synergistic Intelligent Tutoring Systems with Human Physiological Response

The analysis of physiological signals is ubiquitous in health and medical diagnosis as a primary tool for investigation and inquiry. Physiological signals are now being widely used for psychological and social fields. They have found promising application in the field of computer-based learning and tutoring. Intelligent Tutoring Systems (ITS) is a fast-paced growing field which deals with the design and implementation of customized computer-based instruction and feedback methods without human intervention. This paper introduces the key concepts and motivations behind the use of physiological signals. It presents a detailed discussion and experimental comparison of ITS. The synergism of ITS and physiological signals in automated tutoring systems adapted to the learner's emotions and mental states are presented and compared. The insights are developed, and details are presented. The accuracy and classification methods of existing systems are highlighted as key areas of improvement. High-precision measurement systems and neural networks for machine-learning classification are deemed prospective directions for future improvements to existing systems.

The Adaptive Value and Clinical Significance of Allostatic Blood Pressure Variation

In recent years, there has been interest in evaluating the morbidity and mortality risk of circadian, diurnal, or nocturnal blood pressure variation. Variation is a normative property of blood pressure, necessary for survival. Like many physiological functions, blood pressure undergoes allostasis, meaning that the body does not defend a particular blood pressure value, but rather blood pressure maintains bodily stability through continual change that is initiated by constantly fluctuating internal and external environmental stimuli. Because of its allostatic and adaptive properties, the blood pressure response to unusual situations like a visit to the clinic can lead to misdiagnosis of hypertension. However, blood pressure variation is mostly ignored when evaluating hypertension, which is an arbitrary dichotomy. Whether variation is indicative of pathology should be determined by assessing its appropriateness for the circumstance, which requires quantification of the sources and extent of normative blood pressure responses to everyday living. These responses will vary among populations due to evolutionary genetic differences. The inconsistency of reports regarding aspects of ambulatory blood pressure variation as cardiovascular risk factors likely results from the fact that the measures used do not reflect the actual nature of blood pressure allostasis.

Stress among on-duty firefighters: an ambulatory assessment study

BACKGROUND

Stress at work has been broadly acknowledged as a worldwide problem and has been the focus of concern for many researchers. Firefighting, in particular, is frequently reported as a highly stressful occupation. In order to investigate firefighters' occupational health in terms of stress events, perceptions, symptoms, and physiological reactions under real-world conditions, an ambulatory assessment protocol was developed.

METHODS

Seventeen firefighters' cardiac signal was continuously monitored during an average of three shifts within a working week with medical clinically certified equipment (VitalJacket®), which allows for continuous electrocardiogram (ECG) and actigraphy measurement. Psychological data were collected with a software application running on smartphones, collecting potential stressful events, stress symptoms, and stress appraisal.

RESULTS

A total of 450.56 h of medical-quality ECG were collected, and heart rate variability (HRV) analysis was performed. Findings suggest that although 'fire' situations are more common, 'accidents' are more stressful. Additionally, firefighters showed high levels of physiological stress (based on AVNN and LF/HF HRV metrics) when compared to normative healthy population values that may not be diagnosed using merely self-reports.

DISCUSSION

The proposed ambulatory study seems to be useful for the monitoring of stress levels and its potential impact on health of first responders. Additionally, it could also be an important tool for the design and implementation of efficient interventions and informed management resolutions in real time. Potential applications of this research include the development of quantified occupational health (qOHealth) devices for real life monitoring of emergency personnel stress reactions.

Influence of Regular Physical Activity and Fitness on Stress Reactivity as Measured with the Trier Social Stress Test Protocol: A Systematic Review

BACKGROUND

Psychosocial stress is associated with multiple health complaints. Research to date suggests that regular physical activity (PA) and higher cardiorespiratory fitness may reduce stress reactivity and therefore contribute to a reduction of stress-related risk factors. While previous reviews have not differentiated between stressors, we focus on psychosocial stress elicited with the Trier Social Stress Test (TSST).

OBJECTIVE

Our objective was to examine the effect of regular PA and cardiorespiratory fitness on stress reactivity, with a particular focus on the TSST. The TSST is the laboratory task most widely used to induce socio-evaluative stress and elicits stronger stress reactions than most other cognitive stressor tasks.

METHODS

A systematic search within various databases was performed in January 2018. The following outcomes were considered: cortisol, heart rate, psychological stress reactivity, and potential moderators (age, sex, exercise intensity, assessment mode, and psychological constructs).

RESULTS

In total, 14 eligible studies were identified. Cortisol and heart rate reactivity were attenuated by higher PA or better fitness in seven of twelve studies and four of nine studies, respectively. Two of four studies reported smaller increases in anxiety and smaller decreases in calmness in physically active/fitter participants. Three of four studies found that higher PA/fitness was associated with more favorable mood in response to the TSST.

CONCLUSION

About half of the studies suggested that higher PA/fitness levels were associated with an attenuated response to psychosocial stress. Currently, most evidence is based on cross-sectional analyses. Therefore, a great need for further studies with longitudinal or experimental designs exists.

Wearable Biomonitoring Platform for the Assessment of Stress and its Impact on Cognitive Performance of Firefighters: An Experimental Study

BACKGROUND

Stress is a complex process with an impact on health and performance. The use of wearable sensor-based monitoring systems offers interesting opportunities for advanced health care solutions for stress analysis. Considering the stressful nature of firefighting and its importance for the community's safety, this study was conducted for firefighters.

OBJECTIVES

A biomonitoring platform was designed, integrating different biomedical systems to enable the acquisition of real time Electrocardiogram (ECG), computation of linear Heart Rate Variability (HRV) features and collection of perceived stress levels. This platform was tested using an experimental protocol, designed to understand the effect of stress on firefighter's cognitive performance, and whether this effect is related to the autonomic response to stress.

METHOD

The Trier Social Stress Test (TSST) was used as a testing platform along with a 2-Choice Reaction Time Task. Linear HRV features from the participants were acquired using an wearable ECG. Self-reports were used to assess perceived stress levels.

RESULTS

The TSST produced significant changes in some HRV parameters (AVNN, SDNN and LF/HF) and subjective measures of stress, which recovered after the stress task. Although these short-term changes in HRV showed a tendency to normalize, an impairment on cognitive performance was found after performing the stress event.

CONCLUSION

Current findings suggested that stress compromised cognitive performance and caused a measurable change in autonomic balance. Our wearable biomonitoring platform proved to be a useful tool for stress assessment and quantification. Future studies will implement this biomonitoring platform for the analysis of stress in ecological settings.

The consistency of circadian blood pressure and heart rate patterns over three months in women employed in sedentary office jobs

OBJECTIVES

The purpose of this study was to evaluate the consistency of the circadian patterns of blood pressure (BP) and heart rate (HR) variation over a three-month time frame in women employed outside the home.

METHODS

The subjects were 157 healthy women of varying ethnicity (age = 38.2 ± 8.9) who all worked in similar positions at two major medical centers in New York City. Each wore an ambulatory BP monitor during the course of three mid-week work days approximately one month apart. Hourly BPs and HRs were calculated from 9 am to 6 am the following morning and compared among the three days using anova and t tests.

RESULTS

The results indicate that there were virtually no differences in the mean hourly levels of any parameter during the waking period across the three days of assessment. However, mean hourly levels of systolic BP significantly declined from 12 pm to 4 am (P < .04, P = .001, P < .001, P = .001, P = .009, respectively) on the third assessment day compared to the first.

CONCLUSIONS

Because BP and HR respond to environmental demands in an allostatic fashion, the consistency in the waking patterns of BP and HR variation suggest that the patterns of demands on a workday are reasonably stable in this sample of women. The decline in systolic pressures from 12 pm to 4 am over the three assessments may indicate an improving ability to sleep with the monitor over time.

Assessment of the cerebral pressure-flow relationship using psychological stress to manipulate blood pressure

Recent evidence indicates that cerebral autoregulation (CA) might be more pressure passive than previously thought. That is, cerebral blood flow, traditionally thought to be regulated independently of prevailing mean arterial pressure (MAP), might fluctuate, to some extent, as a function of MAP. However, due to limitations associated with experimental usage of pharmaceuticals to manipulate MAP and inconsistent control of arterial carbon dioxide, questions remain regarding the MAP-cerebral blood flow relationship, especially during typical daily activities that alter MAP. Therefore, the current study aimed to assess CA using a nonpharmacological acute psychological stress task to augment MAP, while at the same time controlling for end-tidal carbon dioxide (P_ET CO₂ ). Twenty-five healthy young adults completed a stressful task while continuous measures of MAP, middle cerebral artery blood flow velocity (MCAv), and P_ET CO₂ were recorded. Slope values obtained from hierarchical linear regression were used to assess the strength of the MAP-MCAv relationship and control for P_ET CO₂ . The stress task significantly increased MAP (p < 0.001) and MCAv (p < 0.001), and decreased P_ET CO₂ (p = 0.05). For every 10 mmHg task-induced increase in MAP, MCAv increased by ≈3.5%; task-induced changes in P_ET CO₂ did not appreciably change the MAP-MCAv relationship. Greater task-induced MAP responses were significantly related to decreased MAP-MCAv slope values, consistent with CA. These data support the hypothesis that CA is more pressure passive than previously thought and provide initial evidence indicating that a pressure-passive MAP-MCAv relationship may play a role in the observed associations between MAP stress responses, stroke, and cerebrovascular disease.

The joint influence of emotional reactivity and social interaction quality on cardiovascular responses to daily social interactions in working adults

OBJECTIVE

Social interaction quality is related to cardiovascular functioning. Trait emotional reactivity may amplify cardiovascular responses to social interactions, but is often examined as a tendency to react to negative events. We took a broader approach by examining the joint effects of positive and negative emotional reactivity and social interaction quality on ambulatory blood pressure (ABP) and heart rate (HR) responses to daily social interactions.

METHODS

Participants were part of a larger study on BP and cardiovascular health (N = 805; M_Age = 45.3; 40.1% male). Participants completed a measure of emotional reactivity (BIS/BAS) and 24-hour ABP monitoring accompanied by ecological momentary assessments (EMA) about just-experienced social interactions and their pleasantness. Multilevel models tested the associations of emotional reactivity, average pleasantness, and momentary pleasantness with BP and HR.

RESULTS

Participants who reported more pleasant interactions on average had lower BP (systolic BP: B = -0.51 mmHg; diastolic BP: B = -0.46 mmHg). These effects did not depend on emotional reactivity. The effect of momentary pleasantness depended on BIS/BAS; in less reactive participants, greater pleasantness was associated with lower HR, B = -0.13 bpm; in more reactive participants, greater pleasantness was associated with increased HR, B = 0.16).

CONCLUSIONS

Participants who had more pleasant social interactions throughout the day had lower mean ABP. The acute effect of a given social interaction on HR depended on emotional reactivity: HR increased for participants high in emotional reactivity during pleasant interactions. Thus, emotional reactivity may influence cardiovascular responses to social stimuli.

Stress and Addiction: When a Robust Stress Response Indicates Resiliency

OBJECTIVE

Stress reactivity research has traditionally focused on the idea that exaggerated responses to stress may have adverse effects on health. Accumulating evidence suggests that attenuated responses to stress and delayed recovery may also be problematic.

METHODS

This review focuses on the role of the stress response of the hypothalamic-pituitary-adrenocortical axis, the endogenous opioid system, and the cardiovascular system in hypertension, pain perception, and addictive behaviors. Results from multiple methods of assessment and stress paradigms conducted in our laboratory over the past two decades are integrated with research from other investigators and with existing theories.

RESULTS

Research indicates that exaggerated biological and physiological responses to stress and attenuated pain perception are associated with hypertension and risk for cardiovascular diseases. This research complements work linking reduced stress responses with enhanced pain sensitivity and discomfort. Multiple studies have also demonstrated that an attenuated stress response is linked to exacerbation of withdrawal symptoms and relapse in nicotine addiction. Evidence indicates important moderators (i.e., sex, personality traits, and early life adversity) and hypothalamic-pituitary-adrenocortical- and endogenous opioid system-related mechanisms in the altered response to stress. I integrate these findings in a conceptual model emphasizing that robust stress responses in the context of addiction and relapse should be considered as a marker of resiliency.

CONCLUSIONS

A blunted stress response may indicate long-term physiological dysregulation that could usher harmful consequences for cardiovascular disease, pain perception, and addictive disorders. The impact of dysregulation is influenced by multiple individual and situational factors that should be considered in evaluating the clinical significance of stress response dysregulation.