A sigh following sustained attention and mental stress: effects on respiratory variability

A Systematic Review of In-Vehicle Physiological Indices and Sensor Technology for Driver Mental Workload Monitoring

The concept of vehicle automation ceases to seem futuristic with the current advancement of the automotive industry. With the introduction of conditional automated vehicles, drivers are no longer expected to focus only on driving activities but are still required to stay alert to resume control. However, fluctuations in driving demands are known to alter the driver's mental workload (MWL), which might affect the driver's vehicle take-over capabilities. Driver mental workload can be specified as the driver's capacity for information processing for task performance. This paper summarizes the literature that relates to analysing driver mental workload through various in-vehicle physiological sensors focusing on cardiovascular and respiratory measures. The review highlights the type of study, hardware, method of analysis, test variable, and results of studies that have used physiological indices for MWL analysis in the automotive context.

Physiological comfort evaluation under different airflow directions in a heating environment

Background

Indoor airflow and thermal comfort are difficult to assess through subjective evaluations because airflow sensations can differ based on various factors, such as personal characteristics, interests, preferences, and the current state of mind. Thus, subjective evaluations should be combined with objective assessments, such as physiological measurements. This study evaluated airflow and thermal comfort through physiological measurements, including skin temperature, electroencephalography, respiration, and electrocardiography, in addition to subjective evaluations.

Methods

Twenty participants entered a test room at 30 °C after staying in an acclimation room at 18 °C for 20 min. They were exposed to indirect and direct airflow toward their faces and performed four tasks under each condition: resting, counting to 10 s following time alerts, counting to 10 s in the mind, and mental calculation. The mean speed of the air directed to the participants’ faces was 0.123 m/s and 0.225 m/s in the indirect and direct conditions, respectively.

Results

The gamma and beta bands of electroencephalograms taken at the left-temporal (T3) and left-parietal (P7) sites showed significantly lower amplitudes under the indirect condition (gamma, T3: p = 0.034, P7: p = 0.030; beta, T3: p = 0.051, P7: p = 0.028). Similarly, the variability of respiration was lower under the indirect condition (p < 0.010). The amplitudes of gamma and beta waves showed significant correlations with anxiousness levels (gamma, T3: r = 0.41; beta, T3: r = 0.35).

Conclusions

Our results suggest that indirect heating airflow causes lower mental stress and fatigue than those induced by direct flow, which is equivalent to more comfort. The results of this study suggest that physiological measurements can be used for the evaluation of unconscious indoor comfort, which cannot be detected by subjective evaluations alone.

Meditative-based diaphragmatic breathing vs. vagus nerve stimulation in the treatment of fibromyalgia-A randomized controlled trial: Body vs. machine

IMPORTANCE

Vagus nerve innervation via electrical stimulation and meditative-based diaphragmatic breathing may be promising treatment avenues for fibromyalgia.

OBJECTIVE

Explore and compare the treatment effectiveness of active and sham transcutaneous vagus nerve stimulation (tVNS) and meditative-based diaphragmatic breathing (MDB) for fibromyalgia.

DESIGN

Participants enrolled from March 2019-October 2020 and randomly assigned to active tVNS (n = 28), sham tVNS (n = 29), active MDB (n = 29), or sham MDB (n = 30). Treatments were self-delivered at home for 15 min/morning and 15 min/evening for 14 days. Follow-up was at 2 weeks.

SETTING

Outpatient pain clinic in Oslo, Norway.

PARTICIPANTS

116 adults aged 18-65 years with severe fibromyalgia were consecutively enrolled and randomized. 86 participants (74%) had an 80% treatment adherence and 107 (92%) completed the study at 2 weeks; 1 participant dropped out due to adverse effects from active tVNS.

INTERVENTIONS

Active tVNS is placed on the cymba conchae of the left ear; sham tVNS is placed on the left earlobe. Active MDB trains users in nondirective meditation with deep breathing; sham MDB trains users in open-awareness meditation with paced breathing.

MAIN OUTCOMES AND MEASURES

Primary outcome was change from baseline in ultra short-term photoplethysmography-measured cardiac-vagal heart rate variability at 2 weeks. Prior to trial launch, we hypothesized that (1) those randomized to active MDB or active tVNS would display greater increases in heart rate variability compared to those randomized to sham MDB or sham tVNS after 2-weeks; (2) a change in heart rate variability would be correlated with a change in self-reported average pain intensity; and (3) active treatments would outperform sham treatments on all pain-related secondary outcome measures.

RESULTS

No significant across-group changes in heart rate variability were found. Furthermore, no significant correlations were found between changes in heart rate variability and average pain intensity during treatment. Significant across group differences were found for overall FM severity yet were not found for average pain intensity.

CONCLUSIONS AND RELEVANCE

These findings suggest that changes in cardiac-vagal heart rate variability when recorded with ultra short-term photoplethysmography in those with fibromyalgia may not be associated with treatment-specific changes in pain intensity. Further research should be conducted to evaluate potential changes in long-term cardiac-vagal heart rate variability in response to noninvasive vagus nerve innervation in those with fibromyalgia.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT03180554, Identifier: NCT03180554.

The psychophysiology of the sigh: II: The sigh from the psychological perspective

A sigh is a distinct respiratory behavior with specific psychophysiological roles. In two accompanying reviews we will discuss the physiological and psychological functions of the sigh. The present review will focus on the psychological functions of the sigh. We discuss the regulatory effects of a sigh, and argue how these effects may become maladaptive when sighs occur excessively. The adaptive role of a sigh is discussed in the context of regulation of psychophysiological states. We propose that sighs facilitate transitions from one psychophysiological state to the next, and this way contribute to psychophysiological flexibility, via a hypothesized resetting mechanism. We discuss how a sigh resets respiration, by controlling mechanical and metabolic properties of respiration associated with respiratory symptoms. Next, we elaborate on a sigh resetting emotional states by facilitating emotional transitions. We attempt to explain the adaptive and maladaptive functions of a sigh in the framework of stochastic resonance, in which we propose occasional, spontaneous sighs to be noise contributing to psychophysiological regulation, while excessive sighs result in psychophysiological dysregulation. In this context, we discuss how sighs can contribute to therapeutic interventions, either by increasing sighs to improve regulation in case of a lack of sighing, or by decreasing sighs to restore regulation in case of excessive sighing. Finally, a research agenda on the psychology of sighs is presented.

Let Complexity Bring Clarity: A Multidimensional Assessment of Cognitive Load Using Physiological Measures

The effects of cognitive load on driver behavior and traffic safety are unclear and in need of further investigation. Reliable measures of cognitive load for use in research and, subsequently, in the development and implementation of driver monitoring systems are therefore sought. Physiological measures are of interest since they can provide continuous recordings of driver state. Currently, however, a few issues related to their use in this context are not usually taken into consideration, despite being well-known. First, cognitive load is a multidimensional construct consisting of many mental responses (cognitive load components) to added task demand. Yet, researchers treat it as unidimensional. Second, cognitive load does not occur in isolation; rather, it is part of a complex response to task demands in a specific operational setting. Third, physiological measures typically correlate with more than one mental state, limiting the inferences that can be made from them individually. We suggest that acknowledging these issues and studying multiple mental responses using multiple physiological measures and independent variables will lead to greatly improved measurability of cognitive load. To demonstrate the potential of this approach, we used data from a driving simulator study in which a number of physiological measures (heart rate, heart rate variability, breathing rate, skin conductance, pupil diameter, eye blink rate, eye blink duration, EEG alpha power, and EEG theta power) were analyzed. Participants performed a cognitively loading n-back task at two levels of difficulty while driving through three different traffic scenarios, each repeated four times. Cognitive load components and other coinciding mental responses were assessed by considering response patterns of multiple physiological measures in relation to multiple independent variables. With this approach, the construct validity of cognitive load is improved, which is important for interpreting results accurately. Also, the use of multiple measures and independent variables makes the measurements (when analyzed jointly) more diagnostic-that is, better able to distinguish between different cognitive load components. This in turn improves the overall external validity. With more detailed, diagnostic, and valid measures of cognitive load, the effects of cognitive load on traffic safety can be better understood, and hence possibly mitigated.

Reading on a smartphone affects sigh generation, brain activity, and comprehension

Electronic devices have become an indispensable part of our daily lives, while their negative aspects have been reported. One disadvantage is that reading comprehension is reduced when reading from an electronic device; the cause of this deficit in performance is unclear. In this study, we investigated the cause for comprehension decline when reading on a smartphone by simultaneously measuring respiration and brain activity during reading in 34 healthy individuals. We found that, compared to reading on a paper medium, reading on a smartphone elicits fewer sighs, promotes brain overactivity in the prefrontal cortex, and results in reduced comprehension. Furthermore, reading on a smartphone affected sigh frequency but not normal breathing, suggesting that normal breathing and sigh generation are mediated by pathways differentially influenced by the visual environment. A path analysis suggests that the interactive relationship between sigh inhibition and overactivity in the prefrontal cortex causes comprehension decline. These findings provide new insight into the respiration-mediated mechanisms of cognitive function.

Wearable Sensing Systems for Monitoring Mental Health

Wearable systems for monitoring biological signals have opened the door to personalized healthcare and have advanced a great deal over the past decade with the development of flexible electronics, efficient energy storage, wireless data transmission, and information processing technologies. As there are cumulative understanding of mechanisms underlying the mental processes and increasing desire for lifetime mental wellbeing, various wearable sensors have been devised to monitor the mental status from physiological activities, physical movements, and biochemical profiles in body fluids. This review summarizes the recent progress in wearable healthcare monitoring systems that can be utilized in mental healthcare, especially focusing on the biochemical sensors (i.e., biomarkers associated with mental status, sensing modalities, and device materials) and discussing their promises and challenges.

The sigh and related behaviors

Breathing is a critical, complex, and highly integrated behavior. Normal rhythmic breathing, also referred to as eupnea, is interspersed with different breathing related behaviors. Sighing is one of such behaviors, essential for maintaining effective gas exchange by preventing the gradual collapse of alveoli in the lungs, known as atelectasis. Critical for the generation of both sighing and eupneic breathing is a region of the medulla known as the preBötzinger Complex (preBötC). Efforts are underway to identify the cellular pathways that link sighing as well as sneezing, yawning, and hiccupping with other brain regions to better understand how they are integrated and regulated in the context of other behaviors including chemosensation, olfaction, and cognition. Unraveling these interactions may provide important insights into the diverse roles of these behaviors in the initiation of arousal, stimulation of vigilance, and the relay of certain behavioral states. This chapter focuses primarily on the function of the sigh, how it is locally generated within the preBötC, and what the functional implications are for a potential link between sighing and cognitive regulation. Furthermore, we discuss recent insights gained into the pathways and mechanisms that control yawning, sneezing, and hiccupping.

Investigating the specificity of the neurologic pain signature against breathlessness and finger opposition

ABSTRACT

Brain biomarkers of pain, including pain-predictive "signatures" based on brain activity, can provide measures of neurophysiological processes and potential targets for interventions. A central issue relates to the specificity of such measures, and understanding their current limits will both advance their development and explore potentially generalizable properties of pain to other states. Here, we used 2 data sets to test the neurologic pain signature (NPS), an established pain neuromarker. In study 1, brain activity was measured using high-field functional magnetic resonance imaging (7T fMRI, N = 40) during 5 to 25 seconds of experimental breathlessness (induced by inspiratory resistive loading), conditioned breathlessness anticipation, and finger opposition. In study 2, we assessed anticipation and breathlessness perception (3T, N = 19) under blinded saline (placebo) and remifentanil administration. The NPS responded to breathlessness, anticipation, and finger opposition, although no direct comparisons with painful events were possible. Local NPS patterns in anterior or midinsula, S2, and dorsal anterior cingulate responded to breathlessness and finger opposition and were reduced by remifentanil. Local NPS responses in the dorsal posterior insula did not respond to any manipulations. Therefore, significant global NPS activity alone is not specific for pain, and we offer insight into the overlap between NPS responses, breathlessness, and somatomotor demand.

Towards Mindless Stress Regulation in Advanced Driver Assistance Systems: A Systematic Review

Background: Stress can frequently occur in the driving context. Its cognitive effects can be deleterious and lead to uncomfortable or risky situations. While stress detection in this context is well developed, regulation using dedicated advanced driver-assistance systems (ADAS) is still emergent. Objectives: This systematic review focuses on stress regulation strategies that can be qualified as "subtle" or "mindless": the technology employed to perform regulation does not interfere with an ongoing task. The review goal is 2-fold: establishing the state of the art on such technological implementation in the driving context and identifying complementary technologies relying on subtle regulation that could be applied in driving. Methods: A systematic review was conducted using search operators previously identified through a concept analysis. The patents and scientific studies selected provide an overview of actual and potential mindless technology implementations. These are then analyzed from a scientific perspective. A classification of results was performed according to the different stages of emotion regulation proposed by the Gross model. Results: A total of 47 publications were retrieved, including 21 patents and 26 studies. Six of the studies investigated mindless stress regulation in the driving context. Patents implemented strategies mostly linked to attentional deployment, while studies tended to investigate response modulation strategies. Conclusions: This review allowed us to identify several ADAS relying on mindless computing technologies to reduce stress and better understand the underlying mechanisms allowing stress reduction. Further studies are necessary to better grasp the effect of mindless technologies on driving safety. However, we have established the feasibility of their implementation as ADAS and proposed directions for future research in this field.

Development and validation of a behavioural video coding scheme for detecting mental workload in manual assembly

Manual assembly in the future Industry 4.0 workplace will put high demands on operators' cognitive processing. The development of mental workload (MWL) measures therefore looms large. Physiological gauges such as electroencephalography (EEG) show promising possibilities, but still lack sufficient reliability when applied in the field. This study presents an alternative measure with a substantial ecological validity. First, we developed a behavioural video coding scheme identifying 11 assembly behaviours potentially revealing MWL being too high. Subsequently, we explored its validity by analysing videos of 24 participants performing a high and a low complexity assembly. Results showed that five of the behaviours identified, such as freezing and the amount of part rotations, significantly differed in occurrence and/or duration between the two conditions. The study hereby proposes a novel and naturalistic method that could help practitioners to map and redesign critical assembly phases, and researchers to enrich validation of MWL-measures through measurement triangulation. Practitioner summary: Current physiological mental workload (MWL) measures still lack sufficient reliability when applied in the field. Therefore, we identified several observable assembly behaviours that could reveal MWL being too high. The results propose a method to map MWL by observing specific assembly behaviours such as freezing and rotating parts. Abbreviations: MWL: mental workload; EEG: electroencephalography; fNIRS: functional near infrared spectroscopy; AOI: area of interest; SMI: SensoMotoric Instruments, ETG: Eye-Tracking Glasses; FPS: frames per second; BORIS: Behavioral Observation Research Interactive Software; IRR: inter-rater reliability; SWAT: Subjective Workload Assessment Technique; NASA-TLX: National Aeronautics and Space Administration Task Load Index; EL: emotional load; DSSQ: Dundee Stress State Questionnaire; PHL: physical load; SBO: Strategisch Basis Onderzoek.

Sigh in Patients With Acute Hypoxemic Respiratory Failure and ARDS: The PROTECTION Pilot Randomized Clinical Trial

BACKGROUND

Sigh is a cyclic brief recruitment maneuver: previous physiologic studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity, and increase release of surfactant.

RESEARCH QUESTION

Is the clinical application of sigh during pressure support ventilation (PSV) feasible?

STUDY DESIGN AND METHODS

We conducted a multicenter noninferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or ARDS undergoing PSV. Patients were randomized to the no-sigh group and treated by PSV alone, or to the sigh group, treated by PSV plus sigh (increase in airway pressure to 30 cm H₂O for 3 s once per minute) until day 28 or death or successful spontaneous breathing trial. The primary end point of the study was feasibility, assessed as noninferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiologic parameters in the first week from randomization, 28-day mortality, and ventilator-free days.

RESULTS

Two-hundred and fifty-eight patients (31% women; median age, 65 [54-75] years) were enrolled. In the sigh group, 23% of patients failed to remain on assisted ventilation vs 30% in the no-sigh group (absolute difference, -7%; 95% CI, -18% to 4%; P = .015 for noninferiority). Adverse events occurred in 12% vs 13% in the sigh vs no-sigh group (P = .852). Oxygenation was improved whereas tidal volume, respiratory rate, and corrected minute ventilation were lower over the first 7 days from randomization in the sigh vs no-sigh group. There was no significant difference in terms of mortality (16% vs 21%; P = .337) and ventilator-free days (22 [7-26] vs 22 [3-25] days; P = .300) for the sigh vs no-sigh group.

INTERPRETATION

Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT03201263; URL: www.clinicaltrials.gov.

Motivational nondirective resonance breathing versus transcutaneous vagus nerve stimulation in the treatment of fibromyalgia: study protocol for a randomized controlled trial

BACKGROUND

Chronic widespread pain (CWP), including fibromyalgia (FM), affects one in every ten adults and is one of the leading causes of sick leave and emotional distress. Due to an unclear etiology and a complex pathophysiology, FM is a condition with few, if any, effective and safe treatments. However, current research within the field of vagal nerve innervation suggests psychophysiological and electrical means by which FM may be treated. This study will investigate the efficacy of two different noninvasive vagal nerve stimulation techniques for the treatment of FM.

METHODS

The study will use a randomized, single-blind, sham-controlled design to investigate the treatment efficacy of motivational nondirective resonance breathing (MNRB™) and transcutaneous vagus nerve stimulation (Nemos® tVNS) on patients diagnosed with FM. Consenting FM patients (N = 112) who are referred to the Department of Pain Management and Research at Oslo University Hospital, in Oslo, Norway, will be randomized into one of four independent groups. Half of these participants (N = 56) will be randomized to either an experimental tVNS group or a sham tVNS group. The other half (N = 56) will be randomized to either an experimental MNRB group or a sham MNRB group. Both active and sham treatment interventions will be delivered twice per day at home, 15 min/morning and 15 min/evening, for a total duration of 2 weeks (14 days). Participants are invited to the clinic twice, once for pre- and once for post-intervention data collection. The primary outcome is changes in photoplethysmography-measured heart rate variability. Secondary outcomes include self-reported pain intensity on a numeric rating scale, changes in pain detection threshold, pain tolerance threshold, and pressure pain limit determined by computerized pressure cuff algometry, blood pressure, and health-related quality of life.

DISCUSSION

The described randomized controlled trial aims to compare the efficacy of two vagal nerve innervation interventions, MNRB and tVNS, on heart rate variability and pain intensity in patients suffering from FM. This project tests a new and potentially effective means of treating a major public and global health concern where prevalence is high, disability is severe, and treatment options are limited.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03180554 . Registered on August 06, 2017.

Peripheral-to-central immune communication at the area postrema glial-barrier following bleomycin-induced sterile lung injury in adult rats

The pathways for peripheral-to-central immune communication (P → C I-comm) following sterile lung injury (SLI) are unknown. SLI evokes systemic and central inflammation, which alters central respiratory control and viscerosensory transmission in the nucleus tractus solitarii (nTS). These functional changes coincide with increased interleukin-1 beta (IL-1β) in the area postrema, a sensory circumventricular organ that connects P → C I-comm to brainstem circuits that control homeostasis. We hypothesize that IL-1β and its downstream transcriptional target, cyclooxygenase-2 (COX-2), mediate P → C I-comm in the nTS. In a rodent model of SLI induced by intratracheal bleomycin (Bleo), the sigh frequency and duration of post-sigh apnea increased in Bleo- compared to saline- treated rats one week after injury. This SLI-dependent change in respiratory control occurred concurrently with augmented IL-1β and COX-2 immunoreactivity (IR) in the funiculus separans (FS), a barrier between the AP and the brainstem. At this barrier, increases in IL-1β and COX-2 IR were confined to processes that stained for glial fibrillary acidic protein (GFAP) and that projected basolaterally to the nTS. Further, FS radial-glia did not express TNF-α or IL-6 following SLI. To test our hypothesis, we blocked central COX-1/2 activity by intracerebroventricular (ICV) infusion of Indomethacin (Ind). Continuous ICV Ind treatment prevented Bleo-dependent increases in GFAP + and IL-1β + IR, and restored characteristics of sighs that reset the rhythm. These data indicate that changes in sighs following SLI depend partially on activation of a central COX-dependent P → C I-comm via radial-glia of the FS.

Respiratory Variability, Sighing, Anxiety, and Breathing Symptoms in Low- and High-Anxious Music Students Before and After Performing

Music performance anxiety (MPA) is a major problem for music students. It is largely unknown whether music students who experience high or low anxiety differ in their respiratory responses to performance situations and whether these co-vary with self-reported anxiety, tension, and breathing symptoms. Affective processes influence dynamic respiratory regulation in ways that are reflected in measures of respiratory variability and sighing. This study had two goals. First, we determined how measures of respiratory variability, sighing, self-reported anxiety, tension, and breathing symptoms vary as a function of the performance situation (practice vs. public performance), performance phase (pre-performance vs. post-performance), and the general MPA level of music students. Second, we analyzed to what extent self-reported anxiety, tension, and breathing symptoms co-vary with the respiratory responses. The participants were 65 university music students. We assessed their anxiety, tension, and breathing symptoms with Likert scales and recorded their respiration with the LifeShirt system during a practice performance and a public performance. For the 10-min periods before and after each performance, we computed number of sighs, coefficients of variation (CVs, a measure of total variability), autocorrelations at one breath lag (ARs(1), a measure of non-random variability) and means of minute ventilation (V’_E), tidal volume (V_T), inspiration time (T_I), and expiration time (T_E). CVs and sighing were greater whereas AR(1) of V’_E was lower in the public session than in the practice session. The effect of the performance situation on CVs and sighing was larger for high-MPA than for low-MPA participants. Higher MPA levels were associated with lower CVs. At the within-individual level, anxiety, tension, and breathing symptoms were associated with deeper and slower breathing, greater CVs, lower AR(1) of V’_E, and more sighing. We conclude that respiratory variability and sighing are sensitive to the performance situation and to musicians’ general MPA level. Moreover, anxiety, tension, breathing symptoms, and respiratory responses co-vary significantly in the context of music performance situations. Respiratory monitoring can add an important dimension to the understanding of music performance situations and MPA and to the diagnostic and intervention outcome assessments of MPA.

Information Dynamics of the Brain, Cardiovascular and Respiratory Network during Different Levels of Mental Stress

In this study, an analysis of brain, cardiovascular and respiratory dynamics was conducted combining information-theoretic measures with the Network Physiology paradigm during different levels of mental stress. Starting from low invasive recordings of electroencephalographic, electrocardiographic, respiratory, and blood volume pulse signals, the dynamical activity of seven physiological systems was probed with one-second time resolution measuring the time series of the δ, θ, α and β brain wave amplitudes, the cardiac period (RR interval), the respiratory amplitude, and the duration of blood pressure wave propagation (pulse arrival time, PAT). Synchronous 5-min windows of these time series, obtained from 18 subjects during resting wakefulness (REST), mental stress induced by mental arithmetic (MA) and sustained attention induced by serious game (SG), were taken to describe the dynamics of the nodes composing the observed physiological network. Network activity and connectivity were then assessed in the framework of information dynamics computing the new information generated by each node, the information dynamically stored in it, and the information transferred to it from the other network nodes. Moreover, the network topology was investigated using directed measures of conditional information transfer and assessing their statistical significance. We found that all network nodes dynamically produce and store significant amounts of information, with the new information being prevalent in the brain systems and the information storage being prevalent in the peripheral systems. The transition from REST to MA was associated with an increase of the new information produced by the respiratory signal time series (RESP), and that from MA to SG with a decrease of the new information produced by PAT. Each network node received a significant amount of information from the other nodes, with the highest amount transferred to RR and the lowest transferred to δ, θ, α and β. The topology of the physiological network underlying such information transfer was node- and state-dependent, with the peripheral subnetwork showing interactions from RR to PAT and between RESP and RR, PAT consistently across states, the brain subnetwork resulting more connected during MA, and the subnetwork of brain–peripheral interactions involving different brain rhythms in the three states and resulting primarily activated during MA. These results have both physiological relevance as regards the interpretation of central and autonomic effects on cardiovascular and respiratory variability, and practical relevance as regards the identification of features useful for the automatic distinction of different mental states.

Habituation of the electrodermal response - A biological correlate of resilience?

Current approaches to quantifying resilience make extensive use of self-reported data. Problematically, this type of scales is plagued by response distortions–both deliberate and unintentional, particularly in occupational populations. The aim of the current study was to develop an objective index of resilience. The study was conducted in 30 young healthy adults. Following completion of the Connor-Davidson Resilience Scale (CD-RISC) and Depression/Anxiety/Stress Scale (DASS), they were subjected to a series of 15 acoustic startle stimuli (95 dB, 50 ms) presented at random intervals, with respiration, skin conductance and ECG recorded. As expected, resilience (CD-RISC) significantly and negatively correlated with all three DASS subscales–Depression (r = -0.66, p<0.0001), Anxiety (r = -0.50, p<0.005) and Stress (r = -0.48, p<0.005). Acoustic stimuli consistently provoked transient skin conductance (SC) responses, with SC slopes indexing response habituation. This slope significantly and positively correlated with DASS-Depression (r = 0.59, p<0.005), DASS-Anxiety (r = 0.35, p<0.05) and DASS-Total (r = 0.50, p<0.005) scores, and negatively with resilience score (r = -0.47; p = 0.006), indicating that high-resilience individuals are characterized by steeper habituation slopes compared to low-resilience individuals. Our key finding of the connection between habituation of the skin conductance responses to repeated acoustic startle stimulus and resilience-related psychometric constructs suggests that response habituation paradigm has the potential to characterize important attributes of cognitive fitness and well-being–such as depression, anxiety and resilience. With steep negative slopes reflecting faster habituation, lower depression/anxiety and higher resilience, and slower or no habituation characterizing less resilient individuals, this protocol may offer a distortion-free method for objective assessment and monitoring of psychological resilience.

A sigh of relief or a sigh of expected relief: Sigh rate in response to dyspnea relief

Research has suggested that sighs may serve a regulatory function during stress and emotions by facilitating relief. Evidence supports the hypotheses that sighs both express and induce relief from stress. To explore the potential role of sighs in the regulation of symptoms, the present study aimed to investigate the relationship between sighs and relief of symptoms, and relief of dyspnea, specifically. Healthy volunteers participated in two studies (N = 44, N = 47) in which dyspnea was induced by mild (10 cmH₂ O/l/s) or high (20 cmH₂ 0/l/s) inspiratory resistances. Dyspnea relief was induced by the offset of the inspiratory resistances (transitions from high and mild inspiratory resistance to no resistance). Control comparisons included dyspnea increases (transitions from no or mild inspiratory resistance to high inspiratory resistance) and dyspnea continuations (continuations of either no resistance or a high resistance). In Experiment 1, dyspnea levels were cued. In Experiment 2, no cues were provided. Sigh rate during dyspnea relief was significantly higher compared to control conditions, and sigh rate increased as self-reported dyspnea decreased. Additionally, sigh rate was higher during cued dyspnea relief compared to noncued dyspnea relief. These results suggest that sighs are important markers of dyspnea relief. Moreover, sighs may importantly express dyspnea relief, as they are related to experiential dyspnea decreases and occur more frequently during expected dyspnea relief. These findings suggest that sighs may not only be important in the regulation of stress and emotions, but also may be functional in the regulation of dyspnea.

Parasympathetic Concomitants of Habitual, Spontaneous, and Instructed Emotional Suppression

Abstract. The neurovisceral integration model proposes that different forms of self-regulation, including the emotional suppression, are characterized by the activation of neural network whose workings are also reflected in respiratory sinus arrhythmia (RSA). However, most of the previous studies failed to observe theoretically expected increases in RSA during emotional suppression. Even when such effects were observed, it was not clear whether they resulted from specific task demands, a decrease in muscle activity, or they were the consequence of more specific self-control processes. We investigated the relation between habitual or trait-like suppression, spontaneous, and instructed suppression with changes in RSA during negative emotion experience. A modest positive correlation between spontaneous situational and habitual suppression was observed across two experimental tasks. Furthermore, the results showed greater RSA increase among participants who experienced higher negative affect (NA) increase and reported higher spontaneous suppression than among those with higher NA increase and lower spontaneous suppression. Importantly, this effect was independent from the habitual suppression and observable facial expressions. The results of the additional task based on experimental manipulation, rather than spontaneous use of situational suppression, indicated a similar relation between suppression and RSA. Our results consistently demonstrate that emotional suppression, especially its self-regulation component, is followed by the increase in parasympathetic activity.

Sigh rate during emotional transitions: More evidence for a sigh of relief

Evidence suggests that sighs regulate stress and emotions, e.g. by facilitating relief. This study aimed to investigate sigh rates during relief. In addition, links between sighs, anxiety sensitivity and HPA-axis activity were explored. Healthy volunteers (N=29) were presented cues predicting the valence of subsequent stimuli. By sequencing cues that predicted pleasant or unpleasant stimuli with or without certainty, transitions to certain pleasantness (relief) or to certain unpleasantness (control) were created and compared to no transitions. Salivary cortisol, anxiety sensitivity and respiration were measured. Sigh frequency was significantly higher during relief than during control transitions and no transition states, and higher during control transitions than during no transition states. Sigh frequency increased with steeper cortisol declines for high anxiety sensitive persons. Results confirm a relationship between sighs and relief. In addition, results suggest that sigh frequency is importantly related to HPA-axis activity, particularly in high anxiety sensitive persons.

Individual differences in cardiorespiratory measures of mental workload: An investigation of negative affectivity and cognitive avoidant coping in pilot candidates

Cardiorespiratory measures provide useful information in addition to well-established self-report measures when monitoring operator capacity. The purpose of our study was to refine the assessment of operator load by considering individual differences in personality and their associations with cardiorespiratory activation. Physiological and self-report measures were analyzed in 115 pilot candidates at rest and while performing a multiple task covering perceptual speed, spatial orientation, and working memory. In the total sample and particularly in individuals with a general tendency to worry a lot, a cognitive avoidant coping style was associated with a smaller task-related increase in heart rate. Negative affectivity was found to moderate the association between cardiac and self-reported arousal. Given that physiological and self-report measures of mental workload are usually combined when evaluating operator load (e.g., in pilot selection and training), our findings suggest that integrating individual differences may reduce unexplained variance and increase the validity of workload assessments.

Respiratory Changes in Response to Cognitive Load: A Systematic Review

When people focus attention or carry out a demanding task, their breathing changes. But which parameters of respiration vary exactly and can respiration reliably be used as an index of cognitive load? These questions are addressed in the present systematic review of empirical studies investigating respiratory behavior in response to cognitive load. Most reviewed studies were restricted to time and volume parameters while less established, yet meaningful parameters such as respiratory variability have rarely been investigated. The available results show that respiratory behavior generally reflects cognitive processing and that distinct parameters differ in sensitivity: While mentally demanding episodes are clearly marked by faster breathing and higher minute ventilation, respiratory amplitude appears to remain rather stable. The present findings further indicate that total variability in respiratory rate is not systematically affected by cognitive load whereas the correlated fraction decreases. In addition, we found that cognitive load may lead to overbreathing as indicated by decreased end-tidal CO₂ but is also accompanied by elevated oxygen consumption and CO₂ release. However, additional research is needed to validate the findings on respiratory variability and gas exchange measures. We conclude by outlining recommendations for future research to increase the current understanding of respiration under cognitive load.

[A sigh increases motivation for difficult and monotonous tasks: The effect of one-time voluntary brief exhalation on relief and achievement needs]

We tested possible intrapersonal effects of a sigh as a psychological "resetter/rebooter." Fifty-eight undergraduates were randomly assigned to a sigh or a normal exhalation (control) group. We asked participants on each task to model the experimenter demonstrating how to exhale air into a small plastic bag for breathing manipulation under the pretext that we were interested in the exhaled gas in stressful situations. Results revealed that the sigh group did not experience more relief (as shown by prolonged reaction time) after exposure to threat stimuli, but showed more persistence on a highly-difficult puzzle task (p = .03, d = .62) and more willingness to continue working on a monotonous task (p < .10, d = .48), than the normal exhalation group. A sigh may have an adaptive function to motivate further work; although it may not induce relief--suggesting that a "sigh of refresh" is a voluntary but a "sigh of relief" is an involuntary response.

The role of respiratory measures to assess mental load in pilot selection

While cardiovascular measures have a long tradition of being used to determine operator load, responsiveness of the respiratory system to mental load has rarely been investigated. In this study, we assessed basic and variability measures of respiration rate (RR), partial pressure of end-tidal carbon dioxide (petCO2) as well as performance measures in 63 male pilot candidates during completion of a complex cognitive task and subsequent recovery. Mental load was associated with an increase in RR and a decrease in respiratory variability. A significant decrease was also found for petCO2. RR and respiratory variability showed partial and complete effects of recovery, respectively, whereas petCO2 did not return to baseline level. Overall, a good performance was related to a stronger reactivity in RR. Our findings suggest that respiratory parameters would be a useful supplement to common measures for the assessment of mental load in pilot selection. Practitioner Summary: Respiratory measures are a promising yet poorly investigated approach to monitor operator load. For pilot selection, we assessed respiration in response to multitasking in 63 candidates. Task-related changes as well as covariation with performance strongly support the consideration of respiratory parameters when evaluating reactivity to mental load.

Guidelines for Reporting Articles on Psychiatry and Heart rate variability (GRAPH): recommendations to advance research communication

The number of publications investigating heart rate variability (HRV) in psychiatry and the behavioral sciences has increased markedly in the last decade. In addition to the significant debates surrounding ideal methods to collect and interpret measures of HRV, standardized reporting of methodology in this field is lacking. Commonly cited recommendations were designed well before recent calls to improve research communication and reproducibility across disciplines. In an effort to standardize reporting, we propose the Guidelines for Reporting Articles on Psychiatry and Heart rate variability (GRAPH), a checklist with four domains: participant selection, interbeat interval collection, data preparation and HRV calculation. This paper provides an overview of these four domains and why their standardized reporting is necessary to suitably evaluate HRV research in psychiatry and related disciplines. Adherence to these communication guidelines will help expedite the translation of HRV research into a potential psychiatric biomarker by improving interpretation, reproducibility and future meta-analyses.

The effects of sighing on the cardiovascular system

Elicitation of high-amplitude oscillations in the cardiovascular system may serve to dampen psychophysiological reactivity to emotional and cognitive loading. Prior work has used paced breathing to impose clinically valuable high-amplitude ∼ 0.1 Hz oscillations. In this study, we investigated whether rhythmical sighing could likewise produce high-amplitude cardiovascular oscillations in the very low frequency range (0.003-0.05 Hz). ECG, respiration, skin conductance, and beat-to-beat blood pressure were collected in 24 healthy participants during baseline, 0.1 Hz paced breathing, and 0.02 Hz paced sighing (1 sigh every 50s, with normal breathing interspersed). Results showed that each sigh elicited a strong, well-defined reaction in the cardiovascular system. This reaction did not habituate when participants repeatedly sighed for 8.5 min. The result was a high-amplitude 0.02 Hz oscillation in multiple cardiovascular parameters. Thus, paced sighing is a reliable method for imposing very low frequency oscillations in the cardiovascular system, which has research and clinical implications that warrant further study.

Considerations in the assessment of heart rate variability in biobehavioral research

Heart rate variability (HRV) refers to various methods of assessing the beat-to-beat variation in the heart over time, in order to draw inference on the outflow of the autonomic nervous system. Easy access to measuring HRV has led to a plethora of studies within emotion science and psychology assessing autonomic regulation, but significant caveats exist due to the complicated nature of HRV. Firstly, both breathing and blood pressure regulation have their own relationship to social, emotional, and cognitive experiments – if this is the case are we observing heart rate (HR) changes as a consequence of breathing changes? Secondly, experiments often have poor internal and external controls. In this review we highlight the interrelationships between HR and respiration, as well as presenting recommendations for researchers to use when collecting data for HRV assessment. Namely, we highlight the superior utility of within-subjects designs along with the importance of establishing an appropriate baseline and monitoring respiration.

Everything Hertz: methodological issues in short-term frequency-domain HRV

Frequency analysis of the electrocardiographic RR interval is a common method of quantifying autonomic outflow by measuring the beat-to-beat modulation of the heart (heart rate variability; HRV). This review identifies a series of problems with the methods of doing so—the interpretation of low-frequency spectral power, the multiple use of equivalent normalized low frequency (LFnu), high frequency (HFnu) and ratio (LF/HF) terms, and the lack of control over extraneous variables, and reviews research in the calendar year 2012 to determine their prevalence and severity. Results support the mathematical equivalency of ratio units across studies, a reliance on those variables to explain autonomic outflow, and insufficient control of critical experimental variables. Research measurement of HRV has a substantial need for general methodological improvement.

Respiratory variability and sighing: a psychophysiological reset model

Whereas respiratory psychophysiological research has mainly studied respiratory time and volume, variability in these parameters has been largely disregarded, even though it may provide important information about respiratory regulation. The present paper reviews the literature on respiratory variability and elaborates on the importance of assessing various components of respiratory variability when studying the interrelationships between emotions and breathing. A model is proposed that predicts specific action tendencies related to emotions to disturb the balance between various respiratory variability components depending on valence by arousal and control dimensions. The central focus of the paper is sighing. The causes and consequences of sighing are reviewed and integrated in the proposed model in which sighing is hypothesized to function as a resetter in the regulation of both breathing and emotions, because it restores a balance in respiratory variability fractions and causes relief.