Exploring the association between self-reported and objective measures in search of the restorative quality of natural environments: a systematic review

The benefits of nature contact for psychophysiological restoration have sparked a surge of scientific attention in recent years. The diverse psychophysiological mechanisms of stress recovery make assessment with a single marker impractical. The majority of restoration research employs a holistic approach, including subjective psychological and objective physiological measures concurrently. However, this association has not been decisively supported by empirical studies. The purpose of this systematic review is to determine the degree to which subjectively experienced restoration, as measured by self-reported scales, is associated with actual physiological changes. Searches for peer-reviewed primary research articles were conducted in SCOPUS and PubMed, returning 216 papers; the final synthesis includes 21 empirical studies published between 2008 and 2022. Findings show that there is a strong association between subjective and objective measures of restoration. Further analysis verified that using concurrently self-reported and objective measures in measuring restoration, notably the associations of Profile of Mood States (POMS), Perceived Restorativeness Scale (PRS), and Positive and Negative Affect Scale (PANAS) with Blood Pressure (BP) and Heart Rate (HR), resulted in the highest degree of consistency. However, there were negligible inconsistent associations, which were mainly reported by Restoration Outcome Scale (ROS) in psychological indicators and Salivary Cortisol (SC) and Electroencephalography (EEG) in physiological indicators. This suggests that the results of research that uses these measures simultaneously should be interpreted with caution.

Ecological Momentary Assessment: A Meta-Analysis on Designs, Samples, and Compliance Across Research Fields

Ecological Momentary Assessments (i.e., EMA, repeated assessments in daily life) are widespread in many fields of psychology and related disciplines. Yet, little knowledge exists on how differences in study designs and samples predict study compliance and dropout-two central parameters of data quality in (micro-)longitudinal research. The current meta-analysis included k = 477 articles (496 samples, total N = 677,536). For each article, we coded the design, sample characteristics, compliance, and dropout rate. The results showed that on average EMA studies scheduled six assessments per day, lasted for 7 days, and obtained a compliance of 79%. Studies with more assessments per day scheduled fewer assessment days, yet, the number of assessments did not predict compliance or dropout rates. Compliance was significantly higher in studies providing financial incentives. Otherwise, design or sample characteristics had little effects. We discuss the implications of the findings for planning, reporting, and reviewing EMA studies.

When closeness is effortful: Teachers' physiological activation undermines positive effects of their closeness on student emotions

BACKGROUND

Student perceptions of teachers' interpersonal closeness positively affect their emotions. If closeness is, however, effortful for the teacher (i.e., emotional labour, signalling less genuine closeness), this may undermine these positive effects. We tested this assumption by using student reports and external observations of teacher closeness and ambulant measures of teacher heart rate, to gauge teachers' physiological effort connected to being close during class.

AIMS

We investigated the association between teachers' physiological effort connected to closeness and students' lesson-focused emotions.

SAMPLE

75 teachers and their students (N = 1645) participated during one real-life lesson.

METHODS

Teacher interpersonal closeness was continuously coded based on a video recording and teachers' heart rate was measured continuously as an indicator of physiological effort. Students reported their emotions and perception of teacher closeness at the end of the lesson.

RESULTS

Multilevel models with student emotions as DVs and students' perceptions of teacher warmth (L1 predictor) and teachers' physiological effort when being close (i.e., an intra-individual cross-correlation, L2 predictor) were tested. As expected, students reported more positive and less negative emotions when they perceived more teacher closeness. The physiological effort connected to being close was not directly associated with student emotions; however, such effort moderated the effect of perceived closeness, especially with regard to negative student emotions (i.e., cross-level interactions). The more effortful teacher closeness was, the less closeness protected students from negative emotions.

CONCLUSIONS

In line with extant research on faking enjoyment and emotional labour, students seemed to be affected when teacher closeness was physiologically effortful, and overall positive effects of teacher closeness were undermined.

Wireless Measurement of Sympathetic Arousal During in vivo Occupational Therapy Sessions

Purpose

One goal of occupational therapists working with children who have sensory processing challenges is the regulation of arousal. Regulation strategies have not been evaluated using an empirical measure of physiological arousal.

Objective

To establish the feasibility of using an objective physiologic measure of sympathetic arousal in therapeutic settings and explore the relation between therapeutic activities and sympathetic arousal. To evaluate changes in electrodermal activity (EDA) during occupational therapy sessions.

Methods

Twenty-two children identified with sensory modulation dysfunction (SMD) wore a wireless EDA sensor during 50 min occupational therapy sessions (n = 77 sessions).

Results

All children were able to wear the sensor on the lower calf without being distracted by the device. The five insights below are based on a comparison of EDA recordings in relation to therapists' reflections describing how sympathetic arousal might correspond to therapeutic activities.

Conclusion

Objective physiological assessment of a child's sympathetic arousal during therapy is possible using a wireless EDA measurement system. Changes in EDA may correspond directly with therapeutic activities. The article provides a foundation for designing future therapeutic studies that include continuous measures of EDA.

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.

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.

Psychopathology, everyday behaviors, and autonomic activity in daily life: An ambulatory impedance cardiography study of depression, anxiety, and hypomanic traits

Discrepancies regarding the link between autonomic nervous system (ANS) activity and psychopathology may be due in part to inconsistent measurement of non-psychological factors, including eating, drinking, activity, posture, and interacting with others. Rather than sources of noise, behaviors like being active and being with others may be the behavioral pathways that connect psychopathology symptoms to autonomic activity. The present study examined whether behaviors mediate the association of depression, anxiety, and hypomanic traits with ANS by using experience sampling methodology and ambulatory impedance cardiography. Participants (n = 49) completed measures of affect and one day of experience sampling and ambulatory impedance cardiography. The association of hypomanic traits with heart rate variability and heart rate was mediated by physical activity, and social activity mediated the association of depressive symptoms and respiration. These results highlight the importance of considering the pathways between psychopathology and ANS and the mediating role that everyday behaviors play.

Autonomic Nervous System Responses to Viewing Green and Built Settings: Differentiating Between Sympathetic and Parasympathetic Activity

This laboratory study explored buffering and recovery effects of viewing urban green and built spaces on autonomic nervous system activity. Forty-six students viewed photos of green and built spaces immediately following, and preceding acute stress induction. Simultaneously recorded electrocardiogram and impedance cardiogram signal was used to derive respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP), indicators of respectively parasympathetic and sympathetic activity. The findings provide support for greater recovery after viewing green scenes, as marked by a stronger increase in RSA as a marker of parasympathetic activity. There were no indications for greater recovery after viewing green scenes in PEP as a marker of sympathetic activity, and there were also no indications of greater buffering effects of green space in neither RSA nor PEP. Overall, our findings are consistent with a predominant role of the parasympathetic nervous system in restorative effects of viewing green space.

Beyond catecholamines: Measuring autonomic responses to psychosocial context

Despite longstanding interest among human biologists in autonomic responses to socioecological context or culture change, the adoption of autonomic measures has been limited by methodological challenges. Catecholamine secretion is the most direct measure, but not all study designs are amenable to urinary sampling, and blood pressure lacks specificity to the parasympathetic or sympathetic division of the autonomic nervous system. This article reviews three alternative approaches for measuring autonomic responses: salivary α-amylase as a nonspecific autonomic marker, respiratory sinus arrhythmia as a specific parasympathetic marker, and the pre-ejection period as a specific sympathetic marker. Study design considerations are discussed in detail, including ambulatory sampling protocols that permit the evaluation of autonomic responses to everyday life. Researchers interested in how culture and social experience "get under the skin," as well as those concerned with the evolution of social engagement, can benefit from these well-validated biomarkers that are nevertheless relatively novel in human biology. Am. J. Hum. Biol. 28:309-317, 2016. © 2015 Wiley Periodicals, Inc.

Psychophysiological Assessment of Stress Under Ecological Settings

Abstract. Stress can negatively impact one’s health and well-being, however, despite the recent evolution in stress assessment research methodologies, there is still little agreement about stress conceptualization and assessment. In an attempt to summarize and reflect on this evolution, this paper aims to systematically review research evidence of ecological approaches on psychophysiological stress assessment. Thus, a literature search of electronic databases was conducted spanning 22 years (1990–2012) and 55 studies were reviewed. Studies were considered for inclusion if they contemplated both psychological and physiological measures of stress under ecological settings. This review focuses on five themes: methodology terminology, research population, study design, measurement, and technology. Findings support the need to use a common methodology terminology in order to increase scientific rigor. Additionally, there seems to be an increasing tendency for the use of these methods by multidisciplinary teams among both clinical and nonclinical populations aiming to understand the relationship between stress and disease. Most of the studies reviewed contemplated a time-based protocol and different conceptualizations of stress were found, resulting in the use of different subjective measures. Findings reinforce the importance of combining subjective and objective measures while also controlling for possible time- or situation-dependent confounders’. Advances in technology were evident and different assessment techniques were found. The benefits and challenges of ecological protocols to assess stress are discussed and recommendations for future research are provided, aiming to overcome previous limitations and advance scientific knowledge in the area.

Ambulatory assessment

Ambulatory assessment (AA) covers a wide range of assessment methods to study people in their natural environment, including self-report, observational, and biological/physiological/behavioral. AA methods minimize retrospective biases while gathering ecologically valid data from patients' everyday life in real time or near real time. Here, we report on the major characteristics of AA, and we provide examples of applications of AA in clinical psychology (a) to investigate mechanisms and dynamics of symptoms, (b) to predict the future recurrence or onset of symptoms, (c) to monitor treatment effects, (d) to predict treatment success, (e) to prevent relapse, and (f) as interventions. In addition, we present and discuss the most pressing and compelling future AA applications: technological developments (the smartphone), improved ecological validity of laboratory results by combined lab-field studies, and investigating gene-environment interactions. We conclude with a discussion of acceptability, compliance, privacy, and ethical issues.

Time-of-day effects in arousal: disrupted diurnal cortisol profiles in children with ADHD

BACKGROUND

  Fluctuations in attention-deficit hyperactivity disorder (ADHD) symptoms related to regulatory deficits in arousal states are themselves characterized by circadian rhythms. Although cortisol is an important circadian arousal-related marker, studies focusing on across-the-day cortisol variations in ADHD are scarce. There is no study with multiple measurements to take into account interday and intraday variability.

METHODS

  Salivary cortisol was sampled five times a day (awakening, 30 min after awakening, noon, 4 p.m., 8 p.m.) across five consecutive days in 33 children with ADHD (22 with and 11 without oppositional defiant disorder; ODD) and 33 class- and sex-matched controls (aged 6-12). The cortisol awakening response (increase from awakening to 30 min after awakening) and the diurnal cortisol profile (across-the-day variations) were compared for ADHD with ODD (ADHD + ODD) and without ODD (ADHD) subgroups and the control group.

RESULTS

  The cortisol awakening response was not significantly different between groups. However, longitudinal analyses to evaluate cortisol profiles across the day revealed a significant Group × Time effect (p < .001). More specifically, compared to each other, the ADHD subgroup showed a flatter slope with relative morning hypo-arousal and evening hyperarousal, whereas the ADHD + ODD subgroup showed a steeper slope with relative morning hyperarousal and evening hypo-arousal (p < .001).

CONCLUSIONS

  Findings support time-related arousal disruptions in children with ADHD associated with the presence or absence of ODD comorbidity. We recommend research on cortisol in larger samples for a better understanding of arousal mechanisms involved in ADHD not only with and without ODD but also with other comorbidities which may have implications for timing of arousal-based treatments.

Ambulatory Activity Monitoring

Behavior is central to psychology in almost any definition. Although observable activity is a core aspect of behavior, assessment strategies have tended to focus on emotional, cognitive, or physiological responses. When physical activity is assessed, it is done so mostly with questionnaires. Converging evidence of only a moderate association between self-reports of physical activity and objectively measured physical activity does raise questions about the validity of these self-reports. Ambulatory activity monitoring, defined as the measurement strategy to assess physical activity, posture, and movement patterns continuously in everyday life, has made major advances over the last decade and has considerable potential for further application in the assessment of observable activity, a core aspect of behavior. With new piezoresistive sensors and advanced computer algorithms, the objective measurement of physical activity, posture, and movement is much more easily achieved and measurement precision has improved tremendously. With this overview, we introduce to the reader some recent developments in ambulatory activity monitoring. We will elucidate the discrepancies between objective and subjective reports of activity, outline recent methodological developments, and offer the reader a framework for developing insight into the state of the art in ambulatory activity-monitoring technology, discuss methodological aspects of time-based design and psychometric properties, and demonstrate recent applications. Although not yet main stream, ambulatory activity monitoring – especially in combination with the simultaneous assessment of emotions, mood, or physiological variables – provides a comprehensive methodology for psychology because of its suitability for explaining behavior in context.

Ambulatory Assessment

Convergent experimental data, autobiographical studies, and investigations on daily life have all demonstrated that gathering information retrospectively is a highly dubious methodology. Retrospection is subject to multiple systematic distortions (i.e., affective valence effect, mood congruent memory effect, duration neglect; peak end rule) as it is based on (often biased) storage and recollection of memories of the original experience or the behavior that are of interest. The method of choice to circumvent these biases is the use of electronic diaries to collect self-reported symptoms, behaviors, or physiological processes in real time. Different terms have been used for this kind of methodology: ambulatory assessment, ecological momentary assessment, experience sampling method, and real-time data capture. Even though the terms differ, they have in common the use of computer-assisted methodology to assess self-reported symptoms, behaviors, or physiological processes, while the participant undergoes normal daily activities. In this review we discuss the main features and advantages of ambulatory assessment regarding clinical psychology and psychiatry: (a) the use of realtime assessment to circumvent biased recollection, (b) assessment in real life to enhance generalizability, (c) repeated assessment to investigate within person processes, (d) multimodal assessment, including psychological, physiological and behavioral data, (e) the opportunity to assess and investigate context-specific relationships, and (f) the possibility of giving feedback in real time. Using prototypic examples from the literature of clinical psychology and psychiatry, we demonstrate that ambulatory assessment can answer specific research questions better than laboratory or questionnaire studies.