Self-esteem, performance feedback, and cardiovascular stress reactivity

Associations between general trait anxiety, trait social anxiety and cardiovascular responses to social and non-social stressors

OBJECTIVE

The present study sought to examine whether anxiety propensity dimensions (general trait anxiety vs. trait social anxiety) interact with stressor types (tasks with social vs. non-social challenges) to determine cardiovascular stress responses.

METHODS

A 2 × 3 mixed-factorial experimental design was employed. The State-Trait Anxiety Inventory, the Social Performance and Social Interaction Anxiety Scales were administered to 233 participants, who engaged in a stress task with either social or non-social challenges during which their cardiovascular data were continuously collected.

RESULTS

General trait anxiety negatively predicted heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) reactivity (β = -0.16, p = 0.001; β = -0.17, p = 0.001; β = -0.18, p < 0.001), and positively predicted HR, SBP, DBP recovery (β = 0.16, p = 0.012; β = 0.15, p = 0.014; β = 0.15, p = 0.011), regardless of stress types. Social performance anxiety (β = -0.23, p = 0.002; β = -0.25, p = 0.001; β = -0.24, p = 0.001) and social interaction anxiety (β = -0.22, p < 0.001; β = -0.25, p < 0.001; β = -0.22, p < 0.001) only negatively predicted HR, SBP, DBP reactivity to the stress task with social challenges. No associations were observed between trait social anxiety and cardiovascular recovery from the stress task with social or non-social challenges.

CONCLUSIONS

These findings suggest that different trait anxiety dimensions interact with stressor types in affecting cardiovascular stress responses, which have different health implications.

Personal Resources and Organizational Outcomes: Sex as a Moderator of the Complex Relationships Between Self-Esteem, Heart Rate Variability, and Work-Related Exhaustion

Global self-esteem represents a protective personal resource lowering the risk of psychological distress. Research conducted in the work setting has confirmed the psychosocial benefits of high self-esteem. However, research linking self-esteem to neurobiological adaptability appears quite scarce. In this study, we propose a theoretical model in which self-esteem predicts work-related exhaustion indirectly, through the mediation of heart rate variability (HRV) and negative affect at work. Moreover, we explore the relationship between self-esteem and HRV. From one side, one would expect a positive link between self-esteem and HRV, signaling higher autonomic adaptability. However, recent studies have shown that in women, such associations become more complex, with even reversed patterns as compared with that in men. Thus, we included sex as a moderator of the relationship between HRV and self-esteem. The model was tested on a sample of 110 individuals working in the relational professions (54% males; M _age = 42.6, SD = 13.73), observed for an entire workday. Results confirmed the protective role of self-esteem against the experience of negative affect and (indirectly) work-related exhaustion. Symptoms of exhaustion at work were also negatively predicted by HRV, and both HRV and negative affect acted as mediators of the relationship between self-esteem and work-related exhaustion. Notably, sex differences emerged in the association between global self-esteem and cardiac vagal tone at work: in women, self-esteem was negatively related to HRV, which in turn led to higher work-related exhaustion, whereas in men, no evidence of this indirect effect appeared. Burnout prevention programs should not ignore important sex differences in how individuals respond to work-related stress.

A preliminary comparison of the efficacy of online Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT) stress management interventions for social and healthcare workers

Social and healthcare workers have been shown to experience greater levels of illness, depression and burnout as a result of chronic workplace stress. The purpose of this study was to examine whether brief online ACT and CBT interventions could reduce the experience of stress and burnout in employees, while also improving mental health and psychological flexibility. A total of 42 individuals working within the social and healthcare professions were randomly assigned to either a 2-week online ACT or CBT intervention. Recruitment was undertaken internationally, although the majority of participants were based in Ireland at the time of their participation (79%). Participants' perceived stress, burnout, mental health and work-related psychological flexibility were assessed at baseline and post-treatment. Intent-to-treat analyses were conducted on all data. Outcomes indicated that both interventions resulted in significant improvements in stress, burnout and mental health scores from baseline to post-treatment. No significant differences were observed between ACT and CBT conditions, or in psychological flexibility scores from baseline to post-treatment. Reliable Change Index (RCI) scores indicated that clinically significant improvements in stress and mental health were seen in 42% and 19% of programme-completers, respectively. These results provide preliminary evidence for the usefulness of brief internet-delivered ACT and CBT interventions for the treatment of occupational stress and its comorbid symptoms. Online programmes with a longer duration and additional therapist support should be evaluated, as these may improve the outcomes of future interventions.

Association of self-esteem, personality, stress and gender with performance of a resuscitation team: A simulation-based study

Background

Gender composition, stress and leadership of a resuscitation team influence CPR performance. Whether psychological variables such as self-esteem, motivation and personality traits are associated with resuscitation performance, stress levels and gender of rescuers during a cardiac arrest scenario remains uncertain.

Methods

We included 108 medical students in this prospective, observational simulator study. We videotaped the resuscitation performance and assessed self-esteem, perceived stress-overload and personality traits using validated questionnaires. In addition, we analysed leadership utterances and ECG data of all participants during the simulation. The primary endpoint was cardiopulmonary resuscitation performance, defined as hands-on time within the first 180 sec. Secondary outcomes included first meaningful measure of resuscitation, leadership statements of group leaders and physiological stress parameters of rescuers.

Results

Adjusted for group size and leadership designation, mean self-esteem of students was significantly associated with hands-on time (adjusted regression coefficient 7.94 (95%CI 2.61 to 13.27), p<0.01). The personality trait conscientiousness was positively associated with hands-on time (adjusted regression coefficient 38.4, [95%CI 7.41 to 69.38, p = 0.02]). However, after additional adjustment for self-esteem, this association was no longer significant. Further, agreeableness of team leaders was significantly associated with longer hands-on time (adjusted regression coefficient 20.87 [95%CI 3.81 to 37.94], p = 0.02). Openness to experience was negatively associated with heart rate reactivity (-5.92 (95%CI -10 to -1.85), p<0.01). Male students showed significantly higher (mean, [±SD]) self-esteem levels (24.6 [±3.8] vs. 22.0 [±4.4], p<0.01), expressed significantly more leadership statements (7.9 [±7.8] vs. 4.6 [±3.8], p<0.01) and initiated first resuscitation measures more often (n, [%]) compared to female students (16, [23] vs. 7, [12], p = 0.01).

Conclusion

This simulator study found that self-esteem of resuscitation teams and agreeableness of team leaders of inexperienced students was associated with cardiopulmonary resuscitation performance. Whether enhancing these factors during resuscitation trainings serve for better performance remains to be studied.

Converging evidence that subliminal evaluative conditioning does not affect self-esteem or cardiovascular activity

Self-esteem moderates the relationship between stress and (cardiovascular) health, with low self-esteem potentially exacerbating the impact of stressors. Boosting self-esteem may therefore help to buffer against stress. Subliminal evaluative conditioning (SEC), which subliminally couples self-words with positive words, has previously been successfully used to boost self-esteem, but the existing studies are in need of replication. In this article, we aimed to replicate and extend previous SEC studies. The first 2 experiments simultaneously examined whether SEC increased self-esteem (Experiment 1, n = 84) and reduced cardiovascular reactivity to a stressor in high worriers (Experiment 2, n = 77). On the basis of these results, the 3rd experiment was set up to examine whether an adjusted personalized SEC task increased self-esteem and reduced cardiac activity in high worriers (n = 81). Across the 3 experiments, no effects were found of SEC on implicit or explicit self-esteem or affect or on cardiovascular (re)activity compared to a control condition in which the self was coupled with neutral words. The results do not support the use of the subliminal intervention in its current format. As stress is highly prevalent, future studies should focus on developing other cost-effective and evidence-based interventions.

Self-esteem fluctuations and cardiac vagal control in everyday life

It has been proposed that self-esteem buffers threat-responding. The same effect is ascribed to the vagus nerve, which is a primary nerve of the parasympathetic nervous system. Consequently, it has been suggested that self-esteem and cardiac vagal tone are interconnected on a trait, as well as on a state, level. In this study, we examined the relationship of vagal cardiac control and self-esteem fluctuations across a single day using ecological momentary assessment. Eighty-four participants were recruited, and self-esteem, negative affect, and vagal tone were recorded throughout a 22-hour period. Men provided higher self-esteem ratings than women, but the negative relationship between self-esteem and negative affect was stronger in women. Moreover, controlling for potential confounds (e.g., age, BMI, depressive symptoms, smoking status, regular physical activity), we observed that for men, self-esteem was significantly positively associated with cardiac vagal tone, whereas for women it was not. These findings suggest that the relationship between self-esteem and vagal innervation of the heart during daily life is sex-specific and might involve different central-autonomic pathways for men and women, respectively.

Cardiovascular and psychological reactivity and recovery from harassment in a biracial sample of high and low hostile men and women

BACKGROUND

This study emphasizes the importance of studying the emotional, motivational, and cognitive characteristics accompanying and the potential hemodynamic mechanisms underlying cardiovascular reactivity to and recovery from interpersonal conflict.

PURPOSE

The relation of dispositional hostility to cardiovascular reactivity during a frustrating anagram task and post-task recovery was investigated.

METHODS

The sample was composed of 99 healthy participants (age, 18-30 years; 53% women; 51% Caucasian; 49% African American)-half randomly assigned to a harassment condition. High and low hostility groups were created by a median split specific to sex and race subgroup score distributions on the Cook-Medley Hostility Scale. It was hypothesized that hostility would interact with harassment such that harassed, high hostile individuals would display the greatest cardiovascular and emotional reactivity and slowest recovery of the four groups. Participants completed a 10-min baseline, a 6-min anagram task, and a 5-min recovery period with blood pressure, heart rate, pre-ejection period, stroke index, cardiac index, and total peripheral resistance index measured.

RESULTS

Harassed participants displayed significantly greater cardiovascular responses and lower positive affect to the task and slower systolic blood pressure (SBP) recovery than did nonharassed participants. The high hostile group, irrespective of harassment, showed blunted cardiovascular responses during the task and delayed SBP recovery than the low hostile group.

CONCLUSION

Although the predicted interaction between hostility and harassment was not supported in the context of cardiovascular responses, such an interaction was observed in the context of blame attributions, whereby harassed hostile participants were found to blame others for their task performance than the other subgroups.

Self-esteem levels and cardiovascular and inflammatory responses to acute stress

Acute mental stress tests have helped to clarify the pathways through which psychosocial factors are linked to disease risk. This methodology is now being used to investigate potentially protective psychosocial factors. We investigated whether global self-esteem might buffer cardiovascular and inflammatory responses to acute stress. One hundred and one students completed the Rosenberg Self-Esteem Scale. Heart rate and heart rate variability (HRV) were recorded for 5 min periods at baseline, during two mental stress tasks, (a speech and a color-word task) and 10, 25 and 40 min into a recovery period. Plasma levels of tumor-necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1Ra) were assessed at baseline, immediately post-stress and after 45 min recovery. Repeated measures analysis of variance demonstrated that heart rate levels were lower across all time points in those with high self-esteem, although heart rate reactivity to stress was not related to self-esteem. There were no differences in baseline HRV, TNF-alpha, IL-6 or IL-1Ra. Multiple linear regressions revealed that greater self-esteem was associated with a smaller reduction in heart rate variability during the speech task, but not the color-word task. Greater self-esteem was associated with smaller TNF-alpha and IL-1Ra responses immediately following acute stress and smaller IL-1Ra responses at 45 min post-stress. In conclusion, global self-esteem is associated with lower heart rate and attenuated HRV and inflammatory responses to acute stress. These responses could be processes through which self-esteem protects against the development of disease.