A new paradigm to induce mental stress: the Sing-a-Song Stress Test (SSST)

Seven robust and easy to obtain biomarkers to measure acute stress

With the purpose of identifying a sensitive, robust, and easy-to-measure set of biomarkers to assess stress reactivity, we here study a large set of relatively easy to obtain markers reflecting subjective, autonomic nervous system (ANS), endocrine, and inflammatory responses to acute social stress (n = 101). A subset of the participants was exposed to another social stressor the next day (n = 48) while being measured in the same way. Acute social stress was induced following standardized procedures. The markers investigated were self-reported positive and negative affect, heart rate, electrodermal activity, salivary cortisol, and ten inflammatory markers both in capillary plasma and salivary samples, including IL-22 which has not been studied in response to acute stress in humans before. Robust effects (significant effect in the same direction for both days) were found for self-reported negative affect, heart rate, electrodermal activity, plasma IL-5, plasma IL-22, salivary IL-8 and salivary IL-10. Of these seven markers, the participants' IL-22 responses on the first day were positively correlated to those on the second day. We found no correlations between salivary and capillary plasma stress responses for any of the ten cytokines and somewhat unexpectedly, cytokine responses in saliva seemed more pronounced and more in line with previous literature than cytokines in capillary plasma. In sum, seven robust and easy to obtain biomarkers to measure acute stress response were identified and should be used in future stress research to detect and examine stress reactivity. This includes IL-22 in plasma as a promising novel marker.

Social and natural environmental factors cause the birth-cohort phenomenon of peptic ulcers by superposition mechanism

The widely believed Helicobacter pylori infection has never explained the birth-cohort phenomenon of peptic ulcers. Although numerous studies have observed that environmental factors are associated with peptic ulcers, their role in the disease has yet to be identified. A new etiological theory proposed that environmental factors cause peptic ulcers via inducing psychological stress. Starting from this etiology, an integration of the mortality rates caused by social and natural environmental factors reproduced a representative fluctuation curve in the birth-cohort phenomenon, where a causal role of environmental factors in peptic ulcers was hidden. The reproduced fluctuation curve revealed that multiple environmental factors caused the birth-cohort phenomenon by Superposition Mechanism, and the causal role of each individual environmental factor surfaced if the fluctuation curves in the birth-cohort phenomenon were properly differentiated. A full understanding of the birth-cohort phenomenon highlights the importance of environmental management in improving clinical outcomes, and suggests that the Superposition Mechanism is an indispensable methodological concept for life science and medicine.

Detection of arousal and valence from facial expressions and physiological responses evoked by different types of stressors

Automatically detecting mental state such as stress from video images of the face could support evaluating stress responses in applicants for high risk jobs or contribute to timely stress detection in challenging operational settings (e.g., aircrew, command center operators). Challenges in automatically estimating mental state include the generalization of models across contexts and across participants. We here aim to create robust models by training them using data from different contexts and including physiological features. Fifty-one participants were exposed to different types of stressors (cognitive, social evaluative and startle) and baseline variants of the stressors. Video, electrocardiogram (ECG), electrodermal activity (EDA) and self-reports (arousal and valence) were recorded. Logistic regression models aimed to classify between high and low arousal and valence across participants, where "high" and "low" were defined relative to the center of the rating scale. Accuracy scores of different models were evaluated: models trained and tested within a specific context (either a baseline or stressor variant of a task), intermediate context (baseline and stressor variant of a task), or general context (all conditions together). Furthermore, for these different model variants, only the video data was included, only the physiological data, or both video and physiological data. We found that all (video, physiological and video-physio) models could successfully distinguish between high- and low-rated arousal and valence, though performance tended to be better for (1) arousal than valence, (2) specific context than intermediate and general contexts, (3) video-physio data than video or physiological data alone. Automatic feature selection resulted in inclusion of 3-20 features, where the models based on video-physio data usually included features from video, ECG and EDA. Still, performance of video-only models approached the performance of video-physio models. Arousal and valence ratings by three experienced human observers scores based on part of the video data did not match with self-reports. In sum, we showed that it is possible to automatically monitor arousal and valence even in relatively general contexts and better than humans can (in the given circumstances), and that non-contact video images of faces capture an important part of the information, which has practical advantages.

Validity of mental and physical stress models

Different stress models are employed to enhance our understanding of the underlying mechanisms and explore potential interventions. However, the utility of these models remains a critical concern, as their validities may be limited by the complexity of stress processes. Literature review revealed that both mental and physical stress models possess reasonable construct and criterion validities, respectively reflected in psychometrically assessed stress ratings and in activation of the sympathoadrenal system and the hypothalamic-pituitary-adrenal axis. The findings are less robust, though, in the pharmacological perturbations' domain, including such agents as adenosine or dobutamine. Likewise, stress models' convergent- and discriminant validity vary depending on the stressors' nature. Stress models share similarities, but also have important differences regarding their validities. Specific traits defined by the nature of the stressor stimulus should be taken into consideration when selecting stress models. Doing so can personalize prevention and treatment of stress-related antecedents, its acute processing, and chronic sequelae. Further work is warranted to refine stress models' validity and customize them so they commensurate diverse populations and circumstances.

A study on the effect of music listening on people with high neurotic tendency as evidenced by negative affective scores and physiological responses

BACKGROUND

Music listening has been found to be effective in reducing stress levels with different participant samples. Relatively little evidence has been obtained from people with high neurotic tendency (HNT), whose dispositional psychological characteristics might dampen the effect of music listening. This study therefore tried to examine the immediate effect of music listening in reducing stressful feelings of participants with either high or low neurotic tendency.

PARTICIPANTS AND PROCEDURE

Seventy-nine undergraduate participants who were identified as having either HNT or low neurotic tendency (LNT) accomplished a stressful task before listening to a comforting music piece. Negative affect (NA) scores and heart rate were measured at different phases.

RESULTS

Results in a within-subjects analysis showed that the stressor and music listening could significantly alter the stressful feeling of both participant groups. Although the percentage changes in heart rate were similar between the groups, the changes of NA score which were measured after either the stressful task or the music listening session were consistently lower in the HNT group than the LNT group.

CONCLUSIONS

The divergence revealed a loose connection between the subjective feelings and the bodily changes in the HNT group, which could be important for clinicians and practitioners to take into consideration in psychology when evaluating the stressful feelings for their clients with HNT.

Understanding the combined effects of sleep deprivation and acute social stress on cognitive performance using a comprehensive approach

Background

Sleep deprivation (SD) and acute social stress are common, often unavoidable, and frequently co-occurring stressors in high-risk professions. Both stressors are known to acutely induce inflammatory responses and an increasing body of literature suggests this may lead to cognitive impairment. This study examined the combined effects of total SD and acute social stress on cognitive performance and took a comprehensive approach to explore their (shared) underlying mechanism leading to cognitive decline.

Method

We recorded cognitive performance on a response inhibition task and a multitask and monitored a range of inflammatory, psychophysiological and self-reported markers in 101 participants, both before and after one night of either sleep (control group: N = 48) or SD (N = 53), and both before and after a social stressor (Trier Social Stress Test).

Results

SD decreased cognitive performance. The social stress test also results in cognitive performance decline in the control group on the response inhibition task, but improved rather than decreased performance of sleep deprived participants on both tasks. The subjective ratings of mental effort also reflect this antagonistic interaction, indicating that the social stressor when sleep-deprived also reduced mental effort. In the inflammatory and physiological measures, this pattern was only reflected by IL-22 in blood. SD reduced blood IL-22 concentrations, and the social stress reduced IL-22 in the control group as well, but not in sleep-deprived participants. There were no interactive effects of SD and social stress on any other inflammatory or psychophysiological measures. The effects of the social stress test on autonomic measures and subjective results suggest that increased arousal may have benefited sleep-deprived participants' cognitive performance.

Discussion

SD generally decreased cognitive performance and increased required mental effort. By contrast, the isolated effects of a social stressor were not generic, showing a positive effect on cognitive performance when sleep deprived. Our study is the first that studied combined effects of sleep deprivation and acute social stress on cognitive performance and inflammatory markers. It provides a comprehensive overview of effects of these stressors on a range of variables. We did not show unequivocal evidence of an underlying physiological mechanism explaining changes in performance due to (the combination of) sleep deprivation and social stress, but consider IL-22 as a possible cytokine involved in this mechanism and certainly worth following up on in future research.

The effect of simulated natural environments in virtual reality and 2D video to reduce stress

Stress is a common problem associated with poor physical and psychological health. Exposure to the natural environment is one method for reducing stress. The real and simulated natural environments have a restorative effect on stress reduction. In contrast to the real environment, simulated natural environments, such as virtual reality and 2D video, provide safer and more controllable exposure. Several studies on the restorative effects of the natural environment in virtual reality and 2D video have been conducted. However, the difference between the two in reducing stress must be clarified. This study was conducted to determine the effect of the simulated natural environments in virtual reality and 2D video and their differences in reducing stress. This study hypothesizes that both simulated natural environments in virtual reality and 2D video can reduce stress, but there is a difference between them in reducing stress. Fifty-three subjects were divided into two experimental groups: 2D video (n = 28) and virtual reality (n = 25). The results indicated that simulated natural environments in virtual reality and 2D video reduced stress. However, there was no difference between the two groups regarding stress reduction.

The Effects of Virtual and Physical Elevation on Physiological Stress During Virtual Reality Height Exposure

Advances in virtual reality technology have greatly benefited the acrophobia research field. Virtual reality height exposure is a reliable method of inducing stress with low variance across ages and demographics. When creating a virtual height exposure environment, researchers have often used haptic feedback elements to improve the sense of realism of a virtual environment. While the quality of the rendered for the virtual environment increases over time, the physical environment is often simplified to a conservative passive haptic feedback platform. The impact of the increasing disparity between the virtual and physical environment on the induced stress levels is unclear. This article presents an experiment that explored the effect of combining an elevated physical platform with different levels of virtual heights to induce stress. Eighteen participants experienced four different conditions of varying physical and virtual heights. The measurements included gait parameters, heart rate, heart rate variability, and electrodermal activity. The results show that the added physical elevation at a low virtual height shifts the participant's walking behaviour and increases the perception of danger. However, the virtual environment still plays an essential role in manipulating height exposure and inducing physiological stress. Another finding is that a person's behaviour always corresponds to the more significant perceived threat, whether from the physical or virtual environment.

A novel procedure to investigate social anxiety using videoconferencing software: A proof-of-concept study

Social anxiety disorder (SAD) is very common and can be significantly disabling. New treatments are needed as the remission rate for SAD is the lowest of all the anxiety disorders. Experimental medicine models, in which features resembling a clinical disorder are experimentally induced, are a cost-effective and timely approach to explore potential novel treatments for psychiatric disorders. Following the emergence of SARS-CoV-2, there is a need to develop experimental medicine models that can be carried out remotely. We developed a novel procedure to investigate SAD (the InterneT-based Stress test for Social Anxiety Disorder; ITSSAD) that can be carried out entirely online by a single investigator, potentially reducing costs and maximising internal reliability. The procedure involves an anticipatory period followed by a naturalistic social interaction task. In a sample of 20 non-treatment-seeking volunteers with symptoms of SAD, the ITSSAD induced significant subjective anxiety and reduced positive affect. Further, increased social anxiety symptoms at baseline predicted increased anxiety during the social interaction task. This protocol needs further validation with physiological measures. The ITSSAD is a new tool for researchers to investigate mechanisms underlying social anxiety disorder.

The effects of autonomous sensory meridian response (ASMR) on mood, attention, heart rate, skin conductance and EEG in healthy young adults

Autonomous sensory meridian response (ASMR) is a warm tingling sensation which is often accompanied by feelings of calmness and relaxation. The present study examined the effects of an ASMR video on mood, attention, heart rate (HR), electrodermal activity (EDA), electroencephalography (EEG) and the interaction with personality factors in 38 young adults (33 females and 5 males). Based on the ASMR-checklist responses of having tingles during watching the ASMR video 15 participants out of 38 were classified as ASMR-experiencers. Mood, attention and personality characteristics were measured by the Profile of Mood States, the Flanker task and HEXACO. EEG, HR and EDA were recorded during the ASMR and control videos. Depressive feelings decreased after watching the ASMR video in individuals experiencing tingles relative to those not experiencing tingles. Furthermore, in all participants, irrespective of experiencing tingles, a decrease of HR during watching the ASMR video was found. In ASMR-experiencers scoring low on Conscientiousness EDA tended to increase and HR tended-relatively to the group not experiencing tingles—to decrease during watching the ASMR video. EEG recordings indicated that watching the ASMR video was associated with decreased alpha power in ASMR-sensitive participants and decreased theta as well as increased beta power in the whole group of participants. The observed ASMR-induced decrease of alpha and theta power and increase of beta power and (only in low conscientious participants) EDA may reflect that, apart from relaxation, ASMR is related to arousal and focused attention.

Stress and Emotional Intelligence Shape Giving Behavior: Are There Different Effects of Social, Cognitive, and Emotional Stress?

Acute stress has been linked with prosocial behavior, yet it is entirely unexplored how different types of stressors may affect individuals’ willingness to help: This is particularly relevant while people is experiencing multiple sources of stress due to the COVID-19 pandemic. Here we explore whether different types of stress influence peoples’ giving behavior and the moderating role of emotional intelligence (EI). Undergraduate students were exposed to experimentally induced social, cognitive, or emotional stress and were asked to self-report on their willingness to help and donate to a charity raising funds for COVID-19 and flu patients. Results showed that when compared to a control condition, after being exposed to a social stress, participants were more willing to help a person in need. Our results also provide evidence that, after experiencing a social stress, participants with high (vs low) trait EI were more willing to help, and, as a result, donated more. Findings indicate that moderate levels of distress are associated with increased donations. Interestingly, when stress is not too threatening, high EI can regulate it and promote prosocial behaviors.

Integrating Cognitive Developmental Neuroscience in Society: Lessons Learned From a Multidisciplinary Research Project on Education and Social Safety of Youth

Integrating fundamental science in society, with the goal to translate research findings to daily practice, comes with certain challenges. Successfully integrating research projects into society requires (1) good collaboration between scientists and societal stakeholders, (2) collaboration partners with common expectations and goals, and (3) investment in clear communication. Here we describe an integrative research project conducted by a large Dutch consortium that consisted of neuroscientists, psychologists, sociologists, ethicists, teachers, health care professionals and policy makers, focusing on applying cognitive developmental neuroscience for the benefit of youth in education and social safety. We argue that to effectively integrate cognitive developmental neuroscience in society, (1) it is necessary to invest in a well-functioning, diverse and multidisciplinary team involving societal stakeholders and youth themselves from the start of the project. This aids to build a so-called productive interactive network that increases the chances to realize societal impact in the long-term. Additionally, we propose that to integrate knowledge, (2) a different than standard research approach should be taken. When focusing on integration, the ultimate goal of research is not solely to understand the world better, but also to intervene with real-life situations, such as education or (forensic) youth care. To accomplish this goal, we propose an approach in which integration is not only started after the research has been conducted, but taken into account throughout the entire project. This approach helps to create common expectations and goals between different stakeholders. Finally, we argue that (3) dedicating sufficient resources to effective communication, both within the consortium and between scientists and society, greatly benefits the integration of cognitive developmental neuroscience in society.

Effectiveness of game-based meditation therapy on neurobiological stress systems in adolescents with posttraumatic symptoms: a randomized controlled trial

Many adolescents in residential care have experienced traumatic events and suffer from posttraumatic stress. Prolonged activation of neurobiological stress systems as the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis can result in long-lasting maladaptive alternations. This study investigated the effectiveness of Muse, a game-based meditation intervention, on the sympathetic nervous system (SNS), parasympathetic nervous system (PNS), and cortisol basal activity and reactivity to acute stress among adolescents with posttraumatic symptoms in residential care. The intervention consisted of two gameplay sessions a week, for 6 consecutive weeks. Seventy-seven adolescents with clinical levels of posttraumatic symptoms (10-18 years old) received either Muse as an addition to treatment as usual (n = 40) or treatment as usual alone (n = 37). We expected reduced basal activity for the SNS and cortisol and increased basal activity for the PNS. As for the response to acute stress, we expected decreased PNS and increased HPA axis reactivity. The Muse group exhibited lower basal activity for the SNS and increased HPA reactivity to acute stress. There were no differences between conditions on SNS and HPA axis activity during rest and on SNS and PNS reactivity to acute stress. Game-based meditation therapy is a promising intervention for the treatment of adolescents with posttraumatic symptoms in residential care. Implications for clinical relevance and trauma-focused treatment purposes are discussed.

Alterations of autonomic nervous system and HPA axis basal activity and reactivity to acute stress: a comparison of traumatized adolescents and healthy controls

Alterations in neurobiological stress systems such as the autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis contribute to the development and maintenance of psychological and behavioral problems after traumatic experiences. Investigating neurobiological parameters and how these relate to each other may provide insight into the complex mechanisms at play. Whereas the preponderance of studies focuses on either the ANS or the HPA axis separately, the current study is the first to evaluate relations between posttraumatic stress and both basal activity during rest and stress reactivity of the ANS as well as the HPA axis in a sample of traumatized adolescents and healthy controls. The traumatized sample (n = 77), based on clinical levels of posttraumatic stress, was a convenience sample that was recruited within residential institutions, was compared to a healthy control sample (n = 48) recruited within the general community. For the ANS, we expected increased SNS and decreased PNS activity during rest and increased SNS and decreased PNS reactivity to social stress among traumatized adolescents compared to healthy controls. Regarding the HPA axis, we expected increased basal cortisol levels and decreased cortisol reactivity to stress in the traumatized sample. Compared to healthy controls, traumatized adolescents exhibited significantly higher sympathetic and lower parasympathetic activation during rest and increased sympathetic reactivity to acute stress (ANS parameters). Outcomes on the HPA axis (i.e. cortisol) indicated that traumatized adolescents showed increased cortisol levels during rest and blunted cortisol reactivity to acute stress. Implications for clinical relevance and trauma-focused treatment purposes are discussed.

Clinical Outcomes of Severe Forms of Early Social Stress

Early social stress, particularly severe but nevertheless frequent forms such as abuse and neglect, are among the major risk factors for the development of mental disorders. However, we only have very limited knowledge of the psychobiological disease mechanisms underlying the influence of early life stress and stress-related disorders during this vulnerable phase of life. Early stress can have long-lasting adverse effects on the brain and other somatic systems, e.g. through influences on brain development. In adulthood, the prior experience of abuse or neglect can result in complex clinical profiles. Besides conditions such as mood and anxiety disorders as well as posttraumatic stress disorder, substance use disorders (SUD) are among the most prevalent sequelae of early social stress. Current social stress further influences the development and maintenance of these disorders, e.g., by increasing the risk of relapses. In this chapter, we will first give an overview of currently used methods to assess the phenomenology and pathophysiology of stress-related disorders and then focus on the phenomenological and neurobiological background of the interaction between early social stress and SUD. We will give an overview of important insights from neuroimaging studies and will also highlight recent findings from studies using digital tools such as ecological momentary assessment or virtual reality to capture the influence of early social stress as well as current social stress in everyday life of persons with SUD.

Trier Social Stress Test Elevates Blood Pressure, Heart Rate, and Anxiety, But a Singing Test or Unsolvable Anagrams Only Elevates Heart Rate, among Healthy Young Adults

The Trier Social Stress Test (TSST) is a psychosocial stressor that effectively stimulates the stress response but is labor and time intensive. Although other psychological stressors are often used experimentally, none are known to comparably elevate stress. Two stressors that may potentially elevate stress are a singing task (ST) and unsolvable anagrams, but there are not enough data to support their effectiveness. In the current experiment, 53 undergraduate males and females (mean age = 21.9 years) were brought into the laboratory, and baseline blood pressure, heart rate, self-rated anxiety, and salivary cortisol were recorded. Then, participants were randomly assigned to one of three stress conditions: TSST (n = 24), ST (n = 14), or an unsolvable anagram task (n = 15). Stress measures were taken again after the stressor and during recovery. The TSST significantly elevated systolic blood pressure, diastolic blood pressure, heart rate, and self-rated anxiety from pre-stress levels, replicating its stress-inducing properties. However, the ST and unsolvable anagrams only elevated heart rate, indicating that these methods are not as able to stimulate physiological or psychological stress. Overall, results indicate that out of these three laboratory stressors, the TSST clearly engages the stress response over the ST or unsolvable anagrams.

Validation of Affect-tag Affective and Cognitive Indicators

The Affect-tag solution measures physiological signals to deliver indicators derived from cognitive science. To provide the most accurate and effective results, a database of electrodermal activity (EDA) signals acquired using the Affect-tag A1 band was created. An experimental paradigm was designed to measure action-taking, autonomic regulation, cognitive load (CL), emotions, and stress, affects, and social stress. The Affect-tag emotional power (EP), emotional density (ED), and CL affective and cognitive indicators were refined based on the physiological responses of 48 participants during these tasks. Statistical significance was obtained for all indicators in tasks they were designed to measure, resulting in a total accuracy score of 89% for the combined indicators. Data obtained during this study will be further analyzed to define emotional and affective states.

A standardized validity assessment protocol for physiological signals from wearable technology: Methodological underpinnings and an application to the E4 biosensor

Wearable physiological measurement devices for ambulatory research with novel sensing technology are introduced with ever increasing frequency, requiring fast, standardized, and rigorous validation of the physiological signals measured by these devices and their derived parameters. At present, there is a lack of consensus on a standardized protocol or framework with which to test the validity of this new technology, leading to the use of various (often unfit) methods. This study introduces a comprehensive validity assessment protocol for physiological signals (electrodermal activity and cardiovascular activity) and investigates the validity of the E4 wearable (an example of such a new device) on the three levels proposed by the protocol: (1) the signal level, with a cross-correlation; (2) the parameter level, with Bland–Altman plots; and (3) the event level, with the detection of physiological changes due to external stressor levels via event difference plots. The results of the protocol show that the E4 wearable is valid for heart rate, RMSSD, and SD at the parameter and event levels, and for the total amplitude of skin conductance responses at the event level when studying strong sustained stressors. These findings are in line with the prior literature and demonstrate the applicability of the protocol. The validity assessment protocol proposed in this study provides a comprehensive, standardized, and feasible method for assessment of the quality of physiological data coming from new wearable (sensor) technology aimed at ambulatory research.

Physiological Synchrony in EEG, Electrodermal Activity and Heart Rate Detects Attentionally Relevant Events in Time

Interpersonal physiological synchrony (PS), or the similarity of physiological signals between individuals over time, may be used to detect attentionally engaging moments in time. We here investigated whether PS in the electroencephalogram (EEG), electrodermal activity (EDA), heart rate and a multimodal metric signals the occurrence of attentionally relevant events in time in two groups of participants. Both groups were presented with the same auditory stimulus, but were instructed to attend either to the narrative of an audiobook (audiobook-attending: AA group) or to interspersed emotional sounds and beeps (stimulus-attending: SA group). We hypothesized that emotional sounds could be detected in both groups as they are expected to draw attention involuntarily, in a bottom-up fashion. Indeed, we found this to be the case for PS in EDA or the multimodal metric. Beeps, that are expected to be only relevant due to specific "top-down" attentional instructions, could indeed only be detected using PS among SA participants, for EDA, EEG and the multimodal metric. We further hypothesized that moments in the audiobook accompanied by high PS in either EEG, EDA, heart rate or the multimodal metric for AA participants would be rated as more engaging by an independent group of participants compared to moments corresponding to low PS. This hypothesis was not supported. Our results show that PS can support the detection of attentionally engaging events over time. Currently, the relation between PS and engagement is only established for well-defined, interspersed stimuli, whereas the relation between PS and a more abstract self-reported metric of engagement over time has not been established. As the relation between PS and engagement is dependent on event type and physiological measure, we suggest to choose a measure matching with the stimulus of interest. When the stimulus type is unknown, a multimodal metric is most robust.

Cardiovascular Responses to Stress Utilizing Anticipatory Singing Tasks

Abstract. Models of psychobiological stress reactivity have a foundation in the measurement of responses to standardized stress tasks. Tasks with anticipatory phases have been proposed as an effective method of stress induction, either as a stand-alone task or replacement constituent elements for existing stressor paradigms. Tasks utilizing singing as a primary stressor have been proposed but the efficacy of these tasks have not been demonstrated while maintaining adherence to a resting/reactivity/recovery framework desirable for heart rate variability (HRV) measurement. This study examines the viability of an anticipatory sing-a-song task as a method for inducing mental stress and examines the utility of the task with specific reference to measures of cardiovascular reactivity and recovery activity, and standard protocols to examine HRV reactivity and recovery. Participants completed a dual task with a math task and an anticipation of singing component. Responses were examined according to a resting/reactivity/recovery paradigm and the findings indicate that the sing-a-song stimulus is effective in generating a stress response. Significant differences in heart rate and self-reported stress between baseline and stressor conditions were detected, with greater magnitude differences between baseline and anticipatory phases. This study has demonstrated the viability of the anticipation of singing as a standardized stressor using cardiovascular measures and has described variants of this task that may be used for repeated measures study designs.

A brief positive psychological intervention prior to a potentially stressful task facilitates more challenge-like cardiovascular reactivity in high trait anxious individuals

When confronted with stress, anxious individuals tend to evaluate the demands of an upcoming encounter as higher than the available resources, thus, indicating threat evaluations. Conversely, evaluating available resources as higher than the demands signals challenge. Both types of evaluations have been related to specific cardiovascular response patterns with higher cardiac output relative to peripheral resistance indicating challenge and higher peripheral resistance relative to cardiac output signaling threat. The aim of this research was to evaluate whether a brief positive psychological exercise (best possible selves intervention) prior to a potentially stress‐evoking task shifted the cardiovascular profile in trait anxious individuals from a threat to a challenge type. We randomly assigned 74 participants to either a best possible selves or a control exercise prior to performing a sing a song stress task and assessed their level of trait anxiety. Cardiac output (CO) and total peripheral resistance (TPR) were continuously recorded through baseline, preparation, stress task, and recovery, respectively, as well as self‐reported affect. Trait anxiety was related to higher CO in the best possible selves group and lower CO in the control group. While high trait anxious individuals in the control group showed increasing TPR reactivity, they exhibited a nonsignificant change in the best possible selves group. Moreover, in the latter group a stress‐related decrease in positive affect in high trait anxious participants was prevented. Findings suggest that concentrating on strengths and positive assets prior to a potentially stressful encounter could trigger a more adaptive coping in trait anxious individuals.

According to the biopsychosocial model anxious individuals may evaluate motivated performance tasks as threatening, resulting in stronger vascular than cardiac responding. We found that a positive writing exercise (best possible selves‐intervention) prior to a laboratory stress task led to a more challenge‐type response profile (i.e., higher cardiac output relative to peripheral resistance) in trait anxious individuals, suggesting that positive psychological micro‐interventions could foster more adaptive coping.

Emotional State During Tasting Affects Emotional Experience Differently and Robustly for Novel and Familiar Foods

Emotional state during food consumption is expected to affect food pleasantness. We hypothesize that a negative emotional state reduces food pleasantness and more so for novel foods than for familiar foods because novel foods have not yet been associated with previous emotions. Furthermore, we expect this effect to be stronger when judging the food again from memory without tasting. We induced a positive emotional state in 34 participants by telling them that they earned a monetary bonus and induced a negative emotional state in 35 other participants by subjecting them to a social stress test. After this emotion induction, both groups tasted and rated a (for them) novel soup (sumashi soup) and a familiar soup (vegetable soup). Several explicit and implicit measures of food pleasantness (rated valence, EsSense25, willingness-to-take-home and sip size) indicated that while the negative emotion group did not experience the soups as less pleasant than the positive emotion group, there was an interaction between food familiarity and emotional group. The positive emotion group experienced novel and familiar soups as equally pleasant, whereas the negative emotion group experienced the novel soup as relatively unpleasant and the familiar soup as pleasant. The latter result is consistent with a comforting effect of a familiar taste in a stressful situation. This effect remained in the ratings given 1 week later based on memory and even after retasting. Our results show that emotional state affects food pleasantness differently for novel and familiar foods and that such an effect can be robust.

Game-Based Meditation Therapy to Improve Posttraumatic Stress and Neurobiological Stress Systems in Traumatized Adolescents: Protocol for a Randomized Controlled Trial

BACKGROUND

Many adolescents in residential care have been exposed to prolonged traumatic experiences such as violence, neglect, or abuse. Consequently, they suffer from posttraumatic stress. This not only negatively affects psychological and behavioral outcomes (eg, increased anxiety, depression, and aggression) but also has adverse effects on physiological outcomes, in particular on their neurobiological stress systems. Although current evidence-based treatment options are effective, they have their limitations. An alternative to traditional trauma treatment is meditation-based treatment that focuses on stress regulation and relaxation. Muse is a game-based meditation intervention that makes use of adolescents' intrinsic motivation. The neurofeedback element reinforces relaxation abilities.

OBJECTIVE

This paper describes the protocol for a randomized controlled trial in which the goal is to examine the effectiveness of Muse (InteraXon Inc) in reducing posttraumatic stress and normalizing neurobiological stress systems in a sample of traumatized adolescents in residential care.

METHODS

This will be a multicenter, multi-informant, and multimethod randomized controlled trial. Participants will be adolescents (N=80), aged 10 to 18 years, with clinical levels of posttraumatic symptoms, who are randomized to receive either the Muse therapy sessions and treatment as usual (intervention) or treatment as usual alone (control). Data will be collected at 3 measurement instances: pretest (T1), posttest (T2), and at 2-month follow-up. Primary outcomes will be posttraumatic symptoms (self-report and mentor report) and stress (self-report) at posttest. Secondary outcomes will be neurobiological stress parameters under both resting and acute stress conditions, and anxiety, depression, and aggression at posttest. Secondary outcomes also include all measures at 2-month follow-up: posttraumatic symptoms, stress, anxiety, depression aggression, and neurobiological resting parameters.

RESULTS

The medical-ethical committee Arnhem-Nijmegen (NL58674.091.16) approved the trial on November 15, 2017. The study was registered on December 2, 2017. Participant enrollment started in January 2018, and the results of the study are expected to be published in spring or summer 2021.

CONCLUSIONS

Study results will demonstrate whether game-based meditation therapy improves posttraumatic stress and neurobiological stress systems, and whether it is more effective than treatment as usual alone for traumatized adolescents.

TRIAL REGISTRATION

Netherlands Trial Register NL6689 (NTR6859); https://www.trialregister.nl/trial/6689.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19881.

A Usability Study of Physiological Measurement in School Using Wearable Sensors

Measuring psychophysiological signals of adolescents using unobtrusive wearable sensors may contribute to understanding the development of emotional disorders. This study investigated the feasibility of measuring high quality physiological data and examined the validity of signal processing in a school setting. Among 86 adolescents, a total of more than 410 h of electrodermal activity (EDA) data were recorded using a wrist-worn sensor with gelled electrodes and over 370 h of heart rate data were recorded using a chest-strap sensor. The results support the feasibility of monitoring physiological signals at school. We describe specific challenges and provide recommendations for signal analysis, including dealing with invalid signals due to loose sensors, and quantization noise that can be caused by limitations in analog-to-digital conversion in wearable devices and be mistaken as physiological responses. Importantly, our results show that using toolboxes for automatic signal preprocessing, decomposition, and artifact detection with default parameters while neglecting differences between devices and measurement contexts yield misleading results. Time courses of students' physiological signals throughout the course of a class were found to be clearer after applying our proposed preprocessing steps.

Physiological synchrony in EEG, electrodermal activity and heart rate reflects shared selective auditory attention

OBJECTIVE

Concurrent changes in physiological signals across multiple listeners (physiological synchrony-PS), as caused by shared affective or cognitive processes, may be a suitable marker of selective attentional focus. We aimed to identify the selective attention of participants based on PS with individuals sharing attention with respect to different stimulus aspects.

APPROACH

We determined PS in electroencephalography (EEG), electrodermal activity (EDA) and electrocardiographic inter-beat interval (IBI) of participants who all heard the exact same audio track, but were instructed to either attend to the audiobook or to interspersed auditory events such as affective sounds and beeps that attending participants needed to keep track of.

MAIN RESULTS

PS in all three measures reflected the selective attentional focus of participants. In EEG and EDA, PS was higher for participants when linked to participants with the same attentional instructions than when linked to participants instructed to focus on different stimulus aspects, but in IBI this effect did not reach significance. Comparing PS between a participant and members from the same or the different attentional group allowed for the correct identification of the participant's attentional instruction in 96%, 73% and 73% of the cases, for EEG, EDA and IBI, respectively, all well above chance level. PS with respect to the attentional groups also predicted performance on post-audio questions about the groups' stimulus content.

SIGNIFICANCE

Our results show that selective attention of participants can be monitored using PS, not only in EEG, but also in EDA and IBI. These results are promising for real-world applications, where wearables measuring peripheral signals like EDA and IBI may be preferred over EEG sensors.

Good vibrations: An observational study of real-life stress induced by a stage performance

Stressors induce physiological changes in the brain and periphery that support adaptive defensive responses. The consequences of psychological stress on cognitive functioning are often measured in laboratory settings using experimentally induced stress that leads to mainly negative subjective feelings. There is a need for verification of these studies using real-life stressors that may potentially induce both positive and negative subjective feelings. In an observational study, we investigated real-life stress induced by voluntary stage performance at a large-scale music festival, including 126 participants (60 female, age range = 16-57 years). Our primary measurements involved salivary cortisol, heart rate, blood pressure, and positive and negative affect. In addition, participants completed a 2-back working memory task and a speeded decision-making task. We found that stage performance significantly increased salivary cortisol - with a particularly low number of cortisol non-responders - and heart rate, even when controlling for potential confounding factors, such as sleep, movement, and alcohol use. Interestingly, stage performance significantly decreased negative affect while increasing positive affect. This positively experienced stressor ("eustressor") was related to impaired working memory performance: the stronger the increases in cortisol, the slower participants responded to targets. Decision-making, however, was not affected. In conclusion, we show how stressful experiences in real-life can lead to positive affect, but still have a similar negative impact on cognitive functioning. We suggest that future research should focus more on the consequences of real-life stressors, and the consequences of eustress, in order to extend our understanding of the concept of psychological stress.

Psychophysiological Effects of Different Methods of Inducing Restoration Needs

The purpose of this study was to examine the psychophysiological effects of different restoration need-inducing methods and the changes in these effects overtime. This study adopted a randomized controlled trial to assign participants (experiment 1: n = 120, experiment 2: n = 90) to four experimental treatments: control, imagined fatigue, the Stroop task and the binary classification task, and the Markus and Peters arithmetic test. We used self-report scales (The Pleasure-Arousal-Dominance emotion scale, The Well-being Measures, and The Restoration Scale) and an attention test (backward digit span) as pre- and posttests, and a physiological measuring device to continually assess participants' bodily mobilizations. The results showed that the Stroop task and the binary classification task as well as the Markus and Peters arithmetic test more significantly increased the arousal of subjective perception and decreased restoration than the control and imagined fatigue, and the physiological influences of the methods varied overtime with no definitive trend.

The short Sing-a-Song Stress Test: A practical and valid test of autonomic responses induced by social-evaluative stress

The Sing-a-Song Stress Test (SSST) was recently developed as an alternative to the Trier Social Stress Test (TSST) to investigate autonomic nervous system responses to social-evaluative stress. In the SSST, participants are suddenly cued to sing a song in the presence of confederates. However, the SSST is still quite long (~15 min) and the requirement for confederates makes it labor-intensive. The current study tested whether a shorter (~6.5 min), single-experimenter, version of the SSST can still reliably elicit subjective and physiological stress reactivity. Our sample consisted of 87 healthy young adult participants (age range: 18-35 years). During the short SSST and a speeded reaction time task, in which aversive loud tones were to be avoided (TA), we measured heart period (HP), sympathetic nervous system (SNS) activity using pre-ejection-period (PEP), skin conductance level (SCL), and non-specific skin conductance responses (ns.SCR), and parasympathetic nervous system (PNS) activity using respiratory-sinus-arrhythmia (RSA) and the root-mean-square of successive differences (RMSSD). The short SSST induced significant decreases in positive affect and increases in negative affect. MANOVAs on the clusters of SNS and PNS variables showed that the short SSST elicited significant HP (-118.46 ms), PEP (-7.76 ms), SCL (+4.85 μS), ns.SCR (+8.42 peaks/min) and RMSSD (-14.67) reactivity. Affective, SNS, and PNS reactivity to the new SSST social-evaluative stress task were of comparable magnitude to that evoked by the TA mental stressor. We conclude that the short SSST is a valid and cost-effective task for large scaled studies to induce social-evaluative stress to a sufficient degree to evoke measurable changes in PNS and SNS activity and affective state.

Oxytocin reduces post-stress sweet snack intake in women without attenuating salivary cortisol

Intranasal oxytocin produces anorectic effects on snack intake in men when tested in the absence of deprivation-induced hunger, but its effects on food intake in women without eating disorders have not been reported. Oxytocin may reduce food intake by reducing stress eating, since it inhibits ACTH release. The present study adopted a double-blind, repeated measures and fully concealed crossover protocol in which 38 women self-administered 24 IU of oxytocin or placebo intranasally, ate lunch, and underwent two consecutive stress tests. Snack intake was assessed 15-20 min after lunch, via a sham taste test. Salivary cortisol was measured throughout the test period every 15 min. Oxytocin significantly reduced sweet fatty snack intake independently of any effect on salivary cortisol, which declined over time at a similar rate after either drug or placebo. Ratings of sweet taste were slightly reduced by oxytocin, but only in self-reported stress eaters. These results differ from previous studies with men that found an effect of oxytocin on postprandial cortisol levels. However, previous research assayed the less active form of plasma cortisol and did not control for protein intake, which can drive elevated cortisol. The finding that oxytocin reduces snack intake in females after acute stress has important implications for appetite regulation and its treatment in obese people and in those with eating disorders.

micro-Stress EMA: A Passive Sensing Framework for Detecting in-the-wild Stress in Pregnant Mothers

High levels of stress during pregnancy increase the chances of having a premature or low-birthweight baby. Perceived self-reported stress does not often capture or align with the physiological and behavioral response. But what if there was a self-report measure that could better capture the physiological response? Current perceived stress self-report assessments require users to answer multi-item scales at different time points of the day. Reducing it to one question, using microinteraction-based ecological momentary assessment (micro-EMA, collecting a single in situ self-report to assess behaviors) allows us to identify smaller or more subtle changes in physiology. It also allows for more frequent responses to capture perceived stress while at the same time reducing burden on the participant. We propose a framework for selecting the optimal micro-EMA that combines unbiased feature selection and unsupervised Agglomerative clustering. We test our framework in 18 women performing 16 activities in-lab wearing a Biostamp, a NeuLog, and a Polar chest strap. We validated our results in 17 pregnant women in real-world settings. Our framework shows that the question "How worried were you?" results in the highest accuracy when using a physiological model. Our results provide further in-depth exposure to the challenges of evaluating stress models in real-world situations.

Parental Reactivity to Disruptive Behavior in Toddlerhood: An Experimental Study

Disruptive child behavior is often exacerbated and maintained by negative and inconsistent parenting behavior that unwittingly reinforces disruptive behavior. One explanation for why parents render it difficult to remain positive and consistent might be the impact of disruptive child behavior on parent self-efficacy and stress. This study investigates how disruptive child behavior in a challenging parenting situation shapes parental momentary thoughts of self-efficacy and feelings of stress (i.e., perceived distress and physiological arousal), and how these in turn predict parenting behavior. We experimentally manipulated a challenging parenting situation that was designed to elicit disruptive child behavior. Specifically, we examined: (1) the effects of the challenging condition compared to a control situation on parental state self-efficacy and stress, (2) whether parents with lower trait self-efficacy and higher trait stress in daily life are most affected, and (3) how state self-efficacy and stress predict parental subsequent use of direct commands and positive affect. Parent-toddler dyads were randomly assigned to a challenging or control situation (N = 110, Mage = 30.9 months). As predicted, parents in the challenging situation, relative to control, reported less self-efficacy and more perceived distress, and showed increased physiological arousal. Self-efficacy was compromised particularly in parents with low trait self-efficacy. Our findings suggest that child disruptive behavior drives parental state self-efficacy and stress, especially momentary self-efficacy in parents who generally feel less self-efficacious.

Stress detection in daily life scenarios using smart phones and wearable sensors: A survey

Stress has become a significant cause for many diseases in the modern society. Recently, smartphones, smartwatches and smart wrist-bands have become an integral part of our lives and have reached a widespread usage. This raised the question of whether we can detect and prevent stress with smartphones and wearable sensors. In this survey, we will examine the recent works on stress detection in daily life which are using smartphones and wearable devices. Although there are a number of works related to stress detection in controlled laboratory conditions, the number of studies examining stress detection in daily life is limited. We will divide and investigate the works according to used physiological modality and their targeted environment such as office, campus, car and unrestricted daily life conditions. We will also discuss promising techniques, alleviation methods and research challenges.

Improving Real-Life Estimates of Emotion Based on Heart Rate: A Perspective on Taking Metabolic Heart Rate Into Account

Extracting information about emotion from heart rate in real life is challenged by the concurrent effect of physical activity on heart rate caused by metabolic need. “Non-metabolic heart rate,” which refers to the heart rate that is caused by factors other than physical activity, may be a more sensitive and more universally applicable correlate of emotion than heart rate itself. The aim of the present article is to explore the evidence that non-metabolic heart rate, as it has been determined up until now, indeed reflects emotion. We focus on methods using accelerometry since these sensors are readily available in devices suitable for daily life usage. The evidence that non-metabolic heart rate as determined by existing methods reflect emotion is limited. Alternative possible routes are explored. We conclude that for real-life cases, estimating the type and intensity of activities based on accelerometry (and other information), and in turn use those to determine the non-metabolic heart rate for emotion is most promising.

Latent Growth Curve Models for Biomarkers of the Stress Response

Objective: The stress response is a dynamic process that can be characterized by predictable biochemical and psychological changes. Biomarkers of the stress response are typically measured over time and require statistical methods that can model change over time. One flexible method of evaluating change over time is the latent growth curve model (LGCM). However, stress researchers seldom use the LGCM when studying biomarkers, despite their benefits. Stress researchers may be unaware of how these methods can be useful. Therefore, the purpose of this paper is to provide an overview of LGCMs in the context of stress research. We specifically highlight the unique benefits of using these approaches. Methods: Hypothetical examples are used to describe four forms of the LGCM. Results: The following four specifications of the LGCM are described: basic LGCM, latent growth mixture model, piecewise LGCM, and LGCM for two parallel processes. The specifications of the LGCM are discussed in the context of the Trier Social Stress Test. Beyond the discussion of the four models, we present issues of modeling nonlinear patterns of change, assessing model fit, and linking specific research questions regarding biomarker research using different statistical models. Conclusions: The final sections of the paper discuss statistical software packages and more advanced modeling capabilities of LGCMs. The online Appendix contains example code with annotation from two statistical programs for the LCGM.

Using neurophysiological signals that reflect cognitive or affective state: six recommendations to avoid common pitfalls

Estimating cognitive or affective state from neurophysiological signals and designing applications that make use of this information requires expertise in many disciplines such as neurophysiology, machine learning, experimental psychology, and human factors. This makes it difficult to perform research that is strong in all its aspects as well as to judge a study or application on its merits. On the occasion of the special topic "Using neurophysiological signals that reflect cognitive or affective state" we here summarize often occurring pitfalls and recommendations on how to avoid them, both for authors (researchers) and readers. They relate to defining the state of interest, the neurophysiological processes that are expected to be involved in the state of interest, confounding factors, inadvertently "cheating" with classification analyses, insight on what underlies successful state estimation, and finally, the added value of neurophysiological measures in the context of an application. We hope that this paper will support the community in producing high quality studies and well-validated, useful applications.