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Schleicher D, Jarvers I, Kocur M, Kandsperger S, Brunner R, Ecker A. Does it need an app? - Differences between app-guided breathing and natural relaxation in adolescents after acute stress. Psychoneuroendocrinology 2024; 169:107148. [PMID: 39116517 DOI: 10.1016/j.psyneuen.2024.107148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/16/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024]
Abstract
A key component of stress management and biofeedback training is the use of relaxation exercises, such as slow/deep breathing (6 breaths/minute) in heart coherence exercises (HCEs). Breathing exercises are also increasingly being integrated into smartphones as part of health apps, though their effectiveness in adolescents after acute stress has rarely been validated scientifically. The aim of the current study was to investigate the effectiveness of an app-guided HCE (n = 36) after an acute stress situation (Trier Social Stress Test) compared with natural relaxation (n = 37), among healthy adolescents (aged 11-17 years). Endocrine, autonomic, and psychological stress parameters (cortisol, alpha-amylase, heart rate, heart rate variability, mood) were examined in 73 adolescents (46 female, 27 male; Mage = 13.86, SDage = 1.87). Significant group differences were found in heart rate variability, with higher values in the low frequency band and low-to-high frequency ratio for the HCE condition, possibly indicating improved physiological functions through the stimulation of vagal tone and baroreflex. The use of a general breathing technique (natural and app-guided) also resulted in stronger relaxation reactions in cortisol when controlling for the previous stronger stress reactivity. On the other hand, app-guided slow breathing without a long training may be experienced as more uncomfortable during relaxation. The integration of breathing exercises in health apps for adolescents appears to be useful, offering a helpful and low-threshold coping/relaxation strategy during acute stress situations. Further studies should examine the benefits of app-guided breathing exercises in both psychiatric samples and the general population across a wide age range.
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Affiliation(s)
- Daniel Schleicher
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, Regensburg 93053, Germany.
| | - Irina Jarvers
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, Regensburg 93053, Germany.
| | - Martin Kocur
- Department of Media Informatics, University of Regensburg, Universitätsstraße 31, Regensburg 93053, Germany.
| | - Stephanie Kandsperger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, Regensburg 93053, Germany.
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, Regensburg 93053, Germany.
| | - Angelika Ecker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, Regensburg 93053, Germany.
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2
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Speer KE, Naumovski N, McKune AJ. Heart rate variability to track autonomic nervous system health in young children: Effects of physical activity and cardiometabolic risk factors. Physiol Behav 2024; 281:114576. [PMID: 38692385 DOI: 10.1016/j.physbeh.2024.114576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024]
Abstract
Evidence for a key role of dysregulated autonomic nervous system (ANS) activity in maladaptive stress response/recovery and non-communicable disease development is extensive. Monitoring ANS activity via regular heart rate variability (HRV) measurement is growing in popularity in adult populations given that low HRV has been associated with ANS dysregulation, poor stress response/reactivity, increased cardiometabolic disease risk and early mortality. Although cardiometabolic disease may originate in early life, regular HRV measurement for assessing ANS activity in childhood populations, especially those consisting of children < 6 years of age, remains largely unpractised. A greater understanding of ANS activity modifiers in early life may improve analysis and interpretation of HRV measurements, thereby optimising its usefulness. Taking into consideration that HRV and ANS activity can be improved via daily engagement in physical activity (PA), this review will discuss the ANS and HRV, ANS activity modifiers, cardiometabolic disease risk factors and PA as they relate to childhood/adolescent populations (≤ 18 years old).
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Affiliation(s)
- Kathryn E Speer
- Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Research Institute of Sport and Exercise, University of Canberra, 11 Kirinari Street, Bruce, 2617, Australia.
| | - Nenad Naumovski
- Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Research Institute of Sport and Exercise, University of Canberra, 11 Kirinari Street, Bruce, 2617, Australia; Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, 17671, Greece
| | - Andrew J McKune
- Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Research Institute of Sport and Exercise, University of Canberra, 11 Kirinari Street, Bruce, 2617, Australia; Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, 4000, South Africa
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3
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MacDonald C, Ilie G, Kephart G, Rendon R, Mason R, Bailly G, Bell D, Patil N, Bowes D, Wilke D, Kokorovic A, Rutledge RDH. Mediating Effects of Self-Efficacy and Illness Perceptions on Mental Health in Men with Localized Prostate Cancer: A Secondary Analysis of the Prostate Cancer Patient Empowerment Program (PC-PEP) Randomized Controlled Trial. Cancers (Basel) 2024; 16:2352. [PMID: 39001414 PMCID: PMC11240715 DOI: 10.3390/cancers16132352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Understanding how interventions reduce psychological distress in patients with prostate cancer is crucial for improving patient care. This study examined the roles of self-efficacy, illness perceptions, and heart rhythm coherence in mediating the effects of the Prostate Cancer Patient Empowerment Program (PC-PEP) on psychological distress compared to standard care. In a randomized controlled trial, 128 patients were assigned to either the PC-PEP intervention or standard care. The PC-PEP, a six-month program emphasizing daily healthy living habits, included relaxation and stress management, diet, exercise, pelvic floor muscle exercises, and strategies to improve relationships and intimacy, with daily activities supported by online resources and live sessions. Participants in the intervention group showed significant improvements in self-efficacy and specific illness perceptions, such as personal control and emotional response, compared to the control group. These factors mediated the relationship between the intervention and its psychological benefits, with self-efficacy accounting for 52% of the reduction in psychological distress. No significant differences in heart rhythm coherence were observed. This study highlights the critical role of self-efficacy and illness perceptions in enhancing psychological health in prostate cancer patients through the PC-PEP. The results underscore this program's effectiveness and the key mechanisms through which it operates. Given the high rates of distress among men undergoing prostate cancer treatments, these findings emphasize the importance of integrating the PC-PEP into clinical practice. The implementation of the PC-PEP in clinical settings can provide a structured approach to reducing psychological distress and improving overall patient well-being.
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Affiliation(s)
- Cody MacDonald
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada
| | - Gabriela Ilie
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada
| | - George Kephart
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada
| | - Ricardo Rendon
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Ross Mason
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Greg Bailly
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - David Bell
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Nikhilesh Patil
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada
| | - David Bowes
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada
| | - Derek Wilke
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada
| | - Andrea Kokorovic
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Robert D H Rutledge
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada
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Mensinger JL, Weissinger GM, Cantrell MA, Baskin R, George C. A Pilot Feasibility Evaluation of a Heart Rate Variability Biofeedback App to Improve Self-Care in COVID-19 Healthcare Workers. Appl Psychophysiol Biofeedback 2024; 49:241-259. [PMID: 38502516 PMCID: PMC11101559 DOI: 10.1007/s10484-024-09621-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
COVID-19 exacerbated burnout and mental health concerns among the healthcare workforce. Due to high work stress, demanding schedules made attuned eating behaviors a particularly challenging aspect of self-care for healthcare workers. This study aimed to examine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) mobile app for improving well-being among healthcare workers reporting elevated disordered eating during COVID-19. We conducted a mixed methods pre-mid-post single-arm pilot feasibility trial (ClinicalTrials.gov NCT04921228). Deductive content analysis of participants' commentary generated qualitative themes. Linear mixed models were used to examine changes in pre- mid- to post-assessment scores on well-being outcomes. We consented 28 healthcare workers (25/89% female; 23/82% Non-Hispanic White; 22/79% nurses) to use and evaluate an HRVB mobile app. Of these, 25/89% fully enrolled by attending the app and device training; 23/82% were engaged in all elements of the protocol. Thirteen (52%) completed at least 10 min of HRVB on two-thirds or more study days. Most participants (18/75%) reported being likely or extremely likely to continue HRVB. Common barriers to engagement were busy schedules, fatigue, and technology difficulties. However, participants felt that HRVB helped them relax and connect better to their body's signals and experiences. Results suggested preliminary evidence of efficacy for improving interoceptive sensibility, mindful self-care, body appreciation, intuitive eating, stress, resilience, and disordered eating. HRVB has potential as a low-cost adjunct tool for enhancing well-being in healthcare workers through positively connecting to the body, especially during times of increased stress when attuned eating behavior becomes difficult to uphold.
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Affiliation(s)
- Janell L Mensinger
- Department of Clinical and School Psychology, College of Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL, 33314, USA.
- Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA.
| | - Guy M Weissinger
- Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Mary Ann Cantrell
- Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Rachel Baskin
- Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Cerena George
- Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
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Lafortune D, Dubé S, Lapointe V, Bonneau J, Champoux C, Sigouin N. Virtual Reality Could Help Assess Sexual Aversion Disorder. JOURNAL OF SEX RESEARCH 2024; 61:588-602. [PMID: 37556729 DOI: 10.1080/00224499.2023.2241860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Virtual reality (VR) may improve our understanding of sexual dysfunctions' manifestations, although research in this area remains limited. This study assessed the potential use of a VR Behavior Avoidance Test (VR-BAT) as a tool for examining the clinical features of Sexual Aversion Disorder (SAD): the experience of fear, disgust, and avoidance when facing sexual cues/contexts. A sample of 55 adults (≥ 18y) with (n = 27) and without SAD (n = 28) completed a self-report measure of sexual avoidance. Their anxiety, disgust, electrodermal activity, heart rate, and visual and behavioral avoidance were then examined during two VR-BATs involving sexual or non-sexual stimuli. Mixed repeated measures ANOVAs, t-tests, and correlational analyses were performed. Results showed that individuals in the SAD group reported greater anxiety and disgust compared to their non-SAD counterparts during the sexual stimuli condition. Sexual avoidance scores were largely positively related to anxiety and disgust during the VR sexual condition, and moderately negatively related to the time spent touching the virtual character's genitals. This study is important given the prevalence of sexual difficulties, such as SAD, and the new research avenues offered by emerging technologies, like VR.
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Affiliation(s)
- D Lafortune
- Department of Sexology, Université du Québec à Montréal
| | - S Dubé
- Department of Psychology, Concordia University
| | - V Lapointe
- Department of Psychology, Université du Québec à Montréal
| | - J Bonneau
- School of Media, Université du Québec à Montréal
| | - C Champoux
- School of Media, Université du Québec à Montréal
| | - N Sigouin
- School of Media, Université du Québec à Montréal
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Sargent KS, Martinez EL, Reed AC, Guha A, Bartholomew ME, Diehl CK, Chang CS, Salama S, Popov T, Thayer JF, Miller GA, Yee CM. Oscillatory Coupling Between Neural and Cardiac Rhythms. Psychol Sci 2024:9567976241235932. [PMID: 38568870 DOI: 10.1177/09567976241235932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Oscillations serve a critical role in organizing biological systems. In the brain, oscillatory coupling is a fundamental mechanism of communication. The possibility that neural oscillations interact directly with slower physiological rhythms (e.g., heart rate, respiration) is largely unexplored and may have important implications for psychological functioning. Oscillations in heart rate, an aspect of heart rate variability (HRV), show remarkably robust associations with psychological health. Mather and Thayer proposed coupling between high-frequency HRV (HF-HRV) and neural oscillations as a mechanism that partially accounts for such relationships. We tested this hypothesis by measuring phase-amplitude coupling between HF-HRV and neural oscillations in 37 healthy adults at rest. Robust coupling was detected in all frequency bands. Granger causality analyses indicated stronger heart-to-brain than brain-to-heart effects in all frequency bands except gamma. These findings suggest that cardiac rhythms play a causal role in modulating neural oscillations, which may have important implications for mental health.
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Affiliation(s)
- Kaia S Sargent
- Department of Psychology, University of California, Los Angeles
| | | | | | - Anika Guha
- Department of Psychology, University of California, Los Angeles
| | | | | | | | - Sarah Salama
- Department of Psychology, University of California, Los Angeles
| | - Tzvetan Popov
- Department of Psychology, University of Konstanz
- Department of Psychology, University of Zurich
| | - Julian F Thayer
- Department of Psychological Science, University of California, Irvine
| | - Gregory A Miller
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Cindy M Yee
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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7
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Broc G, Brunel L, Lareyre O. Dynamic Ecosystem Adaptation through Allostasis (DEA-A) Model: Conceptual Presentation of an Integrative Theoretical Framework for Global Health Change. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:432. [PMID: 38673343 PMCID: PMC11050241 DOI: 10.3390/ijerph21040432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/27/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024]
Abstract
Achieving ambitious goals in Global Health first requires an integrative understanding of how individuals and organizations adapt in a living ecosystem. The absence of a unified framework limits the consideration of the issues in their complexity, which further complicates the planning of Global Health programs aimed at articulating population-based prevention and individual-level (clinical) interventions. The aim of the conceptual contribution is to propose such a model. It introduces the Dynamic Ecosystem of Adaptation through Allostasis (DEA-A) theoretical framework, emphasizing the functional adaptation of individuals and organizations in symbiosis with their living ecosystem. The DEA-A framework articulates two central components to grasp the complexity of adaptation: the internal dynamics (intrasystem level) and the environmental dynamics (ecosystem level). It bridges diverse conceptual approaches, including stress and adaptation models, behavior-change models, and ecosystem-based perspectives. Epistemological considerations raised in the conceptual article prompt a reconsideration of methods and tools for the planning of intervention. Further contributions will present a suitable methodology for the application of the DEA-A framework along with practical recommendations.
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Affiliation(s)
- Guillaume Broc
- EPSYLON EA 4556, Paul Valéry Montpellier 3, University of Montpellier, 34090 Montpellier, France; (L.B.); (O.L.)
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Jia Y, Schenkman M, O Connor H, Jayanna K, Pearmain R, Van’t Westeinde A, Patel KD. Validation of the Awareness Atlas-a new measure of the manifestation of consciousness. Front Psychol 2024; 15:1283980. [PMID: 38577121 PMCID: PMC10994143 DOI: 10.3389/fpsyg.2024.1283980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/16/2024] [Indexed: 04/06/2024] Open
Abstract
Consciousness has intrigued philosophers and scholars for millennia and has been the topic of considerable scientific investigation in recent decades. Despite its importance, there is no unifying definition of the term, nor are there widely accepted measures of consciousness. Indeed, it is likely that consciousness-by its very nature-eludes measurement. It is, however, possible to measure how consciousness manifests as a lived experience. Yet here, too, holistic measures are lacking. This investigation describes the development and validation of the Awareness Atlas, a measure of the manifestation of consciousness. The scale was informed by heart-based contemplative practices and the resulting lived experience with a focus on the impacts of manifestation of consciousness on daily life. Four hundred forty-nine individuals from the USA, Canada, India, and Europe participated in psychometric testing of the scale. Exploratory and confirmatory factor analyses were used for validation, demonstrating excellent validity in measuring manifestation of consciousness. The final model fit exceeded all required thresholds, indicating an excellent fitted model with a single dimensionality to measure the manifestation of consciousness comprised of four subscales: Relationship to Others; Listening to the Heart; Connection with Higher Self; and Acceptance and Letting Go. Number of years meditating and practicing Heartfulness meditation were positively related to the total and subscale scores. Test-retest reliability was excellent for the total scale, and good to excellent for the four subscales. Findings demonstrate that the Awareness Atlas is a well-constructed tool that will be useful in examining changes in manifestation of consciousness with various experiences (e.g., meditation, life-altering conditions).
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Affiliation(s)
- Yuane Jia
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers University, Newark, NJ, United States
| | - Margaret Schenkman
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, United States
| | | | - Krishnmurthy Jayanna
- Division of Public Health, Faculty of Life and Allied Health Sciences, Ramaiah University of Applied Sciences, Bangalore, India
- Center for Integrative Health and Wellbeing, Bangalore, India
| | | | - Annelies Van’t Westeinde
- Department of Women’s and Children’s Health, Unit for Pediatric Endocrinology, Karolinska Institutet, Stockholm, Sweden
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Zadok E, Golan O, Lavidor M, Gordon I. Autonomic nervous system responses to social stimuli among autistic individuals: A systematic review and meta-analysis. Autism Res 2024; 17:497-511. [PMID: 38073185 DOI: 10.1002/aur.3068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/18/2023] [Indexed: 03/26/2024]
Abstract
Physiological responses to environmental and social stimuli have been studied broadly in relation to psychological states and processes. This may be especially important regarding autistic individuals, who show disparities in social interactions. However, findings from studies assessing autonomic nervous system (ANS) responses of autistic individuals present contradictions, with reports showing both autonomic disparities and intact autonomic functioning. The current study aimed to review the existing literature and to estimate if there is a difference between autistic individuals and neurotypical (NT) individuals in their autonomic responses to social stimuli. Furthermore, the study examined factors that may moderate this difference, including the type of physiological function measured, the level of participation required, as well as the age and intellectual functioning of the participants. The meta-analysis revealed a small and statistically insignificant overall difference between autistic and NT individuals, albeit with high heterogeneity. A further nested moderator analysis revealed a significant difference between autistic and NT individuals in physiological response that reflects mainly a parasympathetic nervous system (PNS) activity. Another difference was found in physiological response that reflects a combined activity of the sympathetic and parasympathetic systems, but only for experimental tasks that demanded active participation in social interactions. These results suggest a distinctiveness in autonomic regulation of autistic individuals in social situations, and point to the PNS as an important study objective for future investigation.
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Affiliation(s)
- Ester Zadok
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Ofer Golan
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Lavidor
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Ilanit Gordon
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
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10
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DeGraves BS, Titley H, Duan Y, Thorne TE, Banerjee S, Ginsburg L, Salma J, Hegadoren K, Angel C, Keefe J, Lanius R, Estabrooks CA. Workforce resilience supporting staff in managing stress: A coherent breathing intervention for the long-term care workforce. J Am Geriatr Soc 2024; 72:753-766. [PMID: 38156430 DOI: 10.1111/jgs.18727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/14/2023] [Accepted: 11/12/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Staff in long-term care (LTC) homes have long-standing stressors, such as short staffing and high workloads. These stressors increased during the COVID-19 pandemic; better resources are needed to help staff manage stress and well-being. The purpose of this study was to evaluate the effect of a simple stress management strategy (coherent breathing). METHODS We conducted a pre-post intervention study to evaluate a self-managed coherent breathing intervention from February to September 2022. The intervention included basic (breathing only) and comprehensive (breathing plus a biofeedback device) groups. Six hundred eighty-six participants were initially recruited (359 and 327 in the comprehensive and basic groups respectively) from 31 LTC homes in Alberta, Canada. Two hundred fifty-four participants completed pre-and post-intervention questionnaires (142 [55.9%] in comprehensive and 112 [44.1%] in basic). Participants were asked to use coherent breathing based on a schedule increasing from 2 to 10 min daily, 5-7 times a week over 8 weeks. Participants completed self-administered online questionnaires pre- and post-intervention to assess outcomes-stress, psychological distress, anxiety, depression, resilience, insomnia, compassion satisfaction, compassion fatigue, and burnout. We used a mixed-effects regression model to test the main effect of time (pre- and post-intervention) and group while testing the interaction between time and group and controlling for covariates. RESULTS We found statistically significant changes from pre- to post-intervention in stress (b = -2.5, p < 0.001, 95% CI = -3.1, -1.9), anxiety (b = -0.5, p < 0.001, 95% CI = -0.7, -0.3), depression (b = -0.4, p < 0.001, 95% CI = -0.6, -0.2), insomnia (b = -1.5, p < 0.001, 95% CI = -2.1, -0.9), and resilience (b = 0.2, p < 0.001, 95% CI = 0.1, 0.2). We observed no statistically significant differences between the two intervention groups on any outcome. CONCLUSIONS Our findings suggest that coherent breathing is a promising strategy for improving stress-related outcomes and resilience. This intervention warrants further, more rigorous testing.
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Affiliation(s)
| | - Heather Titley
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Trina E Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Liane Ginsburg
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Jordana Salma
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Cybele Angel
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Ruth Lanius
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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11
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Mohapatra B, Lehrer PM, Reed WR, Behel P, Kim S. Heart Rate Variability Biofeedback Training: An Introduction for Clinicians. Arch Phys Med Rehabil 2024; 105:427-431. [PMID: 37105257 DOI: 10.1016/j.apmr.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023]
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12
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Zhang J, Li WC, Braithwaite G, Blundell J. Practice effects of a breathing technique on pilots' cognitive and stress associated heart rate variability during flight operations. Stress 2024; 27:2361253. [PMID: 38859613 DOI: 10.1080/10253890.2024.2361253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
Commercial pilots endure multiple stressors in their daily and occupational lives which are detrimental to psychological well-being and cognitive functioning. The Quick coherence technique (QCT) is an effective intervention tool to improve stress resilience and psychophysiological balance based on a five-minute paced breathing exercise with heart rate variability (HRV) biofeedback. The current research reports on the application of QCT training within an international airline to improve commercial pilots' psychological health and support cognitive functions. Forty-four commercial pilots volunteered in a one-month training programme to practise self-regulated QCT in day-to-day life and flight operations. Pilots' stress index, HRV time-domain and frequency-domain parameters were collected to examine the influence of QCT practice on the stress resilience process. The results demonstrated that the QCT improved psychophysiological indicators associated with stress resilience and cognitive functions, in both day-to-day life and flight operation settings. HRV fluctuations, as measured through changes in RMSSD and LF/HF, revealed that the resilience processes were primarily controlled by the sympathetic nervous system activities that are important in promoting pilots' energy mobilization and cognitive functions, thus QCT has huge potential in facilitating flight performance and aviation safety. These findings provide scientific evidence for implementing QCT as an effective mental support programme and controlled rest strategy to improve pilots' psychological health, stress management, and operational performance.
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Affiliation(s)
- Jingyi Zhang
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
| | - Wen-Chin Li
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
| | - Graham Braithwaite
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
| | - James Blundell
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
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Sun J, Zhuo J, Chu H, Wang J, Chen T, Li B, Lu T, Zheng H, Xu Y, Dong J, Cicchella A. Effects of 3-month Qigong exercise on heart rate variability and respiration in anxious college students. Scand J Med Sci Sports 2024; 34:e14521. [PMID: 37815004 DOI: 10.1111/sms.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 09/18/2023] [Accepted: 10/01/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE This longitudinal study aimed to investigate the effects of Qigong on the anxiety state, heart rate variability (HRV), and breathing of anxious college students. METHODS A total of 37 individuals (18-25 years old) were randomly allocated to the control (n = 19) and intervention (n = 18) groups. Qigong interventions were conducted five times weekly for 12 weeks, with each session lasting 60 min. Hamilton Anxiety Scale, Fatigue Scale 14, Pittsburgh Sleep Quality Index, and 36-item Short Form Survey, HRV, and respiration data were collected before and after the 3-month intervention. RESULTS Individuals who participated in the three-month Qigong exercise intervention showed a significant reduction in anxiety, particularly mental anxiety (p < 0.05). Subjects in the intervention group presented a decrease in skin temperature (p < 0.05) and an increase in blood volume pulsation (p < 0.05). Meanwhile, HRV exhibited a significant increase in the standard deviation of interbeat interval before and after comparisons (p < 0.05) and between the two groups (p = 0.039) and a reduction in the normalized low-frequency power after the intervention. Moreover, the intervention group experienced increased abdominal breathing depth and abdominal breathing per minute (p < 0.05). CONCLUSION These findings indicate that Qigong is an effective mind-body exercise strategy for relieving anxiety. HRV and breathing were improved accordingly among college students after the completion of the 3-month Qigong program.
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Affiliation(s)
- Jingyu Sun
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Jiatong Zhuo
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Hang Chu
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Jing Wang
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Tao Chen
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Bin Li
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Tianfeng Lu
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Hao Zheng
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Yaning Xu
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Jingmei Dong
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, People's Republic of China
| | - Antonio Cicchella
- International College of Football, Tongji University, Shanghai, People's Republic of China
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14
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Amraoui J, Bordenave L, Leclerc G, Salvignol G, Jarlier M, Fiess C, Philibert L, Fuzier R, Touraine C. Benefits of cardiac coherence combined with medical hypnosis on preoperative anxiety before cancer surgery: the COHEC II study trial protocol. BMJ Open 2023; 13:e072215. [PMID: 38086587 PMCID: PMC10729073 DOI: 10.1136/bmjopen-2023-072215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Preoperative anxiety is a frequent problem that can lead to complications both during anaesthesia and in the postoperative period, especially in oncology. Studies have shown that it can be managed using non-pharmacological approaches, but few works have evaluated psychoeducational programmes. The aim of the COHErence Cardiaque (COHEC) II Study is to evaluate the combination of medical hypnosis (MH) and cardiac coherence (CC) training to manage preoperative anxiety in patients with cancer. METHODS AND ANALYSIS COHEC II is an ongoing multicentre randomised clinical trial carried out in three French comprehensive cancer centres. In total, 296 patients who will undergo surgery for cancer will be recruited during 18 months and will be randomised in the control arm or the intervention arm. Patients in the intervention arm will follow a daily programme that combines MH and CC, starting 7 days before surgery. The control arm will receive the standard treatment to manage preoperative anxiety. The primary endpoint is the anxiety level on surgery day, measured using a Visual Analogue Scale. Secondary endpoints are patient adherence to the programme, satisfaction and postsurgery recovery quality. ETHICS AND DISSEMINATION The study protocol was approved by the French Ethics Committee (Comité de Protection des Personnes EST-II) on 24 November 2021 and will be carried out following the good practice guidelines and the Declaration of Helsinki. Results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT05197972.
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Affiliation(s)
- Jibba Amraoui
- Department of Anaesthesia, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | | | - Gilles Leclerc
- Department of Anaesthesia, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | | | - Marta Jarlier
- Biometrics Unit, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | - Catherine Fiess
- Clinical Research and Innovation Department, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | - Laurent Philibert
- Department of Pharmacy, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | | | - Célia Touraine
- Biometrics Unit, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
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Sarimov RM, Serov DA, Gudkov SV. Hypomagnetic Conditions and Their Biological Action (Review). BIOLOGY 2023; 12:1513. [PMID: 38132339 PMCID: PMC10740674 DOI: 10.3390/biology12121513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
The geomagnetic field plays an important role in the existence of life on Earth. The study of the biological effects of (hypomagnetic conditions) HMC is an important task in magnetobiology. The fundamental importance is expanding and clarifying knowledge about the mechanisms of magnetic field interaction with living systems. The applied significance is improving the training of astronauts for long-term space expeditions. This review describes the effects of HMC on animals and plants, manifested at the cellular and organismal levels. General information is given about the probable mechanisms of HMC and geomagnetic field action on living systems. The main experimental approaches are described. We attempted to systematize quantitative data from various studies and identify general dependencies of the magnetobiology effects' value on HMC characteristics (induction, exposure duration) and the biological parameter under study. The most pronounced effects were found at the cellular level compared to the organismal level. Gene expression and protein activity appeared to be the most sensitive to HMC among the molecular cellular processes. The nervous system was found to be the most sensitive in the case of the organism level. The review may be of interest to biologists, physicians, physicists, and specialists in interdisciplinary fields.
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Affiliation(s)
| | | | - Sergey V. Gudkov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilove St. 38, 119991 Moscow, Russia; (R.M.S.); (D.A.S.)
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16
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Pyne JM, Constans JI, Wiederhold BK, Jegley S, Rabalais A, Hu B, Weber MC, Hinkson KD, Wiederhold MD. Predicting Post-Traumatic Stress Disorder Treatment Response Using Heart Rate Variability to Virtual Reality Environment and Modified Stroop Task: An Exploratory Study. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023; 26:896-903. [PMID: 38032955 DOI: 10.1089/cyber.2023.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Predicting treatment response can inform treatment decisions, expectations, and optimize use of mental health treatment resources. This study examined heart rate (HR), heart rate variability (HRV), and a modified Stroop task (mStroop) to predict post-traumatic stress disorder (PTSD) treatment response. We report on an observational, longitudinal study with 45 U.S. veterans in outpatient PTSD care, who had deployed to Iraq or Afghanistan. HR and HRV were collected before, during, and after virtual reality (VR) combat and civilian scenes. HRV recovery was defined as HRV after a 3-minute VR simulation minus HRV during a VR scene. mStroop threat variables included index scores for combat and general threat. Self-report data were collected at baseline and 6 months later. The outcome variable was the 17-item Clinician Administered PTSD Scale (CAPS). Controlling for baseline CAPS and number of combat experiences, the following baseline HRV recovery variables were significant predictors of 6-month CAPS: standard deviation of normal beat to beat interval (SDNN) after combat scene minus SDNN during combat scene and low-frequency (LF HRV) after civilian scene minus LF during civilian scene. HRV at rest, HR reactivity, HR recovery, and mStroop scores did not predict treatment response. In conclusion, HRV recovery variables in the context of a standardized VR stressor were significant predictors of PTSD treatment response after controlling for baseline CAPS and number of combat experiences. The direction of this relationship indicates that greater baseline HRV recovery predicts lower 6-month PTSD symptom severity. This was an exploratory study in need of replication.
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Affiliation(s)
- Jeffrey M Pyne
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Joseph I Constans
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia, USA
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | | | - Susan Jegley
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
| | | | - Bo Hu
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marcela C Weber
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
| | - Kent D Hinkson
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
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Costa R, Abad-Tortosa D, Alacreu-Crespo A, Saiz-Clar E, Salvador A, Serrano MÁ. Looking for the Key to Winning: Psychophysiological Predicting Factors in Healthy University Students. Behav Sci (Basel) 2023; 13:978. [PMID: 38131834 PMCID: PMC10741204 DOI: 10.3390/bs13120978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Performance in competitive situations has been linked to various psychobiological factors such as personality traits (e.g., competitiveness), situational appraisal (e.g., motivation), and cardiovascular response (e.g., heart rate). However, it remains unclear whether these factors can predict competitive success. This paper aims to assess, through discriminant analysis, the predictive capacity of these psychobiological variables regarding the likelihood of winning, ultimately delineating a psychophysiological profile associated with success. Across three distinct studies, a total of 154 participants (66 men) engaged in a face-to-face laboratory competition. Prior to the competition, assessments of competitiveness traits, anxiety, self-efficacy, and motivation were conducted, and heart rate reactivity during the competition was measured. These variables collectively formed the basis for constructing the predictive model. The results of the initial study demonstrated that our model accurately classified 68.8% of the cases. Specifically, high levels of competitiveness, self-efficacy, motivation, and heart rate reactivity, coupled with low anxiety, were predictive of winning. These findings were subsequently replicated in two independent validation samples involving both men and women (studies 2 and 3), thereby reinforcing the robustness of the earlier results. In conclusion, our findings suggest that the psychological state preceding competition, along with cardiovascular reactivity, may serve as predictors for the probability of winning.
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Affiliation(s)
- Raquel Costa
- Departamento de Psicobiología, Universitat de València, 46010 Valencia, Spain; (R.C.); (D.A.-T.); (A.S.)
| | - Diana Abad-Tortosa
- Departamento de Psicobiología, Universitat de València, 46010 Valencia, Spain; (R.C.); (D.A.-T.); (A.S.)
| | - Adrian Alacreu-Crespo
- Departamento de Psicología y Sociología, Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Elena Saiz-Clar
- Departamento de Metodología, Universitat Nacional a Distancia (UNED), 28040 Madrid, Spain;
| | - Alicia Salvador
- Departamento de Psicobiología, Universitat de València, 46010 Valencia, Spain; (R.C.); (D.A.-T.); (A.S.)
- Laboratory of Social Cognitive Neuroscience and IDOCAL, Universitat de València, 46010 Valencia, Spain
- Spanish National Network for Research in Mental Health CIBERSAM, 28029 Madrid, Spain
| | - Miguel Ángel Serrano
- Departamento de Psicobiología, Universitat de València, 46010 Valencia, Spain; (R.C.); (D.A.-T.); (A.S.)
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Kozlowska K, Schollar-Root O, Savage B, Hawkes C, Chudleigh C, Raghunandan J, Scher S, Helgeland H. Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1724. [PMID: 38002815 PMCID: PMC10670544 DOI: 10.3390/children10111724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 11/26/2023]
Abstract
Previous studies suggest that subjective distress in children with functional neurological disorder (FND) is associated with stress-system dysregulation and modulates aberrant changes in neural networks. The current study documents illness-promoting psychological processes in 76 children with FND (60 girls and 16 boys, aged 10.00-17.08 years) admitted to the Mind-Body Program. The children completed a comprehensive family assessment and self-report measures, and they worked with the clinical team to identify psychological processes during their inpatient admission. A total of 47 healthy controls (35 girls and 12 boys, aged 8.58-17.92 years) also completed self-report measures, but were not assessed for illness-promoting psychological processes. Children with FND (vs. controls) reported higher levels of subjective distress (total DASS score, t(104.24) = 12.18; p ˂ 0.001) and more adverse childhood experiences across their lifespans (total ELSQ score, t(88.57) = 9.38; p ˂ 0.001). Illness-promoting psychological processes were identified in all children with FND. Most common were the following: chronic worries about schoolwork, friendships, or parental wellbeing (n = 64; 84.2%); attention to symptoms (n = 61; 80.3%); feeling sad (n = 58; 76.3%); experiencing a low sense of control (helplessness) in relation to symptoms (n = 44; 57.9%); pushing difficult thoughts out of mind (n = 44; 57.9%); self-critical rumination (n = 42; 55.3%); negative/catastrophic-symptom expectations (n = 40; 52.6%); avoidance of activities (n = 38; 50%); intrusive thoughts/feelings/memories associated with adverse events (n = 38, 50%); and pushing difficult feelings out of mind (n = 37; 48.7%). In children with FND-disabled enough to be admitted for inpatient treatment-illness-promoting psychological processes are part of the clinical presentation. They contribute to the child's ongoing sense of subjective distress, and if not addressed can maintain the illness process. A range of clinical interventions used to address illness-promoting psychological processes are discussed, along with illustrative vignettes.
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Affiliation(s)
- Kasia Kozlowska
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Child and Adolescent Heath and Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Brain Dynamics Centre, Westmead Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Olivia Schollar-Root
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Blanche Savage
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Golden Wattle Clinical Psychology, 20 Jarrett St, Leichhardt, NSW 2040, Australia
| | - Clare Hawkes
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Catherine Chudleigh
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Golden Wattle Clinical Psychology, 20 Jarrett St, Leichhardt, NSW 2040, Australia
| | - Jyoti Raghunandan
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Stephen Scher
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Helene Helgeland
- Department of Child and Adolescent Mental Health in Hospitals, Oslo University Hospital, 0424 Oslo, Norway;
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Giaume L, Jimenez A, Kedzierewicz R, Jost D, Pery M, Trouvé J, Burlaton G, Travers S, Prunet B, Trousselard M. FIRECARE: An Evidence-Based Prevention Program to Reduce Burnout among Prehospital Caregivers: Benefits of a Combined Mindfulness, Heart Coherence Training, and Positive Psychology Intervention. PREHOSP EMERG CARE 2023; 28:342-351. [PMID: 37698362 DOI: 10.1080/10903127.2023.2258204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Burnout among emergency health care professionals is well-described, especially during the COVID-19 pandemic. Prevention interventions, such as mindfulness, focus on the management of stress. OBJECTIVE To evaluate the effects of the FIRECARE program (a mindfulness intervention, supplemented by heart coherence training and positive psychology workshops) on burnout, secondary stress, compassion fatigue, and mindfulness among advanced life support ambulance staff of the Paris Fire Brigade. MATERIALS AND METHODS We used a non-randomized, two-group quasi-experimental study design with a waitlist control and before-and-after measurements in each group. The intervention consisted of six, once-weekly, 2.5-h sessions that included individual daily meditation and cardiac coherence practice. The study compared intervention and waitlist control groups, and investigated baseline, post-program, and 3-month follow-up change on burnout (measuring using the ProQOL-5 scale) and mindfulness (measuring using the FMI scores). Baseline burnout (measured using the ProQOL-5) was evaluated and used in the analysis. RESULTS Seventy-four 74 participants volunteered to participate; 66 were included in the final analysis. Of these, 60% were classified as suffering from moderate burnout, the 'burnout cluster'. A comparison of intervention and waitlist control groups found a decrease in the burnout score in the burnout cluster (p = 0.0003; partial eta squared = 0.18). However, while secondary stress fell among the burnout cluster, it was only for participants in the intervention group; scores increased for those in the waitlist group (p = 0.003; partial eta squared = 0.12). The pre-post-intervention analysis of both groups also showed that burnout fell in the burnout cluster (p = 0.006; partial eta squared = 0.11). At 3-month follow-up, the burnout score was significantly reduced in the intervention group (p = 0.02; partial eta squared = 0.07), and both the acceptance (p = 0.007) and mindfulness scores (p = 0.05; partial eta squared = 0.05) were increased in the baseline burnout cluster. CONCLUSION FIRECARE may be a useful approach to preventing and reducing burnout among prehospital caregivers.
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Affiliation(s)
- Louise Giaume
- Emergency Medical Department, Paris Fire Brigade, Paris, France
| | | | - Romain Kedzierewicz
- Unité d'instruction et d'intervention de la Sécurité civile, Brignoles, France
| | - Daniel Jost
- Emergency Medical Department, Paris Fire Brigade, Paris, France
| | - Marie Pery
- Emergency Medical Department, Paris Fire Brigade, Paris, France
| | - Julien Trouvé
- Psychology Department, Paris Fire Brigade, Paris, France
| | | | | | - Bertrand Prunet
- Hospital of Instruction of the Armed Forces Laveran, Marseille, France
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Hall KJ, Van Ooteghem K, McIlroy WE. Emotional state as a modulator of autonomic and somatic nervous system activity in postural control: a review. Front Neurol 2023; 14:1188799. [PMID: 37719760 PMCID: PMC10500443 DOI: 10.3389/fneur.2023.1188799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023] Open
Abstract
Advances in our understanding of postural control have highlighted the need to examine the influence of higher brain centers in the modulation of this complex function. There is strong evidence of a link between emotional state, autonomic nervous system (ANS) activity and somatic nervous system (somatic NS) activity in postural control. For example, relationships have been demonstrated between postural threat, anxiety, fear of falling, balance confidence, and physiological arousal. Behaviorally, increased arousal has been associated with changes in velocity and amplitude of postural sway during quiet standing. The potential links between ANS and somatic NS, observed in control of posture, are associated with shared neuroanatomical connections within the central nervous system (CNS). The influence of emotional state on postural control likely reflects the important influence the limbic system has on these ANS/somatic NS control networks. This narrative review will highlight several examples of behaviors which routinely require coordination between the ANS and somatic NS, highlighting the importance of the neurofunctional link between these systems. Furthermore, we will extend beyond the more historical focus on threat models and examine how disordered/altered emotional state and ANS processing may influence postural control and assessment. Finally, this paper will discuss studies that have been important in uncovering the modulatory effect of emotional state on postural control including links that may inform our understanding of disordered control, such as that observed in individuals living with Parkinson's disease and discuss methodological tools that have the potential to advance understanding of this complex relationship.
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Affiliation(s)
- Karlee J. Hall
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Lane CB, Brauer E, Mascaro JS. Discovering compassion in medical training: a qualitative study with curriculum leaders, educators, and learners. Front Psychol 2023; 14:1184032. [PMID: 37448711 PMCID: PMC10336206 DOI: 10.3389/fpsyg.2023.1184032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background Compassion is considered a fundamental human capacity instrumental to the creation of medicine and for patient-centered practice and innovations in healthcare. However, instead of nurturing and cultivating institutional compassion, many healthcare providers cite the health system itself as a direct barrier to standard care. The trend of compassion depletion begins with medical students and is often attributed to the culture of undergraduate medical training, where students experience an increased risk of depression, substance use, and suicidality. Objectives This qualitative study aims to develop a more comprehensive understanding of compassion as it relates to undergraduate medical education. We used focus groups with key stakeholders in medical education to characterize beliefs about the nature of compassion and to identify perceived barriers and facilitators to compassion within their daily responsibilities as educators and students. Methods Researchers conducted a series of virtual (Zoom) focus groups with stakeholders: Students (N = 14), Small Group Advisors (N = 11), and Medical Curriculum Leaders (N = 4). Transcripts were thematically analyzed using MAXQDA software. Results Study participants described compassion as being more than empathy, demanding action, and capable of being cultivated. Stakeholders identified self-care, life experiences, and role models as facilitators. The consistently identified barriers to compassion were time constraints, culture, and burnout. Both medical students and those training them agreed on a general definition of compassion and that there are ways to cultivate more of it in their daily professional lives. They also agreed that undergraduate medical education - and the healthcare culture at large - does not deliberately foster compassion and may be directly contributing to its degradation by the content and pedagogies emphasized, the high rates of burnout and futility, and the overwhelming time constraints. Discussion Intentional instruction in and cultivation of compassion during undergraduate medical education could provide a critical first step for undergirding the professional culture of healthcare with more resilience and warm-hearted concern. Our finding that medical students and those training them agree about what compassion is and that there are specific and actionable ways to cultivate more of it in their professional lives highlights key changes that will promote a more compassionate training environment conducive to the experience and expression of compassion.
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Affiliation(s)
- Charles B. Lane
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Erin Brauer
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Jennifer S. Mascaro
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Spiritual Health, Emory University Woodruff Health Sciences Center, Emory Healthcare, Atlanta, GA, United States
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Gao J, Sun R, Leung HK, Roberts A, Wu BWY, Tsang EW, Tang ACW, Sik HH. Increased neurocardiological interplay after mindfulness meditation: a brain oscillation-based approach. Front Hum Neurosci 2023; 17:1008490. [PMID: 37405324 PMCID: PMC10315629 DOI: 10.3389/fnhum.2023.1008490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Background Brain oscillations facilitate interaction within the brain network and between the brain and heart activities, and the alpha wave, as a prominent brain oscillation, plays a major role in these coherent activities. We hypothesize that mindfully breathing can make the brain and heart activities more coherent in terms of increased connectivity between the electroencephalogram (EEG) and electrocardiogram (ECG) signals. Methods Eleven participants (28-52 years) attended 8 weeks of Mindfulness Based Stress Reduction (MBSR) training. EEG and ECG data of two states of mindful breathing and rest, both eye-closed, were recorded before and after the training. EEGLAB was used to analyze the alpha band (8-12 Hz) power, alpha peak frequency (APF), peak power and coherence. FMRIB toolbox was used to extract the ECG data. Heart coherence (HC) and heartbeat evoked potential (HEP) were calculated for further correlation analysis. Results After 8 weeks of MBSR training, the correlation between APF and HC increased significantly in the middle frontal region and bilateral temporal regions. The correlation between alpha coherence and heart coherence had similar changes, while alpha peak power did not reflect such changes. In contrast, spectrum analysis alone did not show difference before and after MBSR training. Conclusion The brain works in rhythmic oscillation, and this rhythmic connection becomes more coherent with cardiac activity after 8 weeks of MBSR training. Individual APF is relatively stable and its interplay with cardiac activity may be a more sensitive index than power spectrum by monitoring the brain-heart connection. This preliminary study has important implications for the neuroscientific measurement of meditative practice.
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Affiliation(s)
- Junling Gao
- Buddhist Practices and Counselling Science Lab, Centre of Buddhist Studies, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Rui Sun
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Hang Kin Leung
- Buddhist Practices and Counselling Science Lab, Centre of Buddhist Studies, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Adam Roberts
- Singapore-ETH Centre, Future Resilient Systems Programme, Singapore, Singapore
| | - Bonnie Wai Yan Wu
- Buddhist Practices and Counselling Science Lab, Centre of Buddhist Studies, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Eric W. Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Andrew C. W. Tang
- Department of Psychology, HKU School of Professional and Continuing Education, Hong Kong, Hong Kong SAR, China
| | - Hin Hung Sik
- Buddhist Practices and Counselling Science Lab, Centre of Buddhist Studies, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Beranbaum S, Kouri N, Van der Merwe N, DePierro VK, D’Andrea W. Behavioral and Biological Indicators of Risk and Well-Being in a Sample of South African Youth. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:163-172. [PMID: 37234824 PMCID: PMC10205918 DOI: 10.1007/s40653-021-00426-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 05/28/2023]
Abstract
Self report measures have been widely used in research to illustrate high rates of exposure to violence among youth in trauma-saturated regions, such as Cape Town, South Africa. To better understand the risk and resilience factors of youth who have been exposed to, witnessed, or directly experienced violence, the current study used a multi-method assessment in a naturalistic setting that included heart rate variability (an index of regulatory flexibility and cardiovascular health), a computerized risk-taking task, and self report measures. Youth (N = 83) from Cape Town, South Africa, participated in a psychobiological assessment. Findings suggest elevated age-adjusted heart rate variability compared to age related norms, which is indicative of overregulation of behavior and emotion. Additionally, youth, all of whom had witnessed or experienced violence at least once, demonstrated a low risk taking and reward seeking propensity. Low risk taking in the context of elevated heart rate variability may reflect youth's affective and behavioral inhibition, suggestive of stress among children who have an overgeneralized threat response. These results both demonstrate the feasibility of psychophysiological research in community youth settings, and counter the traditional narrative that there is an overarching lack of capacity to regulate and a high propensity to risk in violence-exposed youth. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-021-00426-1.
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Ilie G, Rendon R, Mason R, MacDonald C, Kucharczyk MJ, Patil N, Bowes D, Bailly G, Bell D, Lawen J, Ha M, Wilke D, Massaro P, Zahavich J, Kephart G, Rutledge RDH. A Comprehensive 6-mo Prostate Cancer Patient Empowerment Program Decreases Psychological Distress Among Men Undergoing Curative Prostate Cancer Treatment: A Randomized Clinical Trial. Eur Urol 2023; 83:561-570. [PMID: 36822969 DOI: 10.1016/j.eururo.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/30/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Although survival rates for newly diagnosed prostate cancer patients are very high, most of them will likely suffer significant treatment-related side effects, depression, or anxiety, affecting their quality of life. OBJECTIVE The aim of this study was to examine the effects of a 6-mo online home-based physical, mental, and social support intervention, the Prostate Cancer Patient Empowerment Program (PC-PEP), on preventing psychological distress among men undergoing curative prostate cancer treatment. DESIGN, SETTING, AND PARTICIPANTS In a crossover randomized clinical trial of 128 men aged 50-82 yr scheduled for curative prostate cancer surgery or radiotherapy (± hormone treatment), 66 received the 6-mo PC-PEP intervention and 62 were randomized to a waitlist-control arm and received the standard of care for 6 mo, and then PC-PEP to the end of the year. The PC-PEP intervention consisted of daily e-mails with video instructions providing education, patient activation, and empowerment on healthy living including physical and mental health, dietary recommendations, social support, physical and pelvic floor fitness, stress reduction using a biofeedback device, social connection and intimacy, and social support. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was nonspecific psychological distress (clinical cutoff ≥20) measured at baseline, and at 6 and 12 mo using the Kessler Psychological Distress Scale (K10). RESULTS AND LIMITATIONS At 6 mo, patients in the waitlist-control group had 3.59 (95% confidence interval: 1.12-11.51) times higher odds for nonspecific psychological distress and need for psychological treatment than men who received the PC-PEP intervention. At 12 mo, the wait-list control group that received the intervention at 6 mo had higher psychological distress than the early group. CONCLUSIONS PC-PEP delivered early following diagnosis significantly prevented the burden of psychological distress in men undergoing curative prostate cancer treatment compared with standard of care, or late (6 mo later) intervention. PATIENT SUMMARY In this report, we looked at the effectiveness of a program (Prostate Cancer Patient Empowerment Program: PC-PEP) developed with patients' engagement on the mental distress of patients awaiting curative treatment for their prostate cancer. The PC-PEP program lasted for 6 mo, and it prescribed, described, and demonstrated daily aerobic and strength training, kegels (pelvic floor training to help with urinary and sexual function), dietary changes that have been shown to be helpful in the prevention of prostate cancer and prostate cancer progression, stress reduction using a biofeedback device, as well as social and emotional support. All patients in the PC-PEP program were invited to a monthly video conference with the leads of the program who appeared in the 6 mo of daily videos prescribing the activities the patients were asked to watch and follow. The leads were a prostate cancer oncologist and a scientist in prostate cancer quality of life research. Half of the patients in this study received PC-PEP daily for the first 6 mo and were re-assessed at the end of the year. The other half received standard of care for 6 month and then received the intervention to the end of the year. The results of the study show that, at 6 mo, this intervention was effective at reducing the mental distress that accompanies a prostate cancer diagnosis and treatment compared with the standard of care. Mental distress was significantly reduced when the intervention was received early, compared with that received late (6 mo after scheduled curative treatment). We conclude that multi-faceted patient education and empowerment programming of this kind that is developed with patient engagement from the start is crucial to the care of patients diagnosed with prostate cancer and should be implemented in the standard of care. While treatment for prostate cancer is highly successful, side effects that accompany most treatments significantly affect the quality of life of patients. Here, we describe PC-PEP, a patient education and activation program that is cost effective, highly enforced by patients, and successful at reducing the impact of prostate cancer active treatment-related side effects on their psychological state. To learn more about this project, please visit www.pcpep.org. The program is now being tested in a phase 4 implementation trial throughout Canada and internationally (New Zealand), and is being expanded and tested for other types of cancer.
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Affiliation(s)
- Gabriela Ilie
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ross Mason
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cody MacDonald
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael J Kucharczyk
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nikhilesh Patil
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Bowes
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Greg Bailly
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Bell
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joseph Lawen
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Ha
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Derek Wilke
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter Massaro
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffery Zahavich
- Department of Kinesiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Bouny P, Arsac LM, Guérin A, Nerincx G, Deschodt-Arsac V. Guiding Breathing at the Resonance Frequency with Haptic Sensors Potentiates Cardiac Coherence. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094494. [PMID: 37177701 PMCID: PMC10181630 DOI: 10.3390/s23094494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Cardiac coherence is a state achieved when one controls their breathing rate during the so-called resonance frequency breathing. This maneuver allows respiratory-driven vagal modulations of the heart rate to superimpose with sympathetic modulations occurring at 0.1 Hz, thereby maximizing autonomous power in heart-to-brain connections. These stimulations have been shown to improve vagal regulations, which results in obvious benefits for both mental and organic health. Here, we present a device that is able to deliver visual and haptic cues, as well as HRV biofeedback information to guide the user in maintaining a 0.1 Hz breathing frequency. We explored the effectiveness of cardiac coherence in three guidance conditions: visual, haptic and visuo-haptic breathing. Thirty-two healthy students (sixteen males) were divided into three groups that experienced five minutes of either visual, haptic and visuo-haptic guided breathing at 0.1 Hz. The effects of guidance on the (adequate) breathing pattern and heart rate variability (HRV) were analyzed. The interest of introducing haptic breathing to achieve cardiac coherence was shown in the haptic and visuo-haptic groups. Especially, the P0.1 index, which indicates how the autonomous power is 'concentrated' at 0.1 Hz in the PSD spectrum, demonstrated the superiority of combining haptic with visual sensory inputs in potentiating cardiac coherence (0.55 ± 0.20 for visuo-haptic vs. 0.28 ± 0.14 for visual only guidance; p < 0.05) haptic-induced effectiveness could be an asset for a more efficient and time-saving practice, allowing improved health and well-being even under tight time constraints.
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Affiliation(s)
- Pierre Bouny
- Univ. Bordeaux, CNRS, Bordeaux INP, IMS, UMR 5218, F-33400 Talence, France
- URGOTECH, 15 Avenue d'Iéna, F-75116 Paris, France
| | - Laurent M Arsac
- Univ. Bordeaux, CNRS, Bordeaux INP, IMS, UMR 5218, F-33400 Talence, France
| | | | - Guillam Nerincx
- Univ. Bordeaux, CNRS, Bordeaux INP, IMS, UMR 5218, F-33400 Talence, France
- URGOTECH, 15 Avenue d'Iéna, F-75116 Paris, France
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ter Harmsel JF, Noordzij ML, van der Pol TM, Swinkels LTA, Goudriaan AE, Popma A. Exploring the effects of a wearable biocueing app (Sense-IT) as an addition to aggression regulation therapy in forensic psychiatric outpatients. Front Psychol 2023; 14:983286. [PMID: 36968738 PMCID: PMC10036768 DOI: 10.3389/fpsyg.2023.983286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/18/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectivePreventing and reducing violence is of high importance for both individuals and society. However, the overall efficacy of current treatment interventions aimed at reducing aggressive behavior is limited. New technological-based interventions may enhance treatment outcomes, for instance by facilitating out-of-session practice and providing just-in-time support. Therefore, the aim of this study was to assess the effects of the Sense-IT biocueing app as an addition to aggression regulation therapy (ART) on interoceptive awareness, emotion regulation, and aggressive behavior among forensic outpatients.MethodsA combination of methods was used. Quantitatively, a pretest-posttest design was applied to explore group changes in aggression, emotion regulation, and anger bodily sensations associated with the combination of biocueing intervention and ART. Measures were assessed at pretest, after 4 weeks posttest, and after one-month follow-up. During the 4 weeks, a single-case experimental ABA design was applied for each participant. Biocueing was added in the intervention phase. During all phases anger, aggressive thoughts, aggressive behavior, behavioral control, and physical tension were assessed twice a day, and heart rate was measured continuously. Qualitative information regarding interoceptive awareness, coping, and aggression was collected at posttest. 25 forensic outpatients participated.ResultsA significant decrease in self-reported aggression was found between pre- and posttest. Furthermore, three-quarters of participants reported increased interoceptive awareness associated with the biocueing intervention. However, the repeated ambulatory measurements of the single-case experimental designs (SCEDs) did not indicate a clear effect favoring the addition of biocueing. On group level, no significant effects were found. On the individual level, effects favoring the intervention were only found for two participants. Overall, effect sizes were small.ConclusionBiocueing seems a helpful addition to increase interoceptive awareness among forensic outpatients. However, not all patients benefit from the current intervention and, more specifically, from its behavioral support component aimed at enhancing emotion regulation. Future studies should therefore focus on increasing usability, tailoring the intervention to individual needs, and on integration into therapy. Individual characteristics associated with effective support by a biocueing intervention should be further investigated, as the use of personalized and technological-based treatment interventions is expected to increase in the coming years.
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Affiliation(s)
- Janna F. ter Harmsel
- Forensic Mental Healthcare, Inforsa, Amsterdam, Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- *Correspondence: Janna F. ter Harmsel,
| | - Matthijs L. Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Thimo M. van der Pol
- Forensic Mental Healthcare, Inforsa, Amsterdam, Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Research and Quality of Care, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Lise T. A. Swinkels
- Forensic Mental Healthcare, Inforsa, Amsterdam, Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anna E. Goudriaan
- Department of Research and Quality of Care, Arkin Mental Health Institute, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Addiction Research, Amsterdam, Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Li WC, Zhang J, Kearney P. Psychophysiological coherence training to moderate air traffic controllers' fatigue on rotating roster. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:391-404. [PMID: 35212002 DOI: 10.1111/risa.13899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
The nature of the current rotating roster, providing 24-h air traffic services over five irregular shifts, leads to accumulated fatigue which impairs air traffic controllers' cognitive function and task performance. It is imperative to develop an effective fatigue risk management system to improve aviation safety based upon scientific approaches. Two empirical studies were conducted to address this issue. Study 1 investigated the mixed effect of circadian rhythm disorders and resource depletion on controllers' accumulated fatigue. Then, study 2 proposed a potential biofeedback solution of quick coherence technique which can mitigate air traffic controllers' (ATCOs') fatigue while on controller working position and improve ATCOs' mental/physical health. The current two-studies demonstrated a scientific approach to fatigue analysis and fatigue risk mitigation in the air traffic services domain. This research offers insights into the fluctuation of ATCO fatigue levels and the influence of a numbers of factors related to circadian rhythm and resource depletion impact on fatigue levels on study 1; and provides psychophysiological coherence training to increase ATCOs' fatigue resilience to mitigate negative impacts of fatigue on study 2. Based on these two studies, the authors recommended that an extra short break for air traffic controllers to permit practicing the quick coherence breathing technique for 5 min at the sixth working hour could substantially recharge cognitive resources and increase fatigue resilience. Application: Present studies highlight an effective fatigue intervention based on objective biofeedback to moderate controllers' accumulated fatigue as a result of rotating shift work. Accordingly, air navigation services providers and regulators can develop fatigue risk management systems based on scientific approaches to improve aviation safety and air traffic controller's wellbeing.
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Affiliation(s)
- Wen-Chin Li
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
| | - Jingyi Zhang
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
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Personality traits affect anticipatory stress vulnerability and coping effectiveness in occupational critical care situations. Sci Rep 2022; 12:20965. [PMID: 36470906 PMCID: PMC9722917 DOI: 10.1038/s41598-022-24905-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
The present study aimed at investigating the influence of personality on both anticipatory stress vulnerability and the effectiveness of coping strategies in an occupational stressful context. Following assessment of individual personality traits (Big Five Inventory), 147 volunteers were exposed to the anticipation of a stressful event. Anxiety and cardiac reactivity were assessed as markers of vulnerability to anticipatory stress. Participants were then randomly assigned to three groups and subjected to a 5-min intervention: relaxation breathing, relaxation breathing combined with cardiac biofeedback, and control. The effectiveness of coping interventions was determined through the cardiac coherence score achieved during the intervention. Higher neuroticism was associated with higher anticipatory stress vulnerability, whereas higher conscientiousness and extraversion were related to lower anticipatory stress vulnerability. Relaxation breathing and biofeedback coping interventions contributed to improve the cardiac coherence in all participants, albeit with greater effectiveness in individuals presenting higher score of openness to experience. The present findings demonstrated that personality traits are related to both anticipatory stress vulnerability and effectiveness of coping interventions. These results bring new insights into practical guidelines for stress prevention by considering personality traits. Specific practical applications for health professionals, who are likely to manage stressful situations daily, are discussed.
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McCraty R. Following the Rhythm of the Heart: HeartMath Institute's Path to HRV Biofeedback. Appl Psychophysiol Biofeedback 2022; 47:305-316. [PMID: 35731454 PMCID: PMC9214473 DOI: 10.1007/s10484-022-09554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/25/2022]
Abstract
This paper outlines the early history and contributions our laboratory, along with our close advisors and collaborators, has made to the field of heart rate variability and heart rate variability coherence biofeedback. In addition to the many health and wellness benefits of HRV feedback for facilitating skill acquisition of self-regulation techniques for stress reduction and performance enhancement, its applications for increasing social coherence and physiological synchronization among groups is also discussed. Future research directions and applications are also suggested.
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Church D, Stapleton P, Gosatti D, O’Keefe T. Effect of virtual group EcoMeditation on psychological conditions and flow states. Front Psychol 2022; 13:907846. [DOI: 10.3389/fpsyg.2022.907846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
BackgroundA plethora of literature has delineated the therapeutic benefits of meditation practice on psychological functioning. A novel meditative practice, EcoMeditation, includes elements of four evidence-based techniques: The Quick Coherence Technique for regulating heart rate variability (HRV), Emotional Freedom Techniques (EFT), mindfulness, and neurofeedback.ObjectivesChanges in psychological symptoms, including anxiety, depression, posttraumatic stress, pain, and happiness were measured following a one-day virtual EcoMeditation training workshop. The current study extended on previous literature by adding measures of transcendent experiences and flow states.MethodsParticipants were drawn from a convenience sample of 151 participants (130 female, 21 male) aged between 26 to 71 years (M = 45.1, SD = 9.19) attending a one-day virtual EcoMeditation workshop. They were assessed pre-workshop, post-workshop, and at 3-months follow-up.ResultsPost-workshop results (N = 111) indicated a significant reduction in anxiety (−42.3%, p < 0.001), depression (−37.5%, p < 0.001), posttraumatic stress (−13.0%, p < 0.001), and pain (−63.2%, p < 0.001) Likert mean scores when compared to pre-workshop. There was also a significant increase in happiness (+111.1%, p < 0.001), flow states (+17.4%, p < 0.001), and transcendent experiences (+18.5%, p < 0.001). At 3-months follow-up, a one-way repeated measures ANOVA (N = 72) found significant decreases in anxiety, depression, and pain symptoms between pre-test and post-test, as well between pre-test and follow-up. Flow, happiness, and transcendent experiences increased significantly between pre-test and post-test, as well as between pre-test and follow-up, with over 71% of participants experiencing clinically significant improvements. Significant reductions in posttraumatic stress and depression symptoms between pre-test and follow-up were also noted.ConclusionEcoMeditation is associated with significant improvements in psychological conditions such as anxiety, depression, pain, and posttraumatic stress. EcoMeditation was also shown to enhance flow states and transcendent experiences. The benefits identified were similar to those found in the existing literature and provide support for the use of EcoMeditation as an effective stress reduction method that improves psychological symptoms and enhances transcendent states.
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Stubbe L, Houel N, Cottin F. Accuracy and reliability of the optoelectronic plethysmography and the heart rate systems for measuring breathing rates compared with the spirometer. Sci Rep 2022; 12:19255. [PMID: 36357452 PMCID: PMC9648890 DOI: 10.1038/s41598-022-23915-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Measuring breathing rates without a mouthpiece is of interest in clinical settings. Electrocardiogram devices and, more recently, optoelectronic plethysmography (OEP) methods can estimate breathing rates with only a few electrodes or motion-capture markers placed on the patient. This study estimated and compared the accuracy and reliability of three non-invasive devices: an OEP system with 12 markers, an electrocardiogram device and the conventional spirometer. Using the three devices simultaneously, we recorded 72 six-minute epochs on supine subjects. Our results show that the OEP system has a very low limit of agreement and a bias lower than 0.4% compared with the spirometer, indicating that these devices can be used interchangeably. We observed comparable results for electrocardiogram devices. The OEP system facilitates breathing rate measurements and offers a more complete chest-lung volume analysis that can be easily associated with heart rate analysis without any synchronisation process, for useful features for clinical applications and intensive care.
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Affiliation(s)
- Laurent Stubbe
- grid.460789.40000 0004 4910 6535Université Paris-Saclay, CIAMS EA 4532, 91405 Orsay, France ,grid.112485.b0000 0001 0217 6921Université d’Orléans, CIAMS EA 4532, 45067 Orléans, France ,ESO-Paris Recherche, Ecole Supérieure d’Ostéopathie – Paris, 77420 Champs Sur Marne, France
| | - Nicolas Houel
- grid.11667.370000 0004 1937 0618Université de Reims Champagne-Ardenne, PSMS, Reims, France
| | - François Cottin
- grid.460789.40000 0004 4910 6535Université Paris-Saclay, CIAMS EA 4532, 91405 Orsay, France ,grid.112485.b0000 0001 0217 6921Université d’Orléans, CIAMS EA 4532, 45067 Orléans, France
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George R, Jose R, Meenakshy K, Jarin T, Senthil Kumar S. Effects of long-term exercise training on physiological signals and personality traits in women in law enforcement. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2022. [DOI: 10.3233/jifs-221588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Law enforcement teams across the globe experience the highest occupational stress and stress-related diseases. Physical exercise and an active lifestyle are recommended as part of their profession to equip them to fight stress and related health adversities. The research is carried out using objective measures of Heart Rate Variability (HRV), Electro Dermal Activity (EDA), Heart Rate Recovery (HRR), and subjective questionnaires. HRV was generated with an electrocardiogram (ECG) signal acquired using NI myRIO 1900 interfaced with the Vernier EKG sensor. HRR was acquired with the help of a Polar chest strap exercise heart rate monitor and EDA acquisition was carried out with Mindfield E-Sense electrodes. Then statistical features are extracted from the collected data, and feed to the AQCNN (Aquila convolution neural network) classifier to predict the stress. Signal analyses were done in Kubios 4.0, Ledalab V3.x in a MATLAB environment. The results pointed out that exercise training is effective in increasing the vagal tone of the Autonomic Nervous System (ANS) and hence improves the recovery potential of the cardiovascular system from stress. The proposed AQCNN method improves the accuracy of 95.12% which is 93.13%, 85.36% and 80.13% better than MANOVA technique, CNN and ML-SVM respectively. The findings have the potential to influence decision-making in the selection and training of recruits in high-stress positions, hence optimizing the cost and time of training by identifying maladaptive recruits early.
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Affiliation(s)
- Remya George
- Department of Biomedical Engineering, Sahrdaya College of Engineering and Technology, Thrissur, Kerala, India
| | - Reshma Jose
- Department of Biomedical Engineering, Sahrdaya College of Engineering and Technology, Thrissur, Kerala, India
| | - K. Meenakshy
- Department of Electrical and Electronics Engineering, Government Engineering College, Thrissur, Kerala, India
| | - T. Jarin
- Department of Electrical and Electronics Engineering, Jyothi Engineering College, Thrissur, Kerala, India
| | - S. Senthil Kumar
- Department of Electrical and Electronics Engineering, New Prince Shri Bhavani College of Engineering and Technology, Chennai, Tamil Nadu, India
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Magnon V, Dutheil F, Vallet GT. The heart to make the right choice: Vagal (re)activity and recovery predict advantageous decision-making. Physiol Behav 2022; 254:113911. [PMID: 35820625 DOI: 10.1016/j.physbeh.2022.113911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/06/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022]
Abstract
From simple everyday choices to life-altering decisions, decision-making is a crucial cognitive process in our daily life. Psychophysiological theories of heart-brain interactions involvement in cognition predict that general self-regulation capacities underlie cognitive processes including decision-making. Yet, in the context of decision-making, the somatic maker hypothesis postulates that the adaptability of the current physiological state should be the best predictor of advantageous decision-making. The present study tests compare self-regulation in general (indexed by resting vagal activity) and in a specific decisional context (vagal reactivity and recovery) to explain advantageous decision-making. Young adults (n = 54) completed a decision-making task while wearing a heart rate monitor. Bayesian regressions show that vagal reactivity and recovery combined is the preferred statistical model to explain advantageous decision-making (BF10 = 163.85). Those findings 1) support the somatic marker hypothesis highlighting the key role of in situ self-regulation in decision-making processes and 2) show that the popular and often used index of general self-regulation, resting vagal activity, is not the best predictor of decision-making performance, and perhaps even for other cognitive functions. A next step could be interventional studies to test whether vagal modulation of heart rate underlies decision-making through interventions that influence vagal activity, which could provide relevant clinical leads.
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Affiliation(s)
- Valentin Magnon
- Université Clermont Auvergne, CNRS, LaPSCo, F-63000 Clermont-Ferrand, France.
| | - Frederic Dutheil
- University Clermont Auvergne, CNRS, LaPSCo, CHU Clermont-Ferrand, WittyFit, F-63000 Clermont-Ferrand, France
| | - Guillaume T Vallet
- Université Clermont Auvergne, CNRS, LaPSCo, F-63000 Clermont-Ferrand, France.
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Bögge L, Colás-Blanco I, Piolino P. Respiratory sinus arrhythmia during biofeedback is linked to persistent improvements in attention, short-term memory, and positive self-referential episodic memory. Front Neurosci 2022; 16:791498. [PMID: 36177356 PMCID: PMC9514056 DOI: 10.3389/fnins.2022.791498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Heart rate variability (HRV) biofeedback, an intervention based on the voluntary self-regulation of autonomic parameters, has been shown to affect prefrontal brain functioning and improve executive functions. The interest in using HRV biofeedback as cognitive training is typically ascribed to parasympathetic activation and optimized physiological functioning deriving from increased cardiac vagal control. However, the persistence of cognitive effects is poorly studied and their association with biofeedback-evoked autonomic changes has not yet been explored. In addition, no study has so far investigated the influence of HRV biofeedback in adults on long-term episodic memory, which is particularly concerned with self-referential encoding processing. Methods In the present study, a novel training system was developed integrating HRV and respiratory biofeedback into an immersive virtual reality environment to enhance training efficacy. Twenty-two young healthy adults were subjected to a blinded randomized placebo-controlled experiment, including six self-regulation training sessions, to evaluate the effect of biofeedback on autonomic and cognitive changes. Cardiac vagal control was assessed before, during, and 5 min after each training session. Executive functions, episodic memory, and the self-referential encoding effect were evaluated 1 week before and after the training program using a set of validated tasks. Results Linear mixed-effects models showed that HRV biofeedback greatly stimulated respiratory sinus arrhythmia during and after training. Moreover, it improved the attentional capabilities required for the identification and discrimination of stimuli ( η p 2 = 0.17), auditory short-term memory ( η p 2 = 0.23), and self-referential episodic memory recollection of positive stimuli ( η p 2 = 0.23). Episodic memory outcomes indicated that HRV biofeedback reinforced positive self-reference encoding processing. Cognitive changes were strongly dependent on the level of respiratory sinus arrhythmia evoked during self-regulation training. Conclusion The present study provides evidence that biofeedback moderates respiration-related cardiac vagal control, which in turn mediates improvements in several cognitive processes crucial for everyday functioning including episodic memory, that are maintained beyond the training period. The results highlight the interest in HRV biofeedback as an innovative research tool and medication-free therapeutic approach to affect autonomic and neurocognitive functioning. Finally, a neurocognitive model of biofeedback-supported autonomic self-regulation as a scaffolding for episodic memory is proposed.
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Affiliation(s)
- Lukas Bögge
- Laboratoire Mémoire, Cerveau et Cognition, Université Paris Cité, Paris, France
| | - Itsaso Colás-Blanco
- Laboratoire Mémoire, Cerveau et Cognition, Université Paris Cité, Paris, France
| | - Pascale Piolino
- Laboratoire Mémoire, Cerveau et Cognition, Université Paris Cité, Paris, France
- Institut Universitaire de France (IUF), Paris, France
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Liu H, Yu X, Wang G, Han Y, Wang W. Effects of 24-h acute total sleep deprivation on physiological coupling in healthy young adults. Front Neurosci 2022; 16:952329. [PMID: 36161147 PMCID: PMC9493191 DOI: 10.3389/fnins.2022.952329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Sleep deprivation is associated with dysregulation of the autonomic nervous system, adverse cardiovascular events, cognitive and complex motor performance impairment. Less is known about the effects of acute total sleep deprivation (ATSD) on physiological coupling. We aimed to determine the effects of 24-h ATSD on the physiological coupling between complex subsystems by evaluating the cardiorespiratory, cardiovascular and cortico-cardiac interactions. This study enrolled 38 young healthy participants aged 23.2 ± 2.4 years. Multiple synchronous physiological signals including electrocardiography, photoplethysmography, bio-electrical impedance, electroencephalography, and continuous hemodynamic data, were performed over a baseline night after regular sleep and after a night with 24-h ATSD in the supine position. The magnitude squared coherence, phase synchronization index, and heartbeat evoked potential amplitudes, were obtained from 10-min synchronous physiological recordings to estimate the coupling strength between two time series. Parameters of hemodynamic characteristics and heart rate variability were also calculated to quantify autonomic regulation. Results indicated that the magnitude squared coherence (0.38 ± 0.17 vs. 0.29 ± 0.12, p = 0.015) between respiration and heart rate variability along with the magnitude squared coherence (0.36 ± 0.18 vs. 0.27 ± 0.13, p = 0.012) between respiration and pulse transit time were significantly decreased after 24-h ATSD. There were no significant differences (all p > 0.05) in phase synchronization indices, heartbeat evoked potential amplitudes as well as other analyzed measurements between baseline and 24-h ATSD states. We conclude that exposure to 24-h ATSD appears to weaken the cardiorespiratory and respiratory-cardiovascular coupling strength of young healthy adults. These findings suggest that physiological coupling analysis may serve as a complementary approach for characterizing and understanding the complex effects of sleep deprivation.
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Affiliation(s)
- Hongyun Liu
- Medical Innovation Research Division, Research Center for Biomedical Engineering, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
- *Correspondence: Hongyun Liu,
| | - Xiaohua Yu
- Medical Innovation Research Division, Research Center for Biomedical Engineering, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
| | - Guojing Wang
- Medical Innovation Research Division, Research Center for Biomedical Engineering, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
| | - Yi Han
- Medical Innovation Research Division, Research Center for Biomedical Engineering, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
| | - Weidong Wang
- Medical Innovation Research Division, Research Center for Biomedical Engineering, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
- Weidong Wang,
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Stapleton P, Church D, Baumann O, Sabot D. EcoMeditation Modifies Brain Resting State Network Activity. INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:61-70. [PMID: 36204165 PMCID: PMC9507148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The tendency of the mind to wander, a characteristic of the brain's default mode network (DMN), correlates with increased unhappiness and self-referential processing and is a deterrent to establishing a consistent meditation practice. The objective of this study was to test the impact of a secular physiological method of meditation. We hypothesized that EcoMeditation would produce increases in neural communication in brain regions associated with compassion and prosociality and decreases in self-referencing networks, such as the DMN, and that these changes would be found in the experimental group, but not the control group. METHODS Participants (n=38) were randomized into two groups, and the final sample consisted of 25 participants. One group listened daily to a 22-minute EcoMeditation audio track, while the other used an active control. Functional magnetic resonance imaging (fMRI) was used to assess brain function before and after four weeks of practice. Mystical experiences, as well as psychological conditions, such as anxiety and depression, were measured. RESULTS Participants in the EcoMeditation group showed significantly increased connectivity between the bilateral hippocampus and the bilateral insula, compared to pre-intervention. In addition, significant decreases of connectivity between the bilateral hippocampus and the midprefrontal and left dorsolateral prefrontal cortices occurred. EcoMeditation participants also scored significantly higher for mystical experiences than the control group. The results for emotional states were mixed, with one assessment finding increased positive mood, but another finding increased negative affect. CONCLUSION After only four weeks, participants using EcoMeditation demonstrated brain states similar to meditation adepts with thousands of hours of traditional practice.
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Affiliation(s)
- Peta Stapleton
- Drs. Stapleton and Baumann and Ms. Sabot are with the School of Psychology, Bond University in Gold Coast, Queensland, Australia
| | - Dawson Church
- Dr. Church is with the National Institute for Integrative Healthcare in Fulton, California
| | - Oliver Baumann
- Drs. Stapleton and Baumann and Ms. Sabot are with the School of Psychology, Bond University in Gold Coast, Queensland, Australia
| | - Debbie Sabot
- Drs. Stapleton and Baumann and Ms. Sabot are with the School of Psychology, Bond University in Gold Coast, Queensland, Australia
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Altered states of consciousness: Chess in the zone. Explore (NY) 2022; 18:395-398. [PMID: 34167903 DOI: 10.1016/j.explore.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 01/17/2023]
Abstract
The Zone is a state of mind/body coordination that is much sought after by athletes because it is so conducive to achieving peak performance. The experience of this state can be so transcendent that some have come to view sport as a spiritual practice. An immensely popular recent movie about competitive chess, The Queen's Gambit, is not overtly about the Zone, addressing such popular themes as female empowerment and chess as a replacement competitive sport in the socially disconnected time of Covid. But its popularity may also stem from its evocation of the peak performance Zone in chess matches. The film's young female protagonist is able to play inspired chess by using a range of approaches to accessing this altered state of consciousness (ASC). This essay will discuss several aspects of the Zone, including psycho-spiritual tools to elicit it, pathology-based medical explanations for its occurrence, paranormal aspects of this ASC, and its possible role in helping humanity cope with the Covid crisis. (Spoiler alert: Important plot points from the Netflix movie The Queen's Gambit will be discussed in this essay.).
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Vallish BN, Dang D, Dang A. Nature and mechanism of immune boosting by Ayurvedic medicine: A systematic review of randomized controlled trials. World J Methodol 2022; 12:132-147. [PMID: 35721243 PMCID: PMC9157632 DOI: 10.5662/wjm.v12.i3.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/16/2022] [Accepted: 04/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many Ayurvedic preparations are claimed to have immune-boosting properties, as suggested in various published randomized clinical trials (RCTs). AIM To compile evidence on the nature and mechanism of immune system enhancement by Ayurvedic preparations in healthy and sick individuals. METHODS After prospectively registering study protocol with PROSPERO, we searched PubMed, DOAJ, Google Scholar, three dedicated Ayurveda research portals, two specialty Ayurveda journals, and reference lists for relevant records published until February 6, 2021 using appropriate search strategies. Baseline features and data pertaining to the nature and mechanism of immune system function were extracted from all eligible records. Methodological quality was assessed using the Cochrane RoB-2 tool. RESULTS Of 12554 articles screened, 19 studies reporting 20 RCTs (17 parallel group design, three crossover design) with 1661 unique patients were included; 11/19 studies had Indian first authors. Healthy population was included in nine studies, of which one study included pregnant women and two included pediatric population; remaining studies included patients with different health conditions, including one study with coronavirus disease 2019 patients. A total of 21 Ayurvedic interventions were studied, out of which five were composite mixtures. The predominant route of administration was oral; dose and frequency of administration of the intervention varied across the studies. The results reported with five RCTs exploring five Ayurvedic interventions were incomplete, ambiguous, or confusing. Of the remaining 16 interventions, indirect evidence of immune enhancement was reported with four interventions, while lack of the same was reported with two interventions. Enhancement of T helper cells and natural killer cells was reported with three and four interventions, respectively, while the pooled results did not clearly point toward enhancement of other components of the immune system, including cytotoxic T cells, B lymphocytes, immunoglobulins, cytokines, complement components, leucocyte counts, and other components. Nine of the 20 RCTs had a high risk of bias, and the remaining 11 RCTs had some concerns according to RoB-2. CONCLUSION Various Ayurvedic preparations appear to enhance the immune system, particularly via enhancements in natural killer cells and T helper cells.
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Affiliation(s)
- B N Vallish
- Medical Writing and Biostatistics, MarksMan Healthcare Communications, Hyderabad 500091, Telangana, India
| | - Dimple Dang
- Co-founder, MarksMan Healthcare Communications, Hyderabad 500032, Telangana, India
| | - Amit Dang
- Founder and CEO, MarksMan Helathcare Communications Pvt. Ltd, Hyderabad 500091, Telangana, India
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Evaluation of the Heart Rhythm Coherence Ratio During Sleep: A Pilot Study With Polysomnography. Appl Psychophysiol Biofeedback 2022; 47:193-198. [PMID: 35503195 DOI: 10.1007/s10484-022-09542-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 01/10/2023]
Abstract
The psychophysiological coherence model proposes that a heart rhythm pattern, known as heart rhythm coherence (HRC), is associated with dominant parasympathetic activity and the entrainment of respiratory function, blood pressure, and heart rhythms. Although the HRC pattern has primarily been assessed during wakefulness, changes in cardiac and autonomic activity that occur during sleep stages can also be associated with the HRC pattern. The objective of this study was to examine whether any differences in the HRC pattern could be detected among various sleep stages. Eighteen healthy young individuals participated in this study. Two consecutive polysomnographic (PSG) recordings were obtained from each participant, several segments of cardiac activity were obtained from the second PSG. The HRC pattern was quantitatively evaluated by calculating the HRC ratio (HRCR). The highest peaks in the coherence band (Coher-Peak), 0.1-Hz index, respiratory sinus arrhythmia (RSA), and heart rate (HR) were evaluated. A Friedman test showed significant differences among sleep stages in the Coher-Peak, 0.1-Hz index, RSA, and HR; the Coher-Peak and RSA values were lower in rapid eye movement (REM) sleep, while the 0.1-Hz and HR values were higher in REM sleep. Post hoc analyses identified significant differences between the N2 and REM sleep stages. Among the various sleep stages, HR and RSA measurements behaved independently of the HRC pattern, and the HRC pattern did not appear to be associated with the 0.1 Hz frequency. Further studies are required to identify the characteristics of the HRC pattern during sleep.
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Muzychenko IN, Apollonova IA, Evans D. Is Silence Golden? Chronic Stress and Psychophysiological Indicators’ Changes over Time in International Students: A Pilot Study. RUDN JOURNAL OF PSYCHOLOGY AND PEDAGOGICS 2022. [DOI: 10.22363/2313-1683-2022-19-1-128-145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Most people assume studying or working abroad would be stressful - but would one ever think that it could be detrimental to the health? Stress literature relates cross-cultural transactions to the chances of gaining higher levels of chronic stress. This paper reports the results of two studies on international students in Moscow in 2018. Specifically, Study 1 assessed how cross-cultural transactions perceived to affect health state during the first 6 months of their relocation. Study 2 aimed to investigate if the psychological stress linked to relocation to a different country can possibly lead to psychobiological effects of chronic stress. In Study 1, qualitative methods were applied to conduct 21 interviews with international students. In Study 2, a longitudinal pilot study was conducted for 10 foreign students during the first 2-5 (M = 3.6) months of their relocation. Stress related to cross-cultural transactions was expected to affect subjective well-being and health variables. The health state was a relatively silent topic in the interview participants of Study 1. The results of Study 2 showed that the participants had changes in the resting heart rate (RHR) baseline. Perceived chronic stress related to cross-cultural transactions may affect psychophysiological state; however, the affect varies depending on a person. Further research is required for the data consistency and for identifying non-invasive objective risk markers and individual stress pathways, with the goal of identifying at-risk students and providing treatment options before any serious harm is done to their health.
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Guerdoux E, Coutant L, Del Rio M, Gourgou S, Quenet F, Ninot G. Adhésion et implémentation d’un programme de cohérence cardiaque visant à réduire l’anxiété de patients opérés pour une carcinose péritonéale : étude pilote randomisée. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : Évaluer l’implémentation d’une pratique quotidienne de cohérence cardiaque chez des patients opérés pour une carcinose péritonéale.
Matériel et méthode : Étude pilote monocentrique, ouverte, contrôlée, randomisée non comparative, incluant 20 patients en soins courants vs 40 patients formés à la cohérence cardiaque avec biofeedback et guide respiratoire pour une pratique au domicile enregistrée.
Résultats attendus : Adhésion satisfaisante au programme, pouvant caractériser les éléments favorisant son implémentation avant et après chirurgie et évaluation de son impact sur l’anxiété.
Perspectives : Efficacité à déterminer pour transférer ce soin de support.
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HeartMath as an Integrative, Personal, Social, and Global Healthcare System. Healthcare (Basel) 2022; 10:healthcare10020376. [PMID: 35206990 PMCID: PMC8871721 DOI: 10.3390/healthcare10020376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
COVID-19 is a recent major event, adding to planet Earth’s contexts of chaos, crime, injustice, illness, and violence. The HeartMath system has produced research evidence for scientific interventions that alter contexts characterized by chaos and stress, promoting health, coherence, and interconnectedness. This study provides an updated overview of HeartMath as an interdisciplinary, scientific, coherent, integral heart-based healthcare system, operated locally through various initiatives and globally through the Global Coherence Initiative. The HeartMath approach integrates ancient and contemporary, indigenous and mainstream, popular and folk, Eastern, Western, and African forms of healing. The HeartMath interdisciplinary, personal, social, and global vision and mission have considerable theoretical and practical potential for promoting planetary health, education, and development.
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“The tonic’s not always in a bottle”: a qualitative study investigating a heart rate variability biofeedback coherence intervention for individuals with gastrointestinal disorders. JOURNAL OF COMPLEXITY IN HEALTH SCIENCES 2022. [DOI: 10.21595/chs.2021.22069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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44
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Psychological Stress Level Detection Based on Heartbeat Mode. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effective detection and quantification of mental health has always been an important research topic. Heart rate variability (HRV) analysis is a useful tool for detecting psychological stress levels. However, there is no consensus on the optimal HRV metrics in psychological assessments. This study proposes an HRV analysis method that is based on heartbeat modes to detect drivers’ stress. We used statistical tools for linguistics to detect and quantify the structure of the heart rate time series and summarized different heartbeat modes in the time series. Based on the k-nearest neighbors (k-NN) classification algorithm, the probability of each heartbeat mode was used as a feature to detect and recognize stress caused by the driving environment. The results indicated that the stress from the driving environment changed the heartbeat mode. Stress-related heartbeat modes were determined, facilitating detection of the stress state with an accuracy of 93.7%. We also concluded that the heartbeat mode was correlated to the galvanic skin response (GSR) signal, reflecting real-time abnormal mood fluctuations. The proposed method revealed HRV characteristics that made quantifying and detecting different mental conditions possible. Thus, it would be feasible to achieve personalized analyses to further study the interaction between physiology and psychology.
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Kemeny B, Burk S, Hutchins D, Gramlich C. Therapeutic Riding or Mindfulness: Comparative Effectiveness of Two Recreational Therapy Interventions for Adolescents with Autism. J Autism Dev Disord 2022; 52:2438-2462. [PMID: 34131850 PMCID: PMC8204925 DOI: 10.1007/s10803-021-05136-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 02/05/2023]
Abstract
Therapeutic riding (THR) and HeartMath (HM) mindfulness-based interventions have promise for reducing stress in adolescents with autism spectrum disorder. In three 10-week periods, this study compared THR, HM, and control on salivary cortisol, self-reported stress, parent-reported social responsiveness, and heart-rate variability. This crossover design included 27 participants (12-21 years) randomly assigned to order of intervention. Findings suggest that HM and THR manualized protocols are equally beneficial in decreasing cortisol levels immediately following a session, but HM sessions had more impact on heart-rate variability. There was no significant effect on follow-up cortisol levels within a week after either intervention, but THR had more impact on decreasing some self-reported stressors.
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Affiliation(s)
- Betsy Kemeny
- Department of Recreational Therapy, Slippery Rock University, 106 Patterson Hall, Slippery Rock, PA 16057 USA
| | - Steffanie Burk
- Department of Equine Science, Otterbein University, Westerville, USA
| | - Deborah Hutchins
- Department of Recreational Therapy, Slippery Rock University, 106 Patterson Hall, Slippery Rock, PA 16057 USA
| | - Courtney Gramlich
- Storm Harbor Equestrian Center, Slippery Rock University, Slippery Rock, USA
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Emotional intelligence developing training program’s impact on teachers’ psycho-emotional state. JOURNAL OF COMPLEXITY IN HEALTH SCIENCES 2021. [DOI: 10.21595/chs.2021.22327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Martin CG, He BJ, Chang C. State-related neural influences on fMRI connectivity estimation. Neuroimage 2021; 244:118590. [PMID: 34560268 PMCID: PMC8815005 DOI: 10.1016/j.neuroimage.2021.118590] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022] Open
Abstract
The spatiotemporal structure of functional magnetic resonance imaging (fMRI) signals has provided a valuable window into the network underpinnings of human brain function and dysfunction. Although some cross-regional temporal correlation patterns (functional connectivity; FC) exhibit a high degree of stability across individuals and species, there is growing acknowledgment that measures of FC can exhibit marked changes over a range of temporal scales. Further, FC can covary with experimental task demands and ongoing neural processes linked to arousal, consciousness and perception, cognitive and affective state, and brain-body interactions. The increased recognition that such interrelated neural processes modulate FC measurements has raised both challenges and new opportunities in using FC to investigate brain function. Here, we review recent advances in the quantification of neural effects that shape fMRI FC and discuss the broad implications of these findings in the design and analysis of fMRI studies. We also discuss how a more complete understanding of the neural factors that shape FC measurements can resolve apparent inconsistencies in the literature and lead to more interpretable conclusions from fMRI studies.
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Affiliation(s)
- Caroline G Martin
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Biyu J He
- Neuroscience Institute, New York University School of Medicine, New York, NY 10016, USA; Departments of Neurology, Neuroscience & Physiology, and Radiology, New York University School of Medicine, New York, NY 10016, USA
| | - Catie Chang
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
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Poli A, Gemignani A, Soldani F, Miccoli M. A Systematic Review of a Polyvagal Perspective on Embodied Contemplative Practices as Promoters of Cardiorespiratory Coupling and Traumatic Stress Recovery for PTSD and OCD: Research Methodologies and State of the Art. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11778. [PMID: 34831534 PMCID: PMC8619958 DOI: 10.3390/ijerph182211778] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022]
Abstract
Baseline respiratory sinus arrhythmia (RSA) has been proposed as a transdiagnostic biomarker of stress vulnerability across psychopathologies, and a reliable association between PTSD, OCD and lower resting RSA was found. Contemplative practices have been linked to the activation of the vagus as well as to an increased RSA that, according to the polyvagal theory, reflects the activation of the ventral vagal complex (VVC) and may promote PTSD and OCD recovery. PubMed and Scopus databases were selected to conduct a search following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines, and A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to appraise the methodological quality for this systematic review. Six articles met the inclusion criteria (one cross-sectional study, one study with pre-post measurements, two cohort studies and two RCT studies). Mindfulness-related interventions promoted parasympathetic activity, an increased vagal tone and improvements in PTSD and OCD symptoms. According to the polyvagal theory, mindfulness-related and compassion-related meditations would be conceptualized as neural exercises expanding the capacity of the ventral vagal complex to regulate the present state and to promote resilience. Clinical and methodological issues are discussed.
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Affiliation(s)
- Andrea Poli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and of Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
| | | | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
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Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults. Sci Rep 2021; 11:19267. [PMID: 34588511 PMCID: PMC8481564 DOI: 10.1038/s41598-021-98736-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/13/2021] [Indexed: 12/04/2022] Open
Abstract
Anxiety is recognized as a major health issue and is quite prevalent among older adults. An efficient way to manage anxiety is abdominal breathing. Breathing exercises seem to reduce anxiety and to increase parasympathetic activity assessed by HRV indexes. Yet, the effect of abdominal breathing on physiological stress (HRV) and anxiety in older adults remains poorly understood. Therefore, the aim of this study is to test the effects of deep and slow breathing (DSB, low inhale/exhale ratio) on physiological stress and anxiety in older adults (n = 22) in comparison with younger ones (n = 25). DSB increased significantly HFpower and reduced state anxiety in both younger and older adults. Interestingly, the increased in HF power was significantly higher among older adults than younger ones. As expected, the ratio inhale/exhale being not equal, RMSSD did not increase following DSB. Thus, we provide evidence suggesting that DSB is more beneficial to older adults than younger ones to restore vagal outflow. Despite future work being required, those results provide relevant clinical application leads to manage state anxiety among older adults and to promote successfull aging.
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Physiological and Behavioral Benefits for People and Horses during Guided Interactions at an Assisted Living Residence. Behav Sci (Basel) 2021; 11:bs11100129. [PMID: 34677222 PMCID: PMC8533143 DOI: 10.3390/bs11100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Assisted living is a fast-growing living option for seniors who require residence-based activities for maintaining mental and physical health. Guided equine interactions may benefit seniors, so an on-site equine program was started at Hacienda at the River senior living community. For research purposes, twenty-four residents and associates, aged fifty-five or over, consented to physiological measurements before, during and after four guided sessions of stroking one of three horses for 10 min over 4–6 weeks. Heart rate variability (HRV) was measured simultaneously in humans and horses during interactions. We hypothesized that human heart rate (HR) and HRV would increase during stroking and HRV power would shift toward the very low frequency (VLF) range common in horses, indicative of healthy function. During stroking, human HR increased (p < 0.05) but HRV (SDRR) and %VLF of HRV power did not change. Diastolic blood pressure (DBP), an exploratory measure, significantly increased after stroking, consistent with arousal. Two horses showed no significant changes in HR or HRV, but one relaxed. Sixteen horse–human pairs demonstrated synchronized HRV peak frequencies during sessions, suggestive of social connection. Participants used more positive than negative words describing their experience during exit interviews (p < 0.05). These data show that horses animate seniors without causing emotional stress and provide opportunities for social bonding.
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