Working from home during lockdown: the association between rest breaks and well-being.

One of the challenges with working from home (WFH) is the question of its effect on health and well-being. The impact of home working on health has so far not been studied extensively. We address this gap by investigating the association between internal recovery, operationalised as rest break frequency (low, medium, and high) during the working day, on self-reported musculoskeletal pain, and post-work recovery symptoms in WFH knowledge workers (n = 382). The analysis showed that failing to take frequent breaks was associated with a dose-response increased risk of reporting headaches. For post-work recovery symptoms, failing to take rest breaks throughout the day was associated with an increased risk of reporting psychological fatigue, physical fatigue, and sleep problems, and a decreased risk of psychologically detaching from work and experiencing adequate rest. Our findings emphasise the importance of remote workers taking recovery breaks from work demands in the maintenance of health and well-being.Practitioner Summary: For the foreseeable future, many knowledge workers will be obliged to work from home for at least, some days of the week. It is therefore important for workers to learn to regulate their behaviour, and workers need to be educated about the value of taking regular rest breaks throughout the working day.Abbreviations: ICT: Information and communications technology; MSDs: musculoskeletal disorders; MSPs: Musculoskeletal pain symptoms; OR: Odds ratio; WFH: Working from home; WRRQ: Work-Related Rumination Questionnaire Questionnaire.

Somatic Symptom Perception From a Predictive Processing Perspective: An Empirical Test Using the Thermal Grill Illusion.

OBJECTIVE: In a predictive processing perspective, symptom perceptions result from an integration of preexisting information in memory with sensory input. Physical symptoms can therefore reflect the relative predominance of either sensory input or preexisting information. In this study, we used the thermal grill illusion (TGI), which applies interlaced warm and cool temperatures to the skin to create a paradoxical heat-pain experience. Assuming that the TGI compared with single-temperature stimulation relies more importantly on an active integration process of the brain to create this paradoxical sensation, we tested the hypothesis whether a manipulation of the expectations during TGI would have more impact than during single-temperature stimulation. METHODS: Sixty-four participants received different temperature combinations (16/16°C, 40/40°C, 16/40°C) with neutral, positive ("placebo"), and negative ("nocebo") instructions. Subjective stimulus intensity was rated, and neuroticism and absorption (openness to absorbing and self-altering experiences) served as potential moderating factors. RESULTS: The TGI condition was rated highest. Overall, negative instructions increased (p < .001, d = 0.58), whereas positive instructions did not significantly change the TGI intensity perception (versus neutral; p = .144, d = 0.19). In the TGI condition, increased modulation of pain was observed with higher neuroticism (ß = 0.33, p = .005) and absorption (ß = 0.30, p = .010). CONCLUSIONS: Whereas negative instructions induced a nocebo effect, no placebo effect emerged after positive instructions. The findings are in line with the predictive processing model of symptom perception for participants with higher levels of neuroticism and absorption.

Learning by heart-the relationship between resting vagal tone and metacognitive judgments: a pilot study.

Metacognitive awareness and resting vagally mediated heart rate variability (HRV) as a physiological trait marker of cognitive inhibitory control capacities are both associated with better well-being and seem to share a common neural basis. Executive functioning which is considered a prerequisite for delivering prospective metacognitive judgments has been found to be correlated with HRV. This pilot study addresses the question, whether metacognitive awareness and resting vagally mediated HRV are positively associated. A sample of 20 healthy participants was analyzed that completed a typical Judgment of Learning task after an electrocardiogram had been recorded. The root-mean-squares of successive differences were used to calculate vagally mediated HRV. Metacognitive awareness was measured by comparing the judgments of learning with the actual memory performance, yielding a deviation score. HRV was found to be positively correlated with metacognitive awareness. Results suggest that metacognitive abilities might relate to physiological trait markers of cognitive inhibitory control capacities. Further experimental studies are needed to investigate causal relations.

Patient informed consent, ethical and legal considerations in the context of digital vulnerability with smart, cardiac implantable electronic devices.

Advancements in digitalisation with cardiac implantable electronic devices (CIEDs) allow patients opportunities for improved autonomy, quality of life, and a potential increase in life expectancy. However, with the digital and functional practicalities of CIEDs, there exists also cyber safety issues with transferring wireless information. If a digital network were to be hacked, a CIED patient could experience both the loss of sensitive data and the loss of functional control of the CIED due to an unwelcome party. Moreover, if a CIED patient were to become victim of a cyber attack, which resulted in a serious or lethal event, and if this information were to become public, the trust in healthcare would be impacted and legal consequences could result. A cyber attack therefore poses not only a direct threat to the patient's health but also the confidentiality, integrity, and availability of the CIED, and these cyber threats could be considered "patient-targeted threats." Informed consent is a key component of ethical care, legally concordant practice, and promoting patient-as-partner therapeutic relationships [1]. To date, there are no standardised guidelines for listing cybersecurity risks within the informed consent or for discussing them during the consent process. Providers are responsible for adhering to the ethical principles of autonomy, beneficence, non-maleficence, and justice, both in medical practice generally and the informed consent process specifically. At present, the decision to include cybersecurity risks is mainly left to the provider's discretion, who may also have limited cyber risk information. Without effective and in-depth communication about all possible cybersecurity risks during the consent process, CIED patients can be left unaware of the privacy and physical risks they possess by carrying such a device. Therefore, cyber risk factors should be covered within the patients' informed consent and reviewed on an ongoing basis as new risk information becomes available. By including cyber risk information in the informed consent process, patients are given the autonomy to make the best-informed decision.

The Role of Trait and State Mindfulness in Cognitive Performance of Male Adolescents.

Purpose: The number of mindfulness intervention projects is continually increasing. Within the educational environment, mindfulness has purported links to well-being, positive behaviour, educational and cognitive performance. Trait mindfulness is related to rational thinking and better performance in cognitive tests, suggesting that innate mindfulness ability contributes to self-regulation ability and thus the efficacy of mindfulness interventions. The current study investigates whether mindfulness is a moderating factor. It examines correlations between cognitive performance and trait mindfulness. The study investigates the influence of trait mindfulness on the ability of students to enter state mindfulness in an attempt to understand the role both types of mindfulness may have on cognitive performance. Participants and Method: Two-hundred and five male students aged fifteen and sixteen completed the adolescent version of the Mindfulness Awareness Scale, the Cognitive Reflection Test, and the Toronto Mindfulness Scale. Results: Hierarchical regression analysis found that state mindfulness was a predictor of cognitive reflection ability. ANOVA also found that having either trait or state mindfulness predicted higher cognitive reflection scores, but only state mindfulness had a significant effect on cognitive reflection. Trait mindfulness was not a moderating factor. Conclusion: Both state and trait aspects of mindfulness ability influence cognitive performance. Those with higher trait mindfulness ability are better able to enter state mindfulness and thus had better cognitive reflection scores. However, where it is possible to induce state mindfulness into those with low trait mindfulness, CRT scores were also higher although not significantly so.

The Role of Emotion Regulation for General Self-Efficacy in Adolescents Assessed Through Both Neurophysiological and Self-Reported Measures.

Background: Self-efficacy, the belief in one's ability and capacity to organize and execute actions required to achieve desired results, is associated with adolescent academic achievement and reduced risk for psychopathology. Adolescent emotion regulation represents an important component in the relationship between self-efficacy and developmental outcomes, but the underlying neurophysiological mechanisms are poorly understood. It is unclear how emotion regulation strategies, which change with experience, and emotion regulation capacity, which is largely determined by genetics, contribute to the development of self-efficacy. Aim: The present study aims to explore the relationship between emotion regulation and self-efficacy in adolescents. We hypothesize that neurophysiological emotion regulation capacity moderates the relationship between emotion regulation strategies and self-efficacy. Methods: The present study applied a cross-sectional design. A sample of high-school students (N = 45, nfemale = 31, age = 17-18) provided answers on the General Self-Efficacy Questionnaire and the Emotion Regulation Questionnaire. Vagal tone was used as an indicator for emotion regulation capacity. Results: In the initial correlational analysis, reappraisal, but not expressive suppression nor vagal tone was associated with self-efficacy. Vagal tone was not associated with any self-report measures of emotion regulation or self-efficacy. Contrary to our hypothesis, vagal tone did not moderate the relationship between emotion regulation and self-efficacy. Conclusion: This is the first study assessing the relationship between neurophysiological indicators of emotion regulation and self-efficacy. Our results do not indicate that vagal tone moderates the relationship between emotion regulation strategies and general self-efficacy. Future studies should also assess the possible influence of metacognition and interoception on relationships.

A 3D mixed reality visualization of network topology and activity results in better dyadic cyber team communication and cyber situational awareness.

Background: Cyber defense decision-making during cyber threat situations is based on human-to-human communication aiming to establish a shared cyber situational awareness. Previous studies suggested that communication inefficiencies were among the biggest problems facing security operation center teams. There is a need for tools that allow for more efficient communication of cyber threat information between individuals both in education and during cyber threat situations. Methods: In the present study, we compared how the visual representation of network topology and traffic in 3D mixed reality vs. 2D affected team performance in a sample of cyber cadets (N = 22) cooperating in dyads. Performance outcomes included network topology recognition, cyber situational awareness, confidence in judgements, experienced communication demands, observed verbal communication, and forced choice decision-making. The study utilized network data from the NATO CCDCOE 2022 Locked Shields cyber defense exercise. Results: We found that participants using the 3D mixed reality visualization had better cyber situational awareness than participants in the 2D group. The 3D mixed reality group was generally more confident in their judgments except when performing worse than the 2D group on the topology recognition task (which favored the 2D condition). Participants in the 3D mixed reality group experienced less communication demands, and performed more verbal communication aimed at establishing a shared mental model and less communications discussing task resolution. Better communication was associated with better cyber situational awareness. There were no differences in decision-making between the groups. This could be due to cohort effects such as formal training or the modest sample size. Conclusion: This is the first study comparing the effect of 3D mixed reality and 2D visualizations of network topology on dyadic cyber team communication and cyber situational awareness. Using 3D mixed reality visualizations resulted in better cyber situational awareness and team communication. The experiment should be repeated in a larger and more diverse sample to determine its potential effect on decision-making.

Prefrontally modulated vagal neuroimmunomodulation is associated with telomere length.

Background: Accumulated senescent cells are proposed to be one of the main drivers of age-related pathology such as dementia and cancer through disruption of tissue structure and function. We recently proposed the Neuro-Immuno-Senescence Integrative Model (NISIM), which relates prefrontally modulated vagal tone and subsequent balance between vagal and sympathetic input to the spleen to inflammatory responses leading to generation of reactive oxygen species and oxidative telomere damage. Aim: In this study, we assess inflammation as a mediator in the relationship between prefrontally modulated vagal tone and leukocyte telomere length (LTL). We also assess the relationship between a recently proposed index of vagal neuroimmunomodulation (vagal tone/inflammation ratio; NIM index) and telomere length. Methods: This study uses participant data from a large nationally representative longitudinal study since 1974 with a total of 45,000 Norwegian residents so far. A sub-sample of 131 participants from which ultrashort recordings (30 s) of vagal tone, c reactive protein, and LTL could be obtained were included in the study. Relationships were analyzed with Pearson's correlations and hierarchical multiple linear regression using either vagal tone and CRP or the NIM index to predict telomere length. Results: Vagal tone was a significant positive predictor of telomere length but this was not mediated by c reactive protein, even after controlling for confounders. The NIM index was a significant positive predictor of telomere length, also when controlling for confounders. In a follow-up analysis simultaneously comparing telomere length between groups with high and low values of vagal tone, and between groups with high and low NIM index values, telomere length was only significantly different between NIM index groups. Conclusion: This is the first study suggesting that prefrontally modulated vagal neuroimmunomodulation is associated with telomere length thus supporting the NISIM. Results indicate that the NIM index is a more sensitive indicator of vagal neuroimmunomodulation than vagal tone and CRP in isolation.

Guided Internet-Delivered Treatment for Depression: Scoping Review.

BACKGROUND: Studies on guided internet-delivered treatment have demonstrated promising results for patients with depressive disorder. OBJECTIVE: The aim of this study was to provide an overview of this research area and identify potential gaps in the research. METHODS: In this scoping review, web-based databases were used to identify research papers published between 2010 and 2022 where guided internet-delivered treatment was administered to participants with depressive disorders, a standardized rating scale of depressive symptoms was used as the primary outcome measure, and the treatment was compared with a control condition. RESULTS: A total of 111 studies were included, and an overview of the studies was provided. Several gaps in the research were identified regarding the design of the studies, treatments delivered, participant representation, and treatment completion. CONCLUSIONS: This review provides a comprehensive overview of the research area, and several research gaps were identified. The use of other designs and active control conditions is recommended. Future studies should provide access to treatment manuals, and more replications should be conducted. Researchers should aim to include underrepresented populations and provide reports of comorbidities. Definitions of adequate dosage, reports of completion rates, and reasons for treatment dropout are recommended for future studies.

The Effect of Heart Rate Variability Biofeedback Training on Vagal Tone in Athletically Talented Secondary School Students.

This study examines whether twelve sessions of heart rate variability biofeedback training would improve vagally mediated heart rate variability. If so, it would go some way in explaining why breathing-based interventions reduce clinical symptoms and improve non-clinical performance outcomes. METHODS: Thirty participants (N = 30, Nfemale = 13) aged 14-13-year-old, all talented athletes, from a sport specialist school in SE London UK, were randomly divided into three groups, a control group, a psychology skills training combined with heart rate variability biofeedback training group, and a heart rate variability biofeedback only group. For the combined group, a variety of typical psychological skill training techniques were also used. RESULTS: Paired participant t-test and the Wilcoxon Signed Rank test found non-significant differences between pre- and post-intervention measurements of heart rate variability. Non-significant results remained even after pooling the biofeedback training groups (n = 19). CONCLUSIONS: Our results do not indicate that beneficial effects associated with focused breathing training can be attributed to improved vagal tone. Further investigation into the underlying mechanisms of the benefits of focused breathing techniques is necessary to maximize clinical and non-clinical outcomes.

Neurophysiological and emotional influences on team communication and metacognitive cyber situational awareness during a cyber engineering exercise.

Background: Cyber operations unfold at superhuman speeds where cyber defense decisions are based on human-to-human communication aiming to achieve a shared cyber situational awareness. The recently proposed Orient, Locate, Bridge (OLB) model suggests a three-phase metacognitive approach for successful communication of cyber situational awareness for good cyber defense decision-making. Successful OLB execution implies applying cognitive control to coordinate self-referential and externally directed cognitive processes. In the brain, this is dependent on the frontoparietal control network and its connectivity to the default mode network. Emotional reactions may increase default mode network activity and reduce attention allocation to analytical processes resulting in sub-optimal decision-making. Vagal tone is an indicator of activity in the dorsolateral prefrontal node of the frontoparietal control network and is associated with functional connectivity between the frontoparietal control network and the default mode network. Aim: The aim of the present study was to assess whether indicators of neural activity relevant to the processes outlined by the OLB model were related to outcomes hypothesized by the model. Methods: Cyber cadets (N = 36) enrolled in a 3-day cyber engineering exercise organized by the Norwegian Defense Cyber Academy participated in the study. Differences in prospective metacognitive judgments of cyber situational awareness, communication demands, and mood were compared between cyber cadets with high and low vagal tone. Vagal tone was measured at rest prior to the exercise. Affective states, communication demands, cyber situational awareness, and metacognitive accuracy were measured on each day of the exercise. Results: We found that cyber cadets with higher vagal tone had better metacognitive judgments of cyber situational awareness, imposed fewer communication demands on their teams, and had more neutral moods compared to cyber cadets with lower vagal tone. Conclusion: These findings provide neuroergonomic support for the OLB model and suggest that it may be useful in education and training. Future studies should assess the effect of OLB-ing as an intervention on communication and performance.

Virtual and Augmented Reality in Social Skills Interventions for Individuals with Autism Spectrum Disorder: A Scoping Review.

In the last decade, there has been an increase in publications on technology-based interventions for autism spectrum disorder (ASD). Virtual reality based assessments and intervention tools are promising and have shown to be acceptable amongst individuals with ASD. This scoping review reports on 49 studies utilizing virtual reality and augmented reality technology in social skills interventions for individuals with ASD. The included studies mostly targeted children and adolescents, but few targeted very young children or adults. Our findings show that the mode number of participants with ASD is low, and that female participants are underrepresented. Our review suggests that there is need for studies that apply virtual and augmented realty with more rigorous designs involving established and evidenced-based intervention strategies.

The cortisol awakening response at admission to hospital predicts depression severity after discharge in major depressive disorder patients-A replication study.

The cortisol awakening response (CAR) is a non-invasive biomarker for hypothalamic-pituitary-adrenal axis (HPA) dysregulation, reflecting accumulated stress over time. In a previous study we reported that a blunted CAR before an inpatient treatment predicted self-reported depressive symptoms six weeks and six months after discharge [Eikeseth, F. F., Denninghaus, S., Cropley, M., Witthöft, M., Pawelzik, M., & Sütterlin, S. (2019). The cortisol awakening response at admission to hospital predicts depression severity after discharge in major depressive disorder (MDD) patients. Journal of Psychiatric Research, 111, 44-50)]. This replication study adopted an improved overall methodology with more stringent assessment protocols and monitoring. The longitudinal design included 122 inpatients from a psychosomatic hospital with a diagnosis of MDD displaying symptoms of moderate to severe major depression (n = 80 females). The CAR was measured at intake. Depression severity was assessed as Beck Depression Inventory II scores at intake, discharge, 6 weeks and 6 months following discharge. Results from the original study were replicated in terms of effect size but did not reach statistical significance (correlation between BDI-II 6 months after discharge and AUCg: r = -0.213; p = 0.054). The replication study yielded nearly identical correlation coefficients as in the original study (BDI-II 6 months and CAR, r = -0.223, p < 0.05). The replication of previously reported effect sizes with a concurrent lack of statistical significance in the more restrictive, larger and better controlled replication study may well inform research on psycho-endocrinological predictors for treatment success, but suggests a rather limited practical relevance for cortisol awakening response measures in this clinical context.

Emotions and emotion up-regulation during the COVID-19 pandemic in Germany.

In stressful situations such as the COVID-19-pandemic, unpleasant emotions are expected to increase while pleasant emotions will likely decrease. Little is known about the role cognitive appraisals, information management, and upregulating pleasant emotions can play to support emotion regulation in a pandemic. In an online survey (N = 1682), we investigated predictors of changes in pleasant and unpleasant emotions in a German sample (aged 18-88 years) shortly after the first restrictions were imposed. Crisis self-efficacy and felt restriction were predictors of changes in unpleasant emotions and joy alike. The application of emotion up-regulation strategies was weakly associated with changes in joy. Among the different upregulation strategies, only "savouring the moment" predicted changes in joy. Our study informs future research perspectives assessing the role of upregulating pleasant emotions under challenging circumstances.

Negation as a means for emotion regulation? Startle reflex modulation during processing of negated emotional words.

This study investigated startle reflex modulation in 33 healthy student participants during the processing of negated emotional items. To build upon previous research, our particular interest was to find out whether processing of negated emotional items modulates emotional responding in line with the logical meaning of the negated expression, or instead leads to paradox emotional effects that point in the direction opposite the one logically implied by the negation. Startle reflex modulation was assessed during silent reading of pleasant and unpleasant nouns. The nouns were either paired with the possessive pronoun my or with the negation word no. The startle eyeblink amplitude was enhanced during processing of the unpleasant pronoun-noun phrases and attenuated during processing of the pleasant phrases. Negation attenuated the startle eyeblink for negated unpleasant nouns and enhanced it for negated pleasant nouns. In line with this finding, negation decreased arousal ratings for unpleasant nouns and reversed the valence ratings for pleasant nouns. Our results are the first to show an effect of negation on both peripheral physiological and subjective indices of affective responding. Our results suggest that negation may be an effective strategy for spontaneous down-regulation of emotional responses to unpleasant, but not to pleasant, stimuli.

Prepubertal gonadotropin-releasing hormone analog leads to exaggerated behavioral and emotional sex differences in sheep.

In mammals, sex specialization is reflected by differences in brain anatomy and function. Measurable differences are documented in reproductive behavior, cognition, and emotion. We hypothesized that gonadotropin-releasing hormone (GnRH) plays a crucial role in controlling the extent of the brain's sex specificity and that changes in GnRH action during critical periods of brain development, such as puberty, will result in altered sex-specific behavioral and physiological patterns. We blocked puberty in half of the 48 same-sex Scottish mule Texel cross sheep twins with GnRH analog (GnRHa) goserelin acetate every 3 weeks, beginning just before puberty. To determine the effects of GnRHa treatment on sex-specific behavior and emotion regulation in different social contexts, we employed the food acquisition task (FAT) and measurement of heart rate variability (HRV). ANOVA revealed significant sex and sex×treatment interaction effects, suggesting that treated males were more likely to leave their companions to acquire food than untreated, while the opposite effect was observed in females. Concordant results were seen in HRV; treated males displayed higher HRV than untreated, while the reverse pattern was found in females, as shown by significant sex and sex×treatment interaction effects. We conclude that long-term prepubertal GnRHa treatment significantly affected sex-specific brain development, which impacted emotion and behavior regulation in sheep. These results suggest that GnRH is a modulator of cognitive function in the developing brain and that the sexes are differentially affected by GnRH modulation.

ARTiiFACT: a tool for heart rate artifact processing and heart rate variability analysis.

The importance of appropriate handling of artifacts in interbeat interval (IBI) data must not be underestimated. Even a single artifact may cause unreliable heart rate variability (HRV) results. Thus, a robust artifact detection algorithm and the option for manual intervention by the researcher form key components for confident HRV analysis. Here, we present ARTiiFACT, a software tool for processing electrocardiogram and IBI data. Both automated and manual artifact detection and correction are available in a graphical user interface. In addition, ARTiiFACT includes time- and frequency-based HRV analyses and descriptive statistics, thus offering the basic tools for HRV analysis. Notably, all program steps can be executed separately and allow for data export, thus offering high flexibility and interoperability with a whole range of applications.

Impact of Initial Emotional States and Self-Efficacy Changes on Nursing Students' Practical Skills Performance in Simulation-Based Education.

Training through simulation has shown to increase relevant and specific skills sets across a wide range of areas in nursing and related professions. Increasing skills has a reciprocal relation to the development of self-efficacy. A study was conducted to assess changes in the development of self-efficacy in simulation training for 2nd year nursing students. Initial emotional states, pre and post self-efficacy, and expert ratings of simulation performance were assessed. Results show that students who displayed an increase in self-efficacy as a result of simulation training were also judged to perform better by expert ratings. The effect of simulation on self-efficacy could be influenced by initial states of physiological activation and over control. Results also showed that initial emotional states did not moderate self-efficacy development on outcome measures. These findings improve our understanding on the relationship between students' self-efficacy and performance of practical skills and inform pedagogical designs and targeted interventions in relation to feedback and supervision in nursing education.

Altered regulation of negative affect in patients with fibromyalgia: A diary study.

BACKGROUND: Fibromyalgia is characterized by widespread musculoskeletal pain and often accompanied by cognitive and emotional problems. Adaptation to fibromyalgia may therefore also rely on one's ability to regulate emotional problems. In this study, we examined two indices of emotion regulation, that is, (a) affective instability, involving frequent large fluctuations in self-reported affect, and (b) resting heart rate variability (HRV). METHODS: Participants were 46 patients with fibromyalgia (Mage  = 45.4 years; 39 females) and 46 matched healthy controls (Mage  = 44.9 years; 37 females). Heart rate was monitored under resting conditions to derive HRV. Subsequently, participants completed an electronic end-of-day diary for 14 consecutive days assessing daily levels of pain, disability, negative affect (NA) and positive affect (PA). Affective instability was operationalized as the mean square of successive differences in daily mood. RESULTS: Results indicate increased levels of NA instability and reduced levels of HRV in patients with fibromyalgia in comparison with healthy controls. Furthermore, HRV and NA instability were inversely related. Finally, in patients, higher NA instability was related to increased pain disability. CONCLUSIONS: Current findings support the idea that patients with fibromyalgia are confronted with fluctuating emotions. These results may have important implications for treatment as they provide support for the use of emotion regulation skills training in patients with fibromyalgia to impact upon NA instability. SIGNIFICANCE: This study provides novel insight in the link between emotion regulation indices,that is, heart-rate variability and negative affective (NA) instability, in patients with fibromyalgia, and presents evidence for differences in both emotion regulation indices between patients with fibromyalgia and healthy people. Furthermore, results link increased NA instability with increased levels of daily disability in patients with fibromyalgia. Together, these findings offer support for a key role of emotion regulation in fibromyalgia outcomes, providing pathways for clinical practice.