Effectiveness of stress arousal reappraisal and stress-is-enhancing mindset interventions on task performance outcomes: a meta-analysis of randomized controlled trials.

Stress arousal reappraisal (SAR) and stress-is-enhancing (SIE) mindset interventions aim to promote a more adaptive stress response by educating individuals about the functionality of stress. As part of this framework, an adaptive stress response is coupled with improved performance on stressful tasks. The goal of this meta-analysis is to evaluate the effectiveness of these interventions on task performance. The literature search yielded 44 effect sizes, and a random-effects model with Knapp-Hartung adjustment was used to pool them. The results revealed an overall small significant improvement in task performance (d = 0.23, p < 0.001). The effect size was significantly larger for mixed interventions (i.e., SAR/SIE mindset instructions combined with additional content, k = 5, d = 0.45, p = 0.004) than SAR-only interventions (k = 33, d = 0.22, p < 0.001) and SIE mindset-only interventions (k = 6, d = 0.18, p = 0.22) and tended to be larger for public performance tasks than cognitive written tasks (k = 14, d = 0.34, p < 0.001 vs. k = 30, d = 0.20, p = 0.002). Although SAR and SIE mindset interventions are not "silver bullets", they offer a promising cost-effective low-threshold approach to improve performance across various domains.

From threat to challenge-Improving medical students' stress response and communication skills performance through the combination of stress arousal reappraisal and preparatory worked example-based learning when breaking bad news to simulated patients: study protocol for a randomized controlled trial.

BACKGROUND: Breaking bad news (BBN; e.g., delivering a cancer diagnosis) is perceived as one of the most demanding communication tasks in the medical field and associated with high levels of stress. Physicians' increased stress in BBN encounters can negatively impact their communication performance, and in the long term, patient-related health outcomes. Although a growing body of literature acknowledges the stressful nature of BBN, little has been done to address this issue. Therefore, there is a need for appropriate tools to help physicians cope with their stress response, so that they can perform BBN at their best. In the present study, we implement the biopsychosocial model of challenge and threat as theoretical framework. According to this model, the balance between perceived situational demands and perceived coping resources determines whether a stressful performance situation, such as BBN, is experienced as challenge (resources > demands) or threat (resources < demands). Using two interventions, we aim to support medical students in shifting towards challenge-oriented stress responses and improved communication performance: (1) stress arousal reappraisal (SAR), which guides individuals to reinterpret their stress arousal as an adaptive and beneficial response for task performance; (2) worked examples (WE), which demonstrate how to BBN in a step-by-step manner, offering structure and promoting skill acquisition. METHODS: In a randomized controlled trial with a 2 (SAR vs. control) x 2 (WE vs. control) between-subjects design, we will determine the effects of both interventions on stress response and BBN skills performance in N = 200 third-year medical students during a simulated BBN encounter. To identify students' stress responses, we will assess their perceived coping resources and task demands, record their cardiovascular activity, and measure salivary parameters before, during, and after BBN encounters. Three trained raters will independently score students' BBN skills performances. DISCUSSION: Findings will provide unique insights into the psychophysiology of medical students who are tasked with BBN. Parameters can be understood more comprehensively from the challenge and threat perspective and linked to performance outcomes. If proven effective, the evaluated interventions could be incorporated into the curriculum of medical students and facilitate BBN skills acquisition. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05037318), September 8, 2021.

Does workplace telepressure get under the skin? Protocol for an ambulatory assessment study on wellbeing and health-related physiological, experiential, and behavioral concomitants of workplace telepressure.

BACKGROUND: The daily working life of many employees requires the use of modern information and communication technology (ICT) devices such as computers, tablets, and smartphones. The double-edged nature of digital work environments has been increasingly highlighted. Benefits such as increased flexibility come at a personal cost. One of the potential downsides is workplace telepressure, i.e., the experience of urge and preoccupation to quickly reply to work-related messages and demands using ICT. There is initial - mainly survey-based-evidence that workplace telepressure may have negative effects on a variety of wellbeing and health outcomes. AIMS AND HYPOTHESES: Adopting the Effort-Recovery Model and the concept of allostatic load as theoretical frameworks, the present study aims to investigate the hypothesis that workplace telepressure is significantly associated with increased "wear and tear", in the form of more psychosomatic complaints, worse sleep quality (self-reported and actigraphy-based), worse mood, and biological alterations (lower cardiac vagal tone, lower anabolic balance defined as the ratio of salivary dehydroepiandrosterone to salivary cortisol, and higher salivary alpha-amylase). Additionally, the study aims to investigate the hypothesis that connection to work defined as work-related workload and work-related perseverative cognition plays a significant role in the mediation of these relationships. METHODS: To test our hypotheses, we will conduct an ambulatory assessment study with a convenience sample of 120 healthy workers regularly using ICTs for job communication. For one week, participants will be asked to complete electronic diaries assessing their level of workplace telepressure, psychosomatic complaints, sleep quality, mood, work-related workload, and work-related perseverative cognition. They will also continuously wear the Bittium Faros 180L ECG monitor, the wrist-worn actigraph MotionWatch 8, and perform saliva sampling five times per day. DISCUSSION: This study will be the most comprehensive ambulatory investigation of workplace telepressure and its psychophysiological concomitants to date and constitutes an important step towards understanding how high levels of workplace telepressure may lead in the long term to secondary alterations (e.g., hypertension, chronic inflammation) and disease (e.g., heart disease). The findings of this study are also anticipated to contribute to guiding the development and implementation of interventions, programs, and policies relevant to employees' digital wellbeing.

How audience and general music performance anxiety affect classical music students' flow experience: A close look at its dimensions.

Flow describes a state of intense experiential involvement in an activity that is defined in terms of nine dimensions. Despite increased interest in understanding the flow experience of musicians in recent years, knowledge of how characteristics of the musician and of the music performance context affect the flow experience at the dimension level is lacking. In this study, we aimed to investigate how musicians' general music performance anxiety (MPA) level (i.e., the general tendency to experience anxiety during solo music performances) and the presence of an audience influence the nine flow dimensions. The participants were 121 university music students who performed solo a music piece once by themselves (private performance) and once in front of an audience (public performance). Their general MPA level was measured with an adapted version of the STAI and ranged from 27 (very low MPA) to 76 (very high MPA). The level of the nine flow dimensions was assessed with the Flow State Scale-2 after each performance. The levels of "concentration on task at hand," "sense of control," and "autotelic experience" decreased significantly with increasing general MPA level. The levels of "unambiguous feedback" and "loss of self-consciousness" decreased significantly with increasing general MPA level during the public performance only. The level of "sense of control" was significantly lower during the public performance than the private performance across participants. The level of "unambiguous feedback" was significantly lower during the public performance than the private performance for participants with a general MPA level higher than 47. The level of "loss of self-consciousness" was significantly lower during the public performance than the private performance for participants with a general MPA level higher than 32. In contrast, the general MPA level and the audience did not significantly affect the levels of "challenge-skill balance," "clear goals," and "action-awareness merging." These results show that the effects of general MPA level and audience vary greatly across flow state dimensions. We conclude that musicians' flow state should be analyzed at the dimension level rather than as a global score. We discuss how our findings could inform the development and implementation of interventions.

Classical Music Students' Pre-performance Anxiety, Catastrophizing, and Bodily Complaints Vary by Age, Gender, and Instrument and Predict Self-Rated Performance Quality.

Music performance anxiety (MPA) is a multifaceted phenomenon occurring on a continuum of severity. In this survey study, we investigated to what extent the affective (anxiety), cognitive (catastrophizing), and somatic (bodily complaints) components of MPA prior to solo performances vary as a function of age, gender, instrument group, musical experience, and practice as well as how these MPA components relate to self-rated change in performance quality from practice to public performance. The sample comprised 75 male and 111 female classical music university students, aged 15-45 years. Age was positively associated with anxious feelings and bodily complaints. Compared to male students, female students reported significantly more anxious feelings and catastrophizing. Singers reported less anxious feelings and catastrophizing than instrumentalists. Breathing-, mouth- and throat-related complaints were highest among singers and wind players; hand- and arm-related complaints were highest among string players and pianists. The indices of musical experience and practice had marginal effects. An average of four bodily complaints bothered the participants strongly to very strongly. Worsening in performance quality from practice to public performance was reported by almost half of the participants and was best predicted by anxious feelings and breathing-related complaints. We conclude that age, gender and instrument play a significant role in understanding the phenomenology of MPA. Musicians should be examined according to these characteristics rather than as one homogenous population. In particular, it might be valuable to develop assessment tools for MPA that incorporate items related to the bodily complaints that are most relevant to the different instrument groups. Breathing-related complaints could add an important dimension to the investigation of MPA and music performance. Finally, the high percentage of students reporting worsening of their performance quality from practice to public performance highlights the need of professional support to help music students be able to perform at their best and thrive as artists.

An etude for post-pandemic practice: The impact of the COVID-19 pandemic on practice methods and instrumental technique.

This paper considers how the pandemic-related concert-free time affected musicians' practice, specifically in relation to technique. A semi-structured interview was carried out on 22 musicians based in Switzerland (11 males, 11 females; 7 students, 15 non-students; 11 with school-aged children, 11 without school-aged children; 16 with teaching duties and 6 non-teachers). The amount of practice during the pandemic-related concert-free time was reported as different to usual by 91% and usual for only 9% of participants (p = 0.002). Forty-one percent of participants reported reduced, and 41% "fluctuating" amounts of practice. The proportion of practice time spent on technique was reported by 55% of participants to have increased and by only 9% to have decreased (p = 0.019). Of those who reported an increase in technique practice, 75% agreed this had a positive impact on technique, and only 8% disagreed (p = 0.037). Moreover, 58% considered this work to have changed their current and future practice. Participants were statistically more likely to report "never" watching online tutorials than "often" (p = 0.014), but, of those that did watch such material, 75% agreed that it had a positive impact upon their practice. Most participants created digital content during this period; only 5% produced no such material. An increased use of digital tools was reported by 55% of participants, 92% of whom described this as having a positive effect upon practice and only 8% were unsure (p = 0.022). However, in the unstructured discussion, the use of digital tools appears to be associated with mixed outcomes. Men reported significantly more frequent use of digital tools (91% vs. 45% describing this use as often, p = 0.038) and spent a larger proportion of time on technique relative to their pre-pandemic habits than women (p = 0.065); moreover, a trend indicated that more women than men created digital content in the form of tutorials (p = 0.095). The exceptional situation musicians experienced during the pandemic, which introduced new aspects to musical instrument practice, and accelerated changes already underway, could lead to future work that improves practice under "normal" conditions, and exposes discrepancies between certain demographic groups.

Positive and Negative Post Performance-Related Thoughts Predict Daily Cortisol Output in University Music Students.

Psychophysiological research on music performance has focused on musicians' short-term affective, cognitive, and physiological responses. Much less attention has been devoted to the investigation of musicians' psychophysiological activity beyond the performance situation. Musicians report having both positive and negative performance-related thoughts (e.g., "My concert was good" and "I made a lot of mistakes") for days following performances. The potential physiological implications of this post-performance cognitive processing are largely unknown. Salivary cortisol (sC) and salivary alpha-amylase (sAA) are markers of the activity of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathoadrenal medullary (SAM) system, respectively. The goal of the present study was to investigate whether self-reported positive and negative post performance-related thoughts predict the daily sC output and the daily sAA activity at the between- and within-person levels during a 2-day period following a solo music performance. Seventy-two university music students collected saliva samples six times per day and reported their positive and negative performance-related thoughts for 2 days after a solo performance. We tested between-person and within-person components of positive and negative post performance-related thoughts as predictors of the diurnal area under the curve with respect to ground (AUCg) for sC and sAA while adjusting for relevant person-level and day-level variables. Negative post performance-related thoughts were positively associated with sC AUCg both at the between- and within-person levels, whereas positive post performance-related thoughts were negatively associated with sC AUCg at the between-person level. Post performance-related thoughts did not significantly predict sAA AUCg. These findings provide evidence for a relationship between affectively valenced cognitive processing of a recent music performance and the activity of the HPA axis. Although the directionality of this relationship remains to be established more conclusively, the study makes a significant contribution to the literature on the prolonged psychophysiological effects of music performance situations and more broadly of social-evaluative stressors. Integrating the topic of post-performance cognitive processing and its optimal management into performance training programs would likely have positive effects on music students.

Music performance anxiety from the challenge and threat perspective: psychophysiological and performance outcomes.

BACKGROUND: Although many musicians perceive music performance anxiety (MPA) as a significant problem, studies about the psychobiological and performance-related concomitants of MPA are limited. Using the biopsychosocial model of challenge and threat as theoretical framework, we aim to investigate whether musicians' changes in their psychobiological responses and performance quality from a private to a public performance are moderated by their general MPA level. According to the challenge and threat framework, individuals are in a threat state when the perceived demands of a performance situation outweigh the perceived resources, whereas they are in a challenge state when the perceived resources outweigh the perceived demands. The resources-demands differential (resources minus demands) and the cardiovascular challenge-threat index (sum of cardiac output and reverse scored total peripheral resistance) are the main indices of these states. We postulate that the relationship between general MPA level and performance quality is mediated by these challenge and threat measures. METHODS: We will test 100 university music students reporting general MPA levels ranging from low to high. They will perform privately (i.e., without audience) and publicly (i.e., with an audience) on two separate days in counterbalanced order. During each performance session, we will record their cardiovascular and respiratory activity and collect saliva samples and self-reported measures. Measures of primary interest are self-reported anxiety, the resources-demands differential, the cardiovascular challenge-threat index, sigh rate, total respiratory variability, partial pressure of end-tidal carbon dioxide and the salivary biomarkers cortisol, dehydroepiandrosterone, and alpha-amylase. Both, the participants and anonymous experts will evaluate the performance quality from audio recordings. DISCUSSION: The results of the planned project are expected to contribute to a more comprehensive understanding of the psychobiology of MPA and of the processes that influence musicians' individual reactions to performance situations. We also anticipate the findings of this project to have important implications for the development and implementation of theory-based interventions aimed at managing musicians' anxiety and improving performance quality. Thanks to the use of multimethod approaches incorporating psychobiology, it might be possible to better assess the progress and success of interventions and ultimately improve musicians' chance to have a successful professional career. TRIAL REGISTRATION: Not applicable.

Respiratory Variability, Sighing, Anxiety, and Breathing Symptoms in Low- and High-Anxious Music Students Before and After Performing.

Music performance anxiety (MPA) is a major problem for music students. It is largely unknown whether music students who experience high or low anxiety differ in their respiratory responses to performance situations and whether these co-vary with self-reported anxiety, tension, and breathing symptoms. Affective processes influence dynamic respiratory regulation in ways that are reflected in measures of respiratory variability and sighing. This study had two goals. First, we determined how measures of respiratory variability, sighing, self-reported anxiety, tension, and breathing symptoms vary as a function of the performance situation (practice vs. public performance), performance phase (pre-performance vs. post-performance), and the general MPA level of music students. Second, we analyzed to what extent self-reported anxiety, tension, and breathing symptoms co-vary with the respiratory responses. The participants were 65 university music students. We assessed their anxiety, tension, and breathing symptoms with Likert scales and recorded their respiration with the LifeShirt system during a practice performance and a public performance. For the 10-min periods before and after each performance, we computed number of sighs, coefficients of variation (CVs, a measure of total variability), autocorrelations at one breath lag (ARs(1), a measure of non-random variability) and means of minute ventilation (V'E), tidal volume (VT), inspiration time (TI), and expiration time (TE). CVs and sighing were greater whereas AR(1) of V'E was lower in the public session than in the practice session. The effect of the performance situation on CVs and sighing was larger for high-MPA than for low-MPA participants. Higher MPA levels were associated with lower CVs. At the within-individual level, anxiety, tension, and breathing symptoms were associated with deeper and slower breathing, greater CVs, lower AR(1) of V'E, and more sighing. We conclude that respiratory variability and sighing are sensitive to the performance situation and to musicians' general MPA level. Moreover, anxiety, tension, breathing symptoms, and respiratory responses co-vary significantly in the context of music performance situations. Respiratory monitoring can add an important dimension to the understanding of music performance situations and MPA and to the diagnostic and intervention outcome assessments of MPA.

Increased Reward-Related Activation in the Ventral Striatum During Stress Exposure Associated With Positive Affect in the Daily Life of Young Adults With a Family History of Depression. Preliminary Findings.

Background: Being the offspring of a parent with major depression disorder (MDD) is a strong predictor for developing MDD. Blunted striatal responses to reward were identified in individuals with MDD and in asymptomatic individuals with family history of depression (FHD). Stress is a major etiological factor for MDD and was also reported to reduce the striatal responses to reward. The stress-reward interactions in FHD individuals has not been explored yet. Extending neuroimaging results into daily-life experience, self-reported ambulatory measures of positive affect (PA) were shown to be associated with striatal activation during reward processing. A reduction of self-reported PA in daily life is consistently reported in individuals with current MDD. Here, we aimed to test (1) whether increased family risk of depression is associated with blunted neural and self-reported reward responses. (2) the stress-reward interactions at the neural level. We expected a stronger reduction of reward-related striatal activation under stress in FHD individuals compared to HC. (3) the associations between fMRI and daily life self-reported data on reward and stress experiences, with a specific interest in the striatum as a crucial region for reward processing. Method: Participants were 16 asymptomatic young adults with FHD and 16 controls (HC). They performed the Fribourg Reward Task with and without stress induction, using event-related fMRI. We conducted whole-brain analyses comparing the two groups for the main effect of reward (rewarded > not-rewarded) during reward feedback in control (no-stress) and stress conditions. Beta weights extracted from significant activation in this contrast were correlated with self-reported PA and negative affect (NA) assessed over 1 week. Results: Under stress induction, the reward-related activation in the ventral striatum (VS) was higher in the FHD group than in the HC group. Unexpectedly, we did not find significant group differences in the self-reported daily life PA measures. During stress induction, VS reward-related activation correlated positively with PA in both groups and negatively with NA in the HC group. Conclusion: As expected, our results indicate that increased family risk of depression was associated with specific striatum reactivity to reward in a stress condition, and support previous findings that ventral striatal reward-related response is associated with PA. A new unexpected finding is the negative association between NA and reward-related ventral striatal activation in the HC group.

Recognizing images: The role of motivational significance, complexity, social content, age, and gender.

Memory for affective events plays an important role in determining people's behavior and well-being. Its determinants are far from being completely understood. We investigated how recognition memory for affective pictures depends on pictures' motivational significance (valence and arousal), complexity (figure-ground compositions vs. scenes), and social content (pictures with people vs. without people) and on observers' age and gender. Younger, middle-aged, and older adults viewed 84 pictures depicting real-life situations. After a break, the participants viewed 72 pictures, half of which had been viewed previously and half of which were novel, and were asked to endorse whether each picture was novel or had been presented previously. Hits, false alarms, and overall performance (discrimination accuracy) were our dependent variables. The main findings were that, across participants, recognition memory was better for unpleasant than pleasant pictures and for pictures depicting people than pictures without people. Low-arousal pictures were more accurately recognized than high-arousal pictures, and this effect was significantly larger among middle-aged and older adults than younger adults. Recognition memory worsened across adulthood, and this decline was steeper among men than women. Middle-aged and older women outperformed their male counterparts. This study suggests that how well we are able to successfully discriminate previously seen pictorial stimuli from novel stimuli depends on several pictures' properties related to their motivational significance and content, and on observer's age and gender.

Eye gaze behavior during affective picture viewing: Effects of motivational significance, gender, age, and repeated exposure.

How top-down and bottom-up factors combine to determine eye movements during affective picture viewing is far from being completely understood. We investigated how observers' fixation frequency and scanpath length - two indices of information seeking and intake - are related to self-reported valence (pleasantness) and arousal and depend on gender, age, and repeated exposure during affective picture viewing. We tracked the eye movements of 157 younger, middle-aged, and older adults when viewing 14 picture series each consisting of six thematically and affectively similar pictures. Participants' valence and arousal ratings were registered for each series. Fixation frequency and scanpath length increased with self-rated unpleasantness and arousal and decreased across the six pictures within series. This decrease was age- and arousal-dependent. Compared to men, women exhibited a more exploratory scanning behavior. These findings suggest that observers' affective appraisal, gender and age and repeated exposure to affective visual stimuli influence visual information seeking and intake.

The mediating role of mood in the relationship between perseverative cognition, sleep and subjective health complaints in music students.

OBJECTIVE: Subjective health complaints (SHC) are frequent in musicians. These complaints may be particularly distressing in this population because they are performance relevant. This paper aims at testing a model positing that (a) perseverative cognition (PC) predicts sleep duration/quality, (b) sleep duration/quality predicts SHC and (c) mood is a mediator of these associations. DESIGN: Participants were 72 music students (mean age (SD): 22.7 (3.0) years), and the assessment period consisted of seven consecutive days, with a solo performance on the fifth day. MAIN OUTCOME MEASURES: Self-reported total sleep time (TST) and sleep quality were assessed 30 min after wake-up, and objective TST/sleep quality were assessed with an actigraphy watch. PC and mood were measured five times a day. Daily SHC were assessed at 9 p.m. RESULTS: PC did not significantly predict sleep duration/quality. Self-reported and objective TST and sleep quality were all significantly associated with SHC. Mood played a mediating role in each of these relationships with the exception of objective sleep quality. CONCLUSION: The tested model on the association among PC, sleep and SHC and the mediating role of mood received partial support, highlighting the importance of sleep and mood in the emergence of SHC among university music students.

The Effects of Hand Massage on Stress and Agitation Among People with Dementia in a Hospital Setting: A Pilot Study.

Agitation in people with dementia is a growing concern as it causes distress for both patients and their nurses and may contribute to relational disorders. Previous studies involving patients with dementia living in long-term care facilities have reported decreased agitation following massage. The objective of this pilot study was to investigate the effect of hand massage on agitation and biological markers of stress in patients with dementia hospitalized in an acute geriatric psychiatry service. In this randomized controlled trial we included 40 agitated patients with dementia with an intervention group and a control group. The study is designed to test the effect of seven hand massages over three continuous weeks on agitation and levels of salivary cortisol (sC) and alpha-amylase (sAA). Compared to the control group, the intervention group exhibited larger increases in sC and sAA at week 1 from before to after the massage, but larger decreases at week 2 and 3, with a significant group effect for sAA at week 2. Agitation scores were not significantly different between the groups but tended to decrease more in the intervention group than the control group. This study provides first encouraging results suggesting that hand massage might have beneficial effects on stress and agitation in hospitalized patients with dementia. It also highlights the challenges associated with conducting such studies with this complex patient population. Further studies are needed to confirm these findings and the benefits of hand massage as part of routine care for patients with dementia.

Prolonged performance-related neuroendocrine activation and perseverative cognition in low- and high-anxious university music students.

Music performances are social-evaluative situations that can elicit marked short-term neuroendocrine activation and anxious thoughts especially in musicians suffering from music performance anxiety (MPA). The temporal patterns of neuroendocrine activity and concert-related worry and rumination (perseverative cognition, PC) days before and after a concert in low- and high-anxious musicians are unknown. The first goal of the present study was to investigate the prolonged effects of a solo music performance and the effects of trait MPA on salivary cortisol (sC), alpha-amylase (sAA), and concert-related PC. The second goal was to investigate whether concert-related PC is associated with neuroendocrine activity and mediates the effects of measurement day and trait MPA on neuroendocrine responses. Seventy-two university music students collected saliva samples and reported their PC for seven consecutive days. On the fifth day, they performed solo. Measurement day and trait MPA were tested as main predictors of the diurnal area under the curve with respect to ground (sC AUCg, sAA AUCg), awakening responses, and PC. SC AUCg, sAA AUCg, and concert-related PC were highest on concert day. SC AUCg decreased only partially on post-concert days. SAA AUCg remained elevated on the first post-concert day among students with moderate to very high trait MPA. Throughout the assessment period, trait MPA was associated with smaller sC AUCg and higher concert-related PC. Concert-related PC showed significant positive associations with sC AUCg and sAA AUCg but did not mediate the effects of measurement day and trait MPA on these measures. These findings suggest that solo music performances have prolonged neuroendocrine effects and that trait MPA is an important factor having specific effects on university music students' hypothalamic-pituitary-adrenal axis, autonomic nervous system, and cognitive activity.

Physicians' psychophysiological stress reaction in medical communication of bad news: A critical literature review.

INTRODUCTION: Stress is a common phenomenon in medical professions. Breaking bad news (BBN) is reported to be a particularly distressing activity for physicians. Traditionally, the stress experienced by physicians when BBN was assessed exclusively using self-reporting. Only recently, the field of difficult physician-patient communication has used physiological assessments to better understand physicians' stress reactions. METHOD: This paper's goals are to (a) review current knowledge about the physicians' psychophysiological stress reactions in BBN situations, (b) discuss methodological aspects of these studies and (c) suggest directions for future research. RESULTS: The seven studies identified all used scenarios with simulated patients but were heterogeneous with regard to other methodological aspects, such as the psychophysiological parameters, time points and durations assessed, comparative settings, and operationalisation of the communication scenarios. Despite this heterogeneity, all the papers reported increases in psychological and/or physiological activation when breaking bad news in comparison to control conditions, such as history taking or breaking good news. CONCLUSION: Taken together, the studies reviewed support the hypothesis that BBN is a psychophysiologically arousing and stressful task for medical professionals. However, much remains to be done. We suggest several future directions to advance the field. These include (a) expanding and refining the conceptual framework, (b) extending assessments to include more diverse physiological parameters, (c) exploring the modulatory effects of physicians' personal characteristics (e.g. level of experience), (d) comparing simulated and real-life physician-patient encounters and (e) combining physiological assessment with a discourse analysis of physician-patient communication.

Autonomic nervous system reactivity within the valence-arousal affective space: Modulation by sex and age.

In the present study, we examined how sex and age shape cardiovascular, electrodermal, and pupillary reactivity to picture series within the valence-arousal affective space in a sample of 176 healthy younger, middle-aged, and older men and women. Across participants, heart rate (HR) decelerated with increasing self-reported unpleasantness, whereas skin conductance level (SCL) and pupil size (PS) increased with increasing self-rated arousal. Systolic (SBP) and diastolic (DBP) blood pressure increased with increasing self-rated arousal when valence was pleasant but much less when valence was unpleasant. Compared to women, men exhibited a stronger correlation between valence and HR and an SBP response characterized by larger increases for pleasant high-arousal states and lower change scores for unpleasant low- and high-arousal and pleasant low-arousal states. Men's largest SCL change scores were for pleasant high-arousal states, whereas women's largest SCL change scores were for unpleasant high-arousal states. The arousal-PS relationship was stronger among women, in particular for unpleasant series. From younger to older age, there were decreases in the strength of the valence-HR, arousal-SCL, and arousal-PS relationships. Older adults had larger overall increases in SBP and DBP than younger adults, but the relationships with self-reported valence and arousal were not age dependent. We discuss how the observed sex and age effects may reflect sex and age differences in emotional processing and in basic autonomic nervous system functioning.

Breathing and affective picture processing across the adult lifespan.

The present study investigated differences between healthy younger, middle-aged, and older adults in their respiratory responses to pictures of different valence and arousal. Expiratory time shortened and end-tidal PCO2 decreased with increasing arousal in all age groups; yet, compared to younger adults, older adults' overall change from baseline was smaller for expiratory time and larger for end-tidal PCO2. Contrary to their younger counterparts, older adults' inspiratory time did not shorten with increasing arousal. Inspiratory duty cycle did not covary with affective ratings for younger adults, increased with unpleasantness for middle-aged adults, and increased with arousal for older adults. Thoracic breathing increased with increasing unpleasantness only among older adults. Age had no effects on mean inspiratory flow and minute ventilation, which both augmented as arousal increased. We discuss how age effects on respiratory response magnitude and pattern may depend on age-associated biological changes or reflect age-related differences in emotional processing.

The down-regulation of disgust by implementation intentions: experiential and physiological concomitants.

Emotion regulation plays a key role in mental health and psychopathology. Therefore, it seems important to develop effective forms of emotion regulation. Implementation intentions are if-then plans that help people attain their self-regulatory goals. Perspective-taking and response-focused implementation intentions have been shown to reduce feelings of unpleasantness and arousal, respectively, in response to briefly presented disgusting pictures. The present study addressed the open research questions whether forming these types of implementation intentions is effective in regulating affect during prolonged presentation of disgusting pictures, and whether it is associated with changes in physiological arousal. Eighty-one participants viewed disgusting, neutral, and pleasant pictures of 6 s duration under four instructions: the goal intention to not get disgusted, this goal intention furnished with a perspective-taking or a response-focused implementation intention, and no emotion regulation instructions. The dependent variables were ratings of disgust, valence, arousal, and electrodermal activity. Only perspective-taking implementation intention participants significantly reduced their disgust and unpleasantness as compared to goal-intention and control participants. Arousal and skin conductance did not significantly differ between conditions. The effectiveness of response-focused but not perspective-taking implementation intentions seems to be substantially reduced during sustained exposure duration.