Patients with hypertension (HTN) are at increased risk of developing cardiovascular disease, which can be reduced with blood pressure (BP) control. Anxiety can contribute to high BP and low heart rate variability (HRV). Although relationships between social support, self-rated health-status (SRHS), anxiety and measures of HRV and BP have been suggested, they have not been clearly established. This cross-sectional correlational study aimed to 1) examine relationships between social support, SRHS, and anxiety; and 2) examine if HRV mediated relationships between anxiety symptoms and BP. Patients with primary HTN were recruited from a cardiovascular outpatient clinic using convenience sampling (N = 300). Data included scale scores for SRHS, social support, and anxiety (Hospital Anxiety and Depression Scale). A handheld limb-lead electrocardiogram monitor measured HRV, using the ratio of low-frequency bands to high-frequency bands; an automatic sphygmomanometer measured systolic and diastolic blood pressure (SBP and DBP, respectively). Path analysis of structural equation models examined relationships between variables; the bootstrap method examined the mediating effects of HRV. Analysis showed scores for SRHS and social support had a direct effect on anxiety scores. Scores for anxiety directly affected HRV and BP. HRV also had a direct effect on BP. Bootstrapping indicated HRV mediated the relationship between anxiety symptoms and BP. The final model indicated SRHS, social support, and anxiety symptoms together explained 80% of SBP and 33% of DBP. These findings suggest HRV could be used to measure the effectiveness of strategies aimed at reducing anxiety and improving control of BP.

Police officers demonstrate increased risk of physical and mental health conditions due to repeated and prolonged exposure to stressful occupational conditions. Occupational stress is broken into two types: operational stress, related to the content of field duties (e.g., physical demands); and organizational stress, related to cultural and structural contexts (e.g., interpersonal relationships). Applied police research focuses on physiological activation in operational tasks as a mechanism explaining health risk and non-optimal performance outcomes. However, recent survey-based studies indicate numerous organizational stressors associated with self-reported mental health symptoms. The question of whether organizational stressors elicit significant physiological activity remains unknown. The current proof-of-concept field study tests the hypothesis that police managers will display significant physiological reactivity before, during, and after engaging in reality-based scenarios representative of stressful police management tasks developed from evidence-based pedagogical approaches. A sample of 25 training police managers (7 female, M = 16 +/- 5.3 years of experience) completed 5 reality-based scenarios, including resolving a heated conflict between colleagues, delivering negative feedback to a subordinate, and critical incident command. Significant increases in heart rate relative to rest were observed during all tasks, and in anticipation of several tasks. Greater increases in reactive heart rate were associated with longer recovery times. Sex differences and relationships between objective biological and subjective psychological measures of stress are discussed. The current findings demonstrate significant physiological responses to organizational stressors similar to levels observed during operational tasks, despite the absence of physical or aerobic exertion. Implications for police health and training are discussed.

Previous research has indicated a critical need for cost-effective alternative therapies. The present pilot study aimed to evaluate a novel, cost-effective therapy for treating insomnia. The study employed a randomized controlled trial with two groups: therapy and control. Participants were screened using research diagnostic criteria for insomnia recommended by the American Academy of Sleep Medicine (AASM) before undergoing simple randomization. The study included participants from Hindu, Muslim, and Christian faiths who were assigned to either the therapy group (Hare Krishna Mantra Based Cognitive Therapy: HMBCT) or the non-therapy group (control with relaxing music). Both groups underwent six weeks of treatment with traditional cognitive-behavioral therapy techniques, including stimulus control, sleep restriction, and sleep hygiene. Each week, participants in the therapy group received six 45-minute sessions of HMBCT in the evening and were asked to practice the therapy in the evening of the day of sleep recording. Sleep quality was assessed using behavioral measures, sleep logs, and polysomnography recordings before and after the six-week treatment period. There was a one-week period before and after the six weeks when no treatment was provided. Results showed that HMBCT significantly improved sleep quality measures, including a 61% reduction in Epworth Sleepiness Scale (ESS) scores and an 80% reduction in Insomnia Severity Index (ISI) scores. Participants did not take any sleep-inducing medication during the study. These findings suggest that adding mantra chanting to traditional cognitive-behavioral therapy may improve sleep quality.

Impairments in cardiac vagal control (CVC) have been independently linked to smoking status and depression and are implicated in self-regulatory processes that may exacerbate depressive symptoms and maintain smoking behavior. Yet, few studies have examined how depressive symptoms, even at low levels, influence CVC reactivity among individuals who smoke. Investigating these relationships may provide novel insights into how depressive symptoms exacerbate existing regulatory vulnerabilities among smokers. This study investigated how depression symptoms affect CVC reactivity as a function of changing situational demands among a community sample of 60 daily adult cigarette smokers. Participants completed a mildly demanding cognitive task while physiological data was recorded. Growth curve modeling was used to examine the main and interactive effects of self-reported depressive symptoms on CVC reactivity over the course of the task. We hypothesized that greater depressive symptoms would be associated with less CVC reactivity, characterized by smaller initial reductions in CVC values and a flatter slope over time. Participants were daily smokers with mild to moderate levels of depression. Final model results, where time was specified as linear and the slope was fixed, showed no significant main or interactive effects of time and depression symptoms on CVC reactivity. Findings suggest that at low to moderate levels, depressive symptom severity is not related to patterns of CVC reactivity among adults who smoke. This is the first study to examine this relationship in this population. Future investigations that examine patterns of CVC reactivity among smokers and non-smokers with more severe depression are needed.

Paced breathing and rhythmical skeletal muscle tension (RSMT) at an individual's resonance frequency [~ 6 breaths or contractions per min (cpm)] can stimulate the arterial and vascular tone baroreflexes. Lehrer (Appl Psychophysiol Biofeedback 1-10, 2022, https://doi.org/10.1007/s10484-022-09535-5 ) has explained that the stimulation rate is important, not the modality. Early RSMT protocols differed in the muscles recruited and whether legs were crossed or uncrossed (in France et al. Clin Physiol Funct Imaging 26: 21-25, 2006, https://doi.org/10.1111/j.1475-097X.2005.00642.x ; Leher et al. Biol Psychol 81: 24-30, 2009, https://doi.org/10.1016/j.biopsycho.2009.01.003 ; Vaschillo et al. Psychophysiology, 48: 927-936, 2011, https://doi.org/10.1111/j.1469-8986.2010.01156.x ). Whereas core muscle RSMT with crossed legs and wrist-ankle RSMT with uncrossed legs produced resonance effects, researchers have not directly compared the effect of these exercises on respiratory sinus arrhythmia (RSA) and low-frequency (LF) power. The current within-subjects experiment investigated whether crossing the legs and recruiting core muscles enhances wrist-ankle RSMT effects on RSA and LF power. We trained 35 participants to complete 6-cpm wrist-ankle RSMT (ankles uncrossed), 6-cpm wrist-core-ankle RSMT (ankles crossed), and a control condition in which participants sat quietly (ankles uncrossed) without performing RSMT. We predicted that 6-cpm wrist-core-ankle RSMT would produce greater heart rate (HR), HR Max-HR Min, and LF power than the other conditions. The experimental findings supported our predictions. Both RSMT conditions produced greater HR, HR Max-HR Min, and LF power than the control condition. Wrist-core-ankle yielded greater HR and HR Max-HR Min than wrist-ankle RSMT. Future research should compare wrist-ankle and wrist-core-ankle RSMT with legs crossed. The practical implication for HRV biofeedback training is that wrist-core-ankle RSMT with legs crossed may more powerfully stimulate the baroreflex than wrist-ankle RSMT with legs uncrossed.

NFB has a clear potential as a recognised treatment option for ADHD, but suffers from a lack of clarity about its efficacy, still unresolved after multiple controlled trials. Comparing learners and non-learners based on the evolution of patient-level indicators during the trial serves as a ‘natural’ control, and can help elucidate the mechanisms of NFB. We present a systematic review motivated by the need to establish the state of the art of patient learning during NFB treatment in current clinical literature. One particularly striking question we would like to answer here is whether existing NFB papers study learning variability, since only individual performance differences can give us information about mechanisms of learning. The results show that very few clinical trial reports have dealt with the heterogeneity of NFB learning, nor analysed whether NFB efficacy is dependent on NFB learning, even though NFB is believed to be a treatment based on learning to perform. In this systematic review we examine not only what has been reported, but also provide a critical analysis of possible flaws or gaps in existing studies, and discuss why no generalized conclusions about NFB efficacy have yet been made. Future research should focus on finding reliable ways of identifying the performers and studying participants’ individual learning trajectories as it might enhance prognosis and the allocation of clinical resources.

Patients with coronary artery disease (CAD) often experience anger events before cardiovascular events. Anger is a psychological risk factor and causes underlying psychophysiological mechanisms to lose balance of the autonomic nervous system (ANS). The heart rate variability (HRV) was the common index for ANS regulation. It has been confirmed that heart rate variability biofeedback (HRV-BF) restored ANS balance in patients with CAD during the resting state. However, the effects of HRV-BF during and after the anger event remain unknown. This study aimed to examine the effects of HRV-BF on ANS reactivity and recovery during the anger recall task in patients with CAD. This study was a randomized control trial with a wait-list control group design, with forty patients in the HRV-BF group (for six sessions) and 44 patients in the control group. All patients received five stages of an anger recall task, including baseline, neutral recall task, neutral recovery, anger recall task, and anger recovery. HRV reactivity in the HRV-BF group at the post-test was lower than that in the control group. HRV recovery at the post-test in the HRV-BF group was higher than that in the control group. The HRV-BF reduced ANS reactivity during anger events and increased ANS recovery after anger events for CAD patients. The possible mechanisms of HRV-BF may increase total HRV, ANS regulation, and baroreflex activation at anger events for patients with CAD, and may be a suitable program for cardiac rehabilitation.

Chronic orthostatic intolerance (COI) is defined by changes in heart rate (HR), blood pressure (BP), respiration, symptoms of cerebral hypoperfusion and sympathetic overactivation. Postural tachycardia syndrome (POTS) is the most common form of COI in young adults and is defined by an orthostatic increase in heart rate (HR) of ≥ 30bpm in the absence of orthostatic hypotension. However, some patients referred for evaluation of COI symptoms do not meet the orthostatic HR response criterion of POTS despite debilitating symptoms. Such patients are ill defined, posing diagnostic and therapeutic challenges. This study explored the relationship among cardiovascular autonomic control, the orthostatic HR response, EtCO2 and the severity of orthostatic symptoms and fatigue in patients referred for evaluation of COI. Patients (N = 108) performed standardized testing protocol of the Autonomic Reflex Screen and completed the Composite Autonomic Symptom Score (COMPASS-31) and the Fatigue Severity Scale (FSS). Greater severity of COI was associated with younger age, larger phase IV amplitude in the Valsalva maneuver and lower adrenal baroreflex sensitivity. Greater fatigue severity was associated with a larger reduction in ETCO2 during 10min of head-up tilt (HUT) and reduced low-frequency (LF) power of heart rate variability. This study suggests that hemodynamic changes associated with the baroreflex response and changes in EtCO2 show a stronger association with the severity of orthostatic symptoms and fatigue than the overall orthostatic HR response in patients with COI.

The natural tendency of the mind to wander (i.e., mind wandering), is often connected to negative thoughts and emotional states. On the other hand, mindfulness (i.e., the ability to focus one's attention on the present moment in a non-judgmental way) has acquired a growing interest in recent years given its beneficial role in improving awareness and self-regulation. Starting from previous evidence, this study aims to clarify the psychological, physiological, and affective impact of a mindfulness exercise on mind wandering. Twenty-eight non-expert female meditators were recruited for this study. Heart rate variability (HRV), state mindfulness, mind wandering manifestations, and affective states, were recorded during a baseline condition, a mindfulness breathing observation exercise, and a final rest condition. Subjects reported significant decreases in mind wandering comparing baseline and mindfulness. Changes in mind wandering were mirrored by changes in HRV, with higher HRV during the breathing observation exercise. Significant associations were found between scores of mindfulness, mind wandering, and affective states measured during the task. Our findings confirmed the role of mindfulness in reducing mind wandering and increasing HRV. Results are discussed considering mindfulness associations with self-regulation and well-being.