Introducing undergraduates to stress testing in the lab

1. HEA Psychology Network – Teaching Biopsychology Workshop University of the West of England 24th April 2009 Introducing undergraduates to stress testing in the lab Dr Mark A Wetherell School of Psychology & Sport Sciences University of Northumbria

2. – the end result? YEAR 3 Project Students [ethics procedures] “I want to study the effects of… stress on X /X on stress (responses) My 3 year plan “I want to do something about stress” Greater understanding of… stress and its effects, types of stressors, how to induce it, how to measure it [research ethics, ethics documents]

3. My 3 year plan – getting there YEAR 1 Health Psychology Stress & disease Acute / chronic stress paradigms Psychoneuroimmunology Biological Psychology: Stress & the endocrine system YEAR 2 Psychobiology Lab Classes [reminder of Year 1 topics!] (acute) Stress testing in the lab [ethics procedures]

4. Previous ‘Psychobiology’ lab classes www study: The effects of ______ on mood / cognitive performance Psychobiology?

5. Report writing Psychobiology Lab Classes – the remit Generic / Core Skills • Literature searching • Ethical considerations & documentation • Experimental design & procedural management • Data management • Data analyses & interpretation • Critical evaluation of literature, findings & methods

6. Psychobiology Lab Classes – the remit Psychobiology Skills • Be more ‘psycho-biological’ (in practice & application – not just topic) • Provide topic specificknowledge & practical skills Acute Stress Reactivity • Methodological issues • Techniques (& critiques) for inducing stress in the lab • Stress measurement parameters (psychological & physiological) • Logistical & practical considerations in stress research

7. 2-4 9-11 11-1 X 12 ~ 200 students Week 1 Week 2 Week 3 The Practicalities / Restraints Assessment Standard practical report Abstract (5) Introduction (20) Methods (20) Results (20) Discussion (25) Misc (10) ?

8. ? The Plan • WEEK 1 • Reminder of stress responses & stressor paradigms • Introduction to Multi-tasking Framework (an acute stressor) • Groups 6 OR 7 (manageable but meaningful!) • Protocol development • Ethics • Familiarisation with materials WEEK 2 STRESS TESTING (your group is your ‘participant pool’) • WEEK 3 • Data reduction, data entry and analyses • Top Tips for the write-up

9. SESSION 1 Background

10. CNS (SNS / PNS) SAM HPA Immune System STRESS > Risk of  morbidity > Risk of disease > Progression of existing disease < Performance Psychosocial Variables (e.g., personality / mood / social support / coping style) Remember Last Year? The effects of stress

11. STRESSOR Hypothalamus Autonomic Nervous System Pituitary Gland Sympathetic & parasympathetic Adrenal Cortex Adrenal Medulla Remember Last Year? Biological Stress Pathways Cortisol Adrenaline / Noradrenaline (Fight / Flight / F**k response) Maintenance of responses (> 20 minutes) > Respiration & Perspiration > Heart rate & blood pressure

12. Remember Last Year? Measuring the effects of stress In order to assess the mechanisms by which stress can lead to states of ill-health it is [unfortunately] necessary to observe / test people while they are experiencing stress • Naturalistic stressors • Controlled / lab stressors

13. High stress jobs Natural disasters Over crowding 10 years Stressful living conditions Caregiving Exams Remember Last Year? Examples of naturalistic stressors

14. Injections Dental treatment Gory stimuli X X Stroop task Cold pressor Mirror-tracing Mental arithmetic Remember Last Year? Examples of controlled / lab stressors Public speaking tasks

15. Remember Last Year? Summary of stressors 1. Naturalisticstress (usually chronic & enduring) > Ecological validity But Time consuming Lacking in control 2. Controlled / lab stress(usually acute) > Control But Often not representative of ‘real stress’ Often produce habituation (People get used to them)

16. Acute / lab stressors…………… Underlying assumption: “….the way that people respond to stressors in the lab [should] reflect the pattern and magnitude of physiological responses they exhibit when confronted in naturalistic settings…” (Cohen & Hamrick, 2003) “…….should provide a ‘system snapshot’ of how an individual would respond to ‘real’ acutely stressful stimuli” (Wetherell et al 2006) SO……….Stronger conclusions can be drawn if lab stressors are…… More representative of ‘real life’

17. The Multi-tasking Framework A performance-based stressor representative of working environments where individuals must attend and respond to several stimuli simultaneously (e.g., a busy office)

18. Workload intensity / stress can be increased by • Increasing the number of stimuli (up to 4) • Increasing the (individual) difficulty of the stimuli Participants are instructed to …… ‘…be as fast and accurate on all tasks as you can in order to get as high a score as you can….’ Tasks require high level of engagement, therefore reduced habituation (Wetherell & Sidgreaves, 2005)

19. Multi-tasking Stress & Behavioural Reactivity Wetherell et al., (2005)

20. Multi-tasking Stress & SAM (HR & SBP) Reactivity Wetherell et al., (2007)

21. Research Question What are the effects of an acute multi-tasking stressor on psychophysiological stress reactivity?

22. Materials & Equipment - Behavioural Workload Mood (Hart & Staveland 1989) (Bond & Lader, 1974 )

23. Materials & Equipment - Physiological • Sympathetic Nervous System Reactivity • Heart Rate • Blood Pressure (systolic & diastolic)

24. Study Design – open your envelopes Use the materials templates in the envelope to design your study Decide which design would best answer your research question (you might not need all of them)

25. But before you stress anyone out….ETHICS

26. Measuring HR & BP

27. The Multi-tasking Framework

28. Choosing Modules

29. 1 Mental arithmetic Memory task Stroop Data entry Auditory monitoring Visual monitoring Visual monitoring Vigilance Module Configurations 2

30. SESSION 2 Stress Testing

31. Within Your Groups…… • Decide which configuration you are using • Use standard protocol and materials……. Each take it in turns to be………….Experimenter & Participant Each group should collect data from a minimum of 6-7 participants

32. STANDARD PROTOCOL This is the most appropriate protocol to address the research question (bearing in mind time & logistical restraints) So, this is what you should be aiming to do (missing out bits of the protocol will affect the quality of the study & your report)

33. IMPORTANT CONSIDERATIONS 1. Verbal Instructions (before each session) Very important to ensure that people ‘engage’ with the stressor ‘…be as fast and accurate on all of the tasks as you can in order to get as high a score as possible….’ 2. Adhere to a strict testing protocol Make sure all experimenters follow exactly the same procedures * Timings of measurements (esp BP & HR) very important e.g., ‘Post’ must be immediately after stress finishes * Don’t be too nice to the participants e.g., no chatting during testing etc – it’s a stress study!

35. SESSION 3 Data reduction, entry & analyses If you still have group members to test you have 30 minutes to finish your testing

36. What will we do today? • Data collation (including measurement & scoring of questionnaires) • Data entry (onto SPSS database) • Data analysis (to answer your research question) By the end of today YOU MUST have completed your data collation sheet (you will then have all the data you need to enter and analyse for your report)

37. Data Collation Cardiovascular variables HR SBP DBP Perceived Workload 64 Mood

38. Data Analyses Remember the Research Question………… You are looking at the effects of an acute stressor on……. …..psychological and physiological markers of stress reactivity Psychological (2 time points: pre & post stress) Mood: Alert, Content, Calm Workload: MD, PD, TD, Eff, Perf, Frus (PICK ONE FOR YOUR WRITE UP: Mood OR Workload) Physiological (6 time points during testing session) Cardio measures: HR, SBP, DBP (PICK ONE FOR YOUR WRITE UP)

39. Analyses – cardiovascular data Multiple (maximum of 6) samples So repeated measures ANOVA to assess differences across time-points for each cardiovascular measure (HR, SBP, DBP)

40. Analyses – Workload & Mood Pre-stress vs Post-stress comparisons so ‘Paired Samples t-Tests’ for each measure (MD, PD, TD, Eff, Perf, Frus & Alert, Content, Calm)

41. What did they find? (heart rate)

42. What did they find? (mood)

43. What did they find? (perceived workload)

44. Conclusions • GENERAL • All groups collected ‘usable’ data / were able to write a report • ‘Full of busy’ • STUDENT FEEDBACK • Enjoyed the practical aspects of the workshops (designing & testing) • BUT • Lots of confusion over ‘data analyses’ • MY FEEDBACK • Multi-tasking Framework worked well as a research / teaching tool • Students found it easy to use & progressed (relatively) unsupervised • BUT • Too much time spent explaining data analyses (at expense of testing time)

45. Report writing Objectives Achieved? Generic / Core Skills • Literature searching • Ethical considerations & documentation • Experimental design & procedural management • Data management • Data analyses & interpretation • Critical evaluation of literature, findings & methods Psychobiology Skills • Be more ‘psycho-biological’ (in practice & application – not just topic) • Provide topic specificknowledge & practical skills • Methodological issues • Techniques (& critiques) for inducing stress in the lab • Stress measurement parameters (psychological & physiological) • Logistical & practical considerations in stress research

46. Issues for Discussion DATA ANALYSES (that’s for the statty workshops) Next time... NO STATS (just descriptives) encourage interpretation of data not just p-value (small sample sizes) ASSESSMENT A better method of assessment (incorporating practical skills)? (continued) STUDENT INVOLVEMENT Overall very busy sessions BUT (for some groups) 2 Ss testing & 5 Ss loafing YOUR THOUGHTS, CRITICISMS, SUGGESTIONS ?????????????????????????????????????????????????????????

47. YEAR 3 Project Students [ethics procedures] My 3 year plan “I want to do something about stress” I’ll tell you next year “I want to study the effects of… stress on X /X on stress (responses) mark.wetherell@northumbria.ac.uk Multi-tasking Framework (www.purple-research.co.uk)

48. References & Resources Information about ‘Measuring Stress’ Wetherell, M.A. & Vedhara, K. (2005). The measurement of physiological outcomes in health psychology. In A Handbook of Research Methods in Clinical and Health Psychology, (Eds. J. Miles & P. Gilbert), Oxford University Press, UK. Wetherell, M.A., Crown, A.L., Lightman, S.L., Miles, J.N.V., Kaye, J., Vedhara, K. (2006). The four-dimensional stress test: Psychological, sympathetic-adrenal-medullary, parasympathetic and hypothalamic-pituitary-adrenal responses following inhalation of 35% CO2. Psychoneuroendocrinology, 31(6), 736-47. Acute stress & cardiovascular reactivity studies Bosch, J.A., De Gues, E.J.C., Kelder, A., Veerman, E.C.I., Hoogstraten, J. & Nieuw Amerongen, A.V. 2001. Differential effects of active versus passive coping on secretory immunity. Psychophysiology, 836-846 Bosch, J.A., De Gues, E.J.C., Veerman, E.C.I., Hoogstraten, J. & Nieuw Amerongen, A.V. 2003. Innate secretory immunity in response to laboratory stressors that evoke distinct patters of cardiac autonomic activity. Psychosomatic Medicine, 65 (2) 245-258 Phillips, A.C., Carrol, D., Ring, C., Sweeting, H., West, P. (2005). Life events and acute cardiovascular reactivity to mental stress: A cohort study. Psychosomatic Medicine, 67:384–392 (2005) Willemsen, G., Ring, C., McKeever, S. & Carroll, D. 2000. Secretory immunoglobulin A and cardiovascular activity during mental arithmetic: effects of task difficulty and task order. Biological Psychology, 127-141 Willemsen, G., Carroll, D., Ring, C. & Drayson, M. 2002. Cellular and mucosal immune reactions to mental and cold stress: Associations with gender and cardiovascular reactivity. Psychophysiology, 39, 222-228

49. References & Resources METHODS Stressor (Multi-Tasking Framework) Details about the Framework can be seen here www.purple-research.co.uk An earlier version of the Framework was called DISS – this is a study about its development Wetherell, M.A., Sidgreaves, M.C. (2005) Secretory immunoglobulin-A reactivity following increases in workload intensity using the Defined Intensity Stress Simulator. Stress Health ,21: 99–106. This reference is for a conference presentation about heart rate and blood pressure increases following multi-tasking Wetherell, M.A., Brant, H., Crown, A.L., Vedhara, K., Lightman, S.L. (2007). Effects of background stress on physiological and behavioural stress reactivity following the Multi-tasking Framework and the 35% CO2 Stress Test in newly qualified doctors. Psychobiology Section of British Psychological Society (BPS), Windermere It has also been used in other studies, for example: Kennedy, D.O., Little, W., Scholey, A.B. (2004). Attenuation of laboratory induced stress in humans following acute administration of Melissa officinalis (Lemon Balm). Psychosomatic Medicine 2004; 66, 607–613 Scales Bond, A., Lader, M. (1974). The use of analogue scales in rating subjective feelings. British Journal of Psychology, 47: 211–218 Hart, S.G., and Staveland, L.E. (1988). Development of a multi-dimensional workload rating scale: Results of empirical and theoretical research. In: P.A. Hancock and N. Meshkati (Eds.), Human Mental Workload. Amsterdam. The Netherlands: Elsevier