Improving Managers’ Psychophysical Well-Being: Effectiveness of Respiratory Sinus Arrhythmia Biofeedback

High work stress has been consistently associated with disturbed autonomic balance, specifically, lowered vagal cardiac control and increased sympathetic activity, which may lead to increased cardiovascular risk. Stress management procedures have been proposed to reduce autonomic dysfunctions related to work stress in different categories of workers exposed to heightened work demands, while a limited number of studies addressed this issue in managers. The present study was aimed at evaluating the effectiveness of a respiratory sinus arrhythmia (RSA) biofeedback (BF) intervention on psychological and physiological outcomes, in managers with high-level work responsibilities. Thirty-one managers leading outstanding private or public companies were randomly assigned to either a RSA-BF training (RSA-BF; N = 16) or a control group (N = 15). The RSA-BF training consisted of five weekly 45 min sessions, designed to increase RSA, whereas controls had to provide a daily stress diary once a week. After the training, managers in both groups reported reduced heart rate at rest, lower anxiety levels and improvement in health-related quality of life. More importantly, managers in the RSA-BF group showed increased vagal control (as indexed by increased RSA), decreased sympathetic arousal (as indexed by reduced skin conductance and systolic blood pressure) and lower emotional interferences, compared to managers in the control group. Results from this study showed that RSA-BF training was effective in improving cardiac autonomic balance at rest. Moreover, findings from this study underline the effectiveness of biofeedback in reducing psychophysiological negative outcomes associated with stress in managers.

[1]  P. Venables,et al.  Publication recommendations for electrodermal measurements. , 1981 .

[2]  A. Camm,et al.  Components of heart rate variability--what they really mean and what we really measure. , 1993, The American journal of cardiology.

[3]  Ritva Luukkonen,et al.  Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees , 2002, BMJ : British Medical Journal.

[4]  C. Cooper,et al.  The development of a framework for a comprehensive approach to stress management interventions at work: From stress to wellbeing , 2003 .

[5]  B. Netterstrøm,et al.  Effort reward imbalance is associated with vagal withdrawal in Danish public sector employees. , 2011, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[6]  C. Spielberger,et al.  Manual for the State-Trait Anxiety Inventory , 1970 .

[7]  Mark S. Schwartz,et al.  Biofeedback: A Practitioner's Guide , 1987 .

[8]  B. McEwen Protective and damaging effects of stress mediators. , 1998, The New England journal of medicine.

[9]  Daniel W. Jones,et al.  Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. , 2005, Hypertension.

[10]  S. Béjean,et al.  Modeling the economic burden of diseases imputable to stress at work , 2005, The European Journal of Health Economics.

[11]  Jacob Cohen Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[12]  Weichung Joe Shih,et al.  Heart Rate Variability Biofeedback Increases Baroreflex Gain and Peak Expiratory Flow , 2003, Psychosomatic medicine.

[13]  P. Landsbergis,et al.  Is job strain a major source of cardiovascular disease risk? , 2004, Scandinavian journal of work, environment & health.

[14]  P. Grossman,et al.  Toward understanding respiratory sinus arrhythmia: Relations to cardiac vagal tone, evolution and biobehavioral functions , 2007, Biological Psychology.

[15]  R. Karasek,et al.  Job strain and autonomic indices of cardiovascular disease risk. , 2005, American journal of industrial medicine.

[16]  Karina W Davidson,et al.  The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. , 2005, Journal of the American College of Cardiology.

[17]  Frederick Muench,et al.  Effects of Respiratory Sinus Arrhythmia Biofeedback Versus Passive Biofeedback Control , 2009 .

[18]  W. Elliott,et al.  Recommendations for Blood Pressure Measurement in Humans and Experimental Animals: Part 1. Blood Pressure Measurement in Humans. A Statement for Professionals From the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure ResearchPickering , 2006 .

[19]  K. Chon,et al.  Can Photoplethysmography Variability Serve as an Alternative Approach to Obtain Heart Rate Variability Information? , 2008, Journal of Clinical Monitoring and Computing.

[20]  J. Ware SF-36 health survey: Manual and interpretation guide , 2003 .

[21]  C. Dewa,et al.  Relationships between job stress and worker perceived responsibilities and job characteristics. , 2011, The international journal of occupational and environmental medicine.

[22]  Carolyn B. Yucha,et al.  Evidence-based practice in biofeedback and neurofeedback , 2008 .

[23]  Peter Chen,et al.  The effectiveness and practicality of occupational stress management interventions: a survey of subject matter expert opinions. , 1997, Journal of occupational health psychology.

[24]  R. Gevirtz,et al.  Biofeedback treatment increases heart rate variability in patients with known coronary artery disease. , 2004, American heart journal.

[25]  Å. Hansen,et al.  Long-term effects of psychosocial factors of home and work on biomarkers of stress. , 2011, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[26]  E. D. de Geus,et al.  Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability. , 2000, Hypertension.

[27]  M. Kumari,et al.  Psychophysiological biomarkers of workplace stressors , 2010, Neuroscience & Biobehavioral Reviews.

[28]  S. Yusuf,et al.  Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study , 2004, The Lancet.

[29]  J. S. Phillips,et al.  Worksite stress management interventions. , 1990, The American psychologist.

[30]  A. Seidler,et al.  The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review , 2011, International Archives of Occupational and Environmental Health.

[31]  M. Ohsuga,et al.  Assessment of phasic work stress using autonomic indices. , 2001, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[32]  D. Nelson,et al.  Health Among Leaders: Positive and Negative Affect, Engagement and Burnout, Forgiveness and Revenge , 2007 .

[33]  Biofeedback Assisted Control of Respiratory Sinus Arrhythmia as a Biobehavioral Intervention for Depressive Symptoms in Patients After Cardiac Surgery: A Preliminary Study , 2013, Applied psychophysiology and biofeedback.

[34]  R. Edelberg,et al.  Respiratory Sinus Arrhythmia Versus Neck/Trapezius EMG and Incentive Inspirometry Biofeedback for Asthma: A Pilot Study , 1997, Applied psychophysiology and biofeedback.

[35]  P. Grossman Respiration, stress, and cardiovascular function. , 1983, Psychophysiology.

[36]  J. Kiecolt-Glaser,et al.  Psychoneuroimmunology and health consequences: data and shared mechanisms. , 1995, Psychosomatic medicine.

[37]  P. Lehrer,et al.  Resonant Frequency Biofeedback Training to Increase Cardiac Variability: Rationale and Manual for Training , 2000, Applied psychophysiology and biofeedback.

[38]  M. Malik,et al.  Does Autonomic Function Link Social Position to Coronary Risk?: The Whitehall II Study , 2005, Circulation.

[39]  M. Manning,et al.  Occupational stress, social support, and the costs of health care. , 1996, Academy of Management journal. Academy of Management.

[40]  C. Ross,et al.  Education, cumulative advantage, and health , 2005 .

[41]  C. Cooper,et al.  Executive stress in different industrial sectors, structures and sizes of business , 1995 .

[42]  E. Israel,et al.  Active albuterol or placebo, sham acupuncture, or no intervention in asthma. , 2011, The New England journal of medicine.

[43]  Scott Schieman,et al.  Job authority and health: unraveling the competing suppression and explanatory influences. , 2009, Social science & medicine.

[44]  O. Lesur,et al.  Impact of Emergency Colectomy on Survival of Patients With Fulminant Clostridium difficile Colitis During an Epidemic Caused by a Hypervirulent Strain , 2007, Annals of surgery.

[45]  Lori J. Ducharme,et al.  Turnover intention and emotional exhaustion "at the top": adapting the job demands-resources model to leaders of addiction treatment organizations. , 2009, Journal of occupational health psychology.

[46]  Massimo Pagani,et al.  Stress Management at the Worksite: Reversal of Symptoms Profile and Cardiovascular Dysregulation , 2007, Hypertension.

[47]  G Aronsson,et al.  Influence of worklife on public health. , 1999, Scandinavian journal of work, environment & health.

[48]  P. Lehrer,et al.  Characteristics of Resonance in Heart Rate Variability Stimulated by Biofeedback , 2006, Applied psychophysiology and biofeedback.

[49]  C. Cooper,et al.  *Managerial Dimensions of Organizational Health: The Healthy Leader at Work , 2007 .

[50]  E. Magnoux,et al.  Resonant frequency heart rate biofeedback in chronic headache , 2012 .

[51]  G. Apolone,et al.  The Italian SF-36 Health Survey: translation, validation and norming. , 1998, Journal of clinical epidemiology.

[52]  Sydney Finkelstein,et al.  Executive Job Demands: New Insights for Explaining Strategic Decisions and Leader Behaviors , 2005 .

[53]  T. Judge,et al.  Job and life attitudes of male executives. , 1994, The Journal of applied psychology.

[54]  Linda K. Stroh,et al.  Working 61 plus hours a week: why do managers do it? , 2003, The Journal of applied psychology.

[55]  Katherine M. Richardson,et al.  Effects of occupational stress management intervention programs: a meta-analysis. , 2008, Journal of occupational health psychology.

[56]  S. Folkman,et al.  Stress, Appraisal, and Coping. New York, NY: Springer; , 1984 .

[57]  J. Boudreau,et al.  Job Demands and Job Search Among High-Level Managers in the United States and Europe , 2005 .

[58]  M. Hintsanen,et al.  Effort—reward imbalance, heart rate, and heart rate variability: the cardiovascular risk in young finns study , 2007, International journal of behavioral medicine.

[59]  G. Mohr,et al.  Stress among managers: the importance of dynamic tasks, predictability, and social support in unpredictable times. , 2010, Journal of occupational health psychology.

[60]  J. Gross Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology. , 1998, Journal of personality and social psychology.

[61]  B. Appelhans,et al.  Heart Rate Variability as an Index of Regulated Emotional Responding , 2006 .

[62]  P. Lehrer,et al.  Principles And Practice Of Stress Management , 1984 .

[63]  S. Chang,et al.  Association between job stress on heart rate variability and metabolic syndrome in shipyard male workers. , 2004, Yonsei medical journal.

[64]  K. Larkin,et al.  Biofeedback of Heart Rate Variability and Related Physiology: A Critical Review , 2010, Applied psychophysiology and biofeedback.

[65]  J. Ribak,et al.  Rational Thinking and Stress Management in Health Workers: A Psychoeducational Program , 1998 .

[66]  S. Folkman,et al.  Stress, appraisal, and coping , 1974 .

[67]  A. Malliani,et al.  Impairment in Cardiac Autonomic Regulation Preceding Arterial Hypertension in Humans: Insights From Spectral Analysis of Beat-by-Beat Cardiovascular Variability , 2002, Circulation.

[68]  A. Ahlbom,et al.  Work related stressful life events and the risk of myocardial infarction. Case-control and case-crossover analyses within the Stockholm heart epidemiology programme (SHEEP) , 2004, Journal of Epidemiology and Community Health.

[69]  P. Picton,et al.  Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart rate control. , 2005, American heart journal.

[70]  B. Aysin,et al.  Effect of Respiration in Heart Rate Variability (HRV) Analysis , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.