Advertisement

Applied Psychophysiology and Biofeedback

, Volume 41, Issue 2, pp 129–139 | Cite as

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

  • Marianna Munafò
  • Elisabetta Patron
  • Daniela Palomba
Article

Abstract

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.

Keywords

Biofeedback Respiratory sinus arrhythmia Managers Stress Cardiovascular risk 

Notes

Acknowledgments

The study was supported by Mind Room International s.r.l., and its partners Confindustria Vicenza and Banca Popolare di Vicenza (Funding Number 382/3/17/5/5/24/2010). The funding source contributed to the recruiting of participants, but it had no involvement in study design, data collection, analysis and interpretation, the writing of the report and the decision to submit the paper for publication.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Apolone, G., & Mosconi, P. (1998). The Italian SF-36 Health Survey: Translation, validation and norming. Journal of Clinical Epidemiology, 51(11), 1025–1036.CrossRefPubMedGoogle Scholar
  2. Appelhans, B. M., & Luecken, L. J. (2006). Heart rate variability as an index of regulated emotional responding. Review of General Psychology, 10(3), 229–240. doi: 10.1037/1089-2680.10.3.229.CrossRefGoogle Scholar
  3. Aronsson, G. (1999). Influence of worklife on public health. Scandinavian Journal of Work, Environment and Health, 25(6), 597–604.CrossRefPubMedGoogle Scholar
  4. Aysin, B., & Aysin, E. (2006). Effect of respiration in heart rate variability (HRV) analysis. In IEEE engineering in medicine and biology society. Annual conference (vol. 1, pp. 1776–1779).Google Scholar
  5. Backé, E.-M., Seidler, A., Latza, U., Rossnagel, K., & Schumann, B. (2012). The role of psychosocial stress at work for the development of cardiovascular diseases: A systematic review. International Archives of Occupational and Environmental Health, 85(1), 67–79.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Béjean, S., & Sultan-Taïeb, H. (2005). Modeling the economic burden of diseases imputable to stress at work. The European Journal of Health Economics, 6(1), 16–23.CrossRefPubMedGoogle Scholar
  7. Belkic, K., Landsbergis, Pa, Schnall, P. L., & Baker, D. (2004). Is job strain a major source of cardiovascular disease risk? Scandinavian Journal of Work, Environment and Health, 30(2), 85–128.CrossRefPubMedGoogle Scholar
  8. Bellarosa, C., & Chen, P. Y. (1997). The effectiveness and practicality of occupational stress management interventions: A survey of subject matter expert opinions. Journal of Occupational Health Psychology, 2(3), 247–262.CrossRefPubMedGoogle Scholar
  9. Bingham, J. B. (2005). Job demands and job search among high-level managers in the United States and Europe. Group and Organization Management, 30(6), 653–681.CrossRefGoogle Scholar
  10. Brett, J. M., & Stroh, L. K. (2003). Working 61 plus hours a week: Why do managers do it? The Journal of Applied Psychology, 88(1), 67–78.CrossRefPubMedGoogle Scholar
  11. Chandola, T., Heraclides, A., & Kumari, M. (2010). Psychophysiological biomarkers of workplace stressors. Neuroscience and Biobehavioral Reviews, 35(1), 51–57.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Cohen, J. (1969). Statistical power analysis for the behavioral sciences. New York: Academic Press.Google Scholar
  13. Collins, S. M., Karasek, R. A., & Costas, K. (2005). Job strain and autonomic indices of cardiovascular disease risk. American Journal of Industrial Medicine, 48(3), 182–193.CrossRefPubMedGoogle Scholar
  14. Del Pozo, J. M., Gevirtz, R. N., Scher, B., & Guarneri, E. (2004). Biofeedback treatment increases heart rate variability in patients with known coronary artery disease. American Heart Journal, 147(3), E11–E17.PubMedGoogle Scholar
  15. Dewa, C. S., Thompson, A. H., & Jacobs, P. (2011). Relationships between job stress and worker perceived responsibilities and job characteristics. International Journal of Occupational and Environmental Medicine, 2(1), 37–46.PubMedGoogle Scholar
  16. Eller, N. H., Blønd, M., Nielsen, M., Kristiansen, J., & Netterstrøm, B. (2011a). Effort reward imbalance is associated with vagal withdrawal in Danish public sector employees. International Journal of Psychophysiology, 81(3), 218–224.CrossRefPubMedGoogle Scholar
  17. Eller, N. H., Kristiansen, J., & Hansen, A. M. (2011b). Long-term effects of psychosocial factors of home and work on biomarkers of stress. International Journal of Psychophysiology, 79(2), 195–202.CrossRefPubMedGoogle Scholar
  18. Flier, J. S., Underhill, L. H., & McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179.CrossRefGoogle Scholar
  19. Fowles, D. C., Christie, M. J., Edelberg, R., Grings, W. W., Lykken, D. T., & Venables, P. H. (1981). Publication recommendations for electrodermal measurements. Psychophysiology, 18(3), 232–239.CrossRefPubMedGoogle Scholar
  20. Gandek, B., & Ware, J. E. (1993). SF-36 Health Survey: Manual and interpretation guide. Boston, MA: The Health Institute, New England Medical Center.Google Scholar
  21. Gevirtz, R., & Lehrer, P. M. (2003). Resonant frequency heart rate biofeedback. In M. S. F. Andrasik (Ed.), Biofeedback: A practitioner’s guide. New York, NY: Guilford.Google Scholar
  22. Giga, S. I., Cooper, C. L., & Faragher, B. (2003). The development of a framework for a comprehensive approach to stress management interventions at work. International Journal of Stress Management, 10(4), 280–296.CrossRefGoogle Scholar
  23. Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74(1), 224–237.CrossRefPubMedGoogle Scholar
  24. Grossman, P. (1983). Respiration, stress, and cardiovascular function. Psychophysiology, 20(3), 284–300.CrossRefPubMedGoogle Scholar
  25. Grossman, P., & Taylor, E. (2007). Toward understanding respiratory sinus arrhythmia: Relations to cardiac vagal tone, evolution and biobehavioral functions. Biological Psychology, 74(2), 263–285.CrossRefPubMedGoogle Scholar
  26. Hambrick, D. C., Finkelstein, S., & Mooney, A. C. (2005). Executive job demands: New insights for explaining strategic decisions and leader behaviors. Academy of Management Review, 30(3), 472–491.CrossRefGoogle Scholar
  27. Hemingway, H., Shipley, M., Brunner, E., Britton, A., Malik, M., & Marmot, M. (2005). Does autonomic function link social position to coronary risk? The Whitehall II study. Circulation, 111(23), 3071–3077.CrossRefPubMedGoogle Scholar
  28. Hintsanen, M., Elovainio, M., Puttonen, S., Kivimaki, M., Koskinen, T., Raitakari, O. T., & Keltikangas-Jarvinen, L. (2007). Effort-reward imbalance, heart rate, and heart rate variability: The cardiovascular risk in young Finns study. International Journal of Behavioral Medicine, 14(4), 202–212.CrossRefPubMedGoogle Scholar
  29. Institute of Management. (1993). Managers under stress: A survey of management morale in the 90s. (Institute of Management, Ed.). London.Google Scholar
  30. Ivancevich, J. M., Matteson, M. T., Freedman, S. M., & Phillips, J. S. (1990). Worksite stress management interventions. American Psychologist, 45(2), 252–261.CrossRefPubMedGoogle Scholar
  31. Judge, T. A., Boudreau, J. W., & Bretz, R. D. (1994). Job and life attitudes of male executives. The Journal of Applied Psychology, 79(5), 767–782.CrossRefPubMedGoogle Scholar
  32. Kang, M. G., Koh, S. B., Cha, B. S., Park, J. K., Woo, J. M., & Chang, S. J. (2004). Association between job stress on heart rate variability and metabolic syndrome in shipyard male workers. Yonsei Medical Journal, 45(5), 838–846.CrossRefPubMedGoogle Scholar
  33. Kiecolt-Glaser, J. K., & Glaser, R. (1995). Psychoneuroimmunology and health consequences: Data and shared mechanisms. Psychosomatic Medicine, 57(3), 269–274.CrossRefPubMedGoogle Scholar
  34. Kivimäki, M., Leino-Arjas, P., Luukkonen, R., Riihimäki, H., Vahtera, J., & Kirjonen, J. (2002). Work stress and risk of cardiovascular mortality: Prospective cohort study of industrial employees. British Medical Journal, 325(7369), 857.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Knudsen, H. K., Ducharme, L. J., & Roman, P. M. (2009). Turnover intention and emotional exhaustion “at the top”: Adapting the job demands-resources model to leaders of addiction treatment organizations. Journal of Occupational Health Psychology, 14(1), 84–95.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Kushnir, T., Malkinson, R., & Ribak, J. (1998). Rational thinking and stress management in health workers: A psychoeducational program. International Journal of Stress Management, 5(3), 169–178.CrossRefGoogle Scholar
  37. Lamontagne, F., Labbé, A.-C., Haeck, O., Lesur, O., Lalancette, M., Patino, C., et al. (2007). Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Annals of Surgery, 245(2), 267–272.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. Appraisal, and coping (p. 445). Berlin: Springer.Google Scholar
  39. Lehrer, P. M., Carr, R. E., Smetankine, A., Vaschillo, E., Peper, E., Porges, S., et al. (1997). Respiratory sinus arrhythmia versus neck/trapezius EMG and incentive inspirometry biofeedback for asthma: A pilot study. Applied Psychophysiology and Biofeedback, 22(2), 95–109.CrossRefPubMedGoogle Scholar
  40. Lehrer, P. M., Vaschillo, E., & Vaschillo, B. (2000). Resonant frequency biofeedback training to increase cardiac variability: Rationale and manual for training. Applied Psychophysiology and Biofeedback, 25(3), 177–191.CrossRefPubMedGoogle Scholar
  41. Lehrer, P. M., Vaschillo, E., Vaschillo, B., Lu, S., Eckberg, D., Edelberg, R., et al. (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosomatic Medicine, 65(5), 796–805.CrossRefPubMedGoogle Scholar
  42. Lehrer, P. M., Woolfolk, R. L., & Sime, W. E. (2007). Principles and practice of stress management. New York, NY: The Guilford Press.Google Scholar
  43. Little, L. M., Simmons, B. L., & Nelson, D. L. (2007). Health among leaders: Positive and negative affect, engagement and burnout, forgiveness and revenge. Journal of Management Studies, 44(2), 243–260.CrossRefGoogle Scholar
  44. Lu, S., Zhao, H., Ju, K., Shin, K., Lee, M., Shelley, K., & Chon, K. H. (2008). Can photoplethysmography variability serve as an alternative approach to obtain heart rate variability information? Journal of Clinical Monitoring and Computing, 22(1), 23–29.CrossRefPubMedGoogle Scholar
  45. Lucini, D., Mela, G. S., Malliani, A., & Pagani, M. (2002). Impairment in cardiac autonomic regulation preceding arterial hypertension in humans: Insights from spectral analysis of beat-by-beat cardiovascular variability. Circulation, 106(21), 2673–2679.CrossRefPubMedGoogle Scholar
  46. Lucini, D., Riva, S., Pizzinelli, P., & Pagani, M. (2007). Stress management at the worksite reversal of symptoms profile and cardiovascular dysregulation. Hypertension, 49(2), 291–297.CrossRefPubMedGoogle Scholar
  47. Malik, M., & Camm, A. J. (1993). Components of heart rate variability—What they really mean and what we really measure. The American Journal of Cardiology, 72(11), 821–822.CrossRefPubMedGoogle Scholar
  48. Manning, M. R., Jackson, C. N., & Fusilier, M. R. (1996). Occupational stress, social support, and the costs of health care. Academy of Management Journal, 39(3), 738–750.CrossRefPubMedGoogle Scholar
  49. Mirowsky, J., & Ross, C. E. (2005). Education, cumulative advantage, and health. Ageing International, 30(1), 27–62.CrossRefGoogle Scholar
  50. Mohr, G., & Wolfram, H.-J. (2010). Stress among managers: The importance of dynamic tasks, predictability, and social support in unpredictable times. Journal of Occupational Health Psychology, 15(2), 167.CrossRefPubMedGoogle Scholar
  51. Möller, J., Theorell, T., de Faire, U., Ahlbom, A., & Hallqvist, J. (2005). Work related stressful life events and the risk of myocardial infarction. Case-control and case-crossover analyses within the Stockholm heart epidemiology programme (SHEEP). Journal of Epidemiology and Community Health, 59(1), 23–30.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Nolan, R. P., Kamath, M. V., Floras, J. S., Stanley, J., Pang, C., Picton, P., & Young, Q. R. (2005). Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart rate control. American Heart Journal, 149(6), 1137.CrossRefPubMedGoogle Scholar
  53. Ohsuga, M., Shimono, F., & Genno, H. (2001). Assessment of phasic work stress using autonomic indices. International Journal of Psychophysiology, 40(3), 211–220.CrossRefPubMedGoogle Scholar
  54. Patron, E., Messerotti Benvenuti, S., Favretto, G., Valfrè, C., Bonfà, C., Gasparotto, R., & Palomba, D. (2013). Biofeedback assisted control of respiratory sinus arrhythmia as a biobehavioral intervention for depressive symptoms in patients after cardiac surgery: A preliminary study. Applied Psychophysiology and Biofeedback, 38(1), 1–9.CrossRefPubMedGoogle Scholar
  55. Pickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J., Hill, M. N., et al. (2005). 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. Circulation, 111(5), 697–716.CrossRefPubMedGoogle Scholar
  56. Quick, J. C., Macik-Frey, M., & Cooper, C. L. (2007). Managerial dimensions of organizational health: The healthy leader at work. Journal of Management Studies, 44(2), 189–205.CrossRefGoogle Scholar
  57. Richardson, K. M., & Rothstein, H. R. (2008). Effects of occupational stress management intervention programs: A meta-analysis. Journal of Occupational Health Psychology, 13(1), 69–93.CrossRefPubMedGoogle Scholar
  58. Rosengren, A., Hawken, S., Ounpuu, S., Sliwa, K., Zubaid, M., Almahmeed, W. A., et al. (2004). 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. The Lancet, 364(9438), 953–962.CrossRefGoogle Scholar
  59. Rozanski, A., Blumenthal, J. A., Davidson, K. W., Saab, P. G., & Kubzansky, L. (2005). The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: The emerging field of behavioral cardiology. Journal of the American College of Cardiology, 45(5), 637–651.CrossRefPubMedGoogle Scholar
  60. Schieman, S., & Reid, S. (2009). Job authority and health: Unraveling the competing suppression and explanatory influences. Social Science and Medicine, 69(11), 1616–1624.CrossRefPubMedGoogle Scholar
  61. Schwartz, M. S., & Andrasik, F. E. (2003). Biofeedback: A practitioner’s guide. New York: Guilford Press.Google Scholar
  62. Sherlin, L., Gevirtz, R., Wyckoff, S., & Muench, F. (2009). Effects of respiratory sinus arrhythmia biofeedback versus passive biofeedback control. International Journal of Stress Management, 16(3), 233.CrossRefGoogle Scholar
  63. Spielberger, C. D., Gorusch, R., & Lushene, R. (1970). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
  64. Spielberger, C. D., Pedrabissi, L., & Santinello, M. (1996). STAI, state-trait anxiety inventory, Forma Y: Manuale. Firenze: Organizzazioni Speciali.Google Scholar
  65. Vaschillo, E. G., Vaschillo, B., & Lehrer, P. M. (2006). Characteristics of resonance in heart rate variability stimulated by biofeedback. Applied Psychophysiology and Biofeedback, 31(2), 129–142.CrossRefPubMedGoogle Scholar
  66. Vrijkotte, T. G. M., van Doornen, L. J. P., & de Geus, E. J. C. (2000). Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability. Hypertension, 35(4), 880–886.CrossRefPubMedGoogle Scholar
  67. Wechsler, M. E., Kelley, J. M., Boyd, I. O. E., Dutile, S., Marigowda, G., Kirsch, I., et al. (2011). Active albuterol or placebo, sham acupuncture, or no intervention in asthma. The New England Journal of Medicine, 365(2), 119–126.CrossRefPubMedPubMedCentralGoogle Scholar
  68. Wheat, A. L., & Larkin, K. T. (2010). Biofeedback of heart rate variability and related physiology: A critical review. Applied Psychophysiology and Biofeedback, 35(3), 229–242.CrossRefPubMedGoogle Scholar
  69. Worrall, L., & Cooper, C. (1995). Executive stress in different industrial sectors, structures and sizes of business. Personnel Review, 24(7), 3–12.CrossRefGoogle Scholar
  70. Yucha, C., & Montgomery, D. (2008). Evidence-based practice in biofeedback and neurofeedback. Wheat Ridge, CO: AAPB.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Marianna Munafò
    • 1
  • Elisabetta Patron
    • 1
  • Daniela Palomba
    • 1
  1. 1.Department of General PsychologyUniversity of PadovaPaduaItaly

Personalised recommendations