Glenn Albright

Effects of stress management on blood pressure and other cardiovascular variables

Blood pressure and impedance cardiography derived measures of heart rate, stroke volume, cardiac output and total peripheral resistance were measured in 16 persons before and after participation in a comprehensive program of stress management that included home monitoring of blood pressure and feedback of finger skin temperature during relaxation. Ten of the subjects were hypertensive and six were normotensive. Baseline measures of systolic and diastolic blood pressure and heart rate decreased significantly after participation in the program. In addition, reactivity to a psychological stressor (oral quiz) was significantly lower as revealed in reduced systolic and diastolic pressure, heart rate and cardiac output at the second assessment. A reduction in sympathetic nervous system activity is postulated as a possible mechanism for the changes observed.

Effects of Warming Imagery Aimed at Trigger-Point Sites on Tissue Compliance, Skin Temperature, and Pain Sensitivity in Biofeedback-Trained Patients with Chronic Pain: A Preliminary Study

13 subjects were trained in biofeedback and self-regulation strategies for reducing chronic pain. Upon demonstrating ability to hand warm, subjects were exposed to an imagery exercise designed to increase skin temperature at trigger-point sites, which are small tender irritative foci located in the soft tissue. Skin temperature, tissue compliance, and pressure-pain sensitivity were recorded before and after imagery intervention. Subjects showed significant increases in skin temperature and muscle relaxation at trigger-point sites and decreases in pressure-pain sensitivity. This suggests that localized trigger-point warming may be an effective adjunct in treating chronic pain.

Interactive effects of type A personality and psychological and physical stressors on human cardiovascular functions

The first part of this study examined the relationship(s) between Type A behavior scores and heart rate, blood pressure and impedance derived cardiovascular measures in response to discrete stressors during a standardized psychophysiological assessment. Expts. 2A and 2B considered cardiovascular responses to dynamic exercise stress alone and in combination with psychological and cold pressor tests. Gender and stroke volume changes during the psychological stress correlated 0.45 (P less than 0.02) with Type A score. Subscale scores of Job Involvement correlated 0.78 (P less than 0.02) with stroke volume, total systemic resistance and heart rate during the psychological stressor, and systolic blood pressure during the cold pressor task. The combined effects of psychological stress and dynamic exercise on systolic and diastolic blood pressure were significantly greater than the individual effects of these stressors. The use of impedance cardiography in measuring cardiovascular variables that correlate with Type A behavior, during psychophysiological assessments, may further elucidate our understanding of Type A behavior in addition to providing information about how stress interacts with aerobic exercise.

Harnessing the power of conversations with virtual humans to change health behaviors

Skillful, collaborative conversations are powerful tools to improve physical and mental health. Whether you are a parent talking with your child about the dangers of substance abuse, an educator concerned about a students signs of psychological distress, a veteran worried about a buddy who is contemplating suicide, or a healthcare professional wanting to better engage patients to increase treatment compliance, having the skill, confidence and motivation to engage in conversations can truly transform the health and well-being of those you interact with. Kognito develops role-play simulations that prepare individuals to effectively lead real-life conversations that measurably improve social, emotional, and physical health. The behavior change model that drives the simulations draws upon components of game mechanics, virtual human simulation technology and integrates evidence-based instructional design components as well as principles of social-cognitive theory and neuroscience such as motivational interviewing, emotional regulation, empathy and mindfulness. In the simulations, users or enter a risk-free practice environment and engage in a conversation with intelligent, fully animated, and emotionally responsive virtual characters that model human behavior. It is in practicing these conversations, and receiving feedback from a virtual coach, that users learn to better lead conversations in real life. Numerous longitudinal studies have shown that users who complete Kognito simulations demonstrate statistically significant and sustained increases in attitudinal variables that predict behavior change including preparedness, likelihood, and self-efficacy to better manage conversations. Pending the target population, each online or mobile simulation resulted in desired behavior changes ranging from increased referrals of students, patients or veterans in psychological distress to mental health support services, or increasing physician patient-centered communication or patient self-confidence and active involved in the decision-making processes. These simulations have demonstrated a capability to address major health and public health concerns where effective conversations are necessary to bring about changes in attitudes and behaviors.

Cardiodynamic response to psychological and cold pressor stress: Further evidence for stimulus response specificity and directional fractionation

In the present study 36 police officers were exposed to a psychological stressor (IQ quiz) and to cold pressor stress while several cardiovascular variables were monitored. Impedance cardiography was used to provide measures of heart rate, stroke volume, cardiac output, myocardial contractility, and total peripheral resistance. In addition, measures of systolic and diastolic blood pressure and peripheral skin temperature were obtained. A multivariate analysis of variance (MANOVA) indicated that significant increases in diastolic and systolic blood pressure during the cold pressor test were mediated by large increases in total peripheral resistance, whereas blood pressure elevation during the IQ quiz were accompanied by significant increases in heart rate and, to a lesser extent, cardiac output. Peripheral skin temperature decreased in response to each stressor. Additional analysis indicated a degree of stimulus specificity for several variables. For example, diastolic blood pressure showed greater increases to cold pressor than quiz, whereas systolic blood pressure increased more with the psychological than the physical stressor. Directional fractionation occurred for both myocardial contractility and cardiac output.

Virtual humans: transforming mHealth for veterans with post-traumatic stress disorder (PTSD)

The use of virtual humans (VHs) in mHealth to manage health conversations, ranging from screening and education to changing attitudes and behaviors that reduce risk and increase treatment compliance, and treatment itself, holds tremendous potential to cost-effectively transform world-wide healthcare as we know it.

Gatekeeper Training to Prevent Suicide in the Emergency Department and in Primary Care

Applied to suicide prevention, a gatekeeper is an individual who can recognize when a person is manifesting signs of psychological distress including depression and suicidal ideation, approach and talk with that person about concerns, and if necessary, make an effective referral to mental health support services. This chapter introduces the reader to new and innovative game-based simulation technology through which primary care professionals and emergency department personnel learn to effectively manage what can be difficult gatekeeper conversations with their patients. The simulations place users in an online environment where they practice role-plays with emotionally responsive virtual patients who have memory and personality and will react like real patients at risk for suicide. It is by practicing these role-plays, and receiving feedback from a virtual coach, that users gain the knowledge, skill, and self-efficacy to successfully apply evidence-based communication strategies such as motivational interviewing to become effective gatekeepers. The chapter overviews the advantages of utilizing virtual humans in role-plays, the learning model embedded into the Kognito conversation platform that drives the simulations, and the results of two outcome studies that examine efficacy.

Using Virtual Patient Simulations to Prepare Primary Health Care Professionals to Conduct Substance Use and Mental Health Screening and Brief Intervention

BACKGROUND: Primary health care professionals are in an excellent position to identify, screen, and conduct brief interventions for patients with mental health and substance use disorders. However, discomfort in initiating conversations about behavioral health, time concerns, lack of knowledge about screening tools, and treatment resources are barriers. OBJECTIVE: This study examines the impact of an online simulation where users practice role-playing with emotionally responsive virtual patients to learn motivational interviewing strategies to better manage screening, brief interventions, and referral conversations. DESIGN: Baseline data were collected from 227 participants who were then randomly assigned into the treatment or wait-list control groups. Treatment group participants then completed the simulation, postsimulation survey, and 3-month follow-up survey. RESULTS: Results showed significant increases in knowledge/skill to identify and engage in collaborative decision making with patients. CONCLUSIONS: Results strongly suggest that role-play simulation experiences can be an effective means of teaching screening and brief intervention.

Enhancing Educator Engagement in School Mental Health Care Through Digital Simulation Professional Development

BACKGROUND Despite the critical role of educators as gatekeepers for school mental health services, they receive limited training to support student mental health. We report findings from a trial of an online mental health role-play simulation for elementary school teachers on changes in attitudes and self-reported helping behaviors for students experiencing psychological distress. METHODS We randomly assigned 18,896 elementary school teachers to wait-list control or intervention conditions in which they received the 45- to 90-minute online role-play simulation. We administered a version of the validated Gatekeeper Behavior Scale at baseline and postintervention, which measures attitudinal dimensions shown to predict teacher helping behavior change. Self-reported helping behaviors were collected at baseline and 3-month follow-up. Outcomes were compared between the intervention follow-up and control group baseline measures. RESULTS The intervention group posttraining scores were significantly higher (p < .001) than the control group for all the preparedness, likelihood, and self-efficacy Gatekeeper Behavior subscales. All 5 helping behaviors were significantly higher among the intervention group at follow-up compared to the control group at baseline. CONCLUSIONS We found that a brief online role-play simulation was an effective strategy for improving teacher attitudes and behaviors needed to perform a positive mental health gatekeeper role in schools.