Physicians' psychophysiological stress reaction in medical communication of bad news: A critical literature review.

Stress is a common phenomenon in medical professions. Breaking bad news (BBN) is reported to be a particularly distressing activity for physicians. Traditionally, the stress experienced by physicians when BBN was assessed exclusively using self-reporting. Only recently, the field of difficult physician-patient communication has used physiological assessments to better understand physicians' stress reactions. This paper's goals are to (a) review current knowledge about the physicians' psychophysiological stress reactions in BBN situations, (b) discuss methodological aspects of these studies and (c) suggest directions for future research. The seven studies identified all used scenarios with simulated patients but were heterogeneous with regard to other methodological aspects, such as the psychophysiological parameters, time points and durations assessed, comparative settings, and operationalisation of the communication scenarios. Despite this heterogeneity, all the papers reported increases in psychological and/or physiological activation when breaking bad news in comparison to control conditions, such as history taking or breaking good news. Taken together, the studies reviewed support the hypothesis that BBN is a psychophysiologically arousing and stressful task for medical professionals. However, much remains to be done. We suggest several future directions to advance the field. These include (a) expanding and refining the conceptual framework, (b) extending assessments to include more diverse physiological parameters, (c) exploring the modulatory effects of physicians' personal characteristics (e.g. level of experience), (d) comparing simulated and real-life physician-patient encounters and (e) combining physiological assessment with a discourse analysis of physician-patient communication

The relationship between music performance anxiety, subjective performance quality and post-event rumination among music students

According to cognitive models, the negative perception of one’s performance and the post-event rumination (PER) occurring after stressful social events maintain social anxiety. These aspects have hardly been studied in music performance anxiety (MPA), a specific form of social anxiety. The first aim of this study was to analyze the development of negative and positive PER over two days following a soloist concert, depending on the usual MPA level. The second aim was to investigate if subjective performance quality serves as mediator between MPA and PER. Negative and positive PER were assessed 10 minutes, one day and two days after a concert in 72 music students with different levels of usual MPA. Subjective performance quality was measured 10 minutes after the study concert. An increasing usual MPA level was associated with more negative and less positive PER. Both decreased over time. Negative PER decreased less rapidly in high-anxious than in low-anxious musicians and positive PER decreased more rapidly in low-anxious than in high-anxious musicians. Subjective performance quality mediated the relationship between MPA and PER. These findings extend previous knowledge in social anxiety to the field of MPA and have implications for interventions aiming at reducing MPA

Music performance anxiety from the challenge and threat perspective: psychophysiological and performance outcomes

Background Although many musicians perceive music performance anxiety (MPA) as a significant problem, studies about the psychobiological and performance-related concomitants of MPA are limited. Using the biopsychosocial model of challenge and threat as theoretical framework, we aim to investigate whether musicians' changes in their psychobiological responses and performance quality from a private to a public performance are moderated by their general MPA level. According to the challenge and threat framework, individuals are in a threat state when the perceived demands of a performance situation outweigh the perceived resources, whereas they are in a challenge state when the perceived resources outweigh the perceived demands. The resources-demands differential (resources minus demands) and the cardiovascular challenge-threat index (sum of cardiac output and reverse scored total peripheral resistance) are the main indices of these states. We postulate that the relationship between general MPA level and performance quality is mediated by these challenge and threat measures. Methods We will test 100 university music students reporting general MPA levels ranging from low to high. They will perform privately (i.e., without audience) and publicly (i.e., with an audience) on two separate days in counterbalanced order. During each performance session, we will record their cardiovascular and respiratory activity and collect saliva samples and self-reported measures. Measures of primary interest are self-reported anxiety, the resources-demands differential, the cardiovascular challenge-threat index, sigh rate, total respiratory variability, partial pressure of end-tidal carbon dioxide and the salivary biomarkers cortisol, dehydroepiandrosterone, and alpha-amylase. Both, the participants and anonymous experts will evaluate the performance quality from audio recordings. Discussion The results of the planned project are expected to contribute to a more comprehensive understanding of the psychobiology of MPA and of the processes that influence musicians’ individual reactions to performance situations. We also anticipate the findings of this project to have important implications for the development and implementation of theory-based interventions aimed at managing musicians’ anxiety and improving performance quality. Thanks to the use of multimethod approaches incorporating psychobiology, it might be possible to better assess the progress and success of interventions and ultimately improve musicians’ chance to have a successful professional career.+ ID: 577187 + PeerReviewed: Peer Reviewe

Respiratory Variability, Sighing, Anxiety, and Breathing Symptoms in Low- and High-Anxious Music Students Before and After Performing

Music performance anxiety (MPA) is a major problem for music students. It is largely unknown whether music students who experience high or low anxiety differ in their respiratory responses to performance situations and whether these co-vary with self-reported anxiety, tension, and breathing symptoms. Affective processes influence dynamic respiratory regulation in ways that are reflected in measures of respiratory variability and sighing. This study had two goals. First, we determined how measures of respiratory variability, sighing, self-reported anxiety, tension, and breathing symptoms vary as a function of the performance situation (practice vs. public performance), performance phase (pre-performance vs. post-performance), and the general MPA level of music students. Second, we analyzed to what extent self-reported anxiety, tension, and breathing symptoms co-vary with the respiratory responses. The participants were 65 university music students. We assessed their anxiety, tension, and breathing symptoms with Likert scales and recorded their respiration with the LifeShirt system during a practice performance and a public performance..

Resiliency in the Age of COVID-19: A Policy Toolkit

Twenty-nine LBJ School authors have come together to craft interdisciplinary and resilience-based policy solutions in one toolkit called Resiliency in the Age of COVID-19. In 18 articles that span public management, climate change, economic development, national security and more, LBJ School policy authors provide a forward-thinking lens on what went wrong and what leadership, public policies and initiatives it will take to fix the system flaws exposed by the pandemic. Published during the LBJ School’s 50th anniversary year, the toolkit also provides a snapshot of the school’s depth and breadth of policy and research engagement at this moment in time.Public Affair