The primary focus of the "Clinical-Experimental Stress Research" working group is on the psychophysiological measures of heart rate variability (HRV). These are indicators of stress and recovery derived from the activities of the autonomic nervous system and the central autonomic network in the brain. The measures of HRV allow, among other things, conclusions to be drawn about the extent of information exchange between the brain (e.g. feelings & perceptions) and the body (e.g. heartbeats) and thus represent the ideal biological marker in the field of psychosomatics.
The research is placed in the context of its diverse applications:
- in the context of prevention as a tool for counselling sessions and as an (early) indicator of health risks
- in a clinical context as a possible measure of therapy success and
- in an experimental context to record reactivity to stress and recovery
The working group works closely with the Competence Centre for Mental Health at the Workplace (LPCU), in particular in the area of preventive application in the work context. In collaboration with Dr Katja Weimer's Translational Research Working Group and Dr Klaus Hönig's Consultative Psychosomatic Research Working Group, the knowledge gained is transferred to the field of clinical therapeutic practice. In an experimental context, the biological measures (stress hormones, immune markers, genetics) obtained in collaboration with the Molecular Psychosomatics Section of Prof. Dr Stefan Reber are being investigated in the context of basic research in connection with heart rate variability.
Projects
BEAT-Covid (Breathing against Coronavirus Disease): Breathing-assisted anti-inflammatory reflex stimulation to reduce systemic inflammation in Covid-19 disease
Project description
Suddenly highly elevated pro-inflammatory cytokines such as interleukin-6 (IL-6) and C-reactive protein (CRP) have been observed in patients with coronavirus disease 2019 (COVID-19) and are associated with worse clinical outcomes (Madjid et al., 2020), also known as cytokine release syndrome (CRS) or cytokine storm. The vagus nerve is centrally involved in the regulation of the systemic immune response via the cholinergic anti-inflammatory reflex (Pavlov & Tracey, 2017) and is associated with mortality in the long term (Jarczok et al. 2021). A study of hospitalised COVID-19 positive soldiers showed that vagal activity decreases, as measured by heart rate variability (HRV) parameters, immediately before the sharp increase in CRP. Consequently, an increase in vagal activity could have a reducing effect on the increase in inflammatory parameters and thus have a positive influence on the course of the disease.
In addition to electrical vagus stimulators or medication, vagus activity can also be reliably stimulated using a specific breathing technique with a reduced frequency and prolonged exhalation phase (slow-paced breathing) (Lehrer & Gevirtz, 2014; Schwerdtfeger et al., 2020). The direct effect on vagal activity can be visualised immediately by measuring heart rate variability. The effect of this breathing technique on inflammatory markers is unknown. The advantage of the breathing technique over drug or electrical stimulation lies in its broad and immediate applicability.
Aim of the study
The aim of the study is to determine whether high-dose (3 times a day for 20 minutes) breath-supported reflex stimulation leads to a reduction in systemic inflammation levels in hospitalised Covid-19 patients and can alleviate the symptoms of COVID-19 in the further course of the disease.
Literature
Jarczok, M.N., Koenig, J. & Thayer, J.F. Lower values of a novel index of vagal neuroimmunomodulation are associated to higher all-cause mortality in two large general population samples with 18 year follow up. Sci Rep 11, 2554 (2021). doi.org/10.1038/s41598-021-82168-6
Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: how and why does it work? Frontiers in Psychology, 5(JUL), 1-9. doi.org/10.3389/fpsyg.2014.00756
Madjid, M., Safavi-Naeini, P., Solomon, S. D., & Vardeny, O. (2020). Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiology, 10, 1-10. doi.org/10.1001/jamacardio.2020.1286
Pavlov, V. A., & Tracey, K. J. (2017). Neural regulation of immunity: molecular mechanisms and clinical translation. Nature Neuroscience, 20(2), 156-166. doi.org/10.1038/nn.4477
Schwerdtfeger, A. R., Schwarz, G., Pfurtscheller, K., Thayer, J. F., Jarczok, M. N., & Pfurtscheller, G. (2020). Heart rate variability (HRV): From brain death to resonance breathing at 6 breaths per minute. Clinical Neurophysiology, 131(3), 676-693. doi.org/10.1016/j.clinph.2019.11.013
Start of study
02/2021
Co-operation:
with the infection ward M1C of the University Hospital, Ulm
Registration:
The study is registered in the German Register of Clinical Studies under the ID DRKS00023971.
PULS
Project description
Officers in the police service are exposed to extraordinary mental stress due to their socially important duties such as hazard prevention, protection and law enforcement. This demands a high degree of resilience and personal skills that need to be maintained and strengthened.
For this reason, the Ulm Police Headquarters, Ulm University Hospital and the Deutsche Traumastiftung e.V. (German Trauma Foundation ) have collaborated on a research project to develop ways of preventing trauma-related stress in the police service. Our common goal is to define preventative measures that enable police officers to deal with incisive and stressful experiences during their police service in a healthy manner. Maintaining the ability to work while minimising absences, especially during periods of high workload, is the common long-term goal, for which this research project to record the current situation is the first building block.
Press:
https://www.regio-tv.de/mediathek/video/studie-zu-psychischer-belastung-von-polizeibeamten/
https://www.regio-tv.de/mediathek/video/schwere-situationen-im-polizeiberuf-besser-ueberstehen-eine-studie-der-uniklinik-und-der-polizei-soll-helfen/
Training for occupational physicians on measuring, analysing and advising on heart rate variability
Good leadership serves, among other things, to maintain the health of employees. It involves the ability to recognise stresses and resources - in employees, but also in oneself. We want to support managers in recognising their personal resources and stresses, linking them to their body and health and motivating them to treat themselves with respect. We see self-awareness and how we deal with ourselves as the basis for how we perceive and deal with our employees. Only what is perceived can then be discussed.
Evaluation of a stress management training programme for managers in small and medium-sized enterprises
Stressed out? A state that many people, especially managers, are familiar with, and not just during the coronavirus pandemic. The KMU-GO project therefore offers stress management training for managers from small and medium-sized companies in all sectors with up to 500 employees, the effectiveness of which is to be proven (once again) with this project. Many (prevention) programmes in the area of mental health in the workplace are primarily offered in larger companies, as they are usually easier to implement for a variety of reasons. KMU-GO helps to close this gap.
VOICE
Project description
The current situation of the COVID-19 pandemic is unknown to all of us and is associated with various types of stress, especially for employees in the healthcare sector: Overcrowding of intensive care beds due to COVID-19 patients, vacancies in entire wards and surgeries, uncertainty about the course of the pandemic, fears for one's own health, stress due to the difficult work-life balance and many more.
Various studies show that during epidemics such as SARS or MERS, employees in the healthcare professions are under particular strain and are also extremely vulnerable in terms of their mental health. At the same time, however, many of them also have structural, social and very personal resources from which they draw strength and support.
Our multidisciplinary working group from the university hospitals in Erlangen, Bonn and Ulm has developed an online survey in order to record the current stress and resources during the Covid-19 pandemic in a broad sample and thus be able to offer targeted help to affected colleagues during and after the crisis as quickly as possible.
Study objective
The aim of the study is to identify specific stresses and anxieties in the context of the COVID-19 crisis (e.g. fear of infection, stress due to changes in tasks, etc.) as well as sources of personal resilience in the structural, social and spiritual areas and, if necessary, to record any resulting stress symptoms such as sleep disorders, but also indications of traumatisation, depression, anxiety disorders and their severity. At the same time, working conditions and aspects of work-life balance and resources are to be surveyed. The data will be used to identify possible correlations between stress/resources and mental health/quality of life as well as possible differences between genders/specialisms/settings. We also want to analyse typical courses of coping processes.
To this end, data from two survey waves (spring and late autumn 2020) will be analysed and a third survey wave is planned. At T1 > 8000 participants took part in the survey, at T2 > 6000 participants. Further qualitative interviews are also planned.
Study management
Prof. Yesim Erim (spokesperson) and Dr.rer.medic. Dipl. Psych. Dipl. Theol. Eva Morawa, Psychosomatic and Psychotherapeutic Department, University Hospital Erlangen
Prof. Dr med Dipl.-Psych. Franziska Geiser, Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy and Prof. Dr med Lukas Radbruch, Clinic for Palliative Medicine, University Hospital Bonn
PD Dr Petra Beschoner and PD Dr bio.hum. Lucia Jerg-Bretzke, Clinic for Psychosomatic Medicine and Psychotherapy, Ulm University Hospital
Study programme
Since mid-April 2020, data has been collected online in anonymised form. The data collected does not allow any conclusions to be drawn about the respective individuals; the longitudinal data is collated using an anonymous code.
A positive ethics vote and approval from the data protection officer have been obtained.
To date, over 5000 employees in the healthcare sector have completed the questionnaire online.
Cooperation partners
Prof Dr Christian Albus, Clinic and Polyclinic for Psychosomatics and Psychotherapy, University Hospital Cologne
Prof Dr Kerstin Weidner, Clinic and Polyclinic for Psychotherapy and Psychosomatics, University Hospital Carl Gustav Carus Dresden
Prof Dr Christoph Herrmann-Lingen, Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Göttingen
Prof. Dr Hans Drexler, Institute and Polyclinic for Occupational, Social and Environmental Medicine, Department of Occupational Medicine, University of Erlangen-Nuremberg,
Prof Eberhard Hauschildt, Institute for Practical Theology, University of Bonn
Prof. Dr Thomas Kühlein, Institute of General Medicine, University Hospital Erlangen Clinic Forchheim - Franconian Switzerland
Prof Dr Christian Maihöfner, Neurological Clinic, Fürth Hospital
Dr Irmgard Pfaffinger, Professional Association of Specialists in Psychosomatic Medicine and Psychotherapy e.V.
Prof Dr Ceren Acartürk, Koc University Istanbul, Turkey
Background to the study
Scientific studies show that epidemics and pandemics, such as the H1N1 pandemic in 2009, lead to an increase in mental stress among medical staff (Matsuishi 2012, Maunder 2006). Initial data on mental stress among healthcare workers during the SARS-CoV-2 outbreak and the associated coronavirus disease 2019 (COVID-19) in China point in the same direction and report enormous mental stress, including sleep disorders, depression, anxiety disorders (Huang 2020) and post-traumatic stress disorder (Liu 2020, Sun 2020). With regard to predictive factors for high levels of stress, Brooks et al. (2018) identified working conditions such as the type of job, whether there is contact with infected people, measures to prepare employees for the situation (Brooks 2018). Social isolation or social support and loss of control were other specific factors associated with increased psychological stress (Brooks 2018). Medical staff working in areas with a high risk of infection during the SARS epidemic in 2003 were significantly more likely to show symptoms of post-traumatic stress disorder than staff in less risky areas (Wu 2009).
The COVID-19 pandemic is now also posing major challenges for Europe. Due to the rapid increase in infections, far-reaching changes had to be made to work processes in hospitals (emergency operation). The number of COVID-19 patients in hospitals is rising, as is the number of cases requiring intensive care and the number of deaths from COVID-19. This places high demands on healthcare staff. In order to be able to deal with the resulting mental stress and crises both preventively and therapeutically during and after the crisis, a well-founded assessment of the specific stress and prevalence is needed in order to derive targeted offers of help.
Psychosomatic impairment in patients attending psychosomatic consultations at the company - pilot project
We want to record not only the subjective complaints but also the physical reactions of patients who attend our psychosomatic consultations at work. We want to check whether these have changed in comparison to healthy values and whether our brief intervention has made a difference on a physical level.
To do this, we use a questionnaire to ask about the subjective symptoms and measure the heartbeat and its changes, known as heart rate variability. We also measure how much cortisol the body releases throughout the day. Both are altered under stress and during illness.
Music therapy for depression: A randomised controlled trial to evaluate the efficacy and psychobiological effects of music therapy in depressed adult women
Background:
Depression is one of the most widespread mental disorders worldwide, with women being affected more frequently than men. Depression is often associated with high levels of physical and psychological stress. Music therapy is a complementary and as yet insufficiently researched therapeutic approach for depression. Music therapy could help to alleviate the symptoms of depression and reduce the stress levels of those affected.
Objectives:
As part of the MUSED study, we want to test whether music therapy is effective for women with depression. The aim of music therapy is to alleviate the symptoms of depression and reduce stress.
Study participants:
The study is open to adult women aged 18-65 who are currently suffering from depression. The number of women who can participate is at least 74. 66 participants were originally planned. The number was increased in order to achieve statistically more meaningful results.
Procedure:
The study participants will be randomly allocated to either the intervention group (music therapy) or the waiting list control group (receives music therapy after all measurements have been completed). The study participants will be asked to take part in questionnaires and psychobiological measurements to determine stress in everyday life (48-hour pulse and saliva samples).
The influence of genetic characteristics in the immune and serotonin systems on cardiovascular stress reactivity in mourners
Purpose of the study: Research findings indicate that the death of a loved one is not only a very stressful event, but also temporarily affects some people's risk of cardiovascular disease (CVD).
The aim of this study is to investigate possible factors that presumably contribute to this increased risk of disease in order to be able to treat people at risk preventively in the future. On the one hand, this includes certain genetic characteristics that can favour an increase in inflammation levels in the blood, particularly in stressful situations. On the other hand, vagus nerve activity, which is associated with the regulation of cardiac activity, emotions and the regulation of inflammation levels. The subject of the study is the correlation between the subjective experience of grief, vagus nerve activity and certain genetic characteristics.
Study procedure: The study consists of an approximately 90-minute appointment at the Clinic for Psychosomatic Medicine and Psychotherapy in Ulm. Potential study participants are women and men between the ages of 50 and 70 who have lost a loved one (parent, sibling, spouse, child) in the last 6-24 months.
After giving written consent, height and weight are recorded and a blood pressure cuff and an ECG chest strap (made of fabric) are fitted. An autonomic reactivity test is then carried out (Dive Reflex). A cold pack with a temperature of 4-6°C is applied to the centre of the forehead for approximately 2 minutes. The effects of this stimulus on the heart action can be recorded on the ECG.
A blood sample (maximum 20 ml) is taken once for genetic testing. These samples are initially given a number (pseudonymised), frozen and only analysed collectively at the end of the study.
During the appointment, various questionnaires on medical history, origin, lifestyle and dealing with bereavement are also completed.
This is followed by a 10-minute concentration task on a computer, followed by a short interview about events in the study participant's past. This interview lasts a maximum of 10 minutes, can be cancelled at any time and is the last part of the research.
Balint, E. M., Braun, S., Kessemeier, F., Gündel, H., Buckley, T., Jarczok, M. (2020). Das Spektogramm individueller 24h-EKG-Aufzeichnungen als Spiegel psychosomatischer Zusammenhänge im Arzt-Patienten-Gespräch: Eine Pilotstudie an Führungskräften auf Basis der Herzratenvariabilität. Deutscher Kongress für Psychosomatische Medizin und Psychotherapie, 20.
Gäbel, C., Rittner, S., Stoffel, M., Jarczok, M. N., Aguilar-Raab, C., Ditzen, B., & Warth, M. (2019). Die MUSED-Studie: Musiktherapie bei Depressionen. Musiktherapeutische Umschau, 40(3), 278-280. [DOI:10.13109/muum.2019.40.3.278]
Jarczok, M.N., Buckley, T., Balint, E.M. Commentary on “Heart Rate Variability and Risk of All-Cause Death and Cardiovascular Events in Patients With Cardiovascular Disease: A Meta-Analysis of Cohort Studies.” Biological Research For Nursing. 2020;22(3):418-420. [DOI:10.1177/1099800420909420
Kempf M., Jerg-Bretzke L., Jarczok M.N., Beschoner P. (2020). Maladaptive Schemata und berufliche Gratifikationskrisen bei ÄrztInnen und PsychotherapeutInnen – ein systematischer Literaturüberblick. Der Psychotherapeut. [DOI 10.1007/s00278-020-00468-0]
Schwerdtfeger, A.R., Schwarz, G., Pfurtscheller, K., Thayer, J.F., Jarczok, M.N., Pfurtscheller, G. Heart rate variability (HRV): From brain death to resonance breathing at 6 breaths per minute. Clin Neurophysiol. 2020 Mar;131(3):676-693. [PubMed] [DOI: 10.1016/j.clinph.2019.11.013]
Mulfinger, N., Lampl, J., Dinkel, A., Weidner, K., Beutel, M. E., Jarczok, M. N., Hildenbrand G., Kruse J.,Seifried-Dübon T., Junne F., Beschoner P., Gündel H. (2020). Psychische Belastungen durch Epidemien bei Beschäftigten im Gesundheitswesen und Implikationen für die Bewältigung der Corona-Krise: eine Literaturübersicht. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 66(3), 220-242 [PubMed]
Siyar Tuerkmen (grief study)
Vincent Goldberg (grief study)
Johannes Kocks (grief study)
Sophia Haase (BEAT-CoV)
Jannik Harbich (MEPP study)
Sünje Adam (MEPP study)
Mastura Ganji (MEPP study)
Alexandra Haupt (MEPP study)
Michael Riesemann (MUSIS)
Elisabeth Saalfrank (MUSIS)
Mareike Hanger(SEEGEN)
