Stress Exposure Training Research Articles

Combining stress inoculation with virtual reality simulation training of malignant hyperthermia

BackgroundLimited research has been conducted on how healthcare simulation can mitigate clinician stress. Stress exposure training (SET) has been shown to decrease stress’s impact on performance. Combining SET with virtual reality (VR) simulation training has not yet been explored in the context of stress inoculation. The primary purpose of this pilot study was to determine if a VR module could induce stress. The secondary purpose was to determine if repeated exposure to stressors could decrease stress response in a simulated environment.MethodsMedical students were recruited to partake in VR simulation modules aimed at treatment of malignant hyperthermia (MH). Those in the SET group were exposed to stressful stimuli during training modules, while those in the Control group were not. Both groups then completed a Test Module with the presence of stressful stimuli. Objective and subjective indicators of stress were measured after each module.ResultsBoth groups indicated increases in perceived stress and module stressfulness after Training Module 1 and decreases after Training Module 2. After the Test Module, the Control group experienced significant elevation in perceived stress (p = .05), and the SET group had a significant decrease in perceived module stressfulness (p < .05). Both groups had a decrease in perceived competence after Training Module 1 (p < .001) and an increase after Training Module 2 (p < .001), with the SET group having significant elevation after the Test Module (p < .01). Both groups found the VR module to be feasible as a teaching tool. Objectively, the SET group showed an upward trend in electrodermal activity (EDA) from the Tutorial to Test Modules (p < .05), with the Control group showing a decrease after Training Module 2 (p = .05) and an increase after the Test Module (p < .01).ConclusionsA VR module targeting treatment of MH successfully induced stress and was regarded favorably by participants. Those in the SET group perceived less stress and more competence after the Test Module than those in the Control. Findings suggest that repeated exposure to stressors through VR may desensitize participants from future stress in a simulated environment.

The Potential of Mental Simulation for Enhancing Self-efficacy and Managing Stress in Emergency Care: A Nurse Education Perspective

This theoretical article explores how mental simulation can enhance self-efficacy and stress management in emergency care, focusing on its application in nurse education. This article delves into the concept, functionality, and applications of mental simulation in nurse education, specifically addressing stress mitigation in emergency care. We offer an overview of relevant literature and research, including a specific focus on surgical skills education. The mechanisms of mental simulation, encompassing the simulation theory of action and dual code theory, are discussed, providing valuable insights into neural networks and image evocation processes. The article underscores the significant impact of stress on emergency care performance. It highlights the potential benefits of incorporating mental simulation as a stress-exposure training technique in the learning process. By adopting a Bandurian theoretical framework, the article proposes how mental simulation can contribute to the cultivation of self-efficacious nurses. Integrating mental simulation in nurse education has the potential to mitigate stress’s negative impact on emergency care. Nurses mentally rehearse and simulate scenarios, becoming familiar with demands and stressors. This practice can potentially refine skills, improve performance under pressure, and boost self-efficacy. Mental simulation replicates real-life situations, enhancing learning from a patient safety perspective. Mental simulation enhances self-efficacy and stress management in emergency care. Its integration into nurse education prepares nurses for high-stress situations. Further research should explore its diverse applications. Understanding mental simulation mechanisms can improve training programmes, potentially empowering nurses in delivering self-confident emergency care.

Evaluating Workload Indicators for Learning During Stress Exposure Training of Endotracheal Intubation

Endotracheal intubation (ETI) is an important procedure of point-of-injury care and emergency medicine. Although ETI is a complex procedure with possible stressful conditions demanding higher levels of mental workload, traditional training methods do not involve stress exposure training. This study aims to evaluate potential workload indicators for stress exposure training for ETI. Twelve participants executed intubation tasks in three separate visits and were exposed to auditory and visual stressors. Participants were instrumented with eye-tracking glasses and a heart rate monitor. Participants rated their perceived workload using the NASA-Task Load Index scale. When comparing the first repetitions during the first visit to the last repetitions on the last visit, participants expressed a significant improvement in performance, reduction in perceived workload, and smaller differences in heart-rate variability between rest and task execution. Results demonstrated the potential effectiveness of stress exposure training in improving performance and reducing mental workload.

SP11.15 Stress Exposure Training in Surgery – A Narrative and Systematic Review

Abstract Aim The operating theatre is an environment associated with intense cognitive stimulus. The coordinated application of technical and non-technical skills is necessary to achieve optimal patient care. Surgeons may undergo a significant “stress response”, activated when perceived demands of a situation exceed perceived resources, leading to measurable variations in physiological and biochemical parameters. This results in impaired performance, demonstrated most acutely in junior and trainee surgeons. Methods A narrative and literature was undertaken searching for stress response, exposure, inoculation in healthcare, medicine, or surgery. 1332 eligible papers were identified, refined to 100 on abstract, with 37 undergoing full text review. Results Stress Exposure Training (SET) facilitates high performances in acutely stressful situations by inoculating individuals from the psychological and physiological impacts of stress. SET was initially a clinical intervention to treat stress-induced psychopathology. Routed in cognitive-behavioural therapy principles, it is now a generalisable training approach implemented by other high-stress high-performance industries, including the military and aeronautics. High-fidelity simulation training is a recognised tool that is commonly applied in medical education. It promotes decision-making, team-working, and technical and communication skills in a controlled environment. Importantly, this tool has been shown to elicit an equivalent stress response to “live” clinical scenarios. Conclusion This review explores the current literature on mitigating stress responses in surgeons and SET, including its current applications and research localised to surgical education. Finally, we propose a high-fidelity simulation training programme, aimed at junior surgeons-in-training based on the principles of SET comprised of gradually increasing stressors and appropriate psychological training in stress-response management.

A framework and serious game for decision making in stressful situations; a fire evacuation scenario

Decision making is a core cognitive process of human behaviour that is often affected by stress. Whilst we make several decisions on a daily basis, firefighters in particular are called to make important decisions in a split second and within life-threatening settings. Stress can therefore impact their ability to perform and carry out their job. The implications of stress are similarly important in other settings requiring high-vigilance. In this paper, we aim to contribute to efforts to better train firefighters in decision making in stressful situations through a serious game solution. The game was designed based on the Stress Exposure Training (SET) approach and in accordance with typical stressors identified in the literature. Those were then mapped to relevant game mechanics. The evaluation of the resulting game was twofold: A. to assess its ability to increase participants’ stress level, and B. to investigate whether decision making performance would be improved for participants under stress. The proposed framework and the prototype were evaluated through empirical research that consisted of the participants’ self-reported stress levels using the State-Trait Anxiety Inventory for Adults (STAI) and the participants’ physiological measurements, namely galvanic skin response (GSR) and heart rate (HR). Our results demonstrate the potential of serious games to assist towards training of firefighters to make better decisions under stressful situations. Our findings are of wider importance as they contribute to ongoing efforts to improve decision making under stress in a variety of settings and scenarios.

A Lost Opportunity: The Use of Unorthodox Training Methods for Prehospital Trauma Care.

Prehospital trauma care guidelines and instruction have advanced significantly over the past 20 years. Although there have been efforts to create a standardized approach to instruction, the use of unorthodox techniques that lack supporting evidence persists. Many instructors use unrealistic scenarios, "no-win" scenarios, and unavoidable failing situations to train students. Doing so, however, creates student confusion and frustration and can result in poor skill acquisition. These training techniques should be reconsidered, with focus placed instead on the development of technical skills and far skill transfer. Knowing when to apply the appropriate type and level of stress within a training scenario can maximize student learning and knowledge retention. Furthermore, modalities such as deliberate practice, cognitive load theory (CLT), and stress exposure training (SET) should be incorporated into training. To improve delivery of prehospital trauma education, instructors should adopt evidence-based educational strategies, grounded in educational and cognitive science, that are targeted at developing long-term information retention as well as consistent, accurate, and timely life-saving interventions.

Implementing a pressure inurement training program to optimize cognitive appraisal, emotion regulation, and sport self-confidence in a women’s state cricket team

Athletes’ responses to stressors affect their performance under pressure. Pressure inurement training (PIT) is a form of stress exposure training which is used to optimize athletes’ stress responses. In this study, we implemented a 4-week PIT program in a state team of female cricket players. We evaluated the difference in players’ cognitive appraisal, emotion regulation, and sport self-confidence before and after the program, and evaluated their experiences of the program. Combined, the results of our multimethod pragmatist approach indicated that PIT is a promising intervention strategy. Estimates of effect sizes showed medium, positive effects of PIT on challenge appraisal and self-confidence, a small, negative effect on threat appraisal, and a small, positive effect on reappraisal. No effect on suppression was found. Furthermore, results from focus groups suggested that PIT made the players’ training sessions more representative of game situations, increased the purpose of the training sessions, provided awareness of emotion regulation and cognitive appraisal under pressure, and allowed practice of psychological skills important for performance under pressure. The players emphasized the importance of continuously monitoring the stressor difficulty level and stressor significance for the duration of the PIT program, and reported experiencing negative affect during the program. Implications for practice and future research are discussed. Lay summary: This study showed that a pressure inurement training program likely optimizes female cricket players’ stress responses when performing under pressure. Players perceived that the programe made their training sessions more representative of match situations, increased the purpose of the training sessions, and increased awareness of their responses to stressors.

Reducing the Effects of Game Day Pressures through Stress Exposure Training

There is a truism that “you play the way you train,” and like most bits of folk wisdom, this has an element of truth. When most baseball batters train, they hit soft pitches, work in a batting cage, and hit during batting practice, typically in a controlled setting with little to no stress. The problem is that most training takes place without systematic attention to preparing for game day demands, such as the heightened demands of actual competition, game day distractions, and other stressors present in the game day context. The purpose of this article is to describe a stress exposure training approach to prepare players to maintain effective performance under high demands. We discuss the implications of this approach for sports training.

Using Presence to Improve a Virtual Training Environment

In the rail industry, drivers must be trained to operate complex heavy machinery while responding appropriately to rapidly unfolding events in environments that are expensive and often dangerous to replicate in the real world. Virtual training environments (VTEs) can deliver stress exposure training to improve the decision-making skills of train drivers. Higher levels of recallable knowledge in the real world have been linked directly to the degree to which trainees have been engrossed in their VTE, an experience often measured through the concept of "presence." This paper reports on the use of presence to guide improvements to a VTE developed to deliver driver training in degraded track conditions. Two surveys were used to collect data on train drivers' introspective feedback on the level of presence created by the virtual rail environment and the simulator's effectiveness in generating immersion across a range of presence causal factors. Results indicate that using presence to investigate VTEs has practical significance. Outcomes provide direct information on where future improvements and modifications to the VTE can be made.

Adaptability of Training in Simulated Process Control: Knowledge- Versus Rule-Based Guidance Under Task Changes and Environmental Stress

The study examined the adaptability of different types of process control training across changes in task and environmental stress. The literature on training leads us to expect greater flexibility for system-based training, as opposed to procedure-based training. However, the stress literature suggests that knowledge-based strategies (making use of executive control) may be more vulnerable under stress conditions. Two groups were given 6 hr of training on the Cabin Air Management System (CAMS), a complex, multilevel, PC-based process control task, emphasizing either system knowledge or use of procedures. They were then required to carry out the task for 3 hr (with noise during the middle 1 hr) across a range of both familiar and unfamiliar fault scenarios. For the primary control task, the system-trained group performed better, especially for less familiar and complex faults. However, for lower priority tasks requiring executive control, procedure-trained operators performed better and were less impaired by noise. System training was more effective for managing unexpected task events, whereas procedural training was better under noise. The results are interpreted in terms of the rationale for instructing operators in the range of strategies required for effective process skills in complex work environments. Training methodologies for safety critical applications should aim to develop skill in the use of both procedural and system knowledge strategies. Operators should be trained in the most effective deployment of these strategies during unfamiliar task events and environmental stress and given stress exposure training.

Efficacy of Stress Exposure Training on Target Acquisition in Combat Simulations

Transfer of training from simulators to real-world environments has recently come under investigation, as the generalizability of task-specific training has come into question. New hypotheses recommend that, to ensure effective performance under stress in real-world environments, one should supplement skill-based training with Stress Exposure Training (SET). Stress Exposure Training has further benefits in that it may serve as a more generalizable form of training and transfer across tasks and stressors. The impact of improving performance and reducing perceived stress and workload is of vital importance to many military operations, especially in high technology and high workload situations such as Landwarrior or Unmanned Arial Vehicles (UAVs; Mouloua, Hancock, &amp; Gilson, 2003), in which mistakes are costly in terms of economics as well as life. In this paper the limits of SET transfer between laboratory training and field performance are investigated in regards to simulated combat target identification tasks.