Heart rate vARiability and physical activity in inpatient treatMent of burnOut and DepressIon (HARMODI): protocol of a cross-sectional study with up to 8-week follow up.

INTRODUCTION: Chronic stress can cause an imbalance within the autonomic nervous system, thereby affecting cardiovascular and mental health. Physical activity (PA) may have a positive effect on the autonomic nervous system and stress-related disorders, such as depression and burnout. Heart rate variability (HRV) is a non-invasive marker of the autonomic nervous system. However, limited and inconsistent data exist on the exact relationship between HRV, PA and depression and burnout symptoms. The HARMODI study aims to explore whether HRV is a feasible marker of depression and burnout symptoms and aims to evaluate the role of PA in the treatment of stress-related disorders. METHODS AND ANALYSES: This is an observational study with a cross-sectional up to 8 week follow-up study design. A total of 153 patients, undergoing psychiatric inpatient treatment with burnout syndrome (Z73) and depressive episode (F32 or F33) or adjustment disorder (F43.2), will be recruited. Data on depression and burnout symptoms, HRV recordings (24-hour, supine, standing and exercise stress test), cognitive function, cardiorespiratory fitness, cardiovascular health, balance and strength will be collected at baseline (T1) and after up to 8 weeks (T2). Continuous data on PA and Ecological Momentary Assessments of exhaustion, mood and tension will be monitored daily throughout inpatient treatment. Multiple regression models, adjusted for potential confounders, will assess the association between HRV as the primary outcome, PA and depression and burnout severity score. ETHICS AND DISSEMINATION: The protocol has been approved by Swiss Ethics Committee, Cantonal Ethics Committee Zürich. Results of HARMODI will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: NCT05874856.

Cross-modal attention capture by affective stimuli: evidence from event-related potentials.

The P3 component of the event-related potential (ERP) to an acoustic startle probe is modulated during picture viewing, with reduced P3 amplitude when participants view either pleasant or unpleasant, as opposed to neutral, pictures. We have interpreted this as reflecting capture of attentional resources by affective pictures, with fewer resources available for processing the secondary startle probe. In the present study, we tested this resource allocation hypothesis by presenting either pictures or sounds as foreground stimuli, with the prediction that P3 amplitude in response to secondary startle probes would be reduced for affectively engaging foregrounds regardless of modality. Using dense-array electroencephalography and a source estimation procedure, we observed that P3 amplitude was indeed smaller when startle probes were presented during emotional, as opposed to neutral, stimuli for both sound and picture foregrounds. Source modeling indicated a common frontocentral maximum of P3 modulation by affect. The data support the notion that emotionally arousing stimuli transmodally attract resources, leading to optimized processing of the affective stimuli at the cost of the processing of concurrent stimuli.