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Hopelessness Is Associated With Decreased Heart Rate Variability During Championship Chess Games ALFONS M. SCHWARZ, MD, HARTMUT SCHÄCHINGER, MD, ROLF H. ADLER, MD, AND STEFAN M. GOETZ, MD Objective: Clinical observations suggest that negative affects such as helplessness/hopelessness (HE/HO) may induce autonomic duration; affects were assessed for every move after reconstruction of the games. In all games compiled, 18 situation of intense confidence/optimism and 20 of intense helplessness/hopelessness were observed. Results: Intense affects of HE/HO were associated with decreasing HF-HRV (Fisher exact test, p ⫽ .003), increasing “nervousness” (p ⫽ .0005), decreasing “optimism” (p ⫽ .0005), and decreasing “calmness” (p ⫽ .0005). Conclusions: Investigation of championship chess game players with an ELO strength ⱖ 2300 in a natural field setting revealed increasing HE/HO being associated with reduced HF-HRV suggestive of vagal withdrawal. Thus, our data may help link negative mood states, autonomic nervous system disturbances, and cardiac events. ECG ⫽ electrocardiogram; ELO ⫽ ranking system of the International Chess Federation for the rating of competitive players, developed by Arpad Elo, Hungarian mathematician; HE ⫽ helplessness; HF ⫽ high frequency; HO ⫽ hopelessness; HR ⫽ heart rate; HRV ⫽ heart rate variability; IPFM ⫽ Integral Pulse Frequency Modulator; LF ⫽ low frequency; LPFES ⫽ low pass filtering of event series; RF ⫽ respiratory frequency; SD ⫽ standard deviation. T here is a long history of attempting to link psychosocial factors to heart disease. Mental stress (1) as well as negative emotional states such as anxiety (2– 4), anger (5), and vital exhaustion (6) have been linked to coronary pathology. The Type D personality (pessimistic, easily irritated, lacking self-esteem/assertiveness, symptoms of depression, and anxiety) is associated with coronary risks (7, 8). High levels of depressive symptoms (9) are associated with increased risks of myocardial infarction and mortality. Furthermore, depressive symptoms differentially predicted survival, with depressive affect and hopelessness (HO) being particularly important (10). In a prospective study, Anda (41) assessed depression by the D subscale of the General Well-Being Schedule, a fouritem scale with a single item for HO. HO was associated with an increased risk of ischemic heart disease (moderate HO: RR ⫽ 1.6, 95% CI ⫽ 1.0 –2.5; severe HO: RR ⫽ 2.1, 95% CI ⫽ 1.1–3). Recently, Stern (11) confirmed these findings and showed that HO predicts mortality from coronary heart disease and may be even a better predictor than depression. Depression may be linked to increased cardiac mortality (12) by autonomic nervous system disturbances, indicated by altered heart rate variability (HRV). The potential mechanisms connecting the feeling of HO with cardiovascular disease are not well understood. Whether emerging HO induces autonomic disturbances has never been tested. Championship chess games offer a natural setting for the study of hopelessness and certain physiologic parameters – From the Department of Internal Medicine (A.M.S., R.H.A., S.M.G.), Medical Division Lory, University of Berne Medical School, Berne, Switzerland; and the Laboratory of Psychophysiology (H.S.), Department of Medicine, University of Basle Medical School, Basle, Switzerland. Address reprint requests to: Rolf H. Adler, MD, Leiserenweg 4, CH-3122 Kehrsatz, Switzerland. Email: [email protected] Received for publication February 24, 2002; revision received October 29, 2002. Part of this material was presented as a poster at the annual meeting of the American Psychosomatic Society, March 2001, Monterey, California. DOI: 10.1097/01.PSY.0000075975.90979.2A 658 0033-3174/03/6504-0658 Copyright © 2003 by the American Psychosomatic Society and possibly induce more intense mood states than other inductive paradigms. The players are deeply committed, experience intense emotions, and their participation in a study poses no ethical problems. Their heart rate variability can be easily registered telemetrically and their behavior during the games, which may last 7 hours, can be closely observed. The aim of our study was to examine the association of positive and negative affects, primarily helplessness (HE), HO, and HRV, during chess games of players with an ELO average score ⱖ 2300, ie, the strength of an international master. METHODS Subjects Nine male players were studied, ages 17 to 33 years. Inclusion criteria were active chess players, ELO score ⱖ 2300, and willingness to participate voluntarily. Exclusion criteria were concomitant disease and medication affecting autonomic nervous system control. The youngest participant was a student; one participant was an unemployed repro-photographer; the others were university students or in academic professions. All were in good health. There was no anamnestic evidence of illicit drug abuse. All were studied during championship games. They were asked to participate in the study by personal contact and received a small compensation. Procedure The necessary installation was completed at least 10 minutes before the start of the game. The experimenter sat beside the player. The experimenter noted the length of elapsed time (on a laptop) for each of the player’s and opponent’s moves. The players noted each move on the score sheets. After the game, the player and the experimenter went through the score sheet several times, the player marking several affects after each of his and his opponent’s moves on numerical rating scales encompassing numbers from ⫹5 to -5. Based on suggestions of master players concerning the affects experienced in past games, the following pairs of affects were assessed: “general mood between negative—positive,” “calm—nervous,” “energetic—tired,” “certain— uncertain,” “pleasantly surprised—frightened,” “proud—ashamed,” “motivated— disinterested,” “happy— disappointed,” “euphoric—anxious,” “determined— undetermined.” Special focus was given to the affect pair “optimistic/in control— hopeless/helpless.” We do not know how the players would have scored their affect levels immediately after a move or days after the game. Our experience during team sessions several days after the game led us to assume that the players relive their games vividly. Data Acquisition and HRV Analysis The electrocardiogram (ECG) was telemetrically registered (HewlettPackard telemetry system) using three stick-pad electrodes placed on the left thorax. It was transmitted from an emitter fixed on the subject’s body to a receiver connected to a laptop. The ECG was recorded and visualized on the screen during the entire game. Analog to digital conversion was performed at 1000 Hz. Data were stored on the personal computer in different files for each move. Only files representing a minimum of 80 seconds duration were subject Psychosomatic Medicine 65:658 – 661 (2003) HEART RATE VARIABILITY AND AFFECT IN CHESS PLAYERS to further analysis of HRV. Offline analysis (13, 14) revealed the beat-to-beat heart rate (HR) from the electrocardiogram. HRV was assessed according to published standards (15, 16). In brief, HRV was determined by low pass filtering of event series (LPFES) method as suggested by Rompelman and colleagues (17). This method is in accordance with the Integral Pulse Frequency Modulator (IPFM) concept, which represents a rational model for the modulation of heart beat generation by autonomic nervous system influences (18). Power of HRV was analyzed over the entire spectrum of 0.01 to 0.50 Hz with a frequency resolution of 0.01 Hz. Low frequency (LF) power of HRV was determined by integrating spectral power in the low frequency range between 0.07 and 0.14 Hz. High frequency (HF) power of HRV was determined by integrating spectral power in the low frequency range between 0.15 and 0.4 Hz. Log transformation of power measures was performed to yield normally distributed values. Respiratory frequency impacts HRV (19, 20). Two independent procedures were employed to estimate dominant respiratory frequency (RF) for each subject and period. RF was depicted from the peak HF component of the HRV power spectrum. RF was further determined by graphical display and subsequent analysis of the R-spike amplitude time series. The R-spike amplitude varies little but consistently within the respiratory cycle. RF was calculated as the average of both methods only if the two procedures revealed similar results (within 0.03 Hz). Previous data from our laboratory (internal report) indicated a high correlation (Pearson r ⬎ 0.86) between both methods and RF assessed by standard respiratory belt system. Statistics Values of recognized affects – LF-HRV, HF-HRV, and RF – were assessed for each person and step in the chess game. These data were log transformed and z-scored to derive standardized individual data. Changes of at least 1 (from one step to the other), representing the standard deviation (SD) of the entire game, were depicted as transitions. Fisher exact test was used to test whether transitions of affects were associated with transitions of HRV and RF. Z scores were used because individuals differed considerably in mean RT, HRV, and reported affective states. Because of the irregular time-spaced nature of the response data in chess games (ie, moves vary considerably in length, the number of moves varies from game to game) a repeated-measures ANOVA did not appear appropriate. Thus, the most simple alternative, nonparametric direct comparisons, was preferred during the planning and setup of the study. Furthermore, nonparametric tests are more robust – an advantage if an unbalanced sample size is expected. RESULTS In the nine games, 18 situations with a transition toward “optimism/in control” and 20 transitions toward “helplessness/hopelessness” (affect-intensity ⱖ SD above/below the average affect-level during the entire game) were observed. At least one change was detectable in each subject, therefore the entire database of all games could be used. The average period of transition to hopelessness was 146 ⫾ 55 seconds (previous move: 273 ⫾ 62 seconds, following move: 245 ⫾ 68 seconds); the transition to hope and control was longer – 265 ⫾ 77 seconds (previous move: 347 ⫾ 118 seconds, following move: 293 ⫾ 89 seconds). As shown in Table 1, affecttransitions toward increasing “optimism/in control” were sigTABLE 1. nificantly associated (p ⫽ .003) to HF-HRV. Affect-transitions toward increasing “helplessness/hopelessness” were associated with decreasing HF-HRV. LF-HRV showed no consistent change during transition of these affects. In transitions toward “optimism/in control,” heart rate increased in 10, decreased in 8, and remained constant in 0 situations. RF increased in 5, decreased in 7, and did not change in 6 situations. In transitions toward “helplessness/hopelessness” heart rate increased in 10, decreased in 9, and remained constant in 1 situation. RF increased in 5, decreased in 7, and remained constant in 8 situations. All other affects changed congruently, with an increase in positive affects with “hope— control” and an increase of negative affects with “helplessness— hopelessness,” or showed no change. The affect pair “calm—nervous” is mentioned in detail because it helps to interpret our findings with respect to “helplessness— hopelessness” (Table 2): calmness correlates with “optimism— control” and “helplessness— hopelessness” with “nervousness” (Fisher exact test, p ⫽ .0005). Similar correlation was observed with respect to “pleasantly surprised—frightened”. DISCUSSION Chess games important to players with ELO scores ⱖ 2300 represent a quasi-natural situation for the study of the correlation between affects of “optimism— control” and “helplessness— hopelessness” on the one hand and autonomic nervous system influences on the heart on the other. The study situation may be closer to real life with respect to the intensity of the evocation of “helplessness— hopelessness” than affect induction in the laboratory because the players are intensely involved and cannot escape and withdraw as would be possible in a laboratory setting. Furthermore, such players are capable of memorizing games and their affective experience in important games for years. In our study, their affects were assessed in retrospect to avoid disturbing the player with questions during the game, a disadvantage which seemed unavoidable in our chess paradigm. The main finding of the current research is that transitions of HE/HO are associated with HF-HRV, suggesting that increased HE/HO induces vagal withdrawal. Thus, analogous to what is known about depression and coronary heart disease (12), our data may help establish a model that links HE/HO to coronary pathology. TABLE 2. Situations of Helplessness-Hopelessness and Their Correlation With Calmness-Nervousness Increased High Frequency Heart Rate Variability (HF-HRV) Optimism/hope Helplessness/ hopelessness Increased Decreased Unchanged N 8 3 2 13 8 4 18 20 () Optimism/helplessness, hopelessness ⬎ 1 SD). Fisher exact test, p ⫽ .003. Psychosomatic Medicine 65:658 – 661 (2003) Helplessnesshopelessness (ⱖ1 SD) Optimismcontrol (ⱖ1 SD) Unchanged N 15 4 20 0 4 18 Calmness Nervousness 1 14 Fisher exact test, p ⫽ .0005. 659 A. M. SCHWARZ et al. HE and HO are mood states linked, but not identical, with depression. The hopelessness which we assessed is a transitional affective state and is not identical with the hopelessness studied epidemiologically (21) or the hopelessness in states of depression assessed in depression and survival of patients with coronary artery disease (10). The term depression encompasses several clinical entities. Although diagnostic manuals (ie, DSM-IV and ICD-10) and standardized diagnosis and validated screening questionnaires (ie, BDI and HADS) are available, the diversity of depression symptoms is reflected by the use of various items. Indeed, past research (22) compared 16 depression scales and found that, of 54 symptoms appearing in at least two scales, only one – self-devaluation – was present in all scales. Negative emotions and depression are related to autonomic nervous system disturbances. Increased sympathicotonia (23) was observed in subjects with Type A personality who were confronted with anger. Lowered HRV was found in very anxious persons (24, 25). High frequency (HF)-HRV (heart rate variability) decreases under mental stress (26, 27). By inducing positive and negative affects with the “freeze-frame” method under laboratory conditions (28), an increase in HRV under positive and negative affects was found; with negative affects, the low frequency (LF) component increased; positive affects led to increases in LF and HF components. A drop in heart rate accompanied by increasing HRV was found in young healthy subjects listening to classical music, inducing positive emotions (29, 30). Further research indicated (31–33) that depression is linked to reduced HRV. Reduced HRV may indicate autonomic nervous system abnormalities of potential importance to coronary heart disease. A temporary decrease in parasympathetic tone after acute myocardial infarction was found (34). Decreased HRV has been associated with increased mortality after myocardial infarction (35, 36), coronary angiography (37), and cardiac failure (38). Engagement and cognitive effort can lower heart rate variability. This might have confused our findings of lowered HRV in the study. In a phase of hopelessness, lower task engagement and less cognitive effort could be expected in the chess players, which should increase HRV. However, we observed the opposite, which makes the confusion less likely. In the present study we observed that loss of “optimism— control” and intensified “helplessness— hopelessness” correlated with a decrease of HF-HRV, suggestive of decreasing vagal tone. The other affects studied changed in the same direction, eg, nervousness, uncertainty, indecisiveness, and fright increased in periods of intense “helplessness— hopelessness”. Our findings suggest a decrease of vagal tone and not bradycardia in situations of increasing HE/HO. However, HO has been observed (in experiments involving animals) to be associated with parasympathetic activation and bradycardia (Compare Richter (39) in rats in swimming experiments and Corley et al. (40) in yoked-control monkeys). 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