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\begin{document}

\title{A cross-sectional comparison of perceived stress and emotional affect
between adults with and without emotional disturbances using a novel
coping strategy.}



\author[1]{Dr. Scott McDoniel}%
\affil[1]{Grand Canyon University}%


\vspace{-1em}



  
  \date{May 25, 2024}


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\selectlanguage{english}
\begin{abstract}
\textsubscript{Perceived stress has increased due to the COVID-19
pandemic. In addition, those with diagnosed emotional disturbances note
higher perceived stress ratings than those without these conditions.
Emotion-focused coping can be a practical adjunctive component with
problem-based solutions during elevated stress. However, it is unknown
if there are differences in perceived stress levels and emotional affect
in adults with and without emotional disturbances using a novel
emotion-focused coping strategy. A cross-sectional study of 97 adults
using the novel strategy completed an online survey of the Perceived
Stress Scale (PSS-10) and Positive and Negative Affect Schedule (PANAS).
Group one (NEDG) included 34 individuals without a history of emotional
disturbance. Group two (EDG) included 63 individuals reporting an
emotional disturbance (Anxiety; N= 58 \& Depression; N=5). There was no
significant difference in perceived stress between the NEDG (17.6}
\textsubscript{+} \textsubscript{5.3) and EDG (17.0} \textsubscript{+}
\textsubscript{5.5) groups. Moreover, there were no significant
differences in PANAS between groups. Positive affect was in the 51st
percentile (95 \% CI: 45.7-56.6\%), and negative affect was in the 74th
percentile (95\% CI: 70.4-78.9\%) of normative data. Individuals with or
without emotional disturbance may experience similar perceived stress
levels and emotional affect while using a novel coping strategy.
Additional research investigating this novel strategy is warranted.}%
\end{abstract}%



\sloppy


\textbf{Introduction}

Perceived stress levels have increased from the COVID-19 pandemic
(TMGH-Global COVID-19 Collaborative, 2021;). Prior to the COVID-19
pandemic, perceived stress levels in diverse (age, gender, education,
etc.) adults, as determined by the perceived stress scale (PSS-10), were
approximately 16-18 pts (Champion, Economides, \& Chandler, 2018; Cohen
\& Janicki-Deverts 2012; Andreou et al., 2011). Since the pandemic,
average PSS-10 scores have increased to approximately 20-29 pts (Napoli,
2022; Aly et al., 2021; Meaklim et al., 2021; TMGH-Global COVID-19
(Collaborative, 2021; Adamsom et al., 2020; Agyapong et al., 2020), and
those with anxiety disorders have higher perceived stress scores
compared to nonanxious individuals (Mozumder 2022; Meaklim et al., 2021;
Agyapong et al., 2020; Cohen \& Janicki-Deverts, 2012; Andreou et al.,
2011).

Prolonged stress severity can result in anxiety and depressive disorders
(Khan \& Khan, 2017) and negatively influence health and mortality
(Keller et al., 2012). Moreover, excess stress can lead to an anxiety
disorder relapse (Francis, Moitra, Dyck, \& Keller, 2012). There are
emotional differences between those with and without anxiety or
depressive disorders. Individuals with anxiety and depressive disorder
demonstrate affective hyperactivity and describe feeling more threatened
and less in control of their emotions when compared to nonanxious
individuals (Llera \& Newman, 2010). Moreover, individuals with anxiety
or depressive disorders have a lower positive affect and higher negative
affect compared to individuals without these disorders (D\selectlanguage{ngerman}íaz-García et
al., 2021; Díaz-García et al., 2020, Crawford \& Henry, 2004.; Watson,
Clark, \& Tellegen, 1988).

Emotion-focused coping is a component of stress management intended to
lower perceived stress and negative affect. Emotion-focused coping
includes soothing behaviors or mechanisms that provide extrinsic and
intrinsic processes involved in monitoring, evaluating, and modifying
emotional reactions (Gross, 1998; Lazarus, 1993). Soothing activities
may include listening to music, taking a shower, massage, and
meditation. Listening to music was one of the most effective coping
strategies during the COVID-19 pandemic (Krause, Dimmock, Rebar, \&
Jackson, 2021; Ribeiro, Lessa, Delmolin, \& Santos, 2021; Vidas,
Larwood, Nelson, \& Dingle, 2021 ). In addition, non-noxious sensory
activities (e.g., touch, massage) for relaxation appear to lower
physiological stress markers (e.g., heart rate, blood pressure, and
cortisol levels) and increase hormones (oxytocin, serotonin, and
dopamine) associated with positive mood and mental well-being (Field,
Hernandez-Reif, Diego, Schanberg, \& Kuhn, 2005; Lindgren, Rundgren,
Winsö, Lehtipalo, Wiklund, et al., 2010; Uvnäs-Moberg, Handlin, \&
Petersson, 2015).

Sensate® (BioSelf Technology, London, England) is a vibrotactile
wellness device providing a non-noxious, somatosensory activity called
Somacoustics (McDoniel \& Chmelik, 2022). Somacoustics combines
infrasonic resonance with aural soundscapes, which posits a soothing
experience for emotion-focused coping. This proposed activity is like
vibroacoustic therapy, which uses infrasonic sound (\textless{} 50 Hz)
to produce vibrations while applied to the body (Skille, 1989). Skille
(1989) suggests that vibroacoustic stimulation may improve
stress-induced depression, anxiety, tension, and fatigue. Bartel and
Mosabbir (2021) offered a theoretical basis using sound vibrations,
including infrasound, for various health benefits but acknowledged the
complexity of sound vibrations and suggested additional research is
needed exploring delivery types (e.g., sound frequency, body location)
on various health conditions. A 2013 qualitative study was conducted
with 11 individuals completing six (30-60 minute) sessions of
low-frequency (27-113 Hz) sound applied to the posterior side of the
whole body while individuals were in a chair (Ahonen, Deek, and Kroeker,
2013). Individuals were instructed to close their eyes during each
session. However, there was no indication of additional music added for
listening. Subjective improvement in perceived stress and emotional
enrichment (e.g., inner peace, self-awareness, and clarity) was noted,
and individuals reported a positive experience from the sessions
(Ahonen, Deek, and Kroeker, 2013). However, no formal stress or
emotional questionnaires were used for assessment. A 2019 study
implemented low-frequency (Hz level not disclosed) music impulse
stimulation on the abdomen of 18 adults with depression while they
listened to synchronized music (Sigurdardóttir et al., 2019).
Individuals completed eight 20-minute sessions throughout 1-month.
Results from the study suggest a significant improvement in the Hamilton
Depression Rating scale and improvement in depressive symptoms with no
adverse side effects (Sigurdardóttir et al., 2019). These findings do
offer some possible support for low-frequency vibroacoustic stimulation
for stress and depression, but additional research is needed, as
recommended by Bartel and Mosabbir (2021).

\textbf{Purpose}

This study aimed to determine if there was a difference in perceived
stress, positive affect, and negative affect in adults with and without
an emotional disturbance using Somaccoustics. A secondary purpose is to
determine subjective changes in emotional disturbance while using
Somaccoustics.

\textbf{Materials \& Methods}

This study was a cross-sectional, comparative analysis of current adults
using Somacoustics for stress management. Participants were recruited
from a marketing email sent by the manufacturer to individuals who
purchased the novel device before June 2022. In addition, a link was
provided on the manufacturer's social media accounts to encourage
consumer participation. Inclusion for this study were adults
(\textgreater{} 18 years of age) who were consistent users of the novel
device (\textgreater{} 3 days per week) between one to six months. There
were no incentives offered for participation.

Individuals were assigned to either a group with or without a
self-reported diagnosis of an emotional disorder (e.g., Anxiety,
Obsessive Compulsive Disorder, Post-Traumatic Stress Disorder, and
Depression). The research dataset was obtained following Human Subject
Regulations 45 CFR Part 46 and per the principles stated in the
Declaration of Helsinki. Ethics approval was obtained by Grand Canyon
University Institutional Review Board (\#2023-5336).

An online survey was developed using Google Forms. The form was password
protected, and only the researcher had access to the development and
individual responses. Each question was an optional response, and
participants could stop the survey anytime. Before beginning the survey,
participants were informed of the purpose and the study. Participants
acknowledged consent by agreeing to participate in the study. Survey
questions were offered as either multiple-choice or multiple-checkbox
responses. Participants were asked about their stress experiences prior
to using the novel device. The historical stress assessment included
standard terms for referencing stress (e.g., anxious, nervous, jittery,
scared, worry, and dread). These questions were not previously validated
but are standard terms used to assess prior stress (Cohen, Kamarck, \&
Mermelstein, 1983).

Perceived stress was assessed with the Perceived Stress Scale-10 (Cohen,
Kamarck, \& Mermelstein, 1983). The PSS-10 instrument includes ten
questions based on the original 14-item questionnaire that assesses how
an individual perceives their current situation as unpredictable,
uncontrollable, and overloaded. Each response is coded to a five-point
Likert scale (0= never to 4=very often-4 pts) with a maximum score of 40
pts. The scale demonstrates acceptable consistency, validity, and
reliability in several demographics and is commonly used in stress
research (Cohen \& Janicki-Deverts, 2012; Lee, 2012). Higher PSS-10
scores indicate more significant perceived stress (Cohen, Kamarck, \&
Mermelstein, 1983).

Positive and negative affect was assessed with the Positive and Negative
Affective Scale (PANAS) (Watson, Clark, \& Tellegen, 1988). Positive
affect assesses emotional constructs related to determination,
enthusiasm, inspiration, and excitement. Negative affect assesses
emotional constructs related to distress, fear, irritability, and
nervousness. This questionnaire consists of 10 positive affect traits
(e.g., PA; interested, excited, strong, enthusiastic, proud, alert,
inspired, determined, attentive, and active) and ten negative affect
traits (NA; distressed, upset, guilty, scared, hostile, irritable,
ashamed, nervous, jittery and afraid) (Watson, Clark, \& Tellegen,
1988). Each response is coded to a five-point Likert scale A( 1= not at
all, to 5= extremely). PANAS is commonly used in positive/negative
affective research, and higher scores (10-50 pts) represent more
significant positive or negative affect. The instrument has high
internal consistency and intercorrelations when assessing effect within
a few weeks (PA=.87, NA=.87, and r=-.22) (Watson, Clark, \& Tellegen,
1988). Prior research has demonstrated PANAS to be correlated with the
Beck Anxiety Inventory, State Anxiety Scale, and Beck Depression
Inventory (Díaz-García et al., 2021; Díaz-García et al., 2020, Serafini,
Malin-Mayor, Nich, Hunkele, \& Carroll, 2016; Watson, Clark, \&
Tellegen, 1988).

Finally, a brief assessment of perceived changes in an emotional
disturbance was included in the survey. Participants who reported being
diagnosed with an anxiety or depressive order were asked if changes
occurred in their condition (Worsened, No Change, Improved, or Greatly
Improved). The survey was administered in August 2022, and the survey
questions, minus PSS-10 and PANSAS, are included in Appendix II.

Each instrument was coded as ratio and ordinal measures. Once coding was
complete, the file was saved and imported to IBM SPSS v27 for
statistical analysis. The sample size was based on approximate PSS-10
scores of those with emotional disturbance to be 4 pts higher than a
baseline PSS-10 score of 19 (Meaklim et al., 2021; TMGH-Global COVID-19
Collaborative, 2021; Agyapong et al., 2020). Assuming a pooled standard
deviation of 6.5 pts (Meaklim et al., 2021; TMGH-Global COVID-19
Collaborative, 2021; Agyapong et al., 2020), an estimated sample of 84
participants (42 per group) to achieve a power o 80\% and a significance
of 5\% ( two-sided) was determined (Dhand \& Kahtkar, 2014). An
independent sample t-test was used to assess possible differences
between PSS-10 and PANAS. In addition, cross-tabulations using a
chi-square analysis were performed on prior historical stress. A
one-sample chi-square goodness of fit (GOF) test was used to assess the
proportion of responses for perceived changes in emotional disorders.
The alpha for this study was set at 95\% (p\textless{}.05).

\textbf{Results}

Two hundred and thirty-one (231) individuals were evaluated for
inclusion. Ninety-seven (97) individuals met the inclusion criteria.
Group 1 included 34 individuals (No Emotional Disorder; NEDG); Group 2
included 58 individuals reporting a diagnosis of anxiety and 5 with
depression (EDG). The average age of the included population was
48.9\emph{+} 10.4 years. The population was skewed towards female
participants, with 81.5\% female and 18.5\% male. The population's
education level included 76\% having at least a bachelor's degree and
46\% having a graduate degree. There was no difference in demographics
between groups. Detailed demographics of the sampled population are
presented in Table 1.

The two questions about previous stress suggest differences in stress
frequency and duration between groups. Fifty-three percent (N=18) of the
NEDG group reported experiencing stress sometimes or on occasion. In
comparison, 79\% (N=50) of the EDG group reported experiencing stress
often or always. These differences are significant when running a
chi-square analysis X2(3,n=97)= 13.14, p\textless{}0.01.

Individuals within the emotional disorder group reported experiencing
stress for a longer duration when compared to individuals in the
nonemotional disorder group X2(5,n=95)= 17.01, p\textless{}0.01.
Eighty-seven percent (N=53) of EDG compared to 55.9\% (N=19) of NEDG
reported experiencing stress for greater than six months. Detailed
stress history is presented in Table 1.

Somacoutstic usage was similar between groups, with no significant
differences in frequency, length, or duration. Most participants
(\textgreater{}60\%) reported using the 10- and 20-minute sessions, and
close to 50\% reported using the device 6-7 days per week. Detailed
Somacoustic usage is presented in Table 2.

An independent sample t-test indicated no significant difference in
PSS-10 levels between groups. Participants in NEDG had a mean PSS-10
score of 17.6 + 5.3 ( 95\% CI: 15.6-19.2), and participants in EDG had a
PSS-10 score of 17.0 + 5.5 (95\% CI: 15.6-18.3). There was no
significant difference in positive affect (NEDG= 31.5 + 6.5 ; EDG=32.0 +
6.4) and negative affect (NEDG= 20.2 + 6.4 ; EDG= 21.2 + 6.8) between
groups.

A chi-square GOF test was performed to determine whether the proportion
of those who indicated a diagnosis of anxiety reported an improvement
(Improved and Greatly Improved) vs. no change in their condition. The
proportions significantly differed with a preference for improvement
compared to no changes X2(1,n=58)= 6.90, p\textless{}0.01. Approximately
41.4\% of those with anxiety report an improvement, and 26\% of the
participants report their anxiety as greatly improved. There was no
significant difference in perceived anxiety changes between types of
anxiety (p=.07), as noted by a Pearson chi-square test. Detailed
responses are presented in Table 3.

Twelve individuals (55\%) with a history of depression (n=18) reported
an improvement in their depression. There was no reported response of
worsening of depression, as seven reported no changes. Chi-square GOF
was performed to determine if there was a significant difference between
responses for improvement and no change, and the proportions did not
differ, X2(1, n=18)=.80, p=.37. Detailed responses are presented in
Table 3.

\textbf{Discussion}

This was the first study examining possible differences in perceived
stress, positive affect, and negative affect between adults using a
novel coping strategy. Perceived stress scores in adults that used this
method were similar to those prior to the COVID-19 pandemic (Champion,
Economides, \& Chandler, 2018; Cohen \& Janicki-Deverts, 2012; Andreou
et al., 2011). It was believed that there would be differences in stress
scores between those with and without an anxiety disorder. However, this
was not the case. A 2017 cross-section study compared PSS-10 scores in
adults (N=150) with confirmed anxiety disorders with active symptoms but
no comorbid major mental health illness. Individuals in the high anxiety
group (HAM-A \textgreater{}17 pts) had PSS-10 scores nearly 7 pts higher
than those in the low anxiety group (21.8 + 4.7 vs. 14.2 + 5.9;
p\textless{}0.001) (Chaudhary, Panchal, Vala, Ratnani, \& Vadher, 2017).
Moreover, as PSS-10 scores increased, so did anxiety symptomology.
Interestingly, nearly all the participants (96\%) reported not receiving
treatment for their anxiety. Andreou et al. (2011) experienced similar
results with increased anxiety symptoms as PSS-10 scores increased.
Stress scores tend to increase by approximately 1.5-2 pts with each
added symptom and 3-4 pts with each progressive classification change in
the Depression Anxiety Stress Scale (DASS-21). The DASS-21 is not a
categorical measure of clinical diagnoses for depression or anxiety but
does have high associations with the PHQ-8 (r=.71, p\textless{}.001) for
depression and GAD-7 (r=.61, p\textless{}.001) for anxiety (Peters,
Peters, Andreopoulos, Pollock, Pande, \& Mochari-Greenberger, 2021).
More recent studies suggest a 4-5 pt increase in PSS-10 scores in
individuals with mental health problems (Mozumder, 2022; Meaklim et al.,
2021;).

When comparing pre-stress assessments from the current study, there was
a significant difference in the number of individuals feeling stress
over a longer duration. Over 85\% of EDG participants reported feeling
stressed for longer than six months compared to approximately 55\% of
NEDG participants (X2(5,n=95)= 17.01, p\textless{}0.01 ). The two
pre-stress questions offered similar wording and duration to criteria
within the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) for evaluating generalized anxiety (American Psychological
Association, 2013). Therefore, many NEDG participants might have an
undiagnosed anxiety disorder, or they chose to abstain from reporting a
diagnosis of a listed mental health condition. Second, participants
surveyed in our study were purposefully using a method to help manage
their stress. Approximately 70\% of study participants reported using
the novel coping strategy for 5-7 days per week, and the average length
of use was 3.5 months. Therefore, the use of the novel coping strategy,
along with other possible stress management options, may have influenced
the outcome and prevented assessing possible differences between study
groups. This is further discussed in the discussion.

Albeit there was no difference in PSS-10 scores between groups, the
results are similar to normative gender and age data prior to the
COVID-19 pandemic and during the COVID-19 pandemic. The current study
was skewed towards female participants, but there was no significant
difference between male and female stress scores (Female= 17.4 + 5.3;
Male=16.2 + 6.5; p=.23). Cohen and Janicki-Deverts (2012) compared three
national surveys incorporating the PSS-10 and demographics between 1983,
2006, and 2009. In 2009, the mean PSS-10 score in women (N=1032) and men
(N=968) was 16.1 + 7.6 and 15.5 + 7.4, respectively. When considering
the age of the 2009 sample, the results are similar to the current
study. Men and women between 45-54 years (N=219) had a stress score of
16.9 + 7.8, and the mean age and PSS-10 score of our study population
were 48.8 + 10.4 years (95\% CI: 46.6 -50.8 yrs) and 17.1 + 5.5 (95\%
CI: 16.0-18.3) respectively. Normative data from Andreou et al. (2011)
reported PSS-10 scores in adults over 35 years of age (N=318) to be 16.7
+ 6.5, and women score higher than men by approximately 2 pts. A 2018
study provided PSS-10 data from adults (N=74; 41 female, 33 male) aged
25--59 years (Mean; 39.4, + 5.76), completing an in-app guided
mindfulness program. Initial PSS-10 of those using the mindfulness app
and control group were 16.7 + 5.3 and 17.6. + 6.0, respectively
(Champion, Economides, \& Chandler, 2018). In contrast, PSS-10 scores of
those using this novel coping strategy are lower than assessed PSS-10
scores (20-22 pts) of similar demographics (i.e., college-educated
middle-aged females) during the COVID-19 pandemic (Napoli, 2022; Aly et
al., 2021; Meaklim et al., 2021; TMGH-Global COVID-19 Collaborative,
2021; Adamsom et al., 2020; Agyapong et al., 2020).

Agyapong et al. (2020) conducted a comparative cross-section study
assessing the effectiveness of a text message intervention (TEXT4HOPE)
focused on reducing stress, anxiety, and depression during the pandemic.
Individuals ((N=766) self-subscribed to a 6-week program receiving daily
supportive text messages. The current study exhibited similar
demographics to the Agypong et al. (2020) study, where 88\% (N=678) of
the participants were female, 61\% (N=413) of females were between 41-60
years of age, and 89\% of females (N=611) reported having a college
education. Results from the TEXT4Hope program resulted in a 4\% decrease
in the PSS-10 score (20.4 + 6.7 to 19.5 + 7; p\textless{}.001) yet
remained similar to other studies assessing PSS-10 during the COVID-19
pandemic (Napoli, 2022; Aly et al., 2021; Meaklim et al., 2021;
TMGH-Global COVID-19 Collaborative, 2021). Based on these data, PSS-10
scores in the current study support pre-pandemic similarities, and over
70\% of individuals using this novel strategy may result in a PSS-10
score considered low to mild stress (Andreou et al., 2012) (Figure 1).

There was no significant difference in positive affect between groups
(NEDG= 31.5 + 6.5; EDG=32.0 + 6.4) in this study. Positive affect with
both groups was similar to established normative data from the general
population and individuals with managed mental health conditions (e.g.,
anxiety, depression) (PA=30-32 pts) (Díaz-García et al., 2021; Crawford
\& Henry, 2004; Watson, Clark, \& Tellegen, 1988). In addition, negative
affect between both groups was not significantly different (NEDG= 20.2 +
6.4; EDG= 21.2 + 6.8) but was higher than population norms (Crawford \&
Henry, 2004; Watson, Clark, \& Tellegen, 1988). Interestingly, the NA
scores were similar to those with emotional disorders receiving a novel,
transdiagnostic internet-based treatment protocol (20-22 pts) and lower
than patients not receiving treatment (28-30 pts) (Díaz-García et al.,
2021; Díaz-García et al., 2020).

Crawford and Henry (2004) offered percentiles due to normative values
from a non-clinical sample cannot estimate the rareness of an individual
score. Based on this information, the participants in the current study
had a positive affect rating in the 50th percentile (95 \% CI:
45.7-56.6\%), and negative affect was in the 74th percentile (95\% CI:
70.4-78.9\%). However, as noted earlier, positive and negative affect
scores were very similar to more recent studies with individuals with
emotional disorders (Díaz-García et al., 2021; Díaz-García et al.,
2020). Diaz-Garcia et al. (2020) evaluated the psychometric properties
of PANAS in a clinical sample with anxiety (N=237) and depression
(N=284). Results from the study demonstrate adequate assessment of
positive and negative affect with norms much different than the general
population (Crawford \& Henry, 2004; Watson, Clark, \& Tellegen, 1988).
Participants were recruited to participate in an online psychological
treatment program (Díaz-García, González-Robles, Fernández-Álvarez,
García-Palacios, Baños, \& Botella 2017). The total sample's average
positive affect scores were 20.2 + 6.9, and negative affect scores were
29.1 + 8.14. There were no differences in negative affect between those
with anxiety and those with depression. However, individuals with
depression scored significantly lower in positive affect by
approximately 3 to 4 pts (p\textless{}0.01) compared to those with
anxiety (Díaz-García et al., 2020). The differences between scores in
the current study may be attributed to the active management of an
emotional disorder. Individuals in the Diax-Garcia et al. (2020) study
had not started a treatment protocol for an emotional disorder.
Therefore, the differences may be confounded by the practice use of a
coping strategy resulting in the differences.

NA scores from the current study are similar to those participating in
an online treatment protocol for emotional disorders (Díaz-García et
al., 2021; Díaz-García, González-Robles, Fernández-Álvarez,
García-Palacios, Baños, \& Botella 2017). Díaz-García et al. (2021)
randomized individuals (N=216) to~a transdiagnostic internet-based
protocol (TIBP; n= 71), a TIBP+ positive affect component (TIBP+PA;
n=73), or a waitlist control group (WLC; n=72)). The primary treatment
protocol was approximately 18 weeks, and participants were encouraged to
work on one of the treatment protocols weekly, with messages encouraging
participants to continue implementing the skills or techniques for
management. The protocols were focused on down-regulating negative
affect and promoting positive affect. Most of the study participants
were female (72\%), with over 50\% having an anxiety disorder, with the
leading comorbid disorder being depression (Díaz-García et al., 2021).
After the treatment protocol, there were significant improvements in
positive and negative affect compared to the control group. More
specifically, individuals in the TIBP and TIBP+PA increased positive
affect to 25.2 + 7.1 and 27.3 + 9.2, respectively, whereas WLC
participants remained unchanged (19.3 + 5 and 19.7 + 7.3). Moreover,
there were significant decreases in negative affect in both treatment
groups with no change in WLC participants (28.6 + 9.0 and 28.8 + 9.0).
The mean negative affect score post-treatment in the TIBP and TIBP+PA
were 20.7 + 6.9 and 20.8 +8.3, respectively. Results from the current
study offer some promise of obtaining PANAS levels similar to those
participating in a therapeutic program for emotional regulation.

At the end of the current study's survey, individuals with anxiety
reported a significant proportion of improvement (67.2\%) when compared
to those reporting no change (32.8\%) (p\textless{}0.01). There was a
slight difference, yet insignificant, between anxiety types and those
responding in improvement. Individuals indicating a diagnosis of PTSD or
OCD reported more unchanged results compared to those with possible
general anxiety. There was no difference between those reporting an
improvement or unchanged status in their depressive disorder. No
participant with anxiety or depression reported worsening their
condition using the novel coping strategy. It is unknown what improved
with the participants since the survey did not assess specific symptoms.
It is speculated that individuals experience some level of emotional
relaxation. Individuals from the Ahonen, Deek, and Kroeker (2013) study
using low-frequency music with acoustic vibration reported a sense of
emotional and physical relaxation with specific descriptive improvement
with emotional enrichment, concentration skills, and tension \& stress
management without adverse effects (Ahonen, Deek, \& Kroeker, 2013). The
study by Sigurdardóttir et al. (2019) suggests improvement in
individuals with depression from targeted low-frequency acoustic
vibration over 3-4 weeks. A more recent study suggests minimal stress
and emotional response improvement from vibroacoustic therapy, but the
researcher did indicate the participants were not previously under
stress, and no adverse side effects were reported (Vilímek et al.,
2022). Therefore, individuals experiencing stress might experience some
emotional improvement without harmful effects from using the novel
technology.

There are limitations to this study design and its findings. First, the
study was a casual, comparative study using this novel strategy from a
cross-section of individuals. It is unknown if stress, positive affect,
or negative affect increased or decreased prior to implementing this
management method. Second, it is unknown if other coping mechanisms may
have been implemented with this novel strategy. Participants could have
implemented additional coping methods, such as problem-based,
emotion-focused, or professional interventions. Third, formal evaluation
of anxiety and depressive changes were not assessed, and results are
solely based on participant perception. Fourth, the population was
skewed towards middle-aged females that were primarily college educated.
It is unknown whether these results would differ from a more homogeneous
sample. Finally, infrasonic resonance for emotional regulation remains
theoretical (McDoniel \& Chmelik, 2022; Bartel and Mosabbir, 2021 ) but
may offer promise based on similar technologies (Vilímek et al., 2022,
Sigurdardóttir et al., 2019, Ahonen, Deek, and Kroeker, 2013). Based on
these limitations, additional research investigating this novel
technology is warranted.

Excess stress continues to be a global problem. Before the COVID-19
pandemic, leading causes of distress were related to finances, job
security, and economic concerns (Clay, 2011; Ray, 2019). These concerns
are still prevalent, and additional stressors include continued concern
with COVID-19 (Meaklim et al., 2021; O'Regan et al., 2021), geopolitical
(war, inflation), and social issues (racial equality, civil liberties,
and violence/crime) (American Psychological Association, 2022). Chronic,
elevated stress levels lead to future emotional disorders (Khan \& Khan,
2017), which can influence early mortality (Keller et al., 2012).
Problem-based stress management options are the preferred mechanism to
resolve stress. However, many of the current influencers of individual
stress may not be within personal control and quickly resolved.
Therefore, additional emotion-based solutions are warranted to manage
perceived stress and emotional disturbances. Somacoustics might offer a
viable coping strategy for middle-aged women. Additional research
validating the various uses of this novel strategy is warranted.

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\textbf{Table 1.} \emph{Detailed demographics of the study population.}\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Group\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Group\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Group\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\emph{NEDG}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\emph{EDG}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\emph{MEAN AGE + SD (yrs)} \emph{GENDER}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
49.1 \emph{+} 9.4\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
48.5 \emph{+}10.9\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\emph{Total (\%)}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Male\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
10\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
18 (18.6)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Female Total\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
26 34\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
53 63\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
79 (81.4) 97 (100)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\emph{EDUCATION}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
High School or Equivalent\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
7 (7.2)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Some College\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
7\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
9 (9.3)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Vocational Training Bachelors Degree Graduate Degree Total \emph{STRESS
FREQUENCY} Never Sometimes or On occasion Often Always Total
\emph{STRESS DURATION} Not Applicable-Stress was managed \textless{} 1
Month 1-2 Months 3-4 Months Months \textgreater{} 6 Months Total\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
1 13 17 34 0 18 12 2 34 6 2 1 3 3 19 34\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
6 16 28 63 1 12 37 13 63 0 2 2 1 3 53 62\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
7 (7.2) 29 (30) 45 (46.4) 97 (100) 1 (1.0) 30 (30.9) 51 (52.6) 15 (15.5)
97 (100) 6 (6.3) 4 (4.2) 3 (3.2) 4 (4.2) 6 (6.3) 72 (75.8) 96
(100)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\emph{EDG: Emotional Disturbance Group, NEDG=No Emotional Disturbance
Group SD= standard deviation}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\emph{EDG: Emotional Disturbance Group, NEDG=No Emotional Disturbance
Group SD= standard deviation}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\emph{EDG: Emotional Disturbance Group, NEDG=No Emotional Disturbance
Group SD= standard deviation}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\emph{EDG: Emotional Disturbance Group, NEDG=No Emotional Disturbance
Group SD= standard deviation}\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 2.} \emph{Somacoustic usage between groups.}\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
Groups & Groups & Groups & & &\tabularnewline
& \emph{NEDG} & \emph{EDG} & \emph{EDG} & &\tabularnewline
\emph{WEEKLY FREQUENCY} & & & & \emph{Total (\%)} & \emph{Total
(\%)}\tabularnewline
3 Days & 2 & 17 & 17 & 19 (16.6) & 19 (16.6)\tabularnewline
4 Days 5 Days 6 Days 7 Days Total & 8 7 1 16 34 & 7 9 5 25 63 & 7 9 5 25
63 & 15 (15.5) 16 (16.5) 6 (6.2) 41 (42.3) 97 (100) & 15 (15.5) 16
(16.5) 6 (6.2) 41 (42.3) 97 (100)\tabularnewline
\emph{LENGTH OF USE} & & & & \emph{Total (\%)} & \emph{Total
(\%)}\tabularnewline
1 Month & 7 & 4 & 4 & 11 (11.3) & 11 (11.3)\tabularnewline
2 Months & 5 & 16 & 16 & 21 (21.6) & 21 (21.6)\tabularnewline
3 Months 4 Months 5 Months 6 Months Total \emph{DURATION OF USE} 10
Minutes 20 Minutes 30 Minutes \textgreater{} 30 Minutes Total & 9 6 4 3
34 15 11 4 4 34 & 19 6 7 11 63 18 18 17 9 62 & 19 6 7 11 63 18 18 17 9
62 & 28 (28.9) 12 (12.4) 11 (11.3) 14 (14.4) 97 (100) \emph{Total (\%)}
33 (34.4) 29 (30.2) 21 (21.9) 13 (13.4) 96 (100) & 28 (28.9) 12 (12.4)
11 (11.3) 14 (14.4) 97 (100) \emph{Total (\%)} 33 (34.4) 29 (30.2) 21
(21.9) 13 (13.4) 96 (100)\tabularnewline
\emph{EDG: Emotional Disturbance Group, NEDG=No Emotional Disturbance
Group} & \emph{EDG: Emotional Disturbance Group, NEDG=No Emotional
Disturbance Group} & \emph{EDG: Emotional Disturbance Group, NEDG=No
Emotional Disturbance Group} & \emph{EDG: Emotional Disturbance Group,
NEDG=No Emotional Disturbance Group} & \emph{EDG: Emotional Disturbance
Group, NEDG=No Emotional Disturbance Group} &\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 3.} \emph{Perceived changes in emotional disturbances}\selectlanguage{english}
\begin{longtable}[]{@{}llllllll@{}}
\toprule
Groups & Groups & Groups & Groups & Groups & Groups & Groups
&\tabularnewline
& \emph{AX} & \emph{AX with OCD} & \emph{AX with OCD} & \emph{AX with
PTSD} & \emph{AX with PTSD} & \emph{Total (\%)} & \emph{Total
(\%)}\tabularnewline
\emph{PERCEIVED ANXIETY} & & & & & & &\tabularnewline
Worsened No Change Improved Greatly Improved Total & 0 5 14 10 29 & 0 6
3 3 14 & 0 6 3 3 14 & 0 9 4 2 15 & 0 9 4 2 15 & 0 (0) 19 (32.8) 24
(41.4) 15 (25.9) 58 (100) & 0 (0) 19 (32.8) 24 (41.4) 15 (25.9) 58
(100)\tabularnewline
\emph{PERCEIVED DEPRESSION CHANGE} & \emph{D} & \emph{D with AX} &
\emph{D with OCD} & \emph{D with OCD} & \emph{D with PTSD} & \emph{Total
(\%)} & \emph{Total (\%)}\tabularnewline
Worsened No Change Improved Greatly Improved Total & 0 2 3 0 5 & 0 2 5 0
7 & 0 2 1 0 3 & 0 2 1 0 3 & 0 1 1 1 3 & 0 (0) 7 (38.9) 10 (55.6) 1 (5.6)
18 (100) & 0 (0) 7 (38.9) 10 (55.6) 1 (5.6) 18 (100)\tabularnewline
\bottomrule
\end{longtable}

\emph{AX=Anxiety, OCD=Obsessive Compulsive Disorder; PTSD:
Post-Traumatic Stress Disorder; D=Depression}

\textbf{Figure 1.} \emph{Perceived stress scale (PSS-10) classifications
of study participants by group.}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
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\textbf{Appendix. Survey Questions without PSS-10 and PANAS.}

What is your current age in years? \_\_\_\_\_\_\_\_\_\_\_

What is your gender? Male Female

What is your highest level of education?

High School or Equivalent Some College Vocational Training Bachelors
Degree

Graduate Degree

Please indicate if you have been medically diagnosed with any of the
listed health

Anxiety Depression Obsessive Compulsive Disorder (OCD) Post Traumatic
Stress Disorder (PTSD)

How long have you been using Sensate device?

\textless{} 1 Month 1 Month 2 Months 3 Months 4 Months 5 Months 6 Months
\textgreater{} 6 Months

How frequent do you use the Sensate device?

0 Days per week 1 Day per week 2 Days per week 3 Days per week 4 days
per week

5 Days per week 6 Days per week 7 Days per week

Over the past month, what is the usual duration of your Sensate device
session?

\textless{}10 Minutes 10 Minutes 11-20 Minutes 21-30 Minutes
\textgreater{}30 Minutes

Prior to using Sensate, For how long were you feeling (anxious, nervous,
jittery, scared, worry, dread) stressed?

Not applicable-Stress was managed \textless{} 1 Month 1-2 Months 3-4
Months 5-6 Months

\textgreater{} 6 Months

Prior to using Sensate, how often did you feel (anxious, nervous,
jittery, scared, worry, dread) stressed?

Never Sometimes or On occasion Often Always

Since using Sensate, please indicate how any listed conditions have
changed. (NA= Not applicable since I do not have this health issue.)\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
& NA & Greatly Improved & Improved & No Change & Worsened\tabularnewline
\midrule
\endhead
Anxiety & & & & &\tabularnewline
Depression & & & & &\tabularnewline
OCD & & & & &\tabularnewline
PTSD & & & & &\tabularnewline
\bottomrule
\end{longtable}

\selectlanguage{english}
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