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 >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<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<.001) for depression and GAD-7 (r=.61, p<.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<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<.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<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<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.