2011 IEEE 7th International Colloquium on Signal Processing and its Applications

A Review on Stress Inducement Stimuli for Assessing Human Stress Using Physiological Signals
P. Karthikeyan#1, M. Murugappan#2, S Yaacob#3
School of Mechatronics Engineering, Universiti Malaysia Perlis Campus Ulu Pauh, Arau, Perlis, Malaysia
1

karthi_209170@yahoo.com 2 m.murugappan@gmail.com 3 sazali22@gmail.com

Abstract Assessing human stress in real-time is more difficult and challenging today. The present review deals about the measurement of stress in laboratory environment using different stress inducement stimuli by the help of physiological signals. Previous researchers have been used different stress inducement stimuli such as stroop colour word test (CWT), mental arithmetic test, public speaking task, cold pressor test, computer games and works used to induce the stress. Most of the researchers have been analyzed stress using questionnaire based approach and physiological signals. The several physiological signals like Electrocardiogram (ECG), Electromyogram (EMG), Galvanic Skin Response (GSR), Blood Pressure (BP), Skin Temperature (ST), Blood Volume Pulse (BVP), respiration rate (RIP) and Electroencephalogram (EEG) were briefly investigated to identify the stress. Different statistical methods like Analysis of variance (ANOVA), two-way ANOVA, Multivariate analysis of variance (MANOVA), t-test, paired t-tests and student t-tests have used to describe the correlation between stress inducement stimuli, subjective parameters (age, gender and etc.,) and physiological signals. This present works aims to find the most appropriate stress inducement stimuli, physiological signals and statistical method to efficiently asses the human stress. Keywords stress, stress inducement stimuli, physiological signals, statistical methods.

previously such as, stroop colour word test [1-6], mental arithmetic task [6-10], public speaking task [11], cold pressor test [6, 12], computer work [6, 13]. For analyse the correlation between the stress inducement stimuli and physiological signals variation, stress, and subjective parameters (age, gender and etc.,), they are several statistical techniques like ANOVA, two-way ANOVA, MANOVA, t-test, paired t-tests and student t-tests are used. This paper has two sections; (1) stress inducement method and protocol design. (2) Methods acquiring physiological signal and its statistical validating techniques. II. PAGE LAYOUT METHODS OF INDUCING STRESS AND ITS
PROTOCOL DESIGN

I. INTRODUCTION Many researchers have agreed that the mental disorders due to stress is a highly challenging issue in the present century [1]. In general, the stress is an afflictive and precarious to health. Stress assessment instruments are significant for health research among the doctors and psychologist to examine the impact of stress. Determining the stress from the physiological signals is reliable and challenging, it is because of reasonable evidence from physiological signal. There are several researches have reported about the impact of stress using physiological signals. The limitation of measuring stress in real time is bounds with the three factors: (1) it is difficult to collect the physiological data from real time stressful environment, (2) Variation in between the subjects on stress, and (3) Difficulty on estimating the level of stress. In order overcome the above limitations, previous researchers considered laboratory based experiments for assessing the stress than real time experiments. The laboratory based experiments are highly useful to obtain more stress samples. The following different stress inducement stimuli have used

A. Strop Colour Word Test The stroop colour word test was introduced by J.R. Stroop in 1935 which includes three different tasks as shown in the Fig. 1. The names of the colour appeared in black colour in the first stimuli, the names of the colour is different than word written in the second stimuli and the third stimuli is squares of certain colours. The subject should verbally answer the colour of the word but not a word. The recent and most popular method is stroop second experiment as shown in Fig. 2. This experiment consists of three different tasks namely called neutral session (introductory session), congruent session (non conflict task) and non congruent session (conflict task). In neutral session the colour of the word appeared in black, congruent session the colour of the word appeared is same than the colour in the word written and incongruent session the colour of the word appeared in different colour than the word written. The stroop observed and compared the response of the participants between three stimuli as incongruent session is harder than other two sessions. Later on, they were several modifications have been taken place from past seven decades until today. This modification either in terms of increasing or decreasing the task duration, adding more colour in each stimuli, instead of reading the word of the colour the subject asked to pronounce loudly, computer based stroop word test and selecting one incongruent stroop among the number of congruent stroop have been used. The strop colour word tests have useful in many applications such as brain imaging and attention studies [14], cognitive, working

978-1-61284-413-8/11/$26.00 2011 IEEE

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memory development and also in the field of psychology test used for identification and measurement of stress [1-6].

years. The complete experiment comprises one Resting Segment (RS) and the three consecutive segments namely, Introductory Segment (IS), Congruent Segment (C) and Incongruent Segment (IC). During the resting section, the neutral pictures were presented to relax the subject and then successively stroop test was presented to induce the mental stress. In this test, each trail was displayed 3 sec duration for user response; if the subject is not response or answered with in 3 sec, than the screen will move automatically to the next trail. B. Mental Arithmetic Task Mental arithmetic task is frequently used methods to induce the stress in the area of psychophysiology [6-10, 12, 15]. It is the task to increase the mental demand by the way of performing a series or combination of arithmetic operation. This method is easy to implement and do not require many instruments as like the video game task and shock avoidance task [15]. Totally, 81 subjects, in the age of 18+0.9 years were participated in the mental arithmetic stress test [12]. In this test, the subjects are asked to carry out 5 min arithmetic subtraction in noise environment (metronome noise at the frequency 2 Hz). The arithmetic task is consisting series of subtraction from 1079 by using number 13; the answers and miscalculation were informed continuously to the subject. Arithmetic task was performed with four different kind of environment to distract the subject [15]. Such as (1) no noise task (control task); (2) variable real life noise; (3) a steady real life noise; (4) meaning less noise task. The variable real life noise are siren, car engine warm up, thunder getting closer, child crying outboard motor running noise and saw cutting through metal etc., were consist of uneven length to distract and induce the stress. The steady real-life noise was to reflect the real-life sounds without any variability. The noises were selected through pilot study and it consists of the collection of background noises from bars and cafes. And finally the meaning less noise task, it is the artificial noise that generated through sine wave generator. Here, the arithmetic operation is subtraction from 2000 by using 6, or 7, or 8, or 9 for the purpose of preventing learning and task habituation. Twenty subjects with the mean age of 27.7 years were participated and performed the two set of mental arithmetic task were presented tape recorder [9]. Each set consist of 11 problems requiring 2 serial arithmetic operations with comparable complexity. After the experiment, subject were asked to rate the level of difficulty in 10 point scale from not difficult to extremely difficult. In [7], Twenty sex healthy subjects (12 men and 14 women) participated with the mean age of 52+ 9 years. They researchers have asked the subjects to perform subtractions of 7 from 700 as soon as possible within 2.5 sec. TABLE I. shows the list of previous approaches to assess the stress. C. Cold Pressor Test Cold pressor test is also considered as one of the stimuli among few stress inducement stimuli. A few minutes hand immersion into the cold water is called cold pressor test.

Fig. 1 Stroop first experiment

Fig. 2 Stroop second experiment

In [1], the researchers have considered 38 subjects (men=13 & women =25) and used the stroop colour word test in visual basic windows environment for inducing stress. The task consist of three level, in first level incongruent stroop appeared on the screen the subject were asked to indicate word itself and second level subject should label the colour of the word that appears with different colour word and finally colour of the word appears concurrently with some recorded warning and beep sound, the participant indicate colour of the word. Each task consists of 3 min for each level. 106 participants (68 male and 38 female) with the mean age of 23.4+1.4 years are considered and comfortably positioned on the chair [3]. Before starting the task, 5 min resting state was performed by the participant with the closed eyes. this test consist of three states, initially 120 sec rest, 40 sec of non conflict test (congruent stroop), 40sec conflict task (incongruent stroop). In this experiment, the entire stimulus was presented on the computer screen, 3 sec for each word and 7sec successive task. Nine male subjects were aged between 22-25 years are participated in two sessions namely stress session and control session [2]. During the task, the subject was engaged to undergone 20 min version of stroop colour word test twice and with the rest of 20 min before and after the test. To elicit the stress, the modified stroop colour word test was used by [5]. The subjects are asked to click the correct answer using mouse rather than stating verbally. 32 subjects were participated in the experiment with age group of (21-42)

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TABLE I

PREVIOUS APPROACHES TO IDENTIFY AND MEASURE THE STRESS USING LABORATORY STRESS INDUCING STIMULI

Author [11] [12]

[3]

[1]

[13]

Stimuli Information Mental arithmetic task and public speaking task. Cold pressor test (1 minute hand immersion of ice water at 0C) and mental arithmetic task (5 min subtraction of number with distraction of noise). Stroop colour word test, three states rest (120 sec), non-conflict (40 sec) and conflict state (40 sec). Stroop colour word, 3 sessions and each 3 min, and finally cold pressor test. Computer work, 3 session as introductory, stress and control session. Each session 3 minutes and four work period. 14 and 28 min mental arithmetic task.

Subjects & Signals 25 subjects & ECG. 81 subjects & BP

Statistical Methods Two-way ANOVA. Paired t-test for absolute response during stress and baseline changes and paired t-test with Pearson correlation for finding stress response stability over the time. t- test.

Conclusion Heart rate increased compared to base line. The BP value during mental arithmetic task is higher than cold pressor test.

106 subjects & Electro dermal Response (EDA). 48 subjects & ECG (HR) and BP. 12 female subjects & BP and ECG.

EDA response increased during the stress events majority of subjects. There is no significant difference when applied the same test after the two week to the same subject HR and BP are strongly correlated for the test. A reduction in high frequency component in HRV & increase the value of low to high frequency ratio of HRV component, there is no changes in low frequency component. Blood pressure level increased during stress event. During mental arithmetic task SBP, DBP, pulse rate were higher than rest.

ANOVA for repeated measures of HR & BP. Two-way ANOVA.

[10]

[4] [9] [8]

Computer version of stroop colour-word interference test. Mental arithmetic task both verbal and non verbal. Mental arithmetic task with silent phase, mental arithmetic task with aloud phase.

24 subjects & Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and pulse rate. 48 subjects & Heart rate and skin conductance. 20 subjects & ECG. 41 male and female college students & heart rate, skin conductance response (SCR), stroke volume (SV), SBP and DBP 62 subjects & 42 cash register operators, 20 university students. SBP, DBP, Heart rate and EMG. 26 healthy subjects, blood samples, BP and ECG.

MANOVA.

MANOVA. ANOVA. ANOVA.

HR and skin conductance significantly increased compared to baseline. During verbal mental arithmetic task the HR responses higher than non verbal. Heart rate and skin conductance response during aloud phase are higher than silent phases.

[6]

Mental arithmetic task, cold pressor test and stroop colour word test.

t-test, ANOVA, paired ttests and correlations.

[7]

Mental arithmetic task (7 subtractions from 700 within 2.5 min).

Student t-test and linear regression analysis.

EMG activity increased significantly from rest to both mental arithmetic task and strop colour word test, EMG activity comparatively higher than stroop colour word test, HR, SBP and DBP values are increased compared to rest periods. Increase in heart rate and blood pressure and also systemic and coronary Vasoconstriction and a plateletaggregating effected, resulting in an increase in myocardial oxygen demand and a decrease in myocardial oxygen supply.

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During this test subject felt completely uncomfortable and unable to adopt the hand on the particular temperature over a definite period time. In [12], The subject right hand is immersed completely in ice water (0C) for the duration of 1 min and the response was observed. However, the subjects are asked to immerse their hands in ice water until they felt discomfort [16]. The subjects informed to put their hand up to wrist in cold ice water (4C) for one min. D. Public Speaking Task The public speaking task is conducted with 25 healthy males, were in the mean age of 23.7 years. After appropriate validation of the protocol, the 5 minutes public speaking task (mock interview) were conducted in front of two unfamiliar evaluator and subsequently 5 minute mental arithmetic task (serial subtraction) is performed out loudly in front of the panel [11]. Wireless heart rate (HR) monitor was used to collect the heart rate before and during the experiment. In [16], The participants were informed to prepare the public speaking task and the task consist of four minutes for preparation and four minute for speech. While speaking the subject, the pose, articulation and styles were evaluated by the staff members. During this experiment 22 subjects are participated. All the subjects wore the autosense chest band platform that enclosed ECG, GSR, RIP and ST sensors E. Computer Work and Games Keying the random number using numeric part of the keyboard and six digits were presented on the computer screen. The participants were told to key the digits within next 4 sec duration. If the subject fails to key the numbers, then the mistakes were accounted. This errors and mistakes are counted to see how they performed [13]. And the heart rate and variability was acquired by using ECG sensors. In general, video games, solving puzzles, arithmetic problems and anagram are usually used to induce stress. However, the video games are very effective to induce the stress and the level of difficulties can be varied to pertain various levels of stress [17]. This event was tried out over a period of month with multiple subjects. By comparing all other stress inducement stimuli the stroop colour word test and mental arithmetic task have used by most of the researchers. III. SUBJECTIVE MEASURES AND STATISTICAL METHODS A. Physiological Signals In 1989, the stress response of stroop test was measured with help of physiological signals. They signal are heart rate, EMG, finger pulse amplitude and skin conductance level (SCL) [2]. The researchers have considered the young subjects and in the same age group. From the analysis, they first reported that the EMG activity of forearm was increased during the colour word test; these findings were not reported before research. During the stress the heart rate are increased 6 (beats/min) than rest. In 1991, investigated about the heart rate and blood pressure of the subjects throughout the mental

arithmetic task to measure the stress response on these stimuli [15]. They investigated about the correlation between 4 types of mental arithmetic stimuli using two physiological signals. Even though the physiological signals shows a significant variation on four stress inducement methods, the vocal delivery during mental arithmetic task greatly influences on reducing the impact of autonomic responses. The same year, ECG and BP were collected and the result shows increased HR and BP [7]. In [13], these researchers have considered heart rate variability (HRV) and BP to identify the relationship between the stress during computer work. During the task BP and ECG continuously recorded and the subjects were informed to rate their experience in the six categories in 11 point scale. This experiment consist of three sessions with various constraints, the result indicates that there is no significant difference in low frequency component of heart rate variability between control sessions and stress session. However, the high frequency (HF) component and low-to high frequency ratio are considerably reduced in stress session compared with control session. The blood pressure is significantly increased in all the sessions compared to rest session. EMG activity of both right and left trapezius muscles response to the stress stimuli is measured by [6]. The effect of EMG activity during colour word test and mental arithmetic task was recorded. After the statistical analysis, the value of EMG activity was increased by comparing to the rest. The EMG activity during mental arithmetic task significantly more than colour word test. ECG and BP are measured during the colour word test and cold pressure test [1]. These signals are acquired during rest condition for considered as baseline. The BP values are measured for every 3 sec throughout the experiment until reaches the baseline values. After the statistical validation heart rate values at initially 83 (beats/min) and at the end of the test the BP value raised up to 110 (beats/min). After the15minutes post test the values are come down to 81 (beats/min). Similarly the BP value is gradually increased from 101 to 118 (mmHg) and after post test the values are similarly down 93 (mmHg). There is no difference in both cardiovascular and hormonal responses in between first and second trail applied to the same subjects after the two weeks. In [12], Blood pressure and heart rate were analysed during the measurement of stress using stroop test and cold pressor test. Result showed that, all the cardiovascular and sympathoadrenal variables increased significantly during the task. Electro dermal activity (EDA) was acquired from the index and middle finger of each hand during the stroop test [3]. After analysing the data the significant changes can be observed from the result. The electro dermal activity is increased during the high complexity and decreased based on low complexity. For the data analysis skinner algorithm with point wise correlation dimension used and they proved better result on determining the stress.

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B. Statistical Methods Statistical analysis is inevitable for physiological signal analysis and particularly for stress measurement. The most important statistical methods are found through review for stress analysis (TABLE I) as ANOVA, two-way ANOVA, MANOVA, and paired t-test. In [1], the researchers are considered to use ANOVA for repeated measures of BP and heart rate with p<0.05 significant level. For comparison between the pre-test and post-test samples of blood pressure the paired t-test was applied. The two-way ANOVA was used for determining the statistical correlation of repeated tasks and on different session [13]. Here the researchers considered the subjects, session and treatment (baseline, computer work and prolonged break) at the significant level p < 0.05 In [2], the researcher considered two factors such as colour word test or rest condition and the subjects for analysing ECG, skin conductance, pulse amplitude EMG and respiration using two way ANOVA. In addition, the Pearson correlation coefficient is used to analyse the relation between initial value during rest and final value at stress. The overall responses of stress task was examined by using paired t-test and the mean value of cardiovascular signals and its base line values are considered [6]. Here, the ANOVA is not applied due to the difference in number of measurements on the two sessions. A paired t-test is used to evaluate the two session namely control and stress session for single time evaluation [11]. However the two-way ANOVA is used for repeated measures for the above two sessions. IV. CONCLUSIONS Among the larger number of stress inducement stimuli, only few stimuli are familiar and efficient to induce the stress. In this, the stroop colour word test and mental arithmetic task are considered as more powerful methods. These methods are simple and easy to implement on various groups of subject. However, there is no ground-truth has been laid by the earlier researches to induce the stress using above stimuli on all the subjects. Because, the level of inducing the stress on the various subjects purely depends on several factors such as age, gender, living environment, culture and etc. It is fully depends on subjective experience and individual mental capability. The Electrocardiogram and Electromyogram, blood pressure, skin conductance response, skin temperature, blood volume pulse and electroencephalogram are the primary physiological measures used to identify and measure the stress using non invasive methods. Several researchers have analyzed any one of the physiological signal for identifying stress. They have found that, the inducement of stress through physiological signal variations using various statistical features [11, 12]. On the other hand, analyzing the stress using multiple physiological signals gives a better result than investigating single signal [5, 18]. Electrocardiogram and blood pressure are most successful evident on determining the stress compared with all other signals [1, 7, 13]. The present review concludes that, stroop test and mental arithmetic task are the unavoidable stress inducement stimuli and the electrocardiogram and blood pressure signals must be combined with any other signal in

order to achieve a better classification rate for mental stress assessment research. The statistical analysis ANOVA and other statistical methods mentioned on this review are highly successful in the stress research for physiological signal interpretation. ACKNOWLEDGMENT This project work is supported by Fundamental Research Grant Scheme (FRGS), Malaysia. Grant Code: 9003-00245. REFERENCES
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