\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}



\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[ngerman,english]{babel}








% Edit this header.tex file to include frontmatter definitions and global macros

% Add here any LaTeX packages you would like to load in all document blocks
% \usepackage{xspace}

% Add here any LaTeX macros you would like to load in all document blocks
% \def\example{This is an example macro.}

% -----

\iflatexml
% Add here any LaTeXML-specific commands

% -----

\else
% Add here any export style-specific LaTeX commands. These will only be loaded upon document export. 
% \paperfield{Subject domain of my document}
% \keywords{keyword1, keyword2}
% \corraddress{Author One PhD, Department, Institution, City, State or Province, Postal Code, Country}
% \fundinginfo{Funder One, Funder One Department, Grant/Award Number: 123456.}
\fi


\begin{document}

\title{The Effects of Cognitive Stimuli on Physical Stress Response~~~~}



\vspace{-1em}



  \date{}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup








\sloppy


~~\textbf{References:}

~~~~~~~~1.~ Kemeny, M. E. (2003). The psychobiology of stress. Current
directions in psychological science, 12(4), 124-129.

~~~~~~~~2.~ Cassidy, J. C., \& Johnson, R. E. (2002). Cognitive Test
Anxiety and Academic Performance.~\emph{Contemporary Educational
Psychology,27}, 270-295.

~~~~~~~~3.~ Aliyari, H., Sahraei, H., Daliri, M. R., Minaei-Bidgoli, B.,
Kazemi, M., Agaei, H., Sahraei, M., Hosseini, S., Hadipour, M. M.,
Mohammadi, M., \ldots{} Dehghanimohammadabadi, Z. (2018). The Beneficial
or Harmful Effects of Computer Game Stress on Cognitive Functions of
Players.~\emph{Basic and clinical neuroscience},~\emph{9}(3), 177-186.

~~~~~~~~4.~ Ahrberg, K. et al. (2012). The interaction between sleep
quality and academic performance.~\emph{Journal of Psychiatric
Research,46}(12), 1618-1622.

~~~~~~~~5.~Berntson, G. G., \& Cacioppo, J. T. (2004). Heart rate
variability: Stress and psychiatric conditions. Dynamic
electrocardiography, 57-64.

~~~~~~~~6.~ Suess, W. M.~ et al.(1980). The Effects of Psychological
Stress on Respiration: A Preliminary Study of Anxiety and
Hyperventilation.~\emph{Psychophyisology,17}(6), 1-7. ~

~~~~~~~~7.~ Strauss, V. (2013, February 10). Test anxiety: Why it is
increasing and 3 ways to curb it. Retrieved from
\url{https://www.washingtonpost.com/news/answer-sheet/wp/2013/02/10/test-anxiety-why-it-is-increasing-and-3-ways-to-curb-it/?utm\_term=.5705c8155d3b}

8. Van Galen, G. P., M\selectlanguage{ngerman}üller, M. L., Meulenbroek, R. G., \& Van Gemmert,
A. W. (2002). Forearm EMG response activity during motor performance in
individuals prone to increased stress reactivity.~\emph{American journal
of industrial medicine},~\emph{41}(5), 406-419.

9. Wijsman, J., Grundlehner, B., Penders, J., \& Hermens, H. (2013).
Trapezius muscle EMG as predictor of mental stress.~\emph{ACM
Transactions on Embedded Computing Systems (TECS)},~\emph{12}(4), 99.

Chris Afonso\textsuperscript{1},~ Paul Lawrence\textsuperscript{2},~
Aimee~ Rosato\textsuperscript{3}, German Martinez\textsuperscript{2}

\par\null

\textsuperscript{1}Department of Psychology, Clarkson University,
Potsdam, New York 13699

~\textsuperscript{2}Department of Chemistry and Biomolecular Science,
Clarkson University, Potsdam, New York 13699 ~

\textsuperscript{3}Department of Biology, Clarkson University, Potsdam,
New York 13699~

\section*{Abstract}

{\label{594581}}

Everyone experience stress during their lifetime, and it is seen that
students very often become stressed when it comes time for them to take
exams. Along with the stress they may be feeling, students may also
exhibit physical symptoms associated with mental stress. This study
looks to see cognitive stress induced from a puzzle game inflicts
different physical responses in students coming from different
backgrounds. Because students often have to take some courses that are
different from what their discipline is, this study aims to find out if
because of different backgrounds, students will show different physical
responses when faced with a puzzle game. Results showed that on average,
engineering students had the smallest change from their baseline to
their testing physiological measures and performed better on the
puzzle.~ ~ ~ ~ ~ ~

\section*{Introduction}

{\label{874460}}

~~~~~~~All over the world, students enrolled in classes are required to
take tests to measure what they have learned over the course of the
class. Studying for these tests can cause students a great deal of
stress and anxiety, especially when someone feels that they are
unprepared and do not know the information that they need to for them to
succeed. As many as 20 percent of students in the United States have
severe test anxiety, and an additional 18 percent have moderate test
anxiety (Strauss, 2013), much of which comes from a student feeling not
in control of their success. This being said, if a student feels
confident that they know the information that they are studying, they
will likely have much lower~{stress levels}~compared to someone who does
not feel that they are prepared. This same pattern can be seen if
someone is told they are going to be ``graded'' on a task they are asked
to perform. If someone is familiar with the task they will likely be far
less stressed/anxious than someone who has never been exposed to such a
task before.

~~~~~~~~~~~~~~~ Preparing for exams in college is stressful for almost
every student. {It is known}~that stress often elicits a variety of
physiological stress response such as increased heart rate and blood
pressure, but more recently it has been seen that these physical
responses vary depending on the situation that is causing someone stress
(Kemeny, 2003). Additionally, in a study done in 2004 by Bernston and
Cacioppo, it was seen that computer-related stress was seen to increase
low-to-high heart rate variability among individuals. Another commonly
known physical sign of stress is an increased respiratory rate (Suess,
Alexander, Smith, Sweeny \& Marion, 1980). ~During the time leading up
to an exam, many {students sacrifice sleep in order to prepare,} which
can have very adverse effects on their performance. Medical students
were seen to suffer from worse sleep leading up to their exams rather
than after them, and it was seen that poor sleep quality before the
exams was correlated with poor performance (Ahrberg, Dresler,
Niedermajer, Steiger \& Genzel, 2012). Students who are stressed during
their studying and fail to get {enough sleep~}~often have higher levels
of test anxiety, and these students were seen to perform significantly
worse on exams (Cassady \& Johnson, 2002). ~~

~~~~~~~~~~~~~~{~ In this experiment, we are trying to elicit a similar
type of stress and anxiety that often comes with studying, and taking
tests, by giving subjects a cognitive puzzle solving~game}. W{e looked
at how students from the~}{different}~ schools at Clarkson (Engineering,
Business, and Arts and Sciences) show physical signs of stress to see
how academic background affects how individuals perform and how they
show signs of stress. Students coming from different academic
backgrounds will be trained in different things and will have different
skill levels at different tasks. By categorizing subjects into different
schools, analysis of the data can determine if a certain school performs
better on this puzzle task and if stress response varies because of
background.

~~~~~~~~~~~~Subjects will be given a~15-minute time limit and will be
instructed to complete 8 levels of the Kami 2 game: page 2 level 4, page
3 level 3, page 4 level 6, page 5 level 5, page 6 level 4, page 7 level
6, page 9 level 3, and page 19 level 3.~{During this time we will be
monitoring the respiratory rate, skin conductance, EMG, and pulse}. We
expect to see that as levels of this puzzle get more difficult,
cognitive stress will become greater and be seen by several physical
stress response symptoms such as increased heart rate and as well as
increased respiration rate and skin conductance. In 2002, Van Galen et
al. found that individuals with high anxiety have higher EMG measures
that those with low anxiety and are less stressed. Additionally, higher
trapezoid EMG signals were found in test subjects under stressful
conditions rather than during periods of rest (Wijsman et al, 2013).~{It
is expected that a change from baseline during the experiment will occur
among all subjects and that change will be greater within students from
the Clarkson University School of~Business.~}Our results will be able to
help understand the relationship between experiences in an area of study
or skill and an individual's stress when performing difficult tasks. ~

\par\null

\par\null\par\null

\section*{Methods}

{\label{523578}}

\subsection*{Study population}

{\label{789985}}

~~~~~~~~Undergraduate students at Clarkson~University from various
academic backgrounds are the focus of the experimentation. The three
schools at Clarkson were used for this study, Engineering, Arts and
Sciences, and the school of Business. A sample population of 2-3
students for each academic discipline was subjected to experimentation.~

\par\null

\subsection*{Experimentation~}

{\label{724229}}

~~~~\emph{\textbf{~}}~ The subjects first filled out a consent form and
pre experiment questionnaire both of which are shown in the appendix.~
All jewelry was removed from the volunteer's hand and arm. Once subjects
were completely hooked up, they underwent a 5 minute baseline test to
measure their resting pulse, respiratory rate, EMG activity, adn skin
conductance. The subject then~ practiced the game on the first 3 levels
of the Kami 2 puzzles. The subjects were then~ instructed that they
would have 15 minutes to solve 8 pre chosen levels of puzzles: page 2
level 4, page 3 level 3, page 4 level 6, page 5 level 5, page 6 level 4,
page 7 level 6, page 9 level 3, and page 19 level 3 . Each level of
puzzle progressed to a higher difficulty.~ Each subjects information was
then saved under their test number and time the experiment occurred. The
subjects were then disconnected from all of the PowerLab equipment. ~

\par\null

\subsection*{Procedure 1, Respiration Set
Up}

{\label{724229}}

\textbf{~}~ The Respiratory Belt was connected into the input on the
front panel of the PowerLab. The Belt was then attached around
the~volunteer's abdomen where breathing change was most apparent with
the writing on the belt facing outward.~ After turning the PowerLab on
the volunteer was instructed to sit relaxed facing away from the
monitor. When the start button for recording was pressed and the subject
was asked to breathe rapidly for 5 seconds and then slowly for 5 seconds
to ensure that the rate was properly displayed. The subjects were then
instructed to breathe normally through their baseline. We talked to them
throughout so they wouldn't be thinking about their breathing so we
could collect a typical baseline. After the experiment the respiratory
rate was found by looking at the cyclic measurements and finding breaths
per minute.

\par\null

\subsection*{Procedure 2, Blood Volume Pulse Set
Up}

{\label{181539}}

~ ~ ~~~~The Finger Pulse Transducer was connected to the input on the
front panel of the PowerLab. The pressure pad of the Finger Pulse
Transducer was then placed on the tip of the subjects non-dominant
middle finger and held firmly in place with a velcro strap without
cutting off circulation. The subject was then instructed to lay their
hand on the table with their palm facing up and requested to not move
their hand as much as possible. After the PowerLab was turned on the
volunteer was instructed to face away from the monitor. After the signal
was analyzed by looking at the beats per minute over the entire thing
compared to their baseline. Each individual level was observed as well
for heart rate.

\par\null

\subsection*{Procedure 3, Skin Conductivity Set
Up}

{\label{725126}}

~ ~ ~ ~ ~~~The GSR Amplifier was connected to the PowerLab with the
I\(^2\)C~cable. Then the BNC cable was connected to the
signal output on the GSR Amplifier and then was connected to input three
on the PowerLab. The finger electrodes were then connected to the GSR
Amplifier. Subjects were instructed to let their non-dominant hand rest
palm up. The skin conductivity throughout the experiment was constantly
compared to the baseline. If there was an increase then it indicated
that a stress response was present.

\par\null

\subsection*{Procedure 4,~ Electromyography (EMG) Set
Up}

{\label{584358}}

~ ~ ~ ~ ~ ~The 5 Lead Shield Bio Amp Cable was connected to Bio Amp
Connector on the front panel of the Powerlab. The hardware was connected
prior to opening the settings file. The volunteer's skin was abraded
with abrasive gel. After abrasion, the area was cleaned to remove dead
skin cells using a alcohol pad. A ballpoint pen was then used to mark
four small crosses about 2-3 inches apart on the skin above the shin and
the calf muscle. Once the skin was dry the disposable electrodes were
connected to the skin at the points mentioned. The Shielded Lead Wires
were connected to the Bio Amp Cable and then the electrodes were
connected to the wires. The color scheme on the Bio Amp Cable was
followed. The green Earth lead was attached to the Dry Earth Strap. The
four electrodes and Dry Earth Strap were then attached to the volunteer.
Channel 1 leads~ to the top of the shin a couple inches below the knee,
channel 2 leads to the shin approximately 3 inches below the first. Then
channel 3 was connected at the same height as channel 1 but on the calf
muscle, ~channel 4 leads to the calf approximately 3 inches below
channel 3. The Earth was connected to the Dry Earth Strap and placed
around the ankle. The EMG was used to measure the movement of the leg
and the tension placed there by stress. When stressed many people move
muscles in their body to help relieve tension and that is what we are
measuring through this experiment. The amount of tension throughout the
experiment was compared to the baseline~and the difference is what was
analyzed.

\par\null

\section*{Results}

{\label{987125}}

\subsection*{Effect of Stress on Heart Rate
(Pulse)}

{\label{621837}}

~~~~The completion of the experimentation and analysis showed that the
largest heart rate change in relation to the individual was 12\% from
baseline from one of the subjects. Three subjects had a 2\% heart rate
change from their baseline which was the lowest recorded change in all
the subjects. Arts \& Science students showed the largest average of
percent change at 6\%. The lowest average change was 2\%, observed in
Business students. Engineering students were closer to the Art \&
Science students at a 5\% change.~

\subsection*{}

{\label{621837}}

\subsection*{Effect of Stress on EMG}

{\label{621837}}

~~~~Results from the EMG data show that engineering students had the
lowest average change in EMG activity at a 7\% change. Business students
had the next lowest percent change at 10\%, while arts and science
students showed a 40\% increase from their baseline to their testing
measures. Three subjects all showed a 3\% change, the lowest change
seen, while one subject showed a 92\% change.~ ~~

\par\null

\subsection*{Effect of Stress on Skin
Conductivity}

{\label{398636}}

~ ~ The largest percent change of data collected was recorded during the
skin conductance. Business students were shown to have an average of
5.02 fold increase, the highest of the disciplines. Within that group,
one subject showed a change of 10.03 fold increase. The highest
individual change was of an engineer subject,~ with a change of 10.98
fold increase from baseline. This subjected noted at the start of the
experiment that they have hyperhidrosis which was diagnosed by their
physician. The engineer average change was a 4.24 fold increase. Art \&
Science students had the lowest average change of 96\%.~ out of all the
subjects a business student, subject 7, and a change of 1\%.~

\par\null

\subsection*{Effect of Stress on
Respiration}

{\label{101210}}

~~~~Analysis of this data showed that engineers had the lowest change in
respiratory rate from their baseline at 15\%. Arts and science students
showed the largest percent change with a 37\% increase in their
respiratory rate, while business students averaged a 27\% change. The
lowest change was 2\% increase seen in an engineering student, whereas
the highest change was 76\% seen in an arts and sciences student.~

\par\null

\subsection*{Kami 2 Gaming Performance}

{\label{993129}}

~ ~ Out of the subjects one engineering student, made it to level 6 to
attempt it. Due to time constraints, they had 17 seconds to solve the
puzzle and did not succeed. Level 6 is the highest level achieved and
was only done so once. Three subjects made it to level 5 with sufficient
time to attempt the levels multiple times. Two of those subjects were
arts \& sciences majors and one was an engineering student. Two subjects
were business students and both reached level 4. One subject did not
have a sufficient amount of time to solve the puzzle in correlation to
the average and the fastest time of those that did move on to level 5.~
The average time to complete level 4 was 78.4 seconds and the fastest
time was 65 seconds. Two subjects did not complete level 3, however,
they did have sufficient time to complete the level. Art and Science
students had the fastest average on level 1 with 13.3 seconds followed
by engineers with 19 seconds and business subjects with 19.5 seconds.
Engineering students had the fastest times on levels 2,3 and 4 with
business students being the slowest on 2 and 3 and not completing 4.
Engineers also had the longest time on question 5 with an average of 608
seconds in comparison to the art and science average of 536.5 seconds.
Business students ran out of moves and/or reset levels 1, 2 and 3 the
most. Level 4 had the same average reset and out of turns by the
business students and the art and science subjects. Engineers had 1 more
average reset than art and science students on level 5.~

\section*{Discussion}

{\label{197388}}

~ ~ ~ Each subject showed a change in each vital measured during the
experiment. A change in vitals was expected for our experiment however,
some vitals did not change in the manner that we expected. For subjects
3, 6, 7 and 8 heart rate was observed to reduce during the experiment.
Out of these subjects, 6 and 7 show a reduction in respiration during
the experiment as well. The reduced breathing may contribute to the
heart rate reduction seen during the experiment. Subjects 3 and 8 may
show a reduction because the subjects may find puzzle solving a means of
relaxation. It was concluded that the subject's heart rate reducing due
to rest could be eliminated from possible causes because the subjects
had already been resting for over five minutes due to the collection of
the baseline. Subjects 2,3 6,7 and 8 all showed a higher heart rate at
the start of testing in comparison to their individual baseline. This
may indicate the first onset of stress due to the start of the timed
testing situation.~

~~~~It was expected that business students would experience the greatest
percent change from their baseline values but from the data analysis,
the art and science subjects show the greatest change in every area
except in skin conductance. Business subjects showed the greatest change
in skin conductance and the second greatest change in electromyography
and respiration. Subjects 4 and 5 both reported a diagnosis of anxiety
on the pre-questionnaire. They also answered to have a 4 and 6 level of
stress respectively. Both Subjects are art and science subjects. With
this information it was concluded that the test does initiate stress in
those with anxiety and the results are skewed because of these
pre-existing diagnosis. The group with the most people with a diagnosed
anxiety condition showed the greatest response to a stress response
test. Taking this into consideration and excluding it due to the bias
business students due show the second greatest change in their recorded
vitals.~

~ ~ The experiment would have more successful data if it had a larger
population as well as a more selective subject selection. The study
would show more effective data if the entire subject group had anxiety
or did not have anxiety instead of the mixed group that was used. The
hypothesis should be adjusted for the experiment as well to be selective
on what to consider. Instead of a hypothesis of a change in recorded
vitals, it could focus on an increase in vitals. Looking at the specific
Clarkson schools it may be found to be more beneficial to look at the
majors within each school as an individual study. This information can
allow for the disciplines and the majors to make possible adjustments or
offer more assistance in managing stress during exam situations. College
students are all required to take examinations and the preparedness of
the student isn't the only factor affecting their test-taking abilities.
Future development may lead to Clarkson having a reduction in the number
of students with test anxiety and offer better management for stress for
students.~

\par\null\par\null\par\null\par\null

\section*{Appendix~}

{\label{687438}}

\subsubsection*{1. Pre-Questionnaire~}

{\label{783599}}\par\null\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Graph1/Graph1}

\end{center}
\end{figure}

\subsubsection*{2. Consent Form~}

{\label{279235}}\par\null\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Consent-form/Consent-form}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

