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Item Implementation of a school nurse-led anxiety screening protocol within an elementary school: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Sanders, Donna Ruth; Chairperson, Graduate Committee: Margaret Hammersla; This is a manuscript style paper that includes co-authored chapters.Childhood anxiety disorders are becoming increasingly prevalent in the US, with reported cases rising from 7.1% in 2016 to over 9.2% by 2020. This increase is often manifested through somatic symptoms in children, highlighting the urgent need for early detection and intervention, particularly in school settings where these symptoms frequently result in visits to school nurses. In a rural elementary school in Montana, there was a lack of systematic screening for anxiety among students aged 8-12. These students often present with somatic complaints that lack a clear medical diagnosis, leading to under-identification and inconsistent referral practices. The Plan-Do-Study-Act (PDSA) framework guided the implementation of a school nurse-led anxiety screening initiative using the SCARED tool. This project focused on systematic screening of English-speaking students who exhibited recurrent, unexplained somatic symptoms. Key interventions included training the school nurse on the SCARED tool, the establishment of structured screening protocols, and improved communication with parents to meet legislative consent requirements. The initiative was highly successful, achieving a 100% identification rate for students meeting the anxiety criteria, with all positively screened students referred for further support. These results demonstrate a significant enhancement in schools' capacity to manage childhood anxiety. This quality improvement project effectively addressed the rising prevalence of anxiety disorders in elementary students, emphasizing the value of structured, nurse-led screening processes. It successfully met and exceeded the set SMART goals, offering a replicable model for early detection and management of anxiety in schools. This model also highlights the importance of considering somatic complaints as potential indicators of anxiety disorders.Item The impact of acoustic stimulation and daytime napping on heart rate variability and sleep architecture(Montana State University - Bozeman, College of Education, Health & Human Development, 2023) Nicevski, Jennifer Rose; Chairperson, Graduate Committee: Dawn TarabochiaReceiving adequate overnight sleep is imperative for proper autonomic nervous system function. Recent studies utilizing acoustic stimulation (AS) have shown an improvement in sleep quality when applied during nighttime sleep, although the implications of AS on napping are not known. The purpose of the current study was to assess the impact of AS during a daytime nap on sleep and autonomic function. We hypothesized that AS (0.8 Hertz monaural beats at 30 decibels) would improve heart rate variability (HRV) during non-rapid eye movement (NREM) sleep and increase time spent in slow wave sleep in young adults. 25 young healthy adult subjects (12 men, 13 women, age: 23 + or - 1 yrs, BMI: 24 + or - 1 kg/m2) took part in the study. Participants were enrolled into a randomized, placebo-controlled crossover design where they completed two 90-minute afternoon nap opportunities with or without AS, at least one day apart. During each testing session, participants were fitted with gold-standard polysomnographic (PSG) equipment and five-lead electrocardiogram (ECG). Subjective questionnaires assessing sleepiness (Epworth Sleepiness Scale) and anxiety (Spielberger State Anxiety Inventory) were given prior to and following each nap opportunity. ECG was recorded continuously starting 5 minutes prior to lights out until awakening, allowing assessment of wake and sleep HRV. Contrary to our hypothesis, there were no significant changes in total sleep time (Control: 73 + or - 4 vs. AS: 72 + or - 4 min, P=0.850), slow wave sleep (Control: 30 + or - 4 vs. AS: 31 + or - 4 min, P=0.855), or other objective sleep measurements between conditions (All P>0.05). AS did not impact sleep HRV measures (All P>0.05). However, there was a significant main effect for time where napping resulted in a significant increase in the R-R interval (F(1,19)=25.683, P<0.001) and reduction of self-report anxiety (F(1,24)=8.229, P=0.008), but these responses were not different across conditions (time x condition, P>0.05). Napping elicited a paradoxical increase of diastolic (F(1,24)=14.483, P=0.001) and mean (F(1,24)=10.857, P=0.003) arterial pressure, but again these responses were not different across conditions (time x condition, P>0.05). In summary, the current study supports beneficial impacts of daytime napping on anxiety levels, but minimal effects of AS on sleep architecture and autonomic function.Item The impact of trait anxiety and psychosocial stress on sympathetic neural control in humans(Montana State University - Bozeman, College of Letters & Science, 2023) Bigalke, Jeremy Andrew; Chairperson, Graduate Committee: Cara A. Palmer; This is a manuscript style paper that includes co-authored chapters.Anxiety is highly prevalent, and while it is often adaptive, excessive stress and anxiety may predispose individuals to a heightened risk of cardiovascular disease. While excessive activity of the sympathetic nervous system (SNS) may underlie this association, direct measures of muscle sympathetic nerve activity (MSNA) indicate little, if any, alterations in resting sympathetic outflow in individuals with anxiety disorders. Assessment of the relationship between trait anxiety, MSNA, and blood pressure using a large cohort of healthy adults has not yet been conducted. Further, utilization of stress tasks within microneurographic settings that minimize the potential influence of breathing alterations, muscle movement, and other variables on the typically observed inter-individual variability in MSNA responsiveness to mental stress are needed to adequately assess the sole contribution of psychological stress on sympathetic neural activity. In Study 1, the association between trait anxiety, MSNA, and resting blood pressure was assessed in a population of 88 healthy adults, representing the largest study to date pairing trait anxiety with directly recorded sympathetic outflow to the periphery. Our findings indicate an independent relationship between trait anxiety, MSNA, and blood pressure when controlling for both age and sex. In Study 2, we utilized the trier social stress test (TSST) to assess the impact of anticipatory stress on MSNA and blood pressure in 28 healthy adults. Our findings showed that anticipatory stress is associated with increased blood pressure and reduced MSNA. Additionally, this appears to be baroreflex mediated as the magnitude of changes in blood pressure were directly proportional to reductions in MSNA, a relationship that was weakened or nonexistent during the active speech portion of the task. Lastly, anticipatory MSNA responsiveness accurately predicted reactivity to subsequent stress tasks. Together, these studies highlight a key relationship between both chronic, and acute psychological stress and anxiety on sympathoneural function in healthy adults.Item Screening for perinatal mood and anxiety disorders during well-child appointments: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Buscher, Jennifer; Chairperson, Graduate Committee: Christina BorstPerinatal mood and anxiety disorders (PMADs) are prevalent among birthing individuals. Conversely, PMAD screening rates are insufficient to support assessment, making PMADs the most underdiagnosed obstetrical complication in the United States. This quality improvement project aimed to improve PMAD screening and referral rates within one pediatric clinic. Prior to implementation, the pediatric clinic was screening with the PHQ-2 at 2-month well child checks. The purpose of this initiative was to update the clinic's screening process to align with current clinical practice guidelines as outlined by the American Academy of Pediatrics. The Edinburgh Postnatal Depression Scale (EPDS) was provided to birthing individuals at each 2-week, 2- month, 4-month, and 6-month well-child check appointment. Individuals who screened positive were provided with follow-up support. Over six weeks 152 birthing individuals were present for 2-week, 2-mo, 4-mo, and 6-mo well-child check appointments. Among these women, 129 (85%) were screened with the EPDS. Among those individuals, 14 (11%) had a positive score. Among the positive scores, 8 (57%) were addressed for follow-up recommendations. When following clinical practice guidelines, more birthing individuals were screened for PMADs and referred for follow-up support as compared to the previous screening intervention used by the pediatric clinic which was misaligned with clinical practice guidelines. This quality improvement project effectively increased PMAD screening rates and amplified awareness of the topic. Additional PDSA cycles are recommended to bolster adequate follow-up among individuals scoring positive.Item The influence of anxiety, age, and retrieval demands on memory(Montana State University - Bozeman, College of Letters & Science, 2021) Whillock, Summer Rain; Chairperson, Graduate Committee: Michelle L. MeadeThe present dissertation sought to determine if anxiety and hypervigilance can be activated outside the confines of specifically threatening stimuli by examining different situational pressures such as age and retrieval demands. In both experiments, participants studied categorized word lists and were randomly assigned to complete an initial recall test under free, forced, or warning (Exp. 2) recall instructions, followed by a second test under free recall instructions, and a final recognition test. For older adults, forced recall influenced the relationship between trait anxiety and memory such that heightened levels of trait anxiety were associated with greater correct recall and lower false recognition. In contrast, for younger adults, free recall influenced the relationship between memory-specific anxiety, hypervigilance, and memory such that heightened levels of memory-specific anxiety and hypervigilance were associated with lower levels of correct recognition. Further, warning recall influenced the relationship between memory-specific anxiety and memory in young adults, such that heightened levels of memory-specific anxiety were related to greater correct recall at test 1. Across two experiments, results show that it is possible for situational pressures to influence the relationship between anxiety and memory in the absence of specifically threatening stimuli. Additionally, the relationship between anxiety and memory depends on age, the type of anxiety being measured, and the retrieval demands of the task.Item Mitigating Rural Adolescent Trauma: Remote Delivery of a Trauma-Informed Yoga Intervention During COVID-19(Springer Science and Business Media LLC, 2022-12) Davis, Lauren; Aylward, AlexandraGiven the prevalence of childhood trauma in rural Montana, this project is intended to help mitigate stressors that may contribute to poor behavioral and mental health in high school-aged children, which may be exacerbated by the collective trauma of the COVID-19 pandemic. The immediate goal was to measure physical and mental health outcomes in adolescents resulting from a remotely delivered trauma-informed yoga intervention designed to foster positive youth development. Our study builds on the successes from an initial feasibility pilot study one year prior in order to evaluate a more robust intervention comparing experimental and control group outcomes. Students at a small, rural high school in Montana volunteered to participate in a 6-week, twice-weekly trauma-informed yoga intervention in their physical education class. Validated survey measures, including the PHQ-A, GAD-7, and ACE-Q instruments, were utilized to measure mental health outcomes pre- vs. post-intervention. Salivary cortisol levels were also measured pre-, mid-, and post-intervention. Statistically significant declines in cortisol levels and improvements in sleep duration were noted when comparing experimental vs. control groups. Noteworthy declines in depression and anxiety levels were also seen when comparing the treatment to control groups. Descriptive differences between the control and experimental groups illustrate the mental health benefits of reduced anxiety and depressive symptoms in rural adolescents resulting from a remotely delivered trauma-informed yoga intervention. Our study holds the potential for a long-term public health impact in reducing adolescent rates of anxiety and depression while mitigating trauma in geographically isolated settings.Item Influence of alpha intrusion during sleep: psychological and physiological implications(Montana State University - Bozeman, College of Letters & Science, 2022) Greenlund, Ian Mark; Chairperson, Graduate Committee: Jason CarterPoor sleep quality is pervasive in developed societies from chronic sleep disturbances or self-imposed sleep curtailment. Sleep disorders like insomnia are associated with regular sleep difficulties including sleep initiation and maintenance. Anxiety and depression exhibit a bidirectional relationship with insomnia, potentially exacerbating poor sleep quality and altering sleep microarchitecture via high frequency electroencephalographic (EEG) intrusion. This includes wake EEG alpha and beta rhythms. An association between high frequency intrusion and psychological dysfunction is present, but little is known regarding alpha and beta frequency intrusion 1) presence with state and trait anxiety symptoms, 2) impact on nocturnal blood pressure regulation, and 3) exacerbation with binge alcohol consumption. In study 1, we examined the relationship between state and trait anxiety severity with alpha and beta intrusion during stage N2 sleep, slow wave sleep (SWS), and rapid eye movement (REM) sleep in 32 participants. We demonstrated that alpha and beta frequency intrusion was augmented in participants with higher state, but not trait anxiety. In study 2, we investigated whether alpha and beta frequency intrusion impacted nocturnal blood pressure regulation in 36 young, healthy adults. Overall, systolic arterial pressure (SAP) dipping and cardiovagal baroreflex sensitivity (cvBRS) were not related alpha and beta spectral power during sleep. In study 3, we explored whether binge alcohol consumption could further exacerbate alpha and beta intrusion during sleep in higher state and trait anxiety participants in 31 participants. A secondary aim of this study was to determine if high frequency spectral power was different between sexes following alcohol consumption. Following laboratory familiarization night (study 2), participants were tested twice, ~1 month apart in a randomized, crossover design consuming either an alcohol dose (study 3) based upon biological sex and body weight, or fluid control beverage (study 1) two hours prior to lights out. Alpha and beta spectral power was not different between lower and higher state and trait anxiety, but was augmented in females compared to age-matched males. Collectively, these studies are the first investigate alpha intrusion presence with state and trait anxiety symptoms, impact on nocturnal blood pressure regulation, and sex specific exacerbation following alcohol consumption.Item Lessons learned: evaluating the implementation of a yoga-cognitive behavioral therapy group(Montana State University - Bozeman, College of Nursing, 2020) Hamilton, Karlee Renee; Chairperson, Graduate Committee: Tracy HellemThere is a significant need for those with depression and anxiety to have complementary treatment options to help treat the multifaceted symptoms of these illnesses. Evaluating programs for the complementary treatment of depression and anxiety is essential for organizations to measure the outcomes of their programs and to offer quality comprehensive care to clients. This project evaluated the outcomes of a yoga-Cognitive Behavioral Therapy group started at a community mental health center in Montana using the CDC's Guide to Effective Evaluation as a guideline. The yoga-CBT group did not show any positive results in either BDI or GAD-7 scores, and a discussion of limitations of this program was had with stakeholders. Despite the number of limitations, lessons were learned about effective implementation of programs at the community mental health center.