Objective: The aim of this study was to assess motivation as a factor in mental fatigue using subjective, performance, and physiological measures. Background: Sustained performance on a mentally demanding task can decrease over time. This decrement has two possible causes: a decline in available resources, meaning that performance cannot be sustained, and decrement in motivation, meaning a decline in willingness to sustain performance. However, so far, few experimental paradigms have effectively and continuously manipulated motivation, which is essential to understand its effect on mental fatigue. Method: Twenty participants performed a working memory task with 14 blocks, which alternated between reward and nonreward for 2.5 hr. In the reward blocks, monetary rewards could be gained for good performance. Besides reaction time and accuracy, we used physiological measures (heart rate variability, pupil diameter, eyeblink, eye movements with a video distractor) and subjective measures of fatigue and mental effort. Results: Participants reported becoming fatigued over time and invested more mental effort in the reward blocks. Even though they reported fatigue, their accuracy in the reward blocks remained constant but declined in the nonreward blocks. Furthermore, in the nonreward blocks, participants became more distractable, invested less cognitive effort, blinked more often, and made fewer saccades. These results showed an effect of motivation on mental fatigue. Conclusion: The evidence suggests that motivation is an important factor in explaining the effects of mental fatigue.

Purpose: There is increasing interest in the use of heart rate variability (HRV) as an objective measurement of mental stress in the surgical setting. To identify areas of improvement, the aim of our study was to review current use of HRV measurements in the surgical setting, evaluate the different methods used for the analysis of HRV, and to assess whether HRV is being measured correctly. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). 17 studies regarding HRV as a measurement of mental stress in the surgical setting were included and analysed. Results: 24% of the studies performed long-term measurements (24 h and longer) to assess the long-term effects of and recovery from mental stress. In 24% of the studies, artefact correction took place. Conclusions: HRV showed to be a good objective assessment method of stress induced in the workplace environment: it was able to pinpoint stressors during operations, determine which operating techniques induced most stress for surgeons, and indicate differences in stress levels between performing and assisting surgery. For future research, this review recommends using singular guidelines to standardize research, and performing artefact correction. This will improve further evaluation of the long-term effects of mental stress and its recovery.

When drivers perform additional tasks while driving, research shows conflicting results: primary driving performance may deteriorate but adaptive changes such as reducing driving speed have also been noted. We hypothesized that the nature of the secondary task may be important: drivers may give more priority to tasks that serve goals of the driving task itself, for example route finding, than tasks not directly relevant for driving, for example tuning the radio. The main objective of the present driving simulator study was to test this hypothesis. Twenty subjects performed two different subsidiary tasks while driving through two levels of traffic density: a working memory (WM) task and a map reading (MAP) task. It was hypothesized that in high task demand situations, the WM task, irrelevant for the driving task, would be neglected more than the MAP task. The results confirmed the hypothesis: in MAP conditions, the WM task was indeed neglected, but map reading resulted in more swerving, indicating that the subjects looked at the map despite the high task demands. It is concluded that drivers will be highly motivated to get route information, and RG systems should therefore present their information in a readily understandable format.