Research Review: Why You Can't "Just Budget Better": The Nervous System Patterns Behind Money Struggles

Stress, Money Beliefs and Financial Behavior: A Research Review

Date: October 26, 2025 Prepared by: MyMoneyCoach Research Team Subject: Research review of "The Nervous System Patterns Behind Money Struggles"

The content here is educational, not legal, medical or financial advice. The MyMoneyCoach Research Team wrote it as a plain-language review, not an independent peer review. Several ideas below, including the nervous-system framing, are working frameworks and not settled science.

Executive Summary

You cannot always budget your way out of money struggles, because knowing what to do does not reliably change what people do. Research does link financial worry, avoidance and weaker decisions. The nervous-system explanation for these patterns is a working framework, not settled science, and evidence for several specific patterns is thin.

The review examines the idea that persistent money struggles are not only a knowledge problem. The review checks each supporting claim against the published source and says how strong the evidence is.

Several findings hold up well. A large 2014 meta-analysis found that financial literacy interventions explained about 0.1% of the variance in financial behaviors (Fernandes et al., 2014). A later meta-analysis of 76 randomized experiments found positive effects of financial education on knowledge and behavior, about three times the size found in earlier work (Kaiser et al., 2022). Taken together, the fair reading is that education helps, but knowledge alone does not guarantee a change in behavior. Studies also show that people tend to look less often at accounts when the news is bad (Olafsson & Pagel, 2025). Reviews of acute stress research describe a loss of prefrontal cognitive abilities under uncontrollable stress (Arnsten, 2009).

Further supported pieces: people who worry more about money report more psychological distress (Ryu & Fan, 2023). Shame about money is linked to financial withdrawal (Gladstone et al., 2021). Relieving debt improved cognitive scores and anxiety in one quasi-experiment (Ong et al., 2019). On the helping side, a review of 24 studies linked heart rate variability biofeedback to lower self-reported stress and anxiety (Goessl et al., 2017), a randomized evaluation found some gains from human financial coaching (Theodos et al., 2015), and a review of 15 randomized trials found that mental-health chatbots reduced depression and distress (Li et al., 2023). No trial has tested an AI financial coach.

Other pieces are weaker. Polyvagal Theory, which the blog post borrows from, is contested by many physiologists. The step from general stress research to specific financial behaviors is plausible but mostly untested. Where that is the case, the sections below say so.

---

Part I: What Research Says About Stress and Financial Behavior

1.1 Does Knowledge Change Behavior?

Two meta-analyses point in different directions, and both matter. Fernandes, Lynch and Netemeyer (2014) reviewed 168 papers covering 201 prior studies and concluded that interventions to improve financial literacy explained only 0.1% of the variance in the financial behaviors studied, with weaker effects in low-income samples. They also reported that effects decay over time. Kaiser, Lusardi, Menkhoff and Urban (2022) meta-analyzed 76 randomized experiments with more than 160,000 people. They found positive causal effects of financial education on knowledge and on downstream behaviors, similar in size to education programs in other fields and at least three times as large as the average in earlier work. The honest summary is that education alone often has modest effects on behavior, and that how much it helps depends on the program and the measure.

1.2 Stress and the prefrontal cortex

Arnsten (2009), in a review in Nature Reviews Neuroscience, wrote that the prefrontal cortex is the brain region most sensitive to the effects of stress, and that "even quite mild acute uncontrollable stress can cause a rapid and dramatic loss of prefrontal cognitive abilities." Much of that literature comes from animal studies and general stress paradigms, not from financial stress. This review does not claim that a specific bill or market drop produces a specific brain state.

A related finding is more direct. Mani, Mullainathan, Shafir and Zhao (2013) found that inducing thoughts about financial problems reduced cognitive performance among poorer participants but not among better-off ones. They also found that Indian farmers scored lower on cognitive tests before harvest than after it. The authors said this could not be explained by stress and proposed that money worries use up mental bandwidth.

The bandwidth finding is disputed. Wicherts and Scholten (2013) reanalyzed the data and said the result was not corroborated when income was not split into two groups, and pointed to ceiling effects. Mani and colleagues replied that the pattern holds with continuous income. Carvalho, Meier and Wang (2016) compared low-income U.S. households before and after payday and found no difference in cognitive function or risk taking, though choices were more present-biased before payday. A 2021 replication audit of 20 scarcity studies reported "strong successes and undeniable failures" (O'Donnell et al., 2021), and its validity is itself contested. The fair reading is that bandwidth effects are a possibility with mixed support, not a settled result.

1.2a Money worry, distress and poverty

In a national U.S. survey, higher financial worry was associated with higher psychological distress, and the link was stronger for unmarried, unemployed, lower-income and renting adults (Ryu & Fan, 2023). It is a cross-sectional association. A major review concluded that poverty may raise stress and negative mood, which may lead to short-sighted, risk-averse decisions, possibly by limiting attention (Haushofer & Fehr, 2014). "May" and "possibly" are the authors' words. When a charity cleared debts for 196 low-income households in Singapore, cognitive scores rose and anxiety fell, and clearing more accounts meant a bigger gain (Ong et al., 2019). The study was not randomized and the mechanism is the authors' interpretation.

1.3 Polyvagal Theory: a framework, not established physiology

Stephen Porges' Polyvagal Theory (Porges, 2011) describes three autonomic states, and many therapists find it a useful way to talk about safety and shutdown. Critics, including Grossman (2023), argue that its core anatomical and evolutionary claims are not supported by the physiological evidence. In 2026, Grossman and 38 co-authors concluded that the theory is untenable (Grossman et al., 2026). Porges has replied to the criticisms. At most, the theory is a model some practitioners use. We therefore use the framework below as a coaching metaphor, not as proof of a mechanism.

Research on heart rate variability is firmer ground and does not depend on polyvagal anatomy. A meta-analysis of 123 studies found a small link (r = 0.09) between higher resting heart rate variability and better top-down self-regulation, with the caveats that it was small and correlational (Holzman & Bridgett, 2017). "Glimmers" and "window of tolerance" are practitioner concepts that we found no study testing.

Framework state	Description in the theory	Possible money pattern (illustrative)
Ventral vagal	Safety, social engagement	Calm planning and conversation about money
Sympathetic	Mobilization (fight/flight)	Rushed decisions, overspending, overwork
Dorsal vagal	Shutdown (freeze)	Avoiding bills and account balances

The table above is our interpretation. No study cited here tests these links between autonomic states and financial behavior.

---

Part II: The Seven Patterns and the Evidence Behind Them

The blog post describes seven patterns. For each, this section states what the published sources support and what they do not.

2.1 The Freeze: Financial Avoidance and the "Ostrich Effect"

Blog claim: "Bills pile up unopened... Logging into your bank account triggers something physical." Evidence level: Supported for avoidance; not tested for the physical mechanism.

The term "ostrich effect" was introduced by Galai and Sade (2006) to describe investors who avoid risky-looking information. Olafsson and Pagel (2025, Review of Economics and Statistics) analyzed a high-frequency panel of bank data including logins. They found that people pay more attention when they hold more cash and receive income, that attention decreases discretely as balances turn from positive to negative, and that it falls further as overdraft debt increases. Shapiro and Burchell (2012) found that financial anxiety is distinct from depression and general anxiety, and that people tend to avoid financial information. Sicherman and colleagues (2016) found that investor account logins fell by 9.5% after market declines. Hilbert and colleagues (2024) found that people put into a money-short state in an incentivized lab task were more likely to delay a payment, although their eye-tracking measure of looking away showed no effect. Gladstone and colleagues (2021) reported across six studies (N = 9,110) that shame induces financial withdrawal, which raises the odds of counterproductive financial decisions, and that affirming acts of kindness reduced the link. Those studies used mixed designs. We found no source showing that avoidance is a "dorsal vagal shutdown" or that it leads to specific spending outcomes.

2.2 The Endless Calculation: Money Vigilance

Blog claim: "No matter how much you save, it never feels safe... Enjoying a purchase feels impossible." Evidence level: Partly supported by the money-scripts research.

Klontz and colleagues (2011) identified money vigilance as one of four money belief patterns. They describe it as linked to alertness, watchfulness and concern about money, and suggest that while it may encourage saving and frugality, excessive wariness or anxiety could be a problem. That is the authors' interpretation. In a later study, Klontz and Britt (2012) reported that money vigilance was associated with higher financial health, while money status and money worship were associated with lower financial health. Mani and colleagues (2013) support the idea that money worries can take up mental bandwidth, in a poverty context.

2.3 The Invisible Price Tag: Underearning and Self-Worth

Blog claim: "You undercharge, over-deliver... Negotiating your salary feels like asking for a kidney." Evidence level: Partly supported for the general link.

Orth, Robins and Widaman (2012) followed 1,824 people aged 16 to 97 over 12 years and reported that higher self-esteem prospectively predicted better outcomes in relationships, work and health, including measures of salary and occupational status. This is an association in observational data. We did not find a source in our review supporting the specific claims about "financial enmeshment," "identity foreclosure" or reluctance to negotiate, so those claims have been removed.

2.4 The Check Grab: Over-Giving

Blog claim: "First to pay at dinner... Giving feels safe; receiving feels unbearable." Evidence level: Not directly tested.

"Fawning" is a concept from clinical writing on trauma, and "financial enabling" appears in the money-scripts literature as one disordered money behavior. Klontz and Britt (2012) reported that certain money scripts predict behaviors including financial dependence on others and financial enabling of one's children. We found no study linking over-giving at dinner to a fawn response or to buying affection, so this pattern is best read as a description, not as a research finding.

2.5 The Guilt Spiral: Shame Around Spending

Blog claim: "You bought something for yourself and now you can't stop thinking about it. Even necessities trigger shame." Evidence level: Partly supported for money avoidance beliefs.

Klontz and colleagues (2011) describe money avoidance as a pattern of beliefs that money is bad or that one does not deserve it, with items such as "I do not deserve money." The study measured beliefs, not the moment-to-moment shame of a purchase. We did not find a source in this review for dopamine "crashes" after buying, so that claim has been removed.

2.6 The Boom-Bust: Income Variability

Blog claim: "Flush one month, panicked the next... Your finances look like a heart monitor." Evidence level: Supported for how common variable income is; not tested for the emotional cycle.

The Federal Reserve's 2024 household survey (published May 2025) reported that 29% of adults had income that varied at least occasionally from month to month, and 11% said they struggled to pay bills in the prior 12 months because of it. The share with bill trouble was 19% for adults with income under $25,000 and 3% for adults at $100,000 or more. We found no verified source for the reward-prediction-error explanation or for the claim that income volatility causes poorer health, so those were removed.

2.7 The Magical Thinking: Not Looking at the Numbers

Blog claim: "You avoid looking at the numbers because not knowing feels safer... The balance exists in a quantum state." Evidence level: Avoidance is supported (see 2.1). The rest is not.

The avoidance part is covered by Olafsson and Pagel (2025) and Shapiro and Burchell (2012). We did not find studies in this review showing that "magical thinking" or "manifestation" lowers financial literacy or raises fraud risk, or that it is a dissociative freeze response, so those claims have been removed.

---

Part III: Current Statistics on Financial Stress

Metric	Statistic	Source
Financial stress prevalence	72% of U.S. adults say they feel stressed about money at least some of the time.	APA Stress in America survey, released 2015
Cost and mental health care	60% of respondents said financial constraints had deterred them from seeking mental health care (online survey of 1,026 U.S. adults, June 2025).	LifeStance Health, 2025
Workplace	60% of full-time employees reported being stressed about their finances in PwC's 2023 survey, and 59% in its 2026 survey of about 3,500 employees (the 2026 figure is as reported on PwC's survey page and in trade coverage; we could not open PwC's page directly).	PwC Employee Financial Wellness Survey
Income variability	29% of adults had income that varied at least occasionally month to month; 11% struggled to pay bills because of it.	Federal Reserve SHED, 2024 data

The four survey results above show how common financial stress is, not what causes it.

---

Part IV: What May Help

4.1 Willpower

The idea that willpower is a "finite resource" is disputed in the research literature, and none of the sources we checked tests it for budgeting. We make no claim about it here.

4.2 Slow breathing and heart rate variability biofeedback

Goessl, Curtiss and Hofmann (2017) meta-analyzed 24 studies with 484 participants. Between-groups, HRV biofeedback was associated with a large reduction in self-reported stress and anxiety (Hedges' g = 0.83). The authors called for more well-controlled studies, and the trials were small and used self-report. A review of 223 studies found that voluntary slow breathing raises vagally mediated heart rate variability (Laborde et al., 2022). The slow-breathing and HRV findings support the practice. They do not support polyvagal explanations of why it works, and they did not measure money outcomes.

4.3 Does Financial Coaching Help?

Theodos and colleagues (2015, Urban Institute) ran a randomized evaluation of two financial coaching programs, The Financial Clinic in New York and Branches in Miami. The Urban Institute concluded that a well-implemented coaching program with engaged clients can produce important improvements in certain financial outcomes. Figures differed by site, and we confirmed the design but not the sample sizes or the effect figures at the source. The coaches were human and the clients had low or moderate incomes.

Archuleta and colleagues (2015) ran a pilot of solution-focused financial therapy with 8 college students. Well-being and financial behaviors improved and financial distress decreased across measurements before, after and three months later. With 8 participants and no stated control group, this is early work.

4.4 AI chatbots

Li, Zhang, Lee, Kraut and Mohr (2023) pooled 15 randomized trials of AI-based conversational agents. Depression improved (Hedges' g 0.64) and so did distress (g 0.7), but the effect on overall psychological well-being was not significant (g 0.32, confidence interval -0.13 to 0.78). Confidence intervals were wide. These were mental-health chatbots. We found no peer-reviewed trial of an AI financial coach, so the claim that an AI coach improves money outcomes is untested. Sophia is a money coach, not a therapy replacement. See section 4.5 for what her design does and does not claim.

4.5 How Sophia works, and what trauma-informed means

Sophia is an AI coach. Asked directly, she says she is an AI, not a human coach and not certified. She is not a licensed therapist or financial advisor. Her approach was built on the methods of two certified human life coaches. The About page lists Jennifer, one of the founders, as an EFT and NLP Master Practitioner with clinical hypnotherapy certification and 15+ years of coaching experience. Jennifer's work is not only about money.

A Sophia conversation usually opens with a question about what is on the person's mind. Sophia reflects back what she heard before offering guidance, asks how the issue sits in the body, and asks what would feel most supportive. If someone raises a block or something stressful, she asks them to choose between a body-based calming practice first (slow breathing, grounding or tapping) and practical steps now, and she goes with the choice. She remembers earlier sessions, avoids repeating questions, can read uploaded worksheets, suggests worksheets only when useful, and paces the conversation.

Sophia does not give specific investment or product advice, promise financial outcomes, or wave away practical problems with spiritual advice. She stays on money and money mindset. For suicide or self-harm she points to 988 and the Crisis Text Line and says she is a coach, not a crisis counselor.

Her toolkit draws on mindset and somatic traditions, such as tapping (EFT), breathwork, grounding, visualization, affirmations and journaling, plus emotional-intelligence ideas. These are coaching practices, not clinical treatments. Slow breathing has the best support (section 4.2), though not for money outcomes. Tapping and polyvagal-based techniques have limited or contested evidence.

Separately, SAMHSA (2014) published a trauma-informed framework with six principles: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and cultural, historical and gender issues. It describes how a service is delivered. Sophia's design does not implement or claim that framework, and she is not a peer-support service. We read the framework's wording through SAMHSA search snippets because the PDF was not retrievable. Outcome evidence for trauma-informed programs is thin. A systematic review of 23 evaluations of trauma-informed organizational interventions found that 5 of the 8 studies with client outcomes reported statistically significant improvements, with many single-group before-and-after designs and short follow-up (Purtle, 2020). Those studies were of organizational training, not of an AI coach.

4.6 Body-based, therapeutic and mindfulness approaches

• Somatic Experiencing (SE): Brom and colleagues (2017) ran a randomized controlled trial of 63 adults with PTSD, comparing a 15-session SE protocol with a waitlist. Symptoms fell significantly in the SE group and stayed stable in the waitlist group. The authors noted the small community sample. The study concerned PTSD, not money stress, and we found no study of SE for financial behavior.
• Financial therapy: A small quasi-experimental study of 40 shopkeepers in Iran (Shahrekord) found that ten sessions of Acceptance and Commitment Therapy-based group financial therapy improved financial literacy and mental accounting scores compared with a no-intervention control group. The control group received nothing, so the study cannot say whether ACT beat financial education alone. We read the abstract only.
• Mindfulness: Hafenbrack, Kinias and Barsade (2014, Psychological Science) reported across three experiments that a brief mindfulness meditation increased resistance to the sunk-cost bias, partly by reducing focus on the past and future and the negative emotion that goes with it. These were short lab tasks, not studies of real financial decisions over time.

---

Conclusion

The research supports a modest version of the blog post's idea. Knowing what to do does not reliably change what people do (Fernandes et al., 2014), though education can help (Kaiser et al., 2022). People often avoid financial information when the news is bad (Olafsson & Pagel, 2025; Shapiro & Burchell, 2012). Money worries can use up mental bandwidth (Mani et al., 2013). Money beliefs are linked to financial behavior (Klontz et al., 2011; Klontz & Britt, 2012).

Avoidance and shame have direct support in several narrow studies, and slow breathing, financial coaching and mental-health chatbots each have some trial evidence of their own. None of those tested Sophia or any AI financial coach.

What the research does not show is that these patterns are caused by nervous system dysregulation, or that regulating the nervous system improves budgeting. That is a hypothesis worth testing. For now, the nervous-system language in the blog post is best read as a useful way to describe experience, not as an established mechanism. If money stress is affecting your health, a licensed professional can help.

References

1. Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. W. W. Norton.
2. Klontz, B. T., & Britt, S. L. (2012). How clients' money scripts predict their financial behaviors. Journal of Financial Planning, 25(11), 46-53.
3. Galai, D., & Sade, O. (2006). The "Ostrich Effect" and the relationship between the liquidity and the yields of financial assets. Journal of Business, 79(5), 2741-2759. doi:10.1086/505250
4. Arnsten, A. F. T. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410-422. doi:10.1038/nrn2648
5. Kaiser, T., Lusardi, A., Menkhoff, L., & Urban, C. (2022). Financial education affects financial knowledge and downstream behaviors. Journal of Financial Economics, 145(2A), 255-272. doi:10.1016/j.jfineco.2021.09.022
6. American Psychological Association. (2015). Stress in America 2014 (survey released 2015).
7. Fernandes, D., Lynch, J. G., & Netemeyer, R. G. (2014). Financial literacy, financial education, and downstream financial behaviors. Management Science, 60(8), 1861-1883. doi:10.1287/mnsc.2013.1849
8. Olafsson, A., & Pagel, M. (2025). The ostrich in us: Selective attention to personal finances. Review of Economics and Statistics. doi:10.1162/rest_a_01566
9. Mani, A., Mullainathan, S., Shafir, E., & Zhao, J. (2013). Poverty impedes cognitive function. Science, 341, 976-980. doi:10.1126/science.1238041
10. Klontz, B., Britt, S. L., Mentzer, J., & Klontz, T. (2011). Money beliefs and financial behaviors: Development of the Klontz Money Script Inventory. Journal of Financial Therapy, 2(1). doi:10.4148/jft.v2i1.451
11. Shapiro, G. K., & Burchell, B. J. (2012). Measuring financial anxiety. Journal of Neuroscience, Psychology, and Economics, 5(2), 92-103. doi:10.1037/a0027647
12. Orth, U., Robins, R. W., & Widaman, K. F. (2012). Life-span development of self-esteem and its effects on important life outcomes. Journal of Personality and Social Psychology, 102(6), 1271-1288. doi:10.1037/a0025558
13. Brom, D., Stokar, Y., Lawi, C., et al. (2017). Somatic Experiencing for posttraumatic stress disorder: A randomized controlled outcome study. Journal of Traumatic Stress. https://pmc.ncbi.nlm.nih.gov/articles/PMC5518443/
14. Hafenbrack, A. C., Kinias, Z., & Barsade, S. G. (2014). Debiasing the mind through meditation: Mindfulness and the sunk-cost bias. Psychological Science. doi:10.1177/0956797613503853
15. Board of Governors of the Federal Reserve System. (2025). Economic Well-Being of U.S. Households in 2024. https://www.federalreserve.gov/publications/2025-economic-well-being-of-us-households-in-2024-executive-summary.htm
16. LifeStance Health. (2025). "Stressflation" survey press release. https://lifestance.com/media-center-release/stressflation-is-here-83-of-americans-say-todays-economic-climate-is-taking-a-toll-on-their-mental-health/
17. PwC. Employee Financial Wellness Survey (2023 and 2026 editions). https://www.pwc.com/us/en/services/consulting/human-resources/library/employee-financial-wellness-survey.html The 2026 figure is also reported by Stream, "This is what financial stress looks like in 2026, according to PwC" (June 2, 2026): https://stream.co/en-us/articles/employee-financial-stress-2026-pwc-survey (secondary, vendor source).
18. Effectiveness of Acceptance and Commitment group financial therapy on financial literacy, personal financial management and mental accounting (small quasi-experimental study, Iran). https://contextualscience.org/publications/effectiveness_acceptance_commitment_group_financial_therapy_financial_literacy
19. Grossman, P. (2023). Fundamental challenges and likely refutations of the five basic premises of the polyvagal theory. Biological Psychology. doi:10.1016/j.biopsycho.2023.108589
20. Sicherman, N., Loewenstein, G., Seppi, D. J., & Utkus, S. P. (2016). Financial attention. Review of Financial Studies, 29(4), 863-897. https://doi.org/10.1093/rfs/hhv073
21. Hilbert, L. P., Noordewier, M. K., Seck, L., & van Dijk, W. W. (2024). Financial scarcity and financial avoidance: an eye-tracking and behavioral experiment. Psychological Research, 88(8), 2211-2220. https://pubmed.ncbi.nlm.nih.gov/39158712/
22. Gladstone, J. J., Jachimowicz, J. M., Greenberg, A. E., & Galinsky, A. D. (2021). Financial shame spirals: How shame intensifies financial hardship. Organizational Behavior and Human Decision Processes, 167, 42-56. https://doi.org/10.1016/j.obhdp.2021.06.002
23. Ong, Q., Theseira, W., & Ng, I. Y. H. (2019). Reducing debt improves psychological functioning and changes decision-making in the poor. Proceedings of the National Academy of Sciences, 116(15), 7244-7249. https://pubmed.ncbi.nlm.nih.gov/30910964/
24. Ryu, S., & Fan, L. (2023). The relationship between financial worries and psychological distress among U.S. adults. Journal of Family and Economic Issues, 44(1), 16-33. https://pubmed.ncbi.nlm.nih.gov/35125855/
25. Haushofer, J., & Fehr, E. (2014). On the psychology of poverty. Science, 344(6186), 862-867. https://pubmed.ncbi.nlm.nih.gov/24855262/
26. Wicherts, J. M., & Scholten, A. Z. (2013). Comment on "Poverty impedes cognitive function." Science, 342(6163), 1169. https://doi.org/10.1126/science.1246680
27. Carvalho, L. S., Meier, S., & Wang, S. W. (2016). Poverty and economic decision-making: Evidence from changes in financial resources at payday. American Economic Review, 106(2), 260-284. https://doi.org/10.1257/aer.20140481
28. O'Donnell, M., et al. (2021). Empirical audit and review and an assessment of evidentiary value in research on the psychological consequences of scarcity. Proceedings of the National Academy of Sciences, 118(44). https://pubmed.ncbi.nlm.nih.gov/34711679/
29. Goessl, V. C., Curtiss, J. E., & Hofmann, S. G. (2017). The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. Psychological Medicine, 47(15), 2578-2586. https://pubmed.ncbi.nlm.nih.gov/28478782/
30. Laborde, S., Allen, M. S., Borges, U., et al. (2022). Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. Neuroscience & Biobehavioral Reviews, 138, 104711. https://pubmed.ncbi.nlm.nih.gov/35623448/
31. Theodos, B., et al. (2015). Randomized evaluation of two financial coaching programs (The Financial Clinic, New York; Branches, Miami). Urban Institute. (Design confirmed on the Urban Institute page; report title and sample sizes not retrieved.)
32. Archuleta, K. L., Burr, E., Bell Carlson, J., Ingram, M., & Irwin Kruger, L. (2015). Solution focused financial therapy: A brief report of a pilot study. Journal of Financial Therapy, 6(1). https://doi.org/10.4148/1944-9771.1081
33. Li, H., Zhang, R., Lee, Y.-C., Kraut, R. E., & Mohr, D. C. (2023). Systematic review and meta-analysis of AI-based conversational agents for promoting mental health and well-being. npj Digital Medicine, 6, 236. https://pubmed.ncbi.nlm.nih.gov/38114588/
34. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach (HHS Publication No. SMA 14-4884).
35. Purtle, J. (2020). Systematic review of evaluations of trauma-informed organizational interventions that include staff trainings. Trauma, Violence, & Abuse, 21(4), 725-740. https://pubmed.ncbi.nlm.nih.gov/30079827/
36. Grossman, P., et al. (2026). Why the polyvagal theory is untenable: An international expert evaluation of the polyvagal theory and commentaries. Clinical Neuropsychiatry, 23(1), 100-112. https://pubmed.ncbi.nlm.nih.gov/41768017/
37. Holzman, J. B., & Bridgett, D. J. (2017). Heart rate variability indices as bio-markers of top-down self-regulatory mechanisms: A meta-analytic review. Neuroscience & Biobehavioral Reviews, 74, 233-255. https://pubmed.ncbi.nlm.nih.gov/28057463/