The stability of and intercorrelations among cardiovascular, immune, endocrine, and psychological reactivity

Exploring the use of thermal infrared imaging in human stress research

High resolution thermal infrared imaging is a pioneering method giving indices of sympathetic activity via the contact-free recording of facial tissues (thermal imprints). Compared to established stress markers, the great advantage of this method is its non-invasiveness. The goal of our study was to pilot the use of thermal infrared imaging in the classical setting of human stress research. Thermal imprints were compared to established stress markers (heart rate, heart rate variability, finger temperature, alpha-amylase and cortisol) in 15 participants undergoing anticipation, stress and recovery phases of two laboratory stress tests, the Cold Pressor Test and the Trier Social Stress Test. The majority of the thermal imprints proved to be change-sensitive in both tests. While correlations between the thermal imprints and established stress markers were mostly non-significant, the thermal imprints (but not the established stress makers) did correlate with stress-induced mood changes. Multivariate pattern analysis revealed that in contrast to the established stress markers the thermal imprints could not disambiguate anticipation, stress and recovery phases of both tests. Overall, these results suggest that thermal infrared imaging is a valuable method for the estimation of sympathetic activity in the stress laboratory setting. The use of this non-invasive method may be particularly beneficial for covert recordings, in the study of special populations showing difficulties in complying with the standard instruments of data collection and in the domain of psychophysiological covariance research. Meanwhile, the established stress markers seem to be superior when it comes to the characterization of complex physiological states during the different phases of the stress cycle.

Hormones: commentary. Riding the physiological roller coaster: adaptive significance of cortisol stress reactivity to social contexts

The authors conjecture that to understand normal stress regulation, including cortisol stress reactivity, it is important to understand why these biomarkers are released and what they function to accomplish within the individual. This perspective holds that high (or rising) cortisol has advantages and disadvantages that must be understood within a context to understand how individual differences unfold. This perspective is juxtaposed with a popular vantage point of this stress hormone or of stress exposure that emphasizes the deleterious consequences or problems of this hormone. While the costs and benefits of cortisol are emphasized for normal stress regulation, this dynamic context-dependent purpose of stress hormones should extend to the development of psychopathology as well. This functional and dynamic view of cortisol is helpful for interpreting why Tackett and colleagues (2014) appear to observe advantageous cortisol recovery from stress in individuals with elevated personality disorder symptoms.

The relation between gaze aversion and cortisol reactivity in middle childhood

The present study sought to investigate the relation between ethological observations of children's gaze aversion during a psychosocial stress task and their cortisol reactivity to the task, and how this relation might be moderated by how stressful the children perceived the stress task to be. Videos of 140 children (74 girls; Mage=10.60years) performing a psychosocial stress task in front of a jury were coded for displays of the children's gaze aversion from the jury, and saliva samples were taken to determine their cortisol reactivity. A questionnaire assessed the children's level of perceived stress. Results showed higher cortisol reactivity in children who perceived the task as more stressful. Furthermore, a quadratic relation between gaze aversion and cortisol was found which depended on the level of perceived stress: for children with low levels of perceived stress, cortisol reactivity was lowest with intermediate levels of gaze aversion, whereas for children with high levels of perceived stress cortisol reactivity was highest at intermediate levels of gaze aversion. The results suggest a modest association between subjective and physiological stress responses in 9- to 11-year-olds, and indicate that gaze aversion may play only a minor role as a behavioural coping strategy at this age.

Academic self-concept of ability and cortisol reactivity

The present study aimed to clarify the relationship between a school-specific trait (academic self-concept of ability [ASCA]) and hormonal stress response by using a trait-compatible stressor (test). First, we determined 52 students' ASCA scores for biology and measured their salivary cortisol concentration before and after a biology test (experimental group, n=28) or a free writing task (control group, n=24). For participants who took the test, statistical analysis indicated a significant negative correlation between ASCA score and cortisol response. In contrast, the control group showed a decrease in cortisol concentrations between test times and no correlation between cortisol concentration and ASCA scores were found. These findings indicated an interaction between ASCA scores and hormonal stress response when an academic-related stressor is present. Furthermore, these variables might influence each other adversely: high cortisol concentrations during a test situation may lead to greater feelings of insecurity, resulting in low ASCA scores and awareness of these low scores may lead to a further increase in cortisol, creating a vicious cycle.

The serotonin transporter gene-linked polymorphic region (5-HTTLPR) and cortisol stress reactivity: a meta-analysis

Recent meta-analyses have stimulated an active debate on whether the serotonin transporter gene-linked polymorphic region (5-HTTLPR) is associated with an elevated vulnerability to psychiatric diseases upon exposure to environmental adversity. As a potential mechanism explaining genotype-dependent differences in stress sensitivity, altered stress-induced activation of the hypothalamus-pituitary-adrenal (HPA) axis has been investigated in several experimental studies, with most of these studies comprising small samples. We evaluated the association of 5-HTTLPR genotype and cortisol reactivity to acute psychosocial stress by applying a meta-analytical technique based on eleven relevant data sets (total N=1686), which were identified through a systematic literature search up to October 2011. This meta-analysis indicates a small (d=0.27), but significant association between 5-HTTLPR genotype and HPA-axis reactivity to acute psychosocial stress with homozygous carriers of the S allele displaying increased cortisol reactivity compared with individuals with the S/L and L/L genotype. The latter association was not further moderated by participants' age, sex or the type of stressor. Formal testing revealed no evidence for a substantial selection or publication bias. Our meta-analytical results are consistent with a wide variety of experimental studies indicating a significant association between 5-HTTLPR genotype and intermediate phenotypes related to stress sensitivity. Future studies are needed to clarify the consistency of this effect and to further explore whether altered HPA-axis stress reactivity reflects a potential biological mechanism conveying an elevated risk for the development of stress-related disorders in S allele carriers.

Differentiating anticipatory from reactive cortisol responses to psychosocial stress

Most psychosocial stress studies assess the overall cortisol response without further identifying the temporal dynamics within hormone levels. It has been shown, however, that the amplitude of anticipatory cortisol stress levels has a unique predictive value for psychological health. So far, no "best practice" in how to investigate the anticipatory cortisol stress response has emerged. The goal of the current research was to develop a protocol that would allow for a sensitive and easy-to-implement laboratory-based investigation into anticipatory cortisol stress levels. We initially tested 26 healthy men in either an anticipation- or stress-only condition of the Trier Social Stress Test (TSST) to map the distinct timelines of anticipatory and reactive cortisol release profiles (study 1). Subsequently, we administered the TSST to 50 healthy men such that the cortisol responses to anticipatory and reactive stress components could be dissociated (study 2). In both studies we sampled saliva cortisol at high frequency (at baseline, during 10min of anticipation and during and after 10min of acute stress) and the current mood state pre- and post-stress. We found anticipatory responder rates of 20% and 40%, with peak anticipatory cortisol levels between 14 and 20min after onset of anticipation. Visible changes in reactive cortisol levels occurred only after the termination of the acute stressor. We conclude that the best practice to detect a maximum number of anticipatory responders in the TSST would be to extend the anticipation phase to 15min. In doing so, the anticipatory cortisol peak could be captured at a time-point of the actual stressor that is uninfluenced by reactive cortisol levels. Overall, we could reveal several features of anticipatory responders. Most importantly, there was a positive correlation between anticipatory and reactive stress responses. There was no association between anticipatory cortisol and alpha-amylase as well as subjective-psychological stress responses. Future studies will have to determine whether the anticipatory responders differ with respect to various stress-sensitive parameters like sex, personality, psychological wellbeing or chronic stress.

Birth weight and perceived stress reactivity in older age

Stress reactivity is a disposition that underlies individual differences in stress responses, thereby affecting vulnerability for the development of disease. Besides genetic and early postnatal environmental factors, stress reactivity has been shown to be influenced by an adverse prenatal developmental environment, but it is unclear if such effects persist into older age. We tested associations between fetal growth and perceived stress reactivity in 421 participants from the Hertfordshire Cohort at age 66-75 years. Regression analysis showed a U-shaped association between birth weight and perceived stress reactivity with increased levels of stress reactivity at the lower and upper end of the birth weight distribution. These effects were stable after adjustment for markers of early adversity and recent adversity and chronic stress. Although the effects were small, they are consistent with findings from studies in younger cohorts, and demonstrate that such effects can persist into older age.

Effects of glucose ingestion on autonomic and cardiovascular measures during rest and mental challenge

BACKGROUND

High levels of dietary sugar consumption may result in dysregulated glucose metabolism and lead to elevated cardiovascular disease risk via autonomic nervous system and cardiovascular dysfunction. Altered cardiovascular function can be examined using perturbation tasks such as mental challenge. This study examined the effects of controlled glucose intake on cardiovascular measures at rest and in responses to mental challenge in a laboratory setting.

METHOD

Using a double blind within-subjects design, participants were monitored at baseline, following ingestion of a glucose or taste-control solution, during structured speech (SS), anger recall (AR) and recovery (N=24, 288 repeated measures; age = 21±2 years). Pre-ejection period (PEP), heart rate (HR), stroke index (SI), cardiac index (CI), blood pressure and total peripheral resistance (TPR) were measured throughout the protocol.

RESULTS

Glucose resulted in sustained decreased PEP levels compared to control condition (Δ=11.98±9.52 vs. 3.27±7.65 m·s, P<.001) and transient increases in resting HR (P=.011), CI (P=.040) and systolic blood pressure (P=.009). Glucose did not result in increased cardiovascular reactivity to mental challenge tasks, but was associated with a delayed HR recovery following AR (P=.032).

CONCLUSION

Glucose intake resulted in a drop in PEP indicating increased sympathetic nervous system activity. No evidence was found for glucose-related exaggerated cardiovascular responses to mental challenge. Dysregulated glucose metabolism may result in elevated cardiovascular disease risk as a result of repeated glucose-induced elevations of sympathetic nervous system activity.

Affective reactivity to daily stressors and long-term risk of reporting a chronic physical health condition

BACKGROUND

Daily stressors, such as an argument with a spouse or an impending deadline, are associated with short-term changes in physical health symptoms. Whether these minor hassles have long-term physical health ramifications, however, is largely unknown.

PURPOSE

The current study examined whether exposure and reactivity to daily stressors is associated with long-term risk of reporting a chronic physical health condition.

METHODS

Participants (N = 435) from the National Study of Daily Experiences completed a series of daily diary interviews between 1995 and 1996 and again 10 years later.

RESULTS

Greater affective (i.e., emotional) reactivity to daily stressors at time 1 was associated with an increased risk of reporting a chronic physical health condition at time 2.

CONCLUSION

Results indicate that how people respond to the daily stressors in their lives is predictive of future chronic health conditions.

Affective reactivity to daily stressors and long-term risk of reporting a chronic physical health condition

BACKGROUND

Daily stressors, such as an argument with a spouse or an impending deadline, are associated with short-term changes in physical health symptoms. Whether these minor hassles have long-term physical health ramifications, however, is largely unknown.

PURPOSE

The current study examined whether exposure and reactivity to daily stressors is associated with long-term risk of reporting a chronic physical health condition.

METHODS

Participants (N = 435) from the National Study of Daily Experiences completed a series of daily diary interviews between 1995 and 1996 and again 10 years later.

RESULTS

Greater affective (i.e., emotional) reactivity to daily stressors at time 1 was associated with an increased risk of reporting a chronic physical health condition at time 2.

CONCLUSION

Results indicate that how people respond to the daily stressors in their lives is predictive of future chronic health conditions.

Early-life stress and recurrent psychological distress over the lifecourse predict divergent cortisol reactivity patterns in adulthood

Early-life stress (ELS) is associated with substantially increased lifetime risk for recurrent psychological problems, with evidence indicating that dysregulation of the physiological stress reactivity system may be partly responsible. However, some ELS-exposed people remain psychologically resilient. Although two distinct patterns of hypothalamic-pituitary-adrenal axis (HPA) stress reactivity have been observed in ELS-exposed samples (hyper- and hypo-reactive), the hypothesis that these patterns may be associated with long-term history of psychological problems has not been explored. We used healthy Whitehall II study subjects (n=543) who participated in the 2008 Heart Scan Study (HSS) to assess salivary cortisol responses to a cognitive stressor, ELS exposure, and other psychosocial factors. Mean age of the sample at the HSS was 63 years. HSS data were linked to nearly 20 years of participants' Whitehall data, including repeated measures of psychological distress (GHQ-28). Piecewise growth curve analyses revealed that ELS-exposed persons with a history of recurrent psychological distress in adulthood had significantly blunted cortisol reactivity compared to non-ELS-exposed participants, while ELS-exposed persons with little or no history of distress had significantly elevated baseline cortisol, prolonged responses, and greater total cortisol production. Our findings indicate that for ELS-exposed individuals, different trajectories in psychological health over their adult lifetimes predict different cortisol reactivity patterns. These findings have important implications for our understanding of ELS-related mental health risk and treatment of these disorders.

Acute psychosocial stress: does the emotional stress response correspond with physiological responses?

Most stress experiences are accompanied by physiological and psychological responses. Laboratory stressors such as the Trier Social Stress Test (TSST) induce reliable stress responses, which are mainly assessed for biological parameters such as cortisol. The associations between physiological and psychological responses to the TSST have been rarely investigated and are addressed in this review. Up to August 2011, 358 studies were published in PubMed examining the impact of the TSST (71%) or variations of the protocol. A total of 49 studies were considered based on the following three inclusion criteria: (1) exposure to the standard TSST or slightly modified TSST versions, (2) at least one assessment of subjective emotional stress experience before, during or after the TSST, (3) reported associations between acute physiological and emotional stress measures. Significant correlations between cortisol responses and perceived emotional stress variables were found in approximately 25% of the studies. Our descriptive analysis revealed various essential elements that potentially contribute to this apparent dissociation, reaching from differing assessment approaches and methodological features of the stress protocols to possible mediating factors and interindividual differences in the degree of psychophysiological correspondence.

Stress reactivity in young marmosets (Callithrix geoffroyi): ontogeny, stability, and lack of concordance among co-twins

Variation in response styles in the hypothalamic-pituitary-adrenal (HPA) axis are known to be predictors of short- and long-term health outcomes. The nature of HPA responses to stressors changes with developmental stage, and some components of the stress response exhibit long-term individual consistency (i.e., are trait-like) while others are transient or variable (i.e., state-like). Here we evaluated the response of marmoset monkeys (Callithrix geoffroyi) to a standardized social stressor (social separation and exposure to a novel environment) at three different stages of development: juvenile, subadult, and young adult. We monitored levels of urinary cortisol (CORT), and derived multiple measures of HPA activity: Baseline CORT, CORT reactivity, CORT Area Under the Curve (AUC), and CORT regulation. Juvenile marmosets exhibited the most dramatic stress response, had higher AUCs, and tended to show poorer regulation. While baseline CORT and CORT regulation were not consistent within an individual across age, CORT reactivity and measures of AUC were highly correlated across time; i.e., individuals with high stress reactivity and AUC as juveniles also had high measures as subadults and adults, and vice-versa. Marmoset co-twins did not exhibit similar patterns of stress reactivity. These data suggest that regardless of the source of variation in stress response styles in marmosets, individually-distinctive patterns are established by six months of age, and persist for at least a year throughout different phases of marmoset life history.

The physiological response to Trier Social Stress Test relates to subjective measures of stress during but not before or after the test

The Trier Social Stress Test (TSST) is an effective psychosocial laboratory protocol for inducing stress in humans and has been used in numerous research studies. The stressor leads to a physiological response of the hypothalamus-pituitary-adrenal axis (HPAA) and the autonomous nervous system (ANS). Common biomarkers are cortisol levels and heart rate. In addition to the physiological stress response, the TSST also triggers a psychological response such as an increase in perceived stress, anxiety and emotional insecurity. Whereas HPA and ANS measures can easily be obtained for the TSST period itself, psychological measures are usually determined prior to (baseline) and after the TSST. This may exclude information of the stressful event itself. In the present study, we assessed perceived stress, anxiety and emotional insecurity before, during and after the TSST using visual analogue scales. In addition, cortisol levels and heart rates were assessed. Data of 260 healthy non-smoking males aged 16-60 yrs were used for analyses. Our results show that stress perception, anxiety and emotional insecurity were significantly higher during the TSST as compared to post-TSST ratings. Furthermore, our results suggest a covariance of the psychological stress response during the TSST and the physiological stress responses (cortisol and heart rate) for stress perception though the explained variance was small. This observation was not found for pre- and post-TSST ratings suggesting that assessing psychological stress measures during the stressor itself present a more informative measure of the stress response.

Cardiovascular and psychological reactivity and recovery from harassment in a biracial sample of high and low hostile men and women

BACKGROUND

This study emphasizes the importance of studying the emotional, motivational, and cognitive characteristics accompanying and the potential hemodynamic mechanisms underlying cardiovascular reactivity to and recovery from interpersonal conflict.

PURPOSE

The relation of dispositional hostility to cardiovascular reactivity during a frustrating anagram task and post-task recovery was investigated.

METHODS

The sample was composed of 99 healthy participants (age, 18-30 years; 53% women; 51% Caucasian; 49% African American)-half randomly assigned to a harassment condition. High and low hostility groups were created by a median split specific to sex and race subgroup score distributions on the Cook-Medley Hostility Scale. It was hypothesized that hostility would interact with harassment such that harassed, high hostile individuals would display the greatest cardiovascular and emotional reactivity and slowest recovery of the four groups. Participants completed a 10-min baseline, a 6-min anagram task, and a 5-min recovery period with blood pressure, heart rate, pre-ejection period, stroke index, cardiac index, and total peripheral resistance index measured.

RESULTS

Harassed participants displayed significantly greater cardiovascular responses and lower positive affect to the task and slower systolic blood pressure (SBP) recovery than did nonharassed participants. The high hostile group, irrespective of harassment, showed blunted cardiovascular responses during the task and delayed SBP recovery than the low hostile group.

CONCLUSION

Although the predicted interaction between hostility and harassment was not supported in the context of cardiovascular responses, such an interaction was observed in the context of blame attributions, whereby harassed hostile participants were found to blame others for their task performance than the other subgroups.

Do whole-body vibration exercise and resistance exercise modify concentrations of salivary cortisol and immunoglobulin A?

A single bout of resistance exercise (RE) induces hormonal and immune responses, playing an important role in a long-term adaptive process. Whole-body vibration (WBV) has also been shown to affect hormonal responses. Evidence suggests that combining WBV with RE may amplify hormonal and immune responses due to the increased neuromuscular load. Therefore, the aim of this study was to evaluate salivary cortisol (Scortisol) and salivary IgA (SIgA) concentrations following a RE session combined or not with WBV. Nine university students (22.9 ± 5.1 years, 175.8 ± 5.2 cm, and 69.2 ± 7.3 kg) performed five sets of squat exercise (70% one-repetition-maximum) combined (R+V30) or not (R) with WBV at 30 Hz. Saliva samples were obtained before and after exercise. Subjects also rated their effort according to the Borg CR-10 scale (RPE). Data were analyzed by a mixed model. RPE was higher after R+V30 (8.3 ± 0.7) compared to R (6.2 ± 0.7). However, Scortisol (pre: 10.6 ± 7.6 and 11.7 ± 7.6, post: 8.3 ± 6.3 and 10.2 ± 7.2 ng/mL for R and R+V30, respectively) and SIgA concentrations (pre: 98.3 ± 22.6 and 116.1 ± 51.2, post: 116.6 ± 64.7 and 143.6 ± 80.5 µg/mL for R and R+V30, respectively) were unaffected. No significant correlations were observed between Scortisol and RPE (r = 0.45, P = 0.22; r = 0.30, P = 0.42, for R and R+V30, respectively). On the basis of these data, neither protocol modified salivary cortisol or IgA, although RPE was higher after R+V30 than R.

Stress-induced salivary cortisol secretion during hypobaric hypoxia challenge and in vivo urinary thromboxane production in healthy male subjects

Few studies have assessed the effects of stress on in vivo platelet activation. In the present study, hypobaric hypoxia induced by rapid decompression during high-altitude simulated flight in a hypobaric chamber was used to evaluate the effects of environmental stress on salivary cortisol and urinary thromboxane metabolite (TXM) excretion, a noninvasive marker of in vivo platelet function. Twenty-one male aviators (mean ± SD age = 36 ± 7 years) experiencing hypoxia by removing their oxygen mask for 4-5 min during a simulated flight to 25,000 ft (7,620 m; pO(2) = 59.17 mmHg) and a matched control group of thirteen flying instructors wearing oxygen masks during the challenge, were studied. Hypobaric hypoxia induced a transient significant increase (P < 0.001) in the aviators' salivary cortisol concentration; the overall pattern of diurnal cortisol fluctuation was maintained in both groups. Urinary TXM showed a significant ∼30% reduction (P < 0.01) after the chamber session in aviators exposed to hypobaric hypoxia, but not in controls. A significant inverse correlation was found between salivary cortisol and urinary TXM in aviators (r = - 0.64, P = 0.0015). Salivary cortisol was a significant predictor (P < 0.001) for urinary TXM concentrations in aviators. In conclusion, here we observed that an acute stress-induced salivary cortisol increase was associated with reduced urinary thromboxane biosynthesis, providing the first indirect evidence for an inhibitory effect of acute stress on in vivo platelet function.

Quality of early family relationships and the timing and tempo of puberty: effects depend on biological sensitivity to context

Guided by evolutionary-developmental theories of biological sensitivity to context and reproductive development, the current research examined the interactive effects of early family environments and psychobiologic reactivity to stress on the subsequent timing and tempo of puberty. As predicted by the theory, among children displaying heightened biological sensitivity to context (i.e., higher stress reactivity), higher quality parent-child relationships forecast slower initial pubertal tempo and later pubertal timing, whereas lower quality parent-child relationships forecast the opposite pattern. No such effects emerged among less context-sensitive children. Whereas sympathetic nervous system reactivity moderated the effects of parent-child relationships on both breast/genital and pubic hair development, adrenocortical activation only moderated the effect on pubic hair development. The current results build on previous research documenting what family contexts predict variation in pubertal timing by demonstrating for whom those contexts matter. In addition, the authors advance a new methodological approach for assessing pubertal tempo using piecewise growth curve analysis.

Perceived early-life maternal care and the cortisol response to repeated psychosocial stress

BACKGROUND

In the past decade, a body of animal and human research has revealed a profound influence of early-life experiences, ranging from variations in parenting behaviour to severe adversity, on hypothalamic-pituitary-adrenal axis regulation in adulthood. In our own previous studies, we have shown how variations in early-life parental care influence the development of the hippocampus and modify the cortisol awakening response.

METHODS

In the present study, we investigated the influence of early-life maternal care on cortisol, heart rate and subjective psychological responses to the repeated administration of a psychosocial laboratory stressor in a population of 63 healthy young adults. Low, medium and high early-life maternal care groups were identified using the Parental Bonding Instrument.

RESULTS

Controlling for the effect of sex, we found an inverted u-shaped relation between increasing levels of maternal care and cortisol stress responsivity. Specifically, overall and stress-induced cortisol levels went from below normal in the low maternal care, to normal in the medium care, back to below normal in the high maternal care groups. We found no group differences with respect to heart rate and subjective psychological stress measures. Whereas low and high maternal care groups exhibited similarly low endocrine stress responses, their psychological profiles were opposed with increased levels of depression and anxiety and decreased self-esteem in the low care group.

LIMITATIONS

Sex was unequally distributed among maternal care groups, whereby the number of men with low maternal care was too small to allow introducing sex as a second between-group variable.

CONCLUSION

We discuss the potential significance of this dissociation between endocrine and psychological parameters with respect to stress vulnerability and resistance for each maternal care group.

Higher cortisol content in hair among long-term unemployed individuals compared to controls

Unemployment and financial strain are chronic stressors that have been shown to be associated with an increase in mean salivary and serum cortisol levels. Hair analysis for cortisol content is a new promising tool by which hair segmental analysis may provide a retrospective calendar of cumulative cortisol exposure over time rather than momentary assessments. Participants of this study were 31 unemployed and 28 employed individuals (46 women). Hair segmental analysis was conducted using 3-cm long segments starting with the scalp-near segment. Due to differing hair length, 52 individuals had values for the second segment and n=33 individuals had values for the third segment. Univariate analysis of variance indicated that unemployed individuals had higher cortisol content in the first (p<0.05, eta(2)=0.071) and second (p<0.05, eta(2)=0.085) hair segment (a total of 6 cm long hair representing the preceding 6 months of collection). Consistent with other data from our laboratory, there was a wash-out effect for the third segment (p<0.05 for segment 3 vs. segment 1 and 2). Unemployed individuals indicated increased levels of perceived stress and impairments in subjective well-being compared to employed individuals. These subjective measures of perceived stress and well-being were unrelated to cortisol content in hair. We conclude that hair analysis for cortisol content may be a valid method to detect differences in cumulative cortisol exposure between chronically stressed individuals and healthy controls. Due to a wash-out effect, retrospective ascertainment of cortisol exposure may be limited to the preceding 6 months of specimen collection.

Why should men and women marry and have children? Parenthood, marital status and self-perceived stress among Canadians

Using the Canadian Community and Health Survey (2000), this study examines self-perceived stress across marital and parental statuses, adjusting for age, education, work status, income and sense of community belonging. Results show that fatherhood increases perceived stress regardless of marital status, particularly among singles. Motherhood does not affect perceived stress among married or cohabitating women but single and post-married mothers endure the highest levels of stress. Interactions between working and parental or marital statuses are also observed. Community belonging acts as a coping mechanism in lowering stress levels. Results are discussed in the context of changing familial roles.

Intraindividual change and variability in daily stress processes: findings from two measurement-burst diary studies

There is little longitudinal information on aging-related changes in emotional responses to negative events. In the present article, we examined intraindividual change and variability in the within-person coupling of daily stress and negative affect using data from 2 measurement-burst daily diary studies. Three main findings emerged. First, average reactivity to daily stress increased longitudinally, and this increase was evident across most of the adult lifespan. Second, individual differences in emotional reactivity to daily stress exhibited long-term temporal stability, but this stability was greatest in midlife and decreased in old age. Third, reactivity to daily stress varied reliably within-persons (across-time), with individuals exhibiting higher levels of reactivity during times when reporting high levels of global subject stress in the previous month. Taken together, the present results emphasize the importance of modeling dynamic psychosocial and aging processes that operate across different time scales for understanding age-related changes in daily stress processes.

Cardiovascular and affective recovery from anticipatory threat

Anticipating a stressor elicits robust cardiovascular and affective responses. Despite the possibility that recovery from these responses may have implications for physical and mental well-being, little research has examined this issue. In this study, participants either gave a public speech or anticipated giving a speech. Compared with speech-givers, participants who anticipated giving a speech, on average, exhibited similar cardiovascular recovery (decreased heart rate [HR] and increased respiratory sinus arrhythmia [RSA]), and reported lower negative affect during recovery. Only in the anticipation condition, however, were cardiovascular recovery and affective recovery associated: poor affective recovery predicted incomplete HR recovery and decreased RSA. These are the first data to compare explicitly recovery from anticipation of a stressor with recovery from the stressor itself. These findings suggest that failing to recover from anticipation has unique physiological costs that, in turn, may contribute to mental and physical illness.

Physiological stress responses in defensive individuals: age and sex matter

The association between defensiveness and physiological responses to stress were evaluated in 81 healthy working men and 118 women, aged 20 to 64 years (M=41; SD=11.45). Participants underwent laboratory testing during which they were exposed to interpersonal stressors. Heart rate (HR), heart rate variability (HRV), blood pressure (BP), and salivary cortisol were measured. Defensiveness was evaluated using the Marlowe-Crowne Social Desirability Scale. In women, higher defensiveness was associated with greater BP and HR reactivity to stress (p<.05). In older men, lower defensiveness was associated with increased systolic BP reactivity to stress (p<.02), delayed HRV recovery (p<.02), and greater salivary cortisol levels (p<.02). In conclusion, greater defensiveness was associated with increased reactivity to stress in women whereas in older men, lower defensiveness was associated with elevated cardiovascular, autonomic, and endocrine responses to stress.

Brain mediators of cardiovascular responses to social threat, part II: Prefrontal-subcortical pathways and relationship with anxiety

Social evaluative threat (SET) is a potent stressor in humans that causes autonomic changes, endocrine responses, and multiple health problems. Neuroimaging has recently begun to elucidate the brain correlates of SET, but as yet little is known about the mediating cortical-brainstem pathways in humans. This paper replicates and extends findings in a companion paper (Wager et al., 2009) using an independent cohort of participants and different image acquisition parameters. Here, we focused specifically on relationships between the medial prefrontal cortex (MPFC), midbrain periaqueductal gray (PAG), and heart rate (HR). We applied multi-level path analysis to localize brain mediators of SET effects on HR and self-reported anxiety. HR responses were mediated by opposing signals in two distinct sub-regions of the MPFC-increases in rostral dorsal anterior cingulate cortex (rdACC) and de-activation in ventromedial prefrontal cortex (vmPFC). In addition, HR responses were mediated by PAG. Additional path analyses provided support for two cortical-subcortical pathways: one linking vmPFC, PAG, and HR, and another linking rdACC, thalamus, and HR. PAG responses were linked with HR changes both before and during SET, whereas cortical regions showed stronger connectivity with HR during threat. Self-reported anxiety showed a partially overlapping, but weaker, pattern of mediators, including the vmPFC, dorsomedial prefrontal cortex, and lateral frontal cortex, as well as substantial individual differences that were largely unexplained. Taken together, these data suggest pathways for the translation of social threats into both physiological and experiential responses, and provide targets for future research on the generation and regulation of emotion.

Brain mediators of cardiovascular responses to social threat: part I: Reciprocal dorsal and ventral sub-regions of the medial prefrontal cortex and heart-rate reactivity

Social threat is a key component of mental "stress" and a potent generator of negative emotions and physiological responses in the body. How the human brain processes social context and drives peripheral physiology, however, is relatively poorly understood. Human neuroimaging and animal studies implicate the dorsal medial prefrontal cortex (MPFC), though this heterogeneous region is likely to contain multiple sub-regions with diverse relationships with physiological reactivity and regulation. We used fMRI combined with a novel multi-level path analysis approach to identify brain mediators of the effects of a public speech preparation task (social evaluative threat, SET) on heart rate (HR). This model provides tests of functional pathways linking experimentally manipulated threat, regional fMRI activity, and physiological output, both across time (within person) and across individuals (between persons). It thus integrates time series connectivity and individual difference analyses in the same path model. The results provide evidence for two dissociable, inversely coupled sub-regions of MPFC that independently mediated HR responses. SET caused activity increases in a more dorsal pregenual cingulate region, whose activity was coupled with HR increases. Conversely, SET caused activity decreases in a right ventromedial/medial orbital region, which were coupled with HR increases. Individual differences in coupling strength in each pathway independently predicted individual differences in HR reactivity. These results underscore both the importance and heterogeneity of MPFC in generating physiological responses to threat.

Racial discrimination and racial identity attitudes in relation to self-rated health and physical pain and impairment among two-spirit American Indians/Alaska Natives

OBJECTIVES

We examined associations between racial discrimination and actualization, defined as the degree of positive integration between self-identity and racial group identity, and self-rated health and physical pain and impairment.

METHODS

We used logistic regressions to analyze data from 447 gay, lesbian, bisexual, and other sexual-minority American Indians/Alaska Natives.

RESULTS

Greater self-reported discrimination was associated with higher odds of physical pain and impairment (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.13, 1.78); high levels of actualization were associated with lower odds of physical pain and impairment (OR = 0.59; 95% CI = 0.35, 0.99) and self-rated fair or poor health (OR = 0.54; 95% CI = 0.32, 0.90). Actualization also moderated the influence of discrimination on self-rated health (t = -2.33; P = .020). Discrimination was positively associated with fair or poor health among participants with low levels of actualization, but this association was weak among those with high levels of actualization.

CONCLUSIONS

Among two-spirit American Indians/Alaska Natives, discrimination may be a risk factor for physical pain and impairment and for fair or poor self-rated health among those with low levels of actualization. Actualization may protect against physical pain and impairment and poor self-rated health and buffer the negative influence of discrimination.

Salivary cortisol as a biomarker in stress research

Salivary cortisol is frequently used as a biomarker of psychological stress. However, psychobiological mechanisms, which trigger the hypothalamus-pituitary-adrenal axis (HPAA) can only indirectly be assessed by salivary cortisol measures. The different instances that control HPAA reactivity (hippocampus, hypothalamus, pituitary, adrenals) and their respective modulators, receptors, or binding proteins, may all affect salivary cortisol measures. Thus, a linear relationship with measures of plasma ACTH and cortisol in blood or urine does not necessarily exist. This is particularly true under response conditions. The present paper addresses several psychological and biological variables, which may account for such dissociations, and aims to help researchers to rate the validity and psychobiological significance of salivary cortisol as an HPAA biomarker of stress in their experiments.

Covariance between psychological and endocrine responses to pharmacological challenge and psychosocial stress: a question of timing

OBJECTIVE

To test if the covariance of hypothalamus-pituitary-adrenal (HPA) axis and subjective-psychological responses to stress is dependent on different dynamics of these systems. Although stress theories typically assume substantial correlations of psychological and endocrine stress responses, studies have produced inconsistent results. One reason for this might be imperfect coupling of the different stress response systems. However, inconsistent correlations might also be a result of different on-/offsets of these stress responses, i.e., specific dynamics of the systems.

METHODS

HPA axis indicators and subjective-psychological states were repeatedly and synchronously measured in a pharmacological challenge test (injection of corticotropin-releasing hormone and infusion of arginine vasopressin; Study 1; n = 42) and a psychosocial stress situation (Trier Social Stress Test; Study 2; n = 219). Cross-correlation analysis was used to test for lag effects in HPA axis reactivity and psychoendocrine responses.

RESULTS

Analyses revealed high cross-correlations of adrenocorticotropic hormone with cortisol responses (up to r = .80 in Study 1 and r = .56 in Study 2) and positive associations of psychological with endocrine stress responses (up to r = .48 in Study 1 and r = .54 in Study 2) at nonzero lags. Subjective-psychological responses preceded HPA axis responses. Moreover, high levels of cortisol were associated with lower later levels of anxiety and activation.

CONCLUSIONS

The findings suggest that psychoendocrine stress responses are more closely coupled than previous studies suggested. Due to different dynamics of the systems, endocrine responses lag behind psychological responses.

Childhood growth and cardiovascular reactivity to psychological stressors in late adulthood

OBJECTIVE

Specific childhood growth patterns relate to risk of cardiovascular (CV) disease later in life, but the underlying mechanisms are unclear. We studied whether CV reactivity, a predictor of CV disease risk, is associated with childhood growth trajectories.

METHODS

A total of 144 (77 women and 67 men) participants of the Helsinki Birth Cohort Study born 1934-1944, whose height and weight were recorded repeatedly during the first 11 years, underwent the Trier Social Stress Test at the average age of 63 years. Beat-to-beat blood pressure was monitored via noninvasive finger photoplethysmograph (Finometer), and CV reactivity scores were determined as the mean increment from baseline.

RESULTS

In both women and men, systolic blood pressure (SBP) reactivity increased by 3.8 mmHg (95% CI 0.8-6.9) and diastolic BP (DBP) reactivity by 1.4 mmHg (95% CI 0.0-2.8) for every standard deviation increase in gain in body mass index (kg m(-2)) between 7 and 11 years. By contrast, effects of height gain were dissimilar between sexes. In women, higher DBP reactivity was associated with a slow gain in height between 0 and 2 years, whilst in men higher SBP reactivity was associated with a slow gain in height between 2 and 7 years, which was preceded by a more rapid gain in height between 0 and 2 years. Adjusting for adult body size, body size at birth or childhood socio-economic status did not change the results.

CONCLUSIONS

We found that growth during childhood is associated with CV reactivity to stress later in adulthood. Early life programming of CV reactivity may partly underlie the link between early growth and CV disease.

Examination stress and components of working memory

Previous research suggests that stress can influence a broad range of memory functions. In this study we investigated the effect of a naturalistic stressor, examination stress, on working memory in young adults. In order to accomplish this aim, participants were tested on psychological and hormonal measures of stress and on Digit Span, once during a low stress period and once during a high stress period. The high examination stress condition was associated with an increase in cortisol and subjective impressions of stress. Although Digits Forward performance did not vary with examination stress, Digits Backward performance improved. These findings suggest that mild increases in stress are associated with improvement in the manipulation component of working memory. However, no correlations were found between working memory and either cortisol or psychological stress. Thus the mechanism by which mild naturalistic stressors improve the manipulation component of working memory needs further investigation.

A nationwide study of discrimination and chronic health conditions among Asian Americans

OBJECTIVES

We examined whether self-reported everyday discrimination was associated with chronic health conditions among a nationally representative sample of Asian Americans.

METHODS

Data were from the Asian American subsample (n = 2095) of the National Latino and Asian American Study conducted in 2002 and 2003. Regression techniques (negative binomial and logistic) were used to examine the association between discrimination and chronic health conditions. Analyses were conducted for the entire sample and 3 Asian subgroups (Chinese, Vietnamese, and Filipino).

RESULTS

Reports of everyday discrimination were associated with many chronic conditions, after we controlled for age, gender, region, per capita income, education, employment, and social desirability bias. Discrimination was also associated with indicators of heart disease, pain, and respiratory illnesses. There were some differences by Asian subgroup.

CONCLUSIONS

Everyday discrimination may contribute to stress experienced by racial/ethnic minorities and could lead to chronic illness.

Cardiovascular reactivity to psychological stressors in late adulthood is predicted by gestational age at birth

The relationships of body size and gestational age at birth with adult blood pressure (BP) are relatively modest compared to their stronger associations with cardiovascular disease. BP reactivity is a strong predictor of cardiovascular morbidity, and it is possible that reactivity, rather than resting level, is determined in utero. We investigated whether body size and gestational age at birth predict BP reactivity during experimentally induced psychosocial stress in late adulthood. A total of 73 men and 80 women born after 36 weeks' gestation in Helsinki, Finland, during 1934-1944 underwent the Trier Social Stress Test (TSST); a standardized psychosocial stress test consisting of a public speech and an arithmetic task. Changes in BP were monitored continuously by a non-invasive finger photoplethysmography (Finometer, FMS, Amsterdam, The Netherlands). The results showed that the most robust early determinant of BP reactivity was gestational age; however, with opposite relationships between the sexes (P for interaction <0.001). A 1-week increase in gestational age was associated with a 3.1 mm Hg (95% confidence interval (CI), 0.2 to 6.0) and 1.2 mm Hg (95% CI, -0.1 to 2.6) decreases in systolic and diastolic BP reactivity in women, but with 5.2 mm Hg (95% CI, 1.9 to 8.4) and 2.3 mm Hg (95% CI, 0.9 to 3.8) increases in men. In conclusion, normal variation in gestational age at birth predicts cardiovascular stress reactivity in later adulthood. Given that hypothalamic-pituitary-adrenal axis contributes to the regulation of autonomic nervous system function and the timing of parturition, and shows well-established sex differences, we speculate a role for early programming of this axis in explaining the findings.

How does optimism suppress immunity? Evaluation of three affective pathways

Studies have linked optimism to poorer immunity during difficult stressors. In this study, when 1st-year law students (N = 46) relocated to attend law school, reducing conflict among curricular and extracurricular goals, optimism predicted larger delayed-type hypersensitivity responses, indicating more robust in vivo cellular immunity. However, when students did not relocate, increasing goal conflict, optimism predicted smaller responses. Although this effect has been attributed to negative affect when difficult stressors violate optimistic expectancies, distress did not mediate optimism's effects on immunity. Alternative affective mediators related to engagement--engaged affect and fatigue--likewise failed to mediate optimism's effects, although all 3 types of affect independently influenced in vivo immunity. Alternative pathways include effort or self-regulatory depletion.

Spontaneous emotion regulation during evaluated speaking tasks: associations with negative affect, anxiety expression, memory, and physiological responding

In these studies, the correlates of spontaneously using expressive suppression and cognitive reappraisal during stressful speeches were examined. Spontaneous emotion regulation means that there were no instructions of how to regulate emotions during the speech. Instead, participants indicated after the speech to what extent they used self-motivated expressive suppression or reappraisal during the task. The results show that suppression is associated with less anxiety expression, greater physiological responding, and less memory for the speech while having no impact on negative affect. In contrast, reappraisal has no impact on physiology and memory while leading to less expression and affect. Taken together, spontaneous emotion regulation in active coping tasks has similar consequences as experimentally induced emotion regulation in passive tasks.

Effects of social anxiety and evaluative threat on cardiovascular responses to active performance situations

This study investigated the joint influence of trait social anxiety and evaluative threat on psychological and cardiovascular responses to active coping situations. Fifty-two normotensive female students characterized as either high or low in trait social anxiety performed a mental arithmetic task and a speech task requiring persuasive behavior in a context of high or low evaluative threat. Trait social anxiety exerted a substantial influence on cardiovascular reactivity. High socially anxious individuals overall exhibited greater heart rate reactivity. For systolic and diastolic blood pressure enhanced reactivity of socially anxious individuals was confined to low evaluative threat. At high levels of evaluative threat no group differences were observed due to somewhat attenuated reactivity in high compared to low socially anxious individuals. Cognitive appraisals and affective arousal were not found to mediate the effects of social anxiety on cardiovascular reactivity. Results were attributed to differences in effort expenditure rather than experienced anxiety.

Inflammatory and hemostatic responses to repeated mental stress: individual stability and habituation over time

An important assumption underlying psychobiological studies relating stress reactivity with disease risk is that individuals are characterized by stable response profiles that can be reliably assessed using acute psychophysiological stress testing. Previous research has mainly focused on the stability of cardiovascular, neuroendocrine, and cellular immune responses to repeated stressors, and less attention has been given to inflammatory and platelet responses. We therefore examined both average stability and individual test-retest stability of cardiovascular, neuroendocrine, hemostatic, inflammatory, and subjective responses to mental stress over two repeated stress sessions, four weeks apart. Ninety-one healthy, non-smoking men (mean age 33.2 years) completed a 3-min speech task followed by a 5-min mirror tracing task on two separate occasions. Blood samples were taken at baseline and 10 min after the stress tasks while cardiovascular activity, saliva samples, and subjective ratings were measured repeatedly. There was significant cardiovascular and cortisol activation to the stressors and stress-induced increases in plasma C-reactive protein, von Willebrand factor antigen, and platelet activation indexed by leukocyte-platelet aggregates. The magnitude of stress responses did not differ between sessions in any variable. Significant test-retest correlations between sessions were observed for baseline and stress values of all variables (r=0.47-0.74, p<.001), but reactivity (change scores) for C-reactive protein, von Willebrand factor, cortisol, and platelet activation were not significantly correlated. Our results demonstrate that the stress-induced responses did not habituate between sessions, though the small magnitude of acute inflammatory, cortisol, and platelet responses limits the test-retest reliability of stress reactivity assessments.

Autonomic and Neuroendocrine Responses to a Psychosocial Stressor in Adults with Autistic Spectrum Disorder

Objective of the study was to replicate in adults our previous findings of decreased heart rate and normal endocrine responses to stress in autistic children and to elucidate the discrepancy between autonomic and endocrine stress responses by including epinephrine, norepinephrine, oxytocin and vasopressin measurements. Ten autistic spectrum disorder (ASD) adults were compared to 14 healthy controls in their response to a psychosocial stressor (public speaking). ASD patients showed decreased heart rate, but normal cortisol responses, consistent with our prior findings in children. No differences in norepinephrine, epinephrine, oxytocin or vasopressin responses to stress were found. However, in contrast to previous findings in low functioning autistic children, ASD adults showed increased basal oxytocin levels, which may be related to developmental factors.

Identifying immune traits and biobehavioral correlates: generalizability and reliability of immune responses in rhesus macaques

Variation in immune responses over time and in different contexts presents a methodological challenge for characterizing the typical immune status of an individual. Our analyses statistically evaluated sampling strategies for optimizing the determination of an "immune trait" in studies of individual differences with nonhuman primates. Lymphocyte proliferation and natural killer cell activity were assessed on multiple occasions at 3-week intervals in male rhesus macaques for up to 1 year while they lived in undisturbed conditions. Generalizability and Monte Carlo analyses were utilized to explore the benefits of multiple evaluations and the effects of reliability on replication. There were substantial gains in reliability and stability by obtaining 4 or more immune assessments of the same individual, and the benefits continued to accrue to an optimal assessment level of 10 or more evaluations for each individual. The value of determining "immune traits" was then exemplified by demonstrating the degree to which the monkeys' handedness correlated with reliable indices of proliferative and cytolytic responses averaged over 1 year of assessment.

Trait anxiety moderates the impact of performance pressure on salivary cortisol in everyday life

Stress and negative affective states are associated with cortisol in everyday life. However, it remains unclear what types of stressors and which affective states yield these associations, and the effect of trait anxiety is unknown. This study investigates the associations of specific task-related stressors and negative affective states in everyday life with salivary cortisol, and explores the mediating and moderating role of state negative affect and trait anxiety, respectively. Salivary cortisol, subjective stress, and state negative affect were measured three times a day on 2 days in 71 participants in everyday life, using a handheld computer to collect self-reports and time stamps and an electronic device to monitor saliva sampling compliance. Stress measures comprised the experience of performance pressure and failure during daily tasks; measures of negative affect comprised worn-out, tense, unhappy, and angry. Effects were tested using multilevel fixed-occasion models. Momentary performance under pressure was related to higher momentary cortisol measures, while mean task failure was related to lower daily cortisol concentrations. The association of performance pressure with cortisol varied between subjects, and this variation was explained by trait anxiety, yielding stronger associations in participants scoring high on trait anxiety. No evidence was found for a mediating role of state negative affect. These results describe the well-documented associations of everyday stressors and affect with salivary cortisol more precisely, suggesting that performance pressure is a significant condition related to short-term changes in cortisol. Subjects scoring high on trait anxiety seem to process stress-relevant information in a way that amplifies the association of performance pressure with reactions of the hypothalamus-pituitary-adrenal axis.

Students' reactions to three typical examinations in health sciences

OBJECTIVE

A search for universal and particular changes in emotional, behavioral and cognitive assessments in relation to three types of examinations: an oral presentation, an objective structured clinical examination (OSCE) and a pencil and paper examination.

METHODS

One hundred and two students of health professions completed the Profile of Mood States (POMS) questionnaire before (t1) and after (t2) each type of examination. Data regarding stress-related symptoms, attitudes, and preparation behavior were collected at (t2).

RESULTS

POMS six subscales scores at (t1) did not differ by examination type and five of them were statistically significant higher at (t1) than (t2) regardless of examination type. "Preparing behavior" also emerged as a universal feature. As for the particular aspects of each examination, OSCE students felt more depression-dejection and fatigue at (t2) than at (t1). Oral presentation was perceived as the most difficult by students, who also reported more symptoms. For this type of examination, the students regained their confidence towards the end of the presentation and perceived classmates as most supportive and least disturbing. The pencil and paper examination was evaluated as the easiest by students, produced fewest symptoms and no excitement during the examination.

CONCLUSIONS

Three types of examinations, frequently used in health sciences, appeared to initiate different physical, emotional, and social reactions.

Stressreaktivität: Theoretisches Konzept und Messung

Zusammenfassung. Das Konstrukt Stressreaktivität bezieht sich auf die Disposition einer Person, Belastungen mit schnellen, intensiven und lang andauernden Stressreaktionen zu beantworten. Als Determinanten der Stressreaktivität werden ungünstige Ausprägungen von vier Personmerkmalen angenommen: hohe Besorgnisneigung, negatives Selbstkonzept eigener Fähigkeiten, hohe Erregbarkeit des ZNS und hohe Negative Affektivität. Die hier vorzustellende Stress-Reaktivitäts-Skala (SRS) erhebt neben der generellen auch belastungsspezifische Stressreaktivitäten. Die SRS wurde an einer Stichprobe von N = 975 Personen evaluiert. Trennschärfe- und Reliabilitätskoeffizienten sowie Verteilungseigenschaften erfüllen die teststatistischen Anforderungen. Im Zusammenhang mit der Validierung des Fragebogens werden Befunde zur faktoriellen Validität, Zusammenhänge zu anderen konstruktnahen Persönlichkeitsmerkmalen, Beschwerden, Schlafverhalten, chronischen Erkrankungen und Cortisolreaktionen in einer standardisierten Stresssituation, Ergebnisse zum Einfluss genetischer Faktoren sowie Geschlechtseffekte berichtet. Die Ergebnisse sprechen deutlich für die Validität der SRS. Der Fragebogen eignet sich für die klinische Forschung, Erfassung von individuellen Stressreaktivitäten und zur Evaluation von Anti-Stress-Trainings.

Engagement and arousal: optimism's effects during a brief stressor

Optimism is usually associated with better psychological and physiological adjustment to stressors, but some contradictory findings exist. The purpose of this study was to investigate how optimism could result in negative immunological changes following difficult stressors. Because optimists are likely to see positive outcomes as attainable, they may invest greater effort to achieve their goals. It is proposed that such engagement would be more physiologically demanding when pursuing difficult goals. Participants (N = 54) worked on 11 difficult or insoluble anagrams. Optimism when combined with high self-awareness increased time spent working on the anagrams and skin conductance and salivary cortisol during the recovery period. The results support the notion that the increased engagement that arises from optimism may lead to short-term physiological costs.

Effect of health-related stereotypes on physiological responses of hypertensive middle-aged and older men

This study examined the influence of health stereotypes on stress response among middle-aged and older men. It was hypothesized that anxiety and cardiovascular reactivity would increase when health stereotypes were activated among veterans seeking care in an outpatient setting. Among a sample of 122 veteran patients with hypertension, the level of stereotype activation varied by means of reference to either their health status (health stereotypes) or, conversely, some personally valued leisure activities (no stereotype activation). Predicted stereotype-related increases in anxiety, galvanized skin conductance, and blood pressure were evident. Potential explanations for these results are explored, including those relating to the negative health stereotypes associated with being a patient.