Impaired memory retrieval after psychosocial stress in healthy young men

COVID-19 Pandemic Affects the Medical Students' Learning Process and Assaults Their Psychological Wellbeing

Background: With the emergence of the COVID-19 pandemic, people are living within a milieu of stress, anxiety, and fear. Medical students are susceptible to these emotional injuries, but their psychological wellbeing and learning may further be assaulted by future uncertainties and altered teaching and training programs. Our objective was to find the extent of the psychological impact of the pandemic and the learning difficulties they are experiencing; Methodology: This cross-sectional study included 418 undergraduate and postgraduate medical students from all over the world. A questionnaire was uploaded in Google survey form. It included background characteristics, questions for psychiatric impact like PHQ-9, GAD-7, ZF-OCS, and questions for learning difficulties perceived in comparison to the pre-pandemic time. Results: Among participants, 34.9% of students were male and 65.1% female. Around 46.4% belonged to the WHO, Eastern Mediterranean region, 26.8% from South East Asia region, 17.5% from the region of America, 5.5% from the European region,2.2%from the Western Pacific region, and 1.7% from the African region. Symptoms due to psychiatric illness were noticed in 393 (93.1%); depression in 386 (92.3%), anxiety in 158 (37.8%), obsessive compulsion disorder in 225 (53.8%), and post-traumatic stress syndrome in 129 (39.9%). Female gender, geographical region, and history of previous psychiatric illness were significantly related to almost all the psychiatric illnesses. Regarding learning difficulty, 96% of students faced problems: trouble with memorizing in 54.0%, concentration problems in 67.0%, about 55.5% of students made more mistakes, while 44.5% noted an increase in reaction time for solving questions. In addition, 90% experienced greater difficulty in overall learning during the pandemic in comparison to the pre-pandemic time. Conclusion: Assault on psychological wellbeing, struggling to memorize, inattention and difficulty in concentration on studies, along with perceived overall trouble with learning, have emerged as collateral damage from the COVID-19 pandemic with respect to medical students.

Examining the effect of stress induction on auditory working memory performance for emotional and non-emotional stimuli in female students

Background

Theoretical frameworks have shown that stress might influence working memory in different ways. Previous research has investigated the effect of stress on female's working memory but there is lack of evidence regarding the impact of emotional aspects.

Objectives

This study examined the effect of stress induction on auditory working memory (AWM) performance among university students for emotional (positive and negative) and non-emotional (neutral) stimuli.

Methods

A sample of 102 female students at the Universities of Isfahan, Iran was selected using convenience sampling in 2018. Participants completed the demographic information sheets, then, they were randomly assigned into the experimental and control groups. The stress was induced by the Socially Evaluated Cold Pressor Test (SECPT). An n-back task was presented pre and post of stress induction, to evaluate the AWM performance (accuracy and reaction time). The research data were analyzed using mixed-model ANOVA.

Results

Both accuracy and reaction time (RT) scores were found to be enhanced for positive words in the experimental condition. However, accuracy and RT indices were found to be worsening for negative words in the experimental condition.

Conclusions

This study supports the idea that stress influences AWM performance depend on emotionally-valenced stimuli, which may help us to better understand the underlying mechanisms of memory processing.

Regression I. Experimental approaches to regression

The concept of regression is considered with an emphasis on the differences between the positions of Freud and Jung regarding its significance. The paper discusses the results of experimental analyses of individual experience dynamics (from gene expression changes and impulse neuronal activity in animals to prosocial behaviour in healthy humans at different ages, and humans in chronic pain) in those situations where regression occurs: stress, disease, learning, highly emotional states and alcohol intoxication. Common mechanisms of regression in all these situations are proposed. The mechanisms of regression can be described as reversible dedifferentiation, which is understood as a relative increase of the representation of low-differentiated (older) systems in the actualized experience. In all of the cases of dedifferentiation mentioned above, the complexity of the systemic organization of behaviour significantly decreases.

The effects of stress on eyewitness memory: A survey of memory experts and laypeople

This survey examined lay and expert beliefs about statements concerning stress effects on (eyewitness) memory. Thirty-seven eyewitness memory experts, 36 fundamental memory experts, and 109 laypeople endorsed, opposed, or selected don't know responses for a range of statements relating to the effects of stress at encoding and retrieval. We examined proportions in each group and differences between groups (eyewitness memory experts vs. fundamental memory experts; experts vs. laypeople) for endorsements (agree vs. disagree) and selections (don't know vs. agree/disagree). High proportions of experts from both research fields agreed that very high levels of stress impair the accuracy of eyewitness testimony. A majority of fundamental experts, but not eyewitness experts, endorsed the idea that stress experienced during encoding can enhance memory. Responses to statements regarding moderating factors such as stressor severity and detail type provided further insight into this discrepancy. Eyewitness memory experts more frequently selected the don't know option for neuroscientific statements regarding stress effects on memory than fundamental memory experts, although don't know selections were substantial among both expert groups. Laypeople's responses to eight of the statements differed statistically from expert answers on topics such as memory in children, in professionals such as police officers, for faces and short crimes, and the existence of repression, providing insight into possible 'commonsense' beliefs on stress effects on memory. Our findings capture the current state of knowledge about stress effects on memory as reflected by sample of experts and laypeople, and highlight areas where further research and consensus would be valuable.

Understanding the heart-brain axis response in COVID-19 patients: A suggestive perspective for therapeutic development

In-depth characterization of heart-brain communication in critically ill patients with severe acute respiratory failure is attracting significant interest in the COronaVIrus Disease 19 (COVID-19) pandemic era during intensive care unit (ICU) stay and after ICU or hospital discharge. Emerging research has provided new insights into pathogenic role of the deregulation of the heart-brain axis (HBA), a bidirectional flow of information, in leading to severe multiorgan disease syndrome (MODS) in patients with confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Noteworthy, HBA dysfunction may worsen the outcome of the COVID-19 patients. In this review, we discuss the critical role HBA plays in both promoting and limiting MODS in COVID-19. We also highlight the role of HBA as new target for novel therapeutic strategies in COVID-19 in order to open new translational frontiers of care. This is a translational perspective from the Italian Society of Cardiovascular Researches.

Mitigating the negative effects of retrieval stress on memory: an arousal reappraisal intervention

In a preregistered experiment, we examined the efficacy of arousal reappraisal as an intervention for reducing the negative effects of stress at retrieval on memory. Participants (N = 177) were semi-randomly assigned to one of three conditions: a Stress-intervention condition, a Stress-placebo condition, and a No-stress-placebo control condition. Participants viewed four images of complex, mildly negatively valenced scenes. One day later, they received an arousal reappraisal intervention or placebo before exposure to a laboratory stressor (or a control version for the No-stress condition). Participants were then tested on their memory of the images using a free recall instruction and multiple-choice recognition questions. As expected, negative affect and blood pressure increased for the stress conditions but not the control condition. Contrary to our hypotheses, memory performance did not statistically significant differ between the Stress-placebo condition and the No-stress-placebo control condition, indicating a lack of negative effects of acute retrieval stress on memory. Furthermore, we also found no statistically significant differences between the Stress-intervention condition and Stress-placebo condition in terms of memory performance, suggesting that the intervention did not assist with enhancing memory. We integrate interpretations of the findings from this study with a discussion of avenues for future research in this area.

Sleep, Cognition and Cortisol in Addison's Disease: A Mechanistic Relationship

Sleep is a critical biological process, essential for cognitive well-being. Neuroscientific literature suggests there are mechanistic relations between sleep disruption and memory deficits, and that varying concentrations of cortisol may play an important role in mediating those relations. Patients with Addison's disease (AD) experience consistent and predictable periods of sub- and supra-physiological cortisol concentrations due to lifelong glucocorticoid replacement therapy, and they frequently report disrupted sleep and impaired memory. These disruptions and impairments may be related to the failure of replacement regimens to restore a normal circadian rhythm of cortisol secretion. Available data provides support for existing theoretical frameworks which postulate that in AD and other neuroendocrine, neurological, or psychiatric disorders, disrupted sleep is an important biological mechanism that underlies, at least partially, the memory impairments that patients frequently report experiencing. Given the literature linking sleep disruption and cognitive impairment in AD, future initiatives should aim to improve patients' cognitive performance (and, indeed, their overall quality of life) by prioritizing and optimizing sleep. This review summarizes the literature on sleep and cognition in AD, and the role that cortisol concentrations play in the relationship between the two.

Relational Decision-Making in the Context of Life-Limiting Fetal Anomalies: Two Cases of Anencephaly Diagnosis

Life-limiting fetal diagnoses such as anencephaly require families to make decisions in which no options offered will lead to the desired outcome of a healthy newborn. Although informed choice and shared decision-making are important aspects of ethics regarding care choices, they have limitations. In this article, 2 cases of anencephaly diagnosis are presented, and a relational decision-making model of care is proposed as an alternative for aiding pregnant people and their families in making challenging choices in the context of perinatal care.

Stress and long-term memory retrieval: a systematic review

Introduction

The experience of stressful events can alter brain structures involved in memory encoding, storage and retrieval. Here we review experimental research assessing the impact of the stress-related hormone cortisol on long-term memory retrieval.

Method

A comprehensive literature search was conducted on PubMed, Web of Science and PsycNet databases with the following terms: “stress,” “long-term memory,” and “retrieval.” Studies were included in the review if they tested samples of healthy human participants, with at least one control group, and with the onset of the stress intervention occurring after the encoding phase and shortly (up to one hour) before the final memory test.

Results

Thirteen studies were included in the qualitative synthesis (N = 962) and were classified according to the time elapsed between stress induction and memory retrieval (stress-retrieval delay), the stress-inducing protocol (stressor), the time of day in which stress induction took place, sex, and age of participants. Most studies induced stress with the Trier Social Stress Test (TSST) between 15 and 25 minutes before the final memory (mostly recall) test and showed significant increases in cortisol levels and memory impairment.

Discussion

The reviewed studies indicate that stress does impair retrieval, particularly when induced with the TSST, in the afternoon, up to 45 minutes before the onset of the final memory test, in healthy young men. These results may inform future research on the impact of stress-induced cortisol surges on memory retrieval.

Stress Impairs Episodic Retrieval by Disrupting Hippocampal and Cortical Mechanisms of Remembering

Despite decades of science investigating the neural underpinnings of episodic memory retrieval, a critical question remains: how does stress influence remembering and the neural mechanisms of recollection in humans? Here, we used functional magnetic resonance imaging and multivariate pattern analyses to examine the effects of acute stress during retrieval. We report that stress reduced the probability of recollecting the details of past experience, and that this impairment was driven, in part, by a disruption of the relationship between hippocampal activation, cortical reinstatement, and memory performance. Moreover, even memories expressed with high confidence were less accurate under stress, and this stress-induced decline in accuracy was explained by reduced posterior hippocampal engagement despite similar levels of category-level cortical reinstatement. Finally, stress degraded the relationship between the engagement of frontoparietal control networks and retrieval decision uncertainty. Collectively, these findings demonstrate the widespread consequences of acute stress on the neural systems of remembering.

D-Ribose-L-cysteine exhibits adaptogenic-like activity through inhibition of oxido-inflammatory responses and increased neuronal caspase-3 activity in mice exposed to unpredictable chronic mild stress

Adaptogens are substances that act nonspecifically to combat stress by regulating the key elements involved in stress-induced pathologies. D-Ribose-L-cysteine (DRLC), a potent glutathione (GSH) booster, has been recommended for relief of stress. Hence, we investigated its adaptogenic-like effect in mice subjugated to unpredictable chronic mild stress (UCMS). Thirty six male Swiss mice were assigned to 6 groups (n = 6): group 1 received saline (p.o, non-stress control), group 2 (stress-control) also had saline, groups 3 to 5 received DRLC (25, 50 and 100 mg/kg, p.o) whereas group 6 had ginseng (50 mg/kg, p.o). The animals in groups 2-6 were subjugated to UCMS 30 min later, daily for 21 days and afterwards, tested for memory and anxiety. Blood glucose, serum corticosterone concentrations and adrenal weight were determined. The brain tissues were processed for estimation of malondialdehyde (MDA), GSH, superoxide-dismutase (SOD), catalase, tumor necrosis factor-alpha (TNF-α), interleukin-6, acetyl-cholinesterase, and caspase-3 activities. The histomorphologic features and neuronal viability of the hippocampus, amygdala and prefrontal cortex were also determined. DRLC (25-100 mg/kg) reduces anxiety, memory deficit, adrenal gland enlargement, glucose, and corticosterone concentrations in UCMS-mice. The increased brain contents of MDA, TNF-α, interleukin-6, acetyl-cholinesterase and decreased antioxidant (GSH, SOD and catalase) status induced by UCMS were attenuated by DRLC. The DRLC increased caspase-3 activity and reduces histomorphological distortions of neuronal cells of the hippocampus, amygdala and prefrontal cortex of stressed-mice. These findings suggest that DRLC has adaptogenic-like effect which might be related to modulation of corticosterone-mediated oxido-inflammatory processes and altered caspase-3 activity.

Parsing inter- and intra-individual variability in key nervous system mechanisms of stress responsivity and across functional domains

Exposure to stressful events is omnipresent in modern human life, yet people show considerable heterogeneity in the impact of stress exposure(s) on their functionality and overall health. Encounter with stressor(s) is counteracted by an intricate repertoire of nervous-system responses. This narrative review starts with a brief summary of the vast evidence that supports heart rate variability, cortisol secretion, and large-scale cortical network interactions as kay physiological, endocrinological, and neural mechanisms of stress responsivity, respectively. The second section highlights potential sources for inter-individual variability in these mechanisms, by focusing on biological, environmental, social, habitual, and psychological factors that may influence stress responsivity patterns and thus contribute to heterogeneity in the impact of stress exposure on functionality and health. The third section introduces intra-individually variability in stress responsivity across functional domains as a novel putative source for heterogeneity in the impact of stress exposure. Challenges and future directions are further discussed. Parsing inter- and intra-individual variability in nervous-system mechanisms of stress responsivity and across functional domains is critical towards potential clinical translation.

Relationship Between Burnout and Professional Behaviors and Beliefs Among US Nurses

OBJECTIVE

To evaluate the relationship between burnout and professional behaviors and beliefs among US nurses.

METHODS

We used data from 2256 nurses who completed a survey that included the Maslach Burnout Inventory and items exploring their professional conduct (documented something they had not done so they could "close out" an encounter in the EHR or part of the assessment not completed, requested continuing education credit for an activity not attended) and beliefs about reporting impaired colleagues.

RESULTS

On multivariable analysis, burnout was independently associated with higher odds of reporting 1 or more unprofessional behaviors in the last year and not believing nurses have a duty to report impairment among colleagues due to substance use or mental health problems.

CONCLUSIONS

Occupational burnout is associated with self-reported unprofessional behaviors and less favorable beliefs about reporting impaired colleagues among nurses.

The perils of murky emotions: Emotion differentiation moderates the prospective relationship between naturalistic stress exposure and adolescent depression

Negative emotion differentiation (NED) refers to the ability to identify and label discrete negative emotions. Low NED has been previously linked to depression and other indices of low psychological well-being. However, this construct has rarely been explored during adolescence, a time of escalating depression risk, or examined in the context of naturalistic stressors. Further, the association between NED and depression has never been tested longitudinally. We propose a diathesis-stress model wherein low NED amplifies the association between stressful life events (SLEs) and depression. A sample of 233 community-recruited midadolescents (Mage 15.90 years, 54% female) completed diagnostic interviews and reported on mood and daily stressors 4 times per day for 7 days. SLEs were assessed using a semistructured interview with diagnosis-blind team coding based on the contextual threat method. Follow-up interviews were conducted 1.5 years after baseline. Low NED was correlated with depression but did not predict prospective changes in depression as a main effect. Confirming predictions and supporting a diathesis-stress model, low NED predicted (a) within-subjects associations between daily hassles and momentary depressed mood, (b) between-subjects associations between SLE severity and depression, and (c) prospective associations between SLE severity and increases in depression at follow-up. Results were specific to negative (vs. positive) emotion differentiation. Results suggest that low NED is primarily depressogenic in the context of high stress exposure. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The role of depressive symptoms within the association of long-term exposure to indoor and outdoor traffic noise and cognitive function - Results from the Heinz Nixdorf Recall study

OBJECTIVES

Traffic noise is negatively associated with cognitive function, and its perception can differ between depressed and non-depressed people. We studied the role of depressive symptoms in the association between traffic noise and cognitive function. We studied the role of depressive symptoms in the association between traffic noise and cognitive function.

METHODS

During the first follow-up examination (2006-2008) of the German Heinz Nixdorf Recall study, cognitive function (five subtests and an additive global summary score, GCS) and depressive symptoms (CES-D score) were assessed in 2745 participants (aged 50-80, 49.8% women). Mild cognitive impairment (MCI) was diagnosed according to the Petersen criteria in 380 participants. Long-term exposure to traffic noise was modeled as weighted 24-h mean (L_DEN) and night-time mean (L_NIGHT) at the façade of the baseline addresses, and was corrected for indoors (L_{DEN_IN} and L_{NIGHT_IN}). We developed multiple linear and logistic regression models adjusted for individual-level characteristics to investigate cross-sectionally the role of depressive symptoms in the association of traffic noise with cognitive function.

RESULTS

Overall, 8.6% participants had depressive symptoms. The median noise values were L_DEN 52.1 dB(A) and L_{DEN_IN} 34.7 dB(A). Associations were slightly stronger for cognitive subtests in those with severe depression (CES-D>21), i.e., per 10 dB(A) L_DEN and verbal fluency: β = -0.04 [-0.11; 0.03] for CES-D≤21 and β = -0.09 [-0.24; -0.06] for CES-D>21. Additional adjustment of the main model for CES-D did not change the association between noise and cognitive outcomes. Estimates using indoor noise exposure were generally stronger and more precise.

CONCLUSIONS

Depressed people may be more susceptible to adverse effects of noise than non-depressed. Modeled estimates of indoor noise exposure is possibly a more appropriate measure of exposure.

Boundary conditions of post-retrieval extinction: A direct comparison of low and high partial reinforcement

Research has shown that a single presentation of the conditioned stimulus prior to extinction training can diminish conditioned responses. However, replication has proven difficult and appears to be limited by boundary conditions. Here we tested the boundary condition of memory strength by comparing the effect of reinforcement rate to assess its role in post-retrieval extinction. Eighty university students had undergone a three-day fear conditioning experiment in which two partial reinforcement schedules (40%, 80%) were applied. The findings indicated that both low and high partial reinforcement groups did not demonstrate recovery of conditioned responses after post-retrieval extinction. In contrast, both groups demonstrated significant recovery to standard extinction with significantly greater recovery in the 80% group relative to the 40% group. Additionally, we found that greater physiological arousal during memory retrieval significantly predicted recovery of fear at test phase. We conclude that when compared to a lower partial reinforcement schedule, a higher partial reinforcement resulted in the formation of a stronger memory as indicated by greater physiological arousal during memory reactivation and recovery of conditioned responses after standard extinction, but that it does not function as a boundary condition of post-retrieval extinction. These data are significant because it is the first study to investigate the effect of varying partial reinforcement schedules on fear recovery and add to the body of literature that continue to identify sources of failure in the application of post-retrieval extinction.

The Forward Testing Effect is Immune to Acute Psychosocial Encoding/Retrieval Stress

The forward testing effect (FTE) refers to the finding that testing of previously studied information enhances memory for subsequently studied other information. Previous research demonstrated that the FTE is a robust phenomenon that generalizes across different materials and populations. The present study examined whether the FTE is robust under acute psychosocial encoding/retrieval stress. In each of two experimental conditions, participants studied three item lists in anticipation of final cumulative recall testing. In the testing condition, participants were tested immediately on lists 1 and 2, whereas in the restudy condition, they restudied lists 1 and 2. In both conditions, participants were tested immediately on list 3. Acute psychosocial stress was induced in participants prior to the encoding of item lists using the Trier social stress test for groups protocol. No stress was induced in a control group. Salivary cortisol, alpha amylase, and subjective stress were measured repeatedly to capture the biopsychological stress response. The results showed a significant FTE on list 3 recall, that is, testing of lists 1 and 2 enhanced the recall of list 3. No significant effect of stress on the FTE was observed, suggesting that the FTE is robust under acute psychosocial encoding/retrieval stress. The discussion provides suggestions for future research directions.

Stress gates an astrocytic energy reservoir to impair synaptic plasticity

Astrocytes support the energy demands of synaptic transmission and plasticity. Enduring changes in synaptic efficacy are highly sensitive to stress, yet whether changes to astrocyte bioenergetic control of synapses contributes to stress-impaired plasticity is unclear. Here we show in mice that stress constrains the shuttling of glucose and lactate through astrocyte networks, creating a barrier for neuronal access to an astrocytic energy reservoir in the hippocampus and neocortex, compromising long-term potentiation. Impairing astrocytic delivery of energy substrates by reducing astrocyte gap junction coupling with dominant negative connexin 43 or by disrupting lactate efflux was sufficient to mimic the effects of stress on long-term potentiation. Furthermore, direct restoration of the astrocyte lactate supply alone rescued stress-impaired synaptic plasticity, which was blocked by inhibiting neural lactate uptake. This gating of synaptic plasticity in stress by astrocytic metabolic networks indicates a broader role of astrocyte bioenergetics in determining how experience-dependent information is controlled.

Enduring changes in synaptic efficacy are highly sensitive to stress. Here, the authors show that astrocytic delivery of metabolites has an important role in the stress-mediated impairment of synaptic plasticity.

Stress Disrupts Human Hippocampal-Prefrontal Function during Prospective Spatial Navigation and Hinders Flexible Behavior

The ability to anticipate and flexibly plan for the future is critical for achieving goal-directed outcomes. Extant data suggest that neural and cognitive stress mechanisms may disrupt memory retrieval and restrict prospective planning, with deleterious impacts on behavior. Here, we examined whether and how acute psychological stress influences goal-directed navigational planning and efficient, flexible behavior. Our methods combined fMRI, neuroendocrinology, and machine learning with a virtual navigation planning task. Human participants were trained to navigate familiar paths in virtual environments and then (concurrent with fMRI) performed a planning and navigation task that could be most efficiently solved by taking novel shortcut paths. Strikingly, relative to non-stressed control participants, participants who performed the planning task under experimentally induced acute psychological stress demonstrated (1) disrupted neural activity critical for mnemonic retrieval and mental simulation and (2) reduced traversal of shortcuts and greater reliance on familiar paths. These neural and behavioral changes under psychological stress were tied to evidence for disrupted neural replay of memory for future locations in the spatial environment, providing mechanistic insight into why and how stress can alter planning and foster inefficient behavior.

Does Acute Stress Impact Declarative and Procedural Learning?

It is well established that acute stress can influence memory function, yet its influence may differ across memory systems. Whereas stress sometimes exerts a negative influence on declarative learning, it does not necessarily harm learning in general, as demonstrated in the case of procedural learning. Probabilistic category learning is mediated by the striatum, but delaying feedback by a few seconds shifts learning to become more hippocampal-dependent. Here, we examined the influence of acute stress on this type of learning, under different conditions that favor either procedural-based (immediate feedback) vs. declarative-based (delayed feedback) learning. Sixty-two participants randomly assigned to either stress or non-stress groups, performed a probabilistic category learning task, in which they were instructed to learn associations between cues and outcomes under different feedback conditions (immediate feedback, short-delayed feedback, and long-delayed feedback). Acute stress was induced by the Maastricht Acute Stress Test (MAST), and stress levels were gauged by Galvanic Skin Response (GSR) measures and a self-reported questionnaire. Results showed that although the MAST was effective in inducing stress, this did not harm learning in either of the feedback conditions. These findings suggest that not all hippocampal-based learning types are negatively influenced by stress.

The effects of a humorous video on memory for orthodontic treatment consent information

INTRODUCTION

Communication of treatment information is critical in orthodontics. The challenge lies in doing so effectively such that patients will understand and remember, which is the definition of true informed consent. Previous studies have established that information is more readily remembered when presented using multimedia presentations. Likewise, humor has been shown to increase information retention.

METHODS

Two videos, 1 humorous (H) and 1 unhumorous (U), were produced with identical information about orthodontic treatment consent. Thirty-eight new orthodontic patients were randomly selected and divided into H (n = 20) and U (n = 18) video groups. Identical questionnaires with multiple-choice responses to judge memory of the content were completed by both groups immediately after watching the video (T1) and 6 weeks later (T2). A one-tailed Welch's t test was used to analyze the scores.

RESULTS

At T1, there was no significant difference in the scores of the questionnaire between H and U groups, whereas at T2, there was a significant difference between groups. The intragroup score difference was also analyzed, with a significant decrease from T1 to T2 in the U, but not H, group. Subjective questions were also asked regarding content. No significant differences were found between the groups regarding the informativeness of each video; however, willingness to watch again and memorability of the content were significantly higher in the H group.

CONCLUSIONS

Patients who received orthodontic treatment information presented with humor retained significantly more of that information after 6 weeks compared with patients who received the same information without humor. Patients who received the humorous content subjectively stated they were more likely to rewatch the video and also found the information presented in this manner to be more memorable.

Do cognitive aids reduce error rates in resuscitation team performance? Trial of emergency medicine protocols in simulation training (TEMPIST) in Australia

BACKGROUND

Resuscitation of patients with time-critical and life-threatening illness represents a cognitive challenge for emergency room (ER) clinicians. We designed a cognitive aid, the Emergency Protocols Handbook, to simplify clinical management and team processes. Resuscitation guidelines were reformatted into simple, single step-by-step pathways. This Australian randomised controlled trial tested the effectiveness of this cognitive aid in a simulated ER environment by observing team error rates when current resuscitation guidelines were followed, with and without the handbook.

METHODS

Resuscitation teams were randomised to manage two scenarios with the handbook and two without in a high-fidelity simulation centre. Each scenario was video-recorded. The primary outcome measure was error rates (the number of errors made out of 15 key tasks per scenario). Key tasks varied by scenario. Each team completed four scenarios and was measured on 60 key tasks. Participants were surveyed regarding their perception of the usefulness of the handbook.

RESULTS

Twenty-one groups performed 84 ER crisis simulations. The unadjusted error rate in the handbook group was 18.8% (121/645) versus 38.9% (239/615) in the non-handbook group. There was a statistically significant reduction of 54.0% (95% CI 49.9-57.9) in the estimated percentage error rate when the handbook was available across all scenarios 17.9% (95% CI 14.4-22.0%) versus 38.9% (95% CI 34.2-43.9%). Almost all (97%) participants said they would want to use this cognitive aid during a real medical crisis situation.

CONCLUSION

This trial showed that by following the step-by-step, linear pathways in the handbook, clinicians more than halved their teams' rate of error, across four simulated medical crises. The handbook improves team performance and enables healthcare teams to reduce clinical error rates and thus reduce harm for patients.

TRIAL REGISTRATION

ACTRN12616001456448 registered: www.anzctr.org.au. Trial site: http://emergencyprotocols.org.au/.

Cognitive Performance and Psychological Distress in Breast Cancer Patients at Disease Onset

Objective

Many cancer patients complain about cognitive dysfunction. While cognitive deficits have been attributed to the side effects of chemotherapy, there is evidence for impairment at disease onset, prior to cancer-directed therapy. Further debated issues concern the relationship between self-reported complaints and objective test performance and the role of psychological distress.

Method

We assessed performance on neuropsychological tests of attention and memory and obtained estimates of subjective distress and quality of life in 27 breast cancer patients and 20 healthy controls. Testing in patients took place shortly after the initial diagnosis, but prior to subsequent therapy.

Results

While patients showed elevated distress, cognitive performance differed on a few subtests only. Patients showed slower processing speed and poorer verbal memory than controls. Objective and self-reported cognitive function were unrelated, and psychological distress correlated more strongly with subjective complaints than with neuropsychological test performance.

Conclusion

This study provides further evidence of limited cognitive deficits in cancer patients prior to the onset of adjuvant therapy. Self-reported cognitive deficits seem more closely related to psychological distress than to objective test performance.

It feels real: physiological responses to a stressful virtual reality environment and its impact on working memory

BACKGROUND

Virtual reality (VR) is increasingly used to study and treat psychiatric disorders. Its fidelity depends in part on the extent to which the VR environment provides a convincing simulation, for example whether a putatively stressful VR situation actually produces a stress response.

METHODS

We studied the stress response in 28 healthy men exposed either to a stressor VR elevator (which simulated travelling up the outside of a tall building and culminated in the participant being asked to step off the elevator platform), or to a control elevator. We measured psychological and physiological (salivary cortisol and alpha-amylase, blood pressure, pulse, skin conductance) stress indices. We also measured subsequent performance on the N-back task because acute stress has been reported to impact on working memory.

RESULTS

Compared to participants in the control elevator, those in the external elevator had increases in skin conductance, pulse and subjective stress and anxiety ratings, altered heart rate variability, and a delayed rise in cortisol. N-back performance was unaffected.

CONCLUSIONS

A putatively stressful VR elevator produces a physiological as well as a psychological stress response, supporting its use in the investigation and treatment of stress-related disorders, and its potential value as an experimental laboratory stressor.

Acute psychosocial stress and working memory performance: the potential of physical activity to modulate cognitive functions in children

Background

Research suggests that physical activity (PA) enhances cognitive performance and prevents stress-related impairments of higher order cognitive functions like working memory (WM) performance. The aim of the current study was to investigate the effect of PA on WM performance after acute stress exposure in preadolescent children.

Methods

Regular PA was assessed for seven consecutive days during a typical school week using accelerometers in a sample of 44 preadolescent children (14 girls, M_age = 11.29 years, SD_age = 0.67). Following this period, participants performed an automated operational span (OSPAN) task immediately after being exposed to the Trier Social Stress Test for Children (TSST-C).

Results

Children exhibited prototypical response slopes in salivary cortisol and salivary α-amylase as markers of the endocrine and autonomic stress response immediately after psychosocial stress induction. A subsequent two-way ANOVA comparing high- and low-stress responders revealed a significant interaction between group affiliation and PA level on WM performance for both stress markers. Interestingly, best WM performance was demonstrated in children showing both high PA levels and high cortisol (or low α-amylase, respectively) stress responses.

Conclusions

Though patterns differed for salivary cortisol and salivary α-amylase, overall findings suggest that PA buffers the negative effects of stress on cognitive performance in children.

Discomfort glare and psychological stress during computer work: subjective responses and associations between neck pain and trapezius muscle blood flow

PURPOSE

Exposure to additional environmental stress during computer work, such as visual and psychological demands, is associated with increased eye and neck discomfort, altered moods, and reduced well-being. The aim of this study is to elucidate further how subjective responses in healthy, young females with normal binocular vision are affected by glare and psychological stress during computer work, and to investigate possible associations between trapezius muscle blood flow and neck pain development.

METHODS

43 females participated in a laboratory experiment with a within-subject design. Four 10-min computer work conditions with exposure to different stressors were performed at an ergonomically optimal workstation, under the following series of conditions: no additional stress, visual stress (induced as direct glare from a large glare source), psychological stress, and combined visual and psychological stress. Before and immediately after each computer work condition, questionnaires regarding different visual and eye symptoms, neck and shoulder symptoms, positive and negative state moods, perceived task difficulty, and perceived ambient lighting were completed. Associations between neck pain and trapezius muscle blood flow were also investigated.

RESULTS

Exposure to direct glare induced greater development of visual/eye symptoms and discomfort, while psychological stress exposure made participants feel more negative and stressed. The perception of work lighting during glare exposure was closely related to perceived stress, and associations between visual discomfort and eyestrain, and neck pain were observed in all conditions. Furthermore, participants with high trapezius muscle blood flow overall reported more neck pain, independent of exposure.

CONCLUSIONS

Exposure to visual and psychological stresses during computer work affects the development of symptoms and negative moods in healthy, young females with normal binocular vision, but in different ways. The results also demonstrate the complex interactions involved in symptom development and lighting appraisal during computer work. When optimizing computer workstations, the complexity of the field must be taken into account, and several factors, including visual conditions, must be considered carefully.

Association of Racial Bias With Burnout Among Resident Physicians

Importance

Burnout, a syndrome characterized by emotional exhaustion, depersonalization, and a decreased sense of efficacy, is common among resident physicians, and negative emotional states may increase the expression of prejudices, which are associated with racial disparities in health care. Whether racial bias varies by symptoms of burnout among resident physicians is unknown.

Objective

To assess the association between burnout and explicit and implicit racial biases toward black people in resident physicians.

Design, Setting, and Participants

This cohort study obtained data from surveys completed by first-year medical students and resident physicians in the United States as part of the Cognitive Habits and Growth Evaluation Study. Participants were followed up from enrollment in 2010 to 2011 through 2017. Participants completed questionnaires at year 4 of medical school as well as at the second and third years of residency. Only data from resident physicians who self-identified as belonging to a racial group other than black (n = 3392) were included in the analyses because of scarce evidence of racial bias in the care provided to black patients by black physicians. Resident physicians training in radiology or pathology were excluded because they provided less direct patient interaction.

Main Outcomes and Measures

Burnout symptoms were measured by 2 single-item measures from the Maslach Burnout Inventory. Explicit attitudes about white and black people were measured by a feeling thermometer (FT, from 0 to 100 points, ranging from very cold or unfavorable [lowest score] to very warm or favorable [highest score]; included in the second-year [R2] and third-year [R3] questionnaires). The R2 Questionnaire included a racial Implicit Association Test (IAT; range: -2 to 2).

Results

Among the 3392 nonblack resident physician respondents, 1693 (49.9%) were male, 1964 (57.9%) were younger than 30 years, and 2362 (69.6%) self-identified as belonging to the white race. In this cohort, 1529 of 3380 resident physicians (45.2%) had symptoms of burnout and 1394 of 3377 resident physicians (41.3%) had depression. From this group, 12 did not complete the burnout items and 15 did not complete the Patient-Reported Outcomes Measurement Information System (PROMIS) items. The mean (SD) FT score toward black people was 77.9 (21.0) and toward white people was 81.1 (20.1), and the mean (SD) racial IAT score was 0.4 (0.4). Burnout at the R2 Questionnaire time point was associated with greater explicit and implicit racial biases. In multivariable analyses adjusting for demographics, specialty, depression, and FT scores toward white people, resident physicians with burnout had greater explicit racial bias (difference in FT score, -2.40; 95% CI, -3.42 to -1.37; P < .001) and implicit racial bias (difference in IAT score, 0.05; 95% CI, 0.02-0.08; P = .002). A dose-response association was found between change in depersonalization from R2 to R3 Questionnaire and R3 Questionnaire explicit bias (for each 1-point increase the difference in R3 FT score decreased, -0.73; 95% CI, -1.23 to -0.23; P = .004) and change in explicit bias.

Conclusions and Relevance

Among resident physicians, symptoms of burnout appeared to be associated with greater explicit and implicit racial biases; given the high prevalence of burnout and the negative implications of bias for medical care, symptoms of burnout may be factors in racial disparities in health care.

The serotonin transporter gene variants modulate acute stress-induced hippocampus and dorsomedial prefrontal cortex activity during memory retrieval

The short (s) allele of a polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) is related to reduced serotonin transporter efficiency and an increased vulnerability to stress and mental disorders. In the present study, we investigated how 5-HTTLPR impacts on memory retrieval under stress and related neural activity by reanalyzing a small genetic neuroimaging data set. Twenty-seven healthy male volunteers participated in both the Trier Social Stress Test (TSST) and a respective control procedure and then their brain activity was measured with functional MRI (fMRI) while they performed an emotional-face-recognition task. Sixteen participants were carriers of the short allele (ss/sl carriers) and 11 were homozygous for the long allele (ll carriers). Genotype groups were compared with respect to stress-related physiological changes, memory performance, and brain activity. No significant genotype-dependent effects on memory performance or cortisol levels were found. The ss/sl carriers showed significantly higher systolic and diastolic blood pressure than the ll carriers, independent of stress. The ss/sl carriers reported stronger stress-induced nervous mood than the ll carriers. Our fMRI data revealed that the ss/sl carriers showed significantly weaker left hippocampus activation and stronger dorsomedial prefrontal cortex (dmPFC) deactivation when retrieving memories under stress as compared with the ll carriers. Subsequent analyses revealed that the distinct hippocampal activation pattern in both genotypes was associated with stress-induced cortisol elevation, while the distinct dmPFC activation pattern in both genotypes was associated with stress-induced changes in reaction times. Our results thus add new evidence that serotonin signaling modulates neural activity in the hippocampus and dmPFC during memory retrieval under acute psychosocial stress.

Memories of and influenced by the Trier Social Stress Test

Psychosocial stress influences cognition, affect and behavior. This current review summarizes the impact of acute stress on human long-term memory taking a neuroendocrine perspective. In this respect the stress associated increase in activity of the sympathetic nervous system (SNS) and the hypothalamus-pituitary-adrenal (HPA) axis are key. A special focus will be placed on findings obtained with the Trier Social Stress Test (TSST). This paradigm can be used to induce stress before or after a memory task. It was shown repeatedly that stress enhances long-term consolidation but impairs long term memory retrieval. However the TSST can also be used to assess memories of this stressful episode itself. The latter requires a standardized presentation of relevant stimuli during the TSST as well as a carefully designed control condition. Moreover special care has to be taken to control potential influences on visual exploration and working memory in order to correctly interpret observed effects on memory. The results obtained so far fit to the idea of enhanced encoding of salient information under stress. These findings are of relevance for educational, organizational and clinical applications.

Negative Mental States and Their Association to the Cognitive Function of Nurses

Abstract. Nurses’ inherently stressful occupation leaves them at a higher risk of developing negative mental states (stress, anxiety, and depression). However, research examining the effect of negative mental states on these health professionals’ cognitive performance is sparse. Thus, the present study aimed to assess the link between negative mental states and cognitive performance in nurses ( n = 53). Negative mental state data was obtained using the Depression Anxiety Stress Scale, brain activity was measured using electroencephalography, and finally, cognitive performance was assessed using the Cognistat and the Mini-Mental State Examination. Significant negative correlations ( p < .05) were observed between anxiety and attention, and all three negative mental states and memory performance. Electroencephalographic changes indicated that increases in anxiety were significantly associated ( p < .05) with decreases in gamma reactivity at fronto-central sites. The current study suggests that higher levels of negative mental states are associated with domain-specific cognitive impairments, and variations in gamma reactivity; possibly reflecting less optimal cortical functioning.

Memory, stress, and the hippocampal hypothesis: Firefighters' recollections of the fireground

Nadel, Jacobs, and colleagues have postulated that human memory under conditions of extremely high stress is "special." In particular, episodic memories are thought to be susceptible to impairment, and possibly fragmentation, attributable to hormonally based dysfunction occurring selectively in the hippocampal system. While memory for highly salient and self-relevant events should be better than the memory for less central events, an overall nonmonotonic decrease in spatio/temporal episodic memory as stress approaches traumatic levels is posited. Testing human memory at extremely high levels of stress, however, is difficult and reports are rare. Firefighting is the most stressful civilian occupation in our society. In the present study, we asked New York City firefighters to recall everything that they could upon returning from fires they had just fought. Communications during all fires were recorded, allowing verification of actual events. Our results confirmed that recall was, indeed, impaired with increasing stress. A nonmonotonic relation was observed consistent with the posited inverted u-shaped memory-stress function. Central details about emergency situations were better recalled than were more schematic events, but both kinds of events showed the memory decrement with high stress. There was no evidence of fragmentation. Self-relevant events were recalled nearly five times better than events that were not self-relevant. These results provide confirmation that memories encoded under conditions of extremely high stress are, indeed, special and are impaired in a manner that is consistent with the Nadel/Jacobs hippocampal hypothesis.

An oral presentation causes stress and memory impairments

Laboratory experiments revealed the stress hormone cortisol to decrease memory retrieval of emotional material, but a translation to real-life settings is missing so far. In this study, 51 students encoded a list of neutral, positive, and negative words as well as two neutral, biographical notes one day before attendance at a seminar at the university. In the stress condition, students gave a graded oral presentation, whereas they just attended the same seminar in the control condition immediately before retrieval took place. Measures of state anxiety, salivary cortisol and alpha-amylase confirmed the oral presentation to constitute a potent stressor. Importantly, stress significantly impaired retrieval of negative words, but not retrieval of the biographical notes. These results indicate that a real-life stressor decreases memory retrieval for negative items. In contrast, delayed memory retrieval of neutral information and interrelated details of biographical notes seems to be less prone to stress effects. These results have critical implications for educational settings.

Immediate pre-learning stress enhances baseline startle response and fear acquisition in a fear-potentiated startle paradigm

Extensive work has shown that stress time-dependently influences hippocampus-dependent learning and memory. In particular, stress that is administered immediately before learning enhances long-term memory, while stress that is temporally separated from learning impairs long-term memory. We have extended these findings by examining the impact of immediate, pre-learning stress on an amygdala-dependent fear conditioning task. One hundred and forty-one healthy participants underwent a stress (socially evaluated cold pressor test) or control manipulation immediately before completing differential fear conditioning in a fear-potentiated startle paradigm. Participants then completed extinction and extinction memory testing sessions 24 and 48 h later, respectively. Stress administered immediately before acquisition increased baseline startle responses and enhanced fear learning, as evidenced by greater fear-potentiated startle to the CS + . Although no group differences were observed during extinction training on Day 2, stressed participants exhibited evidence of impaired extinction processes on Day 3, an effect that was driven by group differences in acquisition. Importantly, stressed participants' cortisol responses to the stressor on Day 1 were positively associated with CS discrimination on Days 2 and 3. These findings suggest that stress immediately before fear conditioning strengthens fear memory formation and produces a more enduring fear memory, perhaps via corticosteroid activity. Such a paradigm could be useful for understanding factors that influence traumatic memory formation.

Physical Activity versus Psychological Stress: Effects on Salivary Cortisol and Working Memory Performance

Background and Objective: The present study was designed to investigate whether acute physical activity and psychological stress produce different effects on cortisol release and working memory performance. Materials and Methods: Male subjects (N = 12; 18–35 years) were recruited and scheduled to come four times to our lab (within-subject design). For each counterbalanced visit, they performed one of the following four protocols: control, moderate physical activity (MOD), vigorous physical activity (VIG), and acute stress. Heart rate was monitored during every protocol. MOD and VIG were performed for 15 min and were defined as 40–50% and 70–80%, respectively, of their maximum heart rate. Acute stress was imposed via the Trier Social Stress Test (TSST). Salivary samples were collected before and after every protocol to assess cortisol concentrations. Working memory (WM) performance was evaluated through the 2N-Back task right after ending the protocol (early WM) and after a delay of 35 min (late WM). Results: VIG and stress, but not MOD, increased salivary cortisol concentrations. However, the increases of cortisol produced by VIG and stress were not significantly different. Also, there were no significant differences in working memory performance (late and early) in any of the experimental protocols tested. Conclusions: These results show that exercise (VIG) and stress produce similar effects on cortisol release and do not support the hypothesis that working memory capacity is influenced by elevated cortisol levels, either from varying exercise intensities or psychological stress.

Does Emotional Intelligence Buffer the Effects of Acute Stress? A Systematic Review

People with higher levels of emotional intelligence (EI: adaptive emotional traits, skills, and abilities) typically achieve more positive life outcomes, such as psychological wellbeing, educational attainment, and job-related success. Although the underpinning mechanisms linking EI with those outcomes are largely unknown, it has been suggested that EI may work as a "stress buffer." Theoretically, when faced with a stressful situation, emotionally intelligent individuals should show a more adaptive response than those with low EI, such as reduced reactivity (less mood deterioration, less physiological arousal), and faster recovery once the threat has passed. A growing number of studies have begun to investigate that hypothesis in respect to EI measured as both an ability (AEI) and trait (TEI), but results are unclear. To test the "stress-buffering" function of EI, we systematically reviewed experimental studies that explored the relationship between both types of EI and acute stress reactivity or recovery. By searching four databases, we identified 45 eligible studies. Results indicated that EI was only adaptive in certain contexts, and that findings differed according to stressor type, and how EI was measured. In terms of stress reactivity, TEI related to less mood deterioration during sports-based stressors (e.g., competitions), physical discomfort (e.g., dental procedure), and cognitive stressors (e.g., memory tasks), but did not appear as helpful in other contexts (e.g., public speaking). Furthermore, effects of TEI on physiological stress responses, such as heart rate, were inconsistent. Effects of AEI on subjective and objective stress reactivity were often non-significant, with high levels detrimental in some cases. However, data suggest that both higher AEI and TEI relate to faster recovery from acute stress. In conclusion, results provide mixed support for the stress-buffering effect of EI. Limitations and quality of studies are also discussed. Findings could have implications for EI training programmes.

Retention of a standard operating procedure under the influence of social stress and refresher training in a simulated process control task

In a simulated process control task, we investigated the effects of refresher training and acute social stress on performing a standard operating procedure (SOP) containing a production and monitoring task and knowledge recall after a retention interval of two weeks. In a 2 × 2 between-group design (Factor 1: induced social stress, Factor 2: refresher training), 76 engineering students performed an SOP at t1 in week 1 and at t2 in week 3. A MANOVA in week three (t2) indicated a main effect of the refresher training for the SOP execution containing a production and a monitoring task and an impairing effect of stress on the monitoring task. That means that after a retention interval, stress mainly affects the SOP's monitoring task. An additional correlational analysis showed that knowledge test performance is negatively associated with cortisol level and that retentivity is a strong predictor for knowledge test performance and production task performance, too. Practitioner Summary: We investigated effects of social stress and refresher training on performing a standard operating procedure (SOP) after a retention interval of two weeks. The impact of social stress reduced the monitoring task performance as part of the SOP, but not the production outcome. Without refresher training, performance is significantly worse. Abbreviation: SOP: Standard Operating Procedure; MANOVA: Multivariate Analysis of Variance; CSB: Chemical Safety and Hazard Investigation Board; TSST: Trierer Social Stress Test; P-TSST: Placebo Trierer Social Stress Test; WaTrSim: Water Treatment Simulation; HPA axis: hypothalamic pituitary adrenal axis; WIT-2: Wilde Intelligenztest - 2; SPSS: Statistical Package for the Social Sciences; ANOVA: Analysis of Variance.

Unpacking the Literature on Stress and Resiliency: A Narrative Review Focused on Learners in the Operating Room

PURPOSE

The operating room is a high pressure environment for surgical trainees as they attempt to reach a high level of performance in the midst of a multitude of stressors. The purpose of this work was to examine the relationships between stress, coping, and psychological resilience and their effects on performance and learning in surgical training.

METHODS

A narrative review was carried out of the existing literature on stress, coping, and resilience in surgeons and surgical trainees. Multiple fields of study were examined including medical education, surgery, surgical safety, anesthesia, workplace ergonomics, and psychology.

RESULTS

Sources of intraoperative stress include fatigue, disruptions, interpersonal conflicts, time pressure, a complex case or high risk patient, surgical errors, and surgeon temperament. These stressors can negatively impact the performance of surgeons and trainees and may inhibit learning. How a learner responds to stress in the operating room is highly variable and influenced by the context of the stress, the coping mechanisms available, and individual psychological resilience. Stress management techniques, such as mental rehearsal, are beneficial for reducing stress. Resilience is protective against stress and burnout, and resilience training is useful for reducing stress and improving mental health in physicians and medical students.

CONCLUSIONS

Surgical trainees experience significant stress in the operating room and their experience of stress is modulated by cognitive and behavioral factors. Further research is required on the development of effective interventions to help trainees manage intraoperative stress, with the potential to improve surgical performance, learning, and patient safety.

Digging deeper in the differential effects of inflammatory and psychosocial stressors in remitted depression: Effects on cognitive functioning

BACKGROUND

Major Depressive Disorder (MDD) covers a wide spectrum of symptoms, including cognitive dysfunction, which can persist during remission. Both inflammatory states and psychosocial stress play a role in MDD pathogenesis.

METHODS

The effects of inflammatory (i.e., Salmonella typhi vaccine) and psychosocial stressor (i.e., Trier Social Stress Test), as well as their combination were investigated on cognition in women (aged 25-45 years, n = 21) with (partially) remitted MDD and healthy controls (n = 18) in a single-blind placebo-controlled study. In a crossover design, patients received on the first day one of the aforementioned interventions and on the other day a placebo, or vice versa, with a washout period of 7-14 days. Short-term and verbal memory, working memory, attention, verbal fluency, information processing speed, psychomotor function, and measures of attentional bias to emotions were measured. Exploratory analyses were performed to assess the correlation between biomarkers of inflammation and the Hypothalamic-Pituitary-Adrenal axis and cognitive functioning.

RESULTS

In patients, inflammatory stress decreased information processing speed and verbal memory, and increased working memory; after psychosocial stress, there was an increase in attention. There was also an increased negative attentional bias in patients after inflammatory stress. Neither stressor had any effect in controls.

LIMITIATIONS

Limitations are the relatively small sample size and antidepressant use by a part of the participants. The effects of the stressors were also measured a relatively short period after administration.

CONCULSION

Patients were sensitive to the cognitive effects of inflammation and psychosocial stress on cognition, while controls were not.

Acute Stress Facilitates LTD Induction at Glutamatergic Synapses in the Hippocampal CA1 Region by Activating μ-Opioid Receptors on GABAergic Neurons

Acute stress impairs recall memory through the facilitation of long-term depression (LTD) of hippocampal synaptic transmission. The endogenous opioid system (EOS) plays essential roles in stress-related emotional and physiological responses. Specifically, behavioral studies have shown that the impairment of memory retrieval induced by stressful events involves the activation of opioid receptors. However, it is unclear whether signaling mediated by μ-opioid receptors (μRs), one of the three major opioid receptors, participates in acute stress-related hippocampal LTD facilitation. Here, we examined the effects of a single elevated platform (EP) stress exposure on excitatory synaptic transmission and plasticity at the Schaffer collateral-commissural (SC) to CA1 synapses by recording electrically evoked field excitatory postsynaptic potentials and population spikes of hippocampal pyramidal neurons in anesthetized adult mice. EP stress exposure attenuated GABAergic feedforward and feedback inhibition of CA1 pyramidal neurons and facilitated low-frequency stimulation (LFS)-induced long-term depression (LTD) at SC-CA1 glutamatergic synapses. These effects were reproduced by exogenously activating μRs in unstressed mice. The specific deletion of μRs on GABAergic neurons (μR_GABA) not only prevented the EP stress-induced memory impairment but also reversed the EP stress-induced attenuation of GABAergic inhibition and facilitation of LFS-LTD. Our results suggest that acute stress endogenously activates μR_GABA to attenuate hippocampal GABAergic signaling, thereby facilitating LTD induction at excitatory synapses and eliciting memory impairments.

I'm going to fail! Acute cognitive performance anxiety increases threat-interference and impairs WM performance

Stress can impair cognitive performance, as commonly observed in cognitive performance anxiety (CPA; e.g., test anxiety). Cognitive theories indicate that stress impairs performance by increasing attention to negative thoughts, a phenomenon also known as threat-interference. These theories are mainly supported by findings related to self-report measures of threat-interference or trait anxiety. Our main aim was to test, for the first time in a single study, the hypotheses that acute CPA-related stress negatively affects both working memory (WM) performance and objectively assessed threat-interference during performance. In addition, we aimed to assess the validity of a new stress-induction procedure that was developed to induce acute CPA. Eighty-six females were randomly assigned to a CPA-related stress group (n = 45) or a control group. WM performance and threat-interference were assessed with an n-back task (2-back and 3-back memory loads), using CPA-related words as distracters. The stress group showed higher state anxiety and slower WM performance. Both effects were moderated by trait CPA: the effects were stronger for individuals with higher trait CPA. Finally, trait CPA moderated the effect of stress on threat-interference during higher cognitive load: individuals with higher trait CPA in the stress group showed higher threat-interference. We conclude that acute CPA increases threat-interference and impairs WM performance, especially in vulnerable individuals. The role of threat-interference, cognitive load, and trait anxiety should be taken into account in future research. Finally, our method (combining our stressor and modified n-back task) is effective for studying stress-cognition interactions in CPA.

Psychophysiological stress response and memory in borderline personality disorder

Background: Previously, we found that patients with borderline personality disorder (BPD) but not healthy controls (HC) showed improved memory retrieval after hydrocortisone administration. Objective: In this study, we examined whether increases in endogenous cortisol after psychosocial stress are associated with memory function in patients with BPD and in healthy individuals. Methods: We recruited 49 female patients with BPD and 49 female HC. All participants were exposed to a psychosocial stressor, the Trier Social Stress Test (TSST) and a control condition (Placebo (P-)TSST) in randomized order. Salivary cortisol, alpha amylase (sAA) and blood pressure were measured in response to stress. Subsequently, we examined free recall of a previously learned word list, autobiographical memory, and working memory. Results: We found a stress*time*group interaction effect for the cortisol response and for sAA to stress, which is mainly triggered by a slightly different increase in cortisol between groups from pre to post TSST. Furthermore, BPD patients showed a less pronounced increase in diastolic blood pressure compared to HC after stress. There was no effect of stress on memory performance in any tests, either in healthy controls or in patients with BPD. Conclusion: Our results suggest a slightly blunted response of the HPA axis and the sympathetic nervous system to stress in BPD compared to healthy women. In contrast to hydrocortisone administration, psychosocial stress did not improve memory retrieval in BPD patients. This might be explained by lower cortisol concentrations and parallel increases in norepinephrine and negative affect after stress.

Glucocorticoid-induced enhancement of extinction-from animal models to clinical trials

Extensive evidence from both animal model and human research indicates that glucocorticoid hormones are crucially involved in modulating memory performance. Glucocorticoids, which are released during stressful or emotionally arousing experiences, enhance the consolidation of new memories, including extinction memory, but reduce the retrieval of previously stored memories. These memory-modulating properties of glucocorticoids have recently received considerable interest for translational purposes because strong aversive memories lie at the core of several fear-related disorders, including post-traumatic stress disorder and phobias. Moreover, exposure-based psychological treatment of these disorders relies on successful fear extinction. In this review, we argue that glucocorticoid-based interventions facilitate fear extinction by reducing the retrieval of aversive memories and enhancing the consolidation of extinction memories. Several clinical trials have already indicated that glucocorticoids might be indeed helpful in the treatment of fear-related disorders.

Retrieval practice improves item memory but not source memory in the context of stress

Smith, Floerke, and Thomas (2016) demonstrated that learning by repeated testing, or retrieval practice, reduced stress-related memory impairment when compared to learning by repeatedly studying material. In the present experiment, we tested whether, relative to study practice, retrieval practice would improve post-stress memory by increasing access to both item and source information. Participants learned two wordlists, which were temporally segregated to facilitate distinction between the two lists. Participants returned one week later for stress induction and two memory tests. Each test featured a recognition test that was given to assess item memory accessibility, and a list-discrimination task that was given to assess source memory. Relative to study practice, successful retrieval practice during learning reduced false alarms but did not improve source memory on the post-stress test. Results are discussed as they relate to current theories surrounding stress effects and retrieval practice effects.