Effectiveness of defenses: a significant predictor of cortisol excretion under stress

Psychological coping styles and cortisol over the day in healthy older adults

Patterns of psychological coping are associated with a variety of health outcomes but the underlying pathways are not yet established. The purpose of this study was to assess the relationship between salivary cortisol output over the course of a day and coping style. Data were available from 350 men and 192 women with an average age of 60.9 years. Participants were drawn from the Whitehall II cohort, and had no history of cardiovascular disease. Individuals who were taking medication that might affect cortisol levels were also excluded. Saliva samples were provided on waking, then 0.5, 2.5, 8 and 12h after waking, and just before the participant went to sleep. Coping style was measured with a standard instrument, the COPE, and data were factor analysed to generate three factors: seeking social support, problem engagement and problem avoidance. The relationships between these factors and the cortisol awakening response (CAR), the slope of cortisol change over the day and total cortisol output over the day (excluding the waking period) were assessed using multiple linear regression. Cortisol output over the day was inversely associated with coping with stress by seeking social support (p=0.034) and by problem engagement (p=0.003), independently of age, gender, body mass index, smoking, depression, self-rated health, time of waking and income. Individuals who coped by problem engagement and seeking support had lower cortisol levels. Additionally, gender, BMI, smoking, self-rated health and time of waking were independently related to cortisol output over the day. There were no significant associations between coping and the CAR or cortisol slope over the day. The results indicate that adaptive coping styles are related to low levels of cortisol over the day, suggesting that neuroendocrine pathways may partly mediate relationships between psychological coping and health.

Emotional expression and diurnal cortisol slope in women with metastatic breast cancer in supportive-expressive group therapy: a preliminary study

We examined coded emotional expression during an initial therapy session and its association with a known physiological risk factor for early death, aberrant diurnal cortisol slope, in women with metastatic breast cancer. Out of 64 women with metastatic breast cancer randomized to a multi-site clinical intervention trial of supportive-expressive group therapy (SET), a subsample of 29 met eligibility criteria for this study. We tested whether longer mean durations of primary negative affect (fear, sadness, and anger) expression were associated with steeper diurnal cortisol slopes after adjusting for speaking time, repressive-defensiveness, anxiety, and the interaction between repressive-defensiveness and anxiety. We found that steeper cortisol slopes were related to lower repressive-defensiveness and greater primary negative affect expression in line with a priori hypotheses. Additionally we explored whether coded positive affect, defensive/hostile affect, constrained anger, and the interaction between primary negative affect and repressive-defensiveness explained additional variance in diurnal cortisol patterns.

Effects of appraisal and coping on the neuroendocrine response to extreme stress

Although many people are exposed to extreme stress, only some of them develop psychobiological disturbances that can lead to posttraumatic stress disorder (PTSD) or other posttrauma psychopathology. This paper examines the effects of different types of appraisal and coping to find clues to how individuals differ in their neuroendocrine responses to extreme stress. It proposes a conceptual model for components of the adult response to stressors. Threat appraisal and defensive coping may play crucial roles in determining the neuroendocrine response to trauma with potential mental health consequences, particularly PTSD.

Psychological stress and neuroendocrine function in humans: the last two decades of research

This paper reviews experimental contributions published in the last two decades and exploring the effect of emotional stress on neuroendocrine function in healthy humans. Laboratory studies allow standardization of the stressor and better control for known confounding factors. Commonly used stressors are mental arithmetics, speech tasks, the Stroop test, videogame playing, films or videotapes and interviews. Little is known about the generalizability of laboratory results, with some studies suggesting great caution in extrapolating data to real-life stress conditions. Another strategy is studying the psychoendocrine reaction to real-life stressors, such as bereavement or anticipated loss, academic examinations, everyday work and parachute jumping. The effects of different stressors on neuroendocrine axes are reviewed, as well as the influence of gender, age, personality, coping style, social support, biological and nonbiological interventions. The subjective perception of the situation is probably a main determinant of the psychoendocrine response pattern. In fact, marked variability in individual responses to a variety of stressors has frequently been observed. Evidently, the 'objective' characteristics of a given event are not the only determinants of reaction to the event itself. According to a constructivistic perspective, every given stressor has a strictly personal and idiosyncratic meaning and loses its 'objective' characteristics. Of course, biological factors may also play a part. In any case, it is mandatory to overcome a rigid dichotomy between psychological and biological processes. Dualistic conceptions which imply a determination of the physical by the psychological or vice versa should give place to a systemic conception, which implies mutual, circular interactions.

Physiological and emotional response to psychological stressors in psychiatric and psychosomatic disorders

Deviations from emotional and physiological homeostasis in humans occur under episodic, chronic, or traumatic stress experiences. These dysregulations can provoke emotional and physical disturbances that may result in stress-related psychiatric or psychosomatic disorders. This brief review discusses a variety of both naturally occurring and experimental stressors and the complexity of intervening variables on cardiovascular and hormonal dysregulations of the hypothalamic-pituitary-adrenal (HPA) axis. In addition to the type, intensity, and duration of the stressor, subject variables such as dispositional factors (e.g., age and sex), personality traits, and coping styles are considered. Finally, emotional and physiological stress responses to naturally occurring stressors and psychological challenge tests in depressed patients and anxiety disorder patients are presented and discussed. Stressors in humans induce emotional arousal, which leads to physiological activation of the central nervous system, an increase of hormones of the HPA axis, and coping reactions on the psychological and behavioral level. Depending on the type, intensity, and duration of the stressor, on personal and psychosocial resources of the individual, stressful situations may provoke emotional and physical disturbances. These dysfunctions may result in psychosomatic or psychiatric disorders. The following brief review intends to discuss a variety of stressors that have been examined in humans in order to gain insight into the complex relationship between physiological and behavioral stress reactions and the occurrence or maintenance of stress related psychosomatic and psychiatric disorders.

Social dynamics and the cortisol response to immobilization stress of the African wild dog, Lycaon pictus

The aims of the study were to characterize the cortisol response to immobilization stress in African wild dogs (Lycaon pictus) and to investigate the relationship between stress and sociality in these pack-living canids. Ad lib. observations were made on a captive pack of 19 wild dogs. Individuals were classified as either dominant or subordinate. Cardinal and ordinal dominance indices were also calculated for pack members, as were three other behavioral indices. Active and passive dominance styles were distinguished. Serial blood samples were drawn from animals after chemical immobilization and again after ACTH challenge. The relationship among rank, plasma cortisol concentration, and behavioral style was investigated. When data were combined over the entire study period, there was no obvious relationship between rank and cortisol concentrations or cortisol responsiveness to immobilization stress. Instead, younger animals had higher cortisol concentrations than older ones. Age cohorts were also clearly separated on the basis of behavioral profiles. For males, these distinctions among age classes were especially apparent during the second part of the study period, when subadults occupied dominant positions in the hierarchy. Adult males maintained relatively low cortisol concentrations, despite being involved in and losing a high proportion of dominance interactions. Age-related differences in cortisol profiles of dominant individuals may be explained by differences in the style of dominance employed, with younger males using proportionately more active dominance (threats used to elicit submission). The separation of age classes according to rank, behavioral styles, and cortisol concentrations may reflect improved social skillfulness with age.

Psychosocial vulnerability to stress: a study of HIV-positive homosexual men

Sixty-one homosexual men with HIV infection participated in a 12-month investigation into the role of stressful life events and mediating variables in the stress process. The results revealed that frequency of stressful life events and psychosocial resilience (a factor indexing levels of support, worry, personal self-esteem, and effective coping efforts) significantly predicted levels of emotional distress in this sample. The combined influence of these variables accounted for 53% (Phase 2) and 55% (Phase 3) of the variance in levels of emotional distress. The data point to a need to incorporate measures of life event frequency and several, rather than single, mediating variables in studies investigating the stress process.

Working with new technologies: hormone excretion as an indicator for sustained arousal. A pilot study

Effects of working with new technologies (visual display units) on hormone levels were investigated in a pilot study. The relationship between subjective strain and hormone levels was also assessed. Twenty subjects participated in the study reported here, which is a part of a comprehensive longitudinal study, in which 279 employees participated. Measurements were taken two months before the new technology was installed (baseline: work with conventional technology), during the implementation phase of the new technology, and at a 12-month interval. Fourteen complete data sets were analysed. The introduction of new technologies was accompanied by enhanced levels of catecholamines (epinephrine and norepinephrine). Levels also remained high one year after the implementation. Similar values were found on work days and rest days. Cortisol changes were less evident; excretion tended to increase after the implementation had been completed. The relationship was weak between hormone levels and subjective strain measurements. The results indicate that working with new technologies was accompanied by enhanced physiological arousal of the employee. Reactivity was related more to a particular occupational setting than to scales of subjective assessment.

Preoperative rehearsal of active coping imagery influences subjective and hormonal responses to abdominal surgery

Existing evidence suggests that preoperative psychological preparation that is designed to reduce anxiety may sensitize cortisol and adrenaline responses to surgery. In a controlled trial of abdominal surgery patients, we therefore tested the effects of a preoperative preparation that used guided imagery, not to reduce anxiety, but to increase patients' feelings of being able to cope with surgical stress; 26 imagery patients were compared with 25 controls who received, instead, background information about the hospital. State-anxiety was similar in each group, but imagery patients experienced less postoperative pain than did the controls, were less distressed by it, felt that they coped with it better, and requested less analgesia. Hormone levels measured in peripheral venous blood did not differ on the afternoon of admission, before preparation. Cortisol levels were, however, lower in imagery patients than in controls immediately before and after surgery. Noradrenaline levels were greater on these occasions in imagery patients than controls. The results are interpreted in relation to two theories. One states that preoperative "worry" reduces surgical stress. The other concerns the influence of active and passive coping on endocrine responses to stress.

Effect of war-induced prolonged stress on cortisol of persons with type II diabetes mellitus

The study was designed to assess the impact of protracted, war-induced stress on cortisol levels and glycemic control in persons with Type II diabetes mellitus. A randomly selected sample of 44 displaced Type II diabetic persons was compared with a group of diabetic persons matched for sex, age, weight, duration of diabetes, and type of treatment who had not been forced to leave their homes. The self-reported stress, depression level, serum cortisol, fasting blood glucose, and glycosylated hemoglobin were compared. The two groups were found to be significantly different in scores for self-reported stress and depression level. Passive coping patterns prevailed in the displaced group. The serum cortisol levels correlated positively with self-reported stress, negatively with active coping patterns, and were significantly higher in the displaced persons group. No significant differences were found between the group on the variables measuring glycemic control. The results indicate that prolonged stress need not worsen glycemic control in Type II diabetic patients.

Coping, ineffectiveness of coping and the psychoendocrinological stress responses during in-vitro fertilization

The psychoendocrinological stress responses during in-vitro fertilization (IVF) and embryo transfer (ET) were investigated in 40 women as a function of a 'coping-ineffectiveness of coping' construct. The results demonstrate an important dissociation between emotional and endocrine stress responses and the existence of relatively independent dimensions of arousal (emotional, prolactin, cortisol). The emotional stress response, i.e. state anxiety levels, are for 34-59% predicted by chronic ineffectiveness of coping, and this both before (anticipation) and after (recovery) the stress of oocyte retrieval (OR) and embryo transfer. The effect of anticipatory stress, i.e. in the follicular phase and before oocyte retrieval or embryo transfer, on prolactin and cortisol release is more important in women with a high chronic ineffectiveness of coping while the effect of oocyte retrieval itself is more important in women who are effective copers. Other prolactin concentrations, i.e. after OR or ET, are for 14-26% predicted by low palliative coping and high avoiding. Other cortisol concentrations, i.e. after OR or ET, are for 13-19% predicted by comforting ideas. The advantages of this 'coping-ineffectiveness of coping' construct are weighed against the 'effectiveness of defenses' construct described by Wolff et al. Psychosom Med 1964; 26: 406-413. It is suggested that these personality dependent stress responses are important for conception rates in spontaneous cycles as well as in stimulated cycles.

Coping style, trait anxiety and cortisol reactivity during mental stress

The present study examined whether salivary cortisol secretion as an index of stress reactivity to continuous mental task performance reflected individual differences in coping styles. During 4 hr of continuous mental tasks significantly higher cortisol levels were found in comparison with a control session. However, individual variability in the cortisol response was high. Correlational data indicate a significant negative relationship between the coping style 'comforting cognitions' and the individual cortisol response during mental stress. During this particular type of cognitive stress, where the subject has no control over the experimental situation, comforting and emotion-focused coping may be effective because of the subject's efforts of trying to reframe the inevitable situation in a positive and self-encouraging way. In contrast, there was no significant relationship between trait anxiety and individual glucocorticoid susceptibility to mental stress.