Momentary emotions and salivary cortisol: A systematic review and meta-analysis of ecological momentary assessment studies

When virtual reality becomes psychoneuroendocrine reality: A stress(or) review

This review article was awarded the Dirk Hellhammer award from ISPNE in 2023. It explores the dynamic relationship between stressors and stress from a historical view as well as a vision towards the future of stress research via virtual reality (VR). We introduce the concept of a "syncytium," a permeable boundary that blurs the distinction between stress and stressor, in order to understand why the field of stress biology continues to inadequately measure stress alone as a proxy for the force of external stressors. Using Virtual Reality (VR) as an illustrative example to explicate the black box of stressors, we examine the distinction between 'immersion' and 'presence' as analogous terms for stressor and stress, respectively. We argue that the conventional psychological approaches to stress measurement and appraisal theory unfortunately fall short in quantifying the force of the stressor, leading to reverse causality fallacies. Further, the concept of affordances is introduced as an ecological or holistic tool to measure and design a stressor's force, bridging the gap between the external environment and an individual's physiological response to stress. Affordances also serve to ameliorate shortcomings in stress appraisal by integrating ecological interdependencies. By combining VR and psychobiological measures, this paper aims to unravel the complexity of the stressor-stress syncytium, highlighting the necessity of assessing both the internal and external facets to gain a holistic understanding of stress physiology and shift away from reverse causality reasoning. We find that the utility of VR extends beyond presence to include affordance-based measures of immersion, which can effectively model stressor force. Future research should prioritize the development of tools that can measure both immersion and presence, thereby providing a more comprehensive understanding of how external stressors interact with individual psychological states.

"What's yours is mine": Partners' everyday emotional experiences and cortisol in older adult couples

The existing literature consistently finds that emotional experiences and cortisol secretion are linked at the within-person level. Further, relationship partners tend to covary in emotional experience, and in cortisol secretion. However, we are only beginning to understand whether and how an individuals' emotions are linked to their relationship partners' cortisol secretion. In this project, we harmonized data from three intensive measurement studies originating from Canada and Germany to investigate the daily dynamics of emotions and cortisol within 321 older adult couples (age range=56-87 years). Three-level multilevel models accounted for the nested structure of the data (repeated assessments within individuals within couples). Actor-Partner Interdependence Models were used to examine the effect of own emotional experiences (actor effects) and partner emotional experiences (partner effects) on momentary and daily cortisol secretion. Adjusting for age, sex, education, comorbidities, assay version, diurnal cortisol rhythm, time spent together, medication, and time-varying behaviors that may increase cortisol secretion, results suggest that higher relationship partner's positive emotions are linked with lower momentary cortisol and total daily cortisol. Further, this association was stronger for older participants and those who reported higher relationship satisfaction. We did not find within-couple links between negative emotions and cortisol. Overall, our results suggest that one's relationship partner's positive emotional experience may be a protective factor for their physiological responding, and that these more fleeting and day-to-day fluctuations may accumulate over time, contributing to overall relationship satisfaction.

Weight stigma as a stressor: A preliminary multi-wave, longitudinal study testing the biobehavioral pathways of the Cyclic Obesity/Weight-Based Stigma (COBWEBS) model

Higher weight individuals often face significant weight stigma. According to the Cyclic Obesity/Weight-Based Stigma (COBWEBS) model, weight stigma operates as a stressor that increases the stress hormone cortisol and promotes comfort eating, thus resulting in weight gain. Such weight gain is harmful as it exposes individuals to further stigmatization. Thus far, no study has yet tested the mechanistic pathways of the COBWEBS model and prospective longitudinal studies are severely lacking. To fill this gap, the current study tested the biobehavioral pathways of the COBWEBS model using a 4-wave yearlong longitudinal study comprising 348 higher weight individuals. Using a structural equation modeling framework, we tested three cross lagged panel models for the putative mediator, comfort eating. The models examined either synchronous and/or lagged effects across weight stigma, perceived stress, comfort eating, weight, and future weight stigma. The best fitting model revealed significant associations between baseline weight stigma, perceived stress, and comfort eating within the same month. However, comfort eating did not significantly predict weight four months later. Weight status and baseline weight stigma both predicted future weight stigma as expected. Additionally, a separate path model with hair cortisol found that weight stigma predicted perceived stress four months later, but stress did not predict aggregate cortisol levels from months 10 and 11. Hair cortisol also did not predict later weight. This preliminary work lays the foundation for identifying modifiable targets of weight stigma, thereby offering potential avenues to reduce weight stigma's harm on higher weight individuals.

Sex-related differences in young binge drinkers on the neurophysiological response to stress in virtual reality

Background

Stress is one of the main environmental factors involved in the onset of different psychopathologies. In youth, stressful life events can trigger inappropriate and health-damaging behaviors, such as binge drinking. This behavior, in turn, can lead to long-lasting changes in the neurophysiological response to stress and the development of psychological disorders late in life, e.g., alcohol use disorder. Our aim was to analyze the pattern of neurophysiological responses triggered with the exposition to a stressful virtual environment in young binge drinkers.

Methods

AUDIT-3 (third question from the full AUDIT) was used to detect binge drinking (BD) in our young sample (age 18-25 years). According to the score, participants were divided into control (CO) and BD group. Next, a standardized virtual reality (VR) scenario (Richie's Plank) was used for triggering the stress response while measuring the following neurophysiological variables: brain electrical activity by electroencephalogram (EEG) and cortisol levels through saliva samples both measurements registered before and after the stressful situation. Besides, heart rate (HR) with a pulsometer and electrodermal response (EDA) through electrodes placed on fingers were analyzed before, during and after the VR task.

Results

Regarding the behavior assessed during the VR task, BD group spent significantly less amount of time walking forward the table and a tendency toward more time walking backwards. There was no statistically significant difference between the BD and the CO group regarding time looking down, but when we controlled the variable sex, the BD women group displayed higher amount of time looking down than the rest of the groups. Neurophysiological measurements revealed that there was not any statistically significant difference between groups in any of the EEG registered measures, EDA response and cortisol levels. Sex-related differences were found in HR response to VR scenario, in which BD women displayed the highest peak of response to the stressor. Also, the change in heartbeat was higher in BD women than men.

Conclusion

Unveiling the neurophysiological alterations associated with BD can help us to prevent and detect early onset of alcohol use disorder. Also, from our data we conclude that participants' sex can modulate some stress responses, especially when unhealthy behaviors such as BD are present. Nevertheless, the moment of registration of the neurophysiological variables respect to the stressor seems to be a crucial variable.

Validity of mental and physical stress models

Different stress models are employed to enhance our understanding of the underlying mechanisms and explore potential interventions. However, the utility of these models remains a critical concern, as their validities may be limited by the complexity of stress processes. Literature review revealed that both mental and physical stress models possess reasonable construct and criterion validities, respectively reflected in psychometrically assessed stress ratings and in activation of the sympathoadrenal system and the hypothalamic-pituitary-adrenal axis. The findings are less robust, though, in the pharmacological perturbations' domain, including such agents as adenosine or dobutamine. Likewise, stress models' convergent- and discriminant validity vary depending on the stressors' nature. Stress models share similarities, but also have important differences regarding their validities. Specific traits defined by the nature of the stressor stimulus should be taken into consideration when selecting stress models. Doing so can personalize prevention and treatment of stress-related antecedents, its acute processing, and chronic sequelae. Further work is warranted to refine stress models' validity and customize them so they commensurate diverse populations and circumstances.

Using EMA to explore the role of Black adolescents' experiences in activity spaces in momentary negative emotion and marijuana use

Research examining the role of place in Black adolescents' health behaviors typically examines neighborhoods, with little attention paid to micro geographies such as activity spaces. Understanding experiences in activity spaces may be especially important for Black adolescents living in neighborhoods traditionally characterized as disadvantaged. The SPIN project recruited 75 Black adolescents living in a single neighborhood to complete ecological momentary assessments (EMA) about the activity spaces they encountered over a month. Perceptions of violence and social support in activity spaces in a day are related to marijuana use during the day, relationships partially explained by negative momentary emotions.

Monitoring Social Determinants of Health Assessing Patients and Communities

Because of the devastating health effects of social determinants of health (SDoH), it is important for the primary care provider to assess and monitor these types of stressors. This can be done via surveys, geomapping, or various biomarkers. To date, however, each of these methods is fraught with obstacles. There are currently are no validated "best" SDoH screening tools for use in clinical practice. Nor is geomapping, a perfect solution. Although mapping can collect location specific factors, it does not account for the fact that patients may live in one area, work in another and travel frequently to a third.

Temporal associations between salivary cortisol and emotions in clinically depressed individuals and matched controls: A dynamic time warp analysis

Depression can be understood as a complex dynamic system where depressive symptoms interact with one another. Cortisol is suggested to play a major role in the pathophysiology of depression, but knowledge on the temporal interplay between cortisol and depressive symptoms is scarce. We aimed to analyze the temporal connectivity between salivary cortisol and momentary affective states in depressed individuals and controls. Thirty pair-matched depressed and non-depressed participants completed questionnaires on momentary positive (PA) and negative (NA) affect and collected saliva three times a day for 30 days. The association between cortisol and affect was analyzed by dynamic time warp (DTW) analyses. These analyses involved lag-1 backward to lag-1 forward undirected analyses and lag-0 and lag-1 forward directed analyses. Large inter- and intra-individual variability in the networks were found. At the group level, with undirected analysis PA and NA were connected in the networks in depressed individuals and in controls. Directed analyses indicated that increases in cortisol preceded specific NA items in controls, but tended to follow upon specific affect items increase in depressed individuals. To conclude, at group level, changes in cortisol levels in individuals diagnosed with a depression may be a result of changes in affect, rather than a cause.

The feasibility of using ecological momentary assessment to understand urinary and fecal incontinence experiences in adults with spina bifida: A 30-day study

In this paper, we evaluate the feasibility of using ecological momentary assessment (EMA) to understand urinary (UI) and fecal (FI) incontinence in adults with spina bifida (SB). As part of a larger 30-day prospective study to understand the incontinence in adults with SB (N = 89), participants completed end-of-day EMA diaries assessing the frequency and context of UI and FI. We used these data to assess the method feasibility across six dimensions: (a) compliance, or data entry which is consistent with study protocol and substantially complete; (b) reactivity, or behavior change attributed to study participation; (c) participant acceptability, or convenience and ease of method beneficial to compliance; (d) data capture, or the volume of incontinence behaviors collected; (e) the accuracy of incontinence reports; and f) participant-provided feedback for future studies. Participants were highly compliant with diary entry protocol and schedule: submitting 95.7% (2576/2700) of the expected total daily entries. The average completion time was two minutes. Neither the total number of submissions nor the completion time varied by demographic characteristics or health history. A sufficient volume of incontinence and affective outcomes were captured, with small downtrends in reporting of UI and affect over time. Exit survey recall was highly correlated with diary reports. Participants found the methodology to be acceptable, reported their experiences honestly, enjoyed and felt comfortable participating in the study and would engage in similar study in the future. Accurate information about the daily context of UI and FI is a key factor in the success of intervention or education programs relying on this information. Our findings demonstrate that EMA is a feasible way to describe UI and FI in adults with SB.

Examination of the Relationship Between Daily Perceptions of Collective Efficacy and Marijuana Use Among Black Youth: Does the Location of the Perception Matters?

Neighborhood-level collective efficacy protects Black youth from substance use; however, neighborhood research does not account for the entirety of adolescents' exposure or their perceptions of space which may be critical to understanding the role of context in substance use. To address this limitation, the SPIN Project recruited 65 Black adolescents (M(SD) = 15.32(1.06)) to complete four brief surveys each day for a month describing their perceptions of spaces and marijuana use. Multilevel negative binomial models were estimated to test the relationship between an individual's perceptions of collective efficacy and the marijuana used during a day, and if the location of the observations moderated these relationships. Findings indicated that the perceptions of collective efficacy protected adolescents from marijuana use when occurring within their home neighborhood, but not outside of it; thereby suggesting important variations in adolescents' perceptions based on the location that matter for Black youth marijuana use.

Psychometric evaluation of an adapted version of the perceived stress scale for ecological momentary assessment research

Ecological momentary assessment (EMA) methodologies are commonly used to illuminate the predictors and impacts of experiencing subjective stress in the course of daily life. The validity of inferences from this research is contingent on the availability of measures of perceived momentary stress that can provide valid and reliable momentary stress scores. However, studies of the development and validation of such measures have been lacking. In this study, we use an EMA data collection design to examine the within- and between- person reliability and criterion validity and between-person gender measurement invariance of a brief EMA-adapted measure of a widely used trait measure of stress: the Perceived Stress Scale (PSS). Scores showed high internal consistency reliability and significant correlations with a range of criterion validity measures at both the within- and between-person level. Gender measurement invariance up to the scalar level also held for scores. Findings support the use of the EMA-adapted PSS presented in the current study for use in community-ascertained samples to address research questions relating to the influences on and effects of momentary stress and their gender differences.

Immersive virtual plus-maze to examine behavior and psychophysiological-related variables in young people with problematic alcohol and cannabis consumption

Stressful events appear to be risky situations that can precipitate the consumption of drugs. One way to recreate stressful contexts, in an ecological and controlled method, is through immersive virtual reality (VR). In our study, we designed the scenario of an elevated plus-maze (EPM) using VR, which is widely used in animal models to assess unconditioned anxiety. This task allowed us to analyze the behavioral, psychophysiological (heart rate and electrodermal activity), and hormonal response (salivary cortisol and Alpha-amylase) to this stressful situation in different moments (before VR task (anticipation), at the end of the task and 10 minutes later) in young people with problematic alcohol use (AU, n = 27), alcohol combined with cannabis consumption (AU + C, n = 10), as well as in a control group (CO, n = 33). Behavioral analysis revealed that the AU group displayed fewer entries into open arms than the CO group, whereas both experimental groups spent less time at the end of the open arms, as well as lower time by look down index compared to the CO group. Moreover, our VR EPM induced different psychophysiological responses in the different moments measured. In general, electrodermal activity seemed to be a good biomarker of recovery from a stressful situation, as once the exposure to the stressful situation ended, the AU + C group took longer to recover compared to the CO group. Regarding hormonal analyses, we observed a similar response pattern in all groups suggesting that our VR task was able to activate both stress systems. The alpha-amylase to cortisol ratio, proposed as a biomarker of stress systems dysregulation, was higher in the group of young participants with alcohol abuse. Interestingly, our VR EPM was able to induce a slight alcohol craving in both experimental groups. In conclusion, our results suggest certain subtle behavioral and physiological differences that could be used to detect young individuals at risk of future severe addictions or other stress-related comorbidities. Moreover, it could help us to develop prevention strategies focused on emotional, cognitive, and psychophysiological aspects.

Age Differences in Physiological Reactivity to Daily Emotional Experiences

How does physiological reactivity to emotional experiences change with age? Previous studies addressing this question have mostly been conducted in laboratory settings during which emotions are induced via pictures, films, or relived memories, raising external validity questions. In the present research, we draw upon two datasets collected using ecological momentary assessment methods (totaling 134,723 daily reports from 14,436 individuals) to examine age differences in heart rate (HR) and blood pressure (BP) reactivity to naturally occurring emotional experiences. We first examined how older and younger individuals differ in the prevalence of emotions varying in valence and arousal. On average, people reported experiencing positive emotions (high or low arousal) more than 70% of the time they were asked, and older (vs. younger) individuals tended to report positive emotions more frequently. In terms of physiological reactivity, we found that age was associated with reduced HR and BP reactivity. Some evidence was also found that the magnitude of such age differences may depend on the valence or arousal of the experienced emotion. The present findings have implications for understanding how emotions can contribute to physical health across the lifespan.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-023-00207-z.

Lifetime discrimination, habitual and daily everyday discrimination, and diurnal cortisol among older African Americans adults

Experiences of discrimination can be major life events or daily chronic hassles that occur in various social contexts (e.g., housing, education, employment) and have been found to predict adverse health outcomes, including dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. Previous work on daily cortisol dynamics has generally revealed an association between discrimination and flatter cortisol slopes, particularly among racial minorities. However, most of the existing studies have focused on youth and young adults, with little work among older adults. The current study aimed to investigate the relationship between three measures of discrimination (lifetime discrimination, habitual everyday discrimination, and daily everyday discrimination) and diurnal cortisol secretion in a sample of 203 older African Americans. Study results indicated that individuals reporting higher levels of lifetime discrimination experienced morning hypocortisolism and flatter diurnal cortisol slopes. Exploratory analyses also showed that prior daily everyday discrimination was significantly associated with blunted cortisol awakening response (CAR) the next day. Our findings underline the role of discrimination in modulating daily cortisol dynamics among older African American adults and advance knowledge on how social stressors influence healthy aging.

Greater Ecologically Assessed Positive Experiences Predict Heightened Sex Hormone Concentrations Across Two Weeks in Older Adults

OBJECTIVES

Sex hormones are important components of healthy aging, with beneficial effects on physical and mental health. Positive experiences such as elevated mood, lowered stress, and higher well-being also contribute to health outcomes and, in younger adults, may be associated with elevated sex hormone levels. However, little is known about the association between positive experiences and sex hormones in older adults.

METHODS

In this study, older men and women (N = 224, 70+ years of age) provided blood samples before and after a 2-week period of ecological momentary assessment (EMA) of positive and negative experiences (assessed based on self-reporting items related to affect, stress, and well-being). Concentrations of a panel of steroid sex hormones and glucocorticoids were determined in blood.

RESULTS

Higher levels of positive experiences reported in daily life across 2 weeks were associated with increases in free (biologically active) levels of testosterone (B = 0.353 [0.106, 0.601], t(221.3) = 2.801, p = .006), estradiol (B = 0.373 [0.097, 0.649], t(225.1) = 2.645, p = .009), and estrone (B = 0.468 [0.208, 0.727], t(224.3) = 3.535, p < .001) between the start and the end of the 2-week EMA period.

DISCUSSION

These findings suggest that sex hormones may be a pathway linking positive experiences to health in older adults.

Effect of Lacticaseibacillus paracasei N1115 on Immunomodulatory and Gut Microbial Composition in Young Children: A Randomized, Placebo-Controlled Study

Lactobacillus paracasei N1115 (Lp N1115) was isolated from fermented milk products. The administration of Lp N1115 is safe and well tolerated in Chinese children, but its effectiveness among young Chinese children is still unclear. To investigate the efficacy of Lp N1115 as a probiotic to enhance gut development in Chinese infants and toddlers born by cesarean section, 109 healthy and cesarean-delivered infants aged 6-24 months were recruited for a 12-week randomized, placebo-controlled trial, with 101 finally completing the study. Saliva and stool samples were collected and detected at weeks 0, 4, 8, and 12 of the intervention. Statistical analyses were performed by using a per-protocol (PP) approach. After 12 weeks of intervention, the fecal pH in the control group increased (p = 0.003), while the fecal pH in the experimental group did not change. Salivary cortisol decreased from baseline in the experimental group (p = 0.023), while the control group showed little change. In addition, Lp N1115 increased the fecal sIgA content of infants aged 6-12 months (p = 0.044) but had no obvious effect on fecal calprotectin and saliva sIgA. At week 4, the increase in Lactobacillus relative to baseline was higher in the experimental group than in the control group (p = 0.019). Further analysis showed a trend toward a higher detection rate of Lactobacillus in the experimental group than in the control group (p = 0.039). In conclusion, Lp N1115 was able to enhance the content of Lactobacillus and maintain fecal pH levels. Its beneficial effects on gut development were more obvious in 6-12-month-old infants.

Time-varying model of engagement with digital self reporting: Evidence from smoking cessation longitudinal studies

Objective

Insufficient engagement is a critical barrier impacting the utility of digital interventions and mobile health assessments. As a result, engagement itself is increasingly becoming a target of studies and interventions. The purpose of this study is to investigate the dynamics of engagement in mobile health data collection by exploring whether, how, and why response to digital self-report prompts change over time in smoking cessation studies.

Method

Data from two ecological momentary assessment (EMA) studies of smoking cessation among diverse smokers attempting to quit (N = 573) with a total of 65,974 digital self-report prompts. We operationalize engagement with self-reporting in term of prompts delivered and prompt response to capture both broad and more granular engagement in self-reporting, respectively. The data were analyzed to describe trends in prompt delivered and prompt response over time. Time-varying effect modeling (TVEM) was employed to investigate the time-varying effects of response to previous prompt and the average response rate on the likelihood of current prompt response.

Results

Although prompt response rates were relatively stable over days in both studies, the proportion of participants with prompts delivered declined steadily over time in one of the studies, indicating that over time, fewer participants charged the device and kept it turned on (necessary to receive at least one prompt per day). Among those who did receive prompts, response rates were relatively stable. In both studies, there is a significant, positive and stable relationship between response to previous prompt and the likelihood of response to current prompt throughout all days of the study. The relationship between the average response rate prior to current prompt and the likelihood of responding to the current prompt was also positive, and increasing with time.

Conclusion

Our study highlights the importance of integrating various indicators to measure engagement in digital self-reporting. Both average response rate and response to previous prompt were highly predictive of response to the next prompt across days in the study. Dynamic patterns of engagement in digital self-reporting can inform the design of new strategies to promote and optimize engagement in digital interventions and mobile health studies.

Relationships between feeding behaviors and emotions: an electroencephalogram (EEG) frequency analysis study

Feeding behaviors may be easily affected by emotions, both being based on brain activity; however, the relationships between them have not been explicitly defined. In this study, we investigated how emotional environments modulate subjective feelings, brain activity, and feeding behaviors. Electroencephalogram (EEG) recordings were obtained from healthy participants in conditions of virtual comfortable space (CS) and uncomfortable space (UCS) while eating chocolate, and the times required for eating it were measured. We found that the more participants tended to feel comfortable under the CS, the more it took time to eat in the UCS. However, the EEG emergence patterns in the two virtual spaces varied across the individuals. Upon focusing on the theta and low-beta bands, the strength of the mental condition and eating times were found to be guided by these frequency bands. The results determined that the theta and low-beta bands are likely important and relevant waves for feeding behaviors under emotional circumstances, following alterations in mental conditions.

The role of moment-to-moment dynamics of perceived stress and negative affect in co-occurring ADHD and internalising symptoms

A maladaptive response to stress in individuals with high ADHD traits may be a key factor explaining co-occurring ADHD symptoms and internalising problems. The current study investigates whether between-person differences in ADHD traits are associated with differences in the within-person moment-to-moment coupling of stress and negative affect; and whether these can explain between-person differences in internalising problems (N = 262, median-age 20). Results of a dynamic structural equation model indicated that between-person differences in ADHD traits significantly moderated the daily life coupling between stress and negative affect. Further, higher ADHD traits were associated with stronger stress carry-over and higher mean levels of negative affect. Stress carry-over and mean levels of negative affect mediated the association between ADHD traits and internalising problems.

Teachers' situational physiological stress and affect

Since teaching is a demanding and stressful profession, the study of teachers' physiological stress in the classroom setting is an emerging field. In cross-sectional studies self-reported stress and affect are related, but less is known about the intraindividual relations between situational physiological stress and corresponding positive and negative affect. The aim of our study was to investigate the associations between situational physiological stress (six salivary cortisol samples per day) and self-reported situational affect (Positive and Negative Affect Schedule four times a day) among 61 Finnish primary school teachers over two workdays. We present a novel multilevel structural equation model (MSEM) that includes cortisol, with time since awakening as a flexibly coded time-varying covariate and affect with time since cortisol measurement as a time-varying covariate. Higher levels of teachers' situational physiological stress were related to lower situational positive affect (e.g., enthusiasm) and higher negative affect (e.g., nervousness), demonstrating the acute/situational effects of stress on affect. In our discussion, we emphasize the importance of the sequence of sampling and observations for further theoretical modeling of relations between stress and affect. We also propose practical implications for improving teachers' awareness of their well-being.

Teachers' daily physiological stress and positive affect in relation to their general occupational well-being

BACKGROUND

Teachers' stress, affect and general occupational well-being influence their teaching and their students. However, how teachers' daily physiological stress and positive affect are related in the classroom is unknown. To reduce teachers' stress and enhance their positive affect, it is crucial to understand how occupational well-being relates to stress and affect.

AIM

The aim of the study was to examine the relationships between teachers' daily physiological stress and positive affect in authentic classroom settings and the roles played by teachers' self-efficacy beliefs, perceptions of school climate and burnout symptoms in daily stress and affect.

SAMPLE

The sample consisted of 45 classroom teachers.

METHOD

Daily physiological stress was assessed by measuring salivary cortisol levels three times in two days. Positive affect was reported by experience sampling at the same time that cortisol was collected. Questionnaires were used to assess self-efficacy beliefs, perceptions of school climate and burnout symptoms. Three-level modelling with random intercepts and slopes was used to analyse the relationships between daily stress and affect and the effect of teachers' general occupational well-being on stress and affect.

RESULTS

No relationships were evident between teachers' physiological stress and positive affect or between daily changes of stress and affect. Self-efficacy beliefs were related to lower stress and higher affect in the middle of the school day. Having sufficient school resources were related to higher positive affect. Teachers' burnout symptoms were associated with lower positive affect.

CONCLUSIONS

We emphasize the potential for self-efficacy and perceptions of school resources as targets for intervening in teachers' stress and affect.

The sound of stress recovery: an exploratory study of self-selected music listening after stress

BACKGROUND

Empirical support for the notion that music listening is beneficial for stress recovery is inconclusive, potentially due to the methodological diversity with which the effects of music on stress recovery have been investigated. Little is presently known about which recovery activities are chosen by individuals for the purpose of stress recovery, and whether audio feature commonalities exist between different songs that are selected by individuals for the purpose of stress recovery. The current pre-registered study investigated whether audio feature commonalities can be extracted from self-selected songs for the purpose of stress recovery. Furthermore, the present study exploratorily examined the relationship between audio features and participants' desired recovery-related emotions while listening and after listening to self-selected music.

METHODS

Participants (N = 470) completed an online survey in which they described what music they would listen to unwind from a hypothetical stressful event. Data analysis was conducted using a split-sample procedure. A k-medoid cluster analysis was conducted to identify audio feature commonalities between self-selected songs. Multiple regression analyses were conducted to examine the relationship between audio features and desired recovery emotions.

RESULTS

Participants valued music listening as a recovery activity to a similar extent as watching TV, sleeping, or talking to a significant other. Cluster analyses revealed that self-selected songs for the purpose of stress recovery can be grouped into two distinct categories. The two categories of songs shared similarities in key, loudness, speechiness, acousticness, instrumentalness, liveness, musical valence, tempo, duration, and time signature, and were distinguished by danceability, energy, and mode. No audio features were significantly associated with participants' desired recovery emotions.

CONCLUSIONS

Although a comprehensive portrait of the relationship between audio features and stress recovery still warrants further research, the present study provides a starting point for future enquiries into the nuanced effects of musical audio features on stress recovery.

The effects of momentary loneliness and COVID-19 stressors on hypothalamic-pituitary adrenal (HPA) axis functioning: A lockdown stage changes the association between loneliness and salivary cortisol

The COVID-19 pandemic can be characterized as a chronic stressor affecting the hypothalamic-pituitary-adrenal (HPA) axis, indexed by glucocorticoids (e.g., cortisol). We investigated whether salivary cortisol level is increased during a lockdown and whether a lockdown condition affects the association between loneliness, specific COVID-19 related stressors and salivary cortisol level. We conducted a smartphone-based ecological momentary assessment (EMA) study with 280 participants in Germany who experienced at least mild loneliness and distress amid COVID-19 from August 2020 to March 2021. We measured their momentary loneliness and COVID-related stressors including worries, information seeking behaviors and feelings of restriction during "no-lockdown" or "lockdown" stages amid COVID-19. Their salivary cortisol was measured 4 times on the last day of a 7-day EMA study. We found a significant increase in salivary cortisol levels during lockdown compared to no-lockdown. Lockdown stage was found to moderate the relationship between momentary loneliness and salivary cortisol level, i.e., loneliness was positively related to cortisol level specifically during lockdown. Mechanisms explaining the effect of forced social isolation on the association between loneliness and salivary cortisol need to be investigated in future studies.

A dual-system, machine-learning approach reveals how daily pubertal hormones relate to psychological well-being in everyday life

The two studies presented in this paper seek to resolve mixed findings in research linking activity of pubertal hormones to daily adolescent outcomes. In study 1 we used a series of Confirmatory Factor Analyses to compare the fit of one and two-factor models of seven steroid hormones (n = 994 participants, 8084 samples) of the HPA and HPG axes, using data from a field study (https://www.icpsr.umich.edu/web/ICPSR/studies/38180) collected over ten consecutive weekdays in a representative sample of teens starting high school. In study 2, we fit a Bayesian model to our large dataset to explore how hormone activity was related to outcomes that have been demonstrated to be linked to mental health and wellbeing (self-reports of daily affect and stress coping). Results reveal, first that a two-factor solution of adolescent hormones showed good fit to our data, and second, that HPG activity, rather than the more often examined HPA activity, was associated with improved daily affect ratios and stress coping. These findings suggest that field research, when it is combined with powerful statistical techniques, may help to improve our understanding of the relationship between adolescent hormones and daily measures of well-being.

Science of interdisciplinary salivary bioscience: history and future directions

Salivary bioscience is noteworthy in its history, as well as in the breadth and scope of its impact. The minimally invasive nature of sampling oral fluid allows for evaluation of individual and intra-individual change in biological processes in ways and settings not possible with traditional biospecimens. The range of measurements is expansive (e.g., DNA, hormones, cytokines, antibodies) and modern technologies enable simultaneous multisystem assessment from a singlet specimen. Used in combination with modern multivariate analytical models, the capacity to repeatedly assess multisystem and level measurements collected from the same individual over time enable operationalization, testing and refinement of complex biobehavioral models. This review describes the emerging narrative of salivary bioscience, and aims to inform and reveal opportunity for innovation and discovery.

Physiological reactions to acute stressors and subjective stress during daily life: A systematic review on ecological momentary assessment (EMA) studies

Objective

This review aims to provide an overview of ecological momentary assessment (EMA) studies analyzing stress reactivity during daily life in terms of direct and moderated influence of acute stress on physiological responses.

Materials and methods

A systematic literature search was performed on November 29, 2021 using Web of Science, MEDLINE and PsycINFO to identify prospective EMA studies targeting acute stressors or stress under naturalistic conditions, without restrictions of publication date or population. Study quality was assessed for multiple EMA-specific sources of bias.

Results

Out of 4285 non-duplicate records, 107 publications involving 104 unique studies were included. The majority of studies assessed acute physiological stress responses primarily through salivary cortisol (n = 59) and cardiovascular outcomes (n = 32). Most studies performed at least three measurements per day (n = 59), and had a moderate risk of recall bias (n = 68) and confounding (n = 85). Fifty-four studies reported a compliance of ≥80%. Direct, non-moderated positive associations were observed between acute stress exposure and concurrent cortisol levels (44%, n = 11/25), systolic (44%, 8/18) and diastolic blood pressure (53%, 8/15) and heart rate (53%, 9/17). Several inter- and intra-individual moderators were identified, such as age, gender, health status, chronic stress, work-related resources, physical activity and stress coping indicators.

Conclusions

About half of the reviewed EMA studies demonstrated direct associations between everyday acute stress exposure and physiological responses, including increased cortisol levels, blood pressure and heart rate. Results further suggested various moderator variables that could help develop tailored prevention strategies and identify groups at higher risk for dysfunctional stress responses.

Registration

PROSPERO—Reg.-No.: PROSPERO 2020 CRD42020163178.

Naturalistic social cognitive and emotional reactions to technology-mediated social exposures and cortisol in daily life

The emotional and social evaluative aspects of social interactions influence cortisol. The interactions that mothers have on social networking sites and via other technology involve heightened social comparison and emotion. We examined the associations between technology-mediated social engagement, social comparisons and emotion during technology-mediated social exposures (TMSEs), and cortisol during daily life. Forty-seven mothers (mean age = 34.38) completed a 4-day monitoring period involving four saliva collections and questionnaires daily at awakening, 4 h post-awakening, 9 h post-awakening, and bedtime. Higher social comparison during TMSE was associated with lower momentary cortisol, whereas higher negative emotions during TMSE and more time spent in TMSE were associated with higher momentary cortisol. Higher average social comparison during TMSE was associated with lower average daily cortisol output (area under the curve with respect to ground; AUCg), and more time spent on TMSE was associated with higher average AUCg. This study presents the first evidence that naturalistic social-cognitive and emotional reactions to TMSE are associated with cortisol in daily life.

The Use of Mobile-Based Ecological Momentary Assessment (mEMA) Methodology to Assess Dietary Intake, Food Consumption Behaviours and Context in Young People: A Systematic Review

Mobile-based ecological momentary assessment (mEMA) offers a novel method for dietary assessment and may reduce recall bias and participant burden. This review evaluated mEMA methodology and the feasibility, acceptability and validity as a dietary assessment method in young people. Five databases were searched from January 2008 to September 2021 for studies including healthy young people aged 16–30 years and used mEMA for obtaining dietary intake data, food consumption behaviours and/or contextual factors. Data on the method used to administer mEMA, compliance with recording and validation were extracted. A total of 46 articles from 39 independent studies were included, demonstrating a wide variation in mEMA methods. Signal-contingent prompting (timed notification to record throughout the day) was used in 26 studies, 9 used event-contingent (food consumption triggered recordings), while 4 used both. Monitoring periods varied and most studies reported a compliance rate of 80% or more. Two studies found mEMA to be burdensome and six reported mEMA as easy to use. Most studies (31/39) reported using previously validated questions. mEMA appears to be a feasible and acceptable methodology to assess dietary intake and food consumption in near real time.

Evoking stress reactivity in virtual reality: A systematic review and meta-analysis

BACKGROUND

Virtual reality (VR) research probes stress environments that are infeasible to create in the real world. However, because research simulations are applied to narrow populations, it remains unclear if VR simulations can stimulate a broadly applicable stress-response. This systematic review and meta-analysis was conducted on studies using VR stress tasks and biomarkers.

METHODS

Included papers (N = 52) measured cortisol, heart rate (HR), galvanic skin response (GSR), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory sinus arrhythmia (RSA), parasympathetic activity (RMSSD), sympathovagal balance (LF/HF), and/or salivary alpha-amylase (sAA). Effect sizes (ES) and confidence intervals (CI) were calculated based on standardized mean change of baseline-to-peak biomarker levels.

RESULTS

From baseline-to-peak (ES, CI), analyses showed a statistically significant change in cortisol (0.56, 0.28-0.83), HR (0.68, 0.53-0.82), GSR (0.59, 0.36-0.82), SBP (.55, 0.19-0.90), DBP (.64, 0.23-1.05), RSA (-0.59, -0.88 to -0.30), and sAA (0.27, 0.092-0.45). There was no effect for RMSSD and LF/HF.

CONCLUSION

VR stress tasks elicited a varied magnitude of physiological stress reactivity. VR may be an effective tool in stress research.

The dynamic experience of taking an examination: Ever changing cortisol and expectancy for success

BACKGROUND

This study examined the relations between students' expectancies for success and a physiological component of test anxiety, salivary cortisol, during an authentic testing setting.

AIMS

The aim of the study was to better understand the connection between shifts in students' control appraisals and changes in the physiological component of test anxiety.

SAMPLE

The study comprised 45 undergraduate engineering majors in the United States.

METHODS

Survey data concerning students' expectancy for success and saliva samples were taken before, during and after the practice midterm examination prior to their actual in-class examination.

RESULTS

Students' expectancy for success declined during the examination while cortisol levels declined from the beginning to middle of the examination and began to increase again as a function of time. Although students' initial levels of expectancy for success and cortisol were not correlated, there was a negative relation between change in cortisol and change in expectancy for success.

CONCLUSIONS

Our study demonstrates a relation between salivary cortisol, a physiological component of test anxiety and students' expectancy for success in an authentic testing context. Most students saw a decrease in cortisol during the examination, suggesting anticipatory anxiety prior to the test and a return to homeostasis as the examination progressed. Some students, however, did not see a declination in cortisol, suggesting they may not have recovered from pre-examination anxiety. The negative relation between change in cortisol and expectancy for success suggests that students who had the greatest decrease in expectancy for success saw the smallest recovery in cortisol.

Neuroendocrine Stress Response in Female and Male Youths With Conduct Disorder and Associations With Early Adversity

OBJECTIVE

Conduct disorder (CD) involves aggressive and antisocial behavior and is associated with blunted cortisol stress response in male youths. Far less is known about cortisol stress responsivity in female youths with CD or other neuroendocrine responses in both sexes. Although CD is linked to early adversity, the possibility that neuroendocrine alterations may mediate the relationship between early adversity and CD has not been systematically investigated.

METHOD

Within the European FemNAT-CD multi-site study, salivary cortisol, testosterone, the testosterone/cortisol ratio, oxytocin, and psychological stress response to a standardized psychosocial stress test (the Trier Social Stress Test [TSST]), together with common pre- and postnatal environmental risk factors, were investigated in 130 pubertal youths with CD (63% female, 9-18 years of age) and 160 sex-, age-, and puberty-matched healthy controls (HCs).

RESULTS

The TSST induced psychological stress in both CD and HCs. In contrast, female and male youths with CD showed blunted cortisol, testosterone, oxytocin, and testosterone/cortisol stress responses compared to HCs. These blunted stress responses partly mediated the relationship between environmental risk factors and CD.

CONCLUSION

Findings from this unique sample, including many female youths with CD, provide evidence for a widespread attenuated stress responsivity of not only stress hormones, but also sex hormones and neuropeptides in CD and its subgroups (eg, with limited prosocial emotions). Results are the first to demonstrate blunted neuroendocrine stress responses in both female and male youths with CD. Early adversity may alter neuroendocrine stress responsivity. Biological mechanisms should be investigated further to pave the way for personalized intervention, thereby improving treatments for CD.

Using Ecological Momentary Assessments to Understand Black Youths' Experiences of Racism, Stress, and Safety

Anti-Black racism, both interpersonal and systemic, is pervasive. Individual- and neighborhood-level expressions of anti-Black racism have been explored in many studies; however, Black youths' experiences of racism across routine activity locations have not been examined as extensively. To address this gap, a Youth Research Advisory Board (YRAB) recruited 75 Black youths (M (SD) = 15.53 (1.77)), living in a segregated neighborhood (93% African American) with 42% of residents living below the poverty line, to participate in research on this topic. Participants in the study completed surveys three times a day for a month (ecological momentary assessment) about their positive and negative emotions and perceptions of racism and social support in routine activity locations (n = 2041). Youths reported more racism when attending school and walking on the street. A relationship between perceptions of racism and social support in routine activity locations and positive and negative momentary emotions was found. This paper will present implications for supporting adolescent development and interrupting anti-Black racism at the level of routine activity locations, along with opportunities for engaging youth-led community-based solutions.

Links Between Socioeconomic Status, Daily Depressive Affect, Diurnal Cortisol Patterns, and All-Cause Mortality

OBJECTIVE

Socioeconomic status (SES) remains a robust risk factor for mortality. Various theoretical models postulate that lower SES is associated with higher negative affect, which then initiates a cascade of physiological disturbances that contribute to illness and early mortality. However, few studies have explicitly investigated the interplay between psychological and biological factors in determining SES disparities in mortality. This study examined the role of daily negative affect and cortisol secretion in explaining the SES-mortality link in a large sample of US adults.

METHODS

Using data from the Midlife in the United States study (n = 1735, mean [standard deviation] age = 56.40 [12.10] years, 56.4% female), we tested longitudinal associations between SES, daily negative affect, daily cortisol levels, and all-cause mortality 13 years later. Daily negative affect was classified into three clusters reflecting depressive affect, anxiety, and anger.

RESULTS

Higher SES was linked to a lower risk of all-cause mortality (hazard ratio = 0.94, 95% confidence interval = 0.90 to 0.97). Furthermore, there was a sequential link between higher SES and lower mortality through lower daily depressive affect and a steeper ("healthier") diurnal cortisol slope (indirect effect = -0.0007, 95% confidence interval = -0.0014 to -0.0002). Daily anxiety and anger were not associated with cortisol levels or mortality (p values > .05).

CONCLUSIONS

These findings suggest that daily negative emotional experiences and the hypothalamic-pituitary-adrenal axis functioning may constitute important psychological and physiological pathways underlying the link between SES and all-cause mortality.

Hormonal abnormalities in alexithymia

Alexithymia is a personality trait characterized by difficulties in emotion recognition and regulation that is associated with deficits in social cognition. High alexithymia levels are considered a transdiagnostic risk factor for a range of psychiatric and medical conditions, including depression, anxiety, and autism. Hormones are known to affect social-emotional cognition and behavior in humans, including the neuropeptides oxytocin and vasopressin, the steroid hormones testosterone and estradiol, the stress hormone cortisol as well as thyroid hormones. However, few studies have investigated hormonal effects on alexithymia and on alexithymia-related impairments in emotion regulation and reactivity, stress response, and social cognition. Here, we provide a brief overview of the evidence linking alexithymia to abnormalities in hormone levels, particularly with regard to cortisol and oxytocin, for which most evidence exists, and to thyroid hormones. We address the current lack of research on the influence of sex hormones on alexithymia and alexithymia-related deficits, and lastly provide future directions for research on associations between hormonal abnormalities and deficits in emotion regulation and social cognition associated with alexithymia.

Patient and Therapist In-Session Cortisol as Predictor of Post-Session Patient Reported Affect

The importance of the role of affect in psychotherapy for major depressive disorder (MDD) is well established, but the common use of self-reported measures may limit our understanding of its underlying mechanisms. A promising predictor of patient affect is the stress hormone cortisol. To date, no studies have studied in-session changes in cortisol in psychotherapy for MDD. We investigated whether an increase in patient cortisol over the course of a session correlated with higher negative and lower positive affect. Given previous findings on healthy individuals on the contagious nature of stress, an additional aim was to examine whether these relationships are moderated by therapist cortisol. To this end, 40 dyads (including 6 therapists) provided saliva samples before and after four pre-specified sessions (616 samples). After each session, the patients provided retrospective reports of in-session affect. We found no association between patient cortisol and affect. However, increases in patient cortisol predicted negative affect when the therapists exhibited decreases in cortisol, and increases in patient cortisol predicted positive affect when the therapists showed increases. Our study provides initial evidence for the importance of the social context in the cortisol-affect relationship in MDD.

Positive and negative affect are associated with salivary cortisol in the everyday life of older adults: A quantitative synthesis of four aging studies

Research on time-fluctuating links between positive affect and cortisol is inconsistent and mostly based on young to middle-aged samples. The current project investigated how moment-to-moment changes in positive and negative affect are associated with moment-to-moment changes in cortisol levels in older adults' daily lives and whether those associations are moderated by differences in health status (as indicated by the number of comorbidities). Affect and cortisol data collected in four separately conducted momentary assessment studies with parallel protocols were pooled to obtain a sample of N=476 individuals aged 56-88 years (M_age=71.9, SD=6.6; 52% female). Participants provided affect reports and collected salivary cortisol 5-7 times a day for a 7-day period and reported the presence of 13 different health conditions. Data were analyzed using multilevel models, with time since waking, daily behaviors associated with cortisol secretion, age, and sex controlled. Feeling more positive affect than usual was associated with lower momentary cortisol. In contrast, feeling more negative affect than usual was associated with higher momentary cortisol. Associations of momentary positive and negative affect with cortisol were weaker among participants in worse as compared to those in better health. Trait positive affectivity was associated with more curvature of waking cortisol profiles and trait negative affectivity was associated with smaller cortisol awakening responses. Findings suggest that HPA axis responses fluctuate with everyday changes in positive and negative affect in older adults, and that higher HPA reactivity may indicate preserved health in this age group.

How to assess and interpret everyday life salivary cortisol measures: A tutorial on practical and statistical considerations

Salivary cortisol has been the central marker in psychoneuroendocrinological stress research for three decades. Given the technological possibilities to assess data in ecologically valid circumstances, many studies have implemented longitudinal assessments of salivary cortisol in study participants' everyday life. Such studies bear the potential to understand real-life associations of cortisol with psychological traits, states, and health variables. Furthermore, changes in the neuroendocrine regulation and in cortisol reactivity can be used to evaluate the effects of behavioral interventions in real-life circumstances. While standardized paradigms have been developed to measure cortisol in laboratory settings, there is high heterogeneity in the assessment, statistical processing, and interpretation of everyday life cortisol measures. This methodological tutorial aims at summarizing important knowledge which had been accumulated during the past two decades and which could be used to set up an ambulatory assessment study focusing on salivary cortisol in everyday life. Practical advice for possible strategies at all stages of the research process is outlined in detail. Additionally, an example on how to statistically process cortisol data in a multilevel framework (including syntax) is provided. In these analyses, we investigate within- and between-person research questions regarding the association between stress and cortisol in daily life. Thus, the present work (a) can be used as tutorial for setting up everyday life studies focusing on the assessment of salivary cortisol, and (b) can be useful to avoid inconsistencies in study planning, data assessment and data processing in future studies.