High trait anxiety in healthy subjects is associated with low neuroendocrine activity during psychosocial stress

Is the Mannheim Multicomponent Stress Test a viable alternative to the Trier Social Stress Test?

Background

The Trier Social Stress Test (TSST) is a widely used laboratory protocol to study acute stress reactivity, a hallmark of which is a meaningful increase in saliva cortisol (>2.5 nmol/L) in most individuals, reflecting hypothalamic-pituitary-adrenal (HPA) axis activation. The Mannheim Multicomponent Stress Test (MMST) has potential as a low staff burden alternative to the TSST, with one study showing statistically significant increases in subjective stress, heart rate and saliva cortisol; however, uncertainty remains about the meaningfulness of these psychobiological responses.

Objective

To assess whether the MMST is a viable alternative to the TSST.

Methods

Using a between subjects design, 31 healthy adults were randomised to the standard TSST or the MMST using stratified block randomisation accounting for sex and trait anxiety. The standard TSST consisted of an anticipation phase, followed by a free speech and mental arithmetic task performed in front of a panel of trained actors. The MMST consisted of a computer based Paced Auditory Serial Addition Task (cognitive stressor) with additional motivational, emotional and acoustic stressors in the presence of one unresponsive observer.

Results

Group × time interactions showed that the MMST induced smaller psychobiological responses compared with the TSST (mixed model ANCOVA, P < 0.05). Post-hoc analyses revealed that the MMST induced a significant yet smaller state anxiety response (score range 20-80, MMST: 47 ± 12 vs. TSST: 57 ± 9; P < 0.01, Cohens d = 0.9) and peak heart rate response (MMST: 98 ± 17 vs. TSST: 110 ± 21 bpm; P < 0.05, Cohens d = 0.6) compared with the TSST. Despite observing stereotypical neuroendocrine responses to the TSST, the MMST did not increase saliva α-amylase or cortisol (Δ saliva cortisol, 0.1 ± 1.1 vs. TSST: 10.3 ± 12.8 nmol/L; between group difference P < 0.01, Cohens d = 1.1). Moreover, meaningful increases in saliva cortisol (>2.5 nmol/L) were observed in 80% of participants after the TSST but in no participant after the MMST.

Conclusion

The Mannheim Multicomponent Stress Test increased state anxiety and heart rate but not saliva cortisol. As such, the present results do not support the utility of the Mannheim Multicomponent Stress Test as a viable alternative to The Trier Social Stress Test.

Sympathetic arousal among depressed college students: Examining the interplay between psychopathology and social activity

Depressed individuals exhibit altered sensitivity to both positive and negative social contact, and may not reap the same psychological and emotional benefits to socializing as non-depressed individuals. Although depressive symptoms and loneliness predict social withdrawal and decreased pleasure, little is currently understood about immediate affective arousal dynamics during real-time socializing. Using a novel ambulatory protocol that tracked both objective features of affective arousal (electrodermal activity) and subjective valence (self-reported) during college students' social interactions, we evaluated the moderating role of depression and loneliness symptoms on the associations between socializing with others (specifically, with a romantic partner, a close friend, or a group of friends) and the arousal and valence dimensions of affect. Among a racially and ethnically diverse sample of 118 college students (64% African American/Black/Continental African, 20% Latinx, 8% Asian, and 8% White) recruited from a large, predominantly White Midwestern university, those lower in depression and loneliness symptomatology evinced decreased average arousal (Β = -0.10, SE = 0.04, p < .01) when in relaxed and intimate socializing contexts (e.g., with a romantic partner and a close friend), consistent with the idea that these contexts facilitate important opportunities for psychological rest and recovery. Those lower in depression and loneliness symptoms also showed higher average arousal when socializing in the energizing context of being with a group of friends. Overall, the results suggest psychopathology is reflected in patterns of sympathetic arousal when socializing, with more depressed and lonely individuals generally feeling worse while receiving fewer psychophysiological rewards in multiple socializing contexts.

Feeding under fire: Relations between parental stress hormones and controlling feeding behaviors

Under stress, parents tend to use more controlling feeding behaviors toward their children (Berge et al., 2017; Doan et al., 2022; Loth et al., 2016). However, the majority of prior work focuses on subjective reports of stress, and there is a dearth of research examining parental physiological stress and its impact on feeding behaviors. In the current study, we examined how parental physiological stress reactivity would influence their feeding behaviors under mild stress in a lab-based setting. Parents (n = 83, 50 % females) and their children (59% female, Mage = 42 months, SD = 4.48) participated. Stress was induced using the Trier Social Stress Test in the laboratory (Kirshbaum et al., 1993). Salivary samples were collected at 4 time points during the visit to index stress reactivity and later assayed for cortisol and DHEA. Parent-child interactions during the anticipatory period of the stress test were observationally coded for parent use of controlling feeding behaviors. To examine whether parent stress physiology predicts their feeding behaviors, we ran a Poisson regression using income, parent ethnicity, parent sex (mom/dad), time of day, and DHEA/cortisol ratio as predictors of controlling feeding behavior. Latinx parents used less controlling feeding behaviors, b = -0.323, p = 0.041 than non-Latinx parents. Parents with a higher DHEA/Cortisol ratio were less likely to use controlling feeding behaviors, b = -0.231, p = 0.008. To our knowledge, this is the first study to show that for both mothers and fathers, DHEA relative to cortisol has a protective role in controlling feeding practices, and lends support to the role of acute stress reactivity in predicting behavioral outcomes.

The neurocomputational signature of decision-making for unfair offers in females under acute psychological stress

Stress is a crucial factor affecting social decision-making. However, its impacts on the behavioral and neural processes of females' unfairness decision-making remain unclear. Combining computational modeling and functional near-infrared spectroscopy (fNIRS), this study attempted to illuminate the neurocomputational signature of unfairness decision-making in females. We also considered the effect of trait stress coping styles. Forty-four healthy young females (20.98 ± 2.89 years) were randomly assigned to the stress group (n = 21) and the control group (n = 23). Acute psychosocial stress was induced by the Trier Social Stress Test (TSST), and participants then completed the one-shot ultimatum game (UG) as responders. The results showed that acute psychosocial stress reduced the adaptability to fairness and lead to more random decision-making responses. Moreover, in the stress group, a high level of negative coping style predicted more deterministic decision. fNIRS results showed that stress led to an increase of oxy-hemoglobin (HbO) peak in the right temporoparietal junction (rTPJ), while decreased the activation of left middle temporal gyrus (lMTG) when presented the moderately unfair (MU) offers. This signified more involvement of the mentalization and the inhibition of moral processing. Moreover, individuals with higher negative coping scores showed more deterministic decision behaviors under stress. Taken together, our study emphasizes the role of acute psychosocial stress in affecting females' unfairness decision-making mechanisms in social interactions, and provides evidences for the "tend and befriend" pattern based on a cognitive neuroscience perspec.

Social media does not elicit a physiological stress response as measured by heart rate and salivary cortisol over 20-minute sessions of cell phone use

The pervasive use of social media has raised concerns about its potential detrimental effects on physical and mental health. Others have demonstrated a relationship between social media use and anxiety, depression, and psychosocial stress. In light of these studies, we examined physiological indicators of stress (heart rate to measure autonomic nervous system activation and cortisol to assess activity of the hypothalamic-pituitary-adrenal axis) associated with social media use and investigated possible moderating influences of sex, age, and psychological parameters. We collected physiological data from 59 subjects ranging in age from 13 to 55 across two cell phone treatments: social media use and a pre-selected YouTube playlist. Heart rate was measured using arm-band heart rate monitors before and during cell phone treatments, and saliva was collected for later cortisol analysis (by enzyme immunoassay) before and after each of the two cell phone treatments. To disentangle the effects of cell phone treatment from order of treatment, we used a crossover design in which participants were randomized to treatment order. Our study uncovered a significant period effect suggesting that both heart rate and cortisol decreased over the duration of our experiment, irrespective of the type of cell phone activity or the order of treatments. There was no indication that age, sex, habits of social media use, or psychometric parameters moderated the physiological response to cell phone activities. Our data suggest that 20-minute bouts of social media use or YouTube viewing do not elicit a physiological stress response.

Association of Blood Metabolomics Biomarkers with Brain Metabolites and Patient-Reported Outcomes as a New Approach in Individualized Diagnosis of Schizophrenia

Given its polygenic nature, there is a need for a personalized approach to schizophrenia. The aim of the study was to select laboratory biomarkers from blood, brain imaging, and clinical assessment, with an emphasis on patients' self-report questionnaires. Metabolomics studies of serum samples from 51 patients and 45 healthy volunteers, based on the liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS/MS), led to the identification of 3 biochemical indicators (cortisol, glutamate, lactate) of schizophrenia. These metabolites were sequentially correlated with laboratory tests results, imaging results, and clinical assessment outcomes, including patient self-report outcomes. The hierarchical cluster analysis on the principal components (HCPC) was performed to identify the most homogeneous clinical groups. Significant correlations were noted between blood lactates and 11 clinical and 10 neuroimaging parameters. The increase in lactate and cortisol were significantly associated with a decrease in immunological parameters, especially with the level of reactive lymphocytes. The strongest correlations with the level of blood lactate and cortisol were demonstrated by brain glutamate, N-acetylaspartate and the concentrations of glutamate and glutamine, creatine and phosphocreatine in the prefrontal cortex. Metabolomics studies and the search for associations with brain parameters and self-reported outcomes may provide new diagnostic evidence to specific schizophrenia phenotypes.

Selected neuroendocrine factors as potential molecular biomarkers of early non-affective psychosis course in relation to treatment outcome: A pilot study

The aim of this pilot study was to find whether the dysregulation of neuroendocrine biomarker signaling pathways in the first episode of non-affective psychosis is a predictive factor of treatment outcome. Patients with the first episode of non-affective psychosis (N = 29) were examined at admission, at discharge, and at follow-up (N = 23). The biomarkers included serum aldosterone, cortisol, free thyroxine, thyroid stimulating hormone, and prolactin. We revealed lower baseline aldosterone and higher baseline cortisol concentrations in patients with very good outcome compared to those with good outcome after one year. We failed to reveal any significant association between treatment outcome and neurohumoral biomarkers in the whole sample at 1-year follow-up. However, baseline aldosterone concentrations negatively correlated with total PANSS scores at the discharge. Lower baseline aldosterone and higher baseline cortisol concentrations have the potential to predict a more favorable outcome for patients with the first episode of psychosis.

Neuroendocrine response to a psychosocial stress test is not related to schizotypy but cortisol elevation predicts inflexibility of semantic memory retrieval

An altered stress response can contribute to the transition from preclinical psychotic symptoms to the clinical manifestation of schizophrenia and other psychotic disorders. The present study was aimed at testing the hypotheses that (i) the autonomic and neuroendocrine responses under psychosocial stress are dysregulated in individuals with high psychosis proneness (schizotypy); (ii) the magnitude of post-stress autonomic activation and cortisol release predicts alterations in semantic memory retrieval. The study was performed in 73 healthy individuals of both sexes with either high or low schizotypal traits preselected out of 609 individuals using the Schizotypal Personality Questionnaire. A psychosocial stress procedure based on public speech was used as a stress model. We found that individuals with high schizotypy engaged in less adaptive emotional stress-coping strategies than low schizotypy individuals. Yet, the neuroendocrine, immune, and sympathetic activation in response to the stress test was not different between the groups. Irrespective of the exposure to the stressor, individuals with high schizotypy were less fluent when retrieving associations from semantic memory. In addition, we demonstrated that acute psychosocial stress reduced the flexibility of semantic memory retrieval. The post-stress mental inflexibility was reliably predicted by the concomitant elevation of cortisol concentrations in saliva. The present study thus brings novel evidence indicating that the acute psychosocial challenge impairs retrieval flexibility in the semantic domain, which may be due to neuroendocrine activation.

Patterns of Respiration Rate Reactivity in Response to a Cognitive Stressor Associate With Self-Reported Mental Health Outcomes

Many studies have examined physiological responses to acute stress in healthy and clinical populations. Some have documented exaggerated physiological stress reactivity in response to acute stress, while others have reported blunted physiological stress reactivity. Although the literature is conflicted, the relationship between abnormal physiological stress reactivity and negative outcomes is well-established. However, past research has neglected a critical aspect of physiological stress response - respiration - and it is unclear whether differences in respiration rate responses to acute stress are related to health outcomes. This secondary cross-sectional analysis explored differences in outcomes between three subgroups: blunted, moderate, and exaggerated respiration rate reactivity to an acute stress task. In a sample of at least mildly-stressed older adults (n = 55), we found that perceived stress (b = -7.63; p = .004) and depression (b = -9.13; p = .007) were significantly lower in the moderate reactivity group compared to the high reactivity group, and that self-reported mindfulness (b = 10.96; p = .008) was significantly lower in the moderate reactivity group as compared to the low reactivity group. Across outcomes, participants in the moderate range of physiological reactivity showed less negative and more positive psychological attributes and better health outcomes, while the blunted subgroup demonstrated more negative and less positive psychological attributes and worse health outcomes overall, when compared to the exaggerated and moderate groups. This study extends the literature by adding respiration to markers of acute physiological stress reactivity and demonstrating the effects of blunted respiration reactivity on negative psychological attributes and health outcomes.

Psychosomatic response to acute emotional stress in healthy students

The multidimensionality of the stress response has shown the complexity of this phenomenon and therefore the impossibility of finding a unique biomarker among the physiological variables related to stress. An experimental study was designed and performed to guarantee the correct synchronous and concurrent measure of psychometric tests, biochemical variables and physiological features related to acute emotional stress. The population studied corresponds to a group of 120 university students between 20 and 30 years of age, with healthy habits and without a diagnosis of chronic or psychiatric illnesses. Following the protocol of the experimental pilot, each participant reached a relaxing state and a stress state in two sessions of measurement for equivalent periods. Both states are correctly achieved evidenced by the psychometric test results and the biochemical variables. A Stress Reference Scale is proposed based on these two sets of variables. Then, aiming for a non-invasive and continuous approach, the Acute Stress Model correlated to the previous scale is also proposed, supported only by physiological signals. Preliminary results support the feasibility of measuring/quantifying the stress level. Although the results are limited to the population and stimulus type, the procedure and methodological analysis used for the assessment of acute stress in young people can be extrapolated to other populations and types of stress.

Blunted cortisol and normal sympathetic nervous system responses to an acute psychosocial stressor in internet addiction

Studies have demonstrated that addiction leads to blunted responses of cortisol and sympathetic nervous system (SNS) to acute stressors; however, limited studies have examined the neuroendocrine and SNS stress responses in Internet addiction (IA). To examine acute stress responses in IA, the current study recruited a total of 76 Japanese university students and staff members (51 females and 25 males, mean age = 22.4 years, SD = 4.7), and measured the salivary cortisol, salivary alpha-amylase (sAA), and blood pressure (BP) responses to an acute stressor under stress or a nonstress placebo conditions in IA and non-IA groups. The results revealed that patients with IA showed a blunted cortisol response to a stressor. In contrast, no differences were found in the sAA and BP responses between the IA and non-IA groups. These results suggest that IA may be characterized by blunted cortisol responses in acute stress settings.

Predicting Generalized Anxiety Disorder from Impromptu Speech Transcripts Using Context-Aware Transformer-Based Neural Networks: Model Evaluation study (Preprint)

BACKGROUND

The ability to automatically detect anxiety disorders from speech could be useful as a screening tool for an anxiety disorder. Prior studies have shown that individual words in textual transcripts of speech have an association with anxiety severity. Transformer-based neural networks are models that have been recently shown to have powerful predictive capabilities based on the context of more than one input word. Transformers detect linguistic patterns and can be separately trained to make specific predictions based on these patterns.

OBJECTIVE

This study aimed to determine whether a transformer-based language model can be used to screen for generalized anxiety disorder from impromptu speech transcripts.

METHODS

A total of 2000 participants provided an impromptu speech sample in response to a modified version of the Trier Social Stress Test (TSST). They also completed the Generalized Anxiety Disorder 7-item (GAD-7) scale. A transformer-based neural network model (pretrained on large textual corpora) was fine-tuned on the speech transcripts and the GAD-7 to predict whether a participant was above or below a screening threshold of the GAD-7. We reported the area under the receiver operating characteristic curve (AUROC) on the test data and compared the results with a baseline logistic regression model using the Linguistic Inquiry and Word Count (LIWC) features as input. Using the integrated gradient method to determine specific words that strongly affect the predictions, we inferred specific linguistic patterns that influence the predictions.

RESULTS

The baseline LIWC-based logistic regression model had an AUROC value of 0.58. The fine-tuned transformer model achieved an AUROC value of 0.64. Specific words that were often implicated in the predictions were also dependent on the context. For example, the first-person singular pronoun "I" influenced toward an anxious prediction 88% of the time and a nonanxious prediction 12% of the time, depending on the context. Silent pauses in speech, also often implicated in predictions, influenced toward an anxious prediction 20% of the time and a nonanxious prediction 80% of the time.

CONCLUSIONS

There is evidence that a transformer-based neural network model has increased predictive power compared with the single word-based LIWC model. We also showed that the use of specific words in a specific context-a linguistic pattern-is part of the reason for the better prediction. This suggests that such transformer-based models could play a useful role in anxiety screening systems.

Cortisol response to psychosocial stress, mental distress, fatigue and quality of life in coronary artery disease patients

We aimed to explore the relationship between cortisol response to psychosocial stress, mental distress, fatigue and health related quality of life (HRQoL) in individuals with coronary artery disease (CAD) after recent acute coronary syndrome (ACS). A cross-sectional study initially included 113 subjects (88% men, 53 ± 7 years) 1-3 weeks after ACS. Cortisol response was assessed by measuring salivary cortisol during Trier Social Stress Test. Mental distress was measured with Hospital Anxiety and Depression Scale, State-Trait Anxiety Inventory, and Type D Scale-14. Fatigue symptoms were evaluated using Multidimensional Fatigue Inventory 20-items, while HRQoL was assessed with 36-Item Short Form Medical Outcome Questionnaire. After conducting multivariable linear regression analyses, diminished cortisol response sampled after Public speech (T3-T1, + 15 min) was significantly associated with higher anxiety symptoms (β = -0.224; p = 0.035), while diminished cortisol response sampled after preparation time (T2-T1, + 10 min) was significantly linked with the presence of Type D personality (β = -0.290; p = 0.006; β = -0.282; p = 0.008 respectively), even after controlling for confounders (i.e., sex, age, education, New York Heart Association functional class, beta-blockers and baseline levels of cortisol measures). We found that mental distress, but not fatigue and HRQoL, was linked with blunted cortisol response during anticipation time of psychosocial stress, independently of potential covariates.

Associations between general trait anxiety, trait social anxiety and cardiovascular responses to social and non-social stressors

OBJECTIVE

The present study sought to examine whether anxiety propensity dimensions (general trait anxiety vs. trait social anxiety) interact with stressor types (tasks with social vs. non-social challenges) to determine cardiovascular stress responses.

METHODS

A 2 × 3 mixed-factorial experimental design was employed. The State-Trait Anxiety Inventory, the Social Performance and Social Interaction Anxiety Scales were administered to 233 participants, who engaged in a stress task with either social or non-social challenges during which their cardiovascular data were continuously collected.

RESULTS

General trait anxiety negatively predicted heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) reactivity (β = -0.16, p = 0.001; β = -0.17, p = 0.001; β = -0.18, p < 0.001), and positively predicted HR, SBP, DBP recovery (β = 0.16, p = 0.012; β = 0.15, p = 0.014; β = 0.15, p = 0.011), regardless of stress types. Social performance anxiety (β = -0.23, p = 0.002; β = -0.25, p = 0.001; β = -0.24, p = 0.001) and social interaction anxiety (β = -0.22, p < 0.001; β = -0.25, p < 0.001; β = -0.22, p < 0.001) only negatively predicted HR, SBP, DBP reactivity to the stress task with social challenges. No associations were observed between trait social anxiety and cardiovascular recovery from the stress task with social or non-social challenges.

CONCLUSIONS

These findings suggest that different trait anxiety dimensions interact with stressor types in affecting cardiovascular stress responses, which have different health implications.

Anxious Personality Traits: Perspectives from Basic Emotions and Neurotransmitters

Objective: Recently, many emotional diseases, such as anxiety and depression, have prevailed, and it is expected that emotional disease will be the leading cause of social and economic burden in 2030. These emotional diseases may be due to certain personality traits, which could be the reasons for the development of mental illness. Personality theories have been constantly developed over the past hundreds of years, and different dimensions of personality traits corresponding to different physiological bases and emotional feelings have been proposed. However, personality may be the least studied area in psychology. Methods: In this paper, we will give a short review on the development of personality theories as well as dimensional emotional theory. Then, we will compare the similarities between the emotional dimension and personality dimension. Furthermore, we will also investigate the neural mechanisms of personality and emotions, focusing on neuromodulators for anxiety-related personality traits, in order to provide a clear relationship between different neurotransmitters and anxiety-related personality traits. Results: The results of our study suggest that the emotional dimension and personality dimension may be somewhat related, for example, the extrovert/introvert dimension of personality might be related to the hedonic dimension, which includes happiness/sadness, and the neurotic dimensions might be related to emotional arousal. In addition, our study found that personality traits are also related to basic emotions, for instance, people who are too self-centered are prone to feeling a mood of disgust or depression, while anger and fear correspond to unstable personality traits. The analysis suggested that the neural substrates of both personality and emotions might be described as follows: extroverted–joy–dopamine (DA); introverted–disgust–5-hydroxytryptamine (5-HT); unstable (neuroticism)–anger/fear–noradrenaline (NE); stable–calmness. Conclusions: The results of this study suggest that there is a correlation between personality traits and emotions, and both depend on monoamine neurotransmitters (dopamine, norepinephrine and serotonin). In addition, personality disorders can be interfered via the regulation of emotions and neurotransmitters. This paper opens up a whole new perspective for future research on personality traits and emotional diseases and has great clinical value and practical significance.

Signs of Anxiety and Salivary Copeptin Levels in Dogs Diagnosed with Separation-Related Problems in a Short Separation Test

The need for faster diagnosis and more accurate treatment decisions in separation-related problems (SRPs) in dogs is urgent, and a more precise behavioral phenotyping and the development of biomarkers may be of great value. Vasopressin could be a potential non-invasive biomarker of anxiety in dogs with SRPs, but reliable measurement of its concentration is challenging. Here, we compared the behavior and salivary concentrations of copeptin, an arginine vasopressin surrogate, in dogs with SRPs (Case group, n = 13) and with no problems (Control group, n = 15) as they were introduced to a novel environment and subjected to a short episode of separation and reunion with the owner. Dogs in the Case group had greater odds of showing locomotory or oral behaviors during the pre- and post-separation than Controls, while the odds were significantly lower during separation. They also had greater odds of being persistent in seeking attention and proximity from the stranger during reunion. Overall, dogs with SRPs were more likely to express an anxiety-like state during the entire test than Controls, with separation from the owner, and even its anticipation, possibly accounting for this group difference. Although salivary copeptin concentrations did not differ between the two groups, a different trend was detected in Cases and Controls that is worth exploring in further validation studies involving a larger sample.

Acoustic and Linguistic Features of Impromptu Speech and Their Association With Anxiety: Validation Study

BACKGROUND

The measurement and monitoring of generalized anxiety disorder requires frequent interaction with psychiatrists or psychologists. Access to mental health professionals is often difficult because of high costs or insufficient availability. The ability to assess generalized anxiety disorder passively and at frequent intervals could be a useful complement to conventional treatment and help with relapse monitoring. Prior work suggests that higher anxiety levels are associated with features of human speech. As such, monitoring speech using personal smartphones or other wearable devices may be a means to achieve passive anxiety monitoring.

OBJECTIVE

This study aims to validate the association of previously suggested acoustic and linguistic features of speech with anxiety severity.

METHODS

A large number of participants (n=2000) were recruited and participated in a single web-based study session. Participants completed the Generalized Anxiety Disorder 7-item scale assessment and provided an impromptu speech sample in response to a modified version of the Trier Social Stress Test. Acoustic and linguistic speech features were a priori selected based on the existing speech and anxiety literature, along with related features. Associations between speech features and anxiety levels were assessed using age and personal income as covariates.

RESULTS

Word count and speaking duration were negatively correlated with anxiety scores (r=-0.12; P<.001), indicating that participants with higher anxiety scores spoke less. Several acoustic features were also significantly (P<.05) associated with anxiety, including the mel-frequency cepstral coefficients, linear prediction cepstral coefficients, shimmer, fundamental frequency, and first formant. In contrast to previous literature, second and third formant, jitter, and zero crossing rate for the z score of the power spectral density acoustic features were not significantly associated with anxiety. Linguistic features, including negative-emotion words, were also associated with anxiety (r=0.10; P<.001). In addition, some linguistic relationships were sex dependent. For example, the count of words related to power was positively associated with anxiety in women (r=0.07; P=.03), whereas it was negatively associated with anxiety in men (r=-0.09; P=.01).

CONCLUSIONS

Both acoustic and linguistic speech measures are associated with anxiety scores. The amount of speech, acoustic quality of speech, and gender-specific linguistic characteristics of speech may be useful as part of a system to screen for anxiety, detect relapse, or monitor treatment.

Screening for Generalized Anxiety Disorder from Acoustic and Linguistic Features of Impromptu Speech: Prediction Model Evaluation Study (Preprint)

Background

Frequent interaction with mental health professionals is required to screen, diagnose, and track mental health disorders. However, high costs and insufficient access can make frequent interactions difficult. The ability to assess a mental health disorder passively and at frequent intervals could be a useful complement to the conventional treatment. It may be possible to passively assess clinical symptoms with high frequency by characterizing speech alterations collected using personal smartphones or other wearable devices. The association between speech features and mental health disorders can be leveraged as an objective screening tool.

Objective

This study aimed to evaluate the performance of a model that predicts the presence of generalized anxiety disorder (GAD) from acoustic and linguistic features of impromptu speech on a larger and more generalizable scale than prior studies did.

Methods

A total of 2000 participants were recruited, and they participated in a single web-based session. They completed the Generalized Anxiety Disorder-7 item scale assessment and provided an impromptu speech sample in response to a modified version of the Trier Social Stress Test. We used the linguistic and acoustic features that were found to be associated with anxiety disorders in previous studies along with demographic information to predict whether participants fell above or below the screening threshold for GAD based on the Generalized Anxiety Disorder-7 item scale threshold of 10. Separate models for each sex were also evaluated. We reported the mean area under the receiver operating characteristic (AUROC) from a repeated 5-fold cross-validation to evaluate the performance of the models.

Results

A logistic regression model using only acoustic and linguistic speech features achieved a significantly greater prediction accuracy than a random model did (mean AUROC 0.57, SD 0.03; P<.001). When separately assessing samples from female participants, we observed a mean AUROC of 0.55 (SD 0.05; P=.01). The model constructed from the samples from male participants achieved a mean AUROC of 0.57 (SD 0.07; P=.002). The mean AUROC increased to 0.62 (SD 0.03; P<.001) on the all-sample data set when demographic information (age, sex, and income) was included, indicating the importance of demographics when screening for anxiety disorders. The performance also increased for the female sample to a mean of 0.62 (SD 0.04; P<.001) when using demographic information (age and income). An increase in performance was not observed when demographic information was added to the model constructed from the male samples.

Conclusions

A logistic regression model using acoustic and linguistic speech features, which have been suggested to be associated with anxiety disorders in prior studies, can achieve above-random accuracy for predicting GAD. Importantly, the addition of basic demographic variables further improves model performance, suggesting a role for speech and demographic information to be used as automated, objective screeners of GAD.

High trait anxiety blocks olfactory plasticity induced by aversive learning

Aversive learning normally induces alterations in sensory function as the brain's sensory systems are tuned to optimize detection and discrimination of threat-predictive stimuli. Anxiety disorders can disrupt behavioral discrimination between threat-predictive and neutral stimuli, resulting in overgeneralization of negative affective responses to non-threatening situations. We thus hypothesized that anxiety could disrupt learning-induced improvement in sensory discrimination. We tested perceptual discrimination between similar odorants before and after discriminative aversive conditioning. Participants exhibiting normal levels of trait anxiety developed a larger skin conductance response (SCR) to the shock-predictive odorant and substantial improvement in their perceptual discrimination between the two odors. Repeated exposure to the odors without shock partially extinguished the SCRs but the perceptual effect persisted. By contrast, participants with high levels of trait anxiety developed comparably sized SCRs to both odors and displayed no perceptual improvement. Learning-induced perceptual plasticity can thus be impaired in people with high levels of trait anxiety.

The effects of school‐based interventions on physiological stress in adolescents: A meta‐analysis

Chronic stress is associated with dysregulations in the physiological stress system, resulting in diverse negative developmental outcomes. Since adolescence is a period characterized by increased stress-sensitivity, and schools are an important environment for the developing adolescent, school-based interventions promoting psychosocial functioning are of particular interest to prevent adverse outcomes. The present study therefore aimed to investigate the effectiveness of such interventions on hypothalamic pituitary adrenal-axis (i.e., cortisol) and cardiovascular (i.e., blood pressure [BP] and heart rate [HR]/heart rate variability [HRV]) parameters of stress in adolescents, and examined moderators of effectiveness. The search resulted in the inclusion of k = 9 studies for cortisol, k = 16 studies for BP, and k = 20 studies for HR/HRV. The results indicated a significant small overall effect on reducing BP, but no significant effect for HR/HRV. For cortisol, large methodological variation in the few primary studies did not allow for quantitative analyses, but a qualitative review demonstrated inconsistent results. For BP and HR/HRV, larger effects were observed for intervention programs with a mindfulness and/or meditation component, for interventions without a cognitive-behavioural component and for interventions with a higher intensity. Providing adolescents with techniques to improve indicators of physiological stress may prevent emerging mental health problems.

Stressed out and fed up: The effect of stress on maternal feeding behaviors and the moderating role of executive function

Stress is associated with a range of unhealthy eating habits, yet few studies have examined how stress may influence the intergenerational transmission of eating habits from parents to their children. Specifically, there is a lack of data regarding the role of stress on feeding practices. Moreover, most work investigating the associations between parental stress and their feeding behaviors has been correlational, limiting our understanding of causality. In the current study, we used an experimental design, induced high and low stress in mothers using a standard laboratory stressor, and observed mother-child interactions during a snack break. We also examined the potential role of maternal executive functioning (EF) for buffering the effects of stress on maternal feeding behaviors. Levels of maternal stress were manipulated with the Trier Social Stress Task (TSST) in a community sample (N = 80 dyads, Child M_age = 41.89 months, female = 43). We measured maternal EF with a series of computerized tasks. Maternal feeding behaviors were coded for controlling behaviors, which included pressuring and restricting behaviors. Results indicate a main effect of stress on controlling feeding behaviors, such that mothers in the high-stress condition exhibited higher levels of controlling behaviors. The effect of stress on controlling feeding behaviors was ameliorated among mothers with higher levels of EF after controlling for child age and income. Results provide causal evidence for the role of stress on feeding behaviors and suggest EF as a factor to be considered in the treatment and prevention of diet-related illnesses.

Stability and test-retest reliability of different hormonal stress markers upon exposure to psychosocial stress at a 4-month interval

The Trier Social Stress Test (TSST) has been shown to reliably induce physiological stress responses in the hypothalamus-pituitary-adrenal (HPA) and in the sympathetic-adrenal-medullary (SAM) axis in cross-sectional studies. However, it was also reported that repeated exposure to the TSST might be associated with habituation, mainly of the HPA axis responsivity. Thus, in all longitudinal stress studies involving repeated TSST administration, potential habituation of the HPA axis response complicates the interpretation of results. The goal of the present study was therefore to assess stability and test-retest reliability of a number of different endocrinological stress markers as well as subjective stress responses after two exposures to the TSST four months apart. We assessed salivary and plasma cortisol profiles, plasma ACTH and noradrenaline profiles, as well as subjective stress ratings in healthy volunteers before, during, and after the TSST at six time-points both at test-day 1 (TSST_1, n = 42) and test-day 2 (TSST_2, n = 34) 4-months later. Half of the participants received the TSST in the early, the other half in the late afternoon. Discontinuous growth models were applied to model three phases of the stress response (preTSST, reactivity, recovery) for each marker. Subsequently, the stability of these phases was analyzed. Stability and test-retest reliability of standard physiological stress markers such as Area-under-the-Curve (AUC_G, AUC_I), Absolute Peak Change, and Relative Peak Change (RPC) were analyzed as well. We did not observe strong test-retest effects in any of the endocrinological measures. In contrast, test-retest effects in subjective stress were characterized by a faster drop directly after the second TSST, whereas the initial increase before the test period was the same for both test-days. Regarding test-retest-reliability, AUC_G was the most reliable measure across all endocrinological and subjective stress markers (range: r = .606 to .858), while AUC_I and RPC (range: r = - .146 to .548) were least reliable. A 4-month interval is a sufficient time interval between two repeated TSST exposures to largely reinstate the physiological stress response, which was also true for the initial psychological stress response. Thus, the TSST is well applicable in longitudinal studies.

Detection of acute stress by smooth muscle electromyography: A translational study on rat and human

AIMS

Non-invasive and simultaneous recording of gastrointestinal (GI) activity during stress induction is still an unexplored field. In our previous investigation, the stress-induced alteration of the gastrointestinal tract was explored in rats. Our aims were to expand our previous rat experiment and to induce stress response in rats (Study 1) and humans (Study 2) to detect the GI tract activity, heart rate and body temperature.

MATERIALS AND METHODS

In the preclinical sample, acute stress was induced by immobilization in Sprague-Dawley rats (N = 10). Acute stress response was generated by the Trier Social Stress Test among healthy volunteers (N = 16). Detection of acute stress was measured by using smooth muscle electromyography, which recorded the myoelectric waves of the gastrointestinal tract (stomach, ileum and colon) simultaneously with heart rate and body temperature in rats and humans.

KEY FINDINGS

The myoelectric waves of the stomach, the cecum and the ileum increased during immobilization in rats, rising in parallel with heart rate and the dermal temperature of the abdominal surface. The same alterations were found during the stress period among humans, except in the case of the colon, where no change was detected.

SIGNIFICANCE

The crucial role of the GI tract in stress response was revealed by translating the outcome of basic research into human results. The similar GI alterations during stress in rats and humans underpin the robustness of our findings. In summary, our preliminary translational-based study can serve as an appropriate basis for further human studies.

The impact of self-reported levels of anxiety on respiratory sinus arrhythmia levels in adults who stutter

PURPOSE

This study investigated whether subjective levels of anxiety predict respiratory sinus arrythmia (RSA) levels in adults who stutter (AWS) compared to (ANS) during baseline and social stress situations.

METHODS

Participants were eight AWS and 10 ANS who performed a modified version of the Trier Social Stress Test (TSST-M). For this, participants were required to prepare and deliver a 5-minute speech and perform a nonword reading task in front of what was perceived as a group of professionals trained in public speaking. Measures of respiratory sinus arrhythmia (RSA) were calculated for baseline and TSST-M conditions. Participants also completed the State-Trait Anxiety Inventory (STAI), both the trait (STAI-T) and state (STAI-S) portion, which served as subjective anxiety ratings. Univariate analyses of variances (UNIANOVA) were used to assess the effects of the STAI-T and STAI-S anxiety on respiratory sinus arrhythmia (RSA) levels at pre-stress and TSST-M conditions. RSA, an index of parasympathetic nervous system activity, is considered to be a measure of emotional regulation. The strength of the effects of STAI-T and STAI-S on RSA levels was evaluated with the unstandardized coefficients for each group separately.

RESULTS

Results showed a significant difference between groups for the effects of STAI-T on RSA values for the pre-stress nonword reading task. No other significant differences were found between groups for the pre-stress or TSST-M conditions. Slope estimates showed that STAI-T was a significant predictor of RSA values for pre-stress speaking conditions for the AWS but not ANS. No significant fixed effects or interaction effects were found for the STAI-S and RSA levels in the AWS or ANS. Nor were there significant effects of STAI-T on RSA levels in the AWS or ANS for TSST-M conditions. Descriptive analysis revealed the effects found in the AWS during pre-stress conditions were attributed to a subgroup of AWS who reported low self-reports of anxiety (i.e. STAI-T) and high levels of emotional regulation (i.e. RSA) across social stress conditions.

DISCUSSION

Low self-reported STAI-T scores simultaneous with high RSA levels in some AWS may reflect a self-regulatory strategy adapted in response to chronic, daily stress associated with stuttering.

Cortisol reactivity in social anxiety disorder: A highly standardized and controlled study

In order to understand the psychopathology of the social anxiety disorder (SAD) at the neuroendocrine level, standardized experimental studies on endocrine and physiological markers are necessary, especially since empirical data are still ambiguous. Hence, differences in both, the autonomic nervous system (ANS) and the endocrine stress responses (ACTH, salivary and plasma cortisol) were investigated in a particularly homogenous sample after a standardized stressor (Trier Social Stress Test). The sample consisted of n  = 35 patients with SAD, age, and gender matched to n  = 35 healthy controls (HC). In terms of the heart rate, the response pattern was comparable in both groups. Concerning ACTH, no significant group differences in the response pattern nor in the total output (AUC_G) were exhibited. Significant differences were noticeable only in the plasma cortisol response pattern with less total output (AUC_G) in patients suggesting a blunted response. The salivary cortisol response indicated comparable patterns between groups. However, the patients' total output (AUC_G) was significantly smaller relative to the controls. In sum, evidence for a hypo-responsiveness of the HPA-axis in SAD by means of blood cortisol was observed, with no differences in ACTH between the two groups. This reduced reactivity of the HPA-axis might be associated with an inability to elicit an adequate hormone release, possibly accompanied by an enhanced perception of the stress stimulus. This might be explained by an adaptation of the adrenocortical system due to prolonged repeated stress exposure such as social evaluation.

Individual differences in the encoding of contextual details following acute stress: An explorative study

Information processing under stressful circumstances depends on many experimental conditions, like the information valence or the point in time at which brain function is probed. This also holds true for memorizing contextual details (or ‘memory contextualization’). Moreover, large interindividual differences appear to exist in (context‐dependent) memory formation after stress, but it is mostly unknown which individual characteristics are essential. Various characteristics were explored from a theory‐driven and data‐driven perspective, in 120 healthy men. In the theory‐driven model, we postulated that life adversity and trait anxiety shape the stress response, which impacts memory contextualization following acute stress. This was indeed largely supported by linear regression analyses, showing significant interactions depending on valence and time point after stress. Thus, during the acutephase of the stress response, reduced neutral memory contextualization was related to salivary cortisol level; moreover, certain individual characteristics correlated with memory contextualization of negatively valenced material: (a) life adversity, (b) α‐amylase reactivity in those with low life adversity and (c) cortisol reactivity in those with low trait anxiety. Better neutral memory contextualization during the recoveryphase of the stress response was associated with (a) cortisol in individuals with low life adversity and (b) α‐amylase in individuals with high life adversity. The data‐driven Random Forest‐based variable selection also pointed to (early) life adversity—during the acutephase—and (moderate) α‐amylase reactivity—during the recoveryphase—as individual characteristics related to better memory contextualization. Newly identified characteristics sparked novel hypotheses about non‐anxious personality traits, age, mood and states during retrieval of context‐related information.

Neuroendocrine responses to a psychosocial stress test for larger groups of participants: comparison of two test exposures

Objective. Individual stress tests characterized by social evaluative threat and uncontrollability are known to elicit strong neuroendocrine responses. We tested whether a psychosocial stressor submitted to a larger group of participants (up to 60) may elicit comparable stress responses.Methods. A total of 59 adult subjects (33 women, 26 men) participated in the study, whereas 24 of them suffered from allergy and 35 were healthy. The stress test consisted of a distraction stress task followed by a speech task, in which the participants were randomly subjected to questions related to a topic that they had to prepare as well as arithmetic questions in front of their peers and a committee that responded in standardized and non-supporting manner. State and trait anxiety inventory (STAI) for anxiety state was administrated before and after the test and salivary samples taking. The test was repeated after five months.Results. The results showed that the shared psychosocial stress application in a larger group of subjects was prosperous. The larger group test (LGST) resulted in an enhanced subjectively experienced stress and an intensive sympathetic nervous system activation, reflected by elevated salivary alpha-amylase activity and the heart rate. The cortisol increment after exposure to the stress test was not significant. Repeated exposure to the test failed to reproduce the original stress responses with exception of the heart rate rise.Conclusions. In a larger group of subjects, the psychosocial stress test did elicit stress responses similar to the individual stress tests. Our data indicate that the above-mentioned stress test is apparently not an appropriate approach for the repeated use.

Are Individuals with Low Trait Anxiety Better Suited to On-Call Work?

Research has indicated that individuals with certain traits may be better suited to shiftwork and non-standard working arrangements. However, no research has investigated how individual differences impact on-call outcomes. As such, this study investigated the impact of trait anxiety on sleep and performance outcomes on-call. Seventy male participants (20–35 years) completed an adaptation night, a control night, and two on-call nights in a laboratory. Trait anxiety was determined using the State Trait Anxiety Inventory (STAI) X-2, and participants completed the STAI X-1 prior to bed each night to assess state anxiety. Sleep was measured using polysomnography and quantitative electroencephalographic analysis. Performance was assessed using a 10-min psychomotor vigilance task (PVT) performed each day at 0930, 1200, 1430 and 1700 h. Data pooled from three separate but inter-related studies was used for these analyses. Results indicated that the effects of trait anxiety on state anxiety, sleep and performance outcomes on-call were generally limited. These findings suggest that on-call outcomes are not negatively affected by higher levels of trait anxiety.

Cardiovascular Reactivity to Acute Mental Stress: THE IMPORTANCE OF TYPE D PERSONALITY, TRAIT ANXIETY, AND DEPRESSION SYMPTOMS IN PATIENTS AFTER ACUTE CORONARY SYNDROMES

PURPOSE

Links between psychophysiological reactions to stress stimuli and perceived mental distress, including type D personality, anxiety, and depression, are still under debate. The aim of this study was to examine associations between cardiovascular reactivity to social stress and mental distress in patients after acute coronary syndrome.

METHODS

Patients (n = 116, 86% males, 52 ± 8 yr) with coronary artery disease 2 wk after acute coronary syndrome were evaluated for sociodemographic, clinical characteristics and coronary artery disease risk factors. The Trier Social Stress Test was employed to measure cardiovascular reactions to social stress (systolic and diastolic blood pressure and heart rate). Mental distress assessment included type D personality (Type D Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), and state and trait anxiety (State-Trait Anxiety Inventory).

RESULTS

Multiple linear regression analysis showed associations between type D personality and lower heart rate during Trier Social Stress Test periods of task instruction (β = -.196, P < .04), preparation time (β = -.232, P < .01), and recovery time (β = -.209, P < .029). Higher trait anxiety was linked with lower heart rate during baseline rest (β = -.287, P < .01), task instruction (β = -.286, P < .01), preparation time (β = -.241, P < .01), and recovery period (β = -.209, P < .05). Depressive symptoms were associated with higher systolic blood pressure during baseline rest (β =.187, P < .05), task instruction (β = .306 P < .01), and free speech (β = .264, P < .05).

CONCLUSIONS

Mental distress was associated with cardiovascular stress reactions independent from possible covariates, suggesting dysregulated psychophysiological reactions to acute stress.

Low glucocorticoids in stress-related disorders: the role of inflammation

There is evidence that plasma cortisol concentration can be either increased or decreased in patients with depression and related anxiety and stress-related disorders; the exact pathophysiological mechanisms of this state are not almost clear. Several distinct theories were proposed and mechanisms, which could lead to decreased glucocorticoid signaling and/or levels, were described. However, there is a possible drawback in almost all the theories proposed: insufficient attention to the inflammatory process, which is undoubtedly present in several stress-related disorders, including post-traumatic stress disorder (PTSD). Previous studies only briefly mentioned the presence of an inflammatory reaction's signs in PTSD, without giving it due importance, although recognizing that it can affect the course of the disease. With that, the state of biochemical changes, characterized by the low glucocorticoids, glucocorticoid receptor's resistance and the signs of the persistent inflammation (with the high levels of circulating cytokines) might be observed not only in PTSD but in coronary heart diseases and systemic chronic inflammatory diseases (rheumatoid arthritis) as well. That is why the present review aims to depict the pathophysiological mechanisms, which lead to a decrease in glucocorticoids in PTSD due to the action of inflammatory stimuli. We described changes in the glucocorticoid system and inflammatory reaction as parts of an integral system, where glucocorticoids and the glucocorticoid receptor reside at the apex of a regulatory network that blocks several inflammatory pathways, while decreased glucocorticoid signaling and/or level leads to unchecked inflammatory reactions to promote pathologies such as PTSD. LAY SUMMARY This review emphasizes the importance of inflammatory reaction in the development of puzzling conditions sometimes observed in severe diseases including post-traumatic stress disorder - the decreased levels of glucocorticoids in the blood. Following the classical concepts, one would expect an increase in glucocorticoid hormones, since they are part of the feedback mechanism in the immune system, which reduces stress and inflammation. However, low levels of glucocorticoid hormones are also observed. Thus, this review describes potential mechanisms, which can lead to the development of such a state.

Meta-analysis of the effectiveness of the Trier Social Stress Test in eliciting physiological stress responses in children and adolescents

The Trier Social Stress Test (TSST) is known to reliably induce physiological stress responses in adult samples. Less is known about its effectiveness to elicit these responses in youth samples. We performed a meta-analysis of stress responses to the TSST in youth participants. Fifty-seven studies were included representing 5026 youth participants. Results indicated that the TSST was effective at eliciting stress responses for salivary cortisol (sCort; effect size [ES] = 0.47, p = 0.006), heart rate (HR; ES = 0.89, p < 0.001), pre-ejection period (PEP; ES = -0.37, p < 0.001), heart rate variability (HRV; ES = -0.33, p = 0.028), and systolic blood pressure (ES = 1.17, p < 0.001), as well as negative affect (ES = 0.57, p = 0.004) and subjective anxiety (ES = 0.80, p = 0.004) in youth samples. Cardiac output (ES = 0.15, p = 0.164), respiratory sinus arrhythmia (ES = -0.10, p = 0.064), and diastolic blood pressure (ES = 2.36, p = 0.072) did not reach statistical significance. Overall, effect sizes for the TSST varied based on the physiological marker used. In addition, several physiological markers demonstrated variance in reactivity by youth age (sCort, HR, HRV, and PEP), gender (sCort), type of sample (i.e., clinical versus community sample; sCort and HR), duration of TSST (sCort, HR, HRV, negative affect, and subjective anxiety), number of judges present in TSST (HR and subjective anxiety), gender of judges (sCort), and time of day the marker was assessed (morning versus afternoon/evening; sCort). Overall, the findings provide support for the validity of the TSST as a psychosocial stressor for inducing physiological and psychological stress responses in children and adolescents, but also highlight that some markers may capture the stress response more effectively than others.

Higher perceived stress is associated with lower cortisol concentrations but higher salivary interleukin-1beta in socially evaluated cold pressor test

The relationship between subjective stress perception and the objective stress response to acute stress stimuli is not sufficiently understood. The aim of the present study was to test the hypothesis that the neuroendocrine response in socially evaluated cold pressor test (CPT) depends on the extent of perceived stressfulness of the stimulus. The test was performed in 24 healthy male volunteers. Subjective stress perception was assessed using nine visual analog scales. The subjects were divided to low and high stress perception groups according to the median split of the scores. Subjects with high stress perception exhibited slightly lower values of systolic blood pressure and lower overall concentrations of salivary cortisol compared to subjects with low stress perception. Salivary alpha-amylase activity did not show significant changes. Salivary aldosterone decreased in time in subjects with low but increased early after the test in subjects with high stress perception. Interestingly, salivary concentrations of the pro-inflammatory cytokine interleukin-1beta were considerably higher in subjects with high stress perception, particularly immediately before the test. The differences in salivary cortisol and interleukin-1beta were confirmed by the analysis with distress as a continuous covariate. Distress scores correlated negatively with salivary cortisol and positively with interleukin-1beta. The rate pressure product, which is a global measure of energy consumption by the heart, was significantly higher immediately before than after the stress exposure. The present findings show that concentrations of interleukin-1beta are a sensitive component of the stress response at the time before the stressful event.Lay summaryIt is generally expected that higher perceived stressfulness of a stimulus is accompanied by higher activation of stress-related systems. This study evaluating a combined psychosocial and physical stress situation in healthy men provides evidence that individual parameters of the stress response are differently related to perceived stress intensity. Subjects with high stress perception exhibited lower systolic blood pressure and salivary cortisol, higher interleukin-1beta, marginal differences in alpha amylase and aldosterone compared to subjects with low stress perception, which might be important for stress coping.

Focusing attention on biological markers of acute stressor intensity: Empirical evidence and limitations

ARMARIO, A, J. Labad and R. Nadal. Focusing attention on biological markers of acute stressor intensity: empirical evidence and limitations. NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS. The availability of biological markers that objectively quantify stress is a highly relevant issue. However, experimental evidence suggests that most physiological changes elicited by emotional stressors do not reflect their intensity and are not useful for this purpose. Thus, we review experimental evidence in animals and humans about the putative validity of neuroendocrine and sympathetic/parasympathetic variables to measure stress. Plasma levels of some hormones (e.g. ACTH, glucocorticoids, prolactin and catecholamines) have been found to reflect, at least under certain conditions, the intensity of emotional stressors in animals and probably in humans. However, the temporal resolution of hormone changes is insufficient to reflect the very dynamic psychological processes taking place while experiencing stressors. Cardiovascular parameters (e.g. heart rate and blood pressure) have much better temporal resolution but their validity as markers of stressor intensity either in animals or humans is problematic. Skin conductance and pupil dilation appear to be promising. Additional and more systematic studies are needed to demonstrate the actual validity of stress-induced physiological changes to quantify stress.

Salivary Aldosterone, Cortisol, and Their Morning to Evening Slopes in Patients with Depressive Disorder and Healthy Subjects: Acute Episode and Follow-Up 6 Months after Reaching Remission

BACKGROUND/OBJECTIVE

Cortisol is thought to be involved in the pathophysiology of affective disorders. Less attention has been given to other neuroendocrine factors. The aim of the present study was to test the hypothesis that adrenocortical steroids aldosterone and cortisol show different dynamic changes in the course of clinical depression with the assumption that aldosterone is a state marker of depression.

METHODS

A total of 78 adult subjects (39 patients with depressive disorder and 39 healthy controls) participated in a prospective non-interventional clinical study. Patients were investigated at the time of an acute episode and 6 months after reaching remission. The clinical and personal characteristics, and morning and evening salivary concentrations of aldosterone and cortisol were evaluated.

RESULTS

Patients with an acute depressive episode exhibited higher evening aldosterone and lower morning cortisol concentrations compared to healthy subjects. In these patients, both hormone concentrations showed flatter morning to evening slopes. Salivary aldosterone, but not cortisol concentrations, were lower in patients 6 months after reaching remission compared to those in the acute state. Similarly, 6 months of remission resulted in a steeper morning to evening slope of salivary aldosterone compared to the acute state. The cortisol rhythm remained dysregulated. A significant negative correlation between trait anxiety scores and morning cortisol concentrations in patients at 6 months of clinical remission was observed.

CONCLUSION

Diurnal changes in salivary aldosterone concentrations appear to be a state marker, whilst those of cortisol a trait marker of depression.

Role of glucocorticoid- and monoamine-metabolizing enzymes in stress-related psychopathological processes

Glucocorticoid signaling is fundamental in healthy stress coping and in the pathophysiology of stress-related diseases, such as post-traumatic stress disorder (PTSD). Glucocorticoids are metabolized by cytochrome P450 (CYP) as well as 11-β-hydroxysteroid dehydrogenase type 1 (11βHSD1) and 2 (11βHSD2). Acute stress-induced increase in glucocorticoid concentrations stimulates the expression of several CYP sub-types. CYP is primarily responsible for glucocorticoid metabolism and its increased activity can result in decreased circulating glucocorticoids in response to repeated stress stimuli. In addition, repeated stress-induced glucocorticoid release can promote 11βHSD1 activation and 11βHSD2 inhibition, and the 11βHSD2 suppression can lead to apparent mineralocorticoid excess. The activation of CYP and 11βHSD1 and the suppression of 11βHSD2 may at least partly contribute to development of the blunted glucocorticoid response to stressors characteristic in high trait anxiety, PTSD, and other stress-related disorders. Glucocorticoids and glucocorticoid-metabolizing enzymes interact closely with other biomolecules such as inflammatory cytokines, monoamines, and some monoamine-metabolizing enzymes, namely the monoamine oxidase type A (MAO-A) and B (MAO-B). Glucocorticoids boost MAO activity and this decreases monoamine levels and induces oxidative tissue damage which then activates inflammatory cytokines. The inflammatory cytokines suppress CYP expression and activity. This dynamic cross-talk between glucocorticoids, monoamines, and their metabolizing enzymes could be a critical factor in the pathophysiology of stress-related disorders.Lay summaryGlucocorticoids, which are produced and released under the control by brain regulatory centers, are fundamental in the stress response. This review emphasizes the importance of glucocorticoid metabolism and particularly the interaction between the brain and the liver as the major metabolic organ in the body. The activity of enzymes involved in glucocorticoid metabolism is proposed to play not only an important role in positive, healthy glucocorticoid effects, but also to contribute to the development and course of stress-related diseases.

Perinatal exposure to venlafaxine leads to lower anxiety and depression-like behavior in the adult rat offspring

Depression during pregnancy and in the post-partum period is a growing health issue. Venlafaxine, a representative of serotonin and noradrenaline reuptake inhibitors, is used to treat a wide spectrum of mood disorders. However, the limited number of prenatal and perinatal studies raises the question about the long-term consequences of venlafaxine therapy. The aim of this study was to investigate the effect of venlafaxine exposure during pregnancy and lactation on anxiety-like and depression-like behaviors, as well as adrenocortical hormone concentrations in the adult rat offspring. For this purpose, rat dams were treated orally with venlafaxine from day 15 of gestation to postnatal day 20 at doses of 7.5, 37.5, and 75 mg/kg. Administration of venlafaxine during gestation and lactation affected anxiety-like and depression-like behaviors in adult rat offspring of both sexes. The animals exposed through their mothers to venlafaxine, particularly at the lowest and middle doses, were less anxious and less depressive in several relevant behavioral tests, which can be considered a deviation from the normal state. At clinically relevant doses, venlafaxine did not alter circulating level of corticosterone and aldosterone in the adult offspring. In general, the consequences of venlafaxine were dose dependent and more apparent in females. Together, these results suggest that prenatal and early postnatal exposure to venlafaxine may interfere with functional development of the brain, though not necessarily in a negative way.

An inactive control of the 'Trier Social Stress Test' for Youth 10-17 years: Neuroendocrine, cardiac, and subjective responses

The Trier Social Stress Test for children (TSST-C) adapted from TSST is one of the most commonly used laboratory paradigms for investigating the effects of stress on cognitive, affective and physiological responses in children and adolescents. Considering that laboratory procedures generate a significant amount of stress to children and adolescents, even in the absence of a stress paradigm, it is important to validate TSST-C against an inactive control condition in which the stress components were absent. Using a randomized design, we tested an inactive control condition, which replaced the TSST-C with a benign video clip (nature scenes viewed while standing), thus removing the stress associated components of the TSST-C. Eighty-eight youth between the ages of 10 and 17 years were randomly assigned to complete the TSST-C or the Inactive Control (IC). Subjective anxiety rating, salivary cortisol, systolic and diastolic blood pressure, and heart rate were collected at eight time points. Subjects in the Inactive Control condition showed no significant changes in blood pressure and heart rate, and decreased anxiety rating and salivary cortisol level throughout the study. Subjects in the stress condition (TSST-C) showed increased anxiety ratings, salivary cortisol, systolic and diastolic blood pressure, and heart rate immediately following TSST-C stress induction. Our findings validated that the TSST-C induced a systemic stress response, and that the Inactive Control can be a promising standardized control condition for the TSST-C and a tool for future psychobiological research. Our results also showed that anxiety reactivity decreased with age while HR reactivity increased with age. Cortisol reactivity did not fall in a linear relationship with age but rather via a quadratic curve, suggesting the mid-age adolescents had the highest cortisol responses to stress compared to their younger and older peers, potentially due to a dual factor of pubertal development and self-control and emotion regulation capacity.

Patients with atopy exhibit reduced cortisol awakening response but not cortisol concentrations during the rest of the day

It has been documented that cortisol release in response to acute stressors is reduced in patients with atopic dermatitis, allergic rhinitis, and other atopic diseases compared to that in healthy subjects. We aimed to test the hypothesis that atopic patients exert reduced salivary cortisol awakening response (CAR) in comparison with healthy subjects. The hypothesis was tested on a stressful and a relax day selected subjectively. Moreover, we evaluated the impact of trait anxiety. The sample consisted of 60 subjects, out of which 28 were patients with atopy and 32 healthy volunteers of both sexes. Saliva samples were collected in the morning to evaluate CAR as well as in the early afternoon and evening to look at cortisol concentrations during the rest of the day. The results showed reduced CAR in atopic patients compared to that in healthy subjects. This effect was modulated by sex with a significant difference observed in males. While CAR was reduced, atopic patients had unchanged cortisol concentrations throughout the day. The evening cortisol was even higher in atopic patients. If the subjects were stratified according to the trait anxiety, no significant differences in CAR between high and low anxiety were observed. No differences in cortisol variables including CAR were observed between the stressful and relax day. In conclusion, this study presents evidence on reduced CAR suggesting an insufficient HPA axis reactivity in atopy. Furthermore, the data in atopic patients demonstrate that reduced HPA axis reactivity does not necessarily mean lower cortisol concentrations throughout the day. This might be of relevance to immune system function and the course of the disease.

L-Lysine as the Molecule Influencing Selective Brain Activity in Pain-Induced Behavior of Rats

Lysine-rich proteins are some of the most important proteins of neurons and it has become necessary to investigate the possible role of L-lysine as a brain functioning regulator. The purpose of our study is to identify the characteristics and the mechanisms of L-lysine effects on the different types of pain-induced behavior in the stimulation of tail and foot-shock models in 210 adult male Wistar rats. L-lysine was administered in intraperitoneal or intracerebroventricular injections in doses of 0.15-50.0 µg/kg. When a tail is irritated, L-lysine was found to enhance pain sensitivity and affective defense after both intraperitoneal and intracerebroventricular administration. In the case of unavoidable painful irritation of a pair of rats with both types of L-lysine administration, there was no direct correlation of the severity of pain with defensive reactions and outbursts of aggression. This indicates a more complex integration of the activity of brain structures in this situation of animal interaction, which was confirmed by the results of the direct amino acid action on the periventricular brain structures. Our findings show that L-lysine influences the selective brain activity in dependence on the biological significance of pain-induced behavior.

FAAH genotype, CRFR1 genotype, and cortisol interact to predict anxiety in an aging, rural Hispanic population: A Project FRONTIER study

The neurophysiological underpinnings involved in susceptibility to and maintenance of anxiety are not entirely known. However, two stress-responsive systems, the hypothalamic-pituitary-adrenal axis and the endocannabinoid system, may interact in anxiety. Here, we examine the relationship between FAAH genotype, CRFR1 genotype, baseline cortisol, and state anxiety in a rural adult population using data from Project FRONTIER. We predicted that FAAH A (AA and AC vs CC; rs324420) and three CRFR1 SNP minor alleles (rs7209436 C→ T [minor allele]; rs110402, G → A [minor]; and rs242924 G→ T [minor]), would interact to predict low baseline cortisol and low state anxiety scores. We found partial support for our prediction. In CRFR1 minor carriers, the FAAH AA or AC (vs. CC) genotype was associated with higher cortisol and with lower anxiety. In CRFR1 non-minors, those with FAAH AA or AC (vs. CC) showed decreased cortisol and higher anxiety. These results suggest that FAAH CC genotype only conveys risk for anxiety in individuals who are also carriers of the CRFR1 minor combination. FAAH genotype was significantly associated with baseline cortisol but was not independently associated with anxiety. Contrary to our predictions, baseline cortisol was negatively associated with anxiety. Lastly, we did not find any independent relationships between any of our SNPs and baseline cortisol or anxiety. These data suggest FAAH and cortisol interact to predict state anxiety, but that the relationship depends on CRFR1 genotype. The Project FRONTIER dataset is supported by Texas Tech University Health Sciences Center Garrison Institute on Aging.

Prolonged performance-related neuroendocrine activation and perseverative cognition in low- and high-anxious university music students

Music performances are social-evaluative situations that can elicit marked short-term neuroendocrine activation and anxious thoughts especially in musicians suffering from music performance anxiety (MPA). The temporal patterns of neuroendocrine activity and concert-related worry and rumination (perseverative cognition, PC) days before and after a concert in low- and high-anxious musicians are unknown. The first goal of the present study was to investigate the prolonged effects of a solo music performance and the effects of trait MPA on salivary cortisol (sC), alpha-amylase (sAA), and concert-related PC. The second goal was to investigate whether concert-related PC is associated with neuroendocrine activity and mediates the effects of measurement day and trait MPA on neuroendocrine responses. Seventy-two university music students collected saliva samples and reported their PC for seven consecutive days. On the fifth day, they performed solo. Measurement day and trait MPA were tested as main predictors of the diurnal area under the curve with respect to ground (sC AUCg, sAA AUCg), awakening responses, and PC. SC AUCg, sAA AUCg, and concert-related PC were highest on concert day. SC AUCg decreased only partially on post-concert days. SAA AUCg remained elevated on the first post-concert day among students with moderate to very high trait MPA. Throughout the assessment period, trait MPA was associated with smaller sC AUCg and higher concert-related PC. Concert-related PC showed significant positive associations with sC AUCg and sAA AUCg but did not mediate the effects of measurement day and trait MPA on these measures. These findings suggest that solo music performances have prolonged neuroendocrine effects and that trait MPA is an important factor having specific effects on university music students' hypothalamic-pituitary-adrenal axis, autonomic nervous system, and cognitive activity.

Heart rate variability is associated with psychosocial stress in distinct social domains

OBJECTIVE

Psychosocial stress is associated with substantial morbidity and mortality. Accordingly, there is a growing interest in biomarkers that indicate whether individuals show adaptive (i.e., stress-buffering and health-promoting) or maladaptive (i.e., stress-escalating and health-impairing) stress reactions in social contexts. As heart rate variability (HRV) has been suggested to be a biomarker of adaptive behavior during social encounters, it may be possible that inter-individual differences in HRV are associated with inter-individual differences regarding stress in distinct social domains.

METHODS

To test this hypothesis, resting state HRV and psychosocial stress was assessed in 83 healthy community-dwelling individuals (age: 18-35years). HRV was derived from heart rate recordings during spontaneous and instructed breathing to assess the robustness of possible associations between inter-individual differences in HRV and inter-individual differences in psychosocial stress. Psychosocial stress was determined with a self-report questionnaire assessing stress in distinct social domains.

RESULTS

A series of categorical and dimensional analyses revealed an association between inter-individual differences in HRV and inter-individual differences in psychosocial stress: Individuals with high HRV reported less stress in social life, but not in family life, work life or everyday life, than individuals with low HRV.

CONCLUSIONS

On basis of these findings, it may be assumed that individuals with high HRV experience less psychosocial stress than individuals with low HRV. Although such an assumption needs to be corroborated by further findings, it seems to be consistent with previous findings showing that individuals with high HRV suffer less from stress and stress-related disorders than individuals with low HRV.

The impact of pre-existing anxiety on affective and cognitive processing of a Virtual Reality analogue trauma

Dysfunctional processing of traumatic events may be in particular related to high trait anxiety as a pre-traumatic risk factor for the development of post-traumatic stress disorder (PTSD). However, as this has rarely been investigated in prospective, experimental studies, we aimed to analyse the association between high trait anxiety and affective as well as cognitive processing of stress using a new prospective Virtual Reality analogue trauma paradigm to overcome limitations of retrospective or current analogue designs. Individuals with high and low trait anxiety (N = 80) were exposed to a multi-sensory Virtual Reality emergency scenario while psychophysiological stress response, emotion regulation and intrusive memories were assessed. Our results showed that high trait anxiety individuals display increased (i) subjective stress responses, (ii) emotion dysregulation and (iii) intrusive memories upon VR analogue trauma exposure. In particular, our sample of high trait anxiety individuals displayed limited access to different emotion regulation strategies as well as increased worry and rumination regarding perceived intrusive memories. Considering the complex interplay of multiple risk factors, our findings suggests that peri-traumatic affective processing seems to mediate high trait anxiety and post-traumatic intrusive memories thereby pointing out the central role of peri-traumatic processes for intrusion development. In addition, HA as a modulating pre-traumatic risk factor might further increase the risk of later dysfunctional processing of an analogue trauma by interacting with factors of affective processing during analogue trauma exposure. Implications of these findings which may contribute to a higher risk to develop PTSD are discussed.

Emotion socialization as a predictor of physiological and psychological responses to stress

Reactivity patterns to acute stress are important indicators of physical and mental health. However, the relationships between emotion socialization and stress responses are not well understood. This study aimed to examine whether parental responses to negative emotions predicted physiological and psychological responses to acute stress in late adolescence and emerging adulthood, and whether these relationships varied by gender and ethnicity. Participants were 973 individuals (mean age=19.20years; 50% male; 63% African American, 34% European American) who reported on parental emotion socialization. Participants completed a standardized social stress test (the Trier Social Stress Test; TSST). Heart rate, blood pressure and salivary samples were assessed from baseline throughout the task and during recovery period. Psychological responses to stress were measured immediately after the TSST. Unsupportive parental responses to children's negative emotions were associated with blunted cortisol reactivity and greater negative emotions to a psychosocial stress task in females and African American youth, whereas supportive parental responses predicted greater cortisol reactivity and lower negative emotions to stress in European American youth, as well as less negative emotions in males. However, parental responses to negative emotions did not predict heart rate or SBP reactivity to the TSST. Findings suggest that parental emotion socialization may be an important factor influencing HPA axis reactivity and psychological responses to stress, with important differences across gender and ethnic youth subgroups.

Acute stress in residents during emergency care: a study of personal and situational factors

Providing care for simulated emergency patients may induce considerable acute stress in physicians. However, the acute stress provoked in a real-life emergency room (ER) is not well known. Our aim was to assess acute stress responses in residents during real emergency care and investigate the related personal and situational factors. A cross-sectional observational study was carried out at an emergency department of a tertiary teaching hospital. All second-year internal medicine residents were invited to voluntarily participate in this study. Acute stress markers were assessed at baseline (T1), before residents started their ER shift, and immediately after an emergency situation (T2), using heart rate, systolic, and diastolic blood pressure, salivary α-amylase activity, salivary interleukin-1 β, and the State-Trait Anxiety Inventory (STAI-s and STAI-t). Twenty-four residents were assessed during 40 emergency situations. All stress markers presented a statistically significant increase between T1 and T2. IL-1 β presented the highest percent increase (141.0%, p < .001), followed by AA (99.0%, p = .002), HR (81.0%, p < .001), DBP (8.0%, p < .001), and SBP (3.0%, p < .001). In the multivariable analysis, time of residency had a negative correlation with HR during the emergency (adjusted R-square = .168; F = 8.69; p = .006), SBP response (adjusted R-square = .210; F = 6.19; p = .005) and DBP response (adjusted R-square = .293; F = 9.09; p = .001). Trait anxiety (STAI-t) was positively correlated with STAI-s (adjusted R-square = .326; F = 19.9; p < .001), and number of procedures performed during emergency care had a positive association with HR response (adjusted R-square = .241; F = 5.02; p = .005). In the present study, emergency care provoked substantial acute stress in residents. Resident experience, trait anxiety, and number of emergency procedures were independently associated with acute stress response.

Social anxiety and the cortisol response to social evaluation in children and adolescents

Contradictory findings have been reported on the relation between social anxiety and the cortisol response to social evaluation in youth. The present longitudinal study aimed to clarify this relation by taking pubertal development into account. Data were collected in two waves, two years apart, for a community sample of 196 participants, aged 8-17 years at Time 1. Pubertal development and social anxiety were assessed with self-report questionnaires. Salivary cortisol was obtained before and after participants completed the Leiden Public Speaking Task. Data were analyzed using regression analysis with clustered bootstrap. The dependent variable was the cortisol area under the curve. Social anxiety and pubertal development scores were decomposed into between- and within-participants components. Between participants, the relation between social anxiety and the cortisol response to public speaking varied with pubertal development: socially anxious individuals showed higher responses at low levels of pubertal development, but lower responses at high levels of pubertal development. Within participants, an increase in social anxiety over time was associated with a lower cortisol response. The results are in line with the suggestion that the responses of socially anxious individuals change from elevated in childhood to attenuated in adolescence and adulthood. Attenuation of the cortisol response is explained by theories proposing that the stress response changes with the duration of the stressor.