Brief cognitive intervention can modulate neuroendocrine stress responses to the Trier Social Stress Test: buffering effects of a compassionate goal orientation

Compassion Dynamics in Medical Students: An Ecological Momentary Assessment Study

Effective interventions to support compassionate patient- and self-care requires an understanding of how to best assess compassion. Micro-ecological momentary assessment (micro-EMA), a method in which participants provide brief responses in real-time within their own environments, can capture changes in compassion across time and contexts. This study examined a micro-EMA approach for measuring the temporal dynamics of compassion in medical students during the COVID-19 pandemic. Medical students (N = 47) completed demographic information and self-report questionnaires assessing empathy and compassion for self and others. Participants then completed six bursts of micro-EMA smartphone-delivered surveys. Each burst was 14 days, with 28 days between bursts. During each burst, participants received four daily micro-EMA surveys assessing compassion, stress, positive affect, and negative affect. Dynamic structural equation modeling was used to examine micro-EMA responses. The overall micro-EMA response rate was 83.75%. On average, daily compassion did not significantly change across the academic year. However, there was significant within-person variability in medical students' compassion trajectories over the training year (b = 0.027, p < .01). At concurrent timepoints, micro-EMA assessed compassion was associated with greater happiness (b = 0.142, p < .001) and lower stress (b = -0.052, p < .05) but was not associated with sadness. In lagged analyses, higher micro-EMA assessed compassion predicted higher next day happiness (b = 0.116, p < .01) and vice versa (b = 0.185, p < .01). Results suggest it is feasible to use micro-EMA to assess daily levels of compassion among medical students. Additionally, there is wide variability in day-to-day fluctuations in compassion levels among medical students, with some students showing substantial increases in daily compassion across the training year and others showing decreases. Positive affect as opposed to negative affect may have particularly strong associations with compassion. Further examination of antecedents and consequences of fluctuations in daily compassion could inform potent intervention targets.

Do compassion and self-compassion moderate the relationship between childhood socioeconomic position and adulthood body composition?

The study aims to investigate the associations of compassion and self-compassion with body composition, and whether adulthood compassion and self-compassion moderate the relationship between childhood SEP and adulthood body composition. The participants came from the Northern Finland Birth Cohort 1986 Study (n = 789, 52.1% women), with a mean age of 34.0 years. Compassion and self-compassion were measured with the Dispositional Positive Emotions Scale and Self-Compassion Scale-Short Form, respectively. Body composition was assessed using anthropometric and body fat measurements at a clinic. Childhood SEP included parental occupation, education, and employment. The results showed that high compassion was associated with three out of the five body composition measurements, namely lower waist circumference (B = -0.960, p = 0.039, 95% CI: -1.870; -0.498), body fat percentage (B = -0.693, p = 0.030, 95% CI: -1.317; -0.069), and fat mass index (B = -0.325, p = 0.023, 95% CI: -0.605; -0.044) (adjusted for sex, and childhood and adulthood SEP) but not with body mass index or waist-to-hip ratio. Self-compassion was not associated with body composition. Neither compassion nor self-compassion moderated the association between childhood SEP and adulthood body composition, as the interaction effects were not significant. Therefore, the dispositions did not protect against the negative effects of childhood SEP on adulthood body composition. High other-directed compassion may be, however, associated with healthier body composition.

Values- versus monetary reward-enhanced exposure therapy for the treatment of social anxiety in emerging adulthood

Exposure therapy represents the gold-standard treatment for social anxiety, yet evidence indicates the need for improvement. One promising avenue involves linking exposures to a motivator. The current study examined the impact of intrinsically-rewarding, personal values-enhanced versus extrinsically-rewarding, monetary-enhanced exposure on short-term social anxiety fear and avoidance outcomes, and evaluated impacted initial treatment motivation and exposure generalization.

METHODS

Sixty emerging adults ages 17-26 with significantly elevated social and public speaking anxiety were randomized to receive values-enhanced exposure, monetary reward-enhanced exposure, or exposure alone. They completed a laboratory session with a brief intervention and speech exposure, one-week follow-up with novel exposure, and online follow-up two weeks later. Subjective and behavioral anxiety measures were collected.

RESULTS

Linking exposures to values decreased self-reported anxiety following the speech exposure retest, which generalized to anticipatory anxiety prior to a novel speech task. Linking exposures to money temporarily increased speech length, but this difference did not remain during the novel task. Conditions showed similar improvements on other outcomes.

CONCLUSION

Extrinsic motivators can temporarily motivate exposure engagement, whereas a brief values intervention can enhance exposure learning and decrease subjective anxiety across feared situations compared to monetary enhancement. If replicated, this has pragmatic implications for exposure framing within social anxiety treatment.

High compassion predicts fewer sleep difficulties: A general population study with an 11-year follow-up

INTRODUCTION

This study investigated the cross-sectional and longitudinal associations between self-reported compassion and sleep quality.

METHODS

The data came from the population-based Young Finns Study with an 11-year follow-up on compassion and sleep (n = 1064). We used regression models, multilevel models, and cross-lagged panel models to analyze the data.

RESULTS

The results showed that high compassion was cross-sectionally associated with lesser sleep deficiency and fewer sleep difficulties. High compassion also predicted fewer sleep difficulties over an 11-year follow-up (adjusted for age, gender, socioeconomic position in childhood and adulthood, body mass index, health behaviors, and working conditions). This association disappeared when controlling for depressive symptoms. The predictive pathway seemed to proceed more likely from high compassion to fewer sleep difficulties than vice versa.

DISCUSSION

Compassion may buffer against sleep difficulties, possibly via reducing depressive symptoms.

Exploration of possible sex bias in acute social stress research: a semi-systematic review

Stress can have a significant impact on the daily lives of individuals and can increase vulnerability to a number of medical conditions. This study aims to estimate the ratio of male to female participants in acute social stress research in healthy individuals. We examined original research articles published over the last 20 years. Each article was screened to determine the total number of female and male participants. We extracted data from 124 articles involving a total of 9539 participants. A total of 4221 (44.2%) participants were female, 5056 (53.0%) were male and 262 (2.7%) were unreported. Articles incorporating only females were significantly underrepresented compared to articles incorporating only males. Forty articles (63.5%) which presented data from both females and males, failed to analyse and interpret the results by sex, a significant methodological limitation. In conclusion, in the literature published over the last 20 years, female participants are significantly underrepresented. In the studies where females are represented, severe methodological limitations are apparent. Researchers should be conscious of sexual dimorphism, menstrual phase and use of hormonal contraception, which may impact the interpretation of their results.

A biobehavioral examination of emotional eating in adolescents: Evaluating the role of acute cortisol stress reactivity in the context of a multi-method assessment of eating in response to stress

Stress is linked to emotional eating among adolescents, which in turn increases risk for overweight/obesity (OW/OB) development and continuation. There is a lack of research disentangling chronic and acute stress as predictors of adolescent emotional eating. Further, there is a corresponding need to understand the effects of acute physiological stress reactivity within the context of adolescent emotional eating. The primary aim of this study was to examine the impact of cortisol stress reactivity on emotional eating in adolescents, above and beyond the effects of perceived chronic stress. The impact of subjective stress reactivity was also explored. Adolescents' (N = 49) intake of highly palatable snack foods was measured on separate control and stress-induction (following the Trier Social Stress Test for Children) days. A multi-method approach was used to assess objective (caloric intake) and subjective (self-report) emotional eating. Results indicated that greater cortisol reactivity, but not subjective stress reactivity, predicted subjective emotional eating, beyond the impact of chronic stress. Neither chronic stress nor subjective or objective stress reactivity predicted objective emotional eating following stress-induction. Findings point to the role of chronic stress and cortisol reactivity as risks for greater perceived emotional eating among adolescents, while elucidating differences between perceived and objective emotional eating. Future research should explore how chronic versus acute stress differentially contribute to adolescent weight management.

The relationship of trait-like compassion with epigenetic aging: The population-based prospective Young Finns Study

Introduction

Helping others within and beyond the family has been related to living a healthy and long life. Compassion is a prosocial personality trait characterized by concern for another person who is suffering and the motivation to help. The current study examines whether epigenetic aging is a potential biological mechanism that explains the link between prosociality and longevity.

Methods

We used data from the Young Finns Study that follows six birth-cohorts from age 3-18 to 19-49. Trait-like compassion for others was measured with the Temperament and Character Inventory in the years 1997 and 2001. Epigenetic age acceleration and telomere length were measured with five DNA methylation (DNAm) indicators (DNAmAgeHorvath, IEAA_Hannum, EEAA_Hannum, DNAmPhenoAge, and DNAmTL) based on blood drawn in 2011. We controlled for sex, socioeconomic status in childhood and adulthood, and body-mass index.

Results and discussion

An association between higher compassion in 1997 and a less accelerated DNAmPhenoAge, which builds on previous work on phenotypic aging, approached statistical significance in a sex-adjusted model (n = 1,030; b = -0.34; p = 0.050). Compassion in 1997 predicted less accelerated epigenetic aging over and above the control variables (n = 843; b = -0.47; p = 0.016). There was no relationship between compassion in 2001 (n = 1108/910) and any of the other four studied epigenetic aging indicators. High compassion for others might indeed influence whether an individual's biological age is lower than their chronological age. The conducted robustness checks partially support this conclusion, yet cannot rule out that there might be a broader prosocial trait behind the findings. The observed associations are interesting but should be interpreted as weak requiring replication.

Character virtues prospectively predict responses to situational stressors in daily life in clinical and subclinical samples

BACKGROUND

Character strengths and virtues may shape responses to stressors and risk for anxious and depressive distress. However, most studies have relied on cross-sectional designs, and it remains unclear whether virtues directly predict distress in daily life or buffer context-specific stressors. We tested whether higher-order intellectual (inquisitiveness), intrapersonal (self-control), and interpersonal virtues (caring) prospectively predicted coping responses and lower symptoms, and moderated effects of specific stressors on distress.

METHODS

Treatment-seeking individuals diagnosed with anxiety/depression (N = 81; Study 1) and students (N = 112; Study 2) completed the VIA Inventory of Strengths survey at baseline, then experience-sampling of daily symptoms and situational responses (perceptions and/or coping strategies) over seven days (Study 1) or five weeks (Study 2).

RESULTS

Multilevel models generally linked virtues to more adaptive daily responses during individuals' worst and best daily events (Study 1) and worst events (Study 2), but inquisitiveness unexpectedly predicted higher symptoms in both studies. Additionally, virtues buffered against the within-person effects of specific stressor perceptions on distress (Study 2).

CONCLUSIONS

The relevance of character virtues for anxiety, stress, and coping may be complex, predicting higher or lower symptoms depending on both the virtue and the situational context.

Social belonging, compassion, and kindness: Key ingredients for fostering resilience, recovery, and growth from the COVID-19 pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has led to increases in anxiety, depression, posttraumatic stress disorder, burnout, grief, and suicide, particularly for healthcare workers and vulnerable individuals. In some places, due to low vaccination rates and new variants of SARS-CoV-2 emerging, psychosocial strategies for remaining resilient during an ongoing multi-faceted stressor are still needed. Elsewhere, thanks to successful vaccination campaigns, some countries have begun reopening but questions remain regarding how to best recover, adjust, and grow following the collective stress and loss caused by the pandemic.

METHOD

Here, we briefly describe three evidence-based strategies that can help foster individual and collective recovery, growth, and resilience: cultivating social belonging, practicing compassion, and engaging in kindness.

RESULTS

Social belonging involves a sense of interpersonal connectedness. Practicing compassion involves perceiving suffering as part of a larger shared human experience and directing kindness toward it. Finally, engaging in kindness involves prosocial acts toward others.

CONCLUSIONS

Together, these strategies can promote social connectedness and help reduce anxiety, stress, and depression, which may help psychologists, policymakers, and the global community remain resilience in places where cases are still high while promoting adjustment and growth in communities that are now recovering and looking to the future.

Big five traits and interpersonal goals during stressors as predictors of hair cortisol

Background

Hair cortisol concentrations (HCC) provide a biomarker for stress adaptation, which has downstream health consequences. Personality traits (e.g., neuroticism) and social processes (e.g., chronic interpersonal goals) may confer risk or buffer against dysregulated cortisol secretion. However, few studies have examined personality or interpersonal factors predicting hair cortisol, which estimates longer-term secretion and therefore provides a potential biomarker for studying trait-like psychological processes. The present study investigated effects of personality traits and daily interpersonal goals during stressors on HCC.

Method

Participants (N = 90) reported Big Five traits at baseline, recorded interpersonal (self-image and compassionate) goals pursued during their worst psychosocial stressors for 4–5 weeks (1,949 entries), then provided a hair sample to estimate cortisol secretion over the past two months.

Results

As hypothesized, neuroticism predicted higher HCC, beyond other Big Five traits (b = 7.45, SE = 3.36, p = .029). Moreover, this effect was greater for those chronically striving to promote/protect one’s self-image during psychosocial stressors (b = 14.53, SE = 4.72, p = .003), and for those low in conscientiousness (b = 14.84, SE = 4.83, p = .003). Moderate extraversion was associated with higher HCC. Striving to support others (compassionate goals) exerted no direct or interactive effect on HCC, contrary to hypotheses.

Conclusions

Results support the relevance of neuroticism and maladaptive interpersonal strivings to longer-term neuroendocrine responses, suggesting hair cortisol as a potential method for studying links of trait-like psychological and HPA processes.

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Trait neuroticism uniquely predicted higher hair cortisol concentration.

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Interpersonal goals during chronic social stressors amplified effects of neuroticism.

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Trait conscientiousness blunted the effect of neuroticism on hair cortisol.

Rewards of Compassion: Dispositional Compassion Predicts Lower Job Strain and Effort-Reward Imbalance Over a 11-Year Follow-Up

Dispositional compassion has been shown to predict higher well-being and to be associated with lower perceived stress and higher social support. Thus, compassion may be a potential individual factor protecting from job strain. The current study examines (i) whether dispositional compassion predicts job strain and effort-reward imbalance (ERI) or does the predictive relationship run from job strain and ERI to dispositional compassion and (ii) the effect of dispositional compassion on the developmental trajectory of job strain and ERI over a 11-year follow-up. We used data from the Young Finns study (n=723) between 2001 and 2012. The direction of the predictive relationships was analyzed with cross-lagged panel models. Compassion’s effect on the trajectories of job strain, ERI, and their components was examined with multilevel models. First, the cross-lagged panel models demonstrated there was no evidence for the predictive pathways between compassion and job strain or its components. However, the predictive pathways from high dispositional compassion to low ERI and high rewards had better fit to the data than the predictive pathways in the opposite direction. In addition, multilevel models showed that high compassion predicted various job characteristics from early adulthood to middle age (lower job strain and higher job control as well as lower ERI and higher reward). Compassion did not predict job demand/effort. The findings were obtained independently of age, gender, and socioeconomic factors in childhood and adulthood. These findings indicate that compassion may be beneficial in work context. Further, compassion might be useful in the management or prevention of some aspects of strain. Our study provides new insight about the role of compassion in work life.

Genetic differential susceptibility to the parent-child relationship quality and the life span development of compassion

The development of compassion for others might be influenced by the social experiences made during childhood and has a genetic component. No research has yet investigated whether the parent-child relationship quality interacts with genetic variation in the oxytocin and dopamine systems in predicting compassion over the life span. In the prospective Young Finns Study (N = 2099, 43.9% men), we examined the interaction between mother-reported emotional warmth and intolerance toward their child assessed in 1980 (age of participants, 3-18 years) and two established genetic risk scores for oxytocin levels and dopamine signaling activity. Dispositional compassion for others was measured with the Temperament and Character Inventory 1997, 2001, and 2012 (age of participants, 20-50 years). We found a gene-environment interaction (p = .031) that remained marginally significant after adjustment for multiple testing. In line with the differential susceptibility hypothesis, only participants who carry alleles associated with low dopamine signaling activity had higher levels of compassion when growing up with emotionally warm parents, whereas they had lower levels of compassion when their parents were emotionally cold. Children's genetic variability in the dopamine system might result in plasticity to early environmental influences that have a long-lasting effect on the development of compassion. However, our findings need replication.

Compassionate goals predict COVID-19 health behaviors during the SARS-CoV-2 pandemic

We predicted that people with compassionate goals to support others and not harm them practiced more COVID-19 health behaviors during the SARS-CoV-2 pandemic to protect both themselves and others from infection. Three studies (N = 1,143 American adults) supported these predictions and ruled out several alternative explanations. Compassionate goals unrelated to the health context predicted COVID-19 health behaviors better than the general motivation to be healthy (Studies 2 and 3). In contrast, general health motivation predicted general health behaviors better than did compassionate goals. Compassionate goals and political ideology each explained unique variance in COVID-19 health behaviors (Studies 1-3). Compassionate goals predict unique variance in COVID-19 health behaviors beyond empathic concern, communal orientation, and relational self-construal (Study 3), supporting the unique contribution of compassionate goals to understanding health behaviors. Our results suggest that ecosystem motivation is an important predictor of health behaviors, particularly in the context of a highly contagious disease.

The moderated associations of self-compassion with physiological and psychological stress responses: Comparisons between cancer caregivers and non-caregivers

Self-compassion has been shown to be protective against stress. Whether its stress buffering effect differs between cancer caregivers and non-caregivers is unknown. This study examined the moderating effect of self-compassion among cancer caregivers relative to non-caregivers by recruiting cancer caregivers from the hospital and a community sample matching on sex and age. Participants completed a questionnaire which comprised the self-reported anxiety (STAI-6) and self-compassion (SCS-SF) measures, and administered cortisol sample collections with Salivette tubes at home. Whereas caregivers experienced higher diurnal cortisol level, the differential protective effects of self-compassion were only present against anxiety symptoms but not physiological stress.

Compassion protects against vital exhaustion and negative emotionality

We investigated (i) the predictive relationships of compassion with negative emotionality (a marker of susceptibility to stress) and vital exhaustion (a marker of chronic stress response) and (ii) the effect of compassion on the developmental courses of negative emotionality and vital exhaustion over a follow-up from early adulthood to middle age. We used the prospective Young Finns data (n = 1031-1495, aged 20-50). Compassion was evaluated in 1997, 2001, and 2012; and vital exhaustion and negative emotionality in 2001, 2007, and 2012. The predictive paths from compassion to vital exhaustion and negative emotionality were stronger than vice versa: high compassion predicted lower vital exhaustion and lower negative emotionality. The effect of high compassion on lower vital exhaustion and lower negative emotionality was evident from early adulthood to middle age. Overall, high compassion appears to protect against dimensions of stress from early adulthood to middle age, whereas this study found no evidence that dimensions of stress could reduce disposition to feel compassion for others' distress over a long-term follow-up.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11031-021-09878-2.

Functional Polymorphisms in Oxytocin and Dopamine Pathway Genes and the Development of Dispositional Compassion Over Time: The Young Finns Study

Background: We define compassion as an enduring disposition that centers upon empathetic concern for another person's suffering and the motivation to act to alleviate it. The contribution of specific candidate genes to the development of dispositional compassion for others is currently unknown. We examine candidate genes in the oxytocin and dopamine signaling pathways.

Methods: In a 32-year follow-up of the Young Finns Study (N = 2,130, 44.0% men), we examined with multiple indicators latent growth curve modeling the molecular genetic underpinnings of dispositional compassion for others across the life span. We selected five single nucleotide polymorphisms (SNPs) whose functions are known in humans: rs2268498 (OXTR), rs3796863 (CD38) (related to lower oxytocin levels), rs1800497 (ANKK1/DRD2), rs4680 (COMT), and rs1611115 (DBH) (related to higher dopamine levels). Compassion was measured with Cloninger's Temperament and Character Inventory on three repeated observations spanning 15 years (1997–2012). Differences between gender were tested.

Results: We did not find an effect of the five SNPs in oxytocin and dopamine pathway genes on the initial levels of dispositional compassion for others. Individuals who carry one or two copies of the T-allele of DBH rs1611115, however, tend to increase faster in compassion over time than those homozygotes for the C-allele, b = 0.063 (SE = 0.027; p = 0.018). This effect was largely driven by male participants, 0.206 (SE = 0.046; p < 0.001), and was not significant in female participants when analyzed separately.

Conclusions: Men who are known to have, on average, lower compassion than women seem to reduce this difference over time if they carry the T-allele of DBH rs1611115. The direction of the association indicates that dopamine signaling activity rather than overall dopamine levels might drive the development of compassion.

The relationship of socioeconomic status in childhood and adulthood with compassion: A study with a prospective 32-year follow-up

The objective of this study was to investigate (i) whether childhood family SES predicts offspring’s compassion between ages 20–50 years and (ii) whether adulthood SES predicts compassion or vice versa. We used the prospective population-based Young Finns data (N = 637–2300). Childhood family SES was evaluated in 1980; participants’ adulthood SES in 2001 and 2011; and compassion for others in 1997, 2001, and 2012. Compassion for others was evaluated with the Compassion scale of the Temperament and Character Inventory. The results showed that high childhood family SES (a composite score of educational level, occupational status, unemployment status, and level of income) predicted offspring’s higher compassion between ages 30–40 years but not in early adulthood or middle age. These results were obtained independently of a variety of potential confounders (disruptive behavior in childhood; parental mental disorder; frequency of parental alcohol use and alcohol intoxication). Moreover, high compassion for others in adulthood (a composite score of educational level, occupational status, and unemployment status) predicted higher adulthood SES later in their life (after a 10-year follow-up), but not vice versa. In conclusion, favorable socioeconomic environment in childhood appears to have a positive effect on offspring’s compassion in their middle adulthood. This effect may attenuate by middle age. High compassion for others seems to promote the achievement of higher SES in adulthood.

Risky emotional family environment in childhood and depression-related cytokines in adulthood: The protective role of compassion

BACKGROUND

Previously, compassion has been found to protect against depressive symptoms, while emotional adversities in childhood are suggested to increase inflammatory responses. The current study investigated (a) whether emotional family environment in childhood predicts levels of such cytokines in adulthood that are previously found to be elevated in depression (interleukin [IL]-2, IL-6, IL-1b, monocyte chemoattractant protein-1, interferon-gamma [IFN-γ], and tumor necrosis factor alpha [TNF-α]) and (b) whether these associations are modified by compassion in adulthood.

METHODS

The participants (N = 1,198-1,523) came from the prospective population-based Young Finns data. Emotional family environment and parental socioeconomic factors were evaluated in 1980; participants' compassion in 2001; and participants' cytokine levels and adulthood covariates in 2007.

RESULTS

Risky emotional family environment in childhood predicted higher levels of IL-2, IL-6, IFN-γ, and TNF-α in adulthood. Additionally, there were significant interaction effects between compassion and emotional risk in childhood, when predicting IL-2, IL-6, and TNF-α. Specifically, individuals who grew up in a risky emotional family environment had on average higher levels of IL-2, IL-6, and TNF-α in adulthood when combined with low compassion.

CONCLUSIONS

In individuals coming from risky emotional family environments, high compassion for others may protect against elevated levels of cytokines previously linked with depression.

The influence of age, gender and the FKBP5 genotype on subjective health complaints in the Norwegian working population

OBJECTIVE

In the present study we examined the potential association between age, gender, the genetic variant FKBP5 rs9470080 and subjective health complaints.

METHODS

The data were collected through a three-wave nationally representative survey of 1060 Norwegian employees drawn from the Norwegian Central Employee Register by Statistics Norway. The follow-up period was six months. Subjective health complaints were scored by eight items reflecting; headache, neck pain, mid- and low back pain, stomach cramps or intestinal discomfort, problems with sleep onset or maintenance and early morning awakening. Genotyping with regard to FKBP5 rs9470080, previously linked to cortisol sensitivity, was carried out using Taqman assay.

RESULTS

The baseline data showed that in women, levels of subjective health complaints were highest among those above 50 years of age. Moreover, in women the rs9470080 CC variant at baseline was associated with higher levels of subjective health complaints. However, the effect size was not large, and no relationships were demonstrated between age or genotype and subjective health complaints in men. Also, the study variables were not related to any changes in the levels of subjective health complaints during the follow-up period.

CONCLUSION

We conclude that our biology such as age and sex, but also single genetic variants found in non-sex chromosomes, may be important in understanding the mechanisms underlying subjective health complaints in the general working population.

A systematic review of the Trier Social Stress Test methodology: Issues in promoting study comparison and replicable research

Since its development in 1993, the Trier Social Stress Test (TSST) has been used widely as a psychosocial stress paradigm to activate the sympathetic nervous system and hypothalamic-pituitary-adrenal axis (HPAA) stress systems, stimulating physiological functions (e.g. heart rate) and cortisol secretion. Several methodological variations introduced over the years have led the scientific community to question replication between studies. In this systematic review, we used the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) to synthesize procedure-related data available about the TSST protocol to highlight commonalities and differences across studies. We noted significant discrepancies across studies in how researchers applied the TSST protocol. In particular, we highlight variations in testing procedures (e.g., number of judges, initial number in the arithmetic task, time of the collected saliva samples for cortisol) and discuss possible misinterpretation in comparing findings from studies failing to control for variables or using a modified version from the original protocol. Further, we recommend that researchers use a standardized background questionnaire when using the TSST to identify factors that may influence physiological measurements in tandem with a summary of this review as a protocol guide. More systematic implementation and detailed reporting of TSST methodology will promote study replication, optimize comparison of findings, and foster an informed understanding of factors affecting responses to social stressors in healthy people and those with pathological conditions.

Stress-induced cortisol reactivity as a predictor of success in treatment for affective dimensions

BACKGROUND

Response rates to first-line treatments for depression and anxiety remain unsatisfactory. Identification of predictors or moderators that can optimize treatment matching is of scientific and clinical interest. This study examined the role of prolonged laboratory-induced stress cortisol reactivity as a predictor of outcome for a treatment of affective dimensions (TAD). Patients received 15-sessions of a treatment targeting reductions in negative affect or increases in positive affect (Craske et al., 2019). A second aim was to examine whether treatment type would moderate the association between cortisol reactivity and treatment outcome.

METHODS

Thirty-five participants underwent a 36-minute intermittent stress induction task composed of a mental arithmetic task and a fear-potentiated startle task one week before treatment initiation. Cortisol was collected at five-time points with reactivity being quantified as peak during the task minus basal level of cortisol the evening before the assessment. Using multilevel modeling, we examined the associations between cortisol reactivity and slopes of symptom improvement.

RESULTS

Cortisol reactivity was related to treatment outcome, with average and higher levels of stress-induced cortisol response predicting greater decreases in symptoms throughout treatment and 6-month follow-up. Treatment condition differences (moderation) were not observed in the effect of cortisol reactivity on symptoms.

CONCLUSION

Our findings demonstrate the impact of greater cortisol stress reactivity on treatment outcome. Future studies should investigate how to enhance this therapeutic benefit through capitalizing on endogenous diurnal fluctuations or exogenous cortisol manipulation.

Somatic complaints in early adulthood predict the developmental course of compassion into middle age

OBJECTIVE

The aim of the present study was to investigate (i) whether somatic complaints predict the developmental course of compassion in adulthood, and (ii) whether this association depends on alexithymic features.

METHODS

The participants came from the population-based Young Finns study (N = 471-1037). Somatic complaints (headache, stomachache, chest pain, backache, fatigue, exhaustion, dizziness, heartburn, heartbeat, and tension) were evaluated with a self-rating questionnaire in 1986 when participants were aged between 18 and 24 years. Compassion was assessed with the Compassion Scale of the Temperament and Character Inventory (TCI) in 1997, 2001, and 2012. The data were analyzed using growth curve models.

RESULTS

We obtained a significant compassion-age interaction (B = -0.137, p = .02) and a compassion-age squared interaction (B = 0.007, p = .006), when predicting the course of somatic complaints. Specifically, in participants without frequent somatic complaints, compassion steadily increased with age in adulthood. In participants with frequent somatic complaints, however, compassion remained at a lower level until the age of 40 years, then started to increase, and achieved the normal level of compassion approximately at the age of 50 years. The association between somatic complaints and compassion over age was found to be independent of alexithymic features. The analyses were adjusted for a variety of covariates (age, gender, use of health care in childhood, depression in childhood, parental socioeconomic factors, parental care-giving practices, stressful life events, parental alcohol intoxication, and participants' socioeconomic factors in adulthood).

CONCLUSION

Frequent somatic complaints may predict delayed development of compassion in adulthood. This association was found to be independent of alexithymic features.

Psychoneuroendocrinoimmunology-based meditation (PNEIMED) training reduces salivary cortisol under basal and stressful conditions in healthy university students: Results of a randomized controlled study

BACKGROUND

Meditation represents an effective and safe practice to lower distress and promote well-being. PsychoNeuroEndocrinoImmunology-based Meditation (PNEIMED) is a validated method that can reduce stress-related symptoms and salivary cortisol secretion. To date, few randomised controlled trials (RCTs) have assessed cortisol levels through salivary samples, collected both in the morning phase and during acute mental stress elicitation, in healthy young subjects following brief meditation training.

AIM

The present study aims to investigate, in healthy young undergraduate students, the effects of a brief PNEIMED training course on HPA axis by measuring salivary cortisol levels.

METHODS

Forty students attending the Faculty of Psychology, without comorbidities and previous experience of meditation, were enrolled in the study. Twenty subjects were randomly assigned to 30 h of PNEIMED training (intervention group, IG), and twenty subjects were randomly assigned to 30 h of academic lessons (control group, CG). Salivary cortisol measures included basal morning (t0 = baseline time, collected 30 min after waking) and under stress-eliciting task values. Cortisol measurement under the stress-eliciting task was provided through the Subtraction Stress Task (SST) at scheduled time intervals (t1 = 5 min pre-SST, t2 = 10 min post-SST, t3 = 30 min = post-SST). Salivary cortisol was measured among all subjects (IG + CG) at the beginning (pre-test) and at the end (post-test, four days later) of the study.

RESULTS

ANOVA between-group analysis of basal diurnal salivary cortisol showed a significant hormone deflection in the IG at the end of the PNEIMED course (post-test) when compared to the CG (IG post-test 5.64 ± 4.2 vs CG post-test 9.44 ± 4.9; F_1,38 = 6.838; p = 0.013). RM-ANOVA within-group analysis for the IG also showed that time and condition effects were statistically significant, with Ftime = 5.438; p = 0.002 and Fcondition = 10.478; p = 0.004, respectively. The IG group presented a significant reduction in basal morning cortisol at the end of the PNEIMED course (post-test) compared to the salivary concentration at baseline (pre-test) (IG pre-test 9.42 ± 6.0 vs IG post-test 5.64 ± 4.2; F_1,38 8,354; p = 0.009). RM-ANOVA for the control group showed only the main effect of time (F_1,38 = 40.348; p < 0.001). Regarding cortisol measures under the SST-stress eliciting task, ANOVA between-groups analysis showed higher cortisol levels in the IG than in the CG before the PNEIMED course, with significant differences between groups at time t2 and time t3. After the PNEIMED course, the cortisol levels in the IG had decreased, although the differences between groups were not significant. Interestingly, ANOVA within-groups analysis showed that in the IG, the cortisol levels post-test (after the PNEIMED course) were lower than at pre-test (before the PNEIMED course), showing a significant difference of cortisol salivary concentration between conditions at t3 (F = 5.326; p = 0.032). In the control group, the post-hoc analyses for pairwise comparisons between conditions (pre-test vs post-test) did not show significant differences.

CONCLUSION

Although the low number of subjects enrolled in the study does not allow for definitive conclusions to be drawn, the present findings confirmed the capability of the PNEIMED method to lower stress hormone secretion both at baseline and under acute mental stimulation in a group of young naïve practitioners and make a contribution to the existing literature by increasing the number of published RCTs about the topic.

Cognitive behavioral therapy, mindfulness, and cortisol habituation: A randomized controlled trial

BACKGROUND

Hypothalamic-pituitary-adrenocortical (HPA) axis dysregulation is associated with disease and may be indexed by poor cortisol habituation (i.e., a failure to show decreased responding with repeated stressor exposure). Thus, stress management training that can enhance HPA axis habituation may benefit health. To date, the effects of Mindfulness Based Stress Reduction (MBSR) and Cognitive Behavioral Therapy (CBT) interventions on HPA axis habituation remain untested. To test the effects of MBSR and CBT on HPA axis habituation, the present study used a parallel arm randomized controlled trial.

METHODS

Healthy adults reporting moderate-to-high stress (n = 138) were randomly assigned to a 6-week MBSR intervention, a 6-week CBT intervention, or Waitlist control group. Post-intervention, participants completed a social-evaluative performance stressor during each of two laboratory visits scheduled 48-h apart. Salivary cortisol was collected pre-stressor, and 25, 35, and 60 min post-stressor onset during each visit. Final analyses included 86 participants who completed procedures up to the first laboratory visit.

RESULTS

Relative to the control condition, both MBSR and CBT groups showed greater cortisol habituation. The MBSR group exhibited marginally greater habituation than the Waitlist group in cortisol samples corresponding to the recovery time points (35 and 60 min post-stressor onset). In contrast, the CBT group showed greater habituation than the Waitlist across all sampling timepoints collected (pre-stressor, 25, 35, and 60 min post-stressor onset). Yet, the CBT group also demonstrated elevated pre-stressor cortisol during the first visit.

CONCLUSIONS

Results suggest that MBSR and CBT interventions promote greater HPA axis habituation relative to no training, but do not reduce overall cortisol output (i.e., across both visits). Observed differences between CBT and MBSR training in relation to cortisol habituation are discussed.

The relationship of dispositional compassion for others with depressive symptoms over a 15-year prospective follow-up

BACKGROUND

The aim of this study was to investigate (i) the direction of the relationships between dispositional compassion for others and depressive symptoms over a 15-year follow-up in adulthood and (ii) the longitudinal associations of dispositional compassion with total depressive symptoms and various depressive subsymptoms (i.e. negative attitude, performance difficulties, and somatic complaints) from early adulthood to middle age.

METHODS

The participants (N = 1676) came from the prospective Young Finns Study. Dispositional compassion was assessed with the Temperament and Character Inventory and depressive symptoms with a modified version of the Beck Depression Inventory. The measurements were conducted between 1997-2012 including three measurement points. The data was analyzed using structural equation models and multilevel models for longitudinal design.

RESULTS

The predictive relationships were more likely to proceed from high dispositional compassion for others to lower depressive symptoms than in the opposite direction. Additionally, high dispositional compassion predicted a lower total score of depressive symptoms and also lower scores of various depressive subsymptoms (negative attitude, performance difficulties, somatic complaints) in early adulthood. These associations, however, weakened over years and became non-significant in middle age. All the findings were sustained after controlling for age, gender, and socioeconomic factors in childhood and adulthood.

LIMITATIONS

Depressive symptoms were mostly mild and non-clinical in our sample. The findings cannot be directly generalized to severe depressive symptomatology.

CONCLUSIONS

When tailoring psychiatric interventions, it is necessary to be aware that compassion for others may lower the risk for the onset and maintenance of depressive symptoms, especially in early adulthood.

Compassionate Goals Predict Social Support and PTSD Symptoms Following a University Shooting: A Moderated Mediation Analysis

Introduction: Social support is known to buffer posttraumatic stress disorder (PTSD) symptoms, but the stress-buffering properties of striving to help and support others (compassionate goals) have received less attention. Recent research suggests that compassionate goals shape social support processes and dampen stress responses following social threat, but their relevance to trauma have not been examined. The present study tested whether, in the aftermath of a university mass shooting, compassionate goals concurrently and prospectively predicted lower PTSD symptoms indirectly via higher social support, and whether this mediation would be stronger with higher proximity to the trauma.

Method: Participants (N = 369) completed measures four months post-shooting (Time 1), and a subset (n = 85) repeated outcome variables at eight months (Time 2).

Results: As hypothesized, there was a significant moderated mediation, with trauma proximity moderating the indirect effect of compassionate goals on PTSD symptoms at Time 1 (B = −0.88, SE = 0.28, 95% CI [−1.47, −0.37]) and prospectively at Time 2 (B = −1.12, SE = 0.77, 95% CI [−3.16, −0.03]), although not when controlling for Time 1 symptoms. The indirect effects were greatest for those with higher trauma proximity, suggesting particular relevance for individuals most at risk for trauma-related difficulties.

Discussion: These findings suggest the need for further research into compassionate goals and strategies for fostering them, particularly in the context of social or community traumas.

Resilience characteristics and prior life stress determine anticipatory response to acute social stress in children aged 7-11 years

OBJECTIVES

To assess the interplay of prior life stress and characteristics of resilience in determining how children cope with potentially stressful situations, using a two-phase study that triangulates parent-child dyadic interview data with subsequent experience of an acute laboratory stressor in 7-11-year-olds.

METHODS

Participants (n = 34) were designated as being in one of four groups based on high/low levels of prior stress experience and high/low resilience ratings assessed during at-home interviews and from questionnaires measuring recent life events, hassles, and trait coping. During a subsequent laboratory stress protocol, salivary cortisol and heart rate were monitored, and a verbal subjective report was provided.

RESULTS

Salivary cortisol showed a significant increase in anticipation of the stress test, heart rate increased during the test, and children self-reported the task as stressful. Males displayed higher levels of cortisol than females in the anticipatory period. We observed no increase in salivary cortisol in response to the stress testing phase. Using the stress/resilience categorization, children with a higher level of resilience were differentiated by cortisol level in anticipation of the acute stress experiment based on their level of prior life stress. Highly resilient children with greater experience of prior life stress showed a lower anticipatory cortisol response than highly resilient children with less experience of prior life stress.

CONCLUSIONS

This study highlights the relevance of contextual factors, such as prior stress experience and resilience, in physiological response to the anticipation of acute stress and has implications for understanding how children cope with stressful experiences. Statement of contribution What is already known on this subject? An adaptation to the stress testing paradigm, the Bath Experimental Stress Test for Children (BEST-C) was found to reliably induce a salivary cortisol response in young children, suggesting that peer matching the audience was an effective modification to laboratory social stress testing. Recent work focusing on early life adversity has seen the emergence of prior stress experience and resilience as key factors in the examination of acute stress responses. However, much of the research regarding the impact of childhood stress is ambiguous; some research suggests that if children have experienced prior stressful life events this will enact a positive effect on stress responses and lead to resilience, and other research suggested that it will have a compounding negative effect. What does the study add? Findings provide support for the capacity of the BEST-C to induce an anticipation stress response in children. Contextual factors e.g., prior stress experience and resilience are key for understanding stress responses. Resilient children with more experience of stress show lower cortisol than those with less stress experience.

Functional TSPO polymorphism predicts variance in the diurnal cortisol rhythm in bipolar disorder

INTRODUCTION

Psychosocial stress contributes to onset/exacerbation of mood episodes and alcohol use, suggesting dysregulated diurnal cortisol rhythms underlie episodic exacerbations in Bipolar Disorder (BD). However, mechanisms underlying dysregulated HPA rhythms in BD and alcohol use disorders (AUD) are understudied. Knowledge of associated variance factors have great clinical translational potential by facilitating development of strategies to reduce stress-related relapse in BD and AUD. Evidence suggests structural changes to mitochondrial translocator protein (TSPO) (a regulator of steroid synthesis) due to the single nucleotide polymorphism rs6971, may explain much of this variance. However, whether rs6971 is associated with abnormal HPA rhythms and clinical exacerbation in humans is unknown.

METHODS

To show this common TSPO polymorphism impacts HPA rhythms in BD, we tested whether rs6971 (dichotomized: presence/absence of polymorphism) predicted variance in diurnal cortisol rhythm (saliva: morning and evening for 3 days) in 107 BD (50 with and 57 without AUD) and 28 healthy volunteers of similar age and ethno-demographic distribution.

RESULTS

Repeated measures ANOVA confirmed effects BD (F5,525 = 3.0, p = 0.010) and AUD (F5,525 = 2.9, p = 0.012), but not TSPO polymorphism (p > 0.05). Interactions were confirmed for TSPO × BD (F5,525 = 3.9, p = 0.002) and for TSPO × AUD (F5,525 = 2.8, p = 0.017).

DISCUSSION

We identified differences in diurnal cortisol rhythm depending on presence/absence of common TSPO polymorphism in BD volunteers with or without AUD and healthy volunteers. These results have wide ranging implications but further validation is needed prior to optimal clinical translation.

Pituitary volume reduction in schizophrenia following cognitive behavioural therapy

Cognitive behavioural therapy (CBT) for psychosis (CBTp) aims to lower the stress of psychotic symptoms. Given that the pituitary is involved in stress regulation, CBT-led stress reduction may be accompanied by a change in pituitary volume. This study aimed to determine whether CBTp reduces pituitary volume in schizophrenia. The relation between pre-therapy memory and CBTp-led pituitary volume change was also examined given that poor memory relates to a blunted cortisol awakening response, denoting impaired stress response, in schizophrenia. Pituitary volume was measured at baseline in 40 schizophrenia or schizoaffective disorder patients and 30 healthy participants before therapy. Pituitary volume was measured again 6-9months after patients had either received CBTp in addition to standard care (CBTp+SC, n=24), or continued with standard care alone (SC, n=16). CBTp+SC and SC groups were compared on pituitary volume change from baseline to follow-up. Pre-therapy memory performance (Hopkins Verbal Learning and Wechsler Memory Scale - Logical memory) was correlated with baseline-to-follow-up pituitary volume change. Pituitary volume reduced over time in CBTp+SC patients. Additionally, pre-therapy verbal learning correlated more strongly with longitudinal pituitary volume reduction in the CBTp+SC group than the SC group. To conclude, CBTp reduces pituitary volume in schizophrenia most likely by enhancing stress regulation and lowering the distress due to psychotic symptoms.

Acceptance lowers stress reactivity: Dismantling mindfulness training in a randomized controlled trial

OBJECTIVE

Mindfulness interventions, which train practitioners to monitor their present-moment experience with a lens of acceptance, are known to buffer stress reactivity. Little is known about the active mechanisms driving these effects. We theorize that acceptance is a critical emotion regulation mechanism underlying mindfulness stress reduction effects.

METHOD

In this three-arm parallel trial, mindfulness components were dismantled into three structurally equivalent 15-lesson smartphone-based interventions: (1) training in both monitoring and acceptance (Monitor+Accept), (2) training in monitoring only (Monitor Only), or (3) active control training (Coping control). 153 stressed adults (mean age=32years; 67% female; 53% white, 21.5% black, 21.5% Asian, 4% other race) were randomly assigned to complete one of three interventions. After the intervention, cortisol, blood pressure, and subjective stress reactivity were assessed using a modified Trier Social Stress Test.

RESULTS

As predicted, Monitor+Accept training reduced cortisol and systolic blood pressure reactivity compared to Monitor Only and control trainings. Participants in all three conditions reported moderate levels of subjective stress.

CONCLUSIONS

This study provides the first experimental evidence that brief smartphone mindfulness training can impact stress biology, and that acceptance training drives these effects. We discuss implications for basic and applied research in contemplative science, emotion regulation, stress and coping, health, and clinical interventions.

Biological and perceived stress in motor functional neurological disorders

BACKGROUND

Current models explaining motor functional neurological disorders (FND) integrate both the neurobiological mechanisms underlying symptoms production and the role of psychosocial stressors. Imaging studies have suggested abnormal motor control linked to impaired emotional and stress regulation. However, little is known on the biological stress regulation in FND. Our aim was to study the biological and perceived response to stress in patients with motor FND.

METHODS

Sixteen patients with motor FND (DSM-5 criteria) and fifteen healthy controls underwent the Trier Social Stress Test. Hypothalamo-pituitary-adrenal axis (HPA) response was evaluated with salivary cortisol and autonomous sympathetic response with salivary alpha-amylase. Area under the curve was computed to reflect background levels (AUCg) and change over time (AUCi). Life adversities and perceived subjective stress on a visual analog scale (VAS) were correlated with biological responses.

RESULTS

FND patients had significantly higher background levels (AUCg) of both stress markers (cortisol and amylase) than controls. The biological response (AUCi) to stress did not differ between groups for both markers but the subjective response showed an interaction effect with patients reporting higher levels of stress than controls. After stress, controls showed a strong correlation between subjective and objective sympathetic values (amylase) but not patients. The number and subjective impact of adverse life events correlated with cortisol AUCg in patients only.

CONCLUSION

This study confirms a baseline HPA-axis and sympathetic hyperarousal state in motor FND related to life adversities. During a social stress, dissociation between perceived stress and biological markers was observed in patients only, reflecting a dysregulation of interoception capacity, which might represent an endophenotype of this disorder.

Mediators of compassionate goal intervention effects on human neuroendocrine responses to the Trier Social Stress Test

OBJECTIVES

The hypothalamic-pituitary-adrenal (HPA) axis is thought to mediate the effects of stress on illness. Research has identified a limited number of psychological variables that modulate human HPA responses to stressors (e.g. perceived control and social support). Prosocial goals can reduce subjective stress, but have not been carefully examined in experimental settings where pathways of impact on biological stress markers may be traced. Recent work demonstrated that coaching individuals to strive to help others reduced HPA responses to the Trier Social Stress Test (TSST) relative to other cognitive interventions. However, identification of mediational pathways, which were not examined in the original study, is necessary to determine whether the HPA buffering effects were due to helping motivations (compassionate goals; CGs) rather than via previously identified variables such as control or support.

METHODS

In this new analysis, we combined the original cortisol data with novel observer ratings of interpersonal behavior and psychological variables during the stress task, and conducted new, theory-driven analyses to determine psychological mediators for the intervention's effect on cortisol responses (N = 54; 21 females, 33 males; 486 cortisol samples).

RESULTS

Control, support, and task ego-threat failed to account for the effects of the intervention. As hypothesized, self and observer-rated CGs, as well as observer-rated perceptions of participants' interpersonal behavior as morally desirable (but not as dominant or affiliative) were significant mediators of neuroendocrine responses.

CONCLUSIONS

The findings suggest that stress-reduction interventions based on prosocial behavior should target particular motivational and interpersonal features.

Specific reduction in cortisol stress reactivity after social but not attention-based mental training

Psychosocial stress is a public health burden in modern societies. Chronic stress-induced disease processes are, in large part, mediated via the activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal-medullary system. We asked whether the contemplative mental training of different practice types targeting attentional, socio-affective (for example, compassion), or socio-cognitive abilities (for example, perspective-taking) in the context of a 9-month longitudinal training study offers an effective means for psychosocial stress reduction. Using a multimethod approach including subjective, endocrine, autonomic, and immune markers and testing 313 participants in a standardized psychosocial laboratory stressor, we show that all three practice types markedly reduced self-reported stress reactivity in healthy participants. However, only the training of intersubjective skills via socio-affective and socio-cognitive routes attenuated the physiological stress response, specifically the secretion of the HPA axis end-product cortisol, by up to 51%. The assessed autonomic and innate immune markers were not influenced by any practice type. Mental training focused on present-moment attention and interoceptive awareness as implemented in many mindfulness-based intervention programs was thus limited to stress reduction on the level of self-report. However, its effectiveness was equal to that of intersubjective practice types in boosting the association between subjective and endocrine stress markers. Our results reveal a broadly accessible low-cost approach to acquiring psychosocial stress resilience. Short daily intersubjective practice may be a promising method for minimizing the incidence of chronic social stress-related disease, thereby reducing individual suffering and relieving a substantial financial burden on society.

Altered stress system reactivity after pediatric injury: Relation with post-traumatic stress symptoms

Injury is the leading cause of death and disability in childhood. Injured children are at high risk for developing alterations in stress response systems and post-traumatic stress symptoms (PTSS) that may compromise long-term physical and psychological health. In a prospective, observational cohort study, we examined individual differences in, and correlates of, stress-reactivity of the hypothalamic-pituitary-adrenal axis (HPA; salivary cortisol) and autonomic nervous system (ANS; salivary alpha amylase, sAA) following pediatric injury. Participants were 8-15 years of age and hospitalized for traumatic brain injury (TBI; n=55; M age=13.9 yrs; 40 males) or extracranial injury (EI; n=29; M age 12.3 yrs, 20 males) following vehicular accidents. Six months post-injury, saliva was collected before and after the Trier Social Stress Test and later assayed for cortisol and sAA. Relative to a healthy non-injured comparison group (n=33; M age=12.5 yrs, 16 males), injured children (ages 8-12 years), but not adolescents (ages 13-15 yrs), had higher cortisol levels; regardless of age, injured participants showed dampened cortisol reactivity to social evaluative threat. Compared to participants with EI, children with TBI had elevated cortisol and adolescents had elevated sAA. With respect to PTSS, individual differences in sAA were negatively correlated with avoidance in the TBI group and positively correlated with emotional numbing within the EI group. Importantly, psychological and neurobiological sequelae were weakly related to injury severity. Given the high prevalence of pediatric injury, these sequelae affect many children and represent a significant public health concern. Consequently, surveillance of post-traumatic sequelae should include the full spectrum of injury severity. Monitoring the activity, reactivity, and regulation of biological systems sensitive to environmental insults may advance our understanding of individual differences in sequelae and adaptation following traumatic pediatric injury.

Temperament, coping, and involuntary stress responses in preadolescent children: the moderating role of achievement goal orientation

BACKGROUND AND OBJECTIVES

Developmental theorists posit that temperament contributes to preadolescent's stress response styles. Findings from empirical studies, however, have yielded mixed results, thus indicating a need to consider moderators of this relation. Utilizing an analytic framework guided by resiliency theory [Zimmerman, M. A. (2013). Resiliency theory: A strengths-based approach to research and practice for adolescent health. Health Education & Behavior, 40, 381-383], this study examined achievement goal orientation as a moderator of the relation between temperament and stress response styles.

METHODS

96 preadolescent-parent dyads (M_age = 10.30 years, range = 9-12 years) participated in the study. Preadolescents reported on their achievement goal orientation, coping and involuntary stress responses (ISRs) styles and a parent reported on children's temperament.

RESULTS

Multiple regressions revealed that effortful control positively predicted preadolescent's predominant use of engagement coping and negatively predicted predominance of ISRs, but only for children with a predominant mastery goal orientation. For preadolescents with a predominant performance goal orientation, effortful control negatively predicted the predominant use of engagement coping and positively predicted predominance of ISRs. Negative affectivity and its interaction with goal orientation did not predict coping or ISR styles.

CONCLUSIONS

Findings suggest that a predominant mastery goal orientation may function as a promotive factor by enhancing the contribution of effortful control to engagement coping styles and buffering against unmanaged reactivity.

The psychology of HPA axis activation: Examining subjective emotional distress and control in a phobic fear exposure model

The HPA axis plays a key role in mediating the effects of "stress" on health, but clarifying mechanisms requires an understanding of psycho-biological linkages. There has long been an implicit assumption that subjective emotional distress (e.g., fear) should activate the HPA axis. Although this assumption was challenged 25 years ago (Curtis, 1976), laboratory studies in humans are limited. In this study we sought to replicate Curtis' findings and extend it by investigating if presence or absence of stressor control shapes HPA axis reactivity in a phobic fear exposure model. We recruited 19-45-year-old specific phobia participants (n=32 spider/snake phobia; n=14 claustrophobia) and gradually exposed them to their feared object or situation while measuring hormonal (ACTH and cortisol) and subjective (emotional distress, perceived control) responses. Utilizing a dyadic yoked design, we compared HPA reactivity when the pace of exposure was controlled by participants to identical exposure given to matched participants in the absence of control. Results showed that phobic fear exposure generated intense emotional distress without a corresponding increase in HPA axis activity. Although our actual manipulation of control failed to impact HPA responses, perceived control during exposure was associated with lower cortisol, an effect that was moderated by actual availability of stressor control. Our findings replicate Curtis' findings and challenge the still common but unsupported assumption that HPA axis activity reflects subjective distress. These results also highlight the importance of both perceived and actual aspects of stressor control in understanding what is truly "stressful" to the HPA axis system.

Social Motivation: Costs and Benefits of Selfishness and Otherishness

We examine recent evidence on the consequences of selfishness and otherishness for psychological well-being, physical health, and relationships. In the first sections, we consider recent evidence regarding the costs and benefits of giving time, money, and support to others and the costs and benefits of taking or receiving those things from others. Then, because the behaviors of giving and taking can be motivated either by selfish or otherish concerns, we next consider the costs and benefits of the motivation underlying giving and taking. We also examine why and for whom selfishness and otherishness have consequences for psychological well-being, physical health, and relationships. We focus on mechanisms identified in research, including intrapsychic mechanisms such as positive and negative affect, self-esteem and self-efficacy, a sense of meaning and purpose in life, and a sense of connectedness to or isolation from others, as well as interpersonal processes such as reciprocation of support and responsiveness.

Unlocking the Black Box: A Multilevel Analysis of Preadolescent Children's Coping

This random assignment experimental study examined the intersection of children's coping and physiologic stress reactivity and recovery patterns in a sample of preadolescent boys and girls. A sample of 82 fourth-grade and fifth-grade (M_age = 10.59 years old) child-parent dyads participated in the present study. Children participated in the Trier Social Stress Test and were randomly assigned to one of two post-Trier Social Stress Test experimental coping conditions-behavioral distraction or cognitive avoidance. Children's characteristic ways of coping were examined as moderators of the effect of experimental coping condition on cortisol reactivity and recovery patterns. Multilevel modeling analyses indicated that children's characteristic coping and experimental coping condition interacted to predict differential cortisol recovery patterns. Children who characteristically engaged in primary control engagement coping strategies were able to more quickly down-regulate salivary cortisol when primed to distract themselves than when primed to avoid, and vice versa. The opposite pattern was true for characteristic disengagement coping in the context of coping condition, suggesting that regulatory fit between children's characteristic ways of coping and cues from their coping environment may lead to more and less adaptive physiologic recovery profiles. This study provides some of the first evidence that coping "gets under the skin" and that children's characteristic ways of coping may constrain or enhance a child's ability to make use of environmental coping resources.

Panel manipulation in social stress testing: The Bath Experimental Stress Test for Children (BEST-C)

BACKGROUND

Whilst acute stress paradigms in adults make use of adult panel members, similar paradigms modified for child participants have not manipulated the panel. Most work has utilised an audience of adult confederates, regardless of the age of the population being tested. The aim of this study was to trial a social stress test for children that provided a meaningful environment using age-matched child peers as panel actors.

METHODS

Thirty-three participants (7-11 years) underwent the Bath Experimental Stress Test for Children (BEST-C). Based on the Trier Social Stress Test (TSST), it comprises a shortened six-minute public speaking task and four-minute maths challenge. It differs from previous stress tests by using age-matched children on the panel, pre-recorded and presented as a live feed, and includes an expanded manipulation check of subjective experience. Salivary cortisol was assessed at four time points, pre-post stress testing; life events, daily hassles and coping strategies were measured through questionnaires. A simple numerical coding scheme was applied to post-test interview data.

RESULTS

The BEST-C generated a typical stress and adaptation response in salivary cortisol (p=.032). Age and gender differences were observed during recovery. Cortisol responses mapped directly onto three distinct subjective response patterns: (i) expected response and recovery; (ii) expected response, no recovery; (iii) no response.

CONCLUSIONS

The BEST-C, utilising child confederates of participant target age is a meaningful social stress test for children. This is the first social stress test developed specifically for children that manipulates panel characteristics by using child confederates and a pre-recorded sham panel. Greater cortisol responses to the test were also found to match subjective verbal accounts of the experience. It offers a meaningful acute stress paradigm with potential applications to other child and adolescent age groups. Furthermore, it leads the way in the use of panel manipulation in social stress testing.

Can Interoception Improve the Pragmatic Search for Biomarkers in Psychiatry?

Disrupted interoception is a prominent feature of the diagnostic classification of several psychiatric disorders. However, progress in understanding the interoceptive basis of these disorders has been incremental, and the application of interoception in clinical treatment is currently limited to panic disorder. To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and associated root terms in Pubmed, Psychinfo, and ISI Web of Knowledge. This search revealed that interoception is a multifaceted process that is being increasingly studied within the fields of psychiatry, psychology, neuroscience, and biomedical science. To illustrate the multifaceted nature of interoception, we provide a focused review of one of the most commonly studied interoceptive channels, the cardiovascular system, and give a detailed comparison of the most popular methods used to study cardiac interoception. We subsequently review evidence of interoceptive dysfunction in panic disorder, depression, somatic symptom disorders, anorexia nervosa, and bulimia nervosa. For each disorder, we suggest how interoceptive predictions constructed by the brain may erroneously bias individuals to express key symptoms and behaviors, and outline questions that are suitable for the development of neuroscience-based mental health interventions. We conclude that interoception represents a viable avenue for clinical and translational research in psychiatry, with a well-established conceptual framework, a neural basis, measurable biomarkers, interdisciplinary appeal, and transdiagnostic targets for understanding and improving mental health outcomes.