HPA axis responses to psychological challenge linking stress and disease: What do we know on sources of intra- and interindividual variability?

Effects of stress-related neuromodulators on amygdala and hippocampus resting state functional connectivity

BACKGROUND

The human stress response is characterized by increases in neuromodulators, including norepinephrine (NE) and cortisol. Both neuromodulators can enter the brain and affect neurofunctional responses. Two brain areas associated with stress are the amygdala and the hippocampus. The precise influence of NE and cortisol on the amygdala and hippocampal resting state functional connectivity (RSFC) is poorly understood.

AIMS

To investigate the influence of NE and cortisol on the amygdala and hippocampal RSFC.

METHODS

We recruited 165 participants who received 10 mg yohimbine and/or 10 mg hydrocortisone in a randomized, placebo-controlled design. With seed-based analyses, we compared RSFC of the hippocampus and amygdala separately between the three groups that received medication versus placebo.

RESULTS

We found no differences between yohimbine and placebo condition or between hydrocortisone and placebo condition regarding amygdala or hippocampal FC. Compared with placebo, the yohimbine/hydrocortisone condition showed increased amygdala and hippocampal RSFC with the cerebellum. Also, they had increased hippocampal RSFC with the amygdala and cerebral white matter.

DISCUSSION

The group with elevated NE and cortisol showed significantly increased RSFC between the amygdala, hippocampus, and cerebellum compared to placebo. These three brain areas are involved in associative learning and emotional memory, suggesting a critical role for this network in the human stress response. Our results show that NE and cortisol together may influence the strength of this association. Compared to placebo, we found no differences in the groups receiving only one medication, suggesting that increasing one neuromodulator alone may not induce differences in neurofunctional responses. The study procedure has been registered at clinicaltrials.gov (ID: NCT04359147).

Associations of diurnal cortisol parameters with cortisol stress reactivity and recovery: A systematic review and meta-analysis

Researchers commonly assess the functioning of the hypothalamic-pituitary-adrenal (HPA) axis by measuring natural fluctuations of its end product cortisol throughout the day or in response to a standardized stressor. Although it is conceivable that an individual releasing relatively more cortisol when confronted with a laboratory stressor does the same in everyday life, inconsistencies remain in the literature regarding associations between diurnal cortisol parameters and cortisol stress responses. Hence, the current meta-analysis aggregated findings of 12 studies to examine overall associations of diurnal cortisol parameters (including total output, diurnal slope, and cortisol awakening response [CAR]) with cortisol stress reactivity and recovery in the Trier Social Stress Test (TSST). There were no significant overall associations of total output, slope, or CAR with stress reactivity. Lower total diurnal cortisol output was significantly related to better stress recovery, whereas diurnal slope and CAR were unrelated to stress recovery. Moderation analyses revealed that associations between diurnal cortisol and cortisol stress responses were dependent on the computation method of cortisol parameters, questioning the convergence and validity of commonly employed measures of stress reactivity and recovery. Overall, it seems that we cannot predict characteristics of the diurnal cortisol rhythm from a one-time measure of stress reactivity in a standardized psychosocial laboratory paradigm.

Hair cortisol concentration and its association with acute stress responses and recovery in a sample of medical students in Germany

INTRODUCTION

Experiencing acute and chronic stress can contribute to adverse health outcomes. Responses to acute stress differ between individuals (i.e., stress reactivity) and the experience of chronic stress has been discussed to be associated with acute stress responses and stress recovery. This study thus aims to investigate whether hair cortisol concentration (HCC), being an indicator for hypothalamus-pituitary-adrenal (HPA) axis activity over a prolonged period of time, is associated with acute stress responses and recovery in a sample of medical students.

MATERIAL AND METHODS

From July 2020 to July 2021, medical students (n = 54) underwent a virtual-reality Trier Social Stress Test in which their blood pressure and heart rate variability (HRV) were measured, and hair samples were taken to determine HCC. Piecewise linear growth analyses were used to investigate whether HCC (categorized into low, medium and high levels) is associated with acute stress responses and recovery regarding blood pressure and HRV.

RESULTS

Significant interaction effects in piecewise linear growth analyses showed that participants with higher levels of HCC had lower systolic and diastolic blood pressure responses compared to participants with medium levels of HCC. No significant interaction effects were observed for HRV responses or for recovery measures.

CONCLUSIONS

The study suggests that higher levels of HCC are associated with a lower cardiovascular response in terms of blood pressure to an acute stressor in medical students. Therefore, long-term HPA-axis activity may contribute to different magnitudes of acute stress responses in the autonomic nervous system. As the shown lower blood pressure responses to acute stress in individuals with increased long-term HPA-axis activity may represent inadequate stress responses, these should be further studied in order to find out more about their interaction and potential subsequent disease risks.

[Depression in the field of tension of gender roles]

BACKGROUND

The distribution of depression and suicidal ideation by gender reveals a gender paradox: women are at least twice as likely to be diagnosed with depressive disorders but have a lower suicide rate than men. In contrast, the suicide rate of men is at least three times higher than women, while the prevalence of depressive disorders is only half as high. Although these differences have long been known the reasons for this paradox are still not fully understood.

AIM OF THE ARTICLE AND METHOD

The aim of this narrative review article is to discuss possible explanatory models regarding gender differences in depressive disorders. Aspects related to stress processing and traumatization are considered as well as sociological and biological factors. This article summarizes information that was considered particularly relevant in the interdisciplinary dialogue regarding possible explanatory factors for gender differences in depressive disorders.

RESULTS

The summarized studies indicate that women and men differ in certain aspects of stress processing and trauma exposure but men do not have a lower risk of disease as a result. On the contrary, the frequency of depressive disorders in men seems to be underestimated due to an atypical symptom manifestation.

DISCUSSION

The implementation of knowledge about gender-specific vulnerability in the training of physicians and psychotherapists, the systematic assessment of gender beyond binary classifications as well as further diversity domains in research and healthcare as well as gender-sensitive and diversity-sensitive prevention strategies could contribute to the resolution of the gender paradox.

The effect of cognitive reappraisal and early-life maternal care on neuroendocrine stress responses

Early-life adversity (ELA) is related to profound dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, reflected in both, blunted or exaggerated cortisol stress responses in adulthood. Emotion regulation strategies such as cognitive reappraisal might contribute to this inconsistent finding. Here, we investigate an interaction of early-life maternal care (MC), where low MC represents a form of ELA, and instructed emotion regulation on cortisol responses to acute stress. Ninety-three healthy young women were assigned to a low (n = 33) or high (n = 60) MC group, based on self-reported early-life MC. In the laboratory, participants received regulation instructions, asking to cognitively reappraise (reappraisal group, n = 45) or to focus on senses (control group, n = 48) during subsequent stress exposure, induced by the Trier Social Stress Test. Salivary cortisol and subjective stress levels were measured repeatedly throughout the experiment. Multilevel model analyses confirmed a MC by emotion regulation interaction effect on cortisol trajectories, while controlling for hormonal status. Individuals with low MC in the control compared with the reappraisal group showed increased cortisol responses; individuals with high MC did not differ. These results highlight the significance of emotion regulation for HPA axis stress regulation following ELA exposure. They provide methodological and health implications, indicating emotion regulation as a promising target of treatment interventions for individuals with a history of ELA.

Neural and cortisol responses to acute psychosocial stress in work-related burnout: The Regensburg Burnout Project

BACKGROUND

While several attempts have been made to elucidate the pathophysiology of burnout, neural stress responses have not yet been investigated. Therefore, the aim of this study was to examine salivary cortisol and - for the first time - neural responses to acute psychosocial stress within a strictly specified sample consisting of individuals suffering from burnout (BO group) and a healthy comparison group (HC group).

METHODS

After a multi-stage recruitment procedure based on burnout symptomatology and pathogenesis, 55 individuals suffering from burnout (25 women) and 61 individuals serving as HC group (31 women) out of an initial sample of 1022 volunteers were exposed to acute psychosocial stress during functional magnetic resonance imaging (fMRI) applying ScanSTRESS.

RESULTS

No differences were found between the BO and the HC group with respect to cortisol and mean neural stress responses. However, an exploratory comparison of neural stress responses of the first and second run of ScanSTRESS (exposure-time effect) revealed group-specific response patterns in one cluster peaking in the left dorsal anterior cingulate cortex (dACC). While the neural activation of the HC group was higher in the first compared to the second run of ScanSTRESS (i.e., decreasing activation), this pattern was reversed in the BO group (i.e., increasing activation).

CONCLUSIONS

Our analysis mainly did not provide evidence for altered acute cortisol and mean neural stress responses in burnout. However, the BO group was characterized by a limited capacity to show decreasing activation over stress exposure-time and exhibited instead increasing activation. Importantly, this group difference manifested in the left dACC which is both involved in neural stress processing and affected in individuals suffering from burnout. Given the present results, it seems promising to further examining temporal dynamics of neural stress responses in (sub-) clinical conditions such as burnout.

Developmental Dyslexia: Insights from EEG-Based Findings and Molecular Signatures-A Pilot Study

Developmental dyslexia (DD) is a learning disorder. Although risk genes have been identified, environmental factors, and particularly stress arising from constant difficulties, have been associated with the occurrence of DD by affecting brain plasticity and function, especially during critical neurodevelopmental stages. In this work, electroencephalogram (EEG) findings were coupled with the genetic and epigenetic molecular signatures of individuals with DD and matched controls. Specifically, we investigated the genetic and epigenetic correlates of key stress-associated genes (NR3C1, NR3C2, FKBP5, GILZ, SLC6A4) with psychological characteristics (depression, anxiety, and stress) often included in DD diagnostic criteria, as well as with brain EEG findings. We paired the observed brain rhythms with the expression levels of stress-related genes, investigated the epigenetic profile of the stress regulator glucocorticoid receptor (GR) and correlated such indices with demographic findings. This study presents a new interdisciplinary approach and findings that support the idea that stress, attributed to the demands of the school environment, may act as a contributing factor in the occurrence of the DD phenotype.

The Physiological and Pharmacological Significance of the Circadian Timing of the HPA Axis: A Mathematical Modeling Approach

As a potent endogenous regulator of homeostasis, the circadian time-keeping system synchronizes internal physiology to periodic changes in the external environment to enhance survival. Adapting endogenous rhythms to the external time is accomplished hierarchically with the central pacemaker located in the suprachiasmatic nucleus (SCN) signaling the hypothalamus-pituitary-adrenal (HPA) axis to release hormones, notably cortisol, which help maintain the body's circadian rhythm. Given the essential role of HPA-releasing hormones in regulating physiological functions, including immune response, cell cycle, and energy metabolism, their daily variation is critical for the proper function of the circadian timing system. In this review, we focus on cortisol and key fundamental properties of the HPA axis and highlight their importance in controlling circadian dynamics. We demonstrate how systems-driven, mathematical modeling of the HPA axis complements experimental findings, enhances our understanding of complex physiological systems, helps predict potential mechanisms of action, and elucidates the consequences of circadian disruption. Finally, we outline the implications of circadian regulation in the context of personalized chronotherapy. Focusing on the chrono-pharmacology of synthetic glucocorticoids, we review the challenges and opportunities associated with moving toward personalized therapies that capitalize on circadian rhythms.

Metabolomics reveals that chronic restraint stress alleviates carbon tetrachloride-induced hepatic fibrosis through the INSR/PI3K/AKT/AMPK pathway

Hepatic fibrosis (HF) could be developed into liver cirrhosis or even hepatocellular carcinoma. Stress has an important role in the occurrence and development of various considerable diseases. However, the effect of a certain degree stress on HF is still controversial. In our study, stress was simulated with regular chronic restraint stress (CRS) and HF model was induced with CCl4 in mice. We found that CRS was able to attenuate CCl4-induced liver injury and fibrosis in mice. Surprisingly, behavioral analysis showed that the mice in the HF group exhibited depression-like behavior. Further, the metabolomic analysis revealed that 119 metabolites and 20 metabolic pathways were altered in mice liver, especially the betaine metabolism pathway. Combined with the results of Ingenuity Pathway Analysis (IPA), the key proteins INSR, PI3K, AKT, and p-AMPK were identified and verified, and the results showed that CRS could upregulate the protein levels and mRNA expression of INSR, PI3K, AKT, and p-AMPK in liver tissues of HF mice. It suggested that CRS alleviated CCl4-induced liver fibrosis in mice through upregulation of the INSR/PI3K/AKT/AMPK pathway. Proper stress might be a potential therapeutic strategy for the treatment of chronic liver disease, which provided new insights into the treatment of HF. KEY MESSAGES: Chronic restraint stress mitigated CCl4-induced liver injury and hepatic fibrosis. CCl4-induced liver fibrosis could cause depression-like behavior. Chronic restraint stress altered metabolomic profiles in hepatic fibrosis mice, especially the betaine metabolism pathway. Chronic restraint stress increased betaine levels in liver tissue. Chronic restraint stress regulated the INSR/PI3K/AKT/AMPK signaling pathway in hepatic fibrosis mice.

Spouses' coping with stress during the COVID-19 pandemic: is there a difference between male and female attitudes?

This descriptive study was conducted to determine the stress-coping status of spouses and the difference between male and female attitudes during the pandemic period. We collected data with the Personal Information Form and the Scale for Coping with Family Stressors from 533 participants. The mean age of women and men was 36.04 ± 10.04 and 37.13 ± 11.56, respectively. A significant difference in verbalizing with others, work - family segmentation, cognitive restructuring, changing behaviors, emotional disclosure, exercise, and spending more time with family was found between women and men (p < .05). A significant difference was also observed in coping mechanisms with family stressors between women and men, and thus, gender affects their coping attitudes. During crises such as pandemics, the community should be aware of the availability of mental health professionals, and spouses should also use effective coping methods with family stress at regular intervals.

Blunted neurobiological reactivity and attentional bias to threat underlie stress-related disorders in women survivors of intimate partner violence

BACKGROUND

Intimate partner violence (IPV) alters women's neurobiological stress response systems. We propose that individual differences early in the attentional processing of threats are associated with these neurobiological mechanisms and contribute to mental illness in this population.

METHODS

We assessed attentional bias in relation to threat (AB) in women survivors of IPV (n = 69) and controls (n = 36), and examined overall cortisol secretion using hair cortisol (HC), and stress responsiveness measuring salivary cortisol and α-amylase (sAA) before (T0), and after (T1, T2) an acute psychosocial stress task (Trier Social Stress Test). We used repeated-measures ANCOVAs to explore the associations between Group (IPV, control) and AB with acute stress response, and regression models to examine the associations with mental health symptoms.

RESULTS

There were no between-group differences in HC levels. An interaction between Group and AB was found regarding cortisol reactivity (p < 0.05). IPV women with threat avoidance AB showed a blunted cortisol response compared to controls and to IPV participants with threat vigilance AB. The association between sAA reactivity and the interaction between Group, AB, and time approached significance (p = 0.07), with a trend to lower sAA levels particularly in IPV women with threat avoidance AB. Group and cortisol reactivity were associated with symptoms of depression, generalized anxiety, and post-traumatic stress disorder (8-20% explained variance).

CONCLUSIONS

Threat avoidance AB is associated with blunted acute cortisol response among women exposed to chronic stress (IPV). Experiencing IPV and acute cortisol response appear to be clearly implicated in long-term mental health problems.

Associations between cortisol stress responses and limbic volume and thickness in young adults: An exploratory study

The investigation of the relationship between neural measures of limbic structures and hypothalamic pituitary adrenal axis responses to acute stress exposure in healthy young adults has so far focused in particular on task-based and resting state functional connectivity studies. Thus, the present study examined the association between limbic volume and thickness measures and acute cortisol responses to the psychosocial stress paradigm ScanSTRESS. Using Permutation Analysis of Linear Models controlling for sex, age and total brain volume, the associations between (sex-specific) cortisol increases and human connectome project style anatomical variables of limbic structures (i.e. volume and thickness) were investigated in 66 healthy and young (18-33 years) subjects (35 men, 31 women taking oral contraceptives). In addition, exploratory (sex-specific) bivariate correlations between cortisol increases and structural measures were conducted. The present data provide interesting new insights into the involvement of striato-limbic structures in psychosocial stress processing, suggesting that acute cortisol stress responses are also associated with mere structural measures of the human brain. Thus, our preliminary findings suggest that not only situation- and context-dependent reactions of the limbic system (i.e. blood oxygenation level-dependent reactions) are related to acute (sex-specific) cortisol stress responses but also basal and somewhat more constant structural measures. Our study hereby paves the way for further analyses in this context and highlights the relevance of the topic.

Immunoinflammatory Response to Acute Noise Stress in Male Rats Adapted with Different Exercise Training

Objective

Noise pollution is a kind of stress that impairs various physiological functions. This study evaluated the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training (MCT) on corticosterone, interleukin-6 (IL-6), and monocyte responses to acute noise stress in male rats.

Design

Forty-two male Wistar rats were divided into seven groups, including control which was assessed at the beginning, control time which was assessed simultaneously with experimental groups (CT), HIIT, MCT, HIIT followed by noise stress (HIIT+S), MCT followed by noise stress (MCT+S), and noise stress. HIIT and MCT were performed for 8 weeks. Noise stress was induced for one session. Blood samples were taken 48 hours after the last exercise session in training and CT groups and immediately after acute noise stress in stress groups of HIIT+S, MCT+S, and noise stress.

Results

In response to acute noise stress, MCT and HIIT adaptations increased corticosterone, while reduced monocytes compared to CT. MCT increased basal corticosterone and IL-6 and decreased monocytes; however, in response to acute noise stress, corticosterone was higher and monocyte count was lower in the HIIT+S group. Regarding the effect of training, corticosterone and monocytes in MCT were higher than in HIIT. The serum level of IL-6 was lower in MCT than CT group, while it was not significantly different between stress groups.

Conclusion

In response to noise stress, previous exercise, especially HIIT, increased stress while did not increase inflammatory and innate immune response.

Optimal timing of oral metyrapone intake for the suppression of cold-pressor stress-induced cortisol release

BACKGROUND

Pharmacological manipulation of cortisol levels is instrumental in elucidating mechanisms underlying acute stress effects and for distinguishing the physiological and behavioral effects of cortisol from those of the adrenergic system. Administration (oral or IV) of hydrocortisone is a direct and efficient method to elevate cortisol, and thus, frequently used in psychobiological stress research. However, lowering of cortisol (i.e. blockade of stress cortisol) requires a more sophisticated approach, such as the administration of the corticostatic compound metyrapone (MET). However, there is insufficient knowledge about the temporal dynamics of MET for the blocking of stress-induced cortisol reactivity. Thus, the present study aimed to build up an experimental protocol suitable to suppress acute behavioral stress-induced cortisol secretion by MET.

METHODS

50 healthy young men were randomly assigned to one of five treatment groups. They received 750 mg oral MET either 30 (n = 9), 45 (n = 11), or 60 (n = 10) minutes before exposure to a combined cold pressor and mental arithmetic test (stress induction), or were subjected to two different control treatments (placebo 60 min before stress (n = 10) or MET 30 min before non-stressful warm-water condition (n = 10)). Salivary cortisol concentration, hemodynamics, and subjective ratings were assessed.

RESULTS

Suppression of cold stress-induced cortisol release was strongest when MET intake was scheduled 30 min prior to stress onset. Cardiovascular stress-responses and subjective ratings remained unaffected by MET.

CONCLUSION

In healthy young males, 750 mg of MET efficiently block cold stress-induced cortisol release when oral administration is scheduled 30 min prior to stress onset. This finding may guide future research in improving timing of suppression of stress-induced cortisol secretion.

Sex, anxiety and the interplay with physiological variables of stress: a clinical study of patients about to undergo bronchoscopy

Women often report more anxiety than men, but there are divergent results regarding the putative correlation between physiological variables, such as cortisol, blood pressure and heart rate and the experienced emotional states. The aim of the present study was to evaluate sex differences in anxiety, and the relation to serum cortisol, blood pressure and heart rate. We used data from two pooled studies with participants from the same population (N = 405) facing a real-life stressor, bronchoscopy, as part of examination for lung cancer. At admission, blood pressure and heart rate were recorded, and a blood sample was taken for analysis of serum cortisol. Participants then completed Spielberger's State Trait Anxiety Inventory (STAI). Patients had elevated anxiety measured with STAI state compared to relevant age and sex stratified norm scores. Women had significantly higher STAI state score than men (M = 44.9, SD = 13.2 vs M = 36.2, SD = 10.7; t(403) = 7.25, p < 0.001). Mean serum cortisol, systolic blood pressure and heart rate showed no significant sex difference. There was a weak but significant correlation between state anxiety and heart rate and cortisol but none between blood pressure and anxiety. This study adds an important confirmation of sex differences in anxiety in a real-life setting, where women report significantly more anxiety than men do. However, the physiological markers only show a weak link with experienced anxiety, and exhibit no sex differences.

When asking 'are you stressed?' is not enough: Hair cortisol, subjective stress, and alcohol use during the first year of the pandemic

The onset of the COVID-19 pandemic was accompanied by an increase in alcohol use in a third of the population worldwide. To date, the literature shows that subjective reports of stress predicted increased alcohol use during the early stages of the pandemic. However, no studies have investigated the effect of physiological stress (via the stress hormone cortisol) on alcohol use during the pandemic. This study aimed to identify the predictive value of cortisol and/or subjective stress on alcohol use during the first year of the pandemic. Every three months, between June 2020 and March 2021, 79 healthy adults (19-54 years old) answered online questionnaires assessing alcohol use. In May 2020, participants reported pre-pandemic alcohol use, while in June 2020, participants reported current alcohol use, subjective stress measures, and provided a 6 cm hair sample. The latter allowed us to quantify the cumulative levels of cortisol produced in the three months prior to and following the start of the mandatory lockdown measures in March 2020 in Quebec, Canada. A relative change in hair cortisol was computed to quantify the physiological stress response. While controlling for sex, age, and psychiatric diagnoses, multilevel linear regressions revealed that alcohol use increased only among people with concomitant high subjective stress and elevated hair cortisol concentrations. Moreover, this increased alcohol use remained elevated one year later. This study documents the importance of simultaneously considering stress biomarkers and subjective stress to identify people at risk of increasing their alcohol use during major stressful life events.

Hair Cortisone Predicts Lower Stress-induced Salivary Cortisol Response: Resting-state Functional Connectivity Between Salience and Limbic Networks

Previous studies revealed that high long-term hypothalamic-pituitaryadrenal (HPA) axis activity measured by the hair cortisol concentrations predicts lower acute stress cortisol response and reported the influences of hair cortisol on brain activity during acute stress exposure. However, considering that long-term HPA axis activity has a close relationship with the brain's resting-state functional connectivity (RSFC), the current study aimed to explore the role of RSFC between limbic and salience network in this relationship. Seventy-seven healthy participants underwent resting-state imaging scans before performing the acute ScanSTRESS task. Saliva samples were collected to assess the levels of acute stress salivary cortisol. Hair samples were also collected, and the corticosteroid concentration extracted from these samples were used as a biomarker of long-term HPA axis activity. High hair cortisone (HairE) levels predicted lower acute stress cortisol response. Moreover, high HairE levels were significantly correlated with enhanced RSFC between limbic and salience networks, while RSFC was negatively associated with acute stress cortisol response. Importantly, the RSFC between left insula and left parahippocampus mediated the association between HairE and acute cortisol stress response. Taken together, this study uncovers the important role of RSFC between salience and limbic networks in the long-term relationship between HairE and acute cortisol response and contributes to a deeper understanding of the individual differences in acute stress response.

Sex effects in the interaction of acute stress and pain perception

ABSTRACT

A reciprocity between the stress and the pain system is recognized; however, the manner by which sex affects this reciprocity is unclear. Understanding the interactions of stress, pain, and sex may shed light on the apparent women's vulnerability to chronic pain, which often coexists with increased distress, and to affective disorders, which often coexist with chronic pain. The study's aim was to examine the effect of acute, validated, psychosocial stress on pain perception and modulation of women and men in a controlled manner. Participants were 82 women and 66 men. Heat-pain threshold, heat-pain tolerance, and pain modulation by temporal summation of pain (TSP), and pain adaptation were measured before and after exposure to the Montreal Imaging Stress Task (MIST) or to a sham task. The stress response was verified by perceived ratings of stress and anxiety, autonomic variables, and salivary cortisol. A significant stress response was obtained by the MIST among both sexes; however, women displayed a greater increase in perceived distress, and men displayed a greater increase in cortisol. Among women, TSP decreased and pain adaptation increased following the MIST, responses that were predicted by perceived distress levels. Among men, TSP increased following the MIST but was not predicted by the stress variables. In conclusion, acute stress manipulation seems to differentially affect both stress and pain responses of women and men: women exhibited stress-induced antinociception and men exhibited stress-induced pronociception. Higher perceived stress levels among women may trigger a temporary increase in pain inhibition mechanisms to serve evolutionary purposes.

Breath-Body-Mind Core Techniques to Manage Medical Student Stress

Objectives

This pilot study evaluated the feasibility of a live, interactive, synchronous, online, manualized intervention, Breath-Body-Mind Introductory Course (BBM-IC), for medical students. BBM-IC includes breathing, movement, and attention-focus techniques for stress management and better emotion regulation, energy, sleep, and mental focus.

Methods

Medical students attending a 2-h BBM demonstration were invited to participate in the 12-h BBM-IC and weekly 45-min 6-week group practice. Measures were obtained using Survey Monkey: patient health questionnaire (PHQ9), generalized anxiety disorder-7 (GAD-7), exercise-induced feeling inventory (EFI), sleep quality scale (SQS), and body perception questionnaire-short form (BPQ-SF) at pre-BBM-IC (T1), post-BBM-IC (T2), and 6 weeks post (T3). Perceived stress scale (PSS) and meditation practices questionnaire (MPQ) were measured at baseline (T1) only.

Results

Twelve medical students participated in BBM-IC 4-h daily for 3 days. Six attended practice sessions and completed 6-week post-tests. Mean scores comparison identified two variable sets with significant improvements: EFI tranquility (p < .005) and supradiaphragmatic reactivity (p < .040). Two measures reached near significance: SQS (p ≤ .060) and PHQ9 (p ≤ .078).

Conclusion

This pilot study provided preliminary evidence that BBM-IC may reduce stress and anxiety symptoms while improving mood, energy, mental focus, and other correlates of psychophysiological state in medical students. Taking time for self-care is challenging for medical students, as reflected in the small study enrollment. Designating time for BBM as a requirement within the medical curriculum would probably enable more students to participate and acquire skills to reduce the effects of stress on their physical and psychological health, as well as the health of their patients.

Stress in wildlife: comparison of the stress response among domestic, captive, and free-ranging animals

The stress response, which involves joint activity of the nervous and endocrine systems, is one of the basic adaptive mechanisms that ensures the survival of the individual. The activation of the sympathetic nervous system, the sympathetic-adrenal-medullary axis, and the hypothalamic-pituitary-adrenal axis enables organisms to respond to endogenous and exogenous challenges. Repeated short-term stress leads to long-term stress, which disrupts physiological homeostasis. Unlike domestic animals, wild animals are not protected from environmental and weather influences or treated for diseases. In addition, climate change, habitat fragmentation and loss, and urban stressors (such as light, noise and chemical pollution; xenobiotics; traffic; and buildings) affect individual wildlife and populations. In this review, we have attempted to depict the magnitude of the stress response in wildlife and related domestic animals as well as in captive and free-ranging animals. The intensity of the stress response can be estimated by determining the concentration of glucocorticoids in body fluids, tissues, and excreta. A comparison of results from different studies suggests that domestic animals have lower fecal and hair glucocorticoid concentrations than related wild animals. Additionally, fecal and hair glucocorticoid concentrations in captive animals are higher than in free-ranging animals of the same species. As there are limited data on this topic, we cannot draw definitive conclusions about glucocorticoid concentration and stress response. Further studies are needed to clarify these issues.

Real-World Intake of Dietary Sugars Is Associated with Reduced Cortisol Reactivity Following an Acute Physiological Stressor

There is increasing academic and clinical interest in understanding the nature of the relation between diet and response to stress exposure as a risk factor for mental illness. Cross-species evidence shows that conditions of chronic and acute stress increase the intake of, and preference for, caloric-dense palatable foods, a phenomenon thought to be explained by the mitigating effects of comfort foods on the activity of the stress-response network. It is largely unknown whether and how real-world dietary intake of saturated fat and sugars impacts stress responsivity in humans. Therefore, here we examined whether real-world dietary intake of saturated fat and sugars predicted salivary cortisol reactivity following an acute physiological stressor. Multilevel modelling of four salivary cortisol measures collected up to 65 min after the stressor on 54 participants (18-49 years old) were analyzed using a quadratic growth curve model. Sugar intake significantly predicted a weaker cortisol response following the Cold Pressor Test (CPT) controlling for BMI and gender, revealing an inhibitory effect of caloric-dense diets on cortisol reactivity to stress. As the consumption of sugar rose individuals had lower post-stressor cortisol levels, a smaller rate of increase in cortisol 20 and 35 min after the CPT, a lower cortisol peak, and an overall weaker quadratic effect. These observations add to a growing body of evidence reporting suppressive effects of high-energy foods on stress-associated glucocorticoids reactivity and are consistent with the comfort food hypothesis, where people are seen as motivated to eat palatable foods to alleviate the detrimental repercussions of stressor exposure.

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

Beside somatic strains of congenital heart diseases (CHD), affected children often show developmental impairments in the long term. Ventricular septal defect (VSD) is the most common congenital heart defect and early surgical repair is associated with positive somatic outcomes. However, psychological adjustment is of lifelong relevance. We investigated 24 children with a surgically-corrected isolated VSD and their mothers from primary school (6-9 years) to adolescence (10-14 years) and compared them to controls. Both times, mothers reported child internalizing/externalizing problems, mothers and children rated child quality of life, and children performed neurodevelopmental tests. Adolescents also rated internalizing/externalizing problems themselves, and their hair cortisol levels were analyzed. Maternal anxiety and proactive parenting behavior were considered as moderators. Results revealed no group differences in child neurodevelopment (language, cognition), externalizing problems, and cortisol levels at any time. In reports from mothers, internalizing problems (depression, anxiety) were elevated in children with a VSD at both times-when mothers reported anxiety symptoms themselves. In adolescent reports, VSD patients' quality of life was increased and internalizing problems were decreased-proactive parenting behavior went along with decreased symptoms in VSD-affected adolescents and with increased symptoms in controls. The findings pronounce the crucial role of parenting behavior and the influence of maternal anxieties on child mental health after surgical VSD repair and might highlight the need for parent-centered interventions.

Associations between locus coeruleus MRI contrast and physiological responses to acute stress in younger and older adults

Acute stress activates the brain's locus coeruleus (LC)-noradrenaline system. Recent studies indicate that a magnetic resonance imaging (MRI)-based measure of LC structure is associated with better cognitive outcomes in later life. Yet despite the LC's documented role in promoting physiological arousal during acute stress, no studies have examined whether MRI-assessed LC structure is related to arousal responses to acute stress. In this study, 102 younger and 51 older adults completed an acute stress induction task while we assessed multiple measures of physiological arousal (heart rate, breathing rate, systolic and diastolic blood pressure, sympathetic tone, and heart rate variability, HRV). We used turbo spin echo MRI scans to quantify LC MRI contrast as a measure of LC structure. We applied univariate and multivariate approaches to assess how LC MRI contrast was associated with arousal at rest and during acute stress reactivity and recovery. In older participants, having higher caudal LC MRI contrast was associated with greater stress-related increases in systolic blood pressure and decreases in HRV, as well as lower HRV during recovery from acute stress. These results suggest that having higher caudal LC MRI contrast in older adulthood is associated with more pronounced physiological responses to acute stress. Further work is needed to confirm these patterns in larger samples of older adults.

Longitudinal associations of psychosocial stressors with menopausal symptoms and well-being among women in midlife

OBJECTIVE

We examined longitudinal associations of psychosocial stressors with menopausal symptoms and well-being of women in midlife in a longitudinal cohort.

METHODS

This study is based on 682 women from Project Viva, a prospective cohort enrolled in 1999 to 2002 during pregnancy (median age = 33.3 y) and followed for almost two decades. In pregnancy, women self-reported psychosocial stressors (history of physical and sexual abuse and financial instability, from childhood to the current pregnancy). In 2017 to 2021 (median age, 51.6 y), they reported their menopausal symptoms (0-44 point scale) and well-being (general health [good/fair/poor vs excellent/very good], generalized anxiety symptoms, and depressive symptoms [both-more than minimal levels vs none/minimal]). We performed multivariable and logistic regression models to examine associations of psychosocial stressors with outcomes, adjusting for covariates.

RESULTS

History of physical abuse (reported by 37.3%) was associated with worse menopausal symptoms in the somatovegetative (odds ratio [OR], 0.46 points; 95% confidence interval [CI], 0.04-0.87 points) and psychological (OR, 0.52 points; 95% CI, 0.07-0.97 points) domains and with worse general health (OR, 1.73; 95% CI, 1.17-2.55) and greater depressive symptoms (OR, 1.74; 95% CI, 1.05-2.87). History of sexual abuse (7.7%) was associated with worse menopausal symptoms (OR, 2.81 points; 95% CI, 1.05-4.56) and worse general health (OR, 2.04; 95% CI, 1.04-4.03) but not with depressive symptoms. History of financial instability (10.8%) was associated with worse menopausal symptoms (1.92 points; 0.49 to 3.34), worse general health (OR, 2.16; 95% CI, 1.24-3.75), and greater depressive symptoms (OR, 2.68; 95% CI, 1.44-4.98). We observed no association between psychosocial stressors and generalized anxiety symptoms assessed at midlife.

CONCLUSIONS

Psychosocial stressors were associated with worse menopausal symptoms and well-being decades after initial report.

Adverse and traumatic exposures, posttraumatic stress disorder, telomere length, and hair cortisol – Exploring associations in a high-risk sample of young adult residential care leavers

Background

Childhood adversities (CAs), potentially traumatic exposures (PTEs), and posttraumatic stress disorder (PTSD) are known to increase the risk for poor health outcomes, including diseases of aging and early mortality. Telomere length (TL) and hair cortisol concentrations (HCC) are biomarkers known to be associated with CA and PTEs, and PTSD, but there is considerable heterogeneity in findings.

Objectives

This study aims to investigate the association of CAs, PTEs, and PTSD with TL and HCC in a high-risk sample of young adults who were previously placed in youth residential care institutions throughout Switzerland.

Method

Our sample includes 130 participants (30.8% women, M _Age = 26.5 ± 3.7 years) with previous youth residential care placements (M_Placements= 3.9). CAs and PTEs, as well as PTSD, were assessed with self-reported questionnaires and semi-structured clinical interviews. Immune cell TL was measured with quantitative polymerase chain reaction (qPCR) in whole blood. Hair samples were collected for HCC measurement and assayed with high-sensitivity ELISA. Multivariate regression models were fitted to describe the associations between CAs, PTEs, and PTSD with TL and HCC, adjusting for covariates.

Results

In our high-risk sample, a higher burden of CAs, PTEs, Criterion A trauma, and PTSD was associated with longer TL. PTEs, Criterion A trauma, and PTSD were associated with lower HCC, however no significant associations between CAs and HCC were found. The magnitude of these effects varied depending on the dimensional or categorical nature of the stress-phenotype and the specific measure used.

Conclusions

Our findings are in contrast with many, but not all, previous studies of associations between adversity and both TL and HCC. For instance, our findings are in line with other studies that find a state of hypocortisolism in PTSD. Better measurement of adversities and trauma, multisystem biomarker approaches, and more research in larger high-risk samples at the upper end of the adversity-continuum is warranted.

•

In this high-risk sample,childhood adversities, potential traumatic exposures, criterion A trauma, or posttraumatic stress disorder (PTSD) was associated with longer telomere length (TL).

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Potentially traumatic exposures, criterion A trauma, and PTSD were associated with lower hair cortisol concentrations.

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The magnitude of these effects varied depending on the dimensional or categorical nature of the stress-phenotype and the specific measure used.

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Hypocortisolism might explain findings of longer TL in participants with cumulated adverse and traumatic exposures.

•

Research in high-risk populations is strongly needed as results across the entire spectrum of adversity exposures may not generalize to the top end of the spectrum.

Comparing two psychosocial stress paradigms for imaging environments - ScanSTRESS and fNIRS-TSST: correlation structures between stress responses

The present post-hoc analysis of two independent studies conducted in different laboratories aimed at comparing reactions of stress activation systems in response to two different psychosocial stress induction paradigms. Both paradigms are based on the Trier Social Stress Test and suited for neuroimaging environments. In an in-depth analysis, data from 67 participants (36 men, 31 women) from a functional magnetic resonance imaging study implementing ScanSTRESS were compared with data from a functional near-infrared spectroscopy (fNIRS) study implementing the so-called 'fNIRS-TSST' including 45 participants (8 men, 37 women). We tested the equivalence of correlation patterns between the stress response measures cortisol, heart rate, affect, and neural responses in the two samples. Moreover, direct comparisons of affective and neural responses were made. Similar correlation structures were identified for all stress activation systems, except for neural contrasts of paradigm conditions (stress vs. control) showing significant differences in association with cortisol, heart rate, and affective variables between the two samples. Furthermore, both stress paradigms elicited comparable affective and cortical stress responses. Apart from methodological differences (e.g., procedure, timing of the paradigms) the present analysis suggests that both paradigms are capable of inducing moderate acute psychosocial stress to a comparable extent with regard to affective and cortical stress responses. Moreover, similar association structures between different stress response systems were found in both studies. Thus, depending on the study objective and the respective advantages of each imaging approach, both paradigms have demonstrated their usefulness for future studies.

Allostatic load index in patients with multiple sclerosis: A case-control study

Elevated allostatic load (AL) index is a cumulative measure of biological dysregulations associated with stress exposure. It has been reported that stress plays an important role in the pathophysiology of multiple sclerosis (MS). However, the AL index has not been investigated in this population so far. Therefore, we aimed to investigate the AL index in patients with MS compared to healthy controls. A total of 90 patients with relapsing-remitting MS (76.7% females) and 47 healthy controls (76.6% females) were included in the study. The AL index was computed based on percentile distributions of 18 biomarkers. The AL index was significantly higher in patients with MS compared to healthy controls (2.74 ± 0.99 vs. 1.96 ± 0.71, p < 0.001), even after adjustment for age and education. With respect to specific AL biomarkers, individuals with MS had significantly lower resting heart rate, the levels of high-density lipoproteins and dehydroepiandrosterone sulfate as well as significantly higher level of hsCRP and albumin compared to healthy controls. There were no significant correlations of the AL index with depressive and anxiety symptoms, perceived stress, type D personality traits, insomnia, the odds of using specific coping strategies as well as MS-related clinical characteristics. These findings indicate that the AL index is increased in patients with MS. However, the exact mechanisms underlying this observation remain unknown and require additional studies.

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

Objective

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

Materials and methods

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

Results

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

Conclusions

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

Registration

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

Stress reactivity in salivary cortisol and electrocardiogram in adolescents: Investigating sleep disturbances and insomnia

This study examined the role of sleep disturbances and insomnia in the context of stress reactivity in adolescence. One-hundred and thirty-five 11-18 year olds (M_age  = 14.2 years, SD = 1.9, 52% female) completed the Trier Social Stress Test for Children. Salivary cortisol and subjective stress ratings were collected at six time points, and heart rate as well as heart rate variability were measured pre-, during and post-stress induction. Additionally, sleep disturbances and insomnia diagnosis were assessed by a self-report questionnaire and a sleep interview. Robust mixed models investigated if adolescents with compared with adolescents without (a) sleep disturbances and (b) insomnia differ regarding cortisol, heart rate, heart rate variability and psychological stress reactivity considering gender effects. The results indicated that boys with high sleep disturbances showed higher cortisol activity compared with boys with low sleep disturbances, B = 0.88, p < 0.05. Moreover, in boys with insomnia, heart rate and alpha 1 significantly differ less than in boys without insomnia. These findings support the notion of sex differences regarding the association between poor sleep and increased activity of the hypothalamic-pituitary-adrenal axis, and a less adaptable autonomic nervous system in boys in response to an experimental social stress task.

Higher hair cortisol concentrations associated with shorter leukocyte telomere length in high-risk young adults

Chronic stress is associated with accelerated biological aging as indexed by short age-adjusted leukocyte telomere length (LTL). Exploring links of biological stress responses with LTL has proved challenging due to the lack of biological measures of chronic psychological stress. Hair cortisol concentration (HCC) has emerged as a measure of chronic hypothalamic pituitary adrenal (HPA) axis activation, allowing the examination of relationships between aggregate cortisol concentrations over time and LTL. Our sample includes 92 participants (38% women, M_age = 26 ± 3.7 years) from a high-risk sample of young adults with previous residential care placements. Two cm hair was collected for HCC, reflecting approximately eight weeks of cortisol secretion. LTL was measured with quantitative polymerase chain reaction (qPCR) in whole blood samples. All samples for LTL were run in triplicate and assayed twice. Linear and polynomial regression models were used to describe the association between HCC and LTL, adjusting for age and sex. HCC and LTL showed negative associations (std. ß = − 0.67, 95% CI [− 0.83, − 0.52], p < .001) in age- and sex-adjusted analyses, indicating that higher HCCs are associated with shorter LTL. Using polynomial regression, we found a curvilinear relationship indicating a stronger negative association at lower cortisol concentrations. Higher HCCs were associated with shorter LTL, supporting the hypothesized involvement of prolonged cortisol secretion in telomere attrition. Thus, HCC may prove useful as a biological indicator of chronic stress associated with aging-related processes in samples exposed to high levels of stress.

Child maltreatment and hypothalamic-pituitary-adrenal axis functioning: A systematic review and meta-analysis

Alterations in hypothalamic-pituitary-adrenal (HPA) axis and its effector hormone cortisol have been proposed as one possible mechanism linking child maltreatment experiences to health disparities. In this series of meta-analyses, we aimed to quantify the existing evidence on the effect of child maltreatment on various measures of HPA axis activity. The systematic literature search yielded 1,858 records, of which 87 studies (k = 132) were included. Using random-effects models, we found evidence for blunted cortisol stress reactivity in individuals exposed to child maltreatment. In contrast, no overall differences were found in any of the other HPA axis activity measures (including measures of daily activity, cortisol assessed in the context of pharmacological challenges and cumulative measures of cortisol secretion). The impact of several moderators (e.g., sex, psychopathology, study quality), the role of methodological shortcomings of existing studies, as well as potential directions for future research are discussed.

How exposure to chronic stress contributes to the development of type 2 diabetes: A complexity science approach

Chronic stress contributes to the onset of type 2 diabetes (T2D), yet the underlying etiological mechanisms are not fully understood. Responses to stress are influenced by earlier experiences, sex, emotions and cognition, and involve a complex network of neurotransmitters and hormones, that affect multiple biological systems. In addition, the systems activated by stress can be altered by behavioral, metabolic and environmental factors. The impact of stress on metabolic health can thus be considered an emergent process, involving different types of interactions between multiple variables, that are driven by non-linear dynamics at different spatiotemporal scales. To obtain a more comprehensive picture of the links between chronic stress and T2D, we followed a complexity science approach to build a causal loop diagram (CLD) connecting the various mediators and processes involved in stress responses relevant for T2D pathogenesis. This CLD could help develop novel computational models and formulate new hypotheses regarding disease etiology.

Pituitary volume in adolescents with non-suicidal self-injury: Preliminary evidence for alterations in pituitary maturation

BACKGROUND

Non-suicidal self-injury (NSSI), typically observed in the context of various mental disorders, represents a highly prevalent and serious problem among adolescents. Based on studies linking NSSI with stress, alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning have been suggested to contribute to the development and maintenance of this behavior. While research has mainly focused on cortisol - the main hormonal output of this system - to our knowledge, no study has examined pituitary gland volume (PGV) - an alternative approach of assessing HPA axis functionality that is less state-dependent - in adolescents engaging in NSSI.

METHODS

Magnetic Resonance Imaging (MRI) was performed among n = 35 adolescents (aged 12-17 years) fulfilling the diagnostic criteria for NSSI disorder according to DSM-5 and n = 31 age-matched healthy controls; PGV was obtained by manual tracing. To test for group differences - our primary aim - a hierarchical linear regression model was computed, controlling for several potential confounding variables. Since adolescence reflects a time period for significant brain development - including changes in PGV - we also tested for an age-dependent group effect. In a second step, we aimed to investigate whether differences in PGV are accounted for by the experience of childhood adversity or psychopathology. Finally, following an exploratory approach, the dimensional association between PGV and various clinical characteristics (e.g., frequency of NSSI) were explored.

RESULTS

No evidence was found for overall volumetric differences between healthy control participants and adolescents engaging in NSSI (p > 0.05) - recognizing that small effect size differences could not be detected in the present study - but group membership significantly interacted with age in predicting PGV (p = 0.02). Particularly, while PGV increased linearly with age in healthy controls (B = 61.39, SE = 14.94, p < 0.01), no corresponding association was found in NSSI patients (B = 16.83, SE = 12.20, p = 0.17). PGV was not related to adverse experiences during childhood and none of the clinical characteristics (e.g., frequency of NSSI) significantly correlated with PGV (p > 0.05).

CONCLUSION

These results provide preliminary evidence for alterations in pituitary maturation in adolescents engaging in NSSI, although replication in longitudinal studies with larger samples is warranted.

Stress Management Intervention for Leaders Increases Nighttime SDANN: Results from a Randomized Controlled Trial

Stress management interventions aim to reduce the disease risk that is heightened by work stress. Possible pathways of risk reduction include improvements in the autonomous nervous system, which is indexed by the measurement of heart rate variability (HRV). A randomized controlled trial on improving stress management skills at work was conducted to investigate the effects of intervention on HRV. A total of 174 lower management employees were randomized into either the waiting list control group (CG) or the intervention group (IG) receiving a 2-day stress management training program and another half-day booster after four and six months. In the trial, 24 h HRV was measured at baseline and after 12 months. Heart rate (HR), root mean square of successive differences (RMSSD), standard deviation of normal-to-normal intervals (SDNN), and standard deviation of the average of normal-to-normal intervals (SDANN) were calculated for 24 h and nighttime periods. Age-adjusted multilevel mixed effects linear regressions with unstructured covariance, time as a random coefficient, and time × group interaction with the according likelihood-ratio tests were calculated. The linear mixed-effect regression models showed neither group effects between IG and CG at baseline nor time effects between baseline and follow-up for SDANN (24 h), SDNN (24 h and nighttime), RMSSD (24 h and nighttime), and HR (24 h and nighttime). Nighttime SDANN significantly improved in the intervention group (z = 2.04, p = 0.041) compared to the control group. The objective stress axis measures (SDANN) showed successful stress reduction due to the training. Nighttime SDANN was strongly associated with minimum HR. Though the effects were small and only visible at night, it is highly remarkable that 3 days of intervention achieved a measurable effect considering that stress is only one of many factors that can influence HR and HRV.

Significant Improvement of Somatic Symptom Disorder With Brief Psychoeducational Intervention by PMHNP in Primary Care

OBJECTIVE

Patients with somatic symptom disorders (SSD) are prevalent in primary care, urgent care, and emergency rooms and present with reduced quality of life, increased disability, and suicidality . Criteria for SSD include (1) somatic symptoms that cause distress and disrupt life; (2) concurrent physical illness with thoughts and feelings that are disproportionate to the seriousness of the illness; and (3) distress which is persistent and causes suffering. The frequency of SSD in the general population is 5% to 7%; however, in primary care, it is 5% to 35% . Because patients present with anxiety, depression, and/or pain, providers are flummoxed when diagnostic findings do not match symptom intensity. The purpose of this project was to provide an intervention for patients with SSD and measure its effectiveness on their somatic symptoms.

METHOD

This study provided a single-session, 30-minute psychoeducational intervention for patients to explain brain pathways for pain and the body's response to stress, including scientific benefits of exercise and healthy diet. Patients were asked questions using the motivational interviewing technique OARS (open-ended question, affirmation, reflection, summary) and were encouraged to talk about their concerns. The study used a pre- and post-intervention visual analogue scale and a self-reported Patient Health Questionnaire-15 both before and 3 weeks post-intervention.

RESULTS

Measurements showed significant symptom improvement immediately after the intervention with sustained improvement 3 weeks post-intervention.

CONCLUSIONS

This intervention demonstrates an effective treatment for this insidious illness, which plagues up to 35% of patients in primary care.

Cortisol Reactivity to a physical stressor in Patients with Depression and Alzheimer's disease

Some prevalent mental disorders in the elderly, such as Alzheimer's disease (AD) and major depression disorder (MDD), are associated with chronic stress and consequently with possible dysregulation of hypothalamic–pituitary–adrenal (HPA) axis and cortisol levels in basal conditions or in the reactivity of an acute stressor. However, evidence of cortisol behavior after a physical stressor in patients with AD and MDD is scarce.

Stress research during the COVID-19 pandemic and beyond

The COVID-19 pandemic confronts stress researchers in psychology and neuroscience with unique challenges. Widely used experimental paradigms such as the Trier Social Stress Test feature physical social encounters to induce stress by means of social-evaluative threat. As lockdowns and contact restrictions currently prevent in-person meetings, established stress induction paradigms are often difficult to use. Despite these challenges, stress research is of pivotal importance as the pandemic will likely increase the prevalence of stress-related mental disorders. Therefore, we review recent research trends like virtual reality, pre-recordings and online adaptations regarding their usefulness for established stress induction paradigms. Such approaches are not only crucial for stress research during COVID-19 but will likely stimulate the field far beyond the pandemic. They may facilitate research in new contexts and in homebound or movement-restricted participant groups. Moreover, they allow for new experimental variations that may advance procedures as well as the conceptualization of stress itself. While posing challenges for stress researchers undeniably, the COVID-19 pandemic may evolve into a driving force for progress eventually.

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

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

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

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

Pituitary-Adrenal Responses and Glucocorticoid Receptor Expression in Critically Ill Patients with COVID-19

The hypothalamus-pituitary-adrenal (HPA) axis was described as the principal component of the stress response 85 years ago, along with the acute-phase reaction, and the defense response at the tissue level. The orchestration of these processes is essential since systemic inflammation is a double-edged sword; whereas inflammation that is timely and of appropriate magnitude is beneficial, exuberant systemic inflammation incites tissue damage with potentially devastating consequences. Apart from its beneficial cardiovascular and metabolic effects, cortisol exerts a significant immunoregulatory role, a major attribute being that it restrains the excessive inflammatory reaction, thereby preventing unwanted tissue damage. In this review, we will discuss the role of the HPA axis in the normal stress response and in critical illness, especially in critically ill patients with coronavirus disease 2019 (COVID-19). Finally, a chapter will be dedicated to the findings from clinical studies in critical illness and COVID-19 on the expression of the mediator of glucocorticoid actions, the glucocorticoid receptor (GCR).

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.

Executive functioning as a predictor of physiological and subjective acute stress responses in non-clinical adult populations: A systematic literature review and meta-analysis

The goal of this systematic review and meta-analysis was to evaluate whether executive functioning predicts subsequent acute stress responses. A systematic search (conducted between May 22nd and 30th, 2019; updated on April 4th, 2020) on Cochrane, OpenGray, Proquest Dissertations and Thesis Global, PsycInfo, Pubmed, Scopus, and Web of Science revealed 27 correlational and five interventional studies. For quality appraisal, we used the BIOCROSS Tool, the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and the Revised Cochrane Risk-of-bias Tool for Randomized Trials. Attentional control was most consistently associated with acute stress. A robust variation estimation meta-analysis, conducted when sufficient data was available, revealed a small, significant, and negative correlation between higher working memory and subsequent lower cortisol reactivity (r = .09, p = .025, 95 % CI [0.15, 0.02]). These results highlight the role of executive functioning for acute stress responses, the scarcity of relevant data, and the need for both interventional designs and the consideration of mediators and moderators to understand underlying mechanisms.

Externalizing behavior in healthy young adults is associated with lower cortisol responses to acute stress and altered neural activation in the dorsal striatum

The externalizing spectrum is characterized by disinhibition, impulsivity, antisocial-aggressive behavior as well as substance (mis)use. Studies in forensic samples and mentally impaired children suggested that higher rates of externalization are linked to lower cortisol stress responses and altered affect-related neural activation. In this fMRI-study, we investigated whether externalizing behavior in healthy participants is likewise associated with altered cortisol responses and neural activity to stress. Following a quasi-experimental approach, we tested healthy participants (N = 61, 31 males) from the higher versus lower range of the non-clinical variation in externalization (31 participants with high externalization) as assessed by the subscales disinhibition and meanness of the Triarchic-Psychopathy-Measure. All participants were exposed to ScanSTRESS, a standardized psychosocial stress paradigm for scanner environments. In both groups, ScanSTRESS induced a significant rise in cortisol levels with the high externalization group showing significantly lower cortisol responses to stress than the low externalization group. This was mainly driven by males. Further, individual increases in cortisol predicted neural response differences between externalization groups, indicating more activation in the dorsal striatum in low externalization. This was primarily driven by females. In contrast, post-hoc analysis showed that hypothalamic-pituitary-adrenal axis hyporeactivity in males was associated with prefrontal and hippocampal activation. Our data substantiate that individuals from the general population high on externalization, show reduced cortisol stress responses. Furthermore, dorsal striatum activity as part of the mesolimbic system, known to be sensitive to environmental adversity, seems to play a role in externalization-specific cortisol stress responses. Beyond that, a modulating influence of gender was disclosed.

Osteopathic Manipulative Treatment as an Intervention to Reduce Stress, Anxiety, and Depression in First Responders: A Pilot Study

In this pilot study, we examined the efficacy of Osteopathic Manipulative Treatment (OMT) for improving symptoms of stress, anxiety, and depression (SAD) to determine a correlation between overall improvement in health and quality of life for first responders. Participants received weekly OMT or sham OMT targeting autonomic imbalance. Indicators of SAD were examined pre- and post-study. Overall, this pilot study suggests improvement in both the social-psychological (mental) self-assessments, and alterations in SAD-associated biomarkers from OMT.

The Level of Stress and Coping Strategies in Patients with Multiple Sclerosis and Their Relationships with the Disease Course

Objectives: Stress is supposed to be linked with a background of multiple sclerosis (MS) and the disease course. Design: The study aimed to assess the level of stress and coping strategies in MS patients within a year of follow-up and to investigate the relationships between these aspects and factors related—or not—to MS. Methods: In 65 patients with MS, the Perceived Stress Scale (PSS-10), Type D Scale (DS14) and Coping Orientations to Problems Experienced (COPE) were performed at baseline and after a year. Baseline PSS-10, DS-14 and COPE scores were analyzed with regard to demographics, MS duration, treatment, indices of disability and self-reported stressful events (SEs). Final PSS-10 and COPE results were analyzed with reference to MS activity and SE within a year of follow-up. Results: Initially, 67% of patients reported a moderate or high level of stress and 31% met Type-D personality criteria. Diverse coping strategies were preferred, most of which were problem-focused. The negative affectivity DS-14 subscore (NEG) was correlated with disability level. Non-health-related SEs were associated with higher PSS-10 and NEG scores. After a year, the mean PSS-10 score decreased, while COPE results did not change significantly. Non-health-related SEs were associated with a higher PSS-10 score and less frequent use of acceptance and humor strategies. Those with an active vs. stable MS course during the follow-up did not differ in terms of PSS-10 and COPE results. Conclusions: MS patients experienced an increased level of stress. No significant relationships were found between stress or coping and MS course within a year. Non-health-related factors affected measures of stress more than MS-related factors.

Parental Stress and Scalp Hair Cortisol in Excessively Crying Infants: A Case Control Study

BACKGROUND

Caring for an excessively crying infant (ECI) can be stressful for mothers and fathers and is associated with mental and bonding problems. Hair cortisol offers a unique measure for the biological reaction of the body to stress over time.

METHODS

In this case-control study, scalp hair cortisol concentrations (HCC) were measured using liquid chromatography-tandem mass spectrometry (LC-MS) in 35 mothers and 23 fathers and their ECIs. The control group consisted of 64 mothers and 63 fathers of non-ECIs of similar age. Parental stress, depression, anxiety and bonding were assessed using validated questionnaires.

RESULTS

Mean HCC were significantly lower in mothers and fathers of ECIs (2.3 pg/mg, 95% CI 1.8-2.9 and 1.6 pg/mg, 95% CI 1.3-2.0) than that in control mothers and fathers (3.2 pg/mg, 95% CI 3.0-3.7 and 2.9 pg/mg, 95% CI 2.5-3.5). In the total group of parents and within the parents of ECIs, HCC were not associated with negative feelings. In the control group, HCC showed a positive association with stress and depression (r = 0.207, p = 0.020 and r = 0.221, p = 0.013). In infants, no differences were found in mean HCC between the ECI group and the control group. No associations were found between maternal and infant HCC, paternal and infant HCC and maternal and paternal HCC.

CONCLUSION

Parents of ECIs showed significantly lower HCC than control parents, reflecting a diminished response of the hypothalamic-pituitary-adrenal (HPA) axis. More research is needed to examine whether this decrease in response is pre-existing or caused by excessive infant crying.

Sex-Specific Interaction Between Cortisol and Striato-Limbic Responses to Psychosocial Stress

Although women and men differ in psychological and endocrine stress responses as well as in the prevalence rates of stress-related disorders, knowledge on sex differences regarding stress regulation in the brain is scarce. Therefore, we performed an in-depth analysis of data from 67 healthy participants (31 women, taking oral contraceptives), who were exposed to the ScanSTRESS paradigm in a functional magnetic resonance imaging study. Changes in cortisol, affect, heart rate and neural activation in response to psychosocial stress were examined in women and men as well as potential sex-specific interactions between stress response domains. Stress exposure led to significant cortisol increases, with men exhibiting higher levels than women. Depending on sex, cortisol elevations were differently associated with stress-related responses in striato-limbic structures: higher increases were associated with activations in men but with deactivations in women. Regarding affect or heart rate responses, no sex differences emerged. Although women and men differ in their overall stress reactivity, our findings do not support the idea of distinct neural networks as the base of this difference. Instead, we found differential stress reactions for women and men in identical structures. We propose considering quantitative predictors such as sex-specific cortisol increases when exploring neural response differences of women and men.

How peptic ulcer disease could potentially lead to the lifelong, debilitating effects of chronic fatigue syndrome: an insight

Chronic Fatigue Syndrome (CFS) has been defined as unexplained relapsing or persistent fatigue for at least 6 consecutive months. Immuno-inflammatory pathway, bacterial infection, and other causes play essential roles in CFS. Helicobacter pylori infection is one of the most common causes of foregut inflammation, leading to peptic ulcer disease (PUD). This study aimed to analyze the risk of CFS development between patients with and without PUD. Other related factors were also analyzed. We performed a retrospective, nationwide cohort study identifying patients with or without PUD respectively by analyzing the Longitudinal Health Insurance Database 2000 (LHID2000), Taiwan. The overall incidence of CFS was higher in the PUD cohort than in the non- PUD cohort (HR = 2.01, 95% CI = 1.75-2.30), with the same adjusted HR (aHR) when adjusting for age, sex, and comorbidities. The sex-specific PUD cohort to the non-PUD cohort relative risk of CFS was significant in both genders. The age-specific incidence of CFS showed incidence density increasing with age in both cohorts. There is an increased risk of developing CFS following PUD, especially in females and the aging population. Hopefully, these findings can prevent common infections from progressing to debilitating, chronic conditions such as CFS.

Stress Reactivity to the Trier Social Stress Test in Traditional and Virtual Environments: A Meta-Analytic Comparison

OBJECTIVE

The traditional Trier Social Stress Test (TSST) is a widely used standardized stress induction protocol and has recently been adapted in a variety of virtual reality environments (V-TSST). Research has demonstrated the ability of the V-TSST to induce a stress reactivity response measured via cortisol, heart rate, and self-report. However, research comparing stress reactivity induced via the V-TSST to the traditional TSST across neuroendocrine, cardiovascular, and self-report variables has not yet been systematically and quantitatively reviewed.

METHODS

In this meta-analytic review, the existing studies that used V-TSST were gathered, and each was age and sex matched with samples using the traditional TSST. These studies were then meta-analytically synthesized to determine if there was a moderating effect of TSST type (traditional TSST or V-TSST) on multiple measures of stress reactivity (i.e., cortisol, heart rate, and self-report).

RESULTS

Examining the pre-post stress induction, the V-TSST studies demonstrated comparable effect sizes (ESs) for stress reactivity (cortisol ES = 0.61, heart rate ES = 0.98, self-reported stress ES = 0.94) to traditional TSST study ESs (cortisol ES = 0.79, heart rate ES = 0.85, self-reported stress ES = 0.85).

CONCLUSIONS

The TSST type differences between ESs were not statistically significant, indicating that the V-TSST is as effective as the traditional TSST at eliciting a physiological and self-reported stress reactivity response. Implications and limitations of this meta-analysis are discussed, and recommendations for future research are provided.