Cardiovascular, hormonal, and emotional responses to the TSST in relation to sex and menstrual cycle phase

Luteal phase sertraline treatment of premenstrual dysphoric disorder (PMDD): Effects on markers of hypothalamic pituitary adrenal (HPA) axis activation and inflammation

RATIONALE

Premenstrual dysphoric disorder (PMDD) is characterized by severe affective symptoms during the luteal phase of the menstrual cycle. There is some evidence of altered interactions between the hypothalamic pituitary gonadal (HPG) and hypothalamic pituitary adrenal (HPA) axes in PMDD. There is also evidence that similar affective disorders such as major depression and perinatal depression are associated with dysregulation in immune factors, but this has not been characterized in PMDD.

AIMS

The goals of this exploratory study were to identify 1) whether HPA-HPG axis interactions and immune markers differ between PMDD patients and controls across the menstrual cycle; 2) how luteal phase sertraline treatment impacts stress and inflammatory markers.

METHODS

Participants were females age 18-50 with regular menstrual cycles, not using psychotropic or hormonal medications, and were assigned to a control group or PMDD group based on prospective daily symptom ratings and clinical interview. Blood was drawn in the follicular and luteal phases, during laboratory sessions involving a mildly stressful task. In a second luteal phase, PMDD participants received open-label sertraline (50 mg/d) from ovulation to menses. Serum cortisol and ACTH were measured via ELISA and operationalized as area under the curve with respect to ground (AUCg), and peak level following laboratory task. Serum TNF-α, IL-6, CXCL-8, and IL-1β were measured using multiplex kits. Serum allopregnanolone (ALLO) was measured by gas chromatography/mass spectroscopy. To characterize HPA-HPG axis interactions across the menstrual cycle in PMDD participants and controls, multilevel linear models predicted cortisol and ACTH from the interaction of cycle phase (controlling for sertraline treatment), ALLO, and group. To determine the effects of sertraline treatment on inflammatory markers and how groups might differ in cyclical change on each marker, multilevel linear models predicted inflammatory markers from cycle phase (controlling for sertraline treatment) and group. A final set of exploratory models tested whether inflammatory markers predict premenstrual symptom score severity.

RESULTS

The sample included n=77 participants (41 controls, 36 PMDD); 28 participants with PMDD completed sertraline treatment. Group x phase x ALLO interactions showed that higher ALLO levels predicted lower cortisol peak in the treated luteal phase (interaction between phase and ALLO, p=0.042), and there was a higher cortisol peak in the treated luteal phase than the untreated luteal phase (p=0.038). CXCL-8 was significantly associated with premenstrual symptom severity after controlling for group and cycle phase (p=0.011). There were no main effects of group, phase, or ALLO on cortisol AUCg, ACTH AUCg, IL-6, CXCL-8, IL-1β, nor TNF-α (p's>0.05).

CONCLUSION

Serum markers of HPA axis and immune function did not vary by menstrual cycle phase nor PMDD status. However, sertraline treatment in the luteal phase was associated with higher ALLO levels predicting lower cortisol peak in response to mild laboratory stress, suggesting that sertraline treatment may normalize HPG-HPA axis interactions among individuals with PMDD. Greater premenstrual symptomatology was associated with higher levels of the inflammatory marker CXCL-8, but further research is needed into the potential role of inflammation in PMDD.

Hypothalamic pituitary adrenal and autonomic nervous system biomarkers of stress and tobacco relapse: Review of the research

Tobacco smoking is a risk factor for countless diseases, and smoking relapse remains a major public health concern. Subjective reports of stress by smokers are a common theme for relapse, however, the role of objective stress-related biomarkers in predicting tobacco relapse risk has been less studied. The aim of this manuscript was to review existing literature on the connection between biomarkers of stress and smoking relapse. Overall, trends indicate that blunted hypothalamic-pituitary-adrenal (HPA) responses to acute stress, larger reductions in HPA biomarkers during the initial days of abstinence during cessation (compared to pre-cessation levels), and exaggerated autonomic responses to stress predict increased risk of relapse. In addition, successful cessation is followed by changes in stress biomarkers (e.g., reductions in cortisol and heart rate, HR). This review also identifies potential modifiers, such as methodological differences, biological sex, and chronic stress, to account for heterogeneity of findings within and across studies. In addition, we identify gaps in the literature and suggest future research directions focusing on the roles of genetics and gene expression as well as the influence of neurobiological mechanisms on stress and relapse risk. Future clinical implications of this research include identifying reliable indicators of relapse risk and the potential of pharmacotherapeutic treatments to target stress response systems to correct dysregulation and potentially reduce stress-related risk of relapse.

The role of personal, relational, and collective self-esteem in predicting acute salivary cortisol response and perceived stress

Personal self-esteem (PSE) has been well recognized as a buffer against stress; however, the effects of other types of self-esteem, such as relational self-esteem (RSE) and collective self-esteem (CSE), on stress have not been adequately explored. This study investigated the roles of PSE, RSE, and CSE in reducing stress response. The Rosenberg, Relational, and Collective Self-Esteem Scales were adopted to assess PSE, RSE, and CSE, respectively. Participants underwent an acute social stress paradigm, and their acute stress response was assessed using subjective stress reports and salivary cortisol levels. Chronic stress level was estimated using the Perceived Stress Scale and hair cortisol concentration. The results showed that PSE was negatively correlated with salivary cortisol response during acute social stress; however, no significant associations were found between any type of self-esteem and subjective stress reports. For chronic stress, all types of self-esteem were negatively associated with perceived stress level, but not with hair cortisol concentration. Further hierarchical regression analyses suggested that only PSE negatively predicted acute salivary cortisol response and perceived stress level. Overall, the findings suggest the essential role of PSE in predicting acute salivary cortisol responses and perceived stress.

Gonads under stress: A systematic review and meta-analysis on the effects of acute psychosocial stress on gonadal steroids secretion in humans

Animal research has shown that the hypothalamus-pituitary-gonadal (HPG) axis is inhibited by (chronic and/or severe) stress, which can lead to impaired fertility and reproductive functioning, presumably caused by the inhibition of gonadal steroid secretion and in interactions with glucocorticoids. However, what has not been clarified is how acute psychosocial stress modulates gonadal steroid secretion in humans. Here we summarize the experimental research on the acute effects of stress on the secretion of gonadal steroids in humans. A systematic literature search revealed 21 studies (with N=881 individuals) measuring testosterone, progesterone or estradiol in response to a standardized acute laboratory stressor in healthy humans. Both our literature review and quantitative meta-analysis suggest that in humans, acute stress stimulates rather than inhibits HPG axis activity, although there is a considerable heterogeneity in the reported methods and results. Increased gonadal steroids in response to acute stress contrasts with many animal studies reporting the opposite pattern, at least regarding severe and/or chronic stressors. We discuss methodological issues and challenges for future research and hope to stimulate experimental studies within this area. A better understanding of these mechanisms is needed, and may have important implications for health and disease, as well as the modulation of various behaviors by acute stressors.

Associations between Social Adversity and Biomarkers of Inflammation, Stress, and Aging in Children

BACKGROUND

Prior work has found relationships between childhood social adversity and biomarkers of stress, but knowledge gaps remain. To help address these gaps, we explored associations between social adversity and biomarkers of inflammation (interleukin-1β [IL-1β], IL-6, IL-8, tumor necrosis factor-alpha [TNF-α], and salivary cytokine hierarchical "clusters" based on the three interleukins), neuroendocrine function (cortisol, cortisone, dehydroepiandrosterone, testosterone, and progesterone), neuromodulation (N-arachidonoylethanolamine, stearoylethanolamine, oleoylethanolamide, and palmitoylethanolamide), and epigenetic aging (Pediatric-Buccal-Epigenetic clock).

METHODS

We collected biomarker samples of children ages 0-17 recruited from an acute care pediatrics clinic and examined their associations with caregiver-endorsed education, income, social risk factors, and cumulative adversity. We calculated regression-adjusted means for each biomarker and compared associations with social factors using Wald tests. We used logistic regression to predict being in the highest cytokine cluster based on social predictors.

RESULTS

Our final sample included 537 children but varied based on each biomarker. Cumulative social adversity was significantly associated with having higher levels of all inflammatory markers and with cortisol, displaying a U-shaped distribution. There were no significant relationships between cumulative social adversity and cortisone, neuromodulation biomarkers or epigenetic aging.

CONCLUSION

Our findings support prior work suggesting that social stress exposures contribute to increased inflammation in children.

IMPACT

Our study is one of the largest studies examining associations between childhood social adversity and biomarkers of inflammation, neuroendocrine function, neuromodulation, and epigenetic aging. It is one of the largest studies to link childhood social adversity to biomarkers of inflammation, and the first of which we are aware to link cumulative social adversity to cytokine clusters. It is also one of the largest studies to examine associations between steroids and epigenetic aging among children, and one of the only studies of which we are aware to examine associations between social adversity and endocannabinoids among children.

CLINICAL TRIAL REGISTRATION

NCT02746393.

Multifactorial stress reactivity to virtual TSST-C in healthy children and adolescents-It works, but not as well as a real TSST-C

A virtual version of the Trier Social Stress Test (TSST) has been increasingly used in stress research. Benefits of the virtual TSST include that it is more economical, and offers improved control of context and enhanced flexibility of use. Many studies have confirmed the applicability of virtual TSSTs in stress research, but only in adulthood. In the present study, we aimed to experimentally verify the transferability of a virtual TSST to adolescence. A total of 73 healthy adolescents (aged 11-17 years) of both sexes completed either a real (IV-TSST-C) or virtual (VR-TSST-C) TSST for children. The surveyed stress parameters included salivary cortisol and alpha amylase concentrations, heart rate, heart rate variability, and subjective stress ratings across test sessions, as well as a pre- to post-TSST-C comparison. All parameters revealed significant stress responses over time. We observed significant effects of group on cortisol and subjective stress ratings, with the VR-TSST-C inducing less stress than the IV-TSST-C. In alpha amylase, heart rate, and heart rate variability, we found no significant difference between TSST versions, but only significant equivalence for alpha amylase. Some parameters may have been influenced by an expectancy effect and the participant's sex. In conclusion, among adolescents, a virtual TSST-C effectively elicits stress at multiple levels (endocrinological, autonomic, and subjective); however, the magnitude is not always comparable to with the real TSST-C, which should be considered when applied.

Stress-induced brain responses are associated with BMI in women

Overweight and obesity are associated with altered stress reactivity and increased inflammation. However, it is not known whether stress-induced changes in brain function scale with BMI and if such associations are driven by peripheral cytokines. Here, we investigate multimodal stress responses in a large transdiagnostic sample using predictive modeling based on spatio-temporal profiles of stress-induced changes in activation and functional connectivity. BMI is associated with increased brain responses as well as greater negative affect after stress and individual response profiles are associated with BMI in females (pperm < 0.001), but not males. Although stress-induced changes reflecting BMI are associated with baseline cortisol, there is no robust association with peripheral cytokines. To conclude, alterations in body weight and energy metabolism might scale acute brain responses to stress more strongly in females compared to males, echoing observational studies. Our findings highlight sex-dependent associations of stress with differences in endocrine markers, largely independent of peripheral inflammation.

Determining menstrual cycle phase: An empirical examination of methodologies and recommendations for improvement in behavioral and brain sciences

The recent decade has brought an exciting proliferation of behavioral, psychological and neuroscientific research involving the menstrual cycle. However, the reliability and validity of many popular methodologies for determining menstrual cycle phase lack empirical examination. These under-investigated methods include: (1) predicting menstrual cycle phase using self-report information only (e.g., "count" methods), (2) utilizing ovarian hormone ranges to determine menstrual cycle phase, and (3) using ovarian hormone changes from limited measurements (e.g., two time points) to determine menstrual cycle phase. In the current study, we examine the accuracy of these methods for menstrual cycle phase determination using 35-day within-person assessments of circulating ovarian hormones from 96 females across the menstrual cycle. Findings indicate that all three common methods are error-prone, resulting in phases being incorrectly determined for many participants, with Cohen's kappa estimates ranging from -0.13 to 0.53 indicating disagreement to only moderate agreement depending on the comparison. Such methodological challenges are surmountable through careful study design, more frequent hormone assays (when possible), and utilization of sophisticated statistical methods. With increased methodological rigor in behavioral, psychological and neuroscientific research, the field will be poised to detect biobehavioral correlates of ovarian hormone fluctuations for the betterment of the mental health and wellbeing of millions of females.

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.

Neural response to stress differs by sex in young adulthood

Increase in stress-related disorders in women begins post-puberty and persists throughout the lifespan. To characterize sex differences in stress response in early adulthood, we used functional magnetic resonance imaging while participants underwent a stress task in conjunction with serum cortisol levels and questionnaires assessing anxiety and mood. Forty-two healthy subjects aged 18-25 years participated (21M, 21F). Interaction of stress and sex in brain activation and connectivity were examined. Results demonstrated significant sex differences in brain activity with women exhibiting increased activation in regions that inhibit arousal compared to men during the stress paradigm. Women had increased connectivity among stress circuitry regions and default mode network, whereas men had increased connectivity between stress and cognitive control regions. In a subset of subjects (13F, 17M), we obtained gamma-aminobutyric acid (GABA) magnetic resonance spectroscopy in rostral anterior cingulate cortex (rostral ACC) and dorsolateral prefrotal cortex (dlPFC) and conducted exploratory analyses to relate GABA measurements with sex differences in brain activation and connectivity. Prefrontal GABA levels were negatively associated with inferior temporal gyrus activation in men and women and with ventromedial prefrontal cortex activation in men. Despite sex differences in neural response, we found similar subjective ratings of anxiety and mood, cortisol levels, and GABA levels between sexes, suggesting sex differences in brain activity result in similar behavioral responses among the sexes. These results help establish sex differences in healthy brain activity from which we can better understand sex differences underlying stress-associated illnesses.

Integrating the pattern of negative emotion processing and acute stress response with childhood stress among healthy young adults

Background: Childhood adversity might impair corticolimbic brain regions, which play a crucial role in emotion processing and the acute stress response. The dimensional model of childhood adversity proposed that deprivation and threat dimensions might associated with individuals' development through different mechanisms. However, few studies have explored the relationship between different dimensions of childhood stress, emotion processing, and acute stress reactivity despite the overlapping brain regions of the last two. With the aid of event-related potentials technique, we explore whether negative emotion processing, which might be particularly relevant for adaptive stress responding among individuals with adverse childhood experience, mediates the relationship between dimensional childhood stress and acute stress response. Method: Fifty-one young adults completed a free-viewing task to evaluate neural response to negative stimuli measured by late positive potential (LPP) of ERPs (Event-related potentials). On a separate day, heart rate and salivary cortisol were collected during a social-evaluative stress challenge (i.e., TSST, Trier Social Stress Test). After the TSST, childhood trauma questionnaire was measured to indicate the level of abuse (as a proxy of threat) and neglect (as a proxy of deprivation) dimensions. Multiple linear regression and mediation analysis were used to explore the relationship among the childhood stress, emotion processing and acute stress response. Results: Higher level of childhood abuse (but not neglect) was distinctly related to smaller LPP amplitudes to negative stimuli, as well as smaller heart rate reactivity to acute stress. For these participants, smaller LPP amplitudes were linked with smaller heart rate reactivity to acute stress. Furthermore, decreased LPP amplitudes to negative stimuli mediated the relationship between higher level of childhood abuse and blunted heart rate reactivity to stress. Conclusions: Consistent with the dimensional model of childhood stress, our study showed that childhood abuse is distinctly associated with neural as well as physiological response to threat. Furthermore, the blunted neural response to negative stimuli might be the underlying mechanism in which childhood abuse leads to the blunted acute stress response. Considering that all the participants are healthy in the present study, the blunted processing of negative stimuli might rather reflect adaptation instead of vulnerability, in order to prevent stress overshooting in the face of early-life threatening experiences.

Stress responses in high-fidelity simulation and standard simulation training among medical students

BACKGROUND

Simulation has been recognized as a shift in healthcare education that can improve skills and patient safety and outcomes. High-fidelity simulation of critical medical situations can be a source of stress among participants that can interfere with students' abilities leading to unexpected emotional responses. The aim of this study is to determine if two simulation methods, high-fidelity (HF) and procedural simulation (PS), may be associated with stress responses at a self-perceived and biological level (salivary cortisol variations), and to compare stress levels of the two different simulation method. We also wanted to find independent variables associated with cortisol total hormonal output.

METHODS

A quasi-experimental before-after study was used including the administration of questionnaires, and biomarkers evaluation by salivary cortisol samples before and after simulation. A total of 148 students were eligible and agreed to participate in the study. We used paired T-test for mean comparison regarding State-trait anxiety for both HF and PT simulations. For NASA-TLX we performed a T-test mean comparison between groups. We used paired T-test mean comparison for cortisol analysis. Multivariable linear regression has been used to assess variables associated with AUC_g values and perceived stress.

RESULTS

values of STAI-Y scores were relatively higher at the end of the HF and PS sessions. NASA-TLX was significantly higher at baseline for the HF simulations, with respect to the PS simulation. Cortisol fold increase was significantly different in the two groups. Linear regression showed that cortisol AUCg was related to the STAI-Y score in both groups.

CONCLUSION

Participating students developed a stress response both after in the HF and PS training, testified by psychological and biological outputs. According to our results, stress levels were increased for simply being in a simulation scenario than to the intrinsic complexity of the task required. More studies are needed to confirm this trend and to clarify the role of simulated stress response in a long-term learning scenario.

Time-dependent effects of acute stress on working memory performance: A systematic review and hypothesis

Laboratory procedures such as the Trier Social Stress Test or the (Socially Evaluated) Cold Pressor Test have been used to investigate working memory performance under stress. Researchers so far have reported a diverse spectrum of stress effects (including the lack thereof) on working memory tasks. We conducted a systematic review of the effect acute stress on working memory performance in standardized laboratory procedures. An overview of the existing literature suggests that acute stress affects working memory in a time-dependent manner, presumably due to the differing time scales of the main stress-reactive hormones involved. Based on the empirical evidence, we hypothesize that the immediate stress-induced release of noradrenaline decreases working memory performance within the first 10 min post stress. In addition, rapid cortisol effects impair working memory at a later time-interval beginning about 25 min post stress. We outline future research directions which could further explore the implications of our insights, as for example combined pharmacological and naturalistic stressor interventions.

Sex-dependent multimodal response profiles to psychosocial stress

INTRODUCTION

Sex differences in stress reactions are often reported in the literature. However, the sex-dependent interplay of different facets of stress is still not fully understood. Particularly in neuroimaging research, studies on large samples combining different indicators of stress remain scarce.

MATERIALS AND METHODS

In a functional magnetic resonance imaging study, a sample of 140 healthy participants (67 females using oral contraceptives) underwent a standardized stress induction protocol, the ScanSTRESS. During the experiment, salivary cortisol and subjective ratings were obtained at multiple time points and heart rate was recorded.

RESULTS

Sex differences emerged in different facets of the stress response:Women reacted with enhanced subjective feelings of stress and increases in heart rate, while men showed more pronounced neural activation in stress-related brain regions such as the inferior frontal gyrus and insula. Subjective feelings of stress and (para) hippocampal activity were negatively related in women,whereas a slightly positive association was observed in men.

DISCUSSION

These results provide further insight in the sex-specific stress response patterns. Moreover, they emphasize the role of the hippocampus in the regulation of the stress response. This paves the way for the identification of sex-dependent vulnerability factors that can, in the future, be implemented in the prevention and treatment of stress-related disorders.

The association between acute stress & empathy: A systematic literature review

Empathy is a fundamental component of our social-emotional experience. Over the last decade, there has been increased interest in understanding the effects of acute stress on empathy. We provide a first comprehensive-and systematic-overview identifying emerging patterns and gaps in this literature. Regarding affective empathy, there is abundant evidence for stress contagion-the 'spillover' of stress from a stressed target to an unstressed perceiver. We highlight contextual factors that can facilitate and/or undermine these effects. Fewer studies have investigated the effects of acute stress on affective empathy, revealing a nuanced picture, some evidence suggests acute stress can block contagion of other's emotions; but again contextual differences need to be considered. Regarding cognitive empathy, most studies find no conclusive effects for simplistic measures of emotion recognition; however, studies using more complex empathy tasks find that acute stress might affect cognitive empathy differentially for men and women. This review provides an important first step towards understanding how acute stress can impact social-togetherness, and aims to aid future research by highlighting (in)congruencies and outstanding questions.

Stress and Stress-Induced Glucocorticoids Facilitate Empathic Accuracy in Men but Have No Effects for Women

Empathy, the ability to understand the feelings of other people, is critical for navigating our social world and maintaining social connections. Given that acute stress, and resulting increased glucocorticoids, triggers a shift in two large-scale brain networks, prioritizing salience over executive control, we predicted that acute psychosocial stress would facilitate empathic accuracy. We also investigated the moderating role of gender, given that men typically show a more robust glucocorticoid response to acute stress than women. As predicted, results from two independent experiments ( N = 267 college-age participants; 2,256 observations) showed that acute psychosocial stress facilitated empathic accuracy for men, an effect related to their glucocorticoid response in the stress condition. Conversely, psychosocial stress had no effect on empathic accuracy for women, who also showed a smaller cortisol response to stress than men. Exploratory analyses further revealed that women taking oral contraceptives performed worse on the empathic-accuracy task than regularly cycling women. This research highlights the important, but complex, role of stress in cognitive empathy.

The Allopregnanolone Response to Acute Stress in Females: Preclinical and Clinical Studies

The neuroactive steroid allopregnanolone ((3α,5α)-3-hydroxypregnan-20-one or 3α,5α-THP) plays a key role in the response to stress, by normalizing hypothalamic-pituitary-adrenal (HPA) axis function to restore homeostasis. Most studies have been conducted on male rats, and little is known about the allopregnanolone response to stress in females, despite that women are more susceptible than men to develop emotional and stress-related disorders. Here, we provide an overview of animal and human studies examining the allopregnanolone responses to acute stress in females in the context of stress-related neuropsychiatric diseases and under the different conditions that characterize the female lifespan associated with the reproductive function. The blunted allopregnanolone response to acute stress, often observed in female rats and women, may represent one of the mechanisms that contribute to the increased vulnerability to stress and affective disorders in women under the different hormonal fluctuations that occur throughout their lifespan. These studies highlight the importance of targeting neuroactive steroids as a therapeutic approach for stress-related disorders in women.

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.

Sympathetic neural reactivity to the Trier social stress test

Sympathetic responsiveness to laboratory mental stress is highly variable, making interpretations of its role in stress reactivity challenging. The present study assessed muscle sympathetic nerve activity (MSNA, microneurography) responsiveness to the Trier social stress test (TSST), which employs an anticipatory stress phase, followed by a public speaking and mental arithmetic task. We hypothesized that sympathetic reactivity to the anticipatory phase would offer a more uniform response between individuals due to elimination of confounds (i.e. respiratory changes, muscle movement, etc.) observed during more common stress tasks. Participants included 26 healthy adults (11 men, 15 women, age: 25 ± 6 years, body mass index: 24 ± 3 kg/m² ). Continuous heart rate (electrocardiogram) and beat-to-beat blood pressure (finger plethysmography) were recorded from all participants, while MSNA recordings were obtained in 20 participants. MSNA burst frequency was significantly reduced during anticipatory stress. During the speech, although burst frequency was unchanged, total MSNA was significantly increased. Changes in diastolic arterial pressure were predictive of changes in MSNA during anticipatory (β = -0.680, P = 0.001), but not the speech (P = 0.318) or mental maths (P = 0.051) phases. Lastly, sympathetic reactivity to anticipatory stress was predictive of subsequent reactivity to both speech (β = 0.740, P = 0.0002) and maths (β = 0.663, P = 0.001). In conclusion, anticipatory social stress may offer a more versatile means of assessing sympathetic reactivity to mental stress in the absence of confounds and appears to predict reactivity to subsequent mental stress paradigms. KEY POINTS: Cardiovascular reactivity to laboratory mental stress is predictive of future health outcomes. However, reactivity of the sympathetic nervous system to mental stress is highly variable. The current study assessed peripheral muscle sympathetic nerve activity in response to the Trier social stress test, a psychosocial stressor that includes anticipatory stress, public speaking and mental arithmetic. Our findings demonstrate that sympathetic neural activity is consistently reduced during anticipatory stress. Conversely, the classically observed inter-individual variability of sympathetic responsiveness was observed during speech and maths tasks. Additionally, sympathetic reactivity to the anticipatory period accurately predicted how an individual would respond to both speech and maths tasks, outlining the utility of anticipatory stress in future research surrounding stress reactivity. Utilization of the Trier social stress test in autonomic physiology may offer an alternative assessment of sympathetic responsiveness to stress with more consistent inter-individual responsiveness and may be a useful tool for further investigation of stress reactivity.

The acute effect of a laboratory shame induction protocol on endothelial function in young, healthy adults

NEW FINDINGS

What is the central question of this study? Shame is a form of social stress which involves internalizing social devaluations imposed by others. The aim of this study was to determine, for the first time, how acutely experiencing shame impacts endothelial function. What is the main finding and its importance? Brachial artery flow-mediated dilation, an index of endothelial function, was impaired following an intervention that acutely increased self reported shame. This occurred without increases in cortisol or tumor necrosis factor alpha receptor binding. Frequent or prolonged shame induced endothelial dysfunction could have important cardiovascular consequences.

ABSTRACT

Objective The objective of this study was to examine the impact of a shame induction protocol on endothelial function. Methods Fifteen participants (n = 7 men, n = 8 women) completed both a written shame induction and control protocol on two different experimental days. Pre- and post-protocol we assessed: 1) Endothelial function and arterial shear rate via a standard brachial artery reactive hyperemia flow-mediated dilation (FMD) test across two post-intervention time points (15 and 35-min post); 2) Perceived shame via the Experiential Shame Scale (ESS), and; 3) Cortisol and sTNFαRII (soluble tumor necrosis factor alpha receptor) through oral fluid analysis. Results Shame increased after the shame induction protocol (pre: 2.9±.6 vs. post: 3.7±.5, p<.001) but not the control protocol (pre: 3.0±.5 vs. post: 2.8±.5, p = .15) (protocol by time interaction: p<.001). When all three time points were included in the analysis, %FMD did not change over time. Considering only the lowest point, %FMD significantly decreased in response to the shame protocol (pre: 4.8±1.9 vs. post: 3.2±1.6, p<.001) but not the control protocol (4.2±1.8 vs. post: 3.8±1.5, p = .45) (protocol by time interaction: p = .035). Covariation of the shear rate stimulus for FMD did not alter the FMD results. When including both the control and shame protocol, but not the shame protocol alone, increased shame was significantly associated with decreased FMD (r = -.37, p<.046). There were no significant time by protocol interaction effects for cortisol or sTNFαRII. Conclusions Temporary increases in shame may cause transient endothelial dysfunction which, if chronically repeated, could manifest as reduced vasoprotection against atherosclerosis. This article is protected by copyright. All rights reserved.

Alpha-Adrenergic Mechanisms in the Cardiovascular Hyperreactivity to Norepinephrine-Infusion in Essential Hypertension

AIMS

Essential hypertension (EHT) is characterized by cardiovascular hyperreactivity to stress but underlying mechanism are not fully understood. Here, we investigated the role of α-adrenergic receptors (α-AR) in the cardiovascular reactivity to a norepinephrine (NE)-stress reactivity-mimicking NE-infusion in essential hypertensive individuals (HT) as compared to normotensive individuals (NT).

METHODS

24 male HT and 24 male NT participated in three experimental trials on three separate days with a 1-min infusion followed by a 15-min infusion. Trials varied in infusion-substances: placebo saline (Sal)-infusions (trial-1:Sal+Sal), NE-infusion without (trial-2:Sal+NE) or with non-selective α-AR blockade by phentolamine (PHE) (trial-3:PHE+NE). NE-infusion dosage (5µg/ml/min) and duration were chosen to mimic duration and physiological effects of NE-release in reaction to established stress induction protocols. We repeatedly measured systolic (SBP) and diastolic blood pressure (DBP) as well as heart rate before, during, and after infusions.

RESULTS

SBP and DBP reactivity to the three infusion-trials differed between HT and NT (p's≤.014). HT exhibited greater BP reactivity to NE-infusion alone compared to NT (trial-2-vs-trial-1: p's≤.033). Group differences in DBP reactivity to NE disappeared with prior PHE blockade (trial-3: p=.26), while SBP reactivity differences remained (trial-3: p=.016). Heart rate reactivity to infusion-trials did not differ between HT and NT (p=.73).

CONCLUSION

Our findings suggest a mediating role of α-AR in DBP hyperreactivity to NE-infusion in EHT. However, in SBP hyperreactivity to NE-infusion in EHT, the functioning of α-AR seems impaired suggesting that the SBP hyperreactivity in hypertension is not mediated by α-AR.

Low Corticosterone Response to Stress in a Perimenopausal Rat Model Is Associated with the Hypoactivation of PaMP Region of the Paraventricular Nucleus and Can Be Corrected by Exogenous Progesterone Supplementation

INTRODUCTION

The transition to menopause is characterized by mood, behavioral and metabolic changes. However, little is known about the changes in adrenal response to stress.

AIMS

The aim of the study was to evaluate, in an animal model of perimenopause induced by 4-vinylcyclohexene diepoxide (VCD), (1) the endocrine and neuronal stress system activity in response to acute restraint stress and (2) the effect of hormonal therapy in this response.

METHODS

Prepubertal female Wistar rats received daily injections (s.c) of oil or VCD (160 mg/kg) for 15 days. On 56th-66th days after treatment onset, the groups to be stressed received s.c implants containing placebo (PL), 17β-estradiol (E2), progesterone (P4), or E2P4. At 80 ± 5 days after VCD/oil injections, stress was applied for 30 min. Blood samples were collected immediately after and 60 min after the end of stress session from the tail tip followed by transcardial perfusion with PFA 4% for the assessment of c-Fos expression in the medial and posterior parvocellular (PaMP and PaPo) subdivisions of the paraventricular nucleus (PVN) and c-Fos/tyrosine hydroxylase in the locus coeruleus (LC) using immunohistochemistry. Control groups were not stressed nor received hormone therapy.

RESULTS

While basal corticosterone levels were similar between VCD-periestropausal and control rats, the secretion in response to stress in the VCD group was lower. This effect was prevented by P4 therapy. Inversely, basal levels of P4 were lower in VCD-periestropausal rats than in the controls, and no differences were found in response to stress between the groups. As expected, 30-min restraint stress increased c-Fos immunoreactivity in all brain areas studied in both control and VCD-periestropausal rats. However, the c-Fos increase in the PaMP region was attenuated. In all areas examined, there were no significant differences in the number of c-Fos-positive neurons across hormonal therapies.

DISCUSSION/CONCLUSION

This is the first study to demonstrate in a perimenopausal rat model that reproductive aging is accompanied by inadequate secretion of corticosterone in response to acute stress in association with the hypoactivation of the PaMP region of the PVN, while adrenal P4 response is preserved. Moreover, P4 therapy was shown to attenuate the effects of progressive ovarian failure on adrenal functioning during stress.

Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review

LEARNING OBJECTIVE

After participating in this activity, learners should be better able to:• Discuss and outline the general and overlapping effects of the menstrual cycle on women's mental health.

ABSTRACT

A growing body of research demonstrates menstrual cycle-dependent fluctuations in psychiatric symptoms; these fluctuations can therefore be considered as prevalent phenomena. Possible mechanisms underlying these fluctuations posit behavioral, psychological, and neuroendocrine influences. Recent reviews document cyclic exacerbation of symptoms and explore these mechanisms in the context of specific and often single disorders. The question remains, however, as to whether there are general and overlapping effects of the menstrual cycle on women's mental health. To address this gap, we synthesized the literature examining the exacerbation of a variety of psychiatric symptoms across the menstrual cycle in adult women. Results show that the premenstrual and menstrual phases are most consistently implicated in transdiagnostic symptom exacerbation. Specifically, strong evidence indicates increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during these phases. Anxiety, stress, and binge eating appear to be elevated more generally throughout the luteal phase. The subjective effects of smoking and cocaine use are reduced during the luteal phase, but fewer data are available for other substances. Less consistent patterns are demonstrated for panic disorder, symptoms of posttraumatic stress disorder, and borderline personality disorder, and it is difficult to draw conclusions for symptoms of generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and trichotillomania because of the limited data. Future research should focus on developing standardized approaches to identifying menstrual cycle phases and adapting pharmacological and behavioral interventions for managing fluctuations in psychiatric symptoms across the menstrual cycle.

Sex differences in the genetic regulation of the blood transcriptome response to glucocorticoid receptor activation

Substantial sex differences have been reported in the physiological response to stress at multiple levels, including the release of the stress hormone, cortisol. Here, we explore the genomic variants in 93 females and 196 males regulating the initial transcriptional response to cortisol via glucocorticoid receptor (GR) activation. Gene expression levels in peripheral blood were obtained before and after GR-stimulation with the selective GR agonist dexamethasone to identify differential expression following GR-activation. Sex stratified analyses revealed that while the transcripts responsive to GR-stimulation were mostly overlapping between males and females, the quantitative trait loci (eQTLs) regulation differential transcription to GR-stimulation was distinct. Sex-stratified eQTL SNPs (eSNPs) were located in different functional genomic elements and sex-stratified transcripts were enriched within postmortem brain transcriptional profiles associated with Major Depressive Disorder (MDD) specifically in males and females in the cingulate cortex. Female eSNPs were enriched among SNPs linked to MDD in genome-wide association studies. Finally, transcriptional sensitive genetic profile scores derived from sex-stratified eSNPS regulating differential transcription to GR-stimulation were predictive of depression status and depressive symptoms in a sex-concordant manner in a child and adolescent cohort (n = 584). These results suggest the potential of eQTLs regulating differential transcription to GR-stimulation as biomarkers of sex-specific biological risk for stress-related psychiatric disorders.

The effects of acute stress on attentional networks and working memory in females

Neurobiological models indicate that acute stress facilitates bottom-up stimulus processing while impairing top-down executive control. To test this hypothesis, the present study investigated the effects of acute stress on behavioural and electrophysiological measures of human attentional networks, and behavioural measures of working memory. Forty-five female participants (M_age = 22.1, SD = 2.4) performed the Attention Network Test (ANT) and the n-back task before and after the Maastricht Acute Stress Test (MAST; n = 23) or a non-stressful MAST-placebo (n = 22). Subjective distress ratings and salivary cortisol concentrations revealed a successful stress induction. Increased salivary cortisol at baseline was associated with slower reaction times across both tasks, suggesting a general detrimental effect of cortisol on cognitive functioning. Despite these findings, however, the hypothesised effects of the acute stress manipulation were not found for either task. Supplementary analyses indicated that these results were unrelated to the magnitude or duration of the stress response. Our results therefore suggest the standard version of the ANT may be insensitive to the effects of acute stress, and that higher cognitive loads may be necessary to observe stress effects on the n-back task.

The Influence of Neuroticism on the Muscle Response in the Trapezius and Frontalis Muscles to Anticipatory Stress

Abstract. Objective quantification of mental stress in the workplace would be beneficial for designing work tasks to avoid the negative consequences of mental stress. Methods such as surface electromyography have proven to be sensitive to mental demands. However, there is little knowledge about the muscle response and moderating factors during anticipatory stress paradigms. This study examined whether the personality dimension neuroticism moderates the muscle response to the expectation of an unpredictable electrical shock. Forty-seven subjects underwent three expectation phases, in which they could expect a pleasant audio signal (NoShock) or an electric shock in two conditions (anticipation of the first: Shock1, and second electric shock: Shock2) at an unpredictable moment. The frontalis muscle activity and the upper and upper/middle parts of the trapezius muscle were recorded using surface electromyography. Neuroticism was surveyed using the Big Five Inventory to assign the subjects to a group with lower or higher neuroticism. Shock1 only induced higher trapezius muscle activity in the higher neuroticism group, which vanished during Shock2, while the frontalis muscle showed no significant effects. The results suggest that neuroticism should be considered a moderating factor in assessing anticipatory stress using surface electromyography at the trapezius muscle.

Blunted opioid regulation of the HPA stress response during nicotine withdrawal: therapeutic implications

Endogenous opioids regulate pain, drug reward, and stress responses. We have previously shown reduced hypothalamic-pituitary-adrenal (HPA) responses to psychological stress and to opioid blockade among dependent smokers. In this study, we examined the extent to which biologically confirmed nicotine withdrawal alters endogenous opioid regulation of HPA axis functioning during rest and in response to acute stress. Smokers were randomly assigned to one of two conditions; 24 h withdrawal from all nicotine-containing products (n = 62) or smoking ad libitum (n = 44). A nonsmoking comparison group (n = 43) was also included. Participants (85 males and 64 females) completed two acute stress sessions during which a placebo or 50 mg of naltrexone (opioid antagonist) were administered using a double-blind design. Blood and saliva samples (assayed for cortisol and adrenocorticotropic hormone, i.e. ACTH) and mood measures were obtained during a resting absorption period, after acute stress (public speaking, mental arithmetic, and cold pressor tasks), and during an extended recovery period. Results indicated that opioid blockade (naltrexone) was associated with increased ACTH and cortisol responses to stress, and tobacco withdrawal was associated with blunted hormonal responses. A pattern of sex differences also emerged, with women exhibiting reduced ACTH responses to stress and higher ACTH and plasma cortisol responses to opioid blockade. These results indicated that compared to ad libitum smoking, nicotine withdrawal is associated with blunted opioid modulation of the HPA axis. Sex may modulate these effects. Blunted endogenous opioid regulation may underlie an incentive process that reinforces smoking behavior and may warrant therapeutic attention.

Menstrual variation in the acute testosterone and cortisol response to laboratory stressors correlate with baseline testosterone fluctuations at a within- and between-person level

Studies have compared HPA and HPG stress reactivity across the follicular and luteal phases to assess the menstrual impact of estradiol and progesterone fluctuations. Ovulatory shifts in baseline and stressor-induced testosterone among athletic women offer a new framework to explore these responses. Here we investigated menstrual variation in baseline testosterone as a predictor of the acute testosterone and cortisol response to laboratory stressors in female athletes. Using a semi-randomized crossover design, thirty athletic women completed a physical (4 × 6-s bike sprints) and psychological (5 × 2-min cognitive tests with social evaluation) stressor on day seven (D7), 14 (D14), and 21 (D21) of a menstrual cycle. Baseline fluctuations and acute changes in salivary testosterone and cortisol were measured. The D14 testosterone response to both stressors (13.7%) exceeded D7 (7.3%) and D21 (7.0%), whereas cortisol was less responsive on D14 (9.8%) than D7 (13.0%) and D21 (12.0%); all moderate to large effect size differences (p < 0.01). Baseline testosterone, which presented large individual and menstrual variation with a D14 peak, was significantly related (moderate correlations) to testosterone and cortisol stress reactivity on a between-person level. Both outcomes were related (weak correlations) to within-person fluctuations in baseline testosterone, but these effects were mediated by testing day. In conclusion, menstrual variation in baseline testosterone concentration correlated with testosterone and cortisol reactivity to a physical and psychological stressor. Thus, gradients of stressor-induced hormonal change showed some dependency to endogenous testosterone, both individual differences and fluctuations over time, among naturally cycling athletic women.Lay summaryThe female menstrual cycle is accompanied by dramatic shifts in estradiol and progesterone concentration, but less is known about testosterone variability and its role in stress regulation. In this study, menstrual fluctuations in baseline testosterone concentration correlated with acute testosterone and cortisol reactivity to laboratory stressors.

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.

The role of the endogenous oxytocin system under psychosocial stress conditions in adolescents suffering from anxiety disorder: study protocol for a parallel group controlled trial

BACKGROUND

In social neuroscience, the linkage between the endocrinological system and the etiology and symptomatology of mental health problems has received increasing attention. A particular focus is given to the neuropeptide oxytocin with its anxiolytic and stress-buffering effect and the resulting therapeutic potential for anxiety disorders. Even though anxiety disorders are the most prevalent mental health disorders in childhood and adolescence worldwide, the reactivity of the endogenous oxytocin system to an acute stressor (Trier Social Stress Test, TSST) has so far only been investigated in healthy children. It has been shown that peripheral oxytocin levels increased under psychosocial stress conditions. In the present study, it is hypothesized that the endogenous oxytocin system in children and adolescents suffering from a clinically diagnosed anxiety disorder is dysregulated. Three primary outcome parameters will be analyzed: significant differences between participants with anxiety disorders compared to healthy controls in basal oxytocin levels, varying salivary oxytocin release after stress exposure and the correlation between the cortisol peak/-decrease and oxytocin level over time. Secondary outcome criteria are significant differences in physiological (heart rate) and psychological (perceived stress, anxiety, insecurity, tension) responses.

METHODS

The present study is a single-center experimental observation study to investigate the reactivity of the endocrinological system to a psychosocial stressor (TSST). 32 children and adolescents (11-18 years) suffering from anxiety disorder will be compared to a matched healthy control group. After a detailed psychological assessment, saliva samples will be taken to measure oxytocin levels before and after psychosocial stress exposure at eight different time points. Additionally, the stress hormone cortisol will be analyzed according to the same procedure.

DISCUSSION

Due to the high prevalence and comorbidity rate with numerous other psychiatric disorders and mental health problems, there is an urgent need to strengthen research in possible neurobiological underpinnings of anxiety disorders. To our knowledge, the proposed experiment is the first study to examine the endocrinological oxytocin and cortisol reaction to an acute psychosocial stressor in children and adolescents with mental health disorders. Trial registration The study is registered in the German Clinical Trials Register since 11 September 2019, DRKS00017793, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017793 .

Endocrinological effects of social exclusion and inclusion: Experimental evidence for adaptive regulation of female fecundity

When current conditions are probabilistically less suitable for successful reproduction than future conditions, females may prevent or delay reproduction until conditions improve. Throughout human evolution, social support was likely crucial to female reproductive success. Women may thus have evolved fertility regulation systems sensitive to cues from the social environment. However, current understanding of how psychological phenomena might affect female ovarian function is limited. In this study, we examined whether cues of reduced social support-social ostracism-impact women's hormone production. Following an in-lab group bonding task, women were randomly assigned to a social exclusion (n = 88) or social inclusion (n = 81) condition. After social exclusion, women with low background levels of social support experienced a decrease in estradiol relative to progesterone. In contrast, socially-included women with low background social support experienced an increase in estradiol relative to progesterone. Hormonal changes in both conditions occurred specifically when women were in their mid-to-late follicular phase, when baseline estradiol is high and progesterone is low. Follow-up analyses revealed that these changes were primarily driven by changes in progesterone, consistent with existing evidence for disruption of ovarian function following adrenal release of follicular-phase progesterone. Results offer support for a potential mechanism by which fecundity could respond adaptively to the loss or lack of social support.

Physiological responses to acute psychosocial stress in women with menopausal insomnia

INTRODUCTION

Insomnia disorder is a common sleep disorder and frequently emerges in the context of menopause, being associated with menopause-specific factors such as hot flashes and other psychosocial variables. Increased vulnerability to stress may also contribute to the development of insomnia in midlife women. Here, we aimed to investigate whether there are differences in physiological reactivity to acute psychosocial stress in women with menopausal insomnia compared with controls.

METHODS

We investigated cortisol and heart rate [HR] responses to an acute experimental psychosocial stress (Trier Social Stress Test, TSST) approximately 1 h after waking in the morning in midlife women with (n = 22) and without (n = 16) DSM-IV insomnia disorder (Age: 50.05 ± 3.10 years), developed in the context of menopause.

RESULTS

Despite similar perceived stress levels, women with insomnia showed blunted HR increases (~29% HR acceleration) to the TSST compared to controls (~44% HR acceleration) (p = 0.026). No group differences in HR were detected at baseline or during post-task recovery. Cortisol stress responses were inconclusive, with most of the women (60%) failing to exhibit significant cortisol increases in response to the TSST. A greater magnitude of the cortisol awakening response (CAR) predicted the likelihood of being a non-responder (p = 0.036), showing the confounding effect of CAR on cortisol stress responses.

DISCUSSION

Women with menopausal insomnia show blunted cardiac responses to stress, suggesting alterations in the autonomic reactivity to acute stress. Whether these alterations are pre-existing or are a consequence of insomnia, needs to be determined.

Manipulating Levels of Socially Evaluative Threat and the Impact on Anticipatory Stress Reactivity

Previous work suggests that relative increases in socially evaluative threat modulate the psychobiological stress response. However, few studies have compared stressors which manipulate the level of socially evaluative threat to which the participant is exposed. Here we present two studies. In the first, we assessed the integrity of an ecologically valid, laboratory stressor (direct socially evaluated multitasking) and its effects on acute psychobiological reactivity and ability to evoke an anticipatory response prior to participation. Specifically, we assessed whether the expectation and experience of direct social evaluation (multitasking while standing and facing an evaluator) evokes greater reactivity than indirect evaluation (over-the-shoulder evaluation). In the second study, we sought to replicate the findings regarding acute stress reactivity whilst extending the assessment window to assess the extent to which the stressor evokes anticipatory responses. As hypothesized, greater reactivity was observed following direct social evaluation compared with indirect observation. Increases in anxiety, heart rate and blood pressure were demonstrated across both studies and the paradigm therefore provides an ecologically valid technique for the activation of psychological and cardiovascular stress responding. Additionally, anticipation of experiencing socially evaluated multitasking led to increases in anxiety, tension, and worry prior to the event itself, supporting previous suggestions that threat anticipation may prolong the activation of stress mechanisms. In the present studies we assessed whether the expectation and experience of direct social evaluation evokes greater reactivity than indirect evaluation. The findings have demonstrated that direct social evaluation of multitasking is a more potent stressor than multitasking with indirect evaluation. Furthermore, our findings indicate that the period of anticipation of stressful events may be critical to understanding the process of stress regulation, and as such we recommend extending the sampling window to allow for the investigation of these processes.

Taking context to heart: Momentary emotions, menstrual cycle phase, and cardiac autonomic regulation

Emotions have long been discussed in conjunction with the autonomic nervous system. Most research on emotion-autonomic linkages does not consider sex differences or an evident underlying mechanism for sex differences: menstrual cycle phase. Further, most research is limited to cross-sectional and laboratory studies. The degree to which emotion-autonomic associations manifest in everyday life may be different and may vary by sex and, for women, by menstrual cycle phase. This study employs the ambulatory monitoring of cardiovascular measures (e.g., heart rate and heart rate variability; HRV) and concurrent emotional states (e.g., sadness, stress, anxiety, anger, and happiness) in everyday life to better characterize emotion-autonomic associations as a function of sex and menstrual cycle phase. Participants (N = 174; 87 female) ages 18 to 46 (31.23 ± 6.49) were monitored over a 5-day observation period (one 2- and one 3-day session), using an ambulatory 24-hour electrocardiogram to monitor heart rate and ecological momentary assessment to record emotions every ~30 min. Women were monitored in both the early to mid-follicular and -luteal phases and men in two comparably distanced sessions. Multilevel models indicated that across sex, negative emotions and happiness were associated with elevated heart rate. Relative to men, women exhibited an elevated heart rate and reduced HRV during reports of anger. For women, during the luteal phase, but not follicular phase, momentary sadness, stress, and anxiety predicted increased heart rate and reduced HRV. These findings demonstrate the importance of considering sex and menstrual cycle phase in research investigating emotion-autonomic linkages.

Psychosocial stress reactivity habituates following acute physiological stress

Acute and chronic stress are important factors in the development of mental disorders. Reliable measurement of stress reactivity is therefore pivotal. Critically, experimental induction of stress often involves multiple “hits” and it is an open question whether individual differences in responses to an earlier stressor lead to habituation, sensitization, or simple additive effects on following events. Here, we investigated the effect of the individual cortisol response to intravenous catheter placement (IVP) on subsequent neural, psychological, endocrine, and autonomous stress reactivity. We used an established psychosocial stress paradigm to measure the acute stress response (Stress) and recovery (PostStress) in 65 participants. Higher IVP‐induced cortisol responses were associated with lower pulse rate increases during stress recovery (b = −4.8 bpm, p = .0008) and lower increases in negative affect after the task (b = −4.2, p = .040). While the cortisol response to IVP was not associated with subsequent specific stress‐induced neural activation patterns, the similarity of brain responses Pre‐ and PostStress was higher IVP‐cortisol responders (t[64] = 2.35, p = .022) indicating faster recovery. In conclusion, preparatory stress induced by IVP reduced reactivity in a subsequent stress task by modulating the latency of stress recovery. Thus, an individually stronger preceding release of cortisol may attenuate a second physiological response and perceived stress suggesting that relative changes, not absolute levels are crucial for stress attribution. Our study highlights that considering the entire trajectory of stress induction during an experiment is important to develop reliable individual biomarkers.

Systematic manipulations of the biological stress systems result in sex-specific compensatory stress responses and negative mood outcomes

Women are twice as likely as men to be diagnosed with anxiety and mood disorders. One potential underlying mechanism is sex differences in physiological and psychological responses to stress; however, no studies to date have investigated this proposed mechanism experimentally. In a double-blind, placebo-controlled design, pharmacological challenges were administered to individually suppress the hypothalamic-pituitary-adrenal (HPA) axis, or the sympathetic nervous system (SNS) prior to stress exposure, to investigate sex differences in the resulting cross talk among the physiological and psychological stress responses. Sex-specific compensatory patterns and psychological effects emerged when the stress systems were manipulated. Men demonstrated heightened SNS reactivity to stress when the HPA axis was suppressed, and greater HPA reactivity after SNS suppression. This ability to react appropriately to the stressor, even with one system, did not lead to significant negative mood effects. In women, higher baseline activation (but dampened reactivity to stress) of SNS or HPA was observed when the other system was suppressed. This was coupled with worsened mood in response to stress when either stress system was compromised. Our results indicate that men and women may be differentially sensitive to fluctuations of their stress systems. This might be a potential link that underlies the sexual dimorphism in vulnerability for psychopathology.

Regular cannabis use is associated with blunted affective, but not cardiovascular, stress responses

AIMS

To examine the potential impact of regular cannabis use on cardiovascular and subjective responses to acute stress.

DESIGN

We used a quasi-experimental design in which subjective states and cardiovascular measures were obtained during rest and in response to acute stress challenges in a sample of regular cannabis users and non-users.

PARTICIPANTS

Seventy-nine adults (forty-five cannabis users and thirty-four non-users).

MEASUREMENTS

We measured subjective states (positive affect, state stress, state anxiety, cannabis craving) and cardiovascular indicators (blood pressure, heart rate, mean arterial pressure) during baseline rest and in response to public speaking, mental arithmetic, and cold-pressor challenges. Regular cannabis use was established via self-report and was confirmed with a positive urine drug test.

FINDINGS

Regular cannabis use was associated with blunted positive affect (F = 5.67, p = .002), state stress (F = 6.05, p = .002), and state anxiety (F = 6.48, p < .001) in response to acute stress challenges. There was no evidence of an association between cannabis use and cardiovascular responses (Fs ≤ 1.54; Ps ≥ 0.21). Contrary to expectations, cannabis craving decreased in response to stress challenges (F = 8.44, p < .001).

CONCLUSION

Chronic cannabis use is associated with blunted positive and negative (stress, anxiety) affective responses to acute stress, indicating emotional dysregulation in this population.

Empathy and mentalizing abilities in relation to psychosocial stress in healthy adult men and women

Stress has many consequences for our wellbeing, both physically and psychologically, underscoring the need to study markers of differential sensitivity to stressful situations. We examined associations between empathy and mentalizing abilities and psycho-physiological responses to a psychosocial stress task. We conducted two highly comparable studies, the first in men (N = 52) and the second in women (N = 72). Each study started with a self-report empathy measure and a mentalizing test [Reading the Mind in the Eyes Test (RMET)] followed by the Trier Social Stress Test (TSST) or a control task. Stress reactivity was confirmed in both men and women with significantly higher levels of cortisol, blood pressure, and subjective stress levels in response to the TSST compared to the control task. Higher accuracy on the RMET significantly predicted higher cortisol and heart rate reactivity, while self-reported empathic concern significantly predicted higher subjective stress reactivity. These associations were found in men, and when men and women were analyzed together. This indicates that higher levels of mentalizing and empathic abilities may confer sensitivity to socially stressful situations. While a moderation analysis indicated no gender differences in these associations, the findings could not be directly replicated in women. This suggests that gender may impact such associations and that replication of the findings in larger samples is warranted.

Women's Cortisol Stress Responsivity, Sexual Arousability, and Sexual History

Life history theory and the adaptive calibration model state that characteristics of one's early environment influence individual differences in both neuroendocrine reactivity to stress and sexual risk-taking behavior. However, few studies have directly examined the relationship between neuroendocrine reactivity to stress and risky sexual behavior. This study used multilevel modeling to test whether cortisol reactivity and recovery in response to laboratory stress were associated with women's history of sexual behavior and their sexual arousability in response to laboratory sexual stimuli. Participants were 65 women (35% heterosexual, 44% bisexual, and 21% lesbian) who completed two laboratory sessions, two weeks apart. Women's self-reported sexual arousability to sexual stimuli interacted with their sexual abuse history to predict their trajectories of cortisol stress reactivity and recovery. Cortisol reactivity and recovery were not associated with women's sexual risk taking, such as the age of sexual debut, sociosexuality, or lifetime number of sexual partners.

Reflecting on Existential Threats Elicits Self-Reported Negative Affect but No Physiological Arousal

There is mixed evidence whether reflecting on an existential threat increases negative affect and thereby elicits subjective arousal and physiological activation. Additionally, it is debated whether different existential and non-existential threats elicit different arousal responses, although systematic comparisons are lacking. The current study explored affective, subjective, and physiological arousal responses while comparing several existential threats with a non-existential threat and with a control condition. One-hundred-and-seventy-one undergraduate students were randomly allocated to one of four existential threat conditions: mortality salience (MS), freedom restriction, uncontrollability, and uncertainty; or to the non-existential threat condition: social-evaluative threat (SET); or to a control condition (TV salience). Self-reported positive/negative affect was measured before and after reflection, while subjective arousal and physiological activation (electrodermal, cardiovascular, and respiratory) were measured on a high time-scale during baseline and reflection. Results showed larger increases in self-reported negative affect, as compared to the control condition, for all existential threat conditions, while there were no differences between the control condition and threat conditions regarding positive affect, subjective arousal, skin conductance, respiratory rate, and respiratory sinus arrythmia. There were subtle differences between existential and non-existential threat conditions, most notably in affective responses. Correlations showed positive associations between negative affect and subjective arousal and between trait avoidance and subjective arousal. This study is the first to systematically compare affective, subjective, and physiological changes in arousal due to reflecting on different existential threats, as well as one non-existential threat. We showed that, as compared to a control condition, reflecting on threats has a large impact on negative affect, but no significant impact on positive affect, subjective arousal, and physiological activation.

Higher Circulating Cortisol in the Follicular vs. Luteal Phase of the Menstrual Cycle: A Meta-Analysis

Although results of animal research show that interactions between stress and sex hormones are implicated in the development of affective disorders in women, translation of these findings to patients has been scarce. As a basic step toward advancing this field of research, we analyzed findings of studies which reported circulating cortisol levels in healthy women in the follicular vs. luteal phase of the menstrual cycle. We deemed this analysis critical not only to advance our understanding of basic physiology, but also as an important contrast to the findings of future studies evaluating stress and sex hormones in women with affective disorders. We hypothesized that cortisol levels would be lower in the follicular phase based on the proposition that changes in levels of potent GABAergic neurosteroids, including allopregnanolone, during the menstrual cycle dynamically change in the opposite direction relative to cortisol levels. Implementing strict inclusion criteria, we compiled results of high-quality studies involving 778 study participants to derive a standardized mean difference between circulating cortisol levels in the follicular vs. luteal phase of the menstrual cycle. In line with our hypothesis, our meta-analysis found that women in the follicular phase had higher cortisol levels than women in the luteal phase, with an overall Hedges' g of 0.13 (p < 0.01) for the random effects model. No significant between-study difference was detected, with the level of heterogeneity in the small range. Furthermore, there was no evidence of publication bias. As cortisol regulation is a delicate process, we review some of the basic mechanisms by which progesterone, its potent metabolites, and estradiol regulate cortisol output and circulation to contribute to the net effect of higher cortisol in the follicular phase.

How Cortisol Reactivity Influences Prosocial Decision-Making: The Moderating Role of Sex and Empathic Concern

The fight and flight theory and the tend-and-befriend theory suggest two opposite behavioral stress responses, and heterogeneous research results revealed the importance of taking sex into account. The experiment was designed to investigate the effect of stress-related cortisol reactivity on subsequent prosocial decision-making behaviors, and the moderating role of sex and empathic concern (EC) in the process. Sixty-one healthy students (34 women, 27 men) underwent the Trier Social Stress Test for Groups (TSST-G) or the control condition. Subsequently, participants completed three economic tasks-the dictator game, the ultimatum game, and the third-party compensation game. Statistical analyses revealed a significant main effect of cortisol reactivity on individuals' third-party compensation behaviorssex. A sex-specific effect of stress-related cortisol change on prosocial behaviors was found, with men behaving more generously in the dictator game as stress-related cortisol reactivity increased. Furthermore, the level of EC was found to moderate the association between stress-related cortisol change and prosocial behaviors, that individuals with a low level of EC reported more generosity and third-party compensation behaviors. Overall, the present study contributes to a better understanding of the behavioral stress responses, that individuals whose hypothalamic-pituitary-adrenal (HPA) axis are highly activated in response to stress would exhibit tend-and-befriend responses, but only among men and those with a low level of EC.

Social-evaluative threat: Stress response stages and influences of biological sex and neuroticism

Social-evaluative threat (SET) - when the self could be negatively judged by others - can cause pronounced responses in the different stress systems: threat/challenge appraisal, the sympathetic (SNS) and parasympathetic (PNS) nervous systems, experienced motivation and affect, and the hypothalamus-pituitary-adrenal (HPA) axis. Here, we utilize a four-stage stress response model to shed light on the complex associations between different stress responses, where earlier stages are hypothesized to predict later stages. Additionally, we take into account important moderators, such as biological sex (controlling for menstrual cycle phase), personality traits (neuroticism and extraversion), and baseline stress levels. Thirty-seven men and 30 women in their luteal phase participated in an impromptu public speaking task to induce SET. Stress responses in four different stages were measured using: self-reported appraisal (threat or challenge, stage 1: S1), cardiovascular measures (pre-ejection period as SNS index, respiratory sinus arrhythmia as PNS index, S2), self-reported motivation and affect (state approach motivation, state anxiety, S3) and endocrine measures (cortisol as HPA index, S4). Stress reactivity was calculated by subtracting individual peaks from baseline. Results showed that SET induced pronounced stress reactivity in stages two to four. Against expectations, self-reported appraisal (S1) or motivation and affect (S3) did not predict later stress reactivity. As hypothesized, increased SNS (but not PNS) reactivity (S2) predicted increased HPA reactivity (S4). Bayesian model comparison confirmed the absence of sex differences in stress reactivity, likely due to controlling for menstrual cycle phase and sex differences in neuroticism levels. Higher trait neuroticism predicted blunted SNS (S2) and HPA (S4) reactivity, while higher baseline stress levels predicted blunted stages two and three reactivity overall. In conclusion, this rigorously controlled experiment partly supports and partly contradicts previous findings regarding associations between stress response stages, and offers new insight into the causes of blunted HPA responses in women.

Neurobiological mechanisms underlying sex-related differences in stress-related disorders: Effects of neuroactive steroids on the hippocampus

Men and women differ in their vulnerability to a variety of stress-related illnesses, but the underlying neurobiological mechanisms are not well understood. This is likely due to a comparative dearth of neurobiological studies that assess male and female rodents at the same time, while human neuroimaging studies often don't model sex as a variable of interest. These sex differences are often attributed to the actions of sex hormones, i.e. estrogens, progestogens and androgens. In this review, we summarize the results on sex hormone actions in the hippocampus and seek to bridge the gap between animal models and findings in humans. However, while effects of sex hormones on the hippocampus are largely consistent in animals and humans, methodological differences challenge the comparability of animal and human studies on stress effects. We summarise our current understanding of the neurobiological mechanisms that underlie sex-related differences in behavior and discuss implications for stress-related illnesses.

Associations between oxytocin and cortisol reactivity and recovery in response to psychological stress and sexual arousal

Previous research suggests a dynamic regulatory relationship between oxytocin and cortisol, but the specific nature of this relationship and its context-specificity have not been fully specified. In the present study, we repeatedly assessed both salivary oxytocin and salivary cortisol during two experimental sessions (one inducing sexual arousal and one inducing psychological stress), conducted two weeks apart with the same group of 63 female participants. Baseline cortisol and baseline oxytocin were significantly correlated in both sessions. Cortisol levels showed significantly different patterns of change during the stress assessment than during the sexual arousal assessment, but oxytocin showed similar patterns of change across both assessments. Greater cortisol stress reactivity predicted higher oxytocin levels immediately after the stressor, but a different pattern emerged during the arousal assessment: Greater oxytocin arousal reactivity predicted attenuated post-arousal reductions in cortisol. For both cortisol and oxytocin, individual differences in women's reactivity to sexual arousal did not predict their reactivity to psychological stress. These findings contribute new insights regarding associations between cortisol and oxytocin reactivity and recovery in different psychological contexts.

Stress impacts the fidelity but not strength of emotional memories

Psychological stress during memory encoding influences resulting memory representations. However, open questions remain regarding how stress interacts with emotional memory. This interaction has mainly been studied by characterizing the correct identification of previously observed material (memory "hits"), with few studies investigating how stress influences the endorsement of unobserved material as remembered (memory "false alarms"). While hits can provide information about the presence or strength of a memory representation, false alarms provide insight into memory fidelity, indicating to what extent stored memories are confused with similar information presented at retrieval. This study examined the effects of stress on long-term memory for negative and neutral images, considering the separate contributions of hits and false alarms. Participants viewed images after repeated exposure to either a stress or a control manipulation. Stress impaired memory performance for negative pictures and enhanced memory performance for neutral pictures. These effects were driven by false alarms rather than hits: stressed participants false alarmed more often for negative and less often for neutral images. These data suggest that stress undermines the benefits of emotion on memory by changing individuals' susceptibility towards false alarms, and highlight the need to consider both memory strength and fidelity to characterize differences in memory performance.

Acute psychosocial stress alters thalamic network centrality

Acute stress triggers a broad psychophysiological response that is adaptive if rapidly activated and terminated. While the brain controls the stress response, it is strongly affected by it. Previous research of stress effects on brain activation and connectivity has mainly focused on pre-defined brain regions or networks, potentially missing changes in the rest of the brain. We here investigated how both stress reactivity and stress recovery are reflected in whole-brain network topology and how changes in functional connectivity relate to other stress measures. Healthy young males (n = 67) completed the Trier Social Stress Test or a control task. From 60 min before until 105 min after stress onset, blocks of resting-state fMRI were acquired. Subjective, autonomic, and endocrine measures of the stress response were assessed throughout the experiment. Whole-brain network topology was quantified using Eigenvector centrality (EC) mapping, which detects central hubs of a network. Stress influenced subjective affect, autonomic activity, and endocrine measures. EC differences between groups as well as before and after stress exposure were found in the thalamus, due to widespread connectivity changes in the brain. Stress-driven EC increases in the thalamus were significantly correlated with subjective stress ratings and showed non-significant trends for a correlation with heart rate variability and saliva cortisol. Furthermore, increases in thalamic EC and in saliva cortisol persisted until 105 min after stress onset. We conclude that thalamic areas are central for information processing after stress exposure and may provide an interface for the stress response in the rest of the body and in the mind.