Trier Social Stress Test

from Wikipedia, the free encyclopedia

The Trier Social Stress Test (TSST) is a method of experimental psychology, which triggers moderate psychosocial stress in the majority of the people tested in the laboratory and a physiological stress reaction, e.g. B. an increased activity of the HPA axis . In the literature it is described as a reliable bio-psychological instrument with the help of which the reactivity of the organism to psychosocial stress can be examined. It also serves as a method with which the effects of acute stress on psychological and physiological functions can be examined. The TSST is one of the most frequently used research instruments in the field of stress research. The TSST usually consists of a short, simulated application interview and a mental arithmetic task that is completed in front of a committee of 2-3 people. The TSST is standardized and combines elements of social evaluation and uncontrollability.

history

The Trier Social Stress Test (TSST) was developed by the working group of Clemens Kirschbaum and Dirk Hellhammer at the University of Trier and published in 1993. Even before 1993, various standardized methods of stress induction existed, such as the cold water test. However, the stress tests used up to this point only enabled insufficient or non-reliable stimulation of the HPA axis. Only small to moderate increases in ACTH and cortisol concentrations could be caused. In order to be able to examine the effects of acute stress on human behavior and experience, a valid and reliable method of stress induction is necessary.

The TSST makes this possible by combining different types of stress-inducing tasks. Correspondingly, the TSST can have strong effects on various physiological stress markers such as ACTH, GH , prolactin and blood and salivary cortisol.

Since the development of the TSST, it has been widely used in stress research. Using the TSST, for example, gender, genetic influences, nicotine, alcohol and caffeine consumption could be identified as variables relevant for interindividual differences. In addition, there is now a wide variety of different variations of the TSST (for children and groups, as a virtual variant or control condition, etc.).

Procedure

execution

According to the original protocol by Kirschbaum et al. the TSST should be carried out as follows:

1. Ten minute preparation time

2. A five-minute free speech task in which the test subjects should argue in front of "managers" why they are the best candidate for the position they wish to apply for. The test subjects receive the information that the "managers" have been specially trained to observe non-verbal behavior. The test person is accordingly under constant observation. In addition, a voice frequency analysis of non-verbal behavior will be made as tape recordings and a video analysis. In the event that the subject is ready before the five minutes have elapsed, the following should be said: "You still have some time, please continue". If the test subject stops again before the time has expired, they should wait 20 seconds and then ask some prepared questions.

3. After 15 minutes, there is a five-minute serial subtraction task. The test subject has to start over here after every error.

4. After 20 minutes, the tasks are finished and there is a debriefing followed by a 30–70 minute break.

General recommendations

Some general recommendations regarding the study protocol can be derived from the results of a meta-analysis published in 2017. For one, the peak of the cortisol level seems to occur after an average of 38 minutes. It is therefore recommended to take regular measurements 30–45 minutes after the start. The frequency of previous cortisol samples can therefore be reduced in order to reduce costs. On the other hand, the authors raise concerns, although there are still no findings, that the use of an intravenous catheter to take blood samples could possibly lead to sensitization and thus to an increased stress reaction.

Furthermore, according to the authors, the following points of the original study protocol should be adhered to in order to enable the study results to be compared. First, a mixed-gender panel of three people should be used, as an all-female panel appears to mitigate the stress response. Second, the TSST should ideally be carried out in the afternoon, since this is where the least inter-individual variation occurs. Third, the panel should provide neutral rather than negative feedback as this appears to reduce the stress response. Finally, the authors noted that steps of 13 should be used in the subtraction problem.

Quality criteria

Reliability

The TSST is a reliable and valid acute stressor that can be used under experimental conditions. Due to its high effect sizes and high reliability, the TSST has become a worldwide standard for psychological stress induction under controlled conditions. The method induces a consistent, reliable physiological and psychological stress response in the majority of subjects. Specifically, the TSST reliably activates the stress axis of the hypothalamus-pituitary-adrenal cortex (HPA) and triggers a two to three-fold release of the hormone cortisol (compared to non-stress-related control conditions) in around 70-80% of the participants. The experimental conditions during the implementation of the TSST are highly standardized and there are specific guidelines regarding the implementation, the framework conditions, as well as the behavior of the test director and the committee, which could influence the stress response.

validity

There are currently few findings on the validity of the TSST. It turned out, however, that older adults showed lower cortisol and ACTH responses to the TSST compared to younger adults. In addition, by combining a number of stressful components, the TSST induced stress in the majority of participants more reliably than its components (e.g. public speaking) considered individually.

Ecological validity

A first study on the ecological validity of the TSST showed that the stress reaction it triggers shows a high degree of correspondence with stress reactions in real life, such as that of an oral exam.

objectivity

Implementation objectivity

The original protocol of the TSST by Kirschbaum, Pirke and Hellhammer (1993) contains the recommendation that all members of the panel show a strictly neutral behavior towards the test subjects during the public speaking task (the simulated job interview) and the serial subtraction task. The committee should not give any social support. This neutral behavior of the members of the panel contributes to the fact that test subjects experience the uncontrollability and that the HPA axis and the sympathetic nervous system are successfully activated.

Methodologically, there is remarkable variability in the way the TSST protocol is carried out in different laboratories. This is largely due to the relatively short methodological description of the TSST protocol in the original paper by Kirschbaum and colleagues (1993) and to the fact that so far many studies have failed to report in detail on their specific methodology.

Indicators

HPA axes activity

The TSST was designed to induce large HPA axis activity in most of the study participants. Studies have now shown that the HPA axis activity is significantly increased after the TSST. This is particularly evident in the increase in the hormones cortisol, which is released by the adrenal gland , and ACTH, which is released by the pituitary gland . Serum and plasma cortisol as well as ACTH are significantly increased immediately after the end of the TSST. 10 minutes later, the salivary cortisol also reaches its peak, while the salivary cortisol reaction is highly correlated with cortisol from serum and plasma and is considered the best index for measuring the acute stress triggered by the TSST. In salivary cortisol, an average of 2 to 3 times the increase was found in 70–85% of the study participants. Cortisol levels return to their baseline levels approximately 90 minutes after starting the TSST.

SAM system

The hormones norepinephrine (NE) and epinephrine (E), released by the adrenal medulla and measured in the blood, are significantly increased after the TSST. They serve as indicators for the stress response at the level of the autonomic nervous system (ANS), specifically the sympathetic (SNS). Another indicator that is discussed in this context is the enzyme alpha-amylase (sAA), which can be measured in saliva samples. Studies have found an increase in sAA after TSST, peaking immediately after it ends. Since the salivary glands are innervated by the ANS, it was hypothesized that the changes in sAA reflect catecholaminergic changes (e.g. NE). These were in turn related to increased activity of the SAM system. However, study findings examining the relationship between sAA and NE / E reactions to TSST (and thus psychological stress) are contradicting. Some studies found no correlation between sAA and NE responses to the TSST and others found a moderate association. For physiological stress, e.g. B. sports activity, the reactions correlate significantly with each other. The increase in salivary alpha-amylase in response to acute psychological stress is seen as a valid and reliable stress marker at the level of the ANS.

Cardiovascular measurements

The heart rate is significantly increased during the TSST and drops back to its baseline level immediately after it has ended. Study results on changes in heart rate variability (HRV) and blood pressure associated with the TSST are mixed. Some studies found changes in HRV and others did not. With regard to blood pressure, an increase in systolic blood pressure has been found and, in some studies, an increase in diastolic blood pressure as well.

Other hormones

The original study by Kirschbaum, Pirke & Hellhammer (1993) also found changes in the hormones prolactin and somatropin produced by the pituitary gland. Both hormones increased significantly in response to the TSST. For prolactin, the peak was immediately after the end of the TSST and the peak of somatropin was around 40 minutes after the end of the TSST. An average increase of 30% for prolactin and 700% for somatropin above the initial level was found. Study findings on the response of prolactin to acute stress are inconsistent. Lennartsson & Jonsdottir (2011) also found increased prolactin values ​​after the TSST in their study, although no gender effect was found. The extent of the prolactin response to the TSST varied widely among the study participants.

Subjective stress experience

When the TSST is collected, the participants' subjective experience of stress is usually asked using questionnaires. Many empirical studies attempt to investigate the relationship between the subjectively perceived stress and the measured cortisol response in saliva. The earnings situation regarding this is inconsistent. A review article, which includes a total of 49 studies relating to this relationship, reports that 25 percent of the studies found a significant correlation between the cortisol response and the perceived emotional stress. No significant correlations were found between other biological markers such as alpha-amylase in saliva and the subjective perception of stress. Another 25 percent of the studies examined report a significant connection between cardiovascular measurements and the subjective perception of stress.

One problem with the previous studies is the time at which psychological measures are collected, which are supposed to depict the stress experience. The majority of the studies assess subjective stress experience only before or after the TSST, whereby it is questionable to what extent pre-TSST values ​​can be used as a baseline (anticipation) and post-TSST values ​​are possibly already influenced by the beginning recovery. A study by Hellhammer and Schubert (2012) shows, for example, that post-TSST values ​​of subjective stress experience are significantly lower than values ​​recorded during TSST. In addition, the values ​​recorded during the TSST are predictive for the changes in the heart rate and, with a time delay, for the HPA-axis response to the TSST. No clear findings can be drawn from previous research as to whether the subjective experience of stress and the acute reactivity of cortisol, the cardiovascular reaction and other stress parameters are related. Due to the inconsistent results regarding the associations between the biological parameters and the subjective assessment of the subjects, further research is required.

Habituation

The effect of repeated use of the TSST in the same test persons should also be considered. Since the test subjects are already familiar with the stress test, a reduced stress reaction could be seen. Subjects who have already taken part in the TSST should therefore be excluded from the investigation. A study by Schommer, Hellhammer et al. (2003) provides evidence that cortisol in saliva as well as in plasma, ACTH and the heart rate show a significant decrease over several times the TSSTs. However, this decrease cannot be observed for the stress parameters adrenaline and noradrenaline of the sympathetic nervous system. In summary, it can be said that the TSST's habituation to psychosocial stress is specific to the respective response systems. Even if the stress response of the HPA axis habituates quickly, the sympathetic nervous system shows a more uniform activation pattern with repeated exposure to psychosocial stress. However, if there is a longer period of time between executions of the TSST, the habituation of the HPA axis decreases.

Correlations

gender

There are consistent differences between men and women in responding to acute stress. Men showed a significantly higher cortisol response in response to the TSST. This can be up to twice as high as for women. In addition, women and men differ in the extent of their stress reaction depending on the type of stressor. While men have greater stress responses to performance tests, women are more stressful to tests that include social rejection.

pregnancy and breast feeding period

In general, due to the corticotropin-releasing hormone (CRH) production by the placenta, there is an increase in the cortisol level during pregnancy. The level of salivary cortisol in pregnant women rises steadily from the 25th week of pregnancy and reaches a concentration that is up to twice as high as in non-pregnant women.

While a reduced cortisol reaction can be shown in pregnant women with physical stress induction using the cold water test, there are no differences in the cortisol reaction between pregnant and non-pregnant women after stress induction using the TSST. However, the time it takes to restore normal cortisol levels appears to be prolonged in pregnant women.

Breastfeeding also has an impact on the response of the HPA axis to a psychosocial stressor. After performing the TSST, breastfeeding mothers show a weakened cortisol response compared to non-breastfeeding mothers. However, this weakening of the HPA axis response does not relate to the entire period of breastfeeding, but is only a short-term consequence of breastfeeding.

Menstrual cycle and pill

The cortisol response to a psychosocial stressor (TSST) differs in women depending on the current phase of the menstrual cycle. Women in the luteal phase react to a psychosocial stressor with a higher increase in salivary cortisol levels comparable to men. Women in the follicle phase and women who take the pill, on the other hand, show significantly lower cortisol increases.

Nicotine and alcohol consumption

While acute, intensive nicotine consumption (2 cigarettes within 10 minutes) leads to an increase in the ACTH and cortisol levels through the release of CRH, chronic nicotine consumption lowers the responsiveness of the HPA axis. In the case of regular smokers, there is a correspondingly reduced stress response in the form of a lower cortisol response to the TSST.

With regard to chronic alcohol consumption, the study situation has so far been less consistent. While studies that showed pharmacological stimulation by hCRH or Synacthen (synthetic ACTH) in persons with chronic alcohol consumption showed a reduced response of the HPA axis, the findings regarding the TSST are inconsistent. Some studies report decreased cortisol responses in alcohol-dependent compared to healthy people. Other studies could not show any differences in the response of the HPA axis between alcohol-dependent and healthy people.

BMI

Initial study results indicate that people with obesity ( body mass index (BMI) ≥ 30 kg / m²) have a different stress reaction to the TSST than people with a normal weight (BMI ≤ 25 kg / m²). A study by Herhaus and Petrowski (2018) showed a comparable reactivity and course of the cortisol reaction, but a lower cortisol level before, during and after performing the TSST. It should be noted, however, that the results vary and other studies have found higher cortisol reactivity or no difference between obese and non-obese individuals in their stress response to the TSST. Nevertheless, the weight of the test subjects seems to be an influencing factor that should be considered in further studies on the TSST.

Sports

There are studies to suggest that regular physical activity and higher cardiorespiratory fitness result in a lower stress response. In their meta-analysis, however, Mücke et al. (2018) show that higher physical activity or fitness only leads to a significantly weaker stress response on the HPA axis in 58% of the studies examined. There is currently insufficient evidence to draw a conclusion about the relationship between exercise and stress reactivity.

Cultural background

A meta-analysis by Miller and Kirschbaum (2019) showed that around 25% of the variability in the results of the TSST can be traced back to the systematic differences between the countries.

In-depth analysis suggests that the cultural focus on fear-related values ​​is associated with a decreased cortisol stress response. This finding is supported by connections with u. a. regionally different prevalence of mental disorders, regional inequality of family income and regional differences in population growth. Based on these observations, it is believed that the cortisol stress response reflects the ongoing threat in the socio-cultural environment to which the individual is used. A threatening environment therefore leads to a lower cortisol stress response.

genetics

With the help of twin studies, genetic differences in the reaction to a psychosocial stressor could be shown. However, the proportion of genetic influence seems to differ between the different types of stress induction. While hormonally induced stress has a strong genetic influence on the cortisol reaction, there is only a non-significant trend towards heredity for stress induction using the TSST and no genetic influence whatsoever for physical stress induced using a bicycle ergometer.

In later studies it could be shown that the genetic influence on the stress reaction seems to be context-dependent. This was investigated by performing the TSST repeatedly (once a week for three weeks) on monozygotic and dizygotic twin pairs. A genetic influence on the reaction of the HPA axis could be shown after the second and third run of the TSST, but only to a very small extent after the first, significantly more stress-inducing run. Thus, an influence of heredity with regard to the reaction of the HPA axis to moderate, but not to intensive psychosocial stress can be shown.

Sleep cycle

The HPA axis follows a specific daily cycle with several secretion phases. Under normal conditions, the highest cortisol production occurs in the early hours of the morning, the peak occurs shortly after waking up. With increasing time of day, the cortisol level decreases again, especially in the first half of the night there are low cortisol levels, with a low point around midnight.

Social support, social hierarchy

There are also differences between men and women with regard to this aspect. While brief social support in men leads to a significant decrease in the salivary cortisol response, women even react to support from their partner with a slight increase in the stress level. In addition, the position within the social hierarchy seems to have an influence on the reaction to a psychosocial stressor. A higher position in the social hierarchy is associated with an increased increase in salivary cortisol as a result of the TSST.

personality

So far, no close correlations have been shown between personality factors and changes in salivary cortisol as a result of a psychosocial stressor.

Test variants

TSST-G

The TSST-G is a group version of the TSST and was first developed and used in a study by Von Dawans, Kirschbaum and Heinrichs (2011). The motivation for developing the TSST-G was that there was an increased need for the development of a group version of a psychosocial laboratory stressor in a randomized controlled study design .

The procedure of the TSST-G is similar to the regular acid version of the TSST. It includes a preparation phase (50 minutes), a task phase (30 minutes) as well as a recovery and debriefing phase (60 minutes). First, test subjects have to draw a number from 1 to 6 in the preparation phase. They are also instructed not to communicate with each other in order to guarantee anonymity. The subsequent task phase consists of (i) preparation for a public speaking task (a simulated job interview), (ii) carrying out the public speaking task and (iii) a serial subtraction task. As with the original TSST, the test subjects have to present the tasks to a trained evaluation committee consisting of a man and a woman in white lab coats. Subjects are also told that video analysis of their performance will be performed and that the panel could ask questions at any time during the assignment phase. In order to prevent eye contact and social interaction between the test subjects, they are separated from each other in the room with mobile partition walls. The panel asks participants in randomized order to begin speaking. In order to prevent learning effects in the serial subtraction task, each test person is given their own number.

In addition to the regular TSST-G protocol, Von Dawans and colleagues (2011) also designed a protocol for a control condition. The preparation phase (50 minutes) and the recovery and debriefing phase (60 minutes) of the control protocol are the same as the regular TSST-G process. As part of the task phase of the control protocol (30 minutes), 6 test subjects have to read a popular science text simultaneously in a low voice. Then you have to enumerate numbers in steps of 3, 5, 10 or 20 in a low voice. The committee does not wear a white lab coat in the control protocol and does not evaluate or observe the test subjects.

TSST-C

The TSST-C is an adapted version for children and adolescents between 7 and 16 years, which was developed by Buske-Kirschbaum and colleagues (1997). As with the adult version, the TSST-C consists of a part of free speech and a math problem. The tasks are adapted and simplified according to the age. Free speech consists in telling the children the beginning of a story and asking them to complete it in an interesting and exciting way. The end of the story should be told in a more exciting way than that of other children. If the children stop telling the story before the time is up, the panel kindly encourages them to continue. The committee is more friendly and more friendly than that of the adults. A serial subtraction task follows, with the encouragement of completing it as quickly and correctly as possible. The level of difficulty is adjusted according to age. If the answer is wrong, the child has to start over. At the end of the performance, the children are informed that they have not really been evaluated and compared with other test subjects.

TSST-VR

The original TSST was further developed into a virtual version (TSST-VR) in which, apart from a brief interaction with the test leader, there is no interaction. The TSST takes place in a virtual, realistic environment that corresponds exactly to the laboratory environment in the real TSST. There are slight changes to the original TSST minutes, for example a shorter preparation time of 3 minutes before the panel without taking notes. The test subjects are asked to keep eye contact with the virtual panel. In order to check this, “eye-tracking” devices are used which give the test subject real-time feedback if the test subject has not made eye contact with the panel for more than five seconds Reestablish eye contact.

Zimmer et al. (2018) compared test subjects of a TSST-VR group and a TSST in vivo group (TSST-IV) with a virtual and an in vivo control group. Overall, there are very similar patterns of results for the majority of the subjective and physiological dependent variables in both TSST groups. The virtual TSST appears to activate the HPA axis in the same pattern as the in vivo TSST. The subjective stress measure also shows that both the virtual and the in vivo stress condition effectively trigger stress. The virtual version of the TSST seems to be able to reflect stressful situations from reality very effectively. A virtual environment thus has the potential to simulate realistic and complex interactions and to produce comparable subjective and objective stress reactions. For future studies it would be interesting to examine the influence of the experimenter's presence on immersion and presence in virtual reality.

Placebo TSST

The placebo TSST was developed as a simplified control condition for the TSST. In this test, the physical and mental stress (language and maths) is similar to the TSST, but it lacks the negative social assessment component that causes stress.

The participant is initially asked to speak out loud for five minutes about a film, novel, or recent vacation trip. Then the participant is asked to start adding the number 15, starting with 0.

During the placebo treatment, the test subjects showed decreasing cortisol levels in contrast to the TSST. The lack of HPA response in the control condition reflected the fact that the effective component of the TSST, i.e. H. the uncontrollable, socially evaluative threat in which the placebo version has been successfully eliminated. The results for sAA (salivary alpha-amylase) were similar to the results for cortisol. While the control group showed only a small increase in sAA activity, the stressed test subjects showed the expected increase in sAA activity.

f-TSST

The "friendly TSST" (f-TSST) is a control condition in which a friendly version of the TSST is carried out, the structure and the cognitive requirements being comparable to the original version. Unlike the placebo TSST, just like the TSST, the f-TSST involves social interaction with a committee. The test subjects are told from the beginning that they are in a control condition, here the committee member does not wear a white coat and is presented to the test subject as a laboratory employee. After the five minutes of preparation time, the test person speaks freely about his life and career in front of just one committee member for eight minutes. The committee member responds in a friendly manner, smiles, nods and does not allow uncomfortable pauses in which to ask questions. In the following task, the test person should read 30 words out loud. In contrast to the TSST, the entire lecture is not recorded by video camera.

In contrast to the TSST group, the cortisol concentration does not increase for subjects in the f-TSST group; there is no increase in negative affect either. In both groups, however, there is a rapid increase in alpha amylase, followed by a subsequent rapid decrease. Wiemers et al. (2013) explain this through the still attentive committee member in the f-TSST group, as well as the physical demands of the task (speaking and standing upright). The presence of an attentive, but not threatening and evaluating committee therefore does not lead to a reaction of the HPA axis and is therefore suitable as a control group for the TSST.

e-TSST

The e-TSST is an electronic version of the TSST, for which a control condition (e-neutral) was developed. The process corresponds to that of the original TSST, apart from the task part. Test subjects assigned to the e-TSST group have to prepare a speech within this group about why they are most suitable for a particular job. They are then supposed to present these to a committee that is connected live on a TV screen on the wall. The panel is presented to the subjects as a group of HR managers consisting of two women and one man. During the speech, the experimenter sits behind the test subject and controls the e-TSST program with a mouse. He chooses the reactions of the panel according to the behavior of the test subject. After the stress task, as in the original TSST, there is a five-minute arithmetic problem.

The test subjects who were assigned to the e-neutral group must watch a virtual aquarium on a TV screen for 15 minutes in the task part of the investigation.

Diseases

Chronic diseases

Functional Somatic Syndromes (FSS)

Some research deals with the role of stress, especially with possible dysfunction of the stress response at the level of the HPA axis, in FSS (functional somatic syndromes). For example, in connection with fibromyalgia (FM), a dull salivary cortisol response to the TSST was found in affected women, while the subjective stress level was significantly increased. The study checked for the influence of adversity in the childhood of the participants. The results contrast with other studies that found no differences in salivary cortisol response to TSST between FM patients and a healthy control group.

The chronic fatigue syndrome (chronic fatigue syndrome: CFS) is a clinically unexplained chronic fatigue and additionally fast fatigability, or worsening of fatigue, even through the smallest physical or mental exertion. Impairments in stress regulation are discussed as a possible factor in the development and course of the disease. In this context, studies on the response of CFS patients to the TSST found no differences in cortisol levels from a healthy control group. However, the ACTH response was significantly reduced in CFS patients.

There are also some studies on irritable bowel syndrome (IBS) that have tested differences in stress reactivity using the TSST.

psoriasis

Psoriasis , also called psoriasis, is a chronic inflammatory skin disease mainly mediated by T helper cells - type 1. Studies by Buske-Kirschbaum et al. (2007) showed how acute stress induced by the TSST affects pathologically relevant immune functions in psoriasis patients. It was found here that the monocyte count in PSO patients was significantly higher than in the control group. Overall, the results of the study indicated that acute psychosocial stress is linked to changes in immune functions known to be involved in PSO, which could be a possible explanation for how stress can trigger an onset of psoriasis.

Mental illness

Social phobia

There are ambiguous findings on the stress reactions of patients with social phobia (SP). Some studies show that there are significant differences in salivary cortisol, plasma cortisol, sAA and heart rate between patients with an SP and a healthy control group, whereas other studies did not find any significant differences. These inconsistent results can be attributed to various causes, for example to different and often non-standardized stressors, which make it extremely difficult to compare the studies.

Klumbies et al. (2014) show in their study that the physiological stress reactions for patients with SP do not differ from those of a healthy control group, although there are significant differences in the subjectively perceived stress. However, this finding is only one example of the various research results, based on which no clear statements can be made about the stress reactions in patients with SP.

A study by Krämer et al. (2019) shows the comparison of children with an early social phobia and a healthy control group. The group of children with a social phobia generally showed a higher subjective feeling of stress, combined with a higher reactivity following the TSST and a faster recovery than the control group. In addition, the children with social phobia reach higher heart rate levels. The two groups did not differ significantly in terms of sAA and cortisol response.

depressions

A meta-analysis by Ciufolini et al. (2014) showed that persons with depression had a similar activation pattern of the HPA axis to healthy comparators in response to the TSST. However, differences were found within the group of people with depression: those with a high cortisol level in the anticipation phase showed a significantly higher cortisol release in response to the TSST than those with a low cortisol level in the anticipation phase. Generally, people with depression show an increased cortisol level in everyday life. According to the authors, this could be an indication of impaired negative feedback from cortisol.

There are gender differences in people with chronic depression. For example, women who suffer from chronic depression, as described in the previous paragraph, show a comparable activation pattern of the HPA axis in response to the TSST, but based on an increased cortisol concentration at the beginning. This results in a significantly higher cortisol level than in women in the control condition. These differences are not found in men. Instead, men with chronic depression show a weaker increase in cortisol as a result of the TSST than men in the control group.

schizophrenia

In a meta-analysis published in 2014, the summary of study results showed that people diagnosed with schizophrenia appear to have lower cortisol levels in the anticipation phase and while performing the TSST compared to a healthy control group. The authors interpret this finding as a possible indication of impaired HPA axis activation in people with schizophrenia.

Future research

Study protocol

In general, it can be said that further research is needed into the effects of variations in the study protocol on the stress response generated. Especially with regard to the reasonableness for the study participants. A study by Goodman and colleagues in 2017 indicated that an acclimatization period of 15-30 minutes seems to be sufficient. In addition, a reduction in preparation time seems to be possible without influencing the stress response. Influences of the board's characteristics, such as its cultural background, have not yet been investigated and should be focused in future research.

Stress mechanisms

The neurobiological processes involved in the TSST's response to health and disease are highly dependent on the effects of the environment over life and are influenced by a variety of other factors. For example, a potential reaction of the gut microbiome is underestimated. Since there is evidence of changes in gut microbiota composition in stress-related disorders such as depression and irritable bowel syndrome, it is interesting to explore whether different microbial compositions within individuals could be predictive of altered reactivity to TSST.

Limitations

The scope of the TSST is limited to creating a certain type of threat, namely a socially evaluative threat. In addition, the TSST is not suitable for repeated measurement designs: the HPA axis has proven to be highly sensitive to the effects of repeated stimulation with TSST and reacts with habituation.

Individual evidence

  1. ↑ a b c d e f g h i j k l m n o p Kirschbaum, C., Pirke, KM, & Hellhammer, DH (1993). The 'Trier Social Stress Test' - a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology, 28 (1-2), 76-81. doi: 10.1159 / 000119004
  2. ↑ a b c Labuschagne, I., Grace, C., Rendell, P., Terrett, G., & Heinrichs, M. (2019). An introductory guide to conducting the Trier Social Stress Test. Neurosci Biobehav Rev, 107 , 686-695. doi: 10.1016 / j.neubiorev.2019.09.032
  3. ^ Dickerson, SS, & Kemeny, ME (2004). Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychological bulletin, 130 (3), 355-391. doi: 10.1037 / 0033-2909.130.3.355
  4. ↑ a b c d e f g h Allen, AP, Kennedy, PJ, Dockray, S., Cryan, JF, Dinan, TG, & Clarke, G. (2017). The Trier Social Stress Test: Principles and practice. Neurobiol Stress, 6 , 113-126. doi: 10.1016 / j.ynstr.2016.11.001
  5. ↑ a b c d Goodman, WK, Janson, J. & Wolf, JM (2017). Meta-analytical assessment of the effects of protocol variations on cortisol responses to the Trier Social Stress Test. Psychoneuroendocrinology , 80, 26-35.
  6. ↑ a b c Von Dawans, B., Kirschbaum, C., & Heinrichs, M. (2011). The Trier Social Stress Test for Groups (TSST-G): A new research tool for controlled simultaneous social stress exposure in a group format. Psychoneuroendocrinology, 36 (4), 514-522. https://doi.org/10.1016/j.psyneuen.2010.08.004
  7. ↑ a b c Frisch, JU, Häusser, JA, & Mojzisch, A. (2015). The Trier Social Stress Test as a paradigm to study how people respond to threat in social interactions. Frontiers in psychology, 6 , 14.
  8. ↑ Kudielka, BM, Buske-Kirschbaum, A., Hellhammer, DH, & Kirschbaum, C. (2004). HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender. Psychoneuroendocrinology, 29 , 83-98. doi: 10.1016 / S0306-4530 (02) 00146-4
  9. ↑ Henze, G.-I., Zänkert, S., Urschler, DF, Hiltl, TJ, Kudielka, BM, Pruessner, JC, & Wüst, S. (2017). Testing the ecological validity of the Trier Social Stress Test: Association with real-life exam stress. Psychoneuroendocrinology , 75.52-55. https://doi.org/10.1016/j.psyneuen.2016.10.002
  10. ↑ a b c d e f g h Allen, AP, Kennedy, PJ, Cryan, JF, Dinan, TG, & Clarke, G. (2014). Biological and psychological markers of stress in humans: focus on the Trier Social Stress Test. Neurosci Biobehav Rev, 38 , 94-124. doi: 10.1016 / j.neubiorev.2013.11.005
  11. ↑ Kudielka, B., Hellhammer, D., & Kirschbaum, C. (2007). Ten years of research with the Trier Social Stress Test — revisited. In (pp. 56-83).
  12. ↑ a b Foley, P., & Kirschbaum, C. (2010). Human hypothalamus-pituitary-adrenal axis responses to acute psychosocial stress in laboratory settings. Neurosci Biobehav Rev, 35 (1), 91-96. doi: 10.1016 / j.neubiorev.2010.01.010
  13. ↑ a b c Thoma, MV, Kirschbaum, C., Wolf, JM, & Rohleder, N. (2012). Acute stress responses in salivary alpha-amylase predict increases of plasma norepinephrine. Biol Psychol, 91 (3), 342-348. doi: 10.1016 / j.biopsycho.2012.07.008
  14. ↑ a b c d Nater, UM, La Marca, R., Florin, L., Moses, A., Langhans, W., Koller, MM, & Ehlert, U. (2006). Stress-induced changes in human salivary alpha-amylase activity - associations with adrenergic activity. Psychoneuroendocrinology, 31 (1), 49-58. doi: 10.1016 / j.psyneuen.2005.05.010
  15. ^ Nater, UM, & Rohleder, N. (2009). Salivary alpha-amylase as a non-invasive biomarker for the sympathetic nervous system: current state of research. Psychoneuroendocrinology, 34 (4), 486-496. doi: 10.1016 / j.psyneuen.2009.01.014
  16. ↑ a b Lennartsson, AK, & Jonsdottir, IH (2011). Prolactin in response to acute psychosocial stress in healthy men and women. Psychoneuroendocrinology, 36 (10), 1530-1539. doi: 10.1016 / j.psyneuen.2011.04.007
  17. ↑ a b c Campbell, Jana, and Ulrike Ehlert. 2012. "Acute Psychosocial Stress: Does the Emotional Stress Response Correspond with Physiological Responses?" Psychoneuroendocrinology 37 (8): 1111-34.
  18. ↑ a b Hellhammer, J., & Schubert, M. (2012). The physiological response to Trier Social Stress Test relates to subjective measures of stress during but not before or after the test. Psychoneuroendocrinology, 37 (1), 119-124. doi: 10.1016 / j.psyneuen.2011.05.012
  19. ↑ a b Schommer, Nicole C., Dirk H. Hellhammer, and Clemens Kirschbaum. 2003. "Dissociation Between Reactivity of the Hypothalamus-Pituitary-Adrenal Axis and the Sympathetic-Adrenal-Medullary System to Repeated Psychosocial Stress": Psychosomatic Medicine 65 (3): 450-60.
  20. ^ Petrowski, Katja, Gloria-Beatrice Wintermann, and Martin Siepmann. 2012. "Cortisol Response to Repeated Psychosocial Stress". Applied Psychophysiology and Biofeedback 37 (2): 103-7.
  21. ↑ a b c d e f g h Kudielka, BM, Hellhammer, DH, & Wüst, S. (2009). Why do we respond so differently? Reviewing determinants of human salivary cortisol responses to challenge. Psychoneuroendocrinology, 34 (1) , 2-18. https://doi.org/10.1016/j.psyneuen.2008.10.004
  22. ^ De Weerth, C., & Buitelaar, JK (2005). Physiological stress reactivity in human pregnancy — a review. Neuroscience & Biobehavioral Reviews, 29 (2) , 295-312.
  23. ↑ Nierop, A., Bratsikas, A., Klinkenberg, A., Nater, UM, Zimmermann, R., & Ehlert, U. (2006). Prolonged salivary cortisol recovery in second-trimester pregnant women and attenuated salivary α-amylase responses to psychosocial stress in human pregnancy. The Journal of Clinical Endocrinology & Metabolism, 91 (4) , 1329-1335.
  24. ^ Heinrichs, M., Neumann, I., & Ehlert, U. (2002). Lactation and stress: protective effects of breast-feeding in humans. Stress, 5 (3) , 195-203.
  25. ^ Herhaus, B., & Petrowski, K. (2018). Cortisol Stress Reactivity to the Trier Social Stress Test in Obese Adults. Obesity Facts , 11 (6), 491-500. https://doi.org/10.1159/000493533
  26. ↑ Lorig, F., Kießl, GRR, & Laessle, RG (2016). Stress-related cortisol response and laboratory eating behavior in obese women. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity , 21 (2), 237-243. https://doi.org/10.1007/s40519-015-0190-3
  27. ↑ Jayasinghe, SU, Torres, SJ, Nowson, CA, Tilbrook, AJ, & Turner, AI (2014). Physiological responses to psychological stress: Importance of adiposity in men aged 50–70 years. Endocrine Connections, 3 (3), 110-119. https://doi.org/10.1530/EC-14-0042
  28. ↑ Rimmele U, Seiler R, Marti B, Wirtz PH, Ehlert U, Heinrichs M. The level of physical activity affects adrenal and cardiovascular reactivity to psychosocial stress. Psychoneuroendocrinology. 2009; 34: 190-8. https://doi.org/10.1016/j.psyneuen.2008.08.023 .
  29. ↑ Wood CJ, Clow A, Hucklebridge F, Law R, Smyth N. Physicalftness and prior physical activity are both associated with lesscortisol secretion during psychosocial stress. Anxiety Stress Coping. 2017. https://doi.org/10.1080/10615806.2017.1390083 .
  30. ^ Mücke, M .; Ludyga, S .; Colledge, F .; Gerber, M. Influence of regular physical activity and fitness on stress reactivity as measured with the trier social stress test protocol: A systematic review. Sports Med. 2018, 48, 2607-2622.
  31. ↑ a b Miller, R., & Kirschbaum, C. (2019). Cultures under stress: A cross-national meta-analysis of cortisol responses to the Trier Social Stress Test and their association with anxiety-related value orientations and internalizing mental disorders. Psychoneuroendocrinology, 105, 147-154. https://doi.org/10.1016/j.psyneuen.2018.12.236
  32. ↑ Kirschbaum, C., Wüst, S., Faig, HG, & Hellhammer, DH (1992). Heritability of cortisol responses to human corticotropin-releasing hormone, ergometry, and psychological stress in humans. The Journal of clinical endocrinology and metabolism, 75 (6) , 1526-1530. https://doi.org/10.1210/jcem.75.6.1464659
  33. ↑ Federenko, IS, Nagamine, M., Hellhammer, DH, Wadhwa, PD, & Wüst, S. (2004). The heritability of hypothalamus pituitary adrenal axis responses to psychosocial stress is context dependent. The Journal of clinical endocrinology and metabolism, 89 (12) , 6244-6250. https://doi.org/10.1210/jc.2004-0981
  34. ↑ Fries, E., Dettenborn, L., cherry, C. (2008). International Journal of Psychophysiology, 72 (), 67-73. doi: 10.1016 / j.ijpsycho.2008.03.014
  35. ↑ Buckley, TM, Schatzberg, AF (2005). REVIEW: On the Interactions of the Hypothalamic-Pituitary-Adrenal (HPA) Axis and Sleep: Normal HPA Axis Activity and Circadian Rhythm, Exemplary Sleep Disprders. The Journal of Clinical Endocrinology & Metabolism, 90 (5), 3106-3114, doi : 10.1210 / jc.2004-1056
  36. ↑ Buske-Kirschbaum, A., Jobst, S., Wustmans, A., Kirschbaum, C., Rauh, W., Hellhammer, DH, 1997. Attenuated free cortisol response to psychosocial stress in children with atopic dermatitis. Psychosom. Med 59 (4) , 419e426.
  37. ↑ Zimmer, P., Buttlar, B., Halbeisen, G., Walther, E., and Domes, G. (2018). Virtually stressed? A refined virtual reality adaptation of the Trier Social Stress Test (TSST) induces robust endocrine responses. Psychoneuroendocrinology . 101, 186-192. doi: 10.1016 / j.psyneuen.2018.11.010
  38. ↑ a b Het, S., Rohleder, N., Schoofs, D., Kirschbaum, C. & Wolf, OT (2009). Neuroendocrine and psychometric evaluation of a placebo version of the 'Trier Social Stress Test'. Psychoneuroendocrinology, 34 (7), 1075-1086. doi: 10.1016 / j.psyneuen.2009.02.008.
  39. ^ Dickerson, SS & Kemeny, ME (2004). Acute Stressors and Cortisol Responses: A Theoretical Integration and Synthesis of Laboratory Research. Psychological Bulletin, 130 (3), 355-391. doi: 10.1037 / 0033-2909.130.3.355.
  40. ↑ a b Wiemers, US, S., D., & Wolf, OT (2013). A friendly version of the Trier social stress test does not activate the HPA axis in healthy men and women. Stress (Amsterdam, Netherlands), 16 (2), 254-260. https://doi.org/10.3109/10253890.2012.714427
  41. ^ Hawn, SE, Paul, L., Thomas, S., Miller, S., & Amstadter, AB (2015). Stress reactivity to an electronic version of the Trier Social Stress Test: A pilot study. Frontiers in Psychology, 6 . https://doi.org/10.3389/fpsyg.2015.00724
  42. ↑ Coppens, E., Kempke, S., Van Wambeke, P., Claes, S., Morlion, B., Luyten, P., & Van Oudenhove, L. (2018). Cortisol and Subjective Stress Responses to Acute Psychosocial Stress in Fibromyalgia Patients and Control Participants. Psychosom Med, 80 (3), 317-326. doi: 10.1097 / psy.0000000000000551
  43. ↑ Wingenfeld, K., Heim, C., Schmidt, I., Wagner, D., Meinlschmidt, G., & Hellhammer, DH (2008). HPA axis reactivity and lymphocyte glucocorticoid sensitivity in fibromyalgia syndrome and chronic pelvic pain. Psychosom Med, 70 (1), 65-72. doi: 10.1097 / PSY.0b013e31815ff3ce
  44. ↑ Kempke, S., Luyten, P., De Coninck, S., Van Houdenhove, B., Mayes, LC, & Claes, S. (2015). Effects of early childhood trauma on hypothalamic-pituitary-adrenal (HPA) axis function in patients with chronic fatigue syndrome. Psychoneuroendocrinology, 52 , 14-21. doi: 10.1016 / j.psyneuen.2014.10.027
  45. ↑ Gaab, J., Hüster, D., Peisen, R., Engert, V., Heitz, V., Schad, T.,. . . Ehlert, U. (2002). Hypothalamic-pituitary-adrenal axis reactivity in chronic fatigue syndrome and health under psychological, physiological, and pharmacological stimulation. Psychosomatic Medicine, 64 (6), 951-962. doi : 10.1097 / 01.psy.0000038937.67401.61
  46. ↑ Gaab, J., Rohleder, N., Heitz, V., Engert, V., Schad, T., Schürmeyer, TH, & Ehlert, U. (2005). Stress-induced changes in LPS-induced pro-inflammatory cytokine production in chronic fatigue syndrome. Psychoneuroendocrinology, 30 (2), 188-198. doi: 10.1016 / j.psyneuen.2004.06.008
  47. ↑ Kennedy, PJ, Cryan, JF, Quigley, EM, Dinan, TG, & Clarke, G. (2014). A sustained hypothalamic-pituitary-adrenal axis response to acute psychosocial stress in irritable bowel syndrome. Psychol Med, 44 (14), 3123-3134. doi: 10.1017 / s003329171400052x
  48. ↑ Suárez-Hitz, KA, Otto, B., Bidlingmaier, M., Schwizer, W., Fried, M., & Ehlert, U. (2012). Altered psychobiological responsiveness in women with irritable bowel syndrome. Psychosom Med, 74 (2), 221-231. doi: 10.1097 / PSY.0b013e318244fb82
  49. ↑ Sugaya, N., Izawa, S., Kimura, K., Ogawa, N., Yamada, KC, Shirotsuki, K.,. . . Shimada, H. (2012). Adrenal hormone response and psychophysiological correlates under psychosocial stress in individuals with irritable bowel syndrome. Int J Psychophysiol, 84 (1), 39-44. doi: 10.1016 / j.ijpsycho.2012.01.006
  50. ↑ Buske-Kirschbaum, A., Kern, S., Ebrecht, M., & Hellhammer, DH (2007). Altered distribution of leukocyte subsets and cytokine production in response to acute psychosocial stress in patients with psoriasis vulgaris. Brain, behavior, and immunity, 21 (1), 92-99. doi: https://doi.org/10.1016/j.bbi.2006.03.006
  51. ↑ Klumbies, E., Braeuer, D., Hoyer, J., & Kirschbaum, C. (2014). Thereaction to social stress in social phobia: Discordance between physiological and subjective parameters. PLOS ONE , 9 (8), e105670. https://doi.org/10.1371/journal.pone.0105670
  52. ↑ Krämer, M., Seefeldt, WL, Heinrichs, N., Tuschen-Caffier, B., Schmitz, J., Wolf, OT, & Blechert, J. (2012). Subjective, autonomic, and endocrine reactivity during social stress in children with social phobia. Journal of Abnormal Child Psychology , 40 (1), 95-104. https://doi.org/10.1007/s10802-011-9548-9
  53. ↑ a b Ciufolini, S., Dazzan, P., Kempton, MJ, Pariante, C., & Mondelli, V. (2014). HPA axis response to social stress is attenuated in schizophrenia but normal in depression: Evidence from a meta-analysis of existing studies. Neuroscience & Biobehavioral Reviews , 47, 359-368.
  54. ↑ Chopra, KK, Ravindran, A., Kennedy, SH, Mackenzie, B., Matthews, S., Anisman, H., ... & Levitan, RD (2009). Sex differences in hormonal responses to a social stressor in chronic major depression. Psychoneuroendocrinology, 34 (8) , 1235-1241.
  55. ↑ Jiang, H., Ling, Z., Zhang, Y., Mao, H., Ma, Z., Yin, Y., ... Ruan, B. (2015). Altered fecal microbiota composition in patients with major depressive disorder. Brain, Behavior, and Immunity, 48 , 186-194. doi: 10.1016 / j.bbi.2015.03.016
  56. ↑ Kelly, JR, Borre, Y., O'Brien, C., Patterson, E., El Aidy, S., Deane, J., ... Dinan, TG (2016). Transferring the blues: Depression-associated gut microbiota induces neurobehavioural changes in the rat. Journal of Psychiatric Research, 82 , 109-118. doi: 10.1016 / j.jpsychires.2016.07.019
  57. ↑ Naseribafrouei, A., Hestad, K., Avershina, E., Sekelja, M., Linløkken, A., Wilson, R., & Rudi, K. (2014). Correlation between the human fecal microbiota and depression. Neurogastroenterology & Motility, 26 (8), 1155-1162. doi: 10.1111 / nmo.12378
  58. ↑ Jeffery, IB, O'Toole, PW, Öhman, L., Claesson, MJ, Deane, J., Quigley, EMM, & Simrén, M. (2011). An irritable bowel syndrome subtype defined by species-specific alterations in faecal microbiota. Gut, 61 (7), 997-1006. doi: 10.1136 / gutjnl-2011-301501
  59. ↑ Schommer, NC, Hellhammer, DH, & Kirschbaum, C. (2003). Dissociation between reactivity of the hypothalamus-pituitary-adrenal axis and the sympathetic-adrenal-medullary system to repeated psychosocial stress. Psychosomatic medicine, 65 (3), 450-460.