Salivary cortisol and DHEA reactivity to psychosocial stress in socially anxious males

Rethinking Learning Experience: How Generally Perceived Life Stress Influences Students' Course Perceptions in Different Learning Environments

Previous research work has already demonstrated that both the form of teaching as well as different teaching methods directly influence students' learning experience along with their psychobiological responses at the endocrine and autonomic level. Aiming to gain deeper insights into the constitution of the learning experience, this study examined the influence of external factors such as generally perceived life stress and self-efficacy on the immediate learning experience in different learning environments. Therefore, a randomized experimental field study was conducted in which both psychological constructs and physiological data (heart rate variability) were collected from healthy first-year medical students (n = 101) during the COVID-19 pandemic. In an effort to determine the consistency of the effects across various teaching formats, the same content of a practical histology course was carried out in a face-to-face setting as well as in passive and active online teaching. While self-efficacy was a strong predictor for positive course perceptions in all learning conditions (Pearson's r = 0.41-0.58), generally perceived worries correlated with higher anxiety during passive online learning and face-to-face learning (Pearson's r = 0.21-0.44), a finding supported by the negative correlation between the level of perceived life demands and enjoyment during the learning unit (Pearson's r = -0.40--0.43). Here, we additionally report initial evidence pointing towards the role of reduced general life stress as a resilience factor for the expression of physiological stress parameters in an academic context (small-sized effect; Pearson's r = 0.18). The data gathered in this study illustrate the relevance of emerging emotional manifestations-either aversive; negative effect or positive; protective effect-for the immediate learning process and thus establish a connection between medical education and the importance of mental health and wellbeing-especially discussed against the background of current social and political challenges in increasingly complex societal structures.

A novel procedure to investigate social anxiety using videoconferencing software: A proof-of-concept study

Social anxiety disorder (SAD) is very common and can be significantly disabling. New treatments are needed as the remission rate for SAD is the lowest of all the anxiety disorders. Experimental medicine models, in which features resembling a clinical disorder are experimentally induced, are a cost-effective and timely approach to explore potential novel treatments for psychiatric disorders. Following the emergence of SARS-CoV-2, there is a need to develop experimental medicine models that can be carried out remotely. We developed a novel procedure to investigate SAD (the InterneT-based Stress test for Social Anxiety Disorder; ITSSAD) that can be carried out entirely online by a single investigator, potentially reducing costs and maximising internal reliability. The procedure involves an anticipatory period followed by a naturalistic social interaction task. In a sample of 20 non-treatment-seeking volunteers with symptoms of SAD, the ITSSAD induced significant subjective anxiety and reduced positive affect. Further, increased social anxiety symptoms at baseline predicted increased anxiety during the social interaction task. This protocol needs further validation with physiological measures. The ITSSAD is a new tool for researchers to investigate mechanisms underlying social anxiety disorder.

The effect of distraction versus post-event processing on cortisol recovery in individuals with elevated social anxiety

There are preliminary findings that repetitive thinking on social situations (post-event processing; PEP) is associated with impaired cortisol recovery after experiencing social evaluative stressors. However, no studies have examined the effect of experimental manipulation of PEP on cortisol recovery among socially anxious individuals. The aim of the present study was to examine the effect of distraction on cortisol recovery following a social-evaluative stressor in individuals with subclinical social anxiety symptoms. A total of 40 participants, who scored >30 on the Liebowitz Social Anxiety Scale, completed a standardized stress test (the Trier Social Stress Test; TSST). They were then randomized to complete either a 10-min distraction or PEP induction task. Subjective anxiety and salivary cortisol levels were assessed at −20, −10, 0, +10, +20, +30, +40, and +50 min, with respect to the TSST offset. Contrary to the hypothesis, no difference in cortisol recovery was observed between distraction induction and PEP induction. These findings suggest that short-term distraction induction may not be sufficient to promote cortisol recovery in individuals with elevated social anxiety.

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Effect of distraction on cortisol recovery was tested in individuals with elevated social anxiety.

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No effect of distraction on cortisol recovery in comparison to post-event processing induction.

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Short-term distraction induction may not be sufficient for individuals with social anxiety to promote cortisol recovery.

The Frustration Social Stressor for Adolescents (FSS-A): A newly adapted psychosocial stressor

The role of stress on adolescents and its impact on development and mental health is of significant psychological concern. Previous research has investigated physiological changes, stressor characteristics and individual differences in stress responding. Experimental procedures that closely simulate naturally occurring psychosocial stressors have primarily been achievement-related (e.g., test taking, competitive tasks and psychomotor performance) and anxiety-provoking tasks (e.g., public speaking, improvisation and invasive medical-procedures) but few seek to elicit frustration. To address this gap, a new experimental procedure was developed and validated against the Trier Social Stress Test for Teens, with a Low Stress condition as a control. Conflict-related stressors, such as parent- and peer-related debates, have been found to be effective in provoking frustration in adolescents. The Frustration Social Stressor for Adolescents (FSS-A), a moderate frustration-provoking stressor involves a peer debate on a 'hot' topic, followed by a serial subtraction task with still-faced judges. The FSS-A procedure effectively elicited reliable and valid physiological (cortisol, heart rate) stress responses and was an effective stressor for both sexes. This new, stress protocol mirrors frustrating- and anxiety-provoking stressful situations that adolescents commonly encounter and affords a more detailed study of differential stress response patterns, increased understanding of adolescent stress, and potential for psychoeducational programming, such as directions for education and therapeutic intervention.

Pathways from racial discrimination to cortisol/DHEA imbalance: protective role of religious involvement

Objective: Racial discrimination (RD) is hypothesized to dysregulate the production of stress reactive hormones among African Americans. Psychological processes that may mediate the association between RD and such dysregulation (e.g. cortisol/DHEA ratio) are not well articulated. Organizational religious involvement (ORI) has been discussed as a psychological protective factor within the context of RD, but our understanding of ORI as a physiological protective factor remains limited. We evaluated whether RD was directly and indirectly (through depressive symptoms) associated with an imbalance of cortisol and DHEA hormones, and whether ORI buffered these direct and/or indirect pathways.Design: Data were drawn from the Flint Adolescent Study, an ongoing interview study of youth that began in 1994. Participants were 188 African American emerging adults (47.3% Female, ages 20-22). We used mediation and moderated-mediation analyses, as outlined by Hayes [2012. PROCESS SPSS Macro. [Computer Software and Manual]. http://www.afhayes.com/public/process.pdf], to evaluate the study aims.Results: We found that depressive symptoms mediated the association between RD and the cortisol/DHEA ratio. We also found that depressive symptoms mediated the association between RD and the cortisol/DHEA ratio for individuals reporting low and moderate levels of ORI, but not at high levels.Conclusions: Our findings support the socio-psychobiological model of racism and health [Chae et al. 2011. "Conceptualizing Racial Disparities in Health: Advancement of a Socio-Psychobiological Approach." Du Bois Review: Social Science Research on Race 8 (1): 63-77. doi:10.1017/S1742058X11000166] and suggest that the psychological toll of RD can confer physiological consequences. Moreover, ORI may disrupt pathways from RD to cortisol/DHEA ratio by buffering the psychological toll of RD.

DHEA as a Biomarker of Stress: A Systematic Review and Meta-Analysis

Background: Psychosocial stress is a significant public health problem inducing consequences for quality of life. Results about the use of dehydroepiandrosterone (DHEA) as a biomarker of acute stress are conflicting. We conducted a systematic review and meta-analysis to demonstrate that DHEA levels could be a biomarker of stress. Methods: PubMed, Cochrane Library, Embase, and ScienceDirect databases were searched on March 19, 2021 using the keywords "acute stress" AND "DHEA" OR "Dehydroepiandrosterone." Articles needed to describe our primary outcome, i.e., induction of acute stress and at least two measures of DHEA. Results: We included 14 studies, with a total of 631 participants, in our meta-analysis. The DHEA levels increased overtime after acute stress [standardized mean difference (SMD) = 1.56, 95%CI = 1.13-1.99]. Stratification by time showed a main peak at the end of stress (SMD = 2.43, 95%CI = 1.59-3.27), followed by a progressive decrease (coefficient = -0.11, 95%CI = -0.19 to -0.17, p = 0.020). There was no significant change 1 h after the end of acute stress. Metaregressions showed an impact of mental stress (SMD = 2.04, 95%CI = 1.43-2.65), sex (SMD = 0.02, 95%CI = 0.00-0.04), age (SMD = -0.12, 95%CI = -0.2 to -0.05), and obesity (SMD = 0.31, 95%CI = -0.00 to 0.63). There was no difference whatever the type of fluid (blood or saliva) and the measurement technique used. Conclusions: DHEA is a biomarker of acute stress, with a short-term increase (1 h). DHEA increases following acute mental stress, whatever the type and duration of mental stress. Women, young people, and obese individuals had a higher response. Blood and saliva measures were comparable.

Verbal performance during stress in healthy older people: Influence of dehydroepiandrosterone (DHEA) and cortisol reactivity

The impact of stress on the dehydroepiandrosterone (DHEA) response in older population is understudied. This study investigated, in healthy older people, whether the DHEA and cortisol responses to the Trier Social Stress Test (TSST) was related to performance on this task. Both speech (rated by committee and self-rated) and arithmetic (number of mistakes) performance were assessed. Sixty-five participants (55-77 years old) were exposed to the TSST. Increases in negative affect, state anxiety, and cortisol levels could be observed, but there were no significant changes in positive affect or DHEA levels. Interestingly, a larger DHEA response was related to better verbal performance after controlling for the cortisol's reactivity. No relationships were found between hormonal responses and the arithmetic task performance. Our results suggest that, in healthy older people, an increase in DHEA levels in response to acute psychosocial stress may help them to cope with this stressor by increasing verbal performance.

Acute Stress Shapes Creative Cognition in Trait Anxiety

This study examined the cognitive mechanism underlying acute stress in creative cognition among individuals with high and low trait anxiety. Specifically, cognitive inhibition was assessed using the flanker task during acute stress. Fifty-two participants (26 with high trait anxiety, 26 with low trait anxiety, with a mean age of 18.94 years) underwent stress induction via the Trier Social Stress Test (TSST). They all completed the Alternative Uses Test (AUT) and the Remote Associates Test (RAT) before and after the TSST. Biochemical markers (salivary cortisol and salivary alpha amylase) were recorded at regular intervals. The results showed that cognitive inhibition was influenced by trait anxiety and acute stress. In low-trait anxious individuals after experiencing acute stress, there was a lack of cognitive inhibition and they performed better in AUT (fluency), compared to before experiencing acute stress, whereas high-trait anxious individuals showed a decreased interference effect and reduced performance in AUT (fluency, flexibility, and originality). In the RAT, there were shorter response times and increased accuracy after acute stress in both high- and low-trait anxiety groups. Thus, we suggest that cognitive control, which modulates changes in acute stress, influences creative cognition. These findings provide evidence that inhibition control mediates the effect of stress on the creativity of individuals with different trait anxiety.

A review on inflammatory cytokine-induced alterations of the brain as potential neural biomarkers in post-traumatic stress disorder

The heterogeneity of post-traumatic stress disorder (PTSD) symptoms indicates that multiple neurobiological mechanisms underlie the pathophysiology of the condition. However, no generally accepted PTSD biomarkers in clinical practice currently exist. The sequential responses to recurrent and chronic stress by the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS) system are considered to play a significant role in the onset and progression of PTSD. Decreased activity of the HPA axis and parasympathetic nervous system, along with increased activity of the sympathetic nervous system, have been observed in PTSD, which may lead to increased levels of proinflammatory cytokines. Such heightened activity of the immune system may cause alterations in the structure and function of brain regions-for example, the amygdala, hippocampus, medial prefrontal cortex, anterior cingulate cortex, and insula-through changes in levels of serotonin and kynurenine pathway metabolites, and direct neurotoxic effects of cytokines. Although chronic inflammation-induced alterations in brain regions critical in controlling emotional behavior and fear regulation may represent a strong candidate biomarker of PTSD, future studies are necessary to further elucidate inflammation-associated neural biomarkers of PTSD. Continued research on therapeutic methods that involve the normalization of the HPA axis, ANS, and immune system is expected to contribute to the development of novel ways to treat PTSD.

Social anxiety disorder and childhood trauma in the context of anxiety (behavioural inhibition), impulsivity (behavioural activation) and quality of life

Background

Social anxiety disorder (SAD) is one of the most prevalent psychiatric disorders in South Africa. Previous studies have linked childhood trauma with the development of SAD. The behavioural inhibition system (BIS) and the behavioural activation system (BAS), two dimensions of personality related to anxiety and impulsivity, respectively, are said to influence the development of psychopathology, including SAD. Both SAD and childhood trauma have an impact on quality of life. This study investigated the relationship between BIS, BAS and quality of life in patients with SAD with and without exposure to childhood trauma, compared to healthy controls.

Method

Data were collected for 102 adults. A total of 76 participants met SAD criteria, of which 51 were exposed to childhood trauma and 25 were not. The remaining 26 participants were demographically matched healthy controls. Measures of anxiety, impulsivity and quality of life were obtained by administering Carver and White’s BIS/BAS scales and the Quality of Life Enjoyment and Satisfaction Questionnaire – Self Report.

Results

A positive correlation was found between the severity of SAD symptoms and the amount of childhood trauma exposure. No significant differences in impulsivity were found across the three groups. Healthy controls reported significantly lower anxiety and a better quality of life than both groups with SAD, while no differences were found between patients with SAD and childhood trauma and those without childhood trauma.

Conclusion

More childhood trauma exposure appears to be associated with greater SAD severity. The lack of differences in BIS, BAS and quality of life in patients with SAD with or without childhood trauma requires further investigation.

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

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

Inhalation of Japanese cedar (Cryptomeria japonica) wood odor causes psychological relaxation after monotonous work among female participants

Essential oils have potential to mitigate stress symptoms and treat symptoms related to mental health. Few studies have investigated the effects of wood-derived aromatics on endocrinological and psychological responses in an actual space. In this study, we evaluated the effects of essential oil derived from Japanese cedar (Cryptomeria japonica) wood on the recovery state of female participants after they performed monotonous work. We determined the levels of salivary stress markers to describe the endocrinological responses. And we also used questionnaires to assess the perception of the odor of experimental rooms and psychological states. We found that olfactory stimulation with the volatile compounds of essential oil derived from Japanese cedar wood modulates mood states, and may transiently decrease sympathetic nervous activity. We suggest that olfactory stimulation with the volatile compounds of essential oil derived from Japanese cedar wood could be useful for maintaining mental health among women.

Acute social and physical stress interact to influence social behavior: The role of social anxiety

Stress is proven to have detrimental effects on physical and mental health. Due to different tasks and study designs, the direct consequences of acute stress have been found to be wide-reaching: while some studies report prosocial effects, others report increases in antisocial behavior, still others report no effect. To control for specific effects of different stressors and to consider the role of social anxiety in stress-related social behavior, we investigated the effects of social versus physical stress on behavior in male participants possessing different levels of social anxiety. In a randomized, controlled two by two design we investigated the impact of social and physical stress on behavior in healthy young men. We found significant influences on various subjective increases in stress by physical and social stress, but no interaction effect. Cortisol was significantly increased by physical stress, and the heart rate was modulated by physical and social stress as well as their combination. Social anxiety modulated the subjective stress response but not the cortisol or heart rate response. With respect to behavior, our results show that social and physical stress interacted to modulate trust, trustworthiness, and sharing. While social stress and physical stress alone reduced prosocial behavior, a combination of the two stressor modalities could restore prosociality. Social stress alone reduced nonsocial risk behavior regardless of physical stress. Social anxiety was associated with higher subjective stress responses and higher levels of trust. As a consequence, future studies will need to investigate further various stressors and clarify their effects on social behavior in health and social anxiety disorders.

Gender differences in the psychophysiological effects induced by VOCs emitted from Japanese cedar (Cryptomeria japonica)

Background

Wood is a valuable material for interiors, and the psychophysiological relaxation effects of volatile organic compounds (VOCs) from wood chips and essential oils have been reported. However, few studies have identified the odors in full-scale wooden environment, and also, differences in gender have not been clarified. In this study, we aimed to confirm the effects of VOCs emitted from interior wood walls in both human male and female participants.

Methods

We used Japanese cedar timber and analyzed VOCs in the experimental rooms with and without Japanese cedar timber by gas chromatography-mass spectrometry (GC-MS). The physiological effects were measured using neuroendocrinological and immunological parameters in saliva. A questionnaire was used to evaluate the subjective responses to each odor in the experimental rooms.

Results

The main compound emitted from Japanese cedar timber was δ-cadinene, and the total volume of VOCs in the wood condition (presence of VOCs emitted from Japanese cedar) was 282.4 (μg/m³). Significant differences between genders in salivary parameters were shown that there were decreases of α-amylase in wood condition and increases of cortisol in the control (absence of VOCs) condition in female participants compared to male participants. The results demonstrated that VOCs in the experimental room with Japanese cedar timber tend to suppress the activation of the sympathetic nervous activity and non-VOCs of Japanese cedar in the control room increase cortisol in female participants.

Conclusions

These results suggest that an indoor environment with wood interior materials has the potential to be useful for health management, especially women’s health.

Social evaluative threat with verbal performance feedback alters neuroendocrine response to stress

Laboratory stress tasks such as the Trier Social Stress Test (TSST) have provided a key piece to the puzzle for how psychosocial stress impacts the hypothalamic-pituitary-adrenal axis, other stress-responsive biomarkers, and ultimately wellbeing. These tasks are thought to work through biopsychosocial processes, specifically social evaluative threat and the uncontrollability heighten situational demands. The present study integrated an experimental modification to the design of the TSST to probe whether additional social evaluative threat, via negative verbal feedback about speech performance, can further alter stress reactivity in 63 men and women. This TSST study confirmed previous findings related to stress reactivity and stress recovery but extended this literature in several ways. First, we showed that additional social evaluative threat components, mid-task following the speech portion of the TSST, were still capable of enhancing the psychosocial stressor. Second, we considered stress-reactive hormones beyond cortisol to include dehydroepiandrosterone (DHEA) and testosterone, and found these hormones were also stress-responsive, and their release was coupled with one another. Third, we explored whether gain- and loss-framing incentive instructions, meant to influence performance motivation by enhancing the personal relevance of task performance, impacted hormonal reactivity. Results showed that each hormone was stress reactive and further had different responses to the modified TSST compared to the original TSST. Beyond the utility of showing how the TSST can be modified with heightened social evaluative threat and incentive-framing instructions, this study informs about how these three stress-responsive hormones have differential responses to the demands of a challenge and a stressor.

Post-event Processing Predicts Impaired Cortisol Recovery Following Social Stressor: The Moderating Role of Social Anxiety

There is growing evidence that individuals with social anxiety show impaired cortisol recovery after experiencing social evaluative stressors. Yet, little is known regarding the cognitive processes underlying such impaired cortisol recovery. The present study examined the effect of post-event processing (PEP), referred to as repetitive thinking about social situations, on cortisol recovery following a social stressor. Forty-two non-clinical university students (23 women, 19 men, mean age = 22.0 ± 2.0 years) completed the Trier Social Stress Test (TSST), followed by a thought sampling procedure which assessed the frequency of PEP reflecting the TSST. A growth curve model showed PEP and social anxiety interactively predicted cortisol recovery. In particular, PEP predicted impaired cortisol recovery in those with low levels of social anxiety but not in those with high levels of social anxiety, which contradicted the initial hypothesis. These findings suggest that PEP is differentially associated with cortisol recovery depending on levels of social anxiety. The possible mechanisms underlying these findings were discussed in terms of protective inhibition framework.

Attenuated DHEA and DHEA-S response to acute psychosocial stress in individuals with depressive disorders

BACKGROUND

In recent years, a relationship between depression and basal dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) levels has frequently been suggested, but responses of these adrenal steroids to psychosocial stress have not been examined in individuals with depressive disorders. In this study, we examined salivary DHEA, DHEA-S, and cortisol/DHEA response to the Trier Social Stress Test (TSST) in individuals with depressive disorders and in healthy controls to discover whether the responses of DHEA and DHEA-S to acute psychosocial stress could be a more sensitive marker of HPA dysfunction in depressive disorders.

METHODS

We compared salivary cortisol, DHEA, DHEA-S, and cortisol/DHEA levels to the TSST tests between 38 individuals with depression and 43 healthy controls aged 18.4-25.9 years. Depression severity was assessed by the self-reported Beck Depression Inventory-II (BDI-II). Salivary samples were evaluated at four time points: the baseline (-10 time point), before the TSST started (0 time point), the end of the TSST (+20 time point), and the recovery (+50 time points).

RESULTS

No significant differences existed in the basal adrenal hormonal levels between subjects with depressive disorders and controls; however, at the end of TSST, attenuated DHEA and DHEA-S response was identified in subjects with depressive disorders compared to that found in healthy subjects. The differences in the DHEA and DHEA-S levels at the +20 time point, as well as the differences in the cortisol/DHEA at the +50 time point, exhibited negative correlations with depression severity.

CONCLUSION

Attenuated DHEA and DHEA-S response to acute psychosocial stress was identified in subjects with depressive disorders. These findings help us to discover the bi-directional relationship between depression and the hypothalamic-pituitary-adrenal (HPA) axis function, hence furthering our understanding of whether altered DHEA and DHEA-S response to psychosocial stress may be a more sensitive method than basal adrenal steroid analysis for detecting HPA axis dysfunction in depressive disorders.

LIMITATIONS

As this is a case control study, we could only draw the conclusion of the bi-directional relationship between the depression and the altered DHEA (S) response to stress, and could not identify whether depression was due to the HPA dysfunction, or vice versa. Prospective studies such as such as cohort studies or epidemiology experiments are needed to further test the cause of depression or HPA dysfunction; and the mechanisms responsible for altered DHEA and DHEA-S in response to acute psychosocial stress in individuals with depressive disorders are also needed to be clarified.

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

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

The Influence of State Anxiety on Fear Discrimination and Extinction in Females

Formal theories have linked pathological anxiety to a failure in fear response inhibition. Previously, we showed that aberrant response inhibition is not restricted to anxiety patients, but can also be observed in anxiety-prone adults. However, less is known about the influence of currently experienced levels of anxiety on inhibitory learning. The topic is highly important as state anxiety has a debilitating effect on cognition, emotion, and physiology and is linked to several anxiety disorders. In the present study, healthy female volunteers performed a fear conditioning task, after being informed that they will have to perform the Trier Social Stress Test task (n = 25; experimental group) or a control task (n = 25; control group) upon completion of the conditioning task. The results showed that higher levels of state anxiety corresponded with a reduced discrimination between a stimulus (CS+) typically followed by an aversive event and a stimulus (CS-) that is never followed by an aversive event both during the acquisition and the extinction phase. No effect of state anxiety on the skin conductance response associated with CS+ and CS- was found. Additionally, higher levels of state anxiety coincided with more negative valence ratings of the CSs. The results suggest that increased stress-induced state anxiety might lead to stimulus generalization during fear acquisition, thereby impairing associative learning.

Essential Oil of Japanese Cedar (Cryptomeria japonica) Wood Increases Salivary Dehydroepiandrosterone Sulfate Levels after Monotonous Work

Employee problems arising from mental illnesses have steadily increased and become a serious social problem in recent years. Wood is a widely available plant material, and knowledge of the psychophysiological effects of inhalation of woody volatile compounds has grown considerably. In this study, we established an experimental method to evaluate the effects of Japanese cedar wood essential oil on subjects performing monotonous work. Two experiment conditions, one with and another without diffusion of the essential oil were prepared. Salivary stress markers were determined during and after a calculation task followed by distribution of questionnaires to achieve subjective odor assessment. We found that inhalation of air containing the volatile compounds of Japanese cedar wood essential oil increased the secretion of dehydroepiandrosterone sulfate (DHEA-s). Slight differences in the subjective assessment of the odor of the experiment rooms were observed. The results of the present study indicate that the volatile compounds of Japanese cedar wood essential oil affect the endocrine regulatory mechanism to facilitate stress responses. Thus, we suggest that this essential oil can improve employees’ mental health.

Cortisol Stress Response Variability in Early Adolescence: Attachment, Affect and Sex

Attachment, affect, and sex shape responsivity to psychosocial stress. Concurrent social contexts influence cortisol secretion, a stress hormone and biological marker of hypothalamic-pituitary-adrenal axis activity. Patterns of attachment, emotion status, and sex were hypothesized to relate to bifurcated, that is, accentuated and attenuated, cortisol reactivity. The theoretical framework for this study posits that multiple individual differences mediate a cortisol stress response. The effects of two psychosocial stress interventions, a modified Trier Social Stress Test for Teens and the Frustration Social Stressor for Adolescents were developed and investigated with early adolescents. Both of these protocols induced a significant stress reaction and evoked predicted bifurcation in cortisol responses; an increase or decrease from baseline to reactivity. In Study I, 120 predominantly middle-class, Euro-Canadian early adolescents with a mean age of 13.43 years were studied. The girls' attenuated cortisol reactivity to the public performance stressor related significantly to their self-reported lower maternal-attachment and higher trait-anger. In Study II, a community sample of 146 predominantly Euro-Canadian middle-class youth, with an average age of 14.5 years participated. Their self-reports of higher trait-anger and trait-anxiety, and lower parental attachment by both sexes related differentially to accentuated and attenuated cortisol reactivity to the frustration stressor. Thus, attachment, affect, sex, and the stressor contextual factors were associated with the adrenal-cortical responses of these adolescents through complex interactions. Further studies of individual differences in physiological responses to stress are called for in order to clarify the identities of concurrent protective and risk factors in the psychosocial stress and physiological stress responses of early adolescents.

A virtual reality approach to the Trier Social Stress Test: Contrasting two distinct protocols

Virtual reality adaptations of the Trier Social Stress Test (TSST-VR) constitute useful tools for studying the physiologic axes involved in the stress response. Here, we aimed to determine the most appropriate experimental approach to the TSST-VR when investigating the modulation of the axes involved in the stress response. We compared the use of goggles versus a screen projection in the TSST-VR paradigm. Forty-five healthy participants were divided into two groups: the first one (goggles condition; 13 females, 11 males) wore goggles while performing the TSST-VR; the second (screen condition; 15 females, six males) was exposed to the TSST-VR projected on a screen. Sympathetic reactivity to stress was measured by continuously recording skin conductance (SC), while the hypothalamic-pituitary-adrenal axis (HPA) was evaluated by sampling salivary cortisol throughout the experiment. At the end of the task, there was an increase in SC and cortisol level for both means of delivering the TSST-VR, although the increase in SC was greater in the goggles condition, while salivary cortisol was comparable in both groups. Immersion levels were reportedly higher in the screen presentation than in the goggles group. In terms of sex differences, females experienced greater involvement and spatial presence, though comparatively less experienced realism, than their male counterparts. These findings help us determine which protocol of the TSST-VR is most suitable for the stress response under study. They also emphasize the need to consider the sex of participants, as males and females show distinct responses in each protocol.

Moderate alcohol consumption after a mental stressor attenuates the endocrine stress response

Alcohol is often consumed to reduce tension and improve mood when exposed to stressful situations. Previous studies showed that moderate alcohol consumption may reduce stress when alcohol is consumed prior to a stressor, but data on the effect of alcohol consumption after a mental stressor is limited. Therefore, our objective was to study whether moderate alcohol consumption immediately after a mental stressor attenuates the stress response. Twenty-four healthy men (age 21-40 y, BMI 18-27 kg/m²) participated in a placebo-controlled trial. They randomly consumed 2 cans (660 mL, ∼26 g alcohol) of beer or alcohol-free beer immediately after a mental stressor (Stroop task and Trier Social Stress Test). Physiological and immunological stress response was measured by monitoring heart rate and repeated measures of the hypothalamic-pituitary-adrenal axis (HPA-axis), white blood cells and a set of cytokines. After a mental stressor, cortisol and adrenocorticotropic hormone (ACTH) concentrations were 100% and 176% more reduced at 60 min (P = 0.012 and P = 0.001, respectively) and 92% and 60% more reduced at 90 min (P < 0.001 and P = 0.056, respectively) after beer consumption as compared to alcohol-free beer consumption. Heart rate and dehydroepiandrosterone (DHEA) were not influenced by alcohol consumption. Plasma IL-8 concentrations remained lower during the stress recovery period after beer consumption than after alcohol-free beer consumption (P < 0.001). In conclusion, consumption of a moderate dose of alcohol after a mental stressor may facilitate recovery of the endocrine stress response as reflected by decreasing plasma ACTH and cortisol.

No effects of psychosocial stress on memory retrieval in non-treated young students with Generalized Social Phobia

Generalized Social Phobia (GSP) is a common anxiety disorder that produces clear social life disruptions. There is no consensus on the specific processes involved in its development, but the role of the hypothalamic-pituitary-adrenal (HPA) axis has been suggested. This study analyzed the effects of the cortisol response to the Trier Social Stress Test (TSST) on the memory retrieval of pictures with different emotional valences in 45 non-treated young students with GSP and 50 non-anxious (NA) subjects (mean=19.35years, SD=0.18). No differences were found in the cortisol response of GSP and NA subjects to the TSST and control sessions. In addition, psychosocial stress impaired memory retrieval in both the GSP and NA groups, with no differences between them. Regarding the sex factor, no effects were found in the cortisol response to the TSST. However, during the encoding session, GSP men had higher cortisol levels than GSP women and NA subjects. There was also a significant interaction between sex and stress exposure on memory retrieval. Women recognized more unpleasant and neutral pictures than men; however, under stress, the women's advantage disappeared, and the men's performance improved. Sex also interacted with social phobia on positive mood, with GSP women exposed to the TSST showing the lowest positive mood. These results suggest that GSP subjects do not present an HPA axis sensitization to psychosocial stress, and they emphasize the importance of Sex in understanding stress effects on memory.

Prolonged Effects of Acute Stress on Decision-Making under Risk: A Human Psychophysiological Study

This study investigates the prolonged effects of physiological responses induced by acute stress on risk-taking in decision-making. Participants were divided into a Stress group (N = 14) and a Control group (N = 12). The Trier Social Stress Test was administered as an acute stressor, and reading was administered as a control task; thereafter, participants performed a decision-making task in which they needed to choose a sure option or a gamble option in Gain and Loss frame trials 2 h after (non-) exposure to the stressor. Increased cortisol, adrenaline, heart rate (HR), and subjective stress levels validated acute stress manipulation. Stressed participants made fewer risky choices only in the Gain domain, whereas no effect of stress was shown in the Loss domain. Deceleration of HR reflecting attention was greater for Gains compared with Losses only in the Stress group. Risk avoidance was determined by increased levels of cortisol caused by acute stress. These results suggest that processes regarding glucocorticoid might be involved in the prolonged effects of acute stress on the evaluation of risks and the monitoring of outcomes in decision-making.

Dehydroepiandrosterone-sulfate is associated with cardiovascular reactivity to stress in women

Cardiovascular stress reactivity is a predictor of atherosclerosis and cardiac events. Dehydroepiandrosterone (DHEA) protects against cardiovascular diseases, but results among previous studies have been inconsistent. We investigated the association between dehydroepiandrosterone-sulfate (DHEA-s) and cardiovascular stress reactivity in Japanese women and men. Among 979 healthy Japanese subjects (641 women and 338 men), serum levels of DHEA-s, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate, heart rate variability, and peripheral blood flow were measured under rest and two types of task. Mean differences in measured variables during tasks and a post-task period were calculated as changes in stress reactivity. Variables of stress reactivity were adjusted for multiple potential confounding factors. In women, DHEA-s levels showed positive associations with changes in SBP and DBP (standardized beta=0.12, p=0.020; 0.17, 0.002, respectively). Stratification by menopausal status and other lifestyle factors (e.g., smoking status, alcohol consumption) were conducted. Significant positive associations remained in pre-menopausal (standardized beta=0.13, p=0.037; 0.18, 0.005), non-smoking (0.12, 0.010; 0.18, <0.001), and non-drinking women (0.14, 0.021; 0.21, 0.001), and women without a medical history (0.15, 0.020; 0.20, 0.001). In men, there was no significant association between DHEA-s levels and changes in stress reactivity. DHEA-s levels were positively associated with high blood-pressure reactivity to stress in women, and being menopausal, smoking, and alcohol consumption modified this association.

Exposure to acute stress enhances decision-making competence: Evidence for the role of DHEA

Exposure to acute stress can impact performance on numerous cognitive abilities, but little is known about how acute stress affects real-world decision-making ability. In the present study, we induced acute stress with a standard laboratory task involving uncontrollable socio-evaluative stress and subsequently assessed decision-making ability using the Adult Decision Making Competence index. In addition, we took baseline and post-test saliva samples from participants to examine associations between decision-making competence and adrenal hormones. Participants in the stress induction group showed enhanced decision-making competence, relative to controls. Further, although both cortisol and dehydroepiandrosterone (DHEA) reactivity predicted decision-making competence when considered in isolation, DHEA was a significantly better predictor than cortisol when both hormones were considered simultaneously. Thus, our results show that exposure to acute stress can have beneficial effects on the cognitive ability underpinning real-world decision-making and that this effect relates to DHEA reactivity more than cortisol.

Reactivity to Social Stress in Subclinical Social Anxiety: Emotional Experience, Cognitive Appraisals, Behavior, and Physiology

Recent research indicates that subclinical social anxiety is associated with dysfunctions at multiple psychological and biological levels, in a manner that seems reminiscent of social anxiety disorder (SAD). This study aimed to describe multidimensional responses to laboratory-induced social stress in an analog sample selected for social anxiety symptoms. State anxiety, cognitive biases related to negative social evaluation, speech anxiety behaviors, and cortisol reactivity were assessed in the Trier Social Stress Test (TSST). Results showed that social anxiety symptoms were associated with increased state anxiety, biased appraisals related to the probability and cost of negative social evaluations, behavioral changes in facial expression that were consistent with speech anxiety, and lower cortisol reactivity. In addition, multiple interrelations between responses in the TSST were found, with positive associations between subjective experience, cognitive appraisals, and observable behavior, as well as negative associations between each of the former two types of response and cortisol reactivity. These results show that in response to social stressors, subclinical social anxiety is associated with significant changes in emotional experience, cognitive appraisals, behaviors, and physiology that could parallel those previously found in SAD samples.

Social Anxiety, Affect, Cortisol Response and Performance on a Speech Task

BACKGROUND

Social anxiety is characterized by increased emotional reactivity to social stimuli, but results of studies focusing on affective reactions of socially anxious subjects in the situation of social exposition are inconclusive, especially in the case of endocrinological measures of affect.

SAMPLING AND METHODS

This study was designed to examine individual differences in endocrinological and affective reactions to social exposure as well as in performance on a speech task in a group of students (n = 44) comprising subjects with either high or low levels of social anxiety. Measures of salivary cortisol and positive and negative affect were taken before and after an impromptu speech. Self-ratings and observer ratings of performance were also obtained.

RESULTS

Cortisol levels and negative affect increased in both groups after the speech task, and positive affect decreased; however, group × affect interactions were not significant. Assessments conducted after the speech task revealed that highly socially anxious participants had lower observer ratings of performance while cortisol increase and changes in self-reported affect were not related to performance.

CONCLUSIONS

Socially anxious individuals do not differ from nonanxious individuals in affective reactions to social exposition, but reveal worse performance at a speech task.

The cortisol response to social stress in social anxiety disorder

This study evaluated the cortisol stress response (CSR) following the Trier Social Stress Test in Social Anxiety Disorder (SAD) and control participants, to determine whether individual differences in CSR associate more with SAD diagnosis or dimensional characteristics [i.e. childhood trauma (CT)]. Twenty-one participants (11 with SAD) had full data available for both CT-scores and cortisol area-under-the-curve (AUC). Linear regression produced significant results: predicting AUCG with study group, emotional abuse (EA) scores and their interaction (F=3.14, df=5,15; p=.039); of note, the study group by EA interaction was significant at p=.015, driven by a strong positive association between EA and cortisol AUCG in the control group, and a negative association between these variables in the SAD group (standardized-beta=1.56, t=2.75, p=.015). This suggests that EA in SAD patients is associated with altered CSR, highlighting need to measure dimensional characteristics.

Adolescents' internalizing and externalizing problems predict their affect-specific HPA and HPG axes reactivity

We examined psychopathology-neuroendocrine associations in relation to the transition into adolescence within a developmental framework that acknowledged the interdependence of the HPA and HPG hormone systems in the regulation of responses to everyday affective contexts. Saliva samples were collected during anxiety and anger inductions from 51 young adolescents (M 13.47, SD = .60 years) to evaluate cortisol, DHEA, and testosterone responses. Internalizing and externalizing problems were assessed at pre-adolescence (M = 9.27, SD = .58 years) while youths were in elementary school and concurrently with hormones in early adolescence. Externalizing problems from elementary school predicted adolescents' reduced DHEA reactivity during anxiety induction. Follow up analyses simultaneously examining the contributions of elementary school and adolescent problems showed a trend suggesting that youths with higher levels of internalizing problems during elementary school eventuated in a profile of heightened DHEA reactivity as adolescents undergoing anxiety induction. For both the anxiety and the anger inductions, it was normative for DHEA and testosterone to be positively coupled. Adolescents with high externalizing problems but low internalizing problems marshaled dual axes co-activation during anger induction in the form of positive cortisol-testosterone coupling. This is some of the first evidence suggesting affective context determines whether dual axes coupling is reflective of normative or problematic functioning in adolescence.

Hypothalamic-pituitary-adrenocortical axis: neuropsychiatric aspects

Evidence of aberrant hypothalamic-pituitary-adrenocortical (HPA) activity in many psychiatric disorders, although not universal, has sparked long-standing interest in HPA hormones as biomarkers of disease or treatment response. HPA activity may be chronically elevated in melancholic depression, panic disorder, obsessive-compulsive disorder, and schizophrenia. The HPA axis may be more reactive to stress in social anxiety disorder and autism spectrum disorders. In contrast, HPA activity is more likely to be low in PTSD and atypical depression. Antidepressants are widely considered to inhibit HPA activity, although inhibition is not unanimously reported in the literature. There is evidence, also uneven, that the mood stabilizers lithium and carbamazepine have the potential to augment HPA measures, while benzodiazepines, atypical antipsychotics, and to some extent, typical antipsychotics have the potential to inhibit HPA activity. Currently, the most reliable use of HPA measures in most disorders is to predict the likelihood of relapse, although changes in HPA activity have also been proposed to play a role in the clinical benefits of psychiatric treatments. Greater attention to patient heterogeneity and more consistent approaches to assessing treatment effects on HPA function may solidify the value of HPA measures in predicting treatment response or developing novel strategies to manage psychiatric disease.

Neurosteroid, GABAergic and hypothalamic pituitary adrenal (HPA) axis regulation: what is the current state of knowledge in humans?

RATIONALE

A robust epidemiological literature suggests an association between chronic stress and the development of affective disorders. However, the precise biological underpinnings of this relationship remain elusive. Central to the human response and adaptation to stress, activation and inhibition of the hypothalamic pituitary adrenal (HPA) axis involves a multi-level, multi-system, neurobiological stress response which is as comprehensive in its complexity as it is precarious. Dysregulation in this complex system has implications for human stress related illness.

OBJECTIVES

The pioneering research of Robert Purdy and colleagues has laid the groundwork for advancing our understanding of HPA axis regulation by stress-derived steroid hormones and their neuroactive metabolites (termed neurosteroids), which are potent allosteric modulators of GABAA receptor function in the central nervous system. This review will describe what is known about neurosteroid modulation of the HPA axis in response to both acute and chronic stress, particularly with respect to the current state of our knowledge of this process in humans.

RESULTS

Implications of this research to the development of human stress-related illness are discussed in the context of two human stress-related psychiatric disorders - major depressive disorder and premenstrual dysphoric disorder.

CONCLUSIONS

Neurosteroid-mediated HPA axis dysregulation is a potential pathophysiologic mechanism which may cross traditional psychiatric diagnostic classifications. Future research directions are identified.

The role of acute cortisol and DHEAS in predicting acute and chronic PTSD symptoms

BACKGROUND

Decreased activation of the hypothalamus-pituitary-adrenal (HPA) axis in response to stress is suspected to be a vulnerability factor for posttraumatic stress disorder (PTSD). Previous studies showed inconsistent findings regarding the role of cortisol in predicting PTSD. In addition, no prospective studies have examined the role of dehydroepiandrosterone (DHEA), or its sulfate form DHEAS, and the cortisol-to-DHEA(S) ratio in predicting PTSD. In this study, we tested whether acute plasma cortisol, DHEAS and the cortisol-to-DHEAS ratio predicted PTSD symptoms at 6 weeks and 6 months post-trauma.

METHODS

Blood samples of 397 adult level-1 trauma center patients, taken at the trauma resuscitation room within hours after the injury, were analyzed for cortisol and DHEAS levels. PTSD symptoms were assessed at 6 weeks and 6 months post-trauma with the Clinician Administered PTSD Scale.

RESULTS

Multivariate linear regression analyses showed that lower cortisol predicted PTSD symptoms at both 6 weeks and 6 months, controlling for age, gender, time of blood sampling, injury, trauma history, and admission to intensive care. Higher DHEAS and a smaller cortisol-to-DHEAS ratio predicted PTSD symptoms at 6 weeks, but not after controlling for the same variables, and not at 6 months.

CONCLUSIONS

Our study provides important new evidence on the crucial role of the HPA-axis in response to trauma by showing that acute cortisol and DHEAS levels predict PTSD symptoms in survivors of recent trauma.

Acute psychosocial stress and emotion regulation skills modulate empathic reactions to pain in others

Psychosocial stress affects resources for adequate coping with environmental demands. A crucial question in this context is the extent to which acute psychosocial stressors impact empathy and emotion regulation. In the present study, 120 participants were randomly assigned to a control group vs. a group confronted with the Trier Social Stress Test (TSST), an established paradigm for the induction of acute psychosocial stress. Empathy for pain as a specific subgroup of empathy was assessed via pain intensity ratings during a pain-picture task. Self-reported emotion regulation skills were measured as predictors using an established questionnaire. Stressed individuals scored significantly lower on the appraisal of pain pictures. A regression model was chosen to find variables that further predict the pain ratings. These findings implicate that acute psychosocial stress might impair empathic processes to observed pain in another person and the ability to accept one's emotion additionally predicts the empathic reaction. Furthermore, the ability to tolerate negative emotions modulated the relation between stress and pain judgments, and thus influenced core cognitive-affective functions relevant for coping with environmental challenges. In conclusion, our study emphasizes the necessity of reducing negative emotions in terms of empathic distress when confronted with pain of another person under psychosocial stress, in order to be able to retain pro-social behavior.

Salivary VIP concentrations are elevated in humans after acute stress

Salivary (s)-cortisol, s-amylase, s-DHEA are used extensively in stress research. Vasoactive Intestinal Peptide (VIP) is also detectable in saliva using a standard RIA kit. VIP is a 28 amino acid neuropeptide that belongs to the secretin/glucagon family of peptides and acts as a neurotransmitter/neuromodulator. VIP has also been detected in the parasympathetic nerves enervating the salivary glands. Here we measured the level of s-cortisol, s-DHEA, s-amylase and s-VIP in three different stress exercises of different duration and intensity. The results indicate that a brief intense exercise lasting minutes elicited a stress response with significant increases in s-cortisol, s-DHEA, s-amylase and s-VIP. A less rigorous exercise did not elicit a stress response with no significant increases in s-cortisol, s-DHEA, s-amylase and s-VIP. A longer intense exercise lasting hours elicited a stress response with significant increases only in s-cortisol.

Stress Reactivity, Social Anxiety, and Alcohol Consumption in People With Alcoholism: A Laboratory Study

OBJECTIVE

Social anxiety may maintain alcohol dependence through increased reactivity to stressful events, a propensity to drink to cope with stressful events, or both. The current study is a secondary analysis of an existing dataset that examined differences between individuals with alcohol dependence and concurrent high and low social anxiety in objective and subjective stress reactivity to a laboratory stressor (Trier Social Stress Test; TSST), as well as consumption of alcohol following the stressor.

METHODS

Forty participants with alcohol dependence (20 women) were randomly assigned to the TSST condition as part of the parent study. Post-hoc analysis of social anxiety measures yielded high (n = 19) and low (n = 21) social anxiety groups. Participants completed the TSST, followed by a small dose of their favorite alcoholic beverage (target blood alcohol concentration 0.03g/dl) to prime subsequent laboratory drinking. Participants received a sham beer taste test of two glasses (710ml total) of beer. Differences between high and low social anxiety groups was assessed via subjective and objective (mean arterial pressure, serum cortisol) reactivity to the TSST and consumption of alcohol during the taste test (total mls consumed, mls/kg of body weight, and likelihood of consuming all the beer available).

RESULTS

No differences emerged in either objective or subjective measures of stress reactivity between high and low socially anxious groups. There were also no differences between social anxiety groups in amount of alcohol consumed during the taste test.

CONCLUSIONS

No differences were observed between high and low socially anxious participants with concurrent alcohol dependence on stress reactivity or alcohol consumption following a stressor. Given that all participants in this study had alcohol dependence, negative results may suggest that heightened stress reactivity and drinking to cope are more relevant to the development of alcohol dependence and that other factors may maintain alcohol use once dependence has developed.

Mining the salivary proteome with grating-coupled surface plasmon resonance imaging and surface plasmon coupled emission microarrays

Biological indicators have numerous and widespread utility in personalized medicine, but the measurement of these indicators also poses many technological and practical challenges. Blood/plasma has typically been used as the sample source with which to measure these indicators, but the invasiveness associated with sample procurement has led to increased interest in saliva as an attractive alternative. However, there are unique issues associated with the measurement of saliva biomarkers. These issues are compounded by the imperfect correlation between saliva and plasma with respect to biomarker profiles. In this manuscript, we address the technical challenges associated with saliva biomarker quantification. We describe a high-content microarray assay that employs both grating-coupled surface plasmon resonance imaging and surface plasmon-coupled emission modalities in a highly sensitive assay with a large dynamic range. This powerful approach provides the tools to map the proteome of saliva, which in turn should greatly enhance the utility of salivary biomarker profiles in personalized medicine.

The effectiveness of narrative therapy with young people with autism

PROBLEM

The aim of this pilot study was to be the first step toward empirically determining whether narrative therapy is effective in helping young people with autism who present with emotional and behavioral problems. Autism is increasingly being recognized in young people with average and above intelligence. Because of the nature of autism, these young people have difficulty navigating the challenges of school and adolescence. Narrative therapy can help them with their current difficulties and also help them develop skills to address future challenges. Narrative therapy involves working with a person to examine and edit the stories the person tells himself or herself about the world. It is designed to promote social adaptation while working on specific problems of living.

METHOD

This pilot intervention study used a convenience sample of 10 young people with autism (10-16 years) to evaluate the effectiveness of five 1 hr sessions of narrative therapy conducted over 10 weeks. The study used the parent-rated Strengths and Difficulties Questionnaire (SDQ) as the primary outcome measure. Secondary outcome measures were the Kessler-10 Scale of Psychological Distress (K-10), the Beck Hopelessness Scale, and a stress biomarker, the salivary cortisol to dehydroepiandrosterone (DHEA) ratio.

FINDINGS

Significant improvement in psychological distress identified through the K-10 was demonstrated. Significant improvement was identified on the Emotional Symptoms Scale of the SDQ. The cortisol:DHEA ratio was responsive and a power analysis indicated that further study is indicated with a larger sample.

CONCLUSION

Narrative therapy has merit as an intervention with young people with autism. Further research is indicated.

Matter over mind: a randomised-controlled trial of single-session biofeedback training on performance anxiety and heart rate variability in musicians

Background

Musical performance is a skilled activity performed under intense pressure, thus is often a profound source of anxiety. In other contexts, anxiety and its concomitant symptoms of sympathetic nervous system arousal have been successfully ameliorated with HRV biofeedback (HRV BF), a technique involving slow breathing which augments autonomic and emotional regulatory capacity. Objective: This randomised-controlled study explored the impact of a single 30-minute session of HRV BF on anxiety in response to a highly stressful music performance.

Methods

A total of 46 trained musicians participated in this study and were randomly allocated to a slow breathing with or without biofeedback or no-treatment control group. A 3 Group×2 Time mixed experimental design was employed to compare the effect of group before and after intervention on performance anxiety (STAI-S) and frequency domain measures of HRV.

Results

Slow breathing groups (n = 30) showed significantly greater improvements in high frequency (HF) and LF/HF ratio measures of HRV relative to control (n = 15) during 5 minute recordings of performance anticipation following the intervention (effect size: η² = 0.122 and η² = 0.116, respectively). The addition of biofeedback to a slow breathing protocol did not produce differential results. While intervention groups did not exhibit an overall reduction in self-reported anxiety, participants with high baseline anxiety who received the intervention (n = 15) displayed greater reductions in self-reported state anxiety relative to those in the control condition (n = 7) (r = 0.379).

Conclusions

These findings indicate that a single session of slow breathing, regardless of biofeedback, is sufficient for controlling physiological arousal in anticipation of psychosocial stress associated with music performance and that slow breathing is particularly helpful for musicians with high levels of anxiety. Future research is needed to further examine the effects of HRV BF as a low-cost, non-pharmacological treatment for music performance anxiety.

A mind-body approach for precompetitive anxiety in power-lifters: 2 case studies

OBJECTIVE

The aim of this article is to report how Neuro Emotional Technique (NET) was used for precompetitive anxiety in 2 power-lifting athletes.

CLINICAL FEATURES

Two athletes (1 elite and 1 novice), who were participating in major competitions within 2 weeks of testing, were assessed for cognitive and somatic anxiety levels pre- and postintervention. Three psychometrics were used to measure mental state (cognitive anxiety): the Sports Competitive Anxiety Test, the Depression Anxiety Stress Scales, and the SF-36v2 Health Survey. To assess somatic anxiety, saliva samples were collected and screened for cortisol and dehydroepiandrosterone.

INTERVENTION AND OUTCOME

The intervention was performed by a doctor of chiropractic and consisted of one 30-minute session of NET that focused on the athletes' concerns regarding the upcoming competitions. The results showed reductions in reported subjective anxiety levels and changes in the salivary hormone profile of both athletes following the intervention, with the more remarkable changes occurring in the novice athlete. The reduction in reported cognitive anxiety levels and the change in somatic anxiety markers may be the result of the mind-body intervention. However, these changes may also be attributed to other factors, such as the natural course of anxiety during competition. An experimental trial would be required to determine the effectiveness of NET for reducing precompetitive anxiety of power-lifters.

CONCLUSION

Neuro Emotional Technique may have helped these power-lifters control emotional arousal and precompetitive anxiety. However, caution is warranted when using these results to draw conclusions or when extrapolating these results to other settings.

Effect of childhood physical abuse on cortisol stress response

RATIONALE

Abuse and neglect are highly prevalent in children and have enduring neurobiological effects. Stressful early life environments perturb the hypothalamic-pituitary-adrenal (HPA) axis, which in turn may predispose to psychiatric disorders in adulthood. However, studies of childhood maltreatment and adult HPA function have not yet rigorously investigated the differential effects of maltreatment subtypes, including physical abuse.

OBJECTIVE

In this study, we sought to replicate our previous finding that childhood maltreatment was associated with attenuated cortisol responses to stress and determine whether the type of maltreatment was a determinant of the stress response.

METHODS

Salivary cortisol response to the Trier Social Stress Test (TSST) was examined in a non-clinical sample of women (n = 110). Subjects had no acute medical problems and were not seeking psychiatric treatment. Effects of five maltreatment types, as measured by the Childhood Trauma Questionnaire, on cortisol response to the TSST were investigated. To further examine the significant (p < 0.005) effect of one maltreatment type, women with childhood physical abuse (PA) (n = 20) were compared to those without past PA (n = 90).

RESULTS

Women reporting childhood PA displayed a significantly blunted cortisol response to the TSST compared with subjects without PA, after controlling for estrogen use, age, other forms of maltreatment, and other potential confounds. There were no differences between PA and control groups with regard to physiological arousal during the stress challenge.

CONCLUSIONS

In a non-clinical sample of women with minimal or no current psychopathology, physical abuse is associated with a blunted cortisol response to a psychosocial stress task.

Psychoneuroimmunologic factors in inflammatory bowel disease

BACKGROUND

Bidirectional relationships between the immune system, nervous system, and psychological processes likely exist in inflammatory bowel disease (IBD) because stress can affect IBD, and IBD is associated with an increased risk of psychological difficulty. The field of psychoneuroimmunology (PNI) sheds light on specific mechanisms that are involved in these relationships, and this research can be applied specifically to IBD. The purpose of this article is to review research on PNI processes in IBD and provide recommendations for future research.

METHODS

A literature search was conducted using the PubMed and PsychInfo computerized databases and bibliographies of relevant articles.

RESULTS

The hypothalamic-pituitary-adrenal axis, sympathetic-adrenomedullary system, proinflammatory cytokines, substance P, and mast cells play roles in inflammatory processes in IBD. These processes also respond to stress, and they have been implicated in psychological problems in otherwise healthy individuals. These overlapping processes in inflammation and psychological function have received limited attention in IBD, but preliminary evidence suggests that these mechanisms may play a role in the psychological difficulty experienced by those with IBD.

CONCLUSIONS

Several bidirectional PNI mechanisms overlap in IBD, suggesting ways that stress and psychological function can affect disease activity and, conversely, avenues by which the inflammation in IBD may contribute to psychological difficulty. More research on specific PNI processes is needed to fully understand these factors in IBD.