Evaluation of a remote, internet-delivered version of the Trier Social Stress Test

A remote examination of acute stress responses: examining the influence of psychological resilience

BACKGROUND

A few studies have examined psychological resilience as a predictor of physiological responses to acute stress; however, no studies have directly examined psychological resilience as a moderator of subjective responses to acute stress.

METHODS

Adults were recruited to participate in an acute stress response study that was conducted remotely. Demographics, psychological resilience, nicotine use and desire to quit, and information related to cannabis use were measured during a medical screening session. Positive, stressed, and anxious moods were measured during baseline rest prior to acute stress, after performing acute stress tasks, and after 30- and 55-minutes of post-stress recovery during an acute stress session.

RESULTS

Acute stress was successfully induced during the remote audio-video stress session. There were significant increases in stressed and anxious moods and significant decreases in positive mood immediately after the acute stress tasks, followed by a return to baseline levels of these moods. Moreover, psychological resilience was inversely related to stressed and anxious moods reported at baseline and immediately after acute stress. In addition, psychological resilience was positively related to positive mood.

CONCLUSION

The results are consistent with previous research linking psychological resilience to general reports of positive and negative affect. Further, the results demonstrate, for the first time, that psychological resilience may be a significant predictor of negative mood immediately after acute stress.

Do Expectant Mothers Exhibit Different Autonomic Responses to the Infant Cry Stimuli at Home Versus in the Laboratory?

The COVID-19 pandemic introduced challenges for keeping participants and research assistants safe during laboratory visits. One solution was administering research assessments in the participant's home via an online platform, despite limited evidence of whether online tasks have similar effects as laboratory contexts. The present study compares physiological responses to a virtual adaptation of an infant cry stimulus-which is commonly used to evoke and measure autonomic nervous system responses among pregnant individuals-to a traditional laboratory-based cry task. Respiratory sinus arrhythmia (RSA), electrodermal activity (EDA), and heart rate (HR) were collected during infant cry presentation from 120 pregnant women in their third trimester. Half of the participants observed the infant cry stimulus in the laboratory before the pandemic, and the other half had the task delivered remotely using online teleconferencing technology in their homes. Results revealed that EDA increased and RSA decreased in response to the infant cry stimulus. HR did not significantly change from baseline to the infant cry stimulus. Importantly, whether the participants watched the infant cry stimulus at home versus in the laboratory did not affect their autonomic responses to the stimulus. These results demonstrate the ability of remote tasks to elicit an attachment-relevant stress response in pregnant women for remote data collection.

Habituation of the biological response to repeated psychosocial stress: a systematic review and meta-analysis

Recurrent psychosocial stress poses a significant health challenge, prompting research into mechanisms of successful adaptation. Physiological habituation, defined as decreased reactivity to repeated stressors, is pivotal in protecting the organism from allostatic load. Here, we systematically review and meta-analyze data from studies investigating the capacity of central stress systems to habituate when repeatedly exposed to a standardized psychosocial stressor, the Trier Social Stress Test (k = 47). For a comprehensive overview of biological stress systems, we examine multiple markers of the hypothalamic-pituitary-adrenal (HPA) axis, the autonomic nervous system (ANS), and the immune system. Our findings indicate that habituation patterns vary substantially between different stress systems. While most studies provide robust evidence for rapid and substantial HPA-axis habituation, ANS and immune marker responses to repeated stress are less uniform. We further integrate existing knowledge on personal and environmental influences contributing to individual differences in habituation capacity. Additionally, we discuss the implications of stress habituation patterns for health outcomes and the design of longitudinal stress studies and highlight potential avenues for future research.

TSST-OL: Comparison between online and laboratory application and effects on empathy

Online test protocols are increasingly popular in psychological and neuroscientific research. Despite its relevance to the social functioning, the influence of acute stress on cognitive and affective state empathy is not clearly understood. Recently, a remote online version (TSST-OL) of the Trier Social Stress Test (TSST) was established for use in research with both children and adults. In general, the TSST-OL offers the opportunity for context-independent application (e.g., at the participants' home or in field contexts). However, in order to exploit this opportunity, it seems crucial to validate the TSST-OL across different settings and contextual variables. We compared stress reactivity in response to the TSST-OL at home and in the laboratory. In a 2 ×2 factorial design, N=120 participants (n=60 women) underwent the TSST-OL and an online adaption of the friendly TSST (fTSST-OL) either at home (n=60) or at the laboratory (n=60). Stress induction was evaluated in terms of physiological (cortisol and salivary alpha-amylase, sAA) and subjective stress and affect measures. Participants also completed an empathy performance task after stress and control exposure. Results confirmed that the TSST-OL successfully induced stress both when conducted at participants' homes and in the laboratory. Still, cortisol levels were higher during laboratory participation compared to application at home, likely due to anticipatory stress. Consequently, the TSST-OL in a home-based application seems to buffer anticipatory stress thus making it an attractive tool to study experimentally induced stress reactivity. Concerning empathy, positive emotions were generally better identified (cognitive empathy) and empathized (affective empathy) than negative emotions. For the latter, this difference was absent after stress, indicated by decreased affective empathy for positive emotions. Overall, this study indicates that the TSST-OL induces stress and validates the tool using a rigorous study design with sufficient participants and relevant stress parameters. Thus, future studies may apply the TSST-OL in different contexts and diverse samples. The findings on empathy under stress align with mixed results in existing research, highlighting the necessity for further investigations into empathy, considering various measurements, stimulus valence, and sex of the participant.

A Comprehensive Investigation of Social Anxiety and Social Evaluative Stress in Autistic Children and Adolescents and Specific Learning Disorders

The aim was to investigate trait social anxiety and social evaluative stress in autistic children and adolescents and Specific Learning Disorders (SLD). This was done by evaluating behavioral, subjective, and autonomic responses to the Trier Social Stress Test (TSST). Study 1 included 280 children and adolescents: 60 autistic without intellectual disability (ID), 70 SLD, and 150 non-diagnosed (ND) peers. Study 2 involved 55 participants: 15 autistic without ID, 15 SLD, and 20 ND. The sample was predominantly male. In Study 1, behavioral (quality of public speech) and subjective (valence, arousal, perceived competence, and worries) aspects of social stress were examined. Study 2 expands upon the first study, as physiological responses to social stress were also measured. Trait social anxiety was investigated using both parents' and children's reports in the two studies. Parents of autistic participants and with SLD reported higher trait social anxiety in their children than the parents of ND. No differences emerged from the participants' self-reports, though those autistic and with SLD were assigned lower scores in the public speech quality than ND. Autistic children and adolescents reported lower arousal and higher perceived competence than ND, while those with SLD reported a lower perception of competence. Autistic participants had a decreased cardiac reactivity across the TSST when compared to SLD and ND. Our findings show unique patterns of responses within each group, confirming that the combined investigation of trait anxiety and social stress responses could be a valuable insight in research and clinical practice.

Stability and durability of salivary alpha-amylase across different storage conditions

Data collection in remote and field settings gains importance and popularity in stress research. Accordingly, existing stress induction paradigms have been successfully adapted to remote and field settings. However, guidelines for the comprehensive assessment of biomarkers such as salivary alpha-amylase (sAA) have yet to be sufficiently established for such contexts. In remote and field settings, swift freezing of saliva samples is not always possible, and samples must be returned to the laboratory for further processing. The current study investigated the robustness of sAA activity against external factors that may affect measurements obtained from saliva samples collected in field and remote settings. We compared sAA activity of samples that were stored in different vials (Salivettes® and Eppendorf® vials) and that were exposed to (1) up to three cycles of freezing and thawing, (2) different temperatures (4 °C, 20 °C, 30 °C, and 40 °C) for 3, 7, 14, or 28 days, or that were (3) sent via postal delivery. Results indicate sAA activity to be susceptible across different temperatures, different time intervals, and different vials. As a systematic pattern, sAA activity seems to decrease in treated samples with this effect being potentiated by more extreme conditions such as higher temperatures and longer time intervals. To conclude, sAA data collected in remote or field settings could be affected systematically by various external variables. Future studies collecting sAA should take factors influencing the durability and stability of sAA into account to ensure reliable and valid measurements of salivary data.

Associations Between Direct and Indirect Forms of Racism Exposure and Stress-Induced Inflammatory Response and Health in Pregnancy

Theory and research suggest chronic direct and indirect exposures to racism impact health, and stress-responsive inflammation may play a role in these paths. This study examines links between forms of racism-related stress, salivary markers of inflammation during acute psychosocial stress, and perinatal mental and physical health in a racially heterogenous sample. Pregnant people (n = 108, 27% non-white) self-reported personal and vicarious exposure to racism (racial microaggressions, online racism, overt racial/ethnic discrimination) and racial collective self-esteem, as well as affective symptoms and general physical health. Five saliva samples collected before and after the Trier Social Stress Test were assayed for pro-inflammatory cytokines and C-reactive protein. Results revealed associations between racism-related stress and greater inflammatory reactivity/delayed recovery to acute stress, between racial collective self-esteem and lower levels of inflammation, and between profiles of inflammatory responses to stress and mental and physical symptoms. We discuss implications for understanding perinatal health disparities.

Smartphone Photoplethysmography Pulse Rate Covaries With Stress and Anxiety During a Digital Acute Social Stressor

OBJECTIVE

Heart rate is a transdiagnostic correlate of affective states and the stress diathesis model of health. Although most psychophysiological research has been conducted in laboratory environments, recent technological advances have provided the opportunity to index pulse rate dynamics in real-world environments with commercially available mobile health and wearable photoplethysmography (PPG) sensors that allow for improved ecologically validity of psychophysiological research. Unfortunately, adoption of wearable devices is unevenly distributed across important demographic characteristics, including socioeconomic status, education, and age, making it difficult to collect pulse rate dynamics in diverse populations. Therefore, there is a need to democratize mobile health PPG research by harnessing more widely adopted smartphone-based PPG to both promote inclusivity and examine whether smartphone-based PPG can predict concurrent affective states.

METHODS

In the current preregistered study with open data and code, we examined the covariation of smartphone-based PPG and self-reported stress and anxiety during an online variant of the Trier Social Stress Test, as well as prospective relationships between PPG and future perceptions of stress and anxiety in a sample of 102 university students.

RESULTS

Smartphone-based PPG significantly covaries with self-reported stress and anxiety during acute digital social stressors. PPG pulse rate was significantly associated with concurrent self-reported stress and anxiety ( b = 0.44, p = .018) as well as prospective stress and anxiety at the subsequent time points, although the strength of this association diminished the farther away pulse rate got from self-reported stress and anxiety (lag 1 model: b = 0.42, p = .024; lag 2 model: b = 0.38, p = .044).

CONCLUSIONS

These findings indicate that PPG provides a proximal measure of the physiological correlates of stress and anxiety. Smartphone-based PPG can be used as an inclusive method for diverse populations to index pulse rate in remote digital study designs.

A method to induce stress in human subjects in online research environments

This paper presents a method to induce stress in human subjects during online participation in research studies without the presence of researchers. In this study, participants in the stress-inducing condition (N = 52, 44%) were asked to answer general knowledge and mathematical questions which people often get wrong, and did so under time pressure as well as receiving feedback. In contrast, participants in the control condition (N = 66, 56%) did not have time pressure or receive feedback. The stress manipulation was found to be effective, as the reported state anxiety and visual analog scale on stress scores were higher for the stress group than for the non-stress group (both findings, p < 0.001). Consistent findings were found when accounting for trait anxiety as a moderator, with the exception of the state anxiety levels in high trait anxiety group. This stressing method combines the established stress conditions of uncontrollability (such as time pressures) and social evaluative threats (such as negative feedback). In addition, the method contains specific measures (such as a commitment statement and attention check questions) to enhance the internal validity by preventing and detecting cheating or random responses. This method can be deployed through any commonly available online software. It offers a simple and cost-effective way to collect data online - which fits the increasing need to carry out research in virtual and online environments.

Cardiovascular, self-report, and behavioral stress reactivity to the group-based Trier Social Stress Test with pandemic-related protocol adaptations

Research using stress induction protocols such as the Trier Social Stress Test (TSST) and the TSST for groups (TSST-G) during the coronavirus disease (COVID-19) pandemic has been challenging. While institutional review boards have provided guidance on returning to face-to-face research using COVID-19 adaptations (e.g., masking, social distancing), whether these adaptations influence the effectiveness of social-evaluative stress induction remains unknown. We conducted a secondary data analysis from a randomized controlled trial to establish whether using COVID-19 adaptations (i.e., masking, social distancing, and using a single large conference room for the duration of the experiment) to the TSST-G protocol was able to reliably induce stress across cardiovascular, self-report, and behavioral indices of stress. Young adults (N = 53) underwent the TSST-G with COVID-19 adaptations. We measured systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), self-reported, and behavioral responses to the TSST-G, and all variables indicated successful stress induction. Increases in SBP (18 mmHg) and DBP (14 mmHg) were similar in magnitude as those in standard in-person TSST protocols. Increases in HR (9 beats per minute) were smaller in magnitude than standard in-person TSST protocols, but slightly larger than increases documented in remote TSST protocols. The cardiovascular, self-report, and behavioral indices of stress reactivity provide confidence in the effectiveness of TSST-G with COVID-19 adaptations to reliably induce stress. In-person TSST protocols with COVID-19 adaptations represent an alternate option to remote TSST protocols for stress induction researchers to use during times when masking or social distancing are necessary.

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.

Test of daily app-based mindfulness meditation preceding a planned smoking quit attempt date on abstinence: Protocol for a randomized controlled trial recruiting across the 58 counties of California

A majority of the 34 million people who currently smoke cigarettes report wanting to quit smoking yet most attempts to quit end in relapse. A mindfulness based intervention (MBI) is an intervention package used to reinforce an individual's practice of mindfulness meditation in daily life. MBIs delivered by phone app offer daily prompts to guide bouts of mindfulness meditation, that is, sustained attention to moment-by-moment experience without behavior reactivity. Daily bouts of mindfulness meditation offer individuals a replacement behavior for smoking during a quit attempt, and MBI app instruction aims to increase an individual's skill in non-reactivity when they experience cravings. Our study objective is to test the effect of an app-based MBI on abstinence during a scheduled quit attempt among people who currently smoke and who are willing to make a voluntary quit attempt on a selected near-term date. Our delivery of a smartphone app-based MBI occurs daily for the two weeks preceding a planned quit date. Study participants are randomized to a either a app-based MBI or an app-based psychoeducation control group and asked to self-administer their intervention two times a day in 10-min segments for 14 sequential days for a total of 280 min. This preparatory period capitalizes on time to help participants orient toward a near-term goal to quit smoking, practice mindfulness meditation, and increase the skill of non-reactivity during states of craving to smoke. We recruit people who smoke cigarettes from all 58 counties in California. We test the hypothesis that an app-based MBI will outperform a time-matched psychoeducation control on increasing smoking abstinence. Findings contribute knowledge to the addictions treatment field about whether MBIs delivered by app can increase smoking cessation in a geographically diverse sample.

Inducing and Recording Acute Stress Responses on a Large Scale With the Digital Stress Test (DST): Development and Evaluation Study

Background

Valuable insights into the pathophysiology and consequences of acute psychosocial stress have been gained using standardized stress induction experiments. However, most protocols are limited to laboratory settings, are labor-intensive, and cannot be scaled to larger cohorts or transferred to daily life scenarios.

Objective

We aimed to provide a scalable digital tool that enables the standardized induction and recording of acute stress responses in outside-the-laboratory settings without any experimenter contact.

Methods

On the basis of well-described stress protocols, we developed the Digital Stress Test (DST) and evaluated its feasibility and stress induction potential in a large web-based study. A total of 284 participants completed either the DST (n=103; 52/103, 50.5% women; mean age 31.34, SD 9.48 years) or an adapted control version (n=181; 96/181, 53% women; mean age 31.51, SD 11.18 years) with their smartphones via a web application. We compared their affective responses using the international Positive and Negative Affect Schedule Short Form before and after stress induction. In addition, we assessed the participants’ stress-related feelings indicated in visual analogue scales before, during, and after the procedure, and further analyzed the implemented stress-inducing elements. Finally, we compared the DST participants’ stress reactivity with the results obtained in a classic stress test paradigm using data previously collected in 4 independent Trier Social Stress Test studies including 122 participants overall.

Results

Participants in the DST manifested significantly higher perceived stress indexes than the Control-DST participants at all measurements after the baseline (P<.001). Furthermore, the effect size of the increase in DST participants’ negative affect (d=0.427) lay within the range of effect sizes for the increase in negative affect in the previously conducted Trier Social Stress Test experiments (0.281-1.015).

Conclusions

We present evidence that a digital stress paradigm administered by smartphone can be used for standardized stress induction and multimodal data collection on a large scale. Further development of the DST prototype and a subsequent validation study including physiological markers are outlined.

Stress and Emotional Intelligence Shape Giving Behavior: Are There Different Effects of Social, Cognitive, and Emotional Stress?

Acute stress has been linked with prosocial behavior, yet it is entirely unexplored how different types of stressors may affect individuals’ willingness to help: This is particularly relevant while people is experiencing multiple sources of stress due to the COVID-19 pandemic. Here we explore whether different types of stress influence peoples’ giving behavior and the moderating role of emotional intelligence (EI). Undergraduate students were exposed to experimentally induced social, cognitive, or emotional stress and were asked to self-report on their willingness to help and donate to a charity raising funds for COVID-19 and flu patients. Results showed that when compared to a control condition, after being exposed to a social stress, participants were more willing to help a person in need. Our results also provide evidence that, after experiencing a social stress, participants with high (vs low) trait EI were more willing to help, and, as a result, donated more. Findings indicate that moderate levels of distress are associated with increased donations. Interestingly, when stress is not too threatening, high EI can regulate it and promote prosocial behaviors.

Stress research during the COVID-19 pandemic and beyond

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

Induction of acute stress through an internet-delivered Trier Social Stress Test as assessed by photoplethysmography on a smartphone

Recent studies have demonstrated the feasibility of administering the Trier Social Stress Test (TSST) through the internet, with major implications for promoting inclusivity in research participation. However, online TSST studies to date are limited by a lack of control groups and the need for biological measures of stress reactivity that can be fully implemented online. Here, we test smartphone-based photoplethysmography as a measure of heart rate reactivity to an online variant of the TSST. Results demonstrate significant acceleration in heart rate and heightened self-reported stress and anxiety in the TSST condition relative to a placebo version of the TSST. The placebo condition led to a significant increase in self-reported stress and anxiety relative to baseline levels, but this increase was smaller in magnitude than that observed in the TSST condition. These findings highlight the potential for smartphone-based photoplethysmography in internet-delivered studies of cardiac reactivity and demonstrate that it is critical to utilize random assignment to a control or stressor condition when administering acute stress online.