Panel manipulation in social stress testing: The Bath Experimental Stress Test for Children (BEST-C)

'Every day I worry about something': A qualitative exploration of children's experiences of stress and coping

OBJECTIVES

Most research investigating children's experiences of stress and coping has utilized a quantitative approach. This study aimed to examine children's experiences of stress by conducting interviews with children and their parents.

DESIGN

Dyadic child-parent interviews, embedded within a multiphase design.

METHODS

Thirty-eight children (22 boys) aged 7-11 years and 38 parents (34 mothers) completed in-depth dyadic interviews about stressful life events, adversity, and coping, analysed using inductive thematic analysis with a phenomenological lens.

RESULTS

Four themes emerged: (1) navigating the social minefield; (2) pressure to thrive in the modern world; (3) fear of the unknown; and (4) learning life's lessons. The first suggested that social relationships are a major feature of children's stress experiences; however, social support was also found to be a beneficial coping mechanism. The second theme highlighted multiple sources of pressure on young children (including school, extracurricular activities, pressure from self and others); the impact of such pressure was dependent upon children's coping resources. The third theme emphasized the difficulty of coping with novel stressors, and how awareness can help reduce this fear. The final theme highlighted important lessons that children can learn from stressful experiences and how to cope with stress.

CONCLUSIONS

This study addresses the importance of the person and context-dependent nature of stress and coping in order for children to survive and thrive following stressful experiences. These findings contribute to existing knowledge that could be used to develop a toolkit for coping with stress, designed specifically for children, parents, schools, and services. Statement of contribution What is already known on this subject? Stress experienced in childhood can have a significant impact on psychological and physiological outcomes across the life course. It is known that individual differences are vital for understanding the effects of stress on health, for children as well as adults. Qualitative methods enable deeper understanding of children's experiences of stress and coping. What does the study add? Depth and breadth to understanding children's experiences of stressful events. An individual differences focus on the early stress experience that is frequently overlooked. Support for the use of a dyadic interview approach for assessing children's stress experiences.

Resilience characteristics and prior life stress determine anticipatory response to acute social stress in children aged 7-11 years

OBJECTIVES

To assess the interplay of prior life stress and characteristics of resilience in determining how children cope with potentially stressful situations, using a two-phase study that triangulates parent-child dyadic interview data with subsequent experience of an acute laboratory stressor in 7-11-year-olds.

METHODS

Participants (n = 34) were designated as being in one of four groups based on high/low levels of prior stress experience and high/low resilience ratings assessed during at-home interviews and from questionnaires measuring recent life events, hassles, and trait coping. During a subsequent laboratory stress protocol, salivary cortisol and heart rate were monitored, and a verbal subjective report was provided.

RESULTS

Salivary cortisol showed a significant increase in anticipation of the stress test, heart rate increased during the test, and children self-reported the task as stressful. Males displayed higher levels of cortisol than females in the anticipatory period. We observed no increase in salivary cortisol in response to the stress testing phase. Using the stress/resilience categorization, children with a higher level of resilience were differentiated by cortisol level in anticipation of the acute stress experiment based on their level of prior life stress. Highly resilient children with greater experience of prior life stress showed a lower anticipatory cortisol response than highly resilient children with less experience of prior life stress.

CONCLUSIONS

This study highlights the relevance of contextual factors, such as prior stress experience and resilience, in physiological response to the anticipation of acute stress and has implications for understanding how children cope with stressful experiences. Statement of contribution What is already known on this subject? An adaptation to the stress testing paradigm, the Bath Experimental Stress Test for Children (BEST-C) was found to reliably induce a salivary cortisol response in young children, suggesting that peer matching the audience was an effective modification to laboratory social stress testing. Recent work focusing on early life adversity has seen the emergence of prior stress experience and resilience as key factors in the examination of acute stress responses. However, much of the research regarding the impact of childhood stress is ambiguous; some research suggests that if children have experienced prior stressful life events this will enact a positive effect on stress responses and lead to resilience, and other research suggested that it will have a compounding negative effect. What does the study add? Findings provide support for the capacity of the BEST-C to induce an anticipation stress response in children. Contextual factors e.g., prior stress experience and resilience are key for understanding stress responses. Resilient children with more experience of stress show lower cortisol than those with less stress experience.

The Trier Social Stress Test: Principles and practice

Researchers interested in the neurobiology of the acute stress response in humans require a valid and reliable acute stressor that can be used under experimental conditions. The Trier Social Stress Test (TSST) provides such a testing platform. It induces stress by requiring participants to make an interview-style presentation, followed by a surprise mental arithmetic test, in front of an interview panel who do not provide feedback or encouragement. In this review, we outline the methodology of the TSST, and discuss key findings under conditions of health and stress-related disorder. The TSST has unveiled differences in males and females, as well as different age groups, in their neurobiological response to acute stress. The TSST has also deepened our understanding of how genotype may moderate the cognitive neurobiology of acute stress, and exciting new inroads have been made in understanding epigenetic contributions to the biological regulation of the acute stress response using the TSST. A number of innovative adaptations have been developed which allow for the TSST to be used in group settings, with children, in combination with brain imaging, and with virtual committees. Future applications may incorporate the emerging links between the gut microbiome and the stress response. Future research should also maximise use of behavioural data generated by the TSST. Alternative acute stress paradigms may have utility over the TSST in certain situations, such as those that require repeat testing. Nonetheless, we expect that the TSST remains the gold standard for examining the cognitive neurobiology of acute stress in humans.

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The TSST is the human experimental gold standard for evaluating the neurobiology of acute stress.

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The HPA axis response to the TSST is higher in males and lower in older adults.

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Genotype and epigenetic factors moderate the neurobiological response to the TSST.

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Multiple adaptations of the TSST are available for different testing contexts.