Meta-analysis of the effectiveness of the Trier Social Stress Test in eliciting physiological stress responses in children and adolescents

Identifying the most effective acute stress induction methods for producing SAM- and HPA-related physiological responses: a meta-analysis

BACKGROUND AND OBJECTIVES

Laboratory-based stress inductions are commonly used to elicit acute stress but vary widely in their procedures and effectiveness. We compared the effects of stress induction techniques on measures of two major biological stress systems: the early sympathetic-adrenal-medullary (SAM) and the delayed hypothalamic-pituitary-adrenal (HPA) axis response.

DESIGN

A review and meta-analysis to examine the relationship between stress induction techniques on cardiorespiratory and salivary measures of SAM and HPA system activity.

METHODS

A systematic literature search identified 245 reports and 700 effects.

RESULTS

The overall effect of stress induction techniques on the stress response was moderate (Fisher's zr = 0.44), inducing stronger SAM-related (zr = 0.48) versus HPA-related (zr = 0.37) responses. Three factors moderated these associations: the stress system examined (SAM vs HPA), the specific stress induction technique employed (e.g., Cold Pressor), the physiological sampling time relative to the stress induction, and participant sex. Loud music elicited the most robust SAM-related effects, whereas combined stress inductions elicited the most robust HPA-related effects. Men showed stronger stress responses than women.

CONCLUSIONS

Stress induction techniques variably elicit SAM - and HPA-related responses. Results recommend specific induction techniques for targeting stress systems, highlighting the importance of carefully selecting methodologies in laboratory contexts.

Dialectical behavior therapy in autistic adults: effects on ecological subjective and physiological measures of emotion dysregulation

BACKGROUND

Although Ecological Momentary Assessment (EMA) and physiological measurements provide a valuable opportunity to evaluate therapeutic interventions in real time, no study has used this approach to assess Dialectical Behavior Therapy (DBT) in autistic adults with high levels of emotion dysregulation (ED).

METHODS

In this study, 26 autistic adults were evaluated before and after participating in a standard 5-month DBT program, using Ecological Momentary Assessment (EMA). The EMA included: (1) twelve evaluations per day over a 7-day period, measuring alexithymia, emotional states, subjective arousal and emotion control; (2) continuous physiological monitoring with a wristband to record heart-rate (HR), heart-rate variability (HRV) and skin conductance levels (SCL).

RESULTS

Following DBT, no significant differences were found with respect to negative emotions and higher conflicting emotions, but increased rates of identified emotions, positive emotions and emotion control were found. Baseline autonomic responses remained unchanged, whereas subjective arousal was found to correlate positively with HRV. Overall, these results suggest that participants showed enhanced emotion awareness and emotion regulation capabilities following DBT.

CONCLUSION

Our study adds to previous research showing that DBT is efficient in treating ED in autistic adults, using real-time measurements of subjective and physiological markers collected through EMA. Specifically, alexithymia measures decreased post-DBT while positive emotions and emotion control increased. Randomized controlled trials should consider using these methods to improve the assessment of the impact of DBT in the daily life of autistic individuals with ED and/or suicidal behavior.

Experimental stress induction in children and adolescents with the Trier Social Stress Test (TSST): A systematic review and meta-analysis

The Trier Social Stress Test (TSST) and its variations for children and adolescents are among the most frequently used laboratory stressors. A previous meta-analysis revealed moderate but robust psychobiological stress responses in children and adolescents. Here, we focused on non-clinical samples and performed both a systematic review as well as a meta-analysis for the following: (a) to provide an overview of study characteristics in children and adolescents, (b) to update the overview of the reported effect sizes, and (c) to identify established and new potential moderators. Reviewing 143 studies, we identified three major variants in practical use: the TSST-C, the TSST-M, and the original TSST. Although the studies were inconsistent in reporting methodological characteristics, the variants did not differ in exclusion criteria, main procedures (administration and preparation time, duration), and composition of the panel. Based on the 92 studies (N = 8291 participants) included in the meta-analysis, we identified an overall publication bias-corrected effect on salivary cortisol stress responses of Hedge's g = 0.56, p < .0001. Moderation analysis revealed the proportion of girls, number of judges, and total duration of the stress test as significant moderators, all positive. Explorative analysis showed that higher baseline cortisol levels predicted lower baseline-peak reactivity. Overall, variations of the TSST for children and adolescents are suitable for inducing acute psychobiological stress responses in these samples. To promote open and reproducible (meta) science, raising the reporting standards for methods and results in future studies is desirable.

Social stress task with parental support or self-instruction decreases negative cognitions in children with social anxiety disorder

Social anxiety disorder (SAD) is highly prevalent in childhood, yet research on cognitive processes in children with SAD is limited. This study examined anticipatory rumination (AR), self-focused attention (SFA), and post-event processing (PEP) in children with SAD and healthy controls (HC), and the impact of possible influencing factors (two conditions: parental support, self-instruction). Based on adult cognitive models, we hypothesized that children with SAD would report more negative and similar positive AR, more internal SFA, similar external focus, more negative and similar positive PEP compared to HCs. We predicted that both conditions would reduce negative AR, internal SFA, and negative PEP, with stronger effects in HCs. Participants (ages 9-14; SAD: n = 43, HC: n = 48) completed two speech tasks (T1, T2) in front of a peer audience. Children with SAD reported more negative AR, internal SFA, and negative PEP than HCs in both sessions. All children reported more negative AR, internal SFA, and negative PEP in T1 than T2. Surprisingly, these effects were equally strong in both groups. Condition effects were comparable across groups, with reduced negative cognitive processes in T2. These findings highlight cognitive biases in childhood SAD and the need for further research on their modifiability.

Empathic stress in the family: Does diurnal cortisol covariation between adolescents and their parents influence adolescent empathic stress in the laboratory?

Empathic stress is the reproduction of psychological and physiological stress activation in an observer of a directly stressed target individual. It likely allows us to allocate the energy necessary to jointly alleviate a stressor at hand. The tendency to show such an empathic or "second-hand" stress response depends on the relationship between target and observer. Here, we investigated whether adolescents' empathic stress responses to their parents' acute stress experience were associated with the diurnal cortisol covariation the parent-adolescent dyad shared in everyday life. Fathers and mothers (N = 77) were confronted with a standardized laboratory stressor, the Trier Social Stress Test, while their adolescent children (13-16 years old) were watching. In the laboratory, parents and their adolescent children simultaneously provided multiple samples of salivary cortisol. On the weekend following the testing session, dyads provided diurnal cortisol samples over two days. These were used to gain a measure of the dyads' adrenocortical physiological attunement in everyday life. We found that the degree to which dyads covaried in their diurnal cortisol activity significantly increased adolescents' tendency for empathic stress responding in the laboratory. The amount of time that dyads spent together over the weekend, adolescents' attachment experiences, dyad type (father-daughter, mother-daughter, father-son, mother-son), and adolescents' puberty status did not significantly alter this relationship. Adolescent attachment avoidance, however, was negatively correlated with both adolescents' cortisol stress reactivity in the laboratory and the degree to which they covaried with their parents' diurnal cortisol release. We conclude that diurnal cortisol covariation between parents and adolescents is positively associated with stress resonance in the laboratory.

Is respiratory sinus arrhythmia a modifiable index of symptom change in cognitive behavioral therapy for youth? A pooled-data analysis of a randomized trial

OBJECTIVE

We evaluated whether respiratory sinus arrhythmia (RSA) reactivity and resting RSA-physiological markers reflecting the increase in heart rate with inspiration and decrease during expiration related to parasympathetic influence on the heart-are modifiable and predict symptom change during youth psychotherapy. Methods: Diverse youth (N = 158; ages 7-15; 48.1% female) received the Modular Approach to Therapy for Children and completed pre-treatment (pre), post-treatment (post), and 18-months postbaseline (18Mo) assessments. We measured resting RSA, RSA reactivity during stress induction, and psychopathology symptoms. Results: Pre-to-post and pre-to-18Mo, reactivity decreased, and resting RSA increased. Changes in reactivity and resting RSA, separately, did not predict reduced psychopathology. Yet, decreased reactivity combined with increased resting RSA predicted reduced psychopathology over time, suggesting that observed RSA changes were beneficial for some. Higher dosage of a module utilizing slow-breathing, muscle-relaxation, and imagery predicted greater pre-to-18Mo changes in reactivity and resting RSA, whereas a similar module with less emphasis on slow-breathing did not. Conclusions: Findings raise the possibility that youth reactivity and resting RSA could be modifiable during cognitive behavioral therapy and contribute to the amelioration of psychopathology. More studies are needed to determine whether resting RSA and RSA reactivity are modifiable indices of symptom change in slow-breathing practices and psychotherapy.

CLINICALTRIALS.GOV IDENTIFIER

NCT03153904, registered May 15, 2017.

Exposure to diesel-related particulate matter, cortisol stress responsivity, and depressive symptoms in adolescents

Exposure to air pollution is associated with higher risk for psychopathology; however, the mechanisms underlying this association are not clear. Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis in response to stress has been implicated in depression. Here, we estimated annual exposure to particulate matter (PM) from diesel emissions in 170 9- to 15-year-old adolescents (56 % female) using their residential addresses and data from nearby monitoring sites. We obtained salivary cortisol samples from participants while they completed a social stress task and calculated area under the curve with respect to ground (AUCg) and with respect to increase (AUCi) in order to assess cortisol responsivity during stress. Participants also reported on their depressive symptoms and sleep disturbances. Greater exposure to diesel PM was associated with lower cortisol output (AUCg) during stress, which was associated with higher depressive symptoms, particularly for adolescents with more sleep disturbances. Importantly, these effects were independent of household and neighborhood socioeconomic disadvantage and exposure to early adversity. Thus, HPA-axis dysfunction may be one mechanism through which environmental pollutants affect adolescents' mental health.

Measuring empathic stress - A systematic review of methodology and practical considerations for future research

Aside from stressors that each of us experience directly, we also share the stress of the people around us. Such empathic stress exists on psychological and physiological levels, including subjective, sympathetic, parasympathetic and endocrine activation. The objective of this review is to offer an overview of methodology over the past fifteen years of empathic stress research and derive practical considerations for future research endeavors in the field. We used a keyword search strategy in the databases Web of Science, PsycInfo and PubMed to find empathic stress studies published until December 2023, and included 17 studies into our review. The reviewed laboratory studies provide initial yet consistent evidence for the existence of empathic stress across different populations, in intimate and stranger dyads, with direct and virtual contact, across multiple levels of the stress system, and based on diverse statistical analysis methods. We discuss all findings and derive practical considerations for future empathic stress research. The diversity of methods established provides a solid foundation upon which future studies can expand.

Stress reactivity moderates the association between early experiences of unpredictability and emotional problems in adolescents

Researchers have documented that exposure to different kinds of psychosocial stressors can lead to emotional difficulties and, further, that heightened reactivity to stress can moderate these associations. Recently, investigators have distinguished among threat, deprivation, and unpredictability as different dimensions of early life stress (ELS). It is not clear, however, whether reactivity in specific stress response systems functions as a diathesis to lead to emotional difficulties following exposure to these dimensions of ELS. In this study (N = 154) we examined whether stress reactivity, assessed across different psychobiological systems during the Trier Social Stress Test, is a unitary or multidimensional construct, and if reactivity differentially moderates the associations between ELS dimensions and adolescents' susceptibility to emotional and behavioral problems two years later. A factor analysis conducted on stress reactivity measures yielded two factors: one composed of reactivity in heart rate, heart rate variability, and cortisol, and one composed of reactivity in skin conductance and self-reported mood. These two factors independently moderated the associations between early unpredictability and subsequent emotional problems. For each factor, the combination of higher unpredictability and higher stress reactivity predicted higher emotional problems; stress reactivity factors were not significant moderators of the effects of threat and deprivation. Our findings suggest that increased stress reactivity, assessed across several domains of functioning, functions as a diathesis that interacts with ELS characterized by unpredictability to predict subsequent mental health difficulties in adolescents and, further, that low stress reactivity buffers against mental health difficulties in adolescents who have experienced unpredictability early in life.

Reward processing in young people with self-harm behaviour

Twenty percent of young people report a lifetime presence of self-harm (SH) behaviour, associated with negative health and functional outcomes. Understanding the underlying cognitive mechanisms is needed to develop targeted early interventions. Reward processing biases may underlie SH, aligning with accounts of the behaviour acquiring "addictive" characteristics. However, the specific nature of such biases remains unclear, particularly its relationship with negative affect (NA) that frequently triggers SH. In Study 1, we compared young people (aged 16-25) with SH to a group with NA but no SH history and a healthy control group on performance of a novel Incentive Delay Task (IDT), with SH-related (SH trials), positive social (social trials) or monetary images (money trials) as stimuli. In Study 2, a different sample of SH and HC participants completed the same IDT following NA induction via an online Trier Social Stress Test. For both studies, we hypothesised faster and more correct responses in the SH group than control groups on SH trials. Contradicting our hypothesis, there were no significant between-group differences in IDT performance on SH, social and money trials in either study. Certain SH characteristics (positive reinforcement, SH mental imagery, urge) were significantly correlated with better performance on SH trials in SH participants. Thus, broadly SH behaviour may not be underpinned by motivational biases towards SH-related cues or naturalistic rewards. Future studies should clarify whether incentivisation of SH-related cues instead explains individual differences in SH behaviour and its relation with treatment and prognosis.

Adolescents' Hormonal Responses to Social Stress and Associations with Adolescent Social Anxiety and Maternal Comfort: A Preliminary Study

Both social support and social stress can impact adolescent physiology including hormonal responses during the sensitive transition to adolescence. Social support from parents continues to play an important role in socioemotional development during adolescence. Sources of social support and stress may be particularly impactful for adolescents with social anxiety symptoms. The goal of the current study was to examine whether adolescent social anxiety symptoms and maternal comfort moderated adolescents' hormonal response to social stress and support. We evaluated 47 emotionally healthy 11- to 14-year-old adolescents' cortisol and oxytocin reactivity to social stress and support using a modified version of the Trier Social Stress Test for Adolescents that included a maternal comfort paradigm. Findings demonstrated that adolescents showed significant increases in cortisol and significant decreases in oxytocin following the social stress task. Subsequently, we found that adolescents showed significant decreases in cortisol and increases in oxytocin following the maternal comfort paradigm. Adolescents with greater social anxiety symptoms showed higher levels of cortisol at baseline but greater declines in cortisol response following maternal social support. Social anxiety symptoms were unrelated to oxytocin response to social stress or support. Our findings provide further evidence that mothers play a key role in adolescent regulation of physiological response, particularly if the stressor is consistent with adolescents' anxiety. More specifically, our findings suggest that adolescents with higher social anxiety symptoms show greater sensitivity to maternal social support following social stressors. Encouraging parents to continue to serve as a supportive presence during adolescent distress may be helpful for promoting stress recovery during the vulnerable transition to adolescence.

Virtual Reality Exposure Therapy for Reducing School Anxiety in Adolescents: Pilot Study

BACKGROUND

Virtual reality exposure therapy (VRET) is a promising treatment approach for anxiety disorders. However, while its efficacy has been demonstrated in adults, research on the efficacy of VRET in the treatment of adolescents with anxiety disorders is largely lacking.

OBJECTIVE

A pilot study was carried out to test whether exposure to a virtual reality (VR) school environment elicits state anxiety and autonomic arousal in adolescents with school anxiety (diagnoses covering social anxiety disorder or specific phobia involving school contexts). In addition, we examined whether repeated VR exposure led to a reduction in this fear response, trait school anxiety, and social anxiety symptoms. Moreover, the relationship of presence, the subjective sense of "being there," during VR exposure with anxiety measures and treatment response was examined.

METHODS

In a pilot study, 10 adolescents with school anxiety (age range 14 to 17 years) participated in five VRET sessions. Self-reported state anxiety, heart rate, and presence during exposure, as well as trait school anxiety and social anxiety before and after treatment, were measured.

RESULTS

The VR scenario induced state anxiety and autonomic arousal. After VRET, a significant reduction in state anxiety (η2=0.74) and social anxiety symptoms (d=0.82) as well as a trend toward a decrease in trait school anxiety were observed, while autonomic arousal did not change. In addition, presence during VR exposure was associated with state anxiety and treatment response.

CONCLUSIONS

Our findings indicate the feasibility and potential effectiveness of VRET as a treatment method for symptoms of school and social anxiety in adolescents.

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.

Childhood Maltreatment and Electrodermal Reactivity to Stress Among Pregnant Women

There are competing theoretical hypotheses regarding the consequences of early adversity, such as childhood maltreatment, for individuals' autonomic nervous system activity. Research examining potential implications of child maltreatment for sympathetic nervous system activity, specifically, is scarce. In this preregistered study, we examined whether childhood maltreatment history is associated with pregnant adults' sympathetic responses to different stressors. This population is particularly relevant, given potential intergenerational consequences of pregnant individuals' physiological responses to stress. Pregnant women's (N = 162) electrodermal levels were recorded while completing the Trier Social Stress Test (TSST), which elicits social-evaluative threat, and while watching a video of an unfamiliar infant crying, which was intended to activate the attachment system. Pregnant women's retrospective reports of childhood maltreatment were negatively associated with their electrodermal reactivity to the TSST and to the video of the infant crying. Follow-up analyses indicated that these associations were specific to reported experiences of childhood abuse and not childhood neglect. Altogether, these findings indicate that self-reported childhood maltreatment experiences, and childhood abuse in particular, may result in blunted activity of the sympathetic nervous system in response to multiple types of stressors.

Virtual stressors with real impact: what virtual reality-based biobehavioral research can teach us about typical and atypical stress responsivity

Stress contributes to transdiagnostic morbidity and mortality across a wide range of physical and mental health problems. VR tasks have been validated as stressors with robust effect sizes for VR-based stressors to evoke stress across the most common autonomic and adrenocortical stress biomarkers. However, meta-analytic validation of VR stressors have resulted in inconsistent logic: why should something that isn't real evoke a very real suite of stress responses? This review posits that conceptually addressing this question requires differentiating a cause, "stressor", from effects, "stress". Stress comprises a series of well-delineated perturbations in biological systems, such as autonomic and adrenocortical biomarkers in response to stressors. Despite their ubiquity, decades of literature have back-calculated stressor intensity based on the magnitude of a stress response. This causal directionality is not logical, yet remains pervasive because seemingly objective stress indices have generated a wealth of findings showing how stress gets under the skin and skull. This has created challenges for providing clear guidance and strategies to measure acute stressor intensity. Binary thinking about whether something is (not) real has stifled advances in understanding how to measure the dosage of a stressful environment. As a function of being programmed, individualizable, and titrated, virtual reality (VR) based stressors offer the field a platform for quantifying the dose of a stressor and generating reliable dose-response curves. This also raises the possibility to safely and ethically integrate psychosocial stressor administration into clinical and therapeutic settings. For example, Social Evaluative Threat experiments effectively trigger a stress response both in a laboratory setting and in built environments, while also upholding hard-fought trust and rapport with care providers. By focusing attention on the measurement of the stressor, VR paradigms can advance tangible understanding of stressors themselves and the pathways to the stress response.

Cognitive Training Prevents Stress-Induced Working Memory Deficits

BACKGROUND

Working memory is a fundamental cognitive process that is critically involved in planning, comprehension, reasoning, and problem solving. Acute stress has been shown to impair working memory. This stress-induced working memory deficit has profound implications for cognitive functioning in everyday life as well as for stress-related mental disorders. Here, we tested whether a cognitive training intervention would make working memory more resistant to disruptive effects of acute stress.

METHODS

In a preregistered, fully crossed between-subjects design with the factors stress (vs. control) and cognitive training (vs. sham), 123 healthy men and women (ages 18-35 years) completed a daily cognitive training program targeting working memory-related processes or a sham training over a period of 6 weeks. After this 6-week training intervention, participants underwent a standardized stress or control manipulation shortly before their working memory performance was tested.

RESULTS

As expected, the exposure to acute stress led to a significant working memory impairment in the sham training group. Critically, although the subjective, autonomic, and endocrine stress responses were comparable in the 2 training groups, this stress-induced working memory impairment was abolished in the intervention training group.

CONCLUSIONS

These results are the first to show that a cognitive training intervention directed at prefrontal and hippocampal functioning can prevent the detrimental effects of stressful events on working memory performance.

Prefrontal cortex activation under stress as a function of borderline personality disorder in female adolescents engaging in non-suicidal self-injury

BACKGROUND

Neuroimaging studies suggest alterations in prefrontal cortex (PFC) activity in healthy adults under stress. Adolescents with non-suicidal self-injury (NSSI) report difficulties in stress and emotion regulation, which may be dependent on their level of borderline personality disorder (BPD).

AIMS

The aim was to examine alterations in the PFC in adolescents with NSSI during stress.

METHOD

Adolescents (13-17 years) engaging in non-suicidal self-injury (n = 30) and matched healthy controls (n = 29) performed a task with low cognitive demand and the Trier Social Stress Test (TSST). Mean PFC oxygenation across the PFC was measured with an eight-channel near-infrared spectroscopy system. Alongside self-reports on affect, dissociation and stress, BPD pathology was assessed via clinical interviews.

RESULTS

Mixed linear-effect models revealed a significant effect of time on PFC oxygenation and a significant time×group interaction, indicating increased PFC activity in patients engaging in NSSI at the beginning of the TSST compared with healthy controls. Greater BPD symptoms overall were associated with an increase in PFC oxygenation during stress. In exploratory analyses, mixed models addressing changes in PFC connectivity over time as a function of BPD symptoms were significant only for the left PFC.

CONCLUSIONS

Results indicate differences in the neural stress response in adolescents with NSSI in line with classic neuroimaging findings in adults with BPD. The link between PFC oxygenation and measures of BPD symptoms emphasises the need to further investigate adolescent risk-taking and self-harm across the spectrum of BPD, and maybe overall personality pathology, and could aid in the development of tailored therapeutic interventions.

Immune and neural response to acute social stress in adolescent humans and rodents

Studies in adults have linked stress-related activation of the immune system to the manifestation of psychiatric conditions. Using a translational design, this study aimed to examine the impact of social stress on immune activity in adolescents and on neuronal activity in a preclinical mouse model. Participants were 31 adolescents (ages 12-19), including 25 with mood and anxiety symptoms. Whole-blood samples were collected before and after the Trier Social Stress Test (TSST), a stress-inducing public speaking task, then cultured for 6 hours in the presence and absence of the inflammatory endotoxin lipopolysaccharide (LPS). Effects of TSST and LPS on 41 immune biomarkers were examined using repeated-measures analysis of variance. Separately, juvenile (8-week-old) male mice were non-stressed or exposed to reminder social defeat then intraperitoneally injected with saline or LPS (n = 6/group). Brains were perfused and collected for immunohistochemistry and confocal microscopy at 0, 1, 6, and 24 hours post-injection. The activity was determined by the density of cFos-positive neurons in the paraventricular hypothalamus, paraventricular thalamus, and basolateral amygdala, regions known to show sustained activation to immunological challenge. Analyses in the adolescent study indicated a strong effect of LPS but no effects of TSST or TSST×LPS interaction on immune biomarkers. Similarly, reminder social defeat did not induce sustained neuronal activity changes comparable to LPS immunological challenge in juvenile mice. Our convergent findings across species suggest that the acute immune response to stress documented in adults is not present in youth. Thus, aging and chronicity effects may play an important role in the inflammatory response to acute psychosocial stress.

The role of self-reported and physiological stress in nocebo hyperalgesia

Negative expectations can increase pain sensitivity, leading to nocebo hyperalgesia. However, the physiological and psychological factors that predispose individuals to this phenomenon are still not well understood. The present study examined whether stress induced by a social stressor affects nocebo hyperalgesia, and whether this effect is mediated by self-reported and physiological stress responses. We recruited 52 healthy participants (15 men) who were randomly assigned to either the Trier Social Stress Test (TSST) or a control condition (a friendly version of the TSST). Nocebo hyperalgesia was induced using negative suggestions combined with a validated pain conditioning paradigm. We assessed self-reported (anxiety and stress) and physiological (cortisol, alpha-amylase, heart rate, and skin conductance) responses to stress. Both groups exhibited significant nocebo hyperalgesia. The stress group showed higher levels of anxiety, self-reported stress, and cortisol levels compared to the control group while no significant differences were found in other physiological markers. The stress and control groups did not differ in the magnitude of nocebo hyperalgesia, but anxiety levels partially mediated the effects of the stress test on nocebo hyperalgesia. Our findings suggest that an external social stressor does not directly affect nocebo hyperalgesia, but that increased anxiety due to the stressor enhances its magnitude. Thus, it may be worthwhile to investigate whether reducing stress-related anxiety in clinical settings would help alleviate nocebo effects.

Changes in the choice motive and emotional perception of chocolates in response to stress

Although chocolates are often chosen for sensory pleasure, they are also selected to enhance mood and relieve emotional stress, or potentially chosen for its perceived health benefits if stress adversely affects physical well-being. This study aimed to investigate whether emotional stress influenced the motivations behind chocolate selection, subsequent liking, and emotional response. Participants were divided into a control group (n = 76) and a group with induced acute stress (n = 74). Stimuli were presented as dark chocolate packaging, each evoking sensory appeal, health, and emotional stress relief. Participants chose one stimulus from three options that they were most inclined to consume and evaluated the overall liking and emotional attributes of the stimuli. They also rated the overall liking and emotional attributes of three types of chocolates, each identical but paired with distinct stimuli. Their food attitudes were also assessed. Stress did not change the choice of stimuli, indicating that stress did not influence the motivation for chocolate selection. Instead, the choice of stimuli aligned with participants' food attitudes; those favoring sensory appeal and emotional stress relief prioritized pleasure in their usual food choices. Stress tended to increase liking and chocolate-associated positive emotions with sensory appeal, as opposed to others, to immediately alleviate negative emotions. The most robust motivation to consume chocolates was sensory pleasure, irrespective of stress, because of a preestablished association between sensory pleasure and mood enhancement.

Is autonomic functioning distinctly associated with anxiety and unsociability in preschoolers?

There are many benefits of peer interactions for children's social, emotional, and cognitive development, and isolation from peers may have negative consequences for children. Although biological processes may underlie social withdrawal broadly, distinct patterns may be associated with withdrawal behaviors depending on their underlying motivation (e.g., shy versus disinterested). This study investigated the role of autonomic nervous system activity, as assessed via skin conductance level (SCL) and respiratory sinus arrhythmia (RSA) in predicting changes in unsociability (e.g., lack of interest in peers) and anxious-fearfulness (e.g., discomfort among peers). Data were collected using a community sample of 92 US preschool children (45.7% female; Mage = 45.51 months, SDage = 3.81 months) at two time points one year apart. Gender differences were also explored. Baseline physiology was assessed while viewing a neutral video clip, and reactivity was assessed while viewing social exclusion and post-aggression discussion videos. For all children, coinhibition (i.e., SCL inhibition accompanied by RSA inhibition) to the post-aggression discussion video and blunted SCL activation to the exclusion video were prospectively associated with higher levels of anxious-fearfulness one year later. For boys only, baseline reciprocal sympathetic activation (i.e., SCL activation and RSA inhibition) was prospectively related to higher levels of unsociability one year later. For girls only, RSA inhibition in response to the post-aggression discussion video was prospectively related to higher levels of unsociability one year later. Findings contribute to a growing literature on autonomic reactivity in preschoolers' adjustment and suggest possible differences in the physiological processes underlying unsociability and anxious-fearfulness.

Whole unstimulated salivary flow rate decreases during acute stressful condition

OBJECTIVE

To examine the influence of acute stress on salivary flow using a validated stressor paradigm.

STUDY DESIGN

This uniform crossover study consisted of 40 healthy adults who underwent the Trier Social Stress Test, consisting of a 5-minute mental arithmetic task (MAT), and a nonstressful task (NST), consisting of a 5-minute free speech task. The order of the tasks was counterbalanced and unstimulated whole saliva (UWS) was measured in 2 groups of 20 participants during each 5-minute task condition, with a 10-minute washout period between tasks. At baseline, mathematical ability was self-reported and psychological distress was measured using the Symptom Checklist-90-Revised. Heart rate (HR) and breathing rate (BR) were recorded during each task.

RESULTS

Age, sex, HR, BR, and psychological distress were similar between groups at baseline (P > .05). During the MAT, HR increased significantly and mean UWS flow rate decreased significantly compared with the NST (P < .001).

CONCLUSIONS

An acute psychobiological stressor task was associated with a rapid decrease in salivary flow in adults. Thus, stress can contribute to reduced salivary flow and should be considered as a factor during the diagnostic workup of patients who complain of a dry mouth.

Mindfulness-based intervention for depression and insulin resistance in adolescents: Protocol for BREATHE, a multisite, pilot and feasibility randomized controlled trial

BACKGROUND

Elevated depression symptoms have been associated with higher insulin resistance in adolescents, and consequently, greater risk for type 2 diabetes (T2D). Mindfulness-based intervention (MBI) may be suited for adolescents at risk for T2D given its potential to decrease depression and improve stress-related behavior/physiology underpinning insulin resistance. To prepare for a future multisite efficacy randomized controlled trial, a rigorous, multisite, pilot and feasibility study is needed to test this approach. The current paper describes the design and protocol for a multisite, pilot and feasibility randomized controlled trial of six-week MBI, cognitive-behavioral therapy (CBT), and health education (HealthEd) group interventions, to assess multisite fidelity, feasibility, and acceptability.

METHODS

Participants are N = 120 adolescents ages 12-17, with body mass index (BMI) ≥85th percentile, elevated depression symptoms (20-item Center for Epidemiologic Studies-Depression Scale total score > 20), and family history of diabetes. Enrollment occurs across four United States (US) sites, two in Colorado, one in Washington, D·C., and one in Maryland. Group interventions are delivered virtually by trained psychologists and co-facilitators. Assessments occur at baseline, six-week follow-up, and one-year follow-up.

RESULTS

Primary outcomes are intervention implementation fidelity, based upon expert ratings of audio-recorded sessions (≥80% adherence/competence), and recruitment feasibility, based upon percentage enrollment of eligible youth (≥80%). Secondary outcomes are intervention training fidelity/feasibility/acceptability, recruitment timeframe, and retention/assessment feasibility.

CONCLUSION

Findings will inform optimization of training, recruitment, intervention delivery, retention, and assessment protocols for a multisite, efficacy randomized controlled trial evaluating MBI for decreasing depression and improving insulin resistance in adolescents at risk for developing T2D.

Associations of diurnal cortisol parameters with cortisol stress reactivity and recovery: A systematic review and meta-analysis

Researchers commonly assess the functioning of the hypothalamic-pituitary-adrenal (HPA) axis by measuring natural fluctuations of its end product cortisol throughout the day or in response to a standardized stressor. Although it is conceivable that an individual releasing relatively more cortisol when confronted with a laboratory stressor does the same in everyday life, inconsistencies remain in the literature regarding associations between diurnal cortisol parameters and cortisol stress responses. Hence, the current meta-analysis aggregated findings of 12 studies to examine overall associations of diurnal cortisol parameters (including total output, diurnal slope, and cortisol awakening response [CAR]) with cortisol stress reactivity and recovery in the Trier Social Stress Test (TSST). There were no significant overall associations of total output, slope, or CAR with stress reactivity. Lower total diurnal cortisol output was significantly related to better stress recovery, whereas diurnal slope and CAR were unrelated to stress recovery. Moderation analyses revealed that associations between diurnal cortisol and cortisol stress responses were dependent on the computation method of cortisol parameters, questioning the convergence and validity of commonly employed measures of stress reactivity and recovery. Overall, it seems that we cannot predict characteristics of the diurnal cortisol rhythm from a one-time measure of stress reactivity in a standardized psychosocial laboratory paradigm.

Examining the psychobiological response to acute social stress across clinical stages and symptom trajectories in the early psychosis continuum

The stress-vulnerability model has been repeatedly highlighted in relation to the risk, onset and course of psychosis, and has been independently studied in clinical high-risk (CHR) and first-episode psychosis (FEP) populations. Notable in this literature, however, is that there are few studies directly comparing markers of stress response across progressive stages of illness. Here we examined the psychobiological response to the Trier Social Stress Test in 28 CHR (mean age 19.1) and 61 FEP (age 23.0) patients, in order to understand the stage(s) or trajectories in which differences in subjective stress or physiological response occur. The overall clinical sample had greater perceived stress and blunted cortisol (FEP + CHR, n = 89, age 21.7) compared with healthy controls (n = 45, age 22.9). Additional analyses demonstrated elevated heart rate and systolic blood pressure in FEP compared with CHR, but there were no further differences in physiological parameters (cortisol, heart rate, or blood pressure) between stage- or trajectory-based groups. Together, this suggests that individual stress response markers may differentially emerge at particular stages en route to psychosis - and demonstrates how stage-based analyses can shed light on the emergence and evolution of neurobiological changes in mental illness.

C. Social Context in Stress and Autism: Comparing Physiological Profiles Across Two Social Paradigms in Youth with and without Autism Spectrum Disorder

Background

The social world is often stressful for individuals with autism spectrum disorder (ASD). Research shows youth with ASD demonstrate physiological hyperreactivity to some social stressors (e.g., interaction) but not others (e.g., evaluation); therefore, this study examined diagnosis (ASD or typical development (TD)), social context, perceived anxiety, and physiological responsivity across multiple stress systems; namely, the hypothalamic pituitary adrenal (HPA) axis and autonomic nervous system (ANS).

Method

This study examined 244 ten-to-thirteen-year-olds with ASD (N = 140) or TD (N = 104). Physiological responses, measured by salivary cortisol, heart rate (HR), and respiratory sinus arrhythmia (RSA), were assessed before and after a social evaluative threat paradigm (Trier Social Stress Test; TSST) and social interaction (Trier Social Stress Test- Friendly; TSST-F). Mediation models examined the relationships between anxiety, diagnosis, and physiology.

Results

Significant three-way interactions were observed for cortisol (p=0.007) and HR (p=0.002), suggesting diagnostic groups respond differently across context and time points. There was no significant interaction for RSA (p=0.149), although ASD youth had significantly lower RSA overall (p=0.038). State and trait anxiety did not mediate the relationship between diagnosis and physiology (all p>0.05).

Conclusions

Findings emphasize the critical role of context and a multisystem approach in examination of physiological social stress in youth with ASD. Results provide a foundation to elucidate unique response patterns across physiological systems to more precisely identify those with heightened physiological arousal across social contexts. It is proposed that future identification of subtypes may ultimately inform approaches for enhancing social engagement.

Associations between emotion reactivity to daily interpersonal stress and acute social-evaluative stress during late adolescence

Emotion reactivity refers to the intensity of changes in positive and negative emotion following a stimulus, typically studied with respect to daily stressors (e.g., arguments, demands) or laboratory stressors, including the Trier Social Stress Test (TSST). Yet, it is unclear whether emotion reactivity to daily and to laboratory stressors are related. The present study examined whether greater emotion reactivity to daily stressors (i.e., arguments, demands) is associated with greater reactivity to the TSST. Late adolescents (N = 82; Mage = 18.35, SD = 0.51, range 17-19; 56.1% female; 65.9% Latine, 34.2% European American) reported whether they experienced arguments and demands with friends, family, and individuals at school and their negative and positive emotion nightly for 15 days. They also completed the TSST, a validated paradigm for eliciting social-evaluative threat, and reported their emotion at baseline and immediately post-TSST. Multilevel models examined whether daily and laboratory emotion reactivity were related by testing whether the daily associations between arguments and demands with emotion differed by emotion reactivity to the TSST. Individuals with greater positive emotion reactivity (i.e., greater reductions in positive emotion) and greater negative emotion reactivity to the TSST showed greater positive emotion reactivity to daily demands. Emotion reactivity to the TSST was not significantly related to emotion reactivity to arguments. Findings provide preliminary evidence that emotion reactivity to the TSST relates to some aspects of daily emotion reactivity, with relations differing depending on type of daily stressor and valence of emotion. Results contextualise the implications of emotion reactivity to the TSST for daily stress processes.

Novel Assessment of the Impact of Irritability on Physiological and Psychological Frustration Responses in Adolescents

OBJECTIVE

Irritability, typically defined as a proneness to anger, particularly in response to frustration, falls at the intersection of emotion and disruptive behavior. Despite well-defined translational models, there are few convergent findings regarding the pathophysiology of irritability. Most studies utilize computer-based tasks to examine neural responses to frustration, with little work examining stress-related responding to frustration in social contexts. The present study is the first to utilize the novel Frustration Social Stressor for Adolescents (FSS-A) to examine associations between adolescent irritability and psychological and physiological responses to frustration.

METHOD

The FSS-A was completed by a predominantly male, racially, ethnically, and socioeconomically diverse sample of 64 12- to 17-year-olds, who were originally recruited as children with varying levels of irritability. Current irritability was assessed using the Multidimensional Assessment Profiles-Temper Loss scale (MAP-TL-Youth). Adolescents rated state anger and anxiety before and after the FSS-A, and usable salivary cortisol data were collected from 43 participants.

RESULTS

Higher MAP-TL-Youth scores were associated with greater increases in anger during the FSS-A, but not increases in anxiety, or alterations in cortisol. Pre-task state anger negatively predicted the slope of the rise in cortisol observed in anticipation of the FSS-A.

CONCLUSIONS

Results provide support for unique associations between adolescent irritability and anger during, and in anticipation of, frustrating social interactions. Such findings lay a foundation for future work aimed at informing physiological models and intervention targets.

Immune and Neural Response to Acute Social Stress in Adolescent Humans and Rodents

Studies in adults have linked stress-related activation of the immune system to the manifestation of psychiatric conditions. Using a translational design, this study aimed to examine the impact of social stress on immune activity in adolescents and on neuronal activity in a preclinical mouse model. Participants were 31 adolescents (ages 12-19), including 25 with mood and anxiety symptoms. Whole-blood samples were collected before and after the Trier Social Stress Test (TSST), a stress-inducing public speaking task, then cultured for 6 hours in the presence and absence of the inflammatory endotoxin lipopolysaccharide (LPS). Effects of TSST and LPS on 41 immune biomarkers were examined using repeated-measures analysis of variance. Separately, juvenile (8-week-old) male mice were non-stressed or exposed to reminder social defeat then intraperitoneally injected with saline or LPS (n = 6/group). Brains were perfused and collected for immunohistochemistry and confocal microscopy at 0, 1, 6, and 24 hours post-injection. Activity was determined by the density of cFos-positive neurons in the paraventricular hypothalamus, paraventricular thalamus, and basolateral amygdala, regions known to show sustained activation to immunological challenge. Analyses in the adolescent study indicated a strong effect of LPS but no effects of TSST or TSST×LPS interaction on immune biomarkers. Similarly, reminder social defeat did not induce sustained neuronal activity changes comparable to LPS immunological challenge in juvenile mice. Our convergent findings across species suggest that the acute immune response to stress documented in adults is not present in youth. Thus, aging and chronicity effects may play an important role in the inflammatory response to acute psychosocial stress.

Oxytocin and state attachment responses to secure base support after stress in middle childhood

We tried to replicate the finding that receiving care increases children's oxytocin and secure state attachment levels, and tested whether secure trait attachment moderates the oxytocin and state attachment response to care. 109 children (9-11 years old; M = 9.59; SD = 0.63; 34.9% boys) participated in a within-subject experiment. After stress induction (Trier Social Stress Test), children first remained alone and then received maternal secure base support. Salivary oxytocin was measured eight times. Secure trait and state attachment were measured with questionnaires, and Secure Base Script knowledge was assessed. Oxytocin levels increased after receiving secure base support from mother after having been alone. Secure state attachment changed less. Trait attachment and Secure Base Script knowledge did not moderate oxytocin or state attachment responses to support. This might mean that, regardless of the attachment history, in-the-moment positive attachment experiences might have a beneficial effect on trait attachment development in middle childhood.

Susceptibility to peer influence in adolescents: Associations between psychophysiology and behavior

The current study investigated in-the-moment links between adolescents' autonomic nervous system activity and susceptibility to three types of peer influence (indirect, direct, continuing) on two types of behavior (antisocial, prosocial). The sample included 144 racially ethnically diverse adolescents (46% male, 53% female, 1% other; M age  = 16.02 years). We assessed susceptibility to peer influence behaviorally using the Public Goods Game (PGG) while measuring adolescents' mean heart rate (MHR) and pre-ejection period (PEP). Three key findings emerged from bivariate dual latent change score modeling: (1) adolescents whose MHR increased more as they transitioned from playing the PGG alone (pre-influence) to playing while simply observed by peers (indirect influence) displayed more prosocial behavior; (2) adolescents whose PEP activity increased more (greater PEP activity = shorter PEP latency) as they transitioned from indirect influence to being encouraged by peers to engage in antisocial behavior (direct influence) engaged in more antisocial behavior; and (3) adolescents whose PEP activity decreased less as they transitioned from direct influence on prosocial behavior to playing the PGG alone again (continuing influence) displayed more continuing prosocial behavior (marginal effect). The discussion focuses on the role of psychophysiology in understanding adolescents' susceptibility to peer influence.

Adrenocortical and autonomic cross-system regulation in youth: A meta-analysis

Childhood and adolescence are salient periods for the development of adrenocortical and autonomic arms of the stress response system (SRS), setting the stage for subsequent health and adaptive functioning. Although adrenocortical and autonomic systems theoretically function in highly coordinated ways, the strength of the relationship between these systems remains unclear. We leveraged a multivariate mixed effects meta-analytic approach to assess associations between adrenocortical, sympathetic, and parasympathetic functioning at rest and reactivity during stress-inducing tasks across 52 studies (N = 7,671; 5-20 years old). Results suggested a modest positive relation between adrenocortical and sympathetic systems as well as between adrenocortical and parasympathetic systems. Moderation analyses indicated the strength of associations varied as a function of several methodological and sociodemographic characteristics. Environmental effects on cross-system regulation were less clear, perhaps due to underrepresentation of adverse-exposed youth in the included studies. Collectively, our findings call for greater methodological attention to the dynamical, non-linear nature of cross-system functioning, as well as the role of experience in their organization across development.

Using EMA to explore the role of Black adolescents' experiences in activity spaces in momentary negative emotion and marijuana use

Research examining the role of place in Black adolescents' health behaviors typically examines neighborhoods, with little attention paid to micro geographies such as activity spaces. Understanding experiences in activity spaces may be especially important for Black adolescents living in neighborhoods traditionally characterized as disadvantaged. The SPIN project recruited 75 Black adolescents living in a single neighborhood to complete ecological momentary assessments (EMA) about the activity spaces they encountered over a month. Perceptions of violence and social support in activity spaces in a day are related to marijuana use during the day, relationships partially explained by negative momentary emotions.

Patterns of respiratory sinus arrhythmia and trajectories of anxiety and depressive symptoms in early adolescence

In children and adults, individual differences in patterns of respiratory sinus arrhythmia (RSA; i.e., interactions between resting RSA and RSA reactivity to stress) have emerged as a central predictor of internalizing symptoms. However, it is unclear whether individual differences in patterns of RSA also contribute to internalizing symptoms during the key developmental period of early adolescence, when rates of internalizing symptoms sharply increase. In the present multi-wave longitudinal study, we assessed whether patterns of RSA predicted trajectories of the two most common types of internalizing symptoms among adolescents: anxiety and depression. In the baseline session, we assessed RSA at rest and in response to a psychosocial stressor (Trier Social Stress Test [TSST]) in a sample of 75 early adolescents (Mage = 12.85). Youth then completed measures of anxiety and depressive symptoms at baseline and four times over approximately two years. Findings indicate that RSA patterns predicted trajectories of anxiety, but not depression. Specifically, region of significance analyses indicated that individuals with high resting RSA who demonstrated RSA augmentation to the lab stressor evinced decreasing anxiety over the follow-up period. In direct contrast, adolescents with high resting RSA in combination with RSA withdrawal to the stressor exhibited a trajectory of increasing anxiety. Findings provide preliminary evidence for understanding RSA as a developmentally salient risk or protective factor.

Stress system concordance as a predictor of longitudinal patterns of resilience in adolescence

Resilience promotes positive adaptation to challenges and may facilitate recovery for adolescents experiencing psychopathology. This work examined concordance across the experience, expression, and physiological response to stress as a protective factor that may predict longitudinal patterns of psychopathology and well-being that mark resilience. Adolescents aged 14-17 at recruitment (oversampled for histories of non-suicidal self-injury; NSSI) were part of a three-wave (T1, T2, T3) longitudinal study. Multi-trajectory modeling produced four distinct profiles of stress experience, expression, and physiology at T1 (High-High-High, Low-Low-Low, High-Low-Moderate, and High-High-Low, respectively). Linear mixed-effect regressions modeled whether the profiles predicted depressive symptoms, suicide ideation, NSSI engagement, positive affect, satisfaction with life, and self-worth over time. Broadly, concordant stress response profiles (Low-Low-Low, High-High-High) were associated with resilient-like patterns of psychopathology and well-being over time. Adolescents with a concordant High-High-High stress response profile showed a trend of greater reduction in depressive symptoms (B = 0.71, p = 0.052), as well as increased global self-worth (B = -0.88, p = 0.055), from T2 to T3 compared to the discordant High-High-Low profile. Concordance across multi-level stress responses may be protective and promote future resilience, whereas blunted physiological responses in the presence of high perceived and expressed stress may indicate poorer outcomes over time.

Psychophysiological stress response after a 6-week Mindful Self-Compassion training in psychiatric rehabilitation inpatients: a randomized post-test only study

Objectives

Mindfulness-based interventions (including self-compassion interventions) are effective in improving stress management at psychological and physical levels. Mindful Self-Compassion (MSC) is a newly developed program particularly aimed at increasing self-compassion. The main objective of this study was to determine whether the psychophysiological stress response during a social-evaluative speaking task differs in inpatients participating in the MSC or the Progressive Muscle Relaxation (PMR) program at the end of their 6-week psychiatric rehabilitation stay (i.e., post-test only design).

Method

Data from 50 inpatients (25 MSC, 25 PMR, 35 female) aged 19 to 76 years (M = 47.22, SD = 12.44) were analyzed in terms of psychophysiological stress response. For this purpose, heart rate variability, heart rate, and blood pressure were assessed together with several psychometric variables: positive and negative affect (PANAS), subjective stress perception (Visual Analog Scale), self-compassion (Self-Compassion Scale), cognitive reappraisal and suppression (Emotion Regulation Questionnaire), psychological distress (Brief Symptom Inventory-18), and appraisal and rumination (selected items).

Results

After correction for alpha inflation no differences in the psychophysiological stress response and psychometric parameters between the MSC and PMR group were found.

Discussion

In general, our results indicate that MSC is not superior to PMR training. However, more research with clinical randomized controlled trials investigating larger samples are needed to further affirm these initial findings.

Interpersonal Life Stress and Inflammatory Reactivity as Prospective Predictors of Suicide Attempts in Adolescent Females

Adolescents' suicidal behavior frequently is preceded by interpersonal stress, but not all who experience distress attempt to end their lives. Recent theories have posited individual differences in stress-related inflammatory reactivity may be associated with psychopathology risk; this study examined inflammatory reactivity as a moderator of the prospective association between interpersonal stress and adolescents' suicidal behavior. Participants included 157 at-risk adolescent females (ages 12 to 16 years) and assessed individual differences in proinflammatory cytokine responses to a brief laboratory-based social stressor, both interpersonal and non-interpersonal life events, and suicidal behavior over an 18-month follow-up period. Measuring levels of the key proinflammatory cytokines interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) before and after an experimentally-induced social stressor, results revealed that blunted cytokine reactivity heightened the effect of high interpersonal stress exposure on risk for suicidal behaviors over the subsequent 9 months. Significant effects were not revealed for non-interpersonally themed stress. Finding highlight the urgent need for more research examining inflammation reactivity among adolescents.

Effects of tailored interventions for anxiety management in choking-susceptible performing artists: a mixed-methods collective case study

Introduction

Not being able to manage performance anxiety and subsequently experiencing a decline in performance have been called "choking under pressure". High trait anxiety and fear of negative evaluation, as well as low self-efficacy or self-confidence, can put performers especially at risk of experiencing choking. This study, therefore, examined the effects of psychological choking interventions tailored to "choking-susceptible" performing artists individually in a coaching setting.

Methods

We conducted a mixed-methods (QUANT + QUAL) collective case study with nine performing artists, who each received five individual coaching sessions. The tailored choking interventions comprised acclimatization training, goal setting, and pre-performance routines, including elements such as imagery, self-talk, and relaxation techniques. Before and after the 10-week intervention phase, they filled in questionnaires on trait performance anxiety, fear of negative evaluation, and self-efficacy, performed in front of a jury, and were interviewed about their experiences. Transcripts of interviews and coaching sessions were analyzed using thematic analysis. Heart rate measurements, weekly performance videos, and expert evaluations were also part of our comprehensive data.

Results

Quantitative data showed reductions in performance anxiety and fear of negative evaluation, and increases in self-efficacy and performance quality, from before to after the intervention phase. Most participants also had a lower heart rate when performing for the jury. Themes from qualitative analysis comprised managing nervousness and feeling more relaxed, becoming more self-confident, satisfaction with artistic and mental performance, feeling good and enjoying performing, and general positive effects.

Conclusion

Tailoring psychological interventions may provide several benefits for choking-susceptible performing artists.

Stress, hypothalamic pituitary adrenal axis activity and autonomic nervous system function in adolescents with insomnia

INTRODUCTION

Abnormal stress responses have been linked to the etiology of insomnia. We investigated the relationship between insomnia, stress, hypothalamic-pituitary-adrenal (HPA) axis activity, and autonomic nervous system (ANS) function in adolescence.

METHODS

Forty-seven post-pubertal adolescents (16-20 years old, 28 female) with (N = 16; insomnia group) and without (N = 31; control group) DSM-5 insomnia symptoms were assessed for stress levels and stress reactivity and underwent a standardized stress protocol (Trier Social Stress Test (TSST)), after an overnight laboratory stay. Cortisol was measured upon awakening and 30-minutes later to calculate the cortisol awakening response (CAR). During the TSST, perceived stress, salivary cortisol (HPA activity), heart rate (HR) and blood pressure (BP) measures were collected.

RESULTS

Participants in the insomnia group reported more stress from school performance and work overload, with insomnia girls experiencing more stress from peer pressure and future uncertainty than control girls (p < 0.05). No group differences were detected in the CAR and pre-TSST stress levels. All participants showed significant increases in perceived stress (~19 %), HR (~33 %), systolic (~13 %), and diastolic (~15 %) BP in response to the TSST (p < 0.05). Overall HR stress response did not differ between groups, but was lower in boys with insomnia than in girls with insomnia (p < 0.05). Cortisol stress responses were inconclusive, possibly due to a masking effect of CAR, as the task was performed shortly after awakening and larger CARs were associated with blunted cortisol stress responses.

DISCUSSION

Results mostly show no group difference in physiological stress responses, although some interaction effects suggest a potential sex by insomnia interaction. Larger samples are needed to understand the physiological disturbances of insomnia in adolescence.

Neurophysiology of predictable unpleasant event processing in pre-adolescents and early adolescents, part II: Reflex and event-related potential markers of defensive reactivity and peripheral attention modulation

The ability to anticipate and process predictable unpleasant events, while also regulating emotional reactivity, is an adaptive skill. The current article and a companion in this issue test for potential changes in predictable event processing across the childhood-to-adolescence transition, a key developmental period for biological systems that support cognitive/ emotional abilities. While the companion article focuses on neurophysiology of predictable event processing itself, the present article examines peripheral emotional response regulation and attention modulation that coincides with event processing. A total of 315 third-, sixth-, or ninth-grade individuals saw 5-s cues predicting "scary," "every day," or uncertain pictures, and here, blink reflexes and brain event-related potentials (ERPs) elicited by peripheral noise probes are analyzed. During the cue, blink reflexes and probe ERP (P200) amplitudes were increased when the cue predicted scary, compared to everyday, content. After picture onset, reflex enhancement by scary content then disappeared for predictable images, whereas ERP modulation was similar regardless of predictability. Patterns are similar to those in adults and suggest (1) sustained defensive response priming and enhancement of peripheral attention during aversive anticipation, and (2) an ability, even in pre-adolescents, to downregulate defensive priming while maintaining attentional modulation once an awaited predictable aversive event occurs.

Daily stress and eating behaviors in adolescents and young adults: Investigating the role of cortisol reactivity and eating styles

Stress-related eating has been well documented in previous literature. However, there is limited research investigating the role of cortisol reactivity in daily stress-eating associations in samples of adolescents and young adults. 123 participants completed a baseline questionnaire and the Trier Social Stress Test in groups. Four saliva samples were taken at - 10, + 00, + 10 and + 40 min during the stress-induction task. Following this, participants completed an online daily diary each evening for 14 consecutive days to record daily stress and between-meal snack consumption. Multilevel modelling indicated that daily stress was positively associated with daily snack intake, particularly for ego-threatening and work/academic stressors. Emotional and external eating styles were found to moderate the stress-snacking relationship. Cortisol reactivity also moderated stress-eating associations, such that as cortisol reactivity levels increased from lower to higher levels, the impact of stress on eating decreased. The current findings highlight the importance of cortisol reactivity status and eating styles in understanding the complex relationship between daily stress and eating behavior in adolescents and young adults. Future research should continue investigating stress-eating associations in these groups and explore the role of other aspects of hypothalamic-pituitary-adrenal axis functioning.

Vulnerability to anxiety differently predicts cortisol reactivity and state anxiety during a laboratory stressor in healthy girls and boys

BACKGROUND

Children diagnosed with anxiety disorders show altered cortisol and state anxiety reactivity to stressful situations. To date, it remains unclear whether these dysregulations emerge after the pathology or whether they are also detectable in healthy children. If the latter is true, this may provide insight into children's vulnerability to develop clinical anxiety. Various personality factors (anxiety sensitivity, intolerance of uncertainty, perseverative cognitions) increase youth's vulnerability to develop anxiety disorders. This study aimed to examine whether vulnerability to anxiety was associated with cortisol reactivity and state anxiety in healthy youth.

METHODS

114 children (8-12 y/o) were exposed to the Trier Social Stress Test for Children (TSST-C), where saliva samples were collected for cortisol quantification. State anxiety was assessed 20 min before and 10 min after the TSST-C using the state form of the State-Trait Anxiety Inventory for Children. Vulnerability to anxiety was assessed using a composite score of the Childhood Anxiety Sensitivity Index, Intolerance of Uncertainty Scale for Children, and Perseverative Thinking Questionnaire.

RESULTS

Higher vulnerability to anxiety was associated with enhanced cortisol reactivity in boys. Irrespective of vulnerability level, girls reported greater changes in state anxiety in response to the TSST.

LIMITATIONS

Given the correlational nature of this study, the directionality of the results remains to be elucidated.

CONCLUSIONS

These results indicate that endocrine patterns characterizing anxiety disorders are detectable in healthy boys who exhibit a high level of self-reported vulnerability to anxiety. These results could aid in the early identification of children at risk of developing anxiety disorders.

Managing fear and anxiety in development: A framework for understanding the neurodevelopment of emotion regulation capacity and tendency

How we manage emotional responses to environmental threats is central to mental health, as difficulties regulating threat-related distress can blossom into symptoms of anxiety disorders. Given that anxiety disorders emerge early in the lifespan, it is crucial we understand the multi-level processes that support effective regulation of distress. Scholars have given increased attention to behavioral and neural development of emotion regulation abilities, particularly cognitive reappraisal capacity (i.e., how strongly one can down-regulate negative affect by reinterpreting a situation to change one's emotions). However, this work has not been well integrated with research on regulatory tendency (i.e., how often one spontaneously regulates emotion in daily life). Here, we review research on the development of both emotion regulation capacity and tendency. We then propose a framework for testing hypotheses and eventually constructing a neurodevelopmental model of both dimensions of emotion regulation. Clarifying how the brain supports both effective and frequent regulation of threat-related distress across development is crucial to identifying multi-level signs of dysregulation and developing interventions that support youth mental health.

Early Life Stress, Coping, and Cardiovascular Reactivity to Acute Social Stress

OBJECTIVE

Early life stress (ELS) occurring during childhood and adolescence is an established risk factor for later cardiovascular disease and dysregulated reactivity to acute social stress. This study examined whether ELS associations with baseline cardiovascular functioning, cardiovascular stress reactivity and recovery, and emotional stress reactivity vary across levels of emotion-oriented, task-oriented, and avoidant coping styles.

METHODS

The sample included 1027 adolescents and young adults (mean age = 19.29 years; 50% female; 64% Black, 34% non-Hispanic White) who reported on their ELS exposure and coping styles. Participants completed a standardized acute social stress test (the Trier Social Stress Test [TSST]), with heart rate (HR) and blood pressure (BP) measured before, during, and after the TSST. Self-reports of negative emotions during the TSST indexed emotional stress reactivity.

RESULTS

Multiple regression models adjusting for demographic factors and body mass index showed that ELS was associated with lower HR stress reactivity, avoidant coping was related to lower systolic BP and diastolic BP during stress and lower systolic BP during recovery, and higher emotion-oriented coping and lower task-oriented coping predicted greater emotional stress reactivity. A consistent pattern emerged where emotion-oriented coping amplified the associations between ELS and maladaptive stress responses (blunted cardiovascular stress reactivity and recovery; enhanced emotional stress reactivity), whereas lower levels of emotion-oriented coping were associated with resilient profiles among those who experienced ELS (lower resting HR, lower emotional stress reactivity, average HR and BP stress reactivity and recovery). However, low levels of emotion-oriented coping also conferred a risk of higher BP during recovery for those with high levels of ELS.

CONCLUSIONS

These results suggest that low to moderate levels of emotion-oriented coping promote optimal cardiovascular and emotional reactivity to acute stress among individuals exposed to ELS.

Community and domestic violence are associated with DNA methylation GrimAge acceleration and heart rate variability in adolescents

Background: Cumulative exposure to violence can change the regulation of epigenetic and physiological markers. Although violence has been associated with accelerated cellular aging, little is known about associations with cardiac autonomic activity.Objective: The current study aimed to investigate the relationship of exposure to community and domestic violence (CDV) with vagal activity and epigenetic aging acceleration.Methods: A total of 86 adolescents (57% female) were evaluated and interviewed at two time-points in São Gonçalo (2014-2019), a Brazilian city with high levels of violence. Exposure to CDV was assessed in both time-points. GrimAge acceleration was calculated from saliva DNA methylation using Infinium HumanMethylation450K (Illumina) collected in the first assessment. Heart rate variability (HRV) was collected during two stress tasks at the second assessment.Results: The exposure to violence witnessed or directly experienced at home and in the community increased significantly (t = 4.87, p < .01) across two-time points, and males had reported higher violence exposure (t = 2.06, p = .043). Violence at 1st assessment was significantly associated with GrimAge acceleration (B = .039, p value = .043). Violence at both assessments were associated with HRV measured during the narration of the worst trauma (traumaHRV) (B = .009, p value = .039, and B = .007, p value = .024, 1st and 2nd assessment respectively). GrimAge acceleration was significantly associated with traumaHRV (B = .043, p value = .049), and HRV measured during a 3D roller coaster video (B = .061, p value = .024).Conclusions: We found relevant evidence that experiencing violence during adolescence is associated with epigenetic aging and stress-related vagal activity. Understanding these factors during this period could contribute to the development of early interventions for health promotion.HIGHLIGHTS Higher exposure to Community and domestic violence is associated with increased GrimAge acceleration.Higher GrimAge acceleration is associated with increased stress-related vagal activity.Exposure to community and domestic violence increased significantly over time.

Multi-systemic evaluation of biological and emotional responses to the Trier Social Stress Test: A meta-analysis and systematic review

Humans experience multiple biological and emotional changes under acute stress. Adopting a multi-systemic approach, we summarized 61 studies on healthy people's endocrinological, physiological, immunological and emotional responses to the Trier Social Stress Test. We found salivary cortisol and negative mood states were the most sensitive markers to acute stress and recovery. Biomarkers such as heart rate and salivary alpha-amylase also showed sensitivity to acute stress, but the numbers of studies were small. Other endocrinological (e.g., dehydroepiandrosterone), inflammatory (C-Reactive Protein, Interleukin-6) and physiological (e.g., skin conductance level) measures received modest support as acute stress markers. Salivary cortisol showed some associations with mood measures (e.g., state anxiety) during acute stress and recovery, and heart rate showed preliminary positive relationship with calmness ratings during response to TSST, but the overall evidence was mixed. While further research is needed, these findings provide updated and comprehensive knowledge on the integrated psychobiological response profiles to TSST.

Pre-pandemic socio-emotional vulnerability, internalizing and externalizing symptoms predict changes in hair cortisol concentrations in reaction to the COVID-19 pandemic in children

The COVID-19 pandemic led to increased distress in many children, particularly in girls. Socio-emotional vulnerability, as well as psychiatric symptomatology prior to or during the initial stages of the pandemic, have been identified as important predictors of this distress. Still, it is unclear whether the pandemic also had physiological repercussions in children. If so, it remains to be determined whether these same predictors could provide insight into inter-individual variability. This longitudinal study aimed to investigate the effects of socio-emotional vulnerability, as well as pre-pandemic internalizing and externalizing symptoms, on hair cortisol concentrations (HCC) in response to the COVID-19 pandemic in healthy youth. In June 2020 (T1), 69 healthy children (M = 11.57 y/o) who visited the laboratory between 2017 and 2019 (T0) provided a 6 cm hair sample. This technique allowed us to quantify cortisol secretion during the three months preceding the COVID-19 pandemic (Segment A) and during the first three months of the first wave of the pandemic in Quebec, Canada (Segment B). At T0, participants completed the Dominic Interactive to assess pre-pandemic internalizing and externalizing symptoms. A socio-emotional composite score (SECS) was derived using a weighted z-score with the following constructs: anxiety sensitivity (Childhood Anxiety Sensitivity Index) measured at T0, trait anxiety (Trait subscale of the State-Trait Anxiety Inventory for Children (STAI-C)), intolerance of uncertainty (Intolerance of Uncertainty Scale for Children), and trait rumination (Children's Response Style Scale) measured at T1. A linear regression was conducted using the percent change in HCC across Segment A and B as the dependent variable, where SECS, pre-pandemic internalizing and externalizing symptoms, and sex were used as predictors. We found a main effect of sex, with girls presenting increased HCC reactivity compared to boys. We also found that SECS and internalizing symptoms negatively predicted HCC, whereas the opposite relationship was found between externalizing symptoms and HCC reactivity. For healthy children, our results suggest that previous psychiatric symptoms and socio-emotional vulnerability may be risk factors for the presentation of diverging cortisol response patterns in response to an adverse life event (such as the COVID-19 pandemic).

Autonomic Dysregulation in Child Social Anxiety Disorder: An Experimental Design Using CBT Treatment

Models of social anxiety disorder (SAD) stress the relevance of physiological arousal. So far, limited research has been conducted in children with SAD in experimental stress designs. Thus, examining autonomic arousal, children with and without SAD completed a standardized social stressor (Trier Social Stress Test for Children-C; TSST-C). Pre-existing differences to healthy controls (HC) were expected to decrease after receiving cognitive behavior therapy (CBT). Children with SAD (n = 64) and HC children (n = 55) completed a TSST-C. Children with SAD participated in a second TSST-C after either cognitive-behavioral treatment or a waitlist-control period (WLC). As expected, children with SAD showed blunted heart rate reactivity compared to HC children. Further, children with SAD had elevated levels of tonic sympathetic arousal as indexed by skin conductance level compared to HC. Children with SAD showed lower parasympathetic arousal during the baseline compared to HC. Children receiving treatment did not differ from children in the WLC condition in a repeated social stress test. Psychophysiological differences between children with SAD and HC children could be confirmed as indicated by previous research. The lack of physiological effects of the intervention as an experimental manipulation might be related to slower changes in physiology compared to e.g. cognition.