Stress reactivity to an electronic version of the Trier Social Stress Test: a pilot study

Late acute stress effects on decision-making: The magnified attraction to immediate gains in the iowa gambling task

Previous literature indicates that the later phases of the acute stress response may promote poor decision-making, characterized by riskier choices and a likely inclination towards immediate reward-seeking. However, all studies addressing the effect of this phase have treated decisional capacity as a singular dimension, without analyzing the underlying processes under decision-making. Employing the Value-Plus-Perseveration (VPP) RL model, based on Bayesian logic, this study aims to gain specific insights into how late phase of acute stress impacts the cognitive processes underpinning decision-making in the Iowa Gambling Task (IGT), deciphering whether, as expected, gains are processed in a magnified manner. Seventy-three participants were randomly assigned to two groups, stress (N = 35) and control (N = 38). A virtual version of The Trier Social Stress Test (TSST-VR) was employed as a laboratory stressor. Decision-making was evaluated 35 minutes after the stressor onset, by means of the IGT. Results showed that stressed participants, in comparison to control group, displayed more perseverant and consistent decision-making, enhanced memory, and reinforcement learning capabilities, yet were guided by a greater attraction to decks offering immediate high gains. These results are analyzed with the understanding that in the IGT, short-term decisions focused on instant rewards are seen as counterproductive. This suggests that stress could limit the ability to switch to strategies that are more cautious and offer greater long-term benefits.

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 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.

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

The Trier Social Stress Test (TSST) is a widely used, reliable, and ecologically valid method for inducing acute stress under controlled conditions. Traditionally, the TSST is administered with staff physically present with participants, which limits the participant populations that can be exposed to the TSST. We describe an adaptation of the TSST to remote, online delivery over video-conferencing, which we call the internet-delivered Trier Social Stress Test (iTSST). This adaption has participants use wearable, self-administered ECG monitors received and returned via mail. Fifty participants were recruited to take part in a pilot study evaluating stress-reduction interventions and completed the iTSST at two occasions separated by approximately 12 weeks. Perceived stress and heart rate variability (HRV) were measured during both administrations of the iTSST. Forty-one participants completed both assessments and were included in the set of analyses. Both administrations were characterized by an increase in self-reported stress and reduction in self-reported relaxation from the resting phase to the speech task, which returned to baseline during recovery. In terms of HRV, we observed a significant parasympathetic response to the iTSST in 90% of participants, evidenced by a decrease in RMSSD and increase in heart rate from resting to the speech task, which recovered during the recovery phase. In terms of repeatability, there was little evidence of habituation and the iTSST elicited a stress response during both the initial administration and the 12-week follow-up. While the utility is limited by the lack of a measure of sympathetic and HPA-axis activity, the iTSST represents a promising research tool when physically interacting with participants is not feasible.

Schizotypy, social stress and the emergence of psychotic-like states - A case for benign schizotypy?

Schizotypy is a personality-organisation related to schizophrenia-liability as well as the emergence of psychotic symptoms and psychotic-like experiences (PLEs) in non-schizophrenic individuals. It has been suggested that some non-schizophrenic individuals may exhibit PLEs frequently, but in a fashion that is not distressing but life-enhancing ("benign schizotypy"). In schizophrenia and at-risk individuals, however, psychotic symptoms are not only distressing, but also triggered stress. To further investigate questions of causality and examine how PLEs may present as distressing symptoms in some individuals and as benign experiences in others, we explored how schizotypy-facets moderated PLEs-variability under experimentally induced social stress.We performed a standardised social stress-paradigm in 107 healthy adults (77 female, 30 male; average age 22,5 years), measuring changes in psychometrically assessed PLEs and the moderation of changes under stress through positive, negative and disorganised schizotypy. Results suggest two discrete effects: On the one hand, individuals high in disorganised and negative schizotypy showed stress-dependent increases in PLEs; without added effects of positive schizotypy. On the other, individuals low in negative and disorganised schizotypy showed higher levels of PLEs solely as a function of positive schizotypy but not stress. We discuss these findings in light of the fully-dimensional model of schizotypy and hypothesize that PLEs in individuals high in schizotypy-facets suggested to convey risk-for-schizophrenia (negative and disorganised) may reflect qualitatively different entities than PLEs in individuals with low values in these facets, but high expressions of positive schizotypy ("happy schizotypes"). Additionally, we emphasize the importance of not overlooking the disorganised schizotypy-facet in related research.

The Nature of Reality: Human Stress Recovery During Exposure to Biodiverse, Multisensory Virtual Environments

Immersive virtual environments (IVEs) were used to test the effects of biodiversity on recovery from induced stress. Three natural environments and one urban environment were used to represent ordinal levels of biodiversity (none, low, moderate, and high). The four IVEs comprised visual, auditory, and olfactory stimuli. An additional high biodiversity IVE without auditory or olfactory stimuli was also included to study the effects of multisensory stimulation per se on recovery from stress and perceptions of biodiversity. Following stress induction via a novel IVE Trier Social Stress Test (TSST-IVE), heart rate and five self-reported well-being measures were used to assess participants’ recovery after immersion in one of the five IVEs. The results showed consistent well-being responses across both self-reported and physiological measures, suggesting biodiversity does directly affect human well-being. However, the relationship was not linear. For most measures of well-being, stress recovery was least effective in the urban IVE, consistent with past research. The low biodiversity IVE elicited the greatest improvement in all well-being measures except self-reported calmness. One could speculate that the landscape features of the least biodiverse IVE may elicit subconscious preferences toward savanna-like landscapes, as suggested by previous studies. The IVE depicting a moderate level of biodiversity was the least restorative of the natural environments. A multisensory experience was associated with better recovery in all measures of well-being than a visual-only experience, and perceptions of landscape components significantly differed between two identical nature scenes when auditory and olfactory stimuli were removed. Nuances in the data and implications of the findings are discussed. The results signal a need for caution and question the assumption that cultural ecosystem services align with positive outcomes for biodiversity conservation.

A meta-analysis of cortisol reactivity to the Trier Social Stress Test in virtual environments

BACKGROUND

Maladaptive responses to stressors can lead to poor physical and psychological health outcomes. Laboratory studies of stress induction commonly use the Trier Social Stress Test (TSST). The TSST has been shown to reliably induce a stress response, most commonly measured via cortisol reactivity. Recently, researchers have used virtual environment versions of the TSST (V-TSST) in place of the traditional TSST. The V-TSST has many advantages over the traditional TSST, including increased standardization and use of fewer resources, but V-TSST has yet to be quantitatively reviewed and compared to the traditional TSST. This review aims to quantifying the effectiveness of V-TSST with a meta-analysis of cortisol response effects and identify potential moderating variables that are more likely to induce a cortisol response with V-TSST.

METHODS

Literature searches were conducted including the key words Trier Social Stress Test, TSST, and virtual reality. Thirteen studies were included in this meta-analysis after meeting the inclusion criteria of utilizing a V-TSST and having cortisol measurements at baseline and peak stress to assess cortisol reactivity. The standardized mean gain effect size was used.

RESULTS AND DISCUSSION

There was a medium average effect size (ES_sg = 0.65) across all studies for increase in cortisol from baseline to peak measurement. Significant moderating effects were seen for participant age, sex, and level of immersivity of the virtual environment. Studies in which participants were under 25 years old, or all male, showed greater effect sizes for cortisol reactivity. Virtual environments that were more immersive also evidenced greater effect sizes. Although the V-TSST is effective at inducing psychosocial stress, the magnitude of this response is less than the traditional TSST. Based on these results, recommendations for future research are provided.

Neighborhood environments influence emotion and physiological reactivity

Living in a disadvantaged neighborhood is associated with worse health and early mortality. Although many mechanisms may partially account for this effect, disadvantaged neighborhood environments are hypothesized to elicit stress and emotional responses that accumulate over time and influence physical and mental health. However, evidence for neighborhood effects on stress and emotion is limited due to methodological challenges. In order to address this question, we developed a virtual reality experimental model of neighborhood disadvantage and affluence and examined the effects of simulated neighborhoods on immediate stress and emotion. Exposure to neighborhood disadvantage resulted in greater negative emotion, less positive emotion, and more compassion, compared to exposure to affluence. However, the effect of virtual neighborhood environments on blood pressure and electrodermal reactivity depended on parental education. Participants from families with lower education exhibited greater reactivity to the disadvantaged neighborhood, while those from families with higher education exhibited greater reactivity to the affluent neighborhood. These results demonstrate that simulated neighborhood environments can elicit immediate stress reactivity and emotion, but the nature of physiological effects depends on sensitization to prior experience.

Stressful life events, relationship stressors, and cortisol reactivity: The moderating role of suppression

Stressful life events (SLEs) are exceedingly common and have been associated with a range of psychological disorders, perhaps through dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis. The use of certain emotion regulation strategies in response to stress, such as expressive suppression and cognitive reappraisal, has additionally been linked to heightened HPA axis reactivity to acute stress. However, it is unclear how emotion regulation may interact with SLEs to affect HPA axis reactivity, particularly concerning relationship stressors (RSs). Using cross-sectional data from 117 men and 85 women aged 18-55 years old (M = 39.9 ± 10.7), we investigated whether trait use of suppression or reappraisal interacted with recent negatively perceived SLEs and relationship stressors to impact HPA axis response to an acute stressor. Separate area under the curve and linear mixed models revealed that trait suppression interacted with SLEs and RSs to predict cortisol response to stress, while reappraisal did not. Findings indicate higher trait expressive suppression may influence the cortisol response to acute stress after exposure to more recent stressful events, particularly when those stressful events include relationship stress.