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Trier Social Stress Test (TSST)

Trier Social Stress Test (TSST). Based on the ‘Mason’ factors (1968 Psychosom Med) A situation is perceived as stressful if it contains… novelty unpredictability uncontrollability ambiguity anticipation (of negative consequences) ego-involvement

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Trier Social Stress Test (TSST)

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  1. Trier Social Stress Test (TSST)

  2. Based on the ‘Mason’ factors(1968 Psychosom Med) • A situation is perceived as stressful if it contains… • novelty • unpredictability • uncontrollability • ambiguity • anticipation (of negative consequences) • ego-involvement • Recent metaanalysis (Dickerson & Keneny 2004 Psychol Bull) • situations inducing HPA axis responses do often combine Uncontrollability and Social-Evaluative Threat

  3. Meanwhile  well over 4.000 TSST sessions performed world-wide (for recent reviews see Kudielka et al., 2007a, 2007b) • TSST versions for children and older adults • healthy populations • patients (psychiatric disorders, CFS, PTSD, pain, immunological disorders, etc.) • Studies on effects of: • age, gender, sex hormones • genetics, polymorphisms • social support, social hierachy • personality factors • intervention / stress management training • oxytocin, pregnancy, lactation & breast-feeding • nicotine, alcohol & coffee consumption, food/dietary energy supplies • medication (psychoactive drugs, aspirin, beta-blocker etc.) • habituation • […]

  4. Only a very few findings with TSST …

  5. Do men and women show different stress responses? Kudielka et al. (1998) Journal of Clinical Endocrinology & Metabolism Kudielka et al. (2004) Psychoneuroendocrinology Yes ! Role of menstrual cycle phase:Kirschbaum, Kudielka et al. (1999) Psychosomatic Medicine

  6. Role of menstrual cycle phase Kirschbaum, Kudielka et al. (1999) Psychosomatic Medicine

  7. older men (n=15) older women (N=15) Younger men (n=12) younger women (N=15) 14 Dex-premedication 14 Dex-premedication 12 12 10 10 8 100 µg hCRH 8 100 µg hCRH Free Salivary Cortisol (nmol/l) Free Salivary Cortisol (nmol/l) 6 6 4 4 2 2 0 0 0 20 40 60 80 100 120 0 20 40 60 80 100 120 Time (min) Time (min) Kudielka et al. (1999) Neuroendocrinology Kudielka et al. (2000) Stress Age effects TSST: No DEX-CRH-Feedback-Test: Yes Kudielka et al. (2004) Psychoneuroendocrinology

  8. increase area under the curve Methodological aspects: time of day Kudielka et al. (2004) Psychoneuroendocrinology

  9. Variables that show increases after the TSST • salivary free cortisol (2-3fold rise in about 70-80% of subjects) • total plasma cortisol, ACTH • adrenaline, noradrenaline, growth hormone, prolactin, testosterone • blood pressure, heart rate, α-amylase • immune parameters (e.g., lymphocytes, IL-6, TNF-α) • blood coagulation markers (e.g., fibrinogen, D-dimer, vWF, clotting factors) • measures of hemoconcentration (e.g., hematocrit, haemoglobin, plasma volume) • endogenous inhibitor of monoamine oxidase (MAO-AI) • […] • altered well-being, pain sensitivity, alcohol consumption, drug effects etc.

  10. Final Remarks • Identifying the determinants of HPA axis regulation and dysregulation is, particularly in humans, a very challenging task. • An extensive phenotyping with markers of basal as well as stimulated HPA axis activity is required in order • to elucidate the mechanisms mediating stress related disorders and • to develop new therapeutic strategies

  11. Future Challenges • What is a normal range?  huge interindividual variability  HPA axis = highly adaptive system • many aspects not directly observable in humans (brain, earlier adaptive processes) • sensitivity of target tissue • low correlation across tests • cortisol level is not a stable attribute of a subject • influenced by situational factors  extent to which trait components can be detected depends significantly on the quality of the used measures

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