Salivary cortisol, heart rate, electrodermal activity and subjective stress responses to the Mannheim Multicomponent Stress Test (MMST)
Introduction
Life exists by maintaining a complex dynamic equilibrium, or homeostasis, that is constantly challenged by intrinsic or extrinsic adverse forces or stressors (McEwen and Seeman, 2003, De Kloet et al., 2005). Stress can be considered as a state of threatened homeostasis and results in activating a complex repertoire of physiological and psychological responses. Acute psychobiological stress responses include the activation of the autonomic nervous system and the hypothalamo–pituitary–adrenal (HPA) axis, leading to changes in heart rate and blood pressure, as well as changes in adrenocorticotropin hormone (ACTH) and cortisol levels. On the subjective level stress responses include affective (e.g., fear, anger) as well as perceived physical changes (e.g., tension, trembling or sweating). An effective regulatory control of these processes triggered by stress is essential to health and survival (de Kloet et al., 2005).
Different studies have specifically focused on the effects of psychological stressors on stress reactions in a laboratory setting (Kirschbaum et al., 1993, Lejuez et al., 2003, Dickerson and Kemeny, 2004). Several stressor characteristics have been shown to influence stress responses. Social-evaluative threat occurs when a person is (potentially negatively) judged by others. Elements of the experimental protocol with social-evaluative threat include presence of evaluative others during the stress task or permanent recording of the performance for later evaluation. Stressors are defined as uncontrollable when it is difficult for participants to avoid negative consequences. Furthermore, stressors can be categorized as motivated performance tasks or passive tasks. Motivated performance stressors involve active performance situations that demand immediate overt or cognitive responses, whereas passive tasks, for example, include passive watching a film or being exposed to noise.
Laboratory studies established different acute standardized stressors that can be used for investigating stress reactions (Dickerson and Kemeny, 2004). The stressor tasks can be classified into five categories, namely cognitive, emotional, acoustic, public speaking and public speaking/cognitive task combination stressors. In a meta-analysis by Dickerson and Kemeny (2004) on acute psychological stress paradigms, social-evaluative threat and uncontrollability have been demonstrated to cause robust and reliable cortisol responses. In this review, stressors including a combination of public speaking and cognitive tasks were shown to be associated with greater cortisol responses. However, it should be noted that the stressors characterized by social-evaluative threat were not perceived as more distressing than other types of stressors, whereas autonomic changes were not included in this meta-analysis.
Different studies have shown that cognitive, emotional and acoustic stressors were associated with changes in physiological reactivity, neuroendocrine responses, and subjective stress experience (cognitive stressors: Condren et al., 2002, Mathias et al., 2004, Lejuez et al., 2003; emotional stressors: Meagher et al., 2001, Carter et al., 2008; acoustic stressors: Gerra et al., 1998). However, the effects of these stressors on the physiological system are highly variable. Dickerson and Kemeny (2004) have shown that there is substantial variability in the effect sizes depending on the nature of the stressor task. Some tasks provoked large cortisol responses (e.g. public speaking/cognitive task combinations: average Cohen's d = 0.87) whereas others were associated with moderate or small effects (e.g. cognitive tasks: average Cohen's d = 0.20). The best-established laboratory stress paradigm is currently the Trier Social Stress Test (TSST), which is composed of a brief preparation period followed by 5 min of public speaking (job interview) and 5 min of mental arithmetics in front of a panel of evaluators (Kirschbaum et al., 1992, Kirschbaum et al., 1993). The main reason for the success of this protocol is its capability to elicit robust neuroendocrine stress responses in the majority of subjects including increases in salivary cortisol and adrenocorticotropic hormone (ACTH) levels as well as in heart rate (Kudielka et al., 2004a, Kudielka et al., 2004b, Het et al., 2009). However, the TSST is relatively laborious and manpower-intensive. Furthermore, the availability of alternative complementary stress protocols with different psychological profiles would be useful for psychobiological research.
On this account, an economical stress paradigm has recently been developed in our group for inducing relatively high subjective stress without focusing on social-evaluative components (Kolotylova et al., 2010). We proposed that a combination and simultaneous presentation of established stressors focusing on different modalities would provide a context capable of triggering substantial stress-associated changes. This previous study comprised two independent experiments. In the first experiment involving 10 subjects, different cognitive stressors (the Paced Auditory Serial Addition Task (PASAT-C), 2-back test and Stroop test) were combined with emotional (a set of pictures with highly negative emotional valence), acoustic (white noise) and motivational (loss of money after each wrong answer in the cognitive task) stressors to investigate changes in heart rate and subjective stress. During each stress induction, all stressors of different modalities were used simultaneously. The duration of each stress session was 5 min, whereas the stress combinations were used in a permuted order. All stress combinations led to significant increases of heart rate (all p-values < 0.01). At a descriptive level, a higher heart rate increase could be found during the stress induction with the Paced Auditory Serial Addition Task (PASAT-C, Lejuez et al., 2003) as a cognitive stressor. However, there were no significant differences in heart rate increases between the stress combinations. All stress combinations caused significant increases in subjective stress levels (all p-values < 0.001). Following the stress induction with the PASAT-C, significantly higher ratings of subjective stress have been reported (p < 0.01). Consequently, it could be assumed that this stress combination with the PASAT-C as a cognitive stressor, emotional, acoustic and motivational stressors represented a stronger subjective stressor. In the second experiment, this stress combination, the Mannheim Multicomponent Stress Test (MMST), was tested in an independent sample of 32 subjects. In this sample, we also found significant changes in subjective and objective stress measurements during the stress induction with the MMST (Kolotylova et al., 2010).
In laboratory studies, electrodermal responses are measured when it is desired to assess the differential or changing impact of stress (Andreassi, 2009). In different studies, the efficacy of the stress induction has been clearly demonstrated by the pronounced increase in electrodermal activity (Setz et al., 2010, Svetlak et al., 2010). Furthermore, salivary cortisol is frequently used as a biomarker of psychological stress (Hellhammer et al., 2009, Kudielka et al., 2009). Here, we present two studies that sought to replicate the previously observed changes in heart rate and subjective stress responses as well as to investigate electrodermal (study 1) and cortisol responses (study 2) to the MMST. A further aim of study 2 was to investigate sex differences in stress responses to the MMST.
Section snippets
Participants
Exclusion criteria in both studies comprised smoking, endocrine, cardiovascular or other severe medical diseases as well as schizophrenia, bipolar-I-disorder, acute depressive episode, substance dependence or abuse during the last 6 months. Psychiatric diagnoses were assessed by use of the Structured Clinical Interview for The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Axis-I Disorders and the SCID-II Personality Questionnaire for DSM-IV Axis-II Disorders (SCID I, First et
Study 1
Due to a technical problem, HR could not be assessed in three subjects, whereas SCL and NSCF were not assessed in two subjects.
Discussion
In this study, we evaluated a recently developed economical and easily applicable stress paradigm for inducing relatively high subjective stress levels without focusing on social-evaluative components. As this stress protocol was developed in Mannheim (Germany) and consists of several components, it was named the “Mannheim Multicomponent Stress Test” (MMST). Since in previous studies only small or inconsistent effects with protocols employing one type of stressor tasks were observed, we
Disclosure
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. All authors contributed to and have approved the final manuscript.
Acknowledgments
We would like to thank Prof. Dr. C. Kirschbaum for carrying out the salivary cortisol analyses for this study. Furthermore, we thank all the subjects who participated in this study for their pivotal contribution.
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