Der Trierer Sozialstress Test (TSST)
Based on the ‘Mason’ factorsBased on the ‘Mason’ factors (1968 Psychosom Med) (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 UncontrollabilityUncontrollability and Social-Evaluative ThreatSocial-Evaluative Threat
Der Trierer Sozialstress Test (TSST)
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 […]
Der Trierer Sozialstress Test (TSST)
Only a very few findings with TSST …Only a very few findings with TSST …
Der Trierer Sozialstress Test (TSST)
Do men and Do men and women show women show
different stress different stress responses?responses?
Time (min)
0 10 20 30 40 50
Fre
e S
aliv
ary
Co
rtis
ol (
nm
ol/l
)
0
6
8
10
12
14
16
FemalesCol 1 vs Ältere Col 1 vs Col 10 Col 1 vs Männer
STRESS
male
female
Per
ceiv
ed S
tres
s
0
10
20
30
40
50
60
70
80
90
100
Women Men
P<.0075
Kudielka et al. (1998) Journal of Clinical Endocrinology & MetabolismKudielka et al. (1998) Journal of Clinical Endocrinology & MetabolismKudielka et al. (2004) PsychoneuroendocrinologyKudielka et al. (2004) Psychoneuroendocrinology
Yes !Yes !
Role of menstrual cycle phase:Role of menstrual cycle phase: Kirschbaum, Kudielka et al. (1999) Psychosomatic MedicineKirschbaum, Kudielka et al. (1999) Psychosomatic Medicine
Der Trierer Sozialstress Test (TSST)
Kirschbaum, Kudielka et al. (1999) Psychosomatic Medicine
Role of menstrual cycle phaseRole of menstrual cycle phase
Der Trierer Sozialstress Test (TSST)
Time (min)
0 10 20 30 40 50
Fre
e S
aliv
ary
Co
rtis
ol
(nm
ol/
l)
0
4
6
8
10
12
14
16
Col 1 vs Erwachsene
Col 1 vs Ältere
Col 1 vs Col 10 Col 1 vs Kinder
STRESS
older adults
childrenyoung adults
Kudielka et al. (2004) Psychoneuroendocrinology
Age effectsAge effects
TSST: NoTSST: NoDEX-CRH-Feedback-Test: YesDEX-CRH-Feedback-Test: Yes
Kudielka et al. (1999) Neuroendocrinology Kudielka et al. (2000) Stress
Dex-premedication Dex-premedication
Time (min)
0 20 40 60 80 100 1200
2
4
6
8
10
12
14
Younger men (n=12)
older men (n=15)
100
µg
hC
RH
Time (min)
0 20 40 60 80 100 120
Fre
e S
aliv
ary
Co
rtis
ol
(nm
ol/
l)
0
2
4
6
8
10
12
14
younger women (N=15)
older women (N=15)
100
µg
hC
RH
Fre
e S
aliv
ary
Co
rtis
ol
(nm
ol/
l)
Der Trierer Sozialstress Test (TSST)
Methodological aspects: time of dayMethodological aspects: time of day
Kudielka et al. (2004) Psychoneuroendocrinology
increaseincrease
area under the curvearea under the curve
Der Trierer Sozialstress Test (TSST)
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.
Der Trierer Sozialstress Test (TSST)
Final RemarksFinal Remarks
Identifying the determinants of HPA axis regulationdeterminants of HPA axis regulation and dysregulation is, particularly in humans, a very challenging task.
An extensive phenotyping 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
Der Trierer Sozialstress Test (TSST)
Future ChallengesFuture 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