Der Trierer Sozialstress Test (TSST)

Trier Social Stress Test (TSST)Trier Social Stress Test (TSST)

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