Trier social stress test
[2] These studies encountered two problems: First, there was large interindividual variability in the physiological response to stress, and second, the methods previously used tended to produce effects that were too small to be reliably measured.
[1] Clemens Kirschbaum and his colleagues at the University of Trier sought to overcome these limitations by combining different stress-generating tasks in a highly standardized format, which included elements of public speaking, mental arithmetic, and anticipation.
Their task, which they named the Trier social stress test, consistently produced very large physiological effects in the majority of their participants, thus overcoming the limitations of earlier research.
Before the test begins, the participant is fitted with an IV for collecting blood, and with a heart rate monitor.
Stress induction begins with the participant being taken into a room where a panel of three judges are waiting, along with a videocamera and audio recorder.
[8] The presentation is immediately followed by the mental arithmetic component, during which the participant is asked to count backwards from 1,022 in steps of 13.
For example, they provided information about what exclusion criteria should be considered, the composition of the panel of judges, when and how many physiological measures should be taken (i.e., cortisol, heart rate, blood), and many other aspects of the TSST methodology.
The TSST increases levels of several substances known to indicate activation of the hypothalamic-pituitary-adrenal axis (HPAA), a core driver of physiological stress.
[1] Compared to control, normal healthy individuals undergoing the TSST experience increases over baseline ranging from 30% (prolactin) to 700% (hGH).
Most clinical psychological conditions,[2] including unresolved trauma due to sexual abuse,[14] panic disorder,[15] and excessive experience of early life stress, are associated with blunted response to the TSST, although the lower magnitude of percentage changes may be attributable to baseline inflation caused by a higher average level of everyday stress, such that persons with these conditions experience everyday life as being closer to test conditions than do unaffected persons.
In 2012, Jana Campbell and Ulrike Ehlert conducted a review of 358 existing TSST studies to look at possible associations between emotional stress and physiological indicators.
They found a high degree of inconsistency in the subjective measures used by such studies (a variety of Visual Analog Scales were used), and so the results of their analysis were inconclusive.
They argue for a greater degree of standardization in the subjective measures used alongside the TSST so that in the future it will be possible to explore this relationship more fully.
