Hair cortisol concentration and its association with acute stress responses and recovery in a sample of medical students in Germany.

INTRODUCTION: Experiencing acute and chronic stress can contribute to adverse health outcomes. Responses to acute stress differ between individuals (i.e., stress reactivity) and the experience of chronic stress has been discussed to be associated with acute stress responses and stress recovery. This study thus aims to investigate whether hair cortisol concentration (HCC), being an indicator for hypothalamus-pituitary-adrenal (HPA) axis activity over a prolonged period of time, is associated with acute stress responses and recovery in a sample of medical students. MATERIAL AND METHODS: From July 2020 to July 2021, medical students (n = 54) underwent a virtual-reality Trier Social Stress Test in which their blood pressure and heart rate variability (HRV) were measured, and hair samples were taken to determine HCC. Piecewise linear growth analyses were used to investigate whether HCC (categorized into low, medium and high levels) is associated with acute stress responses and recovery regarding blood pressure and HRV. RESULTS: Significant interaction effects in piecewise linear growth analyses showed that participants with higher levels of HCC had lower systolic and diastolic blood pressure responses compared to participants with medium levels of HCC. No significant interaction effects were observed for HRV responses or for recovery measures. CONCLUSIONS: The study suggests that higher levels of HCC are associated with a lower cardiovascular response in terms of blood pressure to an acute stressor in medical students. Therefore, long-term HPA-axis activity may contribute to different magnitudes of acute stress responses in the autonomic nervous system. As the shown lower blood pressure responses to acute stress in individuals with increased long-term HPA-axis activity may represent inadequate stress responses, these should be further studied in order to find out more about their interaction and potential subsequent disease risks.

The association between study conditions and hair cortisol in medical students in Germany - a cross-sectional study.

BACKGROUND: Medical students often experience high levels of stress due to adverse study conditions, which may have adverse health consequences. Hair cortisol concentration (HCC) has been described as a physiological marker for chronic stress and might thus help to identify students under stress and examine the study conditions being responsible for long-term physiological stress responses. This study therefore investigated the association between study conditions and HCC in a sample of medical students. METHODS: Fifty-five students from a medical school in Germany completed a paper-based questionnaire and had hair samples collected between May 2020 and July 2021. Study conditions were assessed with student versions of questionnaires based on the Job-Demand-Control-Support model (StrukStud, 25 items) and Effort-Reward Imbalance model (Student ERI, nine items). HCC of two centimeters closest to the scalp were determined by a cortisol luminescence immunoassay. Linear multiple regression analyses were performed to examine associations between study conditions and HCC. RESULTS: Demands (B = 0.23, p = 0.002), effort (B = 0.12, p = 0.029) and the effort-reward-ratio (B = 0.28, p = 0.007) were positively associated with HCC in separate regression analyses, adjusted for age and sex. Only the association between demands and HCC remained significant when all components of the respective questionnaire were considered in the same model (B = 0.22, p = 0.003). CONCLUSION: The results suggest that adverse study conditions may be associated with activation of the hypothalamic-pituitary-adrenal axis stress response as reflected by increased HCC. Longitudinal research is needed to confirm these cross-sectional results and examine effects of more prolonged stress due to adverse study conditions.

From threat to challenge-Improving medical students' stress response and communication skills performance through the combination of stress arousal reappraisal and preparatory worked example-based learning when breaking bad news to simulated patients: study protocol for a randomized controlled trial.

BACKGROUND: Breaking bad news (BBN; e.g., delivering a cancer diagnosis) is perceived as one of the most demanding communication tasks in the medical field and associated with high levels of stress. Physicians' increased stress in BBN encounters can negatively impact their communication performance, and in the long term, patient-related health outcomes. Although a growing body of literature acknowledges the stressful nature of BBN, little has been done to address this issue. Therefore, there is a need for appropriate tools to help physicians cope with their stress response, so that they can perform BBN at their best. In the present study, we implement the biopsychosocial model of challenge and threat as theoretical framework. According to this model, the balance between perceived situational demands and perceived coping resources determines whether a stressful performance situation, such as BBN, is experienced as challenge (resources > demands) or threat (resources < demands). Using two interventions, we aim to support medical students in shifting towards challenge-oriented stress responses and improved communication performance: (1) stress arousal reappraisal (SAR), which guides individuals to reinterpret their stress arousal as an adaptive and beneficial response for task performance; (2) worked examples (WE), which demonstrate how to BBN in a step-by-step manner, offering structure and promoting skill acquisition. METHODS: In a randomized controlled trial with a 2 (SAR vs. control) x 2 (WE vs. control) between-subjects design, we will determine the effects of both interventions on stress response and BBN skills performance in N = 200 third-year medical students during a simulated BBN encounter. To identify students' stress responses, we will assess their perceived coping resources and task demands, record their cardiovascular activity, and measure salivary parameters before, during, and after BBN encounters. Three trained raters will independently score students' BBN skills performances. DISCUSSION: Findings will provide unique insights into the psychophysiology of medical students who are tasked with BBN. Parameters can be understood more comprehensively from the challenge and threat perspective and linked to performance outcomes. If proven effective, the evaluated interventions could be incorporated into the curriculum of medical students and facilitate BBN skills acquisition. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05037318), September 8, 2021.

The influence of hatha yoga on stress, anxiety, and suppression: A randomized controlled trial.

Engaging in yoga may mitigate stress and anxiety in individuals while potentially enhancing one's capacity to manage distractions. Our research aimed to explore the relation between these two outcomes: Can an eight-week yoga program foster distraction suppression, thereby reducing stress and discomfort? To answer this question, we used Hatha Yoga, the most commonly practiced form of yoga. We tested if the intervention improved participants' ability to suppress distractions and selectively decrease self-reported stress and stress reactivity. In Addition, we investigated whether such an intervention would increase participants' mindfulness. Our study included 98 healthy yoga novices between 18 and 40 years who were randomly assigned to either an experimental or a waitlist condition, with each participant completing pre- and post-intervention assessments, including questionnaires, as well as electrophysiological and behavioral measures. After eight weeks of yoga practice, significant reductions in self-reported stress and stress reactivity levels, as well as increased mindfulness, were observed among those participating in the intervention relative to those in the waitlist control group. There were, however, no significant changes in state or trait anxiety due to the intervention. Changes in stress measures could not be explained by changes in participants' ability to suppress distractors, which was not affected by the intervention. Overall, our findings suggest that regular participation in Hatha Yoga can improve mental health outcomes without impacting cognitive functioning directly related to distractor suppression. CLINICAL TRIAL REGISTRATION NUMBER: NCT05232422.

Adult attachment and social support interact to reduce psychological but not cortisol responses to stress.

OBJECTIVE: Adult attachment has been suggested to mediate the effect of social support on stress protection. The purpose of this study was to investigate the effects of adult attachment and social support on psychological and endocrine responses to psychosocial stress. METHODS: Sixty-three healthy men who were married or cohabiting were randomly assigned to receive either instructed social support from their partner or no social support before being exposed to a standardized psychosocial stressor (Trier Social Stress Test). Attachment was determined using the Experiences in Close Relationships-Revised questionnaire. State anxiety, mood, and salivary cortisol levels were repeatedly assessed before and after stress. RESULTS: Secure attachment was associated with stronger decreases in state anxiety levels following stress exposure. More importantly, the combination of social support and secure attachment exhibited the lowest anxiety levels after stress (interaction effect). Social support alone reduced cortisol responses to stress, whereas secure attachment did not influence cortisol concentrations. CONCLUSION: This first study on the interaction of adult attachment and social support in terms of psychological and endocrine stress responses concurs with previous studies suggesting an important protective role of attachment for psychological stress responsiveness. However, attachment did not directly moderate cortisol responses to acute stress.

Stress-induced changes in human salivary alpha-amylase activity -- associations with adrenergic activity.

The salivary enzyme alpha-amylase has been proposed to indicate stress-reactive bodily changes. A previous study by the authors revealed marked increases in salivary alpha-amylase following psychosocial stress, indicating a stress-dependent activation of salivary alpha-amylase. Salivary alpha-amylase has been suggested to reflect catecholaminergic reactivity. Our aim was to assess/evaluate a possible relationship between salivary alpha-amylase and adrenergic parameters, i.e. catecholamines, as well as other stress markers. Using an intra-individual repeated measures design, 30 healthy young men underwent the Trier Social Stress Test (TSST), which consists of a mental arithmetic task and free speech in front of an audience and a control condition in randomized order. Salivary alpha-amylase and salivary cortisol as well as plasma catecholamines and cardiovascular activity were repeatedly measured before, during, and after both conditions. Significant differences were found between the stress and the rest condition in salivary alpha-amylase, salivary cortisol, plasma catecholamines, and cardiovascular parameters (heart rate, LF, HF, LF/HF). However, general alpha-amylase responses (area under the curve) were not associated with general responses in catecholamines and cortisol in the stress condition (r smaller than 0.25 for all analyses). Analysis of cardiovascular parameters indicates a positive relationship between amylase and sympathetic tone (LF/HF) during stress. Salivary alpha-amylase is sensitive to psychosocial stress. Since it does not seem to be closely related to other biological stress markers such as catecholamines and cortisol, salivary alpha-amylase may be a useful additional parameter for the measurement of stress.