Associations between burnout symptoms and social behaviour: exploring the role of acute stress and vagal function.

BACKGROUND: The study aimed to investigate the link between burnout symptoms and prosocial behaviour, as well as the role of acute stress and vagally-mediated heart rate variability (vmHRV) on this association. METHODS: Seventy men were randomly assigned to either the stress or the control condition of the Trier Social Stress Test for Groups (TSST-G). Prosocial behaviour was assessed via a social decision-making paradigm during the respective TSST-G condition. RESULTS: Correlation analyses revealed negative correlations between prosocial behaviour and burnout symptoms. Acute stress was also associated with reduced prosocial behaviour, whereas no interaction effects with burnout symptoms could be revealed. Exploratory analyses showed that vmHRV was negatively correlated with burnout symptoms during the social decision-making paradigm but did not mediate the link between burnout and prosocial behaviour. CONCLUSION: In conclusion, we report first experimental evidence that burnout symptoms are negatively associated with prosocial behaviour. Further studies are needed to explore the causal relations.

Gaze behavior is associated with the cortisol response to acute psychosocial stress in the virtual TSST.

BACKGROUND: The Trier Social Stress Test (TSST) is a reliable tool for psychobiological stress induction. Because of its socio-evaluative nature, it has been useful for investigating gaze behavior. It has been shown that healthy people avoid looking toward faces when under stress, a finding that corroborates studies demonstrating avoidance of eye contact in social anxiety disorder. Yet, little is known about the relationship between gaze behavior and the biological stress response. METHODS: In a final sample of 74 healthy males, a virtual reality version of the Trier Social Stress Test (TSST-VR) with an integrated eye tracker was implemented to investigate gaze behavior during acute stress induction. Stress response measures were collected via saliva samples and subjective stress ratings. Additional questionnaires were administered for examining the influence of social anxiety traits. RESULTS: The TSST-VR elicited a significant psychobiological stress response. Overall, higher gaze times on judges compared to surroundings were found in the speech task while this pattern was reversed in the arithmetic task. Critically, there was a significant negative association between gaze time on judges and cortisol output in cortisol responders. CONCLUSIONS: In a non-clinical sample, avoidance of gaze is associated with a stronger cortisol response to acute stress. This study demonstrates the potential of eye tracking to disentangle the effects of acute stress on social interaction, warranting further investigation in clinical populations characterized by high levels of anxiety in social situations, such as social anxiety and autism spectrum disorder.

Effects of a 12-week endurance training program on the physiological response to psychosocial stress in men: a randomized controlled trial.

The present study experimentally tested the cross-stressor adaptation hypothesis by examining whether endurance exercise training leads to reductions in the physiological stress response to a psychosocial stressor. We randomly assigned 149 healthy men to a 12-week exercise training, relaxation training, or a wait list control group. Before and after intervention we assessed the groups' physical fitness (lactate testing) and compared their physiological stress responses to the Trier Social Stress Test for Groups in terms of salivary free cortisol, heart rate (HR) and heart rate variability (HRV); the final sample consisted of 96 subjects. As hypothesized, the exercise training significantly improved fitness and reduced stress reactivity in all three parameters; however, it only improved stress recovery in terms of HR. The relaxation program reduced only cortisol, but not HR or HRV reactivity; no changes emerged for the control group. The findings suggest that the cross-stressor adaptation hypothesis is valid for cardiovascular as well as endocrine stress reactivity.

Common oxytocin receptor gene (OXTR) polymorphism and social support interact to reduce stress in humans.

The neuropeptide oxytocin has played an essential role in the regulation of social behavior and attachment throughout mammalian evolution. Because recent studies in humans have shown that oxytocin administration reduces stress responses and increases prosocial behavior, we investigated whether a common single nucleotide polymorphism (rs53576) in the oxytocin receptor gene (OXTR) might interact with stress-protective effects of social support. Salivary cortisol samples and subjective stress ratings were obtained from 194 healthy male participants before, during, and after a standardized psychosocial laboratory stress procedure. Participants were randomly assigned either to prepare alone or to receive social support from their female partner or close female friend while preparing for the stressful task. Differential stress responses between the genotype groups were observed depending on the presence or absence of social support. Only individuals with one or two copies of the G allele of rs53576 showed lower cortisol responses to stress after social support, compared with individuals with the same genotype receiving no social support. These results indicate that genetic variation of the oxytocin system modulates the effectiveness of positive social interaction as a protective buffer against a stressful experience.

Hydrocortisone reduces altruistic punishment in healthy men.

Psychosocial stress modulates social cognition and behavior in humans. One potentially mediating factor is cortisol as part of the human endocrine stress response. With a double-blind, placebo-controlled between-subject study design, we tested possible dose-dependent effects of hydrocortisone (0 mg, 5 mg and 20 mg) in 85 healthy males. During a socio-economic decision-making task we measured trust, trustworthiness, sharing, punishment, and non-social risk behavior. Social value orientation (SVO) was also assessed. We observed significantly lower levels of punishment after hydrocortisone, especially in the 20 mg group. Drug-induced salivary cortisol correlated negatively with punishment behavior. None of the other facets of social behavior or the SVO were affected by hydrocortisone. Our results suggest that hydrocortisone reduces the propensity to punish unfair behavior. Future studies are needed to further disentangle the role played by various psychobiological mechanisms within the stress response as well as their complex interplay on social behavior and cognition.

Gonads under stress: A systematic review and meta-analysis on the effects of acute psychosocial stress on gonadal steroids secretion in humans.

Animal research has shown that the hypothalamus-pituitary-gonadal (HPG) axis is inhibited by (chronic and/or severe) stress, which can lead to impaired fertility and reproductive functioning, presumably caused by the inhibition of gonadal steroid secretion and in interactions with glucocorticoids. However, what has not been clarified is how acute psychosocial stress modulates gonadal steroid secretion in humans. Here we summarize the experimental research on the acute effects of stress on the secretion of gonadal steroids in humans. A systematic literature search revealed 21 studies (with N=881 individuals) measuring testosterone, progesterone or estradiol in response to a standardized acute laboratory stressor in healthy humans. Both our literature review and quantitative meta-analysis suggest that in humans, acute stress stimulates rather than inhibits HPG axis activity, although there is a considerable heterogeneity in the reported methods and results. Increased gonadal steroids in response to acute stress contrasts with many animal studies reporting the opposite pattern, at least regarding severe and/or chronic stressors. We discuss methodological issues and challenges for future research and hope to stimulate experimental studies within this area. A better understanding of these mechanisms is needed, and may have important implications for health and disease, as well as the modulation of various behaviors by acute stressors.

Beliefs about stress moderate the association between COVID-19-related work demands and burnout symptoms in physicians.

The present study set out to investigate the role of different stress beliefs (positive and negative beliefs about stress, as well as perceived control) on the association between central COVID-19-related work demands and burnout symptoms in physicians during the second lockdown of the SARS-CoV-2 pandemic. N = 154 practicing physicians (mean [SD] age = 37.21 [9.43] years]; 57.14% female) participated in our cross-sectional German-wide online survey and answered questions about sociodemographic factors, their current work situation, their stress beliefs, and their current burnout symptoms. Moderation analyses revealed significant interaction effects between stress beliefs and specific COVID-19-related work demands on the prediction of burnout symptoms, most consistent with respect to perceived control. Positive believes about stress and its controllability were cross-sectional associated with reduced, negative believes about stress however with enhanced associations between COVID-19-related work demands and burnout symptoms. This finding indicates, if confirmed by longitudinal research, the potential of the usage of stress beliefs in prevention programs for physicians in order to mitigating negative effects of chronic stress.

The Forward Testing Effect Is Resistant to Acute Psychosocial Retrieval Stress.

The forward testing effect refers to the finding that testing of previously studied information improves memory for subsequently studied newer information. Recent research showed that the effect is immune to acute psychosocial encoding/retrieval stress, i.e., stress that is induced before initial encoding. The present study investigated whether the forward testing effect is also robust to acute psychosocial retrieval stress, i.e., stress that is induced after encoding but before retrieval of the critical item list. Participants (N = 128) studied three lists of words in anticipation of a final cumulative recall test. Participants were tested immediately on Lists 1 and 2 (testing condition) or restudied the two lists after initial study (restudy condition). After study of the critical List 3, psychosocial stress was induced in half of the participants (stress group), whereas no stress was induced in the other half (control group). The Trier Social Stress Test for Groups (TSST-G) was used for stress induction. Salivary cortisol, alpha amylase, and subjective stress were repeatedly measured. The results of the criterion test showed a generally detrimental effect of psychosocial retrieval stress on List 3 recall. Importantly, the forward testing effect was unaffected by retrieval stress. The findings are discussed with respect to current theories of the forward testing effect.

Social high performers under stress behave more prosocially and detect happy emotions better in a male sample.

Psychosocial stress is increasing in society, impacting our lives in all social domains. However, the conditions under which stress facilitates ("tend-and-befriend") or hinders ("fight-or-flight") social approach remain elusive. We tested whether previous heterogeneous findings might be resolved by accounting for individual differences in social performance under stress. For that purpose, we introduce the novel Trier Social Stress Test (TSST) social performance index that was aggregated across ratings from two independent observers. Moreover, we apply an innovative setup enabling electroencephalographic (EEG) data to be measured inside an electrically-shielded cabin during stress, namely the TSST-EEG. Relying on a sample of 59 healthy male participants, we collected behavioral (i.e., sharing resources with others) and cognitive (i.e., detecting facial emotional expressions) approach patterns while participants experienced either acute psychosocial stress (n = 31) or no stress (control condition; n = 28) and while EEG was being recorded. During stress exposure, high-performing participants behaved more prosocially, and differentiated better between happy and neutral emotions on both behavioral and neurophysiological levels (revealed by intensity differences in a N170-like response). Overall, our findings demonstrate the added value of both the novel TSST social performance index and the novel TSST-EEG setup. By showing that high social performance during the TSST is associated with behavioral, cognitive, and neurophysiological approach patterns, our study offers valuable insights into adaptive or maladaptive psychobiological mechanisms in coping with psychosocial stress. Future stress research should address the role of social performance differences during stress in social interaction to better understand the behavioral consequences of psychosocial stress in humans.

The social dimension of stress reactivity: acute stress increases prosocial behavior in humans.

Psychosocial stress precipitates a wide spectrum of diseases with major public-health significance. The fight-or-flight response is generally regarded as the prototypic human stress response, both physiologically and behaviorally. Given that having positive social interactions before being exposed to acute stress plays a preeminent role in helping individuals control their stress response, engaging in prosocial behavior in response to stress (tend-and-befriend) might also be a protective pattern. Little is known, however, about the immediate social responses following stress in humans. Here we show that participants who experienced acute social stress, induced by a standardized laboratory stressor, engaged in substantially more prosocial behavior (trust, trustworthiness, and sharing) compared with participants in a control condition, who did not experience socioevaluative threat. These effects were highly specific: Stress did not affect the readiness to exhibit antisocial behavior or to bear nonsocial risks. These results show that stress triggers social approach behavior, which operates as a potent stress-buffering strategy in humans, thereby providing evidence for the tend-and-befriend hypothesis.

Empathy Modulates the Effects of Acute Stress on Anxious Appearance and Social Behavior in Social Anxiety Disorder.

Patients suffering from social anxiety disorder (SAD) fear social interaction and evaluation, which severely undermines their everyday life. There is evidence of increased prosocial behavior after acute social stress exposure in healthy individuals, which may be interpreted as stress-regulating "tend-and-befriend" behavior. In a randomized controlled trial, we measured empathic abilities in a first diagnostic session. In the following experimental session, we investigated how patients with SAD (n = 60) and healthy control participants (HC) (n = 52) respond to an acute social stressor (Trier Social Stress Test for groups) or a non-stressful control condition, and whether empathic abilities and acute social stress interact to modulate anxious appearance and social behavior in a social conversation test. Salivary cortisol, heart rate, and subjective stress response were repeatedly measured. The anxious appearance and social behavior of participants were rated by the conversation partner. SAD patients demonstrated stronger subjective stress responses while the biological responses did not differ from HC. Moreover, patients performed worse overall in the conversation task, which stress additionally undermined. Finally, we found that both emotional and cognitive empathy buffered the negative effects of acute stress on social behavior in SAD, but not in HC. Our data highlight the importance of empathic abilities for SAD during stressful situations and call for multimodal clinical diagnostics. This may help to differentiate clinical subtypes and offer better-tailored treatment for patients. General Scientific Summary: This study shows that high levels of cognitive and emotional empathy can buffer the negative effects of acute stress on social behavior in social anxiety disorder (SAD). Empathic abilities may be included as an additional diagnostic resource marker for SAD.

Concordance in salivary cortisol and subjective anxiety to the trier social stress test in social anxiety disorder.

BACKGROUND: Social anxiety disorder (SAD) is characterised by an excessive fear of negative social evaluation. There is a limited understanding of how individuals with SAD react physiologically and subjectively to social stress. METHOD: The Trier Social Stress Test (TSST), an acute social stress task, was completed by 40 SAD individuals (50% female) and 41 healthy controls (matched on age, sex, and education) to examine salivary cortisol and self-reported stress reactivity. Salivary cortisol concentrations and self-reported affect (anxiety, sadness, tiredness, withdrawal, and happiness) were assessed at baseline and across nine-time points during the TSST. RESULTS: Bayesian salivary cortisol analyses revealed no group differences in salivary cortisol levels at baseline or during the TSST, with results comparative after the removal of 17 cortisol non-responders (21%). Contrastingly, the groups significantly differed on self-reported affect. At baseline, the SAD group (vs. controls) reported heightened negative affect and diminished happiness. In response to the TSST, the SAD group (vs. controls) displayed greater negative affect reactivity and diminished happiness reactivity, and significantly higher rates of change in their anxiety and sadness over time. After accounting for differences in the temporal resolution of self-reported versus cortisol responses, a moderate positive association was found between salivary cortisol and anxiety reactivity to social stress that was comparable between the groups. CONCLUSIONS: Despite elevated subjective anxiety, our findings suggest concordance in psychobiological stress reactivity in SAD and healthy controls. We discuss the possibility of heightened subjective sensitivity to social evaluative stress as a core treatment target for SAD.

Effects of glucose intake on stress reactivity in young, healthy men.

The psychobiological stress response has a broad impact on energy metabolism, while the availability of energy may, in turn, affect the stress response. Specifically, a reduced cortisol response has been found after 8-11 hours of fasting, while glucose intake has led to an increase in cortisol reactivity. We compared the effects of standardized glucose or artificial sweetener drinks, as well as water, ingested prior to a physical (cold pressor test, CPT) or a psychosocial stressor (Trier Social Stress Test, TSST) after four hours of fasting. Healthy male subjects (N = 151) were randomized to one of six groups (either glucose, sweetener or water group and stress induction with the CPT or TSST). Thirty minutes after ingestion, participants were exposed to the stressor. Repeated measures of the subjective stress response, salivary cortisol and alpha amylase as well as continuous heart rate recordings were taken to capture the psychobiological stress response. Capillary blood glucose levels were measured four times. We found significant psychobiological stress responses for all variables and both stressors, but significantly stronger responses for the TSST. Moreover, we found a significant but small effect for a slightly stronger cortisol response to stress after glucose ingestion, which is presumably driven by a more pronounced effect in the TSST compared to the CPT condition. Responder rates did not differ for the three conditions in either the TSST or in the CPT. Our results demonstrate that even after a short fasting timeframe of four hours, higher glucose availability results in slightly higher cortisol stress responses in men.

The effects of acute stress and stress hormones on social cognition and behavior: Current state of research and future directions.

Stress encompasses profound psychological and physiological changes that are observable on all levels, from cellular mechanisms, humoral changes, and brain activation to subjective experience and behavior. While the impact of stress on health has already been studied for decades, a more recent field of research has revealed effects of stress on human social cognition and behavior. Initial studies have attempted to elucidate the underlying biological mechanisms of these stress-induced effects by measuring physiological responses or by using pharmacological approaches. We provide an overview of the current state of research on the effects of acute stress induction or pharmacological manipulations of stress-related neuro circuitry on social cognition and behavior. Additionally, we discuss the methodological challenges that need to be addressed in order to gain further insight into this important research topic and facilitate replicability of results. Future directions may help to disentangle the complex interplay of psychological and biological stress variables and their effects on social cognition and behavior on health and in disorders with social deficits.

The modulation of social behavior and empathy via oral contraceptives and female sex hormones.

Oral contraceptives (OC) and endogenous female sex hormones in naturally cycling women (NC) are related to a wide range of psychological variables (eg, cognition and affect). Little research on social behavior has been done. One study documented a tendency towards more prosocial behavior in NC than OC women, but the underlying neuroendocrine mechanisms remain unknown. The sex hormones progesterone and estradiol are potential candidates. We analyzed social decision-making and social behavior in 83 healthy women (38 OC and 45 NC) via the Social Value Orientation (SVO) and in real social interactions within a paradigm adapted from behavioral economics. We also measured empathy, and collected saliva samples to quantify the basal levels of estradiol and progesterone. Our analyses revealed higher levels of prosocial behavior and emotional empathy in NC than in OC women, a finding supported by higher levels of prosocial decisions in NC than OC women in the SVO. Regarding the underlying biological mechanisms, we detected lower progesterone levels in OC than NC women. Exploratory analyses revealed a negative correlation between progesterone and trust on the trend level. We found no correlations between estradiol and behavior. Our findings provide evidence that OC modulate social behavior and initial indications of a possible modulation by progesterone. Further research is needed to replicate our findings and extend them to other social behaviors.

Oxytocin, vasopressin, and human social behavior.

There is substantial evidence from animal research indicating a key role of the neuropeptides oxytocin (OT) and arginine vasopressin (AVP) in the regulation of complex social cognition and behavior. As social interaction permeates the whole of human society, and the fundamental ability to form attachment is indispensable for social relationships, studies are beginning to dissect the roles of OT and AVP in human social behavior. New experimental paradigms and technologies in human research allow a more nuanced investigation of the molecular basis of social behavior. In addition, a better understanding of the neurobiology and neurogenetics of human social cognition and behavior has important implications for the current development of novel clinical approaches for mental disorders that are associated with social deficits (e.g., autism spectrum disorder, social anxiety disorder, and borderline personality disorder). This review focuses on our recent knowledge of the behavioral, endocrine, genetic, and neural effects of OT and AVP in humans and provides a synthesis of recent advances made in the effort to implicate the oxytocinergic system in the treatment of psychopathological states.

Acute Psychosocial Stress Modulates the Detection Sensitivity for Facial Emotions.

Psychosocial stress has been shown to alter social perception and behavior. In the present study, we investigated whether a standardized psychosocial stressor modulates the perceptual sensitivity for positive and negative facial emotions and the tendency to allocate attention to facial expressions. Fifty-four male participants underwent the Trier Social Stress Test for Groups (TSST-G) or a nonstressful control condition before they performed a facial emotions detection task and a facial dot-probe task to assess attention for positive and negative facial expressions. Saliva samples were collected over the course of the experiment to measure free cortisol and alpha amylase. In response to the TSST-G, participants showed marked increases in subjective stress, salivary cortisol, and alpha amylase compared to the control condition. In the control condition, detection performance was higher for angry compared to happy facial expressions, while in the stressful condition this difference was reversed. Here, participants were more sensitive to happy compared to angry facial expressions. Attention was unaffected by psychosocial stress. The results suggest that psychosocial stress shifts social perception in terms of detection sensitivity for facial expressions toward positive social cues, a pattern that is consistent with the tendency to seek social support for coping with stress.

The Forward Testing Effect is Immune to Acute Psychosocial Encoding/Retrieval Stress.

The forward testing effect (FTE) refers to the finding that testing of previously studied information enhances memory for subsequently studied other information. Previous research demonstrated that the FTE is a robust phenomenon that generalizes across different materials and populations. The present study examined whether the FTE is robust under acute psychosocial encoding/retrieval stress. In each of two experimental conditions, participants studied three item lists in anticipation of final cumulative recall testing. In the testing condition, participants were tested immediately on lists 1 and 2, whereas in the restudy condition, they restudied lists 1 and 2. In both conditions, participants were tested immediately on list 3. Acute psychosocial stress was induced in participants prior to the encoding of item lists using the Trier social stress test for groups protocol. No stress was induced in a control group. Salivary cortisol, alpha amylase, and subjective stress were measured repeatedly to capture the biopsychological stress response. The results showed a significant FTE on list 3 recall, that is, testing of lists 1 and 2 enhanced the recall of list 3. No significant effect of stress on the FTE was observed, suggesting that the FTE is robust under acute psychosocial encoding/retrieval stress. The discussion provides suggestions for future research directions.

Effects of internet-based stress management on acute cortisol stress reactivity: Preliminary evidence using the Trier Social Stress Test for Groups (TSST-G).

Previous studies have demonstrated the effectiveness of face-to-face stress management programs in reducing psychological and endocrine responses to acute psychosocial stress exposure. With the present pilot study, we compare the effects of a brief internet-based stress management (IBSM) intervention versus relaxation training on subjective, autonomic, and endocrine stress responses to a standardized psychosocial laboratory stressor (Trier Social Stress Test for Groups, TSST-G). A group of male participants receiving IBSM was compared to a group receiving Progressive Muscle Relaxation (PMR) training and a waiting-list control group. All groups underwent the TSST-G following a 6-week training/waiting period. Both the IBSM and PMR group reported lower subjective stress levels than the control group. However, the IBSM group exhibited the lowest free salivary cortisol responses to the TSST-G, with significantly lower levels than the PMR group. The waiting-list control group exhibited an intermediate cortisol response. These preliminary results suggest that a 6-week internet-based stress management program is effective in reducing the subjective stress levels, and might be associated with an attenuated salivary cortisol response to an acute stressor.

Habitual and acute exercise effects on salivary biomarkers in response to psychosocial stress.

OBJECTIVE: Previous research suggests beneficial effects of physical exercise on stress reactivity due to cross-stressor adaptions of physiological stress response systems. However, results remain inconclusive and it is unclear whether only regular engagement in exercise modulates these physiological adaptations or if acute bouts of exercise can elicit similar adaptations. Thus, the aim of the current study was to investigate and compare the effects of habitual and acute exercise on physiological stress responses. METHODS: 84 male participants between 18 and 30 years (half of them were screened to be habitually high active or low active) were randomized into one of two groups: either an acute exercise intervention group (n = 42 with 50% being habitually high active) which engaged in 30 min of moderate-to-high intensity ergometer bicycling, or a control (placebo exercise) group which engaged in 30 min of light stretching (n = 42 with 50% being habitually high active). Following the intervention period, participants took part in a well validated psychosocial stress paradigm. Saliva samples were taken repeatedly to derive alpha-amylase and cortisol as stress-specific parameters. A multilevel growth curve approach was applied to analyse changes in the stress parameters over time. RESULTS: Both, acute and habitual exercise have shown to be positively related to stress reactivity. In particular, a reduction in stress activation was found for both types of exercise, but only habitual engagement in exercise exhibited a beneficial effect on peak cortisol levels. CONCLUSIONS: Taken together, people can profit from regular exercise (i.e. reduced activity of stress-response systems). However, even acute bouts of exercise preceding stress exposure showed beneficial effects on stress reactivity. This finding is particularly important as it may provide a (self-)regulatory mechanism for people facing conceivable acute stress situations.