1. Trier Social Stress Test (TSST)

2. Based on the ‘Mason’ factors (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 Uncontrollability and Social-Evaluative Threat

3. 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
[…]
The TSST protocol can also be employed to test children and older adults after changing the instructions slightly for the respective age group. In elderly adults, subjects are instructed to apply for a (voluntary) part-time job (e.g., child caring, house keeping, technical assistant, etc). To help a retired subject to take over the role of a job applicant, a fabricated newspaper advertisement can be presented (tested age range years).
adapted TSST for children (TSST-C´)

4. Only a very few findings with TSST …

5. Do men and women show different stress responses?
Kudielka et al. (1998) Journal of Clinical Endocrinology & Metabolism
Kudielka et al. (2004) Psychoneuroendocrinology
Yes !
Role of menstrual cycle phase: Kirschbaum, Kudielka et al. (1999) Psychosomatic Medicine

6. Role of menstrual cycle phase
Kirschbaum, Kudielka et al. (1999) Psychosomatic Medicine

7. DEX-CRH-Feedback-Test: Yes
Age effects
TSST: No
DEX-CRH-Feedback-Test: Yes
Kudielka et al. (2004) Psychoneuroendocrinology
Kudielka et al. (1999) Neuroendocrinology
Kudielka et al. (2000) Stress
Dex-premedication
Time (min) 20 40 60 80
100
120 2 4 6 8 10 12 14
Younger men (n=12)
older men (n=15)
100 µg hCRH
Free Salivary Cortisol (nmol/l)
younger women (N=15)
older women (N=15)
N=102
30 Alte
41 Jüngere
31 Kinder

8. Methodological aspects: time of day
increase
area under the curve
Kudielka et al. (2004) Psychoneuroendocrinology
N=180
Vormittag: N=109
Nachmittag: N=71

9. 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.
With this protocol, salivary cortisol levels rise two to threefold in about 70-80% of all subjects with peak levels around minutes after cessation of the stress task. In addition to free cortisol, the levels of total plasma cortisol, ACTH, catecholamines (adrenaline, noradrenaline), growth hormone, prolactin, testosterone, systolic and diastolic blood pressure, heart rate, immune parameters (e.g., neutrophils, eosinophils, basophils, lymphocytes, interleukin-6, TNFα), glucose, alpha-amylase, endogenous inhibitor of monoamine oxidase (MAO-AI) as well as measures of hemoconcentration (e.g., hematocrit, haemoglobin, plasma volume) and blood coagulation (fibrinogen, von Willebrand factor antigen, D-dimer, clotting factors) increase significantly.

10. Final Remarks
Identifying the determinants of HPA axis regulation and dysregulation is, particularly in humans, a very challenging task.
An extensive 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

11. Future 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