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Stress can be defined on several points of view, depending on the perspective. The first approach has been to define stress as the environmental agent associated with the term 'stress.' The second approach is to measure people's reactions to the environment. The third approach is to measure the physiological response of the individual to environment. In this article, we discuss measurement strategies for each of these conceptualizations of stress with extra emphasis on physiological measures of stress.
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Hellhammer D H, Stone A A, Hellhammer J and Broderick J (2010) Measuring
Stress. In: Koob G.F., Le Moal M. and Thompson R.F. (eds.) Encyclopedia of
Behavioral Neuroscience, volume 2, pp. 186–191 Oxford: Academic Press.
ª 2010 Elsevier Ltd. All rights reserved.
Author's personal copy
Measuring Stress
D H Hellhammer, University of Trier, Trier, Germany
A A Stone, Stony Brook University, Stony Brook, NY, USA
J Hellhammer, Daacro, Wissenschaftspark, Trier, Germany
J Broderick, Stony Brook University, Stony Brook, NY, USA
ª 2010 Elsevier Ltd. All rights reserved.
Glossary
Allostatic load The physiological costs of chronic
exposure to the neural or neuroendocrine stress
response. The allostatic load index is conceptualized as
a summary measure capturing the cumulative
physiological burden exacted on the body to adapt to
life’s demands. It is thought to reflect the tax on the body
and brain resulting either from chronic overactivity or
inactivity of physiological systems that are involved in
adaptation to environmental challenge.
Cortisol A corticosteroid hormone that is produced by
the adrenal gland (in the zona fasciculata and the zona
reticularis of the adrenal cortex) in response to a wide
range of stressors. It has a wide range of physiological
effects, that is, increases blood pressure and blood
sugar, and reduces immune responses; virtually every
single nucleated cell in the body is a potent ial target for
cortisol. Only 5–10% of the total plasma cortisol is
unbound and biologically active (c. 90% of the fraction is
silenced by cortisol binding protein).
Hypothalamic–pituitary–adrenal (HPA) axis This
axis is constituted by a complex set of direct influences
and feedback interactions among the hypothalamus,
the pituitary gland, and the adrenal glands. It is a major
part of the endocrine system that controls responses to
stress and regulates many physiological processes,
including the immune system, energy storage and
expenditure, and a broad range of psychological as well
as biological mediators of adaptation to stressful
events. The HPA axis mediates stress adaptation. Under
stress, the hypothalamus secretes corticotropin-
releasing factor and arginine vasopressin that provoke
the release of adrenocorticotropic hormone (ACTH)
from the pituitary, which targets the adrenals and
triggers the secretion of cortisol. The functioning of the
axis is controlled by a negative-feedback loop, with
cortisol feeding back not only on the pituitary to
downregulate ACTH but also on the hypothalamus and
the hippocampus, where it acts as a brake of the HPA-
axis response to stress.
Introduction
Background
Stressors can take many forms, for example, loud noise,
extreme temperature, physical exer tion, pathogens, social
disturbance, and emotional arousal. Social and psycholo-
gical stressors are especially prevalent in primates and
humans because of their complex social environments
and advanced capacity for emotional responding. The
perception of social hierarchy and interpersonal
exchanges, the capacity for worry and rumination, the
pain of self-doubt and low self-esteem, and the preoccu-
pation with possible future events are among the common
sources of chronic stress. The organism’s repertoire of
responses is not well suited to dissipate the impact of
these sources of chronic stress. Indeed, the organism’s
response as it extends over time creates a state of pathol-
ogy that is characterized by psychological disturbance
and physiological states that can progress into illness.
During the mid-twentieth century, Hans Selye, an
endocrinologist born in the Austrian–Hungarian Empire
and later naturalized Canadian, pioneered the scientific
investigation of stress and devel oped the concept of the
‘general adaptation syndrome’ to describe the common
biological responses to stress. Specifically, he noted the
progression from alarm, to adaptation, and then to
exhaustion. The initial alarm response is associated with
a marked increase of attention to the stimulus and phy-
siological readiness to engage in the fight-or-flight
response, which was first described by Walter Cannon at
the beginning of the century. The brain triggers an organ-
ism-wide response through activation of the sympathetic
nervous system and the hypothalamic–pituitary–adrenal
(HPA) axis. These systems allow optimal adaptation for
the organism to flee a threat or to repel a threat through
increased respiratory and cardiac output, release of glu-
cose, blood, and other nutrients to supply fully engaged
muscles, constriction of blood to the extremities, and a
variety of additional reactions. Selye argued that these
neurophysiological responses cannot be indefinitely
sustained, and the organism will enter a state of
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exhaustion. In fact, subsequent research ha s demonstrated
that the responses do cease, but transform into a sustained
and altered state that are damaging.
While Selye believed that these response patterns are
nonspecific and account for any type of stressor, Mason,
an American endocrinologist, challenged this position in
the late 1960s by demonstrating that the HPA response
clearly varies with the emotional reaction to the stressor.
The exact emotion that is triggered by the stressor
and, therefore, the inten sity and dynamics of the
HPA response depend on factors such as perception
of uncertainty, anticipation, novelty, unpredictability,
uncontrollability, and ego involvement. These observa-
tions have been confirmed in numerous studies in the past
40 years. In addition, it has been found that the HPA
response habituates under repeated exposure to stressors
in most subjects, once the situation loses the characteris-
tics described above, while the sympathetic response
remains largely unchanged under such conditions. This
article provides a brief overview of psychological and
biological measures of acute and chronic stress.
Definition of Stress
This brief history illustrates the complexities of the defini-
tion of stress in showing that there are three distinctive
components comprising it. Researchers have focused on
different aspects of the definition, often to the exclusion of
other parts of the definition, which has created some con-
fusion of the meaning, indeed, even the utility of the term
stress. The first approach has been to define stress as an
environmental. Records of the number of recent life events
or of single, major event, such as death of a loved one, are
examples of this approach. The second approach is to
measure people’s reactions to the environment, regardless
of what has actually happened to them. This allows for
individual differences such that a given environment
could engender little perceived stress in one individual,
yet high levels of stress in another (presumably because of
differential life histories or constitutional makeup). The
third approach is to measure the physiological response of
the individual to the environment, which also allows for
individual differences in response patterns. We shall discuss
measurement strategies for each of these conceptualizations
of stress with extra emphasis on physiological measures of
stress. A book on stress measurement was published several
years ago, and the organization of this article is very similar
to the one used by the authors of this book.
Distinction and Importance of Acute versus
Chronic Measures
An important distinction in stres s research is that between
acute stress and chronic stress. While most species are
highly adapted to cope with an acute stressor, chronic
stress poses a much more challenging situation. The
response to acute stress is designed to provide the organ-
ism with the alertness, energy, physiological regulation,
and immunological activation that are necessary to coun-
terbalance the effects of the stressor in order to survive.
The removal of an acute stressor allows the organism to
return to baseline. In contrast, chronic stress presents an
unrelenting challenge that can exhaust the organism’s
response and results in a chronic state of dysregulation.
While the impact of acute and chronic stress may be
distinctive, the measurement of the two is less well defined.
Measurement of acute and chronic marital discord shows
the association between the two measurements. A single
marital argument could be considered an acute stressor; in
fact, laboratory study of arguments between spouses has
shown considerable evidence of brief, but intense, physio-
logical activation. Chronic marital stress can be defined as
frequent arguments over some reasonable period of time.
In this case, the measurement strategy for acute and
chronic stress is distinguished only by duration. However,
another strategy for measuring marital stress is to obtain a
single rating about marital stressors pertaining to a period
of time (e.g., child rearing, finances, etc.). Both measure-
ment strategies are valid, but they probably measure
somewhat different aspects of the relationship between
spouses. We will note both acute and chronic measures
throughout the article.
Environmental Measures of Stress
Self-report questionnaires are the most common method
of measuring stress. Several approaches have been devel-
oped reflecting different theoretical frameworks for
conceptualizing stress. Some of the earliest environmental
approaches focused on the occurrence of life events as a
means of quantifying the amount of stress the individual
had been exposed to. Initially, only major events were
measured, while later minor events or hassles and the
person’s perception of stress caused by the event
were incorporated in the measures. Another, more recent
approach is real-time assessment of events, mood, and
coping responses. In contrast to the traditional retrospec-
tive questionnaire approach, real-time assessment
involves multiple prospective assessments of the respon-
dent’s experience at the moment. (The real-time
approach is applicable to the measurement of both envir-
onmental and perceived stress.)
The earliest measures of stress focused on the occur-
rence of life events. The Holmes and Rahe Social
Readjustment Scale, published in 1967, includes 43
weighted items of important life changes both positive
and negative, such as marriage or death of family member
that might have happened to the respondent in the last
12 months. The cumulative sum of events was viewed as an
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index of the degree of stress experienced by the individual.
Ten years later, Sarason and colleagues developed the Life
Experiences Survey that asks the respondent to indicate if
any 30–57 life events (depending upon instrument version)
occurred in the last 12 months and to rate the impact of the
event on a 5-point scale that yields life change units.
Negative and positive event scores can be summed sepa-
rately or together for a total score. Bruce Dohrenwend
developed the Psychiatric Epidemiology Research
Interview (PERI) life events scale in the 1980s, and more
recently, Stamm and colleagues developed a 20-item ques-
tionnaire, the Stressful Life Experiences Screening, that
focuses on traumatic life events and asks the respondent
to indicate the extent to which they have experienced each,
and the degree of stress at the time of the event and now.
Scales assessing only major life events were criticized
by some for failing to include typical sources of chronic
stress for most people. Richard Lazarus and colleagues
asserted that small daily difficulties or hassles should be
the focus of stress measurement to capture the extent to
which an individual is psychologically burdened by
chronic stressors. They developed the 117-item Hassles
Scale including items relating to difficulties with finances,
time pressure, employm ent, health, and family. While
earlier research supported the association of major life
events and subsequent health, subsequent work documen-
ted the independent association of stress induced by daily
hassles in predicting health outcomes.
Another approach is a change of measurement method
more tha n item content. Assessment of stress can be done
for much shorter time periods, thus avoiding the bias of
retrospective reporting. Stone and colleagues were among
the first to measure stress on a daily basis prospect ively in
the early 1980s. This approach has been able to capture
the relationship between elevations in stress preceding
onset of a respiratory infection and concurrent changes
in immunological function. In addition, it has raised doubt
about the accuracy of measures of coping that generalize
across time and situations.
This was taken to an even finer level of detail with the
development of the strategies termed the Experience
Sampling Method (ESM) and Ecological Momentary
Assessment (EMA). These measurement strategies
involve sampling peoples’ momentary experiences as
they occur using hand-held recording devices, which
yield a profile of the experiences throughout the day.
These self-reports of both environmental occurrences
(small events) and inner feelings (stressfulness) can be
associated with ambulatory measurements of physiologi-
cal indicators, enabling a dynamic view of environmental,
perceived, and physiological approaches to stress mea-
surement. A good example of this research is that of
Thomas Kamar ck, who is studying psychosocial stress
exposure during the course of the day. In this work, an
individual could be characterized as experiencing work
stress if they felt work experiences were very demanding,
yet that they also ha d little control over them (as opposed
to providing the same information based on recall judg-
ments of the same).
Perceptual Measures of Stress
The second type of stress measurement has generated
measures that focus on the subjective appraisal of stress
in one’s life and on associated emotions. With the recogni-
tion of posttraumatic stress disorder in the 1980 Diagnostic
and Statistical Manual of Mental Disorders, question-
naires and structured interviews began to incorporate the
designated psychiatric symptomatology. These measures
all involve self-reports from individuals about their feel-
ings and appraisals of their psychosocial environment;
thus, they are all questionnaire-based assessments.
Several questionnaires have been designed to assess the
degree of chronic stress an individual perceives. The
Perceived Stress Scale (PSS) publi shed by Sheldon
Cohen and colleagues in 1983 is a typical example.
Currently, three version s are available: 4-items, 10-items,
and 14-items; all use a reporting period of the last month,
and yield a total score. The scale’s items are designed to
reflect the degree to which the respondent experiences life
as unpredictable, uncontrollable, and overloaded, and that
the resources necessary to respond to the event are insuffi-
cient. Scores from a normative sample of over 2300 adults
have been published. Cohen has shown that the PSS not
only is associated with psych opathology, but it is also
independently associat ed with health outcomes, such as
development of a cold when a rhinovirus is introduced,
likelihood of being a cigarette smoker, lower physical
activity, and impaired immun e function.
The Derogatis Stress Scale, first published in 1980,
takes an even more complex approach. It is based on the
interactional stress model of Lazarus and Folkman that
incorporates measurement of three domains: environ-
mental events (vocational, interpersonal, and health),
personality characteristics (time pressure, excessive
achievement drive, and relaxation potential), and emo-
tional response (hostility, anxiety, and depression). The
scale uses 77 items to assess the three domains and yields
scale scores for each, a global score, as well as a score for
the respondent’s subjective level of stress. Normative data
on 1000 working adults is published. Few studies have
examined associations with biological or health outcomes.
The Impact of Events Scale, reported by Horowitz and
colleagues in 1979, is an example of instruments designed
to measure posttraumatic psychiatric symptomotology.
This 15–22-item instrument asks respondents to indicate
the frequency of intrusive thoughts, avoidance and numb-
ing, and physiological hyperarousal in the last 7 days. It is
most frequently used to document traumatic stress in
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different populations and as an outcome meas ure in trials
designed to reduce posttraumatic stress.
Physiological Measures of Stress
During the past decades many tests for labo ratory
research on acute stress in humans have been developed.
Probably the most prominent is the Trier Social Stress
Test (TSST). In front of an audience and monitored by a
camera and tape recorder, subjects are asked to deliver a
motivated performance task.
In thousands of TSSTs performed in many different
laboratories worldwide, much data have been collected
showing a robust rise of stress hormones, autonomic
measures, immune parameters, and perceived stress in
the majority of the tested subjects. Interest ingly, phy-
siological and psychological responses do not or only
poorly correlate, indicating that both psychological and
biological measures need to be applied for a reasonable
assessment of the stress response.
For the TSST, broad intra-and inter-individual dif-
ferences in the stress response have been observed. Age,
gender, dietary and drug consumption, medical
conditions and interventions, personality factors, social
support and social hierarchy, menstrual cycle,
pregnancy and lactation in women, time of testing,
habituation, early-life experience, and genetic factors,
among others, are known to influence the acute stress
reaction. These factors and the complex interaction
amongtheminagivenindividual finally explain s uch
differences.
The TSST has been shown to exert robust effects on
several psychobiological measures:
Psychological measures: anxiety, negative mood, and
perceived stress.
Autonomic measures: blood pressure, heart rate, heart
rate variability, electrodermal activity, perspiration,
body temperature, epinephrine, and norepinephrine.
Endocrine and metabolic measures: adrenocorticotro-
pic hormone (ACTH), plasma and saliva cortisol,
prolactin, growth hormone, and glucose.
Hematological measures: hematocrit, hemoglobin, and
plasma volume.
Coagulation measures: fibrinogen, von Willebrand fac-
tor antigen,
D-dimer, and clotting factors.
Immune meas ures: neutrophils, eosinophils, basophils,
lymphocytes, interleukin-6, and tumor necrosis factor
alpha (TNF).
Genetic measures: repression/induction profiles of
genes in target tissues.
Psychomotor measures: muscle activity (electromyo-
gram), voice (spectral analyses), limb movements, and
dexterity (Figure 1).
This broad spectrum of response measures has turned out
to be useful in both basic and clinical research. For exam-
ple, it has been shown that specific pharmacological and
psychological interventions change single profiles, pre-
dicting comparable effects in clinical practice.
As mentioned above, measures of perceived stress are
poorly associated with biological measures of stress. This is
also true for the assessment of chronic stress. For example,
both elevated and dampened cortisol levels have been
reported to be associated with depression, posttraumatic
stress disorders, irritable bowel disease, burnout, chronic
fatigue, fibromyalgia, etc. Thus, an endocrine status does
not necessarily predict a psychological status or specific
stress-related disorders. Rather, it seems that the HPA axis
can adapt to chronic stress by first becoming up-and later
down-regulated. In both cases, however, corticotropin-
releasing factor (CRF)/ arginine vasopressin (AVP)
neurons of the hypothalamus may be overactivated, first
triggering HPA axis hyperactivity, and later becoming
disinhibited due to low cortisol levels.
While a hypercortisolemic state may promote the
metabolic syndrome and disorders of the immune system,
hypocortisolism seems rather to facilitate pain, fatigue,
and irritability, probably by disinhibition of proinflamma-
tory cytokines, prostaglandin synthesis, and noradrenergic
neurons in the central nervous system. Effects of
chronic stress on the sympathetic nervous system seem
to be mainly observed in panic disorder and essential
hypertension.
Yet another approach to use biomarkers as measures of
chronic stress is the concept of ‘allostasis’ and ‘allostatic
load.’ The basic assumption is that allostasi s allows adap-
tation to chronic stress by maintaining (homeostatic)
stability through change. There are four conditions
under which this kind of adaptation occurs: (1) failure to
habituate to repeated stressors of the same kind; (2) failure
to turn off each stress response in a timely manner due to
delayed shut down; (3) repeated frequency of stress
responses to multiple novel stressors; and (4) inadequate
response that leads to compensatory hyperactivity of
other mediators. Allostatic overload refers to dysregula-
tions of multiple physiological systems, which exert
cumulative strain on multiple organs and tissues.
Measures of allostatic load predict some variance of
diverse health outcomes, including cognitive and physical
functioning, cardiovascular and inflammatory disease,
and even mortality. Allostatic load is assessed as a com-
posite index by the number of biomark ers for which an
individual is at risk.
However, the physiological pathways linking chronic
stress to health outcomes are affected by the interplay of
multiple variables: genetic and epigenetic determinants,
brain maturation during pre- and postnatal development,
duration, quality, and intensity of life events, and resili-
ence; socioeconomic conditions; coping skills, organ
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function, etc. Thus, chronic stress affects subjects quite
differently, and the individual outcomes of stress are very
heterogeneous. Clearly, a meaningful interpretation of
stress effects on health needs to consider such individual
constellations.
From such a viewpoint, measures of chronic stress
have to be defined differently, particularly if they should
serve a diagnostic purpose. Hypothetically, one could
define neuroendophenotypes, which descri be discrete
brain systems that participate in the stress response. For
each of these systems, one could develop psychological,
biological, and symptomatic outcome measures, which
reflect the activity or reactivity of each system.
Furthermore, one could describe how gene–environment
interactions affect these systems. A diagnostic assessment
of chronic stress effects would then comprehend a num-
ber of measures which could probably tell, which of
these neuroendophenotypes participate in stress-related
disorders of a given patient. If so, individualized pharma-
cotherapeutic and psychotherapeutic treatments could be
assigned.
A first approach of this kind has been termed
Neuropattern. To reduce com plexit y and heterogeneity
as well as to avoid the missing covariance of the psycho-
logical and biological stress response, this approach
solely focuses on the interfaces, that participate in the
cross talk between the brain and the rest of the body.
Endophenotypes for the activity and reactivity of these
interfaces were defined and are assessed by measures of
concomitant psychological, biological, and symptomatic
events. Practically, each physician can apply
Neuropattern to explore if and how stress affects his/
her patient’s health. The Neuropattern kit contains
questionnaires, a small electrophysiological device, and
tubes for the collection of saliva. In his/her office, the
physician provides master f ile data, a br ief medical his-
tory, and takes several measures, such as blood pressure,
waist-to-hip ratio, body mass index, etc. At home, the
patient fills questionnaires, collects saliva samples before
and after a low-dose dexamethasone test, and uses a
portable electrocardiogram. Once all d ata have been
collected, the patient sends the kit to a company, which
performs the laboratory analyses of all the data and
performs a comprehensive medical report for the
physician. This strategy allows to transport expert
knowledge to the practitioner across m edical disciplines,
Stress
22
20
Stress
Salivary free control (nmol l
–1
)
18
16
14
12
10
8
6
0
0 20 40 60 80 100 120
550
500
Stress
Total plasma cortisol (nmol l
–1
)
450
400
350
300
250
200
0
0 20 40 60 80 100 120
70
60
TSST 1
TSST 2
TSST 3
Stress
ACTH (pg ml
–1
)
50
40
30
20
0
0 20 40 60 80 100 120
80
70
Epinephrine (pg ml
–1
)
60
50
40
30
0
0 1020304050
Stress
1000
900
Norepinephrine (pg ml
–1
)
800
700
600
500
Time (min)
Baseline Stress Recovery
0
0 1020304050
105
100
Heartrate (bpm)
95
90
80
85
75
70
0
Figure 1 Endocrine and heart rate responses in 88 healthy volunteers under three repeated TSST exposures (SEM; 4-week
intervals). Reproduced with permission from Schommer NC, Hellhammer DH, and Kirschbaum C (2003) Dissociation between reactivity
of the hypothalamus–pituitary–adrenal axis and the sympathetic–adrenal–medullary system to repeated psychosocial stress.
Psychosomatic Medicine 65(3): 450–460.
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and without implying specific education or expertise
from the r espective physician.
Perspectives
Both our knowledge and methods in the assessm ent of
stress rapidly proceed, and, obviously, new biotechnolo-
gies and psychological measure will enable us to assess
neuroendophenotypes of stress. In the future, it should be
possible to refer such neuroendophenotypes to discrete
neurobiological systems and functions, which can be
assessed with respect to their genetic, epigenetic, physio-
logical, and psychological features, so as to assess their
relevance to the development of stress-related psycholo-
gical and physical disorders.
See also: Animal Tests for Anxiety; Circadian and
Ultradian Clocks/Rhythms; Depression; Effects of Stress
on Learning and Memory; Maternal Deprivation; Offensive
and Defensive Aggression; Psychosocial Influences on
Immunity; Regulation of the HPA Axis by Acute and
Chronic Stress; Social Bonding and Attachment; Stress
and Social Behavior.
Further Reading
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Stress: A Guide for Health and Social Scientists. New York: Oxford
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Derogatis LR (1987) The derogatis stress profile (DSP): Quantification of
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Hellhammer DH and Hellhammer J (eds.) (2008) Stress the Brain
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Measuring Stress 191
Encyclopedia of Behavioral Neuroscience, 2010, Vol. 2, 186-191
... Human trait anxiety is commonly measured using rest state recording [11] whereas, state anxiety is an instant form of anxiety and is generally measured in response to some stimulus which instigates mental strain [12]. When a person is facing stress or anxiety, the human body responds by providing the required physiological and immune system adjustment in order to achieve the required cerebral equilibrium [13]. Stressors trigger changes in the human nervous system which instigates numerous physical and physiological variations in the human body which have been measured with different markers to date [14]. ...
... Hence the raw EEG data is represented by the power spectrum of its frequency bands [80]. Obtained frequency bands of the EEG signal from each channel of the Emotiv EPOC include delta (2-4 Hz), theta (5-7 Hz), alpha (8-12 Hz), beta (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), and gamma (30-45 Hz) bands. Following this, the feature extraction is performed from these frequency ranges. ...
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Human anxiety is a grave mental health concern that needs to be addressed in the appropriate manner in order to develop a healthy society. In this study, an objective human anxiety assessment framework is developed by using physiological signals of electroencephalography (EEG) and recorded in response to exposure therapy. The EEG signals of twenty-three subjects from an existing database called “A Database for Anxious States which is based on a Psychological Stimulation (DASPS)” are used for anxiety quantification into two and four levels. The EEG signals are pre-processed using appropriate noise filtering techniques to remove unwanted ocular and muscular artifacts. Channel selection is performed to select the significantly different electrodes using statistical analysis techniques for binary and four-level classification of human anxiety, respectively. Features are extracted from the data of selected EEG channels in the frequency domain. Frequency band selection is applied to select the appropriate combination of EEG frequency bands, which in this study are theta and beta bands. Feature selection is applied to the features of the selected EEG frequency bands. Finally, the selected subset of features from the appropriate frequency bands of the statistically significant EEG channels were classified using multiple machine learning algorithms. An accuracy of 94.90% and 92.74% is attained for two and four-level anxiety classification using a random forest classifier with 9 and 10 features, respectively. The proposed state anxiety classification framework outperforms the existing anxiety detection framework in terms of accuracy with a smaller number of features which reduces the computational complexity of the algorithm.
... Stress can be defined as a disturbance in an individual's homeostatic balance, with which the body attempts to cope, and this is known as the stress response [11]. Stress can be acute, i.e., immediate response to a stressor, or chronic, i.e., a state caused by a constant stress stimulus [12]. Chronic stress can lead to a stage where the body can no longer achieve homeostatic balance and the individual can no longer deal with the stressors. ...
... Moreover, estradiol levels were unrelated to any competitive feeling. [51] 2004 Salivary cortisol (in the blood) 12 The psychosocial stress test, Trier social test (TSST), and reading test ...
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Stress is a known contributor to several life-threatening medical conditions and a risk factor for triggering acute cardiovascular events, as well as a root cause of several social problems. The burden of stress is increasing globally and, with that, is the interest in developing effective stress-monitoring solutions for preventive and connected health, particularly with the help of wearable sensing technologies. The recent development of miniaturized and flexible biosensors has enabled the development of connected wearable solutions to monitor stress and intervene in time to prevent the progression of stress-induced medical conditions. This paper presents a review of the literature on different physiological and chemical indicators of stress, which are commonly used for quantitative assessment of stress, and the associated sensing technologies.
... This illustrates that physiological and subjective stress measures canand often dodissociate (D. Hellhammer, Stone, Hellhammer and Broderick, 2010;J. Hellhammer and Schubert, 2012). ...
Article
Acute stress triggers a broad psychophysiological response that is adaptive if rapidly activated and terminated. While the brain controls the stress response, it is strongly affected by it. Previous research of stress effects on brain activation and connectivity has mainly focused on pre-defined brain regions or networks, potentially missing changes in the rest of the brain. We here investigated how both stress reactivity and stress recovery are reflected in whole-brain network topology and how changes in functional connectivity relate to other stress measures. Healthy young males (n = 67) completed the Trier Social Stress Test or a control task. From 60 min before until 105 min after stress onset, blocks of resting-state fMRI were acquired. Subjective, autonomic, and endocrine measures of the stress response were assessed throughout the experiment. Whole-brain network topology was quantified using Eigenvector centrality (EC) mapping, which detects central hubs of a network. Stress influenced subjective affect, autonomic activity, and endocrine measures. EC differences between groups as well as before and after stress exposure were found in the thalamus, due to widespread connectivity changes in the brain. Stress-driven EC increases in the thalamus were significantly correlated with subjective stress ratings and showed non-significant trends for a correlation with heart rate variability and saliva cortisol. Furthermore, increases in thalamic EC and in saliva cortisol persisted until 105 min after stress onset. We conclude that thalamic areas are central for information processing after stress exposure and may provide an interface for the stress response in the rest of the body and in the mind.
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Introduction: Stress is associated with a multitude of physical and psychological health impairments. To tackle these health disorders, over-the-counter (OTC) products like Neurodoron® are popular since they are considered safe and tolerable. Experience reports and first studies indicate that Neurodoron® is efficient in the treatment of stress-associated health symptoms. To confirm this, a non-interventional study (NIS) with pharmacies was conducted. Methods: The NIS was planned to enroll female and male patients who suffered from nervous exhaustion with symptoms caused by acute and/or chronic stress. The main outcome measures were characteristic stress symptoms, stress burden, and perceived stress. Further outcome measures included perceived efficacy and tolerability of the product as assessed by the patients and collection of adverse drug reactions (ADRs). A study duration of about 21 days with a recommended daily dose of 3-4 tablets was set. Results: 279 patients were enrolled at 74 German pharmacies. The analyzed set (AS) included 272 patients (mean age 44.8 ± 14.4 years, 73.9% female). 175 patients of the AS completed the NIS. During the study, all stress symptoms declined significantly (total score 18.1 vs. 12.1 (of max. 39 points), p < 0.0001). Furthermore, a reduction of stress burden (relative difference in stress burden, VAS = -29.1%, p < 0.0001) was observed. For most patients, perceived stress was reduced at the study end (PSQ total score decreased in 70.9% of the patients). 75.9% of the study population rated the product efficacy as "good" or "very good" and 96.6% rated its tolerability as "good" or "very good." One uncritical ADR was reported. Discussion/Conclusion. This study adds information on the beneficial effects of Neurodoron® in self-medication. The results from this NIS showed a marked reduction in stress burden and perceived stress, along with an excellent safety profile of the medicinal product (MP) Neurodoron®. Further trials are required to confirm these results.
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Tiger individuals are translocated to ex-situ conservations due to human-tiger conflicts and may express behavioral change (stereotypic) in captivity. Furthermore, medical check-up routines may cause injury and stress between tiger and operators under tough circumstances. Positive reinforcement conditioning (PRC) is a well-known method to minimize the risks on medical examination and as social enrichment. Therefore, the purposes of this research are (i) to examine PRC on tiger's blood sample collections and (ii) the correlation between physiological stress and tiger's stereotypic behavior (SB) through the neutrophil per lymphocyte ratio (N/L ratio) method. Four Sumatran tigers’ (1 female, 3 males) behavior were observed using focal animal sampling at Tambling Wildlife Nature Conservation Rescue Centre, Lampung, Indonesia. Each baseline and post-enrichment tiger's behavioral observations were conducted for 1.920 minutes (1 male & 1 female) and 960 minutes (2 males). Then SB was categorized into low (<33,33%), intermediate (33,34-66,66%) or high (>66,67%). Blood collections (BC) were conducted twice (1st without PRC and 2nd with PRC) directly on the tiger after the behavior observation. Tiger's physiological stress during BC was analyzed with Wilcoxon. The correlation between physiological stress and SB was analyzed with Kruskal-Wallis. All tigers’ N/L ratios were in normal value from this present research during both BC. The tigers did not show chronic stress as long as this research was conducted. PRC was significantly effective to reduce tiger physiological stress during BC (Z= -0,730, P= 0,465 < 0,05). All tigers showed low (<33,33%) pacing SB (without fur-plucking, self-biting, and self-mutilation behavior) both in baseline and post-enrichment. Any fur-plucking, self-biting & self-mutilation behaviors were not observed. Physiological stress was not correlated to SB (X2= 3, P= 0,392 > 0,05). The PRC was an appropriate and effective tool to handle Sumatran tigers during BC. These tigers performed SB as a coping mechanism in the enclosure.
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Zusammenfassung Stress und seine komplexen Wirkungen werden bereits seit Anfang des 20. Jahrhunderts erforscht. Die vielfältigen psychischen und physischen Stressoren in der Arbeitswelt können in Summe zu Störungen des Organismus und zu Erkrankungen führen. Da die Ausprägung körperlicher und subjektiver Folgen von Stress individuell unterschiedlich ist, lassen sich keine absoluten Grenzwerte ermitteln. Zur Erforschung der systematischen Mustererkennung physiologischer und subjektiver Stressparameter sowie einer Stressvorhersage, werden in dem vorliegenden Beitrag Methoden des maschinellen Lernens (ML) eingesetzt. Als praktischer Anwendungsfall dient die Logistikbranche, in der Belastungsfaktoren häufig in der Tätigkeit und der Arbeitsorganisation begründet liegen. Ein Gestaltungselement bei der Prävention von Stress ist die Arbeitspause. Mit ML-Methoden wird untersucht, inwieweit Stress auf Basis physiologischer und subjektiver Parameter vorhergesagt werden kann, um Pausen individuell zu empfehlen. Im Beitrag wird der Zwischenstand einer Softwarelösung für ein dynamisches Pausenmanagement für die Logistik vorgestellt. Praktische Relevanz: Das Ziel der Softwarelösung „Dynamische Pause“ besteht darin, Stress in Folge mentaler und physischer Belastungsfaktoren in der Logistik präventiv vorzubeugen und die Beschäftigten auf lange Sicht gesund, zufrieden, arbeitsfähig und produktiv zu halten. Infolge individualisierter Erholungspausen als Gestaltungselement, können Unternehmen unterstützt werden, Personalressourcen entsprechend der dynamischen Anforderungen der Logistik flexibler einzusetzen.
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Public speaking is a common type of social evaluative situation and a significant amount of the population feel uneasy with it. It is of utmost importance to detect public speaking stress so that appropriate action can be taken to minimize its impacts on human health. In this study, a multimodal human stress classification scheme in response to real-life public speaking activity is proposed. Electroencephalography (EEG), galvanic skin response (GSR), and photoplethysmography (PPG) signals of forty participants are acquired in rest-state and during public speaking activity to divide data into a stressed and non-stressed group. Frequency domain features from EEG and time-domain features from GSR and PPG signals are extracted. The selected set of features from all modalities are fused to classify the stress into two classes. Classification is performed via a leave-one-out cross-validation scheme by using five different classifiers. The highest accuracy of 96.25% is achieved using a support vector machine classifier with radial basis function. Statistical analysis is performed to examine the significance of EEG, GSR, and PPG signals between the two phases of the experiment. Statistical significance is found in certain EEG frequency bands as well as GSR and PPG data recorded before and after public speaking supporting the fact that brain activity, skin conductance, and blood volumetric flow are credible measures of human stress during public speaking activity.
Conference Paper
Have you ever studied or worked abroad? Most people assume it would be stressful --- but would you ever think that it could be detrimental to your health, though? Stress literature relates cross-cultural transactions to the chances of gaining higher levels of chronic stress. The present article aims to study if the psychological stress linked to relocation to a different country can possibly lead to psychobiological effects of chronic stress, namely elevated levels of resting heart rate. A longitudinal pilot study was conducted for 10 expatriate students during the first 2-5 months (with a mean of 3.6 months) of their relocation. Quantitative data was gathered via surveys cross-sectionally, the health data and daily activity journals were collected weekly and provided continuous information about the participants' pulse rate and clues of what its changes can be related to. The results show that the participants have changes in the resting heart rate (RHR) baseline and thus are consistent with those of previous chronic stress research. However, additional further research is required for the consistency of the data and for identifying risk markers and individual stress pathways, with the goal of identifying "at-risk" students and providing treatment options before any serious harm is done to their health.
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Assessment in clinical psychology typically relies on global retrospective self-reports collected at research or clinic visits, which are limited by recall bias and are not well suited to address how behavior changes over time and across contexts. Ecological momentary assessment (EMA) involves repeated sampling of subjects' current behaviors and experiences in real time, in subjects' natural environments. EMA aims to minimize recall bias, maximize ecological validity, and allow study of microprocesses that influence behavior in real-world contexts. EMA studies assess particular events in subjects' lives or assess subjects at periodic intervals, often by random time sampling, using technologies ranging from written diaries and telephones to electronic diaries and physiological sensors. We discuss the rationale for EMA, EMA designs, methodological and practical issues, and comparisons of EMA and recall data. EMA holds unique promise to advance the science and practice of clinical psychology by shedding light on the dynamics of behavior in real-world settings.
Chapter
Here is a monumental work that continues in the tradition pioneered by co-author Richard Lazarus in his classic book Psychological Stress and the Coping Process. Dr. Lazarus and his collaborator, Dr. Susan Folkman, present here a detailed theory of psychological stress, building on the concepts of cognitive appraisal and coping which have become major themes of theory and investigation. As an integrative theoretical analysis, this volume pulls together two decades of research and thought on issues in behavioral medicine, emotion, stress management, treatment, and life span development. A selective review of the most pertinent literature is included in each chapter. The total reference listing for the book extends to 60 pages. This work is necessarily multidisciplinary, reflecting the many dimensions of stress-related problems and their situation within a complex social context. While the emphasis is on psychological aspects of stress, the book is oriented towards professionals in various disciplines, as well as advanced students and educated laypersons. The intended audience ranges from psychiatrists, clinical psychologists, nurses, and social workers to sociologists, anthropologists, medical researchers, and physiologists.
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Serious shortcomings in existing instruments for assessing life events coupled with the inadequacy of retrospective designs in evaluating hypotheses concerning the causal impact of experience led to the development of a new methodology for assessing daily occurrences. First, using diary recordings a sample supplied a pool of events. These events were then categorized, arranged in outline form and linked to a set of dimensions used to rate psychological reactions to the events which were experienced. This initial instrument was pilot-tested for two weeks with husbands (targets) reporting their own experiences and their wives completing the form as observers. The instrument allowed husbands to adequately record their daily experiences and several predictions (e.g., desirable events related directly to 'positive' moods) were confirmed. Nonetheless, husband-wife concordance was low and prompted an additional study. Several revisions based on participants' comments and our own experience with the initial form were made and more extensive training was provided to the participants. Additionally, some subjects received phone calls on selected days to allow us to better understand the reasons for low husband-wife concordance. The major source of discordance was that information known to the target was unavailable to the observer. Thus, the instrument appears to be a convenient way of collecting accurate data on daily experience. (Author)