Psychological characteristics and physiological reactivity to acute stress in mothers of children with autism spectrum disorder

Stress related to parenting a child with autism spectrum disorder can differently affect caregiver's physiological reactivity to acute stress. Here, parental stress levels, psychological characteristics, and coping strategies were assessed alongside measures of heart rate, heart rate variability, and cortisol during a psychosocial stress test in mothers of children with ASD (M‐ASD, n = 15) and mothers of typically developing children (n = 15). M‐ASD reported significantly higher levels of parental stress, anxiety, negative affectivity, social inhibition, and a larger preference for avoidance strategies. M‐ASD showed larger heart rate and cortisol responses to the psychosocial stress test. A positive relationship was found between parental stress levels and the magnitude of the cortisol stress response in both groups. The present findings indicate exaggerated physiological reactivity to acute psychosocial stress in M‐ASD and prompt further research to explore the role of individual differences in mediating the effects of parental stress on physiological stress responses.     

Stress,symptoms of depression and anxiety,and cortisol patterns in working parents

Whether stress or psychological distress is associated with alterations in diurnal cortisol secretion patterns in healthy adults is still uncertain. In this study, the authors tested for associations between stress or symptoms of depression or anxiety and changes in diurnal cortisol patterns in 91 working parents (57 women and 34 men) across the United States. Saliva samples were collected for cortisol analysis at six timepoints over 2 days. The diurnal cortisol slope and time‐weighted average cortisol levels were analysed in relation to (1) two survey measures of stress, (2) diary reports of stress during cortisol sampling, and (3) self‐reported depression and anxiety. Cortisol slopes and average cortisol levels varied widely across individuals and within individuals across days. Only two of the 24 associations between stress or psychological symptoms and cortisol were significant at the p < 0.05 level; men with more severe symptoms of anxiety had significantly higher average cortisol levels and women who reported that work was more frequently stressful had significantly lower average cortisol levels. These results highlight the variability of diurnal cortisol secretion patterns in healthy adults and suggest that neither stress nor psychological symptomatology is a strong determinant of differences in diurnal cortisol patterns in healthy individuals. Copyright © 2004 John Wiley & Sons, Ltd.     

Applying a cognitive‐emotional model to nonsuicidal self‐injury

The recently proposed cognitive‐emotional model of nonsuicidal self‐injury (NSSI) draws on emotion regulation models and social cognitive theory to understand the onset, maintenance, and cessation of NSSI. We tested the prediction of the model that the relationship between emotional reactivity and NSSI is moderated by specific cognitions about self‐injury (i.e., self‐efficacy to resist NSSI, NSSI outcome expectancies), emotion regulation, and rumination. A sample of 647 university students aged 17–25 years (M = 19.92, SD = 1.78) completed self‐report measures of the constructs of interest. As expected, we found that emotional reactivity was positively related to NSSI, particularly for people who had weak self‐efficacy to resist NSSI. However, emotional reactivity was negatively related to NSSI for people who were more likely to use expressive suppression to regulate emotion. Implications for the theoretical understanding of NSSI are discussed.     

Stress and quality of sleep among individuals diagnosed with diabetes

Several studies have suggested that stress and sleep may be related to diabetic disease progression. Cortisol is one physiological indicator of stress that has been well validated in previous research. The primary objectives of the present study were (1) to examine the experiences of stress among patients diagnosed with diabetes and (2) to evaluate the quality of sleep among these participants. Participants (mean age = 34.99 years) were 20 adolescents and adults with Diabetes Mellitus; 13 had Type 1 and 17 were female. Primary measures included actigraphy, the Pittsburgh Sleep Quality Index (PSQI), salivary cortisol and the Perceived Stress Scale (PSS). Participants reported a moderate amount of stress (mean PSS scores = 20.2), slept an average of 6.51 h and exhibited at least one clinical indicator of sleep disturbance. Objectively measured total sleep time was associated with awakening cortisol (r = 0.62, p = 0.004) and PSQI Global scores (r = ‐0.51, p = 0.021). Awakening cortisol and PSS scores were not associated with PSQI Global scores, but were related to specific self‐reported sleep disturbances. Given the interacting physiological pathways of stress and sleep, both of which were evident in this small sample, these variables warrant further study. Copyright © 2009 John Wiley & Sons, Ltd.     

Exploring daily affective changes in university students with a mindful positive reappraisal intervention: A daily diary randomized controlled trial

Brief and cost‐effective interventions focused on emotion regulation techniques can buffer against stress and foster positive functioning. Mindfulness and positive reappraisal are two techniques that can mutually enhance one another to promote well‐being. However, research testing the effectiveness of interventions combining mindfulness and reappraisal is lacking. The current pilot examined the effect of a combined mindful‐reappraisal intervention on daily affect in a 5‐day diary study with 106 university students. Participants were randomized to a mindful‐reappraisal intervention (n = 36), a reappraisal‐only intervention (n = 34), or an active control activity (n = 36). All participants described a negative event each day but only reappraised the event in the intervention conditions. Using multilevel growth modelling, results indicated that negative affect in both interventions declined over 5 days compared to the control; however, there were no differences in the growth of positive affect. Compared to reappraisal‐only, the mindful‐reappraisal group reported overall lower daily negative affect and marginally higher daily positive affect over the 5‐day intervention. These findings suggest that brief daily practice combining mindfulness and positive reappraisal can be trained as a self‐regulatory resource to promote positive affect and buffer negative affect above and beyond reappraisal practice alone.     

Medically unexplained symptoms in women as related to physiological stress responses

The present, cross‐sectional study explored whether self‐reported symptoms are related to physiological stress indicators in a group of 43‐year‐old women representing the general population in Sweden. Analyses were performed both on raw scores of physiological indicators and on a multisystem summary index of allostatic load as a measure of cumulative biological burden. Participants answered a health questionnaire and underwent a medical examination including blood pressure, heart rate measurements, determination of blood lipids and stress hormones. Urinary epinephrine and norepinephrine were measured both on a working day and a work free day at home. In addition, salivary morning cortisol was measured on a non‐work day. The physiological profiles based on raw scores from 222 women showed that women with a high symptom load had significantly higher levels of cortisol (p < 0.05), and higher heart rate (p < 0.05) than did those with a low symptom load. In contrast, women with a low symptom load had significantly higher levels of epinephrine on a work free day than did women with a high symptom load (p < 0.05). No significant differences were found in norepinephrine responses. When analysing the summary measure of allostatic load in relation to symptom prevalence no significant difference between the symptom groups emerged. One possible explanation for this result could be that a majority of the study population was healthy, reporting a low level of symptoms in general. However, the results support the notion that common, medically unexplained symptoms among women are associated with certain biological parameters known to play a role in the development of ill health. Copyright © 2004 John Wiley & Sons, Ltd.     

Cortisol variability and self‐reports in the measurement of work‐related stress

We examined whether a high cortisol awakening response (CAR) and low cortisol decline over the day (CDD) are related to self‐reported work stress and well‐being, and whether there are gender differences in these relationships. Three hundred eighty‐three working men and women responded to a survey measuring job stress factors, mastery at work, symptoms and well‐being. Salivary cortisol was sampled at awakening, after 45 min and at 21:00, from which the variables CAR and CDD were defined. A high CAR was associated with lower perceived job control and work mastery, and poorer well‐being. Low CDD was associated only with higher job demands, but the self‐report scores showed a number of interactions between cortisol group and gender. Among women, those showing a low CDD, compared with those with a higher CDD, had more favourable scores on a number of job stress factors and symptom load. In contrast, among men, a similar comparison showed those with low CDD to have poorer scores on job stress factors and symptom load. We conclude that individuals displaying high CAR or low CDD differ from those not displaying these cortisol profiles in self‐report of work stress and well‐being, and that gender differences appear in these relationships. Copyright © 2010 John Wiley & Sons, Ltd.     

Combining walking and relaxation for stress reduction—A randomized cross‐over trial in healthy adults

Both physical activity and relaxation have stress‐relieving potential. This study investigates their combined impact on the relaxation response while considering participants' initial stress level. In a randomized cross‐over trial, 81 healthy adults completed 4 types of short‐term interventions for stress reduction, each lasting for 1 hr: (1) physical activity (walking) combined with resting, (2) walking combined with balneotherapy, (3) combined resting and balneotherapy, and (4) resting only. Saliva cortisol, blood pressure, state of mood, and relaxation were measured preintervention and postintervention. Stress levels were determined by validated questionnaires. All interventions were associated with relaxation responses in the variables saliva cortisol, blood pressure, state of mood, and subjective relaxation. No significant differences were found regarding the reduction of salivary cortisol (F = 1.30; p = .281). The systolic blood pressure was reduced best when walking was combined with balneotherapy or resting (F = 7.34; p < .001). Participants with high stress levels (n = 25) felt more alert after interventions including balneotherapy, whereas they reported an increase of tiredness when walking was combined with resting (F = 3.20; p = .044). Results suggest that combining physical activity and relaxation (resting or balneotherapy) is an advantageous short‐term strategy for stress reduction as systolic blood pressure is reduced best while similar levels of relaxation can be obtained.     

Dynamic changes in salivary cortisol and secretory immunoglobulin A response to acute stress

Psychological stress leads to the secretion of cortisol. While this psychoneuroendocrine response helps to maintain physiological as well as psychological homeostasis under stress, exaggerated release of cortisol can suppress aspects of immune function and have negative effects on health. The present study set out to investigate the dynamic changes in salivary secretory immunoglobulin A (sIgA) and cortisol before and after acute stress, and to analyse the relationship between sIgA and cortisol trend. Thirty‐five healthy subjects took part in this study. All subjects underwent an acute stress test (mental arithmetic task). Salivary cortisol and sIgA responses were assessed repeatedly before the stress test, immediately after the stress test and 20 min after the stress test. The levels of salivary cortisol and sIgA both significantly increased after the acute mental arithmetic challenge. However, the increase of sIgA is transient; the sIgA fall was significantly correlated with the cortisol rise during the 20 min after stress (r = 0.569, p < 0.001). These results may help determine the timing of effective intervention in order to reduce the hypersecretion of cortisol and improve mucosal immune function. Copyright © 2008 John Wiley & Sons, Ltd.     

The effect of perceived appearance judgements on psychological and biological stress processes across adulthood

Social self‐preservation theory posits that stress is experienced when an aspect of an individual's identity has the potential to be negatively evaluated. Appearance is a central part of identity; however, little research has examined whether perceived appearance judgements are a source of social‐evaluative stress. In addition, stress may be an explanatory link in the association between appearance perceptions and depressive symptoms. This study examined whether perceived appearance judgements were associated with increased stress and greater depressive symptoms among adults. Study 1 examined the associations between self‐reported appearance judgements and cortisol stress responses in response to a laboratory stressor (Trier Social Stress Test) among 71 individuals aged 18–65. Study 2 assessed self‐reported appearance judgements and depressive symptoms among 498 adults ages 18–65 via an online survey data collection. Appearance judgement was associated with a stronger cortisol response, higher self‐reported stress, and greater depressive symptoms. Stress mediated all associations between appearance judgements and depressive symptoms and neither age nor gender moderated these associations. The findings suggest that appearance judgements contribute to psychological and biological stress processes and demonstrated that stress mediated the association between appearance judgements and depressive symptoms.     

Correlates of hair cortisol concentrations in disadvantaged young children

Children from highly disadvantaged families tend to experience worse health, educational, and job outcomes than less disadvantaged peers. However, the mechanisms underlying these relationships remain to be explicated. In particular, few studies have investigated the relationships between the psychosocial influences that children are exposed to early in life and longer term cortisol output. This study aims to contribute to the literature by exploring how disadvantaged young children's experiences of family adversity, and parenting and family functioning, are related to their long‐term cortisol levels. A sample of 60 children (26 males, mean = 4.25 years, SD = 1.68) and their mothers (mean = 34.18 years, SD = 7.11) from a low‐income population took part in a single assessment. Mothers completed questionnaires on the family environment, parenting practices, and child behaviour. Children provided a hair sample for cortisol assay and anthropometric measures. A parsimonious multivariate regression model (including potential predictors identified by a selection algorithm) was used to investigate the correlates of hair cortisol concentration (HCC) in children. Higher levels of social exclusion, being male, and younger age were each associated with higher HCC. Maternal nurturing and emotion coaching were associated with lower HCC. Findings suggest that chronic stress may underlie relationships between adversity and its long‐term effects and that HCC offers a promising method for examining chronic stress in children and evaluating interventions by which it can be ameliorated.     

The influence of production systems on physiological responses measured in urine and saliva

The aim of the present study was to investigate physiological effects of highly similar production systems with different degrees of automation by use of urinary catecholamines and cortisol as well as salivary cortisol. Furthermore, it was determined whether the physiological response was related to real‐time self‐reports in terms of feelings of positive and negative arousal, physical exertion, and sleepiness. Sixteen healthy women sorting wooden slats participated in the study. The work was highly repetitive and demanded intense concentration and rapid qualified decisions. The women rotated between three production systems with varying degrees of automation. Real‐time logbooks were completed and urine was collected five times and saliva seven times on four workdays and on one day off. When working at the most automated production system urinary concentrations of adrenaline and noradrenaline were 14 per cent lower compared to those obtained when working at the other production systems. For salivary cortisol, the profile over the day differed between production systems. The type of production system did not affect urinary cortisol. Feelings of positive and negative arousal were associated with increased concentrations of urinary adrenaline, while sleepiness was associated with lower salivary cortisol. These associations were independent of the relationship between production systems and biomarkers. In conclusion, decreased physiological arousal was observed in response to increased automation and real‐time self‐reports appeared to be related to specific physiological systems. Copyright © 2003 John Wiley & Sons, Ltd.     

Exposure to Discrimination and Heart Rate Variability Reactivity to Acute Stress among Women with Diabetes

Exposure to racial discrimination has been linked to physiological reactivity. This study investigated self‐reported exposure to racial discrimination and parasympathetic [high‐frequency heart rate variability (HF‐HRV)] and sympathetic (norepinephrine and cortisol) activity at baseline and then again after acute laboratory stress. Lifetime exposure to racial discrimination was measured with the Schedule of Racist Events scale. Thirty‐two women (16 Black and 16 White) with type 2 diabetes performed a public speaking stressor. Beat‐to‐beat intervals were recorded on electrocardiograph recorders, and HF‐HRV was calculated using spectral analysis and natural log transformed. Norepinephrine and cortisol were measured in blood. Higher discrimination predicted lower stressor HF‐HRV, even after controlling for baseline HF‐HRV. When race, age, A1c and baseline systolic blood pressure were also controlled, racial discrimination remained a significant independent predictor of stressor HF‐HRV. There was no association between lifetime discrimination and sympathetic markers. In conclusion, preliminary data suggest that among women with type 2 diabetes mellitus (T2DM), exposure to racial discrimination is adversely associated with parasympathetic, but not sympathetic, reactivity. Copyright © 2013 John Wiley & Sons, Ltd.     

Stress experiences of parents with premature infants in a special care nursery

A controlled prospective longitudinal study was carried out to determine the stress experiences of parents whose premature infants were admitted to a tertiary‐based special care nursery in Melbourne, Australia. The control group consisted of parents of term infants matched on maternal age, parity and socioeconomic status. Sixty mothers and 59 fathers of premature infants and 60 mothers and fathers of term infants were followed from birth to 16 weeks after discharge home. A range of repeated self‐reports was carried out regarding feelings, moods, marital/partner relationships, availability and satisfaction with perceived social support and salivary markers of stress (cortisol and tribulin) were collected. Assessments occurred on five occasions with parents of premature infants and with parents of healthy term infants, data were collected on three occasions. Findings revealed that parents of premature infants reported higher subjective stress levels than parents of term infants within the first week of their infant's birth but returned lower objective markers of stress. There was no correlation between self‐reported stress and the biochemical markers of stress. The stress levels for parents of premature infants reduced over time. Issues for future research are discussed. Copyright © 2003 John Wiley & Sons, Ltd.     

Basal SIgA and cortisol levels predict stress‐related health outcomes

The present study investigates the relationship between stress and health in young adults. We predicted that academic stressor exposure would lead to an increase in self‐reported stress and health symptoms, as well as alterations in salivary secretory immunoglobulin A (SIgA) and salivary cortisol concentration. Thirty‐four healthy participants were administered stress and health inventories and tested to assess SIgA and cortisol levels during a baseline (low‐stress) session and during an examination (high‐stress) session. Self‐report stress and health scores increased between low‐ and high‐stress sessions in all participants. Cortisol level also increased between study sessions, but only in those participants who experienced an increase in perceived stress. No changes in SIgA were observed. Multiple linear regression revealed that baseline SIgA and cortisol level moderated the relationship between stressor exposure and health outcome. Participants with low basal SIgA levels and high basal cortisol levels had poorer health outcomes during the examination session than did participants with high basal SIgA levels and low basal cortisol levels. Neither cortisol reactivity, nor SIgA reactivity moderated the relationship between stressor exposure and health outcome. These findings suggest that individual differences in basal immune and endocrine activity predict stress‐related susceptibility to ill health. Copyright © 2006 John Wiley & Sons, Ltd.     

A Pilot Study: Short‐term Reduction in Salivary Cortisol Following Low Level Physical Exercise and Relaxation among Adolescents and Young Adults on the Autism Spectrum

Many adolescents and young adults with autism spectrum disorders (ASD) experience high levels of stress and anxiety. The purpose of this pilot study was to examine whether physical exercise and relaxation could reduce stress and anxiety among those with ASD. Salivary cortisol levels were collected before and after each of three sessions during an 8‐week exercise programme. Our findings showed a significant reduction in cortisol at the end of the sessions compared with the beginning. This was supported by a self‐report anxiety measure. Although reductions in these stress measures were not sustained over time, our results highlight the potential of exercise and relaxation for improving symptoms of stress. Future studies are needed which examine longer term reductions in stress following physical exercise interventions. Copyright © 2011 John Wiley & Sons, Ltd.     

An Online Educational Program for Individuals With Dissociative Disorders and Their Clinicians: 1‐Year and 2‐Year Follow‐Up

Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and posttraumatic stress disorder (PTSD) symptoms with significant disability. Patients with DD have high rates of nonsuicidal self‐injury (NSSI) and suicide attempts. Despite this, there is a dearth of training about DDs. We report the outcome of a web‐based psychoeducational intervention for an international sample of 111 patients diagnosed with dissociative identity disorder (DID) or other complex DDs. The Treatment of Patients with Dissociative Disorders Network (TOP DD Network) program was designed to investigate whether, over the course of a web‐based psychoeducational program, DD patients would exhibit improved functioning and decreased symptoms, including among patients typically excluded from treatment studies for safety reasons. Using video, written, and behavioral practice exercises, the TOP DD Network program provided therapists and patients with education about DDs as well as skills for improving emotion regulation, managing safety issues, and decreasing symptoms. Participation was associated with reductions in dissociation and PTSD symptoms, improved emotion regulation, and higher adaptive capacities, with overall sample |d|s = 0.44–0.90, as well as reduced NSSI. The improvements in NSSI among the most self‐injurious patients were particularly striking. Although all patient groups showed significant improvements, individuals with higher levels of dissociation demonstrated greater and faster improvement compared to those lower in dissociation |d|s = 0.54–1.04 vs. |d|s  = 0.24–0.75, respectively. These findings support dissemination of DD treatment training and initiation of treatment studies with randomized controlled designs.     

Cumulative Trauma Exposure,Emotion Regulation,and Posttraumatic Stress Disorder Among Incarcerated Women

Incarcerated women report high rates of trauma exposure and posttraumatic stress disorder (PTSD). Emotion regulation has been identified as a potential mechanism that contributes to the association between trauma exposure and PTSD severity. The present study examined associations among cumulative trauma exposure, emotion regulation difficulties, and current (30‐day) PTSD in 152 randomly selected women in prison. Utilizing structural equation modeling (SEM), results indicated cumulative trauma was significantly associated with emotion regulation difficulties, β = .31, SE = .13, p  = .005; and PTSD symptom severity, β = .41, SE = .14, p  = .005. We identified a significant indirect effect, 0.11, z = 2.37, p = .018, of emotion regulation on the association between cumulative trauma exposure and severity of current PTSD symptoms. These findings are consistent with previous longitudinal research suggesting that emotion regulation is significantly affected by trauma exposure, and they support previously identified associations between emotion regulation difficulties and severity of PTSD. Further, these findings have the potential to inform current efforts to identify and implement effective PTSD‐focused interventions with incarcerated women. In particular, it appears that emotion regulation skills may be an important component of effective PTSD focused interventions for this population.