Abstract
The Trier Social Stress Test (TSST) is commonly used to induce stress in laboratories by instructing participants to deliver a speech and to solve arithmetic tasks in front of a committee. Its implementation in virtual reality (VR) enables an investigation of stress responses under highly standardized controllable conditions.
 The aim of this study was to compare stress responses among men and women in a VR version of the TSST (VR-TSST).
 To this end, 16 women taking oral contraceptives and 16 men underwent the VR-TSST in a modified version including a competitor. Stress ratings, heart rate, electrodermal reactivity, and salivary cortisol responses were analyzed.
 The VR-TSST induced endocrine, peripher-physiological and self-reported stress responses, indicated by a significant increase in heart rate, electrodermal activity and stress ratings as well as a small but significant cortisol response. Significant gender differences were found only for stress ratings. In conclusion, these findings confirm earlier results that VR is suitable to induce social stress both in males and females.
Highlights
The Trier Social Stress Test (TSST) developed by Kirschbaum et al in 1993 is a highly standardized stress protocol that combines social evaluative threat as well as uncontrollability of the test situation (Kirschbaum et al, 1993)
The first study integrating the TSST into virtual reality (VR) using a head mounted display (HMD) compared endocrine responses evoked by a TSST in front of a real versus a virtual audience and the authors found lower cortisol responses compared to the original version (Kelly et al, 2007)
Self-report, physiological, and humoral responses to the TSST differed between females and males: For instance, ACTH and salivary cortisol levels in response to the TSST are found to be higher for men than for women, while in woman menstrual cycle and intake of oral contraceptives exert important effects on the HPA responsiveness, too (Kirschbaum et al, 1999; Kirschbaum et al, 1992a; Montero-Lopez et al, 2018)
Summary
The Trier Social Stress Test (TSST) developed by Kirschbaum et al in 1993 is a highly standardized stress protocol that combines social evaluative threat as well as uncontrollability of the test situation (Kirschbaum et al, 1993). Self-report, physiological, and humoral responses to the TSST differed between females and males: For instance, ACTH and salivary cortisol levels in response to the TSST are found to be higher for men than for women, while in woman menstrual cycle and intake of oral contraceptives exert important effects on the HPA responsiveness, too (Kirschbaum et al, 1999; Kirschbaum et al, 1992a; Montero-Lopez et al, 2018). We aimed to investigate whether there are gender differences by comparing endocrine, peripher-physiological, and self-reported stress among men and women. Due to previous studies on the original TSST, we expected women to report higher stress ratings and men to show higher endocrine responses to the VR-TSST
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