Trier Social Stress Task Research Articles

Negative auditory hallucinations are associated with increased activation of the defensive motivational system in schizophrenia

Auditory hallucinations (AH) are the most common symptom of psychosis. The voices people hear make comments that are benign or even encouraging, but most often voices are threatening and derogatory. Negative AH are often highly distressing and contribute to suicide risk and violent behavior. Biological mechanisms underlying the valence of voices (i.e., positive, negative, neutral) are not well delineated. In the current study, we examined whether AH voice valence was associated with increased activation of the Defensive Motivational System, as indexed by central and autonomic system response to unpleasant stimuli. Data were evaluated from two studies that used a common symptom rating instrument, the Psychotic Symptom Rating Scale (PSY-RATS), to measure AH valence. Participants included outpatients diagnosed with SZ. Tasks included: Study 1: Trier Social Stress Task while heart rate was recorded via electrocardiography (N = 27); Study 2: Passive Viewing Task while participants were exposed to pleasant, unpleasant, and neutral images from the International Affective Picture System (IAPS) library while eye movements, pupil dilation, and electroencephalography were recorded (N = 25). Results indicated that negative voice content was significantly associated with: 1) increased heart rate during an acute social stressor, 2) increased pupil dilation to unpleasant images, 3) higher neural reactivity to unpleasant images, and 4) a greater likelihood of having bottom-up attention drawn to unpleasant stimuli. Findings suggest that negative AH are associated with greater Defensive Motivational System activation in terms of central and autonomic nervous system response.

Reducing neuroendocrine psychosocial stress response through socio-emotional dyadic but not mindfulness online training.

Stress-related diseases pose significant health risks and show wide prevalence. Empirical evidence suggests that contemplative practices, such as socio-emotional dyadic mental exercises, hold promise in mitigating the adverse effects of stress and promoting psychosocial well-being. This study aimed to investigate the differential effects of two online contemplative mental training programs on the psychosocial stress response: the first involved classic mindfulness practices, while the second incorporated a socio-emotional dyadic approach known as Affect Dyad. The study was conducted as part of the longitudinal CovSocial project's phase 2 in the context of the COVID-19 pandemic. 140 individuals participated in the Trier Social Stress Task (TSST), where the psychosocial stress response was assessed with cortisol saliva samples and subjective stress questionnaires in a cross-sectional design after the active training groups finished their intervention period. Participants were randomly assigned to the socio-emotional training group, mindfulness-based training group, or a control group that did not receive any training. Both training programs consisted of a ten-week intervention period with a daily 12-minute app-based mental training practice and weekly 2-hour online coaching sessions led by mental training teachers. Results showed that the socio-emotional Dyad group but not the mindfulness-based group exhibited significantly lower cortisol levels at 10, 20, 30, and 40 minutes after the stressor as well as lower total cortisol output compared to the control group during the TSST, indicating a reduced hormonal stress response to a social stressor. Subjective markers did not show differences between the three groups. These findings indicate that the daily socio-emotional dyadic practice, which emphasizes non-judgmental and empathic listening as well as the acceptance of challenging emotions in the presence of others within one's daily life context, may serve as a protective factor against the adverse effects of psychosocial stress triggered by the fear of negative social judgments. Given the high prevalence of stress-related diseases, such online mental training programs based on dyadic practices may thus represent an efficient and scalable approach for stress reduction.

Social network size moderates the association between loneliness and cardiovascular reactivity to acute stress

Loneliness and objective measures of social isolation (e.g., social network size) have been associated with increased risk of cardiovascular disease (CVD). However, the evidence is mixed and the precise causal mechanisms remain unclear. Cardiovascular reactivity (CVR) to acute stress has been posited as a proposed mechanism. This study aimed to investigate: (i) effects of loneliness and social isolation on CVR to stress and, (ii) whether the loneliness – CVR relationship was moderated by social network size. Two hundred and six participants from the Pittsburgh Cold Study underwent a modified version of the Trier Social Stress Task. Cardiovascular measures of systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were taken throughout the laboratory stress trial. Hierarchical regression analyses found that social network size was positively associated with DBP reactivity (β = 0.19 95 % CI [0.05, 0.29] p = 0.005), while loneliness was not. In addition, social network size moderated the loneliness - DBP reactivity relationship such that a higher number of outer social network ties were beneficial at lower levels of loneliness but not higher. The current study contributes new evidence linking loneliness and social network size to cardiovascular psychophysiology but raises questions about the loneliness - CVD relationship. The findings confirm the importance of social network size and highlight that the characteristics of the networks may be more important than the number of networks.

Cortisol and changes in depressive symptoms: The moderating role of DHEA

Stress is associated with activation of the hypothalamus-adrenal-axis (HPA). Cortisol, a product of the HPA, is thought to predict depression. However, to date, the majority of studies investigating the cortisol-depression relationship have been cross-sectional and results have been mixed. One possible reason for these mixed findings, may be that many studies fail to consider the moderating role of dehydroepiandosterone (DHEA), which is released alongside cortisol and is thought to serve opposing functions. Therefore, the present study investigated the main and interactive effects of cortisol and DHEA on depressive symptoms. Salivary cortisol and DHEA were measured from saliva throughout the Trier Social Stress task for N = 417 participants at baseline. Participants reported on their depressive symptoms using the Beck Depression Inventory - II at both baseline and follow up (ranging from 1–20 months post baseline; M = 11.60, SD = 5.80) as well as general demographics. The lavaan package in R (version 0.6.11; Rosseel, 2012) was used to conduct multiple regression analyses with FIML to explore the relationships between these variables. Results demonstrated no main effect of cortisol or DHEA, but did show a significant interaction with DHEA. The relations between cortisol and depressive symptoms depended on levels of DHEA such that the relationship was positive at low and negative at high levels of DHEA, with the overall interaction significant (β = −.22, p < .001, 95% CI = [−.333, −.115]). DHEA can act as a protective factor against depression when cortisol levels are high. This presents opportunities for future research on how to improve DHEA levels to potentially reduce depression.

Acute stress selectively blunts reward anticipation but not consumption: An ERP study

Stress-induced dysfunction of reward processing is documented to be a critical factor associated with mental illness. Although many studies have attempted to clarify the relationship between stress and reward, few studies have investigated the effect of acute stress on the temporal dynamics of reward processing. The present study applied event-related potentials (ERP) to examine how acute stress differently influences reward anticipation and consumption. In this study, seventy-eight undergraduates completed a two-door reward task following a Trier Social Stress Task (TSST) or a placebo task. The TSST group showed higher cortisol levels, perceived stress, anxiety, and negative affect than the control group. For the control group, a higher magnitude of reward elicited a reduced cue-N2 but increased stimulus-preceding negativity (SPN), suggesting that controls were sensitive to reward magnitude. In contrast, these effects were absent in the stress group, suggesting that acute stress reduces sensitivity to reward magnitude during the anticipatory phase. However, the reward positivity (RewP) and P3 of both groups showed similar patterns, which suggests that acute stress has no impact on reward responsiveness during the consummatory phase. These findings suggest that acute stress selectively blunts sensitivity to reward magnitude during the anticipatory rather than the consummatory phase.

Sex differences in stress responses among underrepresented minority adolescents at risk for substance use disorder

Adolescence is a period of dramatic physiological changes preparing individuals to face future challenges. Prolonged exposure to stressors during childhood can result in dysregulated stress systems which alter normative physiological progression, leading to exacerbated risk for developing psychiatric disorders. Parental substance use disorder (SUD) is considered a significant childhood stressor which increases risk for the offspring to develop SUD. Thus, it is important to understand stress reactivity among adolescents with parental SUD. We used the Trier Social Stress Task (TSST), which includes a public speech presentation, as an acute stressor. Changes in heart-rate (HR) were measured while disadvantaged minority adolescents with and without a family history (FH+/FH-) of SUD performed the TSST. We investigated sex-specific stress response patterns during the TSST. HR peaked during the speech presentation and was overall higher in females than males. Changes in HR measures between baseline and speech showed an interaction between biological sex and FH group. Specifically, FH- females and FH+ males had significantly larger positive HR changes than FH- males. These results suggest that male and female adolescents with parental SUD have atypical, but divergent changes in stress reactivity that could explain their increased risk for developing SUD via different sexually dimorphic mechanisms.

The relationship between salivary Fibroblast Growth Factor-2 and cortisol reactivity and psychological outcomes prior to and during the COVID-19 pandemic.

Fibroblast growth factor-2 (FGF2) is a biomarker that is associated with depression, anxiety and stress in rodents. In humans, we have previously demonstrated that salivary FGF2 increased following stress in a similar pattern to cortisol, and FGF2 (but not cortisol) reactivity predicted repetitive negative thinking, a transdiagnostic risk factor for mental illness. The current study assessed the relationship between FGF2, cortisol, and mental health before and during the COVID-19 pandemic. We employed a longitudinal correlational design using a convenience sample. We assessed whether FGF2 and cortisol reactivity following the Trier Social Stress Task (TSST) were associated with DASS-21 depression, anxiety and stress, measured at the time of the TSST in 2019-20 (n=87; time 1), and then again in May 2020 during the first wave of COVID-19 in Sydney (n=34 of the original sample; time 2). FGF2 reactivity (but not absolute FGF2 levels) at time 1 predicted depression, anxiety, and stress across timepoints. Cortisol reactivity at time 1 was associated with stress over timepoints, and absolute cortisol levels were associated with depression across timepoints. The sample was comprised of mostly healthy participants from a student population, and there was high attrition between timepoints. The outcomes need to be replicated in larger, more diverse, samples. FGF2 and cortisol may be uniquely predictive of mental health outcomes in healthy samples, potentially allowing for early identification of at-risk individuals.

Socioeconomic Status and Cortisol Concentrations during a Social-Evaluative Stressor: Associations with Emotional Reactivity

The Reserve Capacity Model suggests that individuals from low socioeconomic status (SES) backgrounds are more reactive to stress. However, SES has been inconsistently associated with cortisol responses to acute stressors. This study examined how SES affects emotional and cortisol reactivity to an acute social-evaluative stressor. We hypothesized that low SES individuals would show more emotional reactivity during the stressor, higher peak cortisol, and elevated cortisol an hour after the stressor. Participants were adults from the Pittsburgh Cold Study 3 (N = 213, M = 30.1 yrs., SD = 10.9, 57% male). In the laboratory study, participants underwent the Trier Social Stress Task (TSST) and provided seven salivary cortisol samples throughout the task. The current analyses focused on concentrations of peak cortisol (+10 minutes) and final samples (+50 minutes) as proxies for estimating physiological reactivity and recovery to the stressor. Emotional reactivity was captured through one item asking about feelings of nervousness during the stressor. SES was calculated as composite score combining income and education. Covariates included age, sex, race, and baseline cortisol concentration. All variables were collected prior to virus exposure. Low SES was associated with high emotional reactivity during the TSST, but not with cortisol peak or final concentrations. Emotional reactivity significantly mediated the relationship between low SES and elevated peak cortisol but not final cortisol concentrations. Findings from the present study suggest that SES predicts emotional reactivity to a laboratory stressor which, in turn, predicts cortisol reactivity to said stressor.

The interplay of acute cortisol response and trait affectivity in associating with stress resilience

Resilience is the cornerstone to mental health, and entails multiple biological and psychological mechanistic processes. However, the interplay of the psychobiological processes in shaping resilience is unclear. Here we report the results of testing whether an acute cortisol response and positive affectivity traits moderate the relationship between participants’ five-year major life stress and current psychological symptoms. The participants comprised 147 individuals (93 females and 54 males, age = 24–45 years) without clinical diagnosis. Acute stress was induced using the Trier Social Stress Task. We found that both the cortisol response to anticipatory acute stress and positive affectivity moderated the stress–symptom relationship. Specifically, a positive relationship between life stress and current symptoms was only observed at low, but not high, levels of cortisol response and positive affectivity. Moreover, the moderating effect of cortisol response was only observed at a low level of trait positive affectivity. These results unravel how the biological and emotional processes of the stress response interact to shape resilience to major life stress.

Stress-induced impairment reveals the stage and features of post-error adaptive adjustment.

An increased reaction time often occurs after error responses (post-error slowing, PES). However, the role of top-down regulation in post-error processing remains to be debated. Impairing cognitive control function through acute stress would help to investigate the role and stage of top-down adaptive regulation in post-error processing. Here, we recruited 50 healthy male participants who were randomly assigned to either a stress condition (Trier Social Stress Task, TSST) or a control condition (control version of the TSST). A color-word Stroop task with different response stimulus intervals (RSIs) was used to investigate the effects of acute stress on different stages of post-error processing. The results showed that cortisol, heart rate, perceived stress level, and negative affect were higher in the stress group (n = 24) than in the control group (n = 26), indicating successful stress induction. The accuracy of post-error response in the control group increased with the extension of RSI, and the reaction time decreased. However, the accuracy of 1,200 ms RSI was close to that of 700 ms RSI in the stress group but was significantly lower than that in the control group. The results suggested that acute stress caused the impairment of top-down adaptive regulation after error. Furthermore, our study manifested adaptive adjustment only in the late stages of post-error processing, indicating the phasic and adaptive features of post-error adjustment.

Nonsuicidal self-injury, sleep quality, and shame response to a laboratory stress task.

Nonsuicidal self-injury (NSSI) frequently functions to regulate shame-based emotions and cognitions in the context of interpersonal stress. The present study sought to examine how sleep quality (SQ) may influence this process in a laboratory setting. Participants included 72 adults (Mage = 24.28; 36 with a lifetime history of NSSI) who completed a self-report measure of prior month SQ and engaged in a modified Trier social stress task (TSST). State shame ratings were collected immediately before and following the TSST, as well as 5 min post-TSST, to allow for the measurement of shame reactivity and recovery. No significant results emerged for NSSI history and SQ as statistical predictors of shame reactivity. However, NSSI history was significantly associated with heightened shame intensity during the recovery period of the task, and this was moderated by SQ. Simple slopes analyses revealed a conditional effect whereby poorer SQ (1SD above the mean) was associated with greater intensity of shame during recovery, but only for those with a history of NSSI. Poor SQ may contribute to worrisome emotional responses to daytime stressors in those at risk for NSSI.

Negative caregiving and stress reactivity moderate the relation between early life stress and externalizing in adolescence.

Exposure to early life stress (ELS) is common and has been implicated in the development of psychopathology; importantly, however, many individuals who experience ELS do not develop emotional or behavioral difficulties. Prior research implicates stress exposure, negative caregiving behaviors, and patterns of physiological reactivity in predicting psychological well-being; however, the precise factors that contribute to resilience versus vulnerability to the adverse effects of stress exposures are not well understood. In a longitudinal study of adolescents (N=120) assessed at three timepoints approximately every 2 years beginning at the ages of 913 years, we examined the roles of autonomic reactivity to social stress (assessed through skin conductance during the Trier Social Stress Task) and negative caregiving behaviors as moderators of the association between exposure to ELS and internalizing and externalizing symptoms. We found that the relation between ELS and externalizing symptoms was moderated by both negative caregiving and autonomic reactivity, such that the relation between ELS and externalizing was positive at low levels of negative caregiving and at high levels of autonomic reactivity; interactions predicting internalizing symptoms were not statistically significant. These findings highlight the importance of considering physiological and environmental variables that might contribute to susceptibility or resilience to symptoms of psychopathology following exposure to ELS.

Stress and eating responses in adolescent females predisposed to obesity: A pilot and feasibility study

ObjectiveTo explore how chronic stress, reactivity to acute stress, and obesogenic eating are linked in adolescent females predisposed to obesity. MethodsParticipants included 21 adolescent females (mage = 14.57 years) and their biological mothers with obesity (body mass index [BMI] ≥ 30 kg/m2). The pilot and feasibility study involved adolescent self-report of chronic stress, an acute stress-induction paradigm (Trier Social Stress Task, TSST), salivary cortisol collection to assess stress reactivity, and both subjective (self-report) and objective (snack buffet) measures of obesogenic eating. ResultsAdolescent females reporting high chronic stress were significantly more likely to engage in self-reported emotional and external eating and to have higher food cravings (p's < .05) compared to adolescents with low chronic stress. Effect size estimates suggested a blunting effect of cortisol in the high chronic stress group. Blunted cortisol reactivity significantly predicted higher self-reported food cravings for the high chronic stress group (p = .04). Associations among chronic stress, cortisol, and self-reported and objective obesogenic eating reflected medium to large effect sizes. ConclusionsThis study built on limited extant research on stress and eating to demonstrate that chronic stress was associated with self-reported obesogenic eating patterns in adolescent females predisposed to obesity. Different patterns of cortisol reactivity and eating emerged depending on chronic stress group (low versus high). Understanding these eating patterns in the context of chronic stress can inform interventions to reduce obesity risks in adolescence.

Socioeconomic status in early adolescence predicts blunted stress responses in adulthood.

Individuals who grow up in families with lower socioeconomic status (SES) tend to experience disproportionate rates of chronic stress. The “freeze” response, characterized by blunted cardiovascular reactivity and reduced engagement with the environment, is associated with chronic stress and may be utilized when an individual is unable to escape or overcome environmental stressors. Using a diverse community sample of 184 adolescents followed from the age of 13 to 29 years, along with their friends and romantic partners, this study examined links between family SES and stress responses in adulthood. Low family SES at the age of 13 years directly predicted blunted heart rate responding and fewer attempts to answer math problems during a modified version of the Trier Social Stress Task at the age of 29 years. Indirect effects were found from low family SES to blunted respiratory sinus arrhythmia responding and the number of words spoken during a speech task. SES at the age of 29 years mediated many of these relations. Findings held after accounting for a number of potential confounds, including adolescent academic and attachment functioning and body mass index. We interpret these findings as evidence that low familial SES may predict freezing‐type responses in adulthood.

Sex and drug differences in stress, craving and cortisol response to the trier social stress task

The hypothalamic-pituitary-adrenal (HPA) axis is a critical hormonal system involved in stress response. A number of studies have investigated the HPA axis response of drug-dependent individuals to stressors. Stress-induced vulnerabilities in the HPA axis may differ in response to chronic use of different substances, possibly leading to different target therapies. There has not been a direct comparison of HPA axis and subjective response between individuals with different types of substance use disorders following a laboratory stress intervention. The primary goal of the current study was to compare subjective and neuroendocrine response to the Trier Social Stress Task (TSST) across multiple primary types of substance use disorders and investigate differential response between males and females. Four hundred participants were drawn from seven studies completed at the Medical University of South Carolina between 2011 and 2021. The TSST was utilized across studies and subjective and neuroendocrine responses measured following completion. Generalized linear mixed effects models and area under the response curve analysis were used to compare both substance type and sex differences. The study groups involving individuals with cocaine use disorder had blunted stress, craving and cortisol response following the TSST as compared to other substance use groups. Females in the cocaine groups reported higher subjective stress but lower cortisol than males. The study results indicate that there may be differential effects of substances on the HPA axis, with cocaine using individuals exhibiting more blunting of the HPA axis response as compared to users of other substances.

Cortisol Reactivity and Observed Parenting among Mothers of Children with and without ADHD

Objective: Neurobiological models suggest links between maternal cortisol reactivity and parenting; however, no studies have examined cortisol reactivity and parenting in mothers of school-age children with ADHD. Method: We examined the relationship between observed parenting and maternal cortisol reactivity in two laboratory contexts: the Trier Social Stress Task (TSST) and parenting-child interaction (PCI). Mothers of children with (N = 24) and without (N = 36) ADHD participated. Results: During the TSST, greater cortisol output and increase were associated with decreased positive and increased negative parenting. However, during the PCI, cortisol output was associated with increased self-reported and observed positive parenting, and decreased observed negative parenting. Cortisol change during the PCI was associated with decreased observed positive parenting and increased self-reported negative parenting. Among mothers of children with ADHD, cortisol output during the PCI was negatively associated with negative, inconsistent parenting. Change in cortisol predicted more inconsistent discipline and corporal punishment. Conclusion: Findings contribute to an integrative biological, psychological, and cognitive process model of parenting in families of children with ADHD.

Effects of an incremental theory of the personality intervention on psychophysiological responses to social stress during the transition to college

This randomized controlled trial (NCT04786496) examined the effects of a preventive intervention based on Incremental Theory of the Personality (ITP) on psychophysiological responses to social stress and evaluated whether levels of depression moderate the intervention effects. The participants, 107 first-year university students, were randomly assigned to one of three conditions: ITP intervention, ITP + a self-affirmation intervention (SA), and a control condition (CC). Indicators of the Hypothalamic–Pituitary–Adrenal axis, autonomic nervous system, and subjective mood were assessed with the Trier Social Stress Task. Participants in the ITP condition displayed a lower decline in respiratory sinus arrythmia (RSA) compared to those in the CC during the first phases of the task [Slopes: -0.08 (0.09) vs -0.21 (0.09), z = 2.86, p = .004] and a higher decrease in cortisol at recovery [β = -0.18 (0.08), z = -2.37, p = .018]. Depressive symptoms moderated the effect of ITP [β = -0.10 (0.05), z = -2.15, p =.032] and ITP+SA [β = -0.09 (0.04), z = -2.06, p =.039] in the decline during stress and recovery in RSA. In participants with low/medium levels of depressive symptoms, both interventions predicted a lower decline during stress [Slopes: -0.06 (0.09) for ITP, -0.17 (.09) for ITP+SA, and -0.26 (0.09) for CC] and higher recovery in RSA [Slopes: 0.18 (0.01) for ITP, 0.24 (0.01) for ITP+SA, and 0.30 (0.01) for CC]. The findings suggest that the ITP intervention has the potential to be an effective preventive intervention to reduce the stress response.

Stressed out and fed up: The effect of stress on maternal feeding behaviors and the moderating role of executive function

Stress is associated with a range of unhealthy eating habits, yet few studies have examined how stress may influence the intergenerational transmission of eating habits from parents to their children. Specifically, there is a lack of data regarding the role of stress on feeding practices. Moreover, most work investigating the associations between parental stress and their feeding behaviors has been correlational, limiting our understanding of causality. In the current study, we used an experimental design, induced high and low stress in mothers using a standard laboratory stressor, and observed mother-child interactions during a snack break. We also examined the potential role of maternal executive functioning (EF) for buffering the effects of stress on maternal feeding behaviors. Levels of maternal stress were manipulated with the Trier Social Stress Task (TSST) in a community sample (N = 80 dyads, Child Mage = 41.89 months, female = 43). We measured maternal EF with a series of computerized tasks. Maternal feeding behaviors were coded for controlling behaviors, which included pressuring and restricting behaviors. Results indicate a main effect of stress on controlling feeding behaviors, such that mothers in the high-stress condition exhibited higher levels of controlling behaviors. The effect of stress on controlling feeding behaviors was ameliorated among mothers with higher levels of EF after controlling for child age and income. Results provide causal evidence for the role of stress on feeding behaviors and suggest EF as a factor to be considered in the treatment and prevention of diet-related illnesses.

Brain 5-HT1A Receptor PET Binding, Cortisol Responses to Stress, and the Familial Transmission of Suicidal Behavior.

BackgroundThe serotonin 1A (5-HT1A) receptor has been implicated in depression and suicidal behavior. Lower resting cortisol levels are associated with higher 5-HT1A receptor binding, and both differentiate suicide attempters with depression. However, it is not clear whether 5-HT1A receptor binding and cortisol responses to stress are related to familial risk and resilience for suicidal behavior.Methods[11C]CUMI-101 positron emission tomography imaging to quantify regional brain 5-HT1A receptor binding was conducted in individuals considered to be at high risk for mood disorder or suicidal behavior on the basis of having a first- or second-degree relative(s) with an early onset mood disorder and history of suicidal behavior. These high-risk individuals were subdivided into the following groups: high risk resilient having no mood disorder or suicidal behavior (n = 29); high risk with mood disorder and no suicidal behavior history (n = 31); and high risk with mood disorder and suicidal behavior (n = 25). Groups were compared with healthy volunteers without a family history of mood disorder or suicidal behavior (n = 34). Participants underwent the Trier Social Stress Task (TSST). All participants were free from psychotropic medications at the time of the TSST and PET scanning.ResultsWe observed no group differences in 5-HT1A receptor binding considering all regions simultaneously, nor did we observe heterogeneity of the effect of group across regions. These results were similar across outcome measures (BPND for all participants and BPp in a subset of the sample) and definitions of regions of interest (ROIs; standard or serotonin system-specific ROIs). We also found no group differences on TSST outcomes. Within the high risk with mood disorder and suicidal behavior group, lower BPp binding (β = −0.084, SE = 0.038, P = .048) and higher cortisol reactivity to stress (β = 9.25, 95% CI [3.27,15.23], P = .004) were associated with higher lethality attempts. There were no significant relationships between 5-HT1A binding and cortisol outcomes.Conclusions5-HT1A receptor binding in ROIs was not linked to familial risk or resilience protecting against suicidal behavior or mood disorder although it may be related to lethality of suicide attempt. Future studies are needed to better understand the biological mechanisms implicated in familial risk for suicidal behavior and how hypothalamic-pituitary-adrenal axis function influences such risk.

Craving Moderates the Effects of Intranasal Oxytocin on Anger in Response to Social Stress Among Veterans With Co-Occurring Posttraumatic Stress Disorder and Alcohol Use Disorder

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur among US military veterans. Oxytocin may have therapeutic value in treating both conditions. The potential for oxytocin to augment affective features common to PTSD and AUD, such as anger, is relevant to inform emerging treatments.We examined the influence of intranasally administered oxytocin on connections between alcohol craving and stress-induced anger in a sample of 73 veterans (91.3% men) with co-occurring PTSD and AUD. Participants self-administered oxytocin (40 IU) or placebo (saline) 45 minutes before completing the Trier Social Stress Task (TSST). Self-reports of alcohol craving and anger were assessed pre- and post-TSST using a modified visual analog scale. Multiple regression analysis, including main effects for group, baseline craving, and their interaction, was used to predict post-TSST anger.A marginally significant interaction was observed, suggesting a positive association between baseline craving and anger for those in the oxytocin group (B = 0.65, P = 0.01). Among those reporting low craving, participants in the oxytocin group reported significantly lower post-TSST anger than those in the placebo group.The current study is among the first to examine relevant psychosocial moderators that may influence the effects of oxytocin among veterans with comorbid PTSD and AUD. Although oxytocin attenuated ratings of anger after a stress task among those with low baseline craving, findings suggest that oxytocin may not be as effective at reducing anger, a highly salient factor in PTSD, for individuals experiencing high levels of craving. Findings are consistent with the social salience hypothesis and suggest that individual differences in alcohol craving should be considered when evaluating oxytocin as a potential treatment for individuals with comorbid PTSD and AUD.