​The Physiological Effects of Mental Stress

Erin McMurray and Alex Aquino

Keli Veillette
Biotechnology Research and Zoological Science HS
01/21/19
 PROBLEM STATEMENT

According to the American Institute Stress, stress can be defined as “physical, mental, or
emotional strain or tension” (American Institute of Stress, n.d.). Stress is experienced by all
humans, and can be caused from a number of different things, depending on the individual. As
determined by the American Institute of Stress, there are two different types of stress that a
person can experience: acute stress or chronic stress. Acute Stress is stress that is experiences for
a short amount of time, and is triggered by the brain’s flight or fight response, which triggers the
release of stress hormones, like cortisol. Chronic Stress is stress that is endured over long periods
of time, that is usually ignored and left unmanaged (American Institute of Stress, n.d.). When left
unmanaged, chronic stress can have negative effects on the immune system and the body, which
can lead to health issues (Mayo Clinic, 2016). Common symptoms of untreated common stress
include insomnia, nightmares, tremors, back pains, angina, heartburn, and severe panic attacks
just to name a few (Mayo Clinic, 2016). Symptoms of chronic stress are experienced in
variations of severity depending on the amount of stress experienced by the individual, and the
individual’s ability to deal with challenges (Alvord, n.d.). According to a survey conducted by
the American Psychological Association, more than 40 percent of adults living in America said
that they have experienced insomnia like symptoms and severe lacks of sleep due to stress
(American Psychological Association, n.d.). In the same survey, 33 percent of adults responded
that they have never discussed the area of stress managements with their health care providers.
According to another survey conducted by the National Institute for Occupational Safety and
Health (NIOSH), it was found that 40 percent of respondents said that their job is extremely
stressful, and they sourced it as the main cause of stress in their lives (Murphy, n.d.). These
trends related to stress are similar in the educational world, where it was found in a different
survey administered by the American Institute of Stress, where eight in ten college students said
that they have experience unmanaged chronic stress (American Institute of Stress, 2008). These
statistics, along with the previously described symptoms of stress, are all evidence of a clear
problem in today’s society; a lack of awareness towards stress management. The symptoms of
chronic stress that were previously mentioned are considered to be common symptoms of
chronic stress. This being said, these symptoms should not be considered as “common”, because
they are among some of the most severe symptoms of chronic stress. This means that chronic
stress has become so widespread and untreated, that it’s most severe symptoms are now
considered to be normal. The statistics provided indicate that chronic stress is experienced by
many American citizens in both the workplace and in schools, and that there is a need for
research towards providing wats for this stress to be managed (American Institute of Stress,
2016).
The information included focuses on physical effects of stress, like body temperature
increase and heart rate changes. There is also information about how the brain and body responds
to stress with different stress responses. Overall, these topics are all very important, because they
all provide information related to stress responses in the body, and the biological implication of
chronic stress.

LITERATURE REVIEW

“Influence of Mental Stress on Heart Rate and Heart Rate Variability”

The work done in this study was done to investigate if it is possible to measure stress
based off of measures of HRV (heart rate variability). The research and the paper itself were both
conducted and published in Leuven, Belgium, at Katholieke University in Leuven. The scientists
that conducted the study, J. Taelman and A. Spaepen, are from Katholieke University’s
Department of Biomedical Kinesiology, and scientists S. Vanderput and S. Van Huffel came
from the University’ Electrical Engineering Department. The work done in this study is valid,
because it was conducted by professors at a well established University. Heart rate variability
can be defined as the variation in time intervals between heartbeats, which is measured by
observing the intervals in which the heart beats (Campos, 2017). The study would also be done
to observe the autonomic nervous system’s activity, since the sympathetic nervous system
increases heart rate, and the parasympathetic nervous system decreases heart rate. This study was
done by inducing a stressful situation in the form of a mental stressor on 28 test subjects (15 men
and 13 women) of good health, and then measuring their heart rate and heart rate variability. The
participants were of a mean age of 22, with an average body mass index (BMI) of 22.2 The
participants in the experiment were students at Katholieke University, in Leuven, Belgium,
where the study took place. For each subject included in the study, data was collected in ways:
with and without a mental task. The Mensa Test, which is a difficult test that is used for
measuring IQ, was used a means of inducing mental stress (Mensa International, n.d.). Once in
the laboratory where the study was conducted, all of the participants were shown calming
images, which were used to lower their heart rates, and to put soothe their mind, preparing them
for the mental stress that the mensa test would induce. Heart rate was measured for each
participant throughout the test. HRV was calculated a different way; by examining the difference
in time between consecutive R-Peaks, which are the maximum amplitudes in the R wave of an
Electrocardiograph (ECG) (Heart Foundation, n.d.). The Electrocardiograph, which is used to
record electrical activity of the heart (Heart Foundation, n.d.), was used to measure heart rate
through the use of Nikomed brand electrodes of 10 millimeters, that were placed on the body.
Electromyography preamplifiers (EMG) were used to register the data collected in the study,
which was in the form of signals, because that is how the electrocardiograph processes data
(Heart Foundation, n.d.)
The data that was collected compared different aspects of both the resting heart rate and
the heart rate changes that occurred during the mental task. The mean RR intervals, which is the
term for heart rate variability when it is show on the electrocardiograph (Karius, n.d.), mean
standard deviation of heart rate variability, mean pNN50, which is a time domain measure of
heart rate variability that counts the number of consecutive heartbeats in increments of 50
milliseconds, and mean low frequency (LF) and high frequency (HF) values of the
electrocardiograph are all of the factors that were analyzed in this study. The RR intervals were
determined using the Pan-Tompkins algorithm, to detect the QRS complexes, which is the
combination of three graphs typically shown on the electrocardiogram (Karius, n.d.). Looking at
the QRS complex helped the scientists in the study to clearly see the RR intervals of their
subjects. HRV was calculated in this study by analyzing the time domain, and calculating it
from the RR interval. Standard deviation of RR, and standard deviation and mean of heart rate
were used as parameters for the time domain. The scientists working on the study used a Fourier
Transformation, which is a function that is used to break down functions of time into
frequencies, to determine the exact range of the time frequency. This method of calculating the
time domain by using the standard deviation and the fourier transformation is used because it
provides the most accurate solution, rather than just looking at one set of data. When looking at
the low frequency and high frequency values of the electrocardiograph, the data supported that
heart rate would increase with a mental task.
Overall among the participants in the study, it was found that 24 out of the 28 total
subjects had an increased mean heart rate when taking the mensa test. In this study, low
frequency and high frequency values of the electrocardiograph were used to measure
sympathovagal activity, which is the interaction between the sympathetic nervous system and
vagus nerve (Pagani, 2012). The vagus nerve is the tenth cranial nerve, which is found in the
upper part of the chest, that has parasympathetic control of the heart, lungs, and digestive tract
(Pagani, 2012). When analyzing sympathovagal activity, the low frequency has been shown to be
affected sympathetic and parasympathetic nervous system activity. The range of numbers found
within the low frequency of the electrocardiograph is related to activity of the sympathetic
nervous system, while the high frequency is related to activity in the parasympathetic nervous
system. In all of the participants in the study, the researchers found that both ratios for low
frequency and high frequency increased when doing the mensa test, which was used as a mental
task in this study. The researchers in the study came to the conclusion that the increases in heart
rate, low frequency, and high frequency occurred because of a heightened response of the
sympathetic nervous system while taking the mensa test. Based on all of their data that they
collected and the study as a whole, the scientists came to the conclusion that the sympathovagal
balance increased along with heart rate variability when performing a mental task. In the future,
the same research team plans to expand their research by continually analyzing heart rate
variability data, and by applying more linear and non-linear techniques to their research. A
similar study that yielded similar results was conducted by scientists from the University of Cape
Town’s Unit for Exercise Science and Sports Medicine Departments, in Cape Town, South
Africa, along with scientists from Columbia University's National Center for Addiction and
Substance Abuse in New York (Ian Lambert, 2011). This study focused on how induced
cognitive stress would affects both short term heart rate variability and mental performance. In
this study, eighteen males of good heath had that had been exposed to work related stress had
their heart rate variability examined for 10 minutes while performing a test that included
different mental challenged and puzzles. After the test, the male participants completed a survey
about their anxiety during the test. The data collected and the conclusions drawn by the scientists
in this study showed that short term heart rate variability and cognitive performance, when doing
a mental task, share a connection that relates to an experience of h. higher heart rate. This state of
a higher heart rate while taking the test, which was caused by induced stress, was concluded to
be caused by the sympathetic nervous system, which triggers the stress response in the body (Ian
Lambert, 2011). When the stress response is triggered by the sympathetic nervous system, heart
rate is one of the vitals in the body that is affected (American Institute of Stress, n.d.). Another
similar study was conducted at Texas A&M University, in the Department of Computer Science
and Engineering, where heart rate monitors were used to see if mental stress could be detected
(Choi, 2009). This experiment was conducted with the use of medical grade heart monitors, that
were placed on 4 human participants in the study. Heart rate was measured from these
participants on 2 different experimental conditions that caused mental stress, and two conditions
that induced a feeling of relaxation. Each participant underwent 20 totals trials, with the 4
different experimental conditions taking place 5 days in a row.The heart rate monitors used in
this study were in the form of sensors, that were placed on the body. The conclusions drawn
from this study were that, both medical grade and consumer grade heart rate monitors were able
to detect stress in the body (Choi, 2009). This indicated to the scientists in this study that
autonomic changes occurred in the body as their participants were undergoing stress (Choi,
2009). These two additional studies support the conclusions made by J. Taelman and A. Spaepen
from Katholieke University, because the scientists in these studies used very similar methods, in
which mental stress was induced upon participants through administering a test. They also
support J. Taelman and A. Spaepen because Jongyoon Choi, Ricardo Gutierrez-Osuna, and the
team from University of Cape Town all drew very similar conclusions to the conclusions drawn
by J. Taelman and A. Spaepen, which were that mental tasks increase heart rate and heart rate
variability in humans.
The topic of stress’s effects on the human body included in “Influence of Mental Stress
on Heart Rate and Heart Rate Variability”, is highly related to “Mechanisms and Mediators of
Psychological Stress-Induced Rise in Core Temperature”, which also talks about how stress
affects the body, but in a different way regarding to stress’s effect on body temperature, rather
than heart rate. The main similarity between the two studies conducted in these two different
papers is that both research teams focused on investigating how stress affects the body.
“Influence of Mental Stress on Heart Rate Variability” focused on how mental stress affects
heart rate, while “Mechanisms and Mediators of Psychological Stress-Induced Rise in Core
Temperature” focuses on how mental stress can cause rises in body temperature. Both studies
also focused on the responses related to mental stress in the body.“Influence of Mental Stress on
Heart Rate Variability” focused on how the different nervous systems of the body react to stress
and cause the stress response, and this “Mechanisms and Mediators of Psychological
Stress-Induced Rise in Core Temperature” discusses how neurotransmitters like serotonin
contribute to the stress responses of the human body. Both studies used mammalian test subjects,
and done by inducing mental stress.

“Mechanisms and Mediators of Psychological Stress-Induces Rise in Core Temperature”

“Mechanisms and Mediators of Psychological Stress-Induced Rise in Core
Temperature,” focused on a study conducted on different laboratory animals, like rats, in which
an investigation was conducted looking into mammalian fever responses. This experiment was
conducted by Doctors Takakazu Oka from Harvard University, and Doctor Tetsuro Hori, who
are both members of the American Psychosomatic Society, which makes them and their work
credible, because there work was done through a prestigious University, and a national science
society. This experiment was conducted to investigate the natural phenomenon of psychogenic
fever, which is a stress induced, psychosomatic reaction that causes high body temperature (Oka,
2015). Psychogenic fever is caused by both chronic stress and emotional trauma (Oka, 2015).
With this study, the scientists set out to determine whether the noticeable rise in body
temperature experienced with chronic stress is a real fever, or in fact just a typical symptom of
hyperthermia. Hyperthermia is the condition of having an elevated body temperature, due to the
body’s inability to thermoregulate properly (Roland, 2017). As said by the writers of this paper,
the purpose of this study was to “review the mechanisms and mediators of PSRCT
(psychological stress induced rise in core temperature) in animals with the aim of understanding
psychogenic fever in humans” (Oka, 2001). In the mammalian body, whether it be an animal like
a dog or a human being, there are thermosensitive neurons that are located in the preoptic area of
the hypothalamus (Oka, 2001). The thermosensitive neurons, which can either be warm sensitive
neurons or cold sensitive neurons, interact with endogenous pyrogens, which are
proinflammatory cytokines that are a part of the immune system, which increase the
thermoregulatory functions of the hypothalamus, which causes fever (Oka, 2001). Endogenous
pyrogens increase the production and firing rate of cold sensitive neurons, while simultaneously
decreasing the production and firing rate of warm sensitive neurons (Oka, 2001). Cold sensitive
neurons are responsible for activating heat production, and warm sensitive neurons are
responsible for heat loss, which explains why the presence of both endogenous pyrons and
thermosensitive neurons would cause increases in body temperature (Oka, 2001).
To conduct this experiment, a variety of laboratory animals were used, like rats, lizards,
and pigs. Stress was induced on these subjects by engaging in typical behaviors that would
normally cause an animal to feel stress in a healthy way. This type of stress, when induced upon
an animal test subject, is called open field stress, which is when an animal is removed from it’s
home cage, and handled in a large open space. Stress was also induced upon animals through a
commonly used method by scientists called cage exchange stress, which is when an animal is
place into a new cage that is different from the one that they are normally used to (Oka, 2001). In
this study, when handling a stressed out rats, mice, and rabbits, it was found that their core
temperatures increased by an average of 2 degrees celsius. Another aspect of the experiment,
conducted on reptiles, focused on how ectothermic animals that rely on outside sources of heat to
survive would respond to both stress and calming. It was found that when conducting this
experiment that when taking a lizard away from it’s heating lamp for a very short period of time
using the experimental method of open field stress inducement, that it’s body temperature still
increased despite being away from its heat source (Oka, 2001). When handled in a gentle, and
calming way, it was found that the body temperature of the lizard then decreased, and the lizard
began to move towards it’s heat lamp seeking out warmth in attempt to raise it’s core body
temperature (Oka, 2001). This particular short experiment on the lizard showed that the body’s
hyperthermic responses are depend on both emotion and stimuli, because the stimuli from
changing the lizard’s environment caused it’s core body temperature to increase, and then the
feeling of being gently handled caused an emotional response, where the lizard’s core body
temperature decreased as stress was relieved. On a part of the experiment conducted on rats, it
was found that anti-inflammatory drugs like sodium salicylate can affect increases and decreases
in body temperature in the presence of stress (Oka, 2001). When administered either
intraperitoneally or intracerebroventricularly, it was found that sodium salicylate and
indomethacin significantly decreased the rise in core body temperature in rats exposed to open
field stress (Oka, 2001). This is because the anti-inflammatory properties of these drugs, that
provide oxygen to the body with the use of cyclooxygenase inhibitors, that worked hand in hand
to prevent core body temperature increases. Typically, the core body temperature of a rat rises
within a few minutes, and reached a peak temperature within 15 minutes, after being exposed to
open field stress (Oka, 2001). In a lizard called ​Callopistes maculatus,​ sodium salicylate
prevented fever, along with gentle handling of the lizard. In both rats and guinea pigs, it was
found that stress augmented the release of the neurotransmitter noradrenaline in the
hypothalamus, which is the main neurotransmitter of the sympathetic nerves of the
cardiovascular system (Oka, 2001). This altered release of noradrenaline caused a stress induced
rise core body temperature in both the rats and the guinea pigs, because the release of
noradrenaline in the preoptic area of the hypothalamus, causes the intra-preoptic area of the
hypothalamus to administer noradrenaline throughout the nervous system (Oka, 2001). In rats
and rabbits, local applications of noradrenaline activated cold sensitive neurons, and inhibited
warm sensitive neurons, causing an increase in core body temperature resemblant to that of a
fever (Oka, 2001). Intracerebroventricularly injecting beta adrenergic receptor antagonists in a
rat immersed in shallow water as a psychological stress model showed that core body
temperature increase was inhibited, because the release of neurotransmitters was blocked. When
using a different beta blocker, called nadolol, it was found that core body temperature increase
was not affected because this beta blockers is unable to cross the blood brain barrier (Oka, 2001).
This side study showed that beta adrenoreceptors in the central nervous system and in the
preoptic area of the hypothalamus are involved in psychological stress induced rise in core
temperature (Oka, 2001). Another neurotransmitter that affects core body temperature in
mammalian test subjects is serotonin. One short study showed that application of serotonin in the
body increased the functionality of warm sensitive neurons, while decreasing the functionality of
cold sensitive neurons in both rats and rabbits, causing core body temperature to very slightly
decrease. This response is typical to the hypothermic effects of intracerebroventricularly
administered serotonin (Oka, 2001). A more in depth study that used different mammal subjects
in a different trial of this research project showed that serotonin raised core body temperature
when it was injected in the preoptic area of the hypothalamus of cats. The scientists working on
this small study came to the conclusion that this hypothermic reaction is caused by the activation
of serotonin receptors. Anxiolytic drugs, like benzodiazepines, where found by the same research
team to have an inhibiting effect on anxiety-stress induced rises in core body temperature (Oka,
2001)). In rat test subjects, it was found that dopamine decreases core body temperature, because
it inhibits the activity of cold sensitive neurons in the preoptic area of the hypothalamus. Unlike
other neurotransmitters, dopamine agonists and antagonists had no effect on the anticipatory
anxiety stress-induced rise in core body temperature, which lead scientists to draw the conclusion
that dopamine has no effects or involvement in the stress induced rise in core body temperature
(Oka, 2001). “​Psychogenic Fever: How Psychological Stress Affects Body Temperature in the
Clinical Population”​ , supports the conclusions drawn in “​Mechanisms and Mediators of
Psychological Stress-Induced Rise in Core Temperature”​ . In “​Psychogenic Fever: How
Psychological Stress Affects Body Temperature in the Clinical Population”​ , which was also
conducted by Dr. Takakazu Oka, it was found that core body temperature also increased in
mammals, and in this study humans, when experiencing chronic stress. Both studies drew the
same conclusions, which were that in mammals core body temperature is increased by engaging
in a mental task.
 One of the main conclusions drawn by the scientists in this study is that there are two
different mechanisms of psychological stress-induced rises in core temperature: a mechanism
that depends upon PGE2, and one that is independent of PGE2, but is instead dependant upon
serotonin. The PGE2 (prostaglandin) dependent mechanism causes core temperature to increase
through PGE2 synthesis, while the second mechanism causes core body temperature to increase
with the presence of noradrenaline in the brain, without PGE2 synthesis. In the case of humans,
doctors usually treat psychogenic fever with cyclooxygenase inhibitors, because they lower the
core body temperature (Oka, 2001). This brings into question whether humans exhibit PGE2
dependendent psychogenic fever like the animals in the study did. Currently the answer to this
question is unknown, but it is known that psychogenic fever is suppressed by anxiolytic,
neuroleptic, and antidepressant drugs. In human patients with and without psychogenic fever, it
was found that blood levels of cytokines shared no difference between the normal core body
temperature state and the raised core body temperature state. The most important conclusion
drawn by the scientists from the animal studies was that the main mediators of psychogenic
fever are the neurotransmitters GABA, serotonin, noradrenaline, and PGE2. Future studies will
aim to investigate how these neurotransmitters interact with the occurrence of psychological
stress induces rise in core temperature in both lab animals and human beings. An additional
highly related source to “​Mechanisms and Mediators of Psychological Stress-Induced Rise in
Core Temperature
A very highly related research project to “​Mechanisms and Mediators of Psychological
Stress-Induced Rise in Core Temperature”​ conducted by Doctors Takakazu Oka from Harvard
University, and Doctor Tetsuro Hori is “​Age and Gender Differences of Psychogenic Fever​”.
“​Age and Gender Differences of Psychogenic Fever​” describes a separate project conducted by
Takakazu Oka and his research assistant Kae Oka. “​Age and Gender Differences of Psychogenic
Fever”​ looked into the occurrences of psychogenic fever and how they differ amongst different
age groups and genders. This experimenters completes “​Age and Gender Differences of
Psychogenic Fever”​ by researching Japanese medical databases and various Japanese medical
publication that were related to psychogenic fever. It was found that psychogenic fever was the
most prevalent amongst both males and females ranging from ages 13 to 56 (Oka ,2007).
“​Mechanisms and Mediators of Psychological Stress-Induced Rise in Core Temperature”​ is
highly related to “​Age and Gender Differences of Psychogenic Fever”​ , because the latter of the
two discusses the specific range of people affected by psychogenic fever, which is explained in
the former of the two, “​Mechanisms and Mediators of Psychological Stress-Induced Rise in Core
Temperature”​ . This focus on the relationship between body temperature and mental stress is also
looked into in “​Effects of Heat Stress on Cognitive Performance: The Current State of
Knowledge”​ . “​Effects of Heat Stress on Cognitive Performance: The Current State of
Knowledge”​ , was conducted by professors from the University of Central Florida’s Department
of Psychology. This study was conducted to investigate how stress induced body temperature
increase affects cognitive function. The researchers in this study utilized healthy males and
females to look into this phenomenon. In “​Effects of Heat Stress on Cognitive Performance: The
Current State of Knowledge”​ , it was found that a heated body temperature caused slower
cognitive function in both males and females, compromising the overall ability to complete a
task (Hancock, 2002). “​Mechanisms and Mediators of Stress-Induced Rise in Core Temperature​”
is similar to “​Effects of Heat Stress on Cognitive Performance: The Current State of
Knowledge”​ , because “​Effects of Heat Stress on Cognitive Performance: The Current State of
Knowledge”​ , describes how psychogenic fever described in “​Mechanisms and Mediators of
Stress-Induced Rise in Core Temperature”​ affects cognitive function, which is also something
that is affected by stress.
The topic of stress induced rises in core body temperature discussed in “​Mechanisms and
Mediators of Psychological Stress-Induced Rise in Core Temperature”​ shares close relation to
“​Neurobiological and Systemic Effects of Chronic Stress”​ , which talks about the structural and
mental effects that stress has on the brain and body. These two topics share relation because
“​Neurobiological and Systemic Effects of Chronic Stress”​ provides insight on what the chronic
stress discussed in “​Mechanisms and Mediators of Psychological Stress-Induced Rise in Core
Temperature”​ does to the body and how it can have severe impacts on the body. “​Mechanisms
and Mediators of Psychologicals Stress-Induced Rise in Core Temperature​”, and
“​Neurobiological and Systemic Effects of Chronic Stress”​ both provide information about how
stress works in the brain, and the different effects that stress can have in the body.
 “Neurobiological and Systemic Effects of Chronic Stress”
“Neurobiological and Systemic Effects of Chronic Stress” provides a wealth of
information on how stress affects the brain, and the rest of the body. It goes in depth about the
physiological responses that occur in the brain when stress is detected, and it also provides
information on pathophysiology. “​Neurobiological and Systemic Effects of Chronic Stress​” also
discusses how structural plasticity of the adult brain can be changed in response to stress. This
article was written by Professor Bruce S. McEwen, in the Laboratory of Neuroendocrinology, at
Rockefeller University, in New York. Professor Bruce S. McEwen’s work and study is credible,
because he is a well known neuroendocrinologist in his field and the head of the neuroscience
department at the university he is employed at, meaning that his work was done with proper
funding and resources, making his work valid (Mirsky, 2017). “​Neurobiological and Systemic
Effects of Chronic Stress”​ focuses primarily on research conducted on the effects of stress on the
body, rather than focusing on a conducted experiment, where the data was then analyzed to draw
conclusions. Small experiments are described throughout this paper, but they are not it’s main
focus. Research conducted by team of scientists at Rockefeller University, lead them to establish
three distinguishable types of stress: eustress, tolerable stress, and toxic stress. Eustress, also
called good stress, is the type of stress that has a positive impact upon a person, like causing
someone to try something new, or to take a challenge. Eustress is most often followed by a
rewarding feeling and a positive outcome (McEwen, 2017). Tolerable stress, refers to situations
where stress in endured, but where the stress is manageable, and the individual knows how to
cope (McEwen, 2017). Toxic stress refers to situations where an individual has bad things
happen to him and or her, and they have no way of dealing with it. People that experience toxic
stress have most likely endured negative forms of stress in the past, that have changed the
structure of their brains, and impeded the development of proper impulse control and
management skills (McEwen, 2017). Based on Bruce S. McEwens’ research, who is a professor
of neuroendocrinology at Rockefeller University, there has been an established link between
toxic stress and allostatic overload. Allostatic overload is the term used to describe the negative
effects that long term exposure to chronic/toxic stress has on the brain. One of the negative
effects of allostatic overload is fluctuation in endocrine responses (McEwen, 2017).
When chronic stress causes structural changes in the brain, glutamate, which is an
excitatory amino acid, is usually to blame (McEwen, 2017). This is because glutamate is one of
the major excitatory neurotransmitters of the brain. When present in an excess amount, glutamate
causes inflammation, and can permanently damage to the brain (McEwen, 2017). In a separate
study done on rats that were induced with restraint stress, which causes autonomic and heart rate
increases, it was found that the presence of restraint stress in chronic amounts caused structural
changes in the brain. The apical dendrites of the hippocampus shrunk, which was caused by the
increase in extracellular glutamate levels in response to the presence of stress in the body
(McEwen, 2017). In a different study conducted by the same team, but on different rats, it was
found that overflows of glutamate in the brain caused depressive-like behavior. The rats isolated
themselves and refused to eat their food, which are two behaviors that signal depression in
animals. This was believed to have happened because the excess glutamate caused the dendrites
in the hippocampus to shrink (McEwen, 2017). A possible solution that was provided to the
excess glutamate release in the body is the use of the therapeutic, glucagon-like-peptide (GLP-1),
that has insulinotropic actions. GLP-1 promotes weight loss, exerts neuroprotective effects,
reduces plaque accumulation, and improves synaptic plasticity. All of these benefits of GLP-1
help to protect against inflammation and damage that can occur when glutamate is produced in
abundance.
A highly related study to “​Neurobiological and Systemic Effects of Chronic Stress​” and
its focus on the different ways that stress can impact the body, is “​The Impact of Daily Stress on
Health and Mood: Psychological and Social Resources as Mediators”​ . “​The Impact of Daily
Stress on Health and Mood: Psychological and Social Resources as Mediators​” looked into the
somatic and psychological impacts that stressful tasks had on the bodies of 75 married couples in
a time span of six months, with the use of 20 different tests. The researchers in this study,
Richard Lazarus, Susan Folkman, and Anita DeLongis came from University of California
Berkeley, University of California San Francisco, and University of Illinois respectively. From
this study it was found that in the six month study period that when stress was induced upon the
participants when completing common tasks, that a relationship was found between health
problems and induced stress. When stress was induced for a long period of time, many of the
participants ended up getting sick with illnesses like the flu, sore throat, headaches, backaches,
and muscle aches (Lazarus, 1988). “​The Impact of Daily Stress on Health and Mood:
Psychological and Social Resources as Mediators​” provided support toward “​Neurobiological
and Systemic Effects of Chronic Stress​”, because “​The Impact of Daily Stress on Health and
Mood: Psychological and Social Resources as Mediators”​ , describes how the stress and
psychogenic fever and mental effects of stress researched in “​Neurobiological and Systemic
Effects of Chronic Stress”​ impacts a person’s overall health and their day to day function. “​The
Impact of Daily Stress on Health and Mood: Psychological and Social Resources as Mediators”​
provides more examples and description about how stress can negatively impact the body.
A big finding from one of the experiments included in this study, was that male rodents
and female rodent displayed different patterns of neural structure change after experiencing
chronic stress. In male rodents, after experiencing chronic stress, the CA3 dendrites were slightly
reshaped, while for female rodents they stayed the same, although measures of stress hormones
showed that both genders of rodents were experiencing the same amounts of stress (McEwen,
2017). Instead, the female rodents displayed an expansion of the dendrites of their neurons,
found in the basolateral amygdala. Another difference is that after experiencing chronic stress,
male rodents experienced struggles with hippocampal dependent memories, while female rodents
did not. The findings lead the researchers to come to the conclusion that differences in gender
come with difference in brain systems, which controls how males and females react to stressful
stimuli (McEwen, 2017).
The main takeaway provided by “​Neurobiological and Systemic Effects of Chronic
Stress”​ is that there is a lot that needs to be done research wise, and socially to tackle the issue of
chronic stress. The researchers in “​Neurobiological and Systemic Effects of Chronic Stress”​ plan
to conduct more research, looking into how the female sex hormone estrogen, and the male sex
hormone androgen, effect the stress response, since it was found that brain structure changes
occur more in males. The researchers also plan on developing ways to inform, and educate the
general public about these findings. With this knowledge, they hope to inform people about how
important it is to properly manage stress, because when stress is poorly managed, a person is at
risk for structural brain change. Things that can be done to manage stress are maintaining a high
quality of sleep, promoting a positive life outlook, maintaining a healthy diet, avoiding smoking,
and engaging in physical activity. The research group also plans to do more research on
pharmaceutical agents that can help prevent the inflammation caused by excess production of
glutamate.

“Randomized controlled evaluation of the effects of cognitive-behavioral stress

management on cortisol responses to acute stress in healthy subjects”
The purpose of this study was to evaluate the effects of short-term, group-based
cognitive-behavioral stress management training on endocrine responses and cognitive appraisal
under acute stress in a population of healthy young male students. In order to find participants,
the research team sent out a recruiting email for a study involving stress management to all
students of the Swiss Federal Institute of Technology in Zurich, Switzerland. Within the email, a
link was provided to a website that briefly described the study. Those interested in partaking in
the study had the opportunity to enroll online. Following enrollment, each volunteer subject
received a screening questionnaire, which contained exclusion criteria. These criteria were
specifically designed to eliminate confounding factors that have been shown to affect
physiological dependent measures, and included the female gender and smokers. Additionally,
participants that reported any acute or chronic somatic or psychiatric disorder were excluded as
well. Subsequent to the providing of complete written and oral descriptions of the study, the
subjects were required to fill out written consent forms.
First, the research team needed to induce the same type of stress on each of the
participants, so they decided to use a psychosocial stress test. It has been found that the Trier
Social Stress Test (TSST) has consistently induced significant endocrine and cardiovascular
responses in a large majority of study participants (70-80%). Subjects were introduced to the
TSST subsequent to basal samples of salivary free cortisol. Then, they were ordered to go to a
different room, in which they had ten minutes to prepare and to complete a questionnaire
designed to assess cognitive appraisal processes regarding the anticipated stress scenario. Then,
the subjects returned to the testing room, where each of them took part in a simulated
five-minute job interview and a five-minute mental arithmetic task in front of an audience of two
people. To assess salivary free cortisol levels, saliva samples were taken immediately before and
after the Trier Social Stress Test, in addition to further samples taken at ten, twenty, thirty,
forty-five, and sixty minutes.
After stress was induced, all participants were subject to the stress management training.
Each of them attended group-based cognitive-behavioral stress management training following
the principles of stress inoculation training. Four groups attended group therapy sessions. Groups
1 and 2 met separately on two alternate Saturdays. Groups 3 and 4 also met separately on two
alternate Sundays. Each group consisted of twelve people and each session lasted from 1000
hours to 1700 hours. Each group was led by a qualified, postdoctoral psychotherapist in training
using a training manual. The groups were assisted on each training day by two psychology
students. The intervention mainly focused on the four cognitive–behavioral stress-reducing
techniques, including stress management (cognitive restructuring, problem-solving,
self-instruction) and relaxation training modules (progressive muscle relaxation). The first
session of group therapy consisted of a theoretical introduction and a group discussion regarding
transactional stress concepts. Two hours later, they had a one-hour lunch break. After, each stress
inoculation module was introduced and practiced in groups of four for one hour. At the end of
the first session, subjects received a training manual containing a summary of the transactional
stress concept and of all stress-reducing techniques that were introduced. The manual also
included a set of flashcards that briefly described what each stress-reducing technique entailed.
For “homework”, all study participants were encouraged to assess stress-relevant cognitions, to
carry and use the flashcards consistently, and to apply the techniques before the second group
session. The second group session began with a two-hour homework review, then a one-hour
lunch break, and afterwards, each technique was discussed and practiced again.
As for protocol, the research team implemented certain factors into their study. “Upon
return of all screening questionnaires, all subjects fulfilling the selection criteria were randomly
assigned to four groups by drawing numbers out of an envelope. Because the a priori power
calculation resulted in an optimal sample size of N = 48 (see below), only 48 subjects were
randomized. The remaining subjects were excluded. After randomization but before the group
treatment or waiting condition, all participants were given a set of questionnaires in order to
obtain comprehensive descriptions of relevant personality and stress factors (TICS, MESA,
FKK). Groups 1 and 2 underwent the TSST after completing the SIT while Groups 3 and 4
received the TSST before the SIT. Thus, Groups 1 and 2 served as treatment groups, while
Groups 3 and 4 formed the waiting control condition. The TSST committee did not know
whether or not the respective participant had performed the SIT beforehand. The TSST was
performed in different rooms from the SIT.”
In order to take measurements from the participants, sampling methods and biochemical
analyses were put in place. Saliva was collected by the subjects using Salivette collection devices
and stored at room temperature until completion of the session and stored at room temperature
until completion of the session. Samples were then stored at -20 degrees Celsius until they could
be biochemically analyzed. The free cortisol concentration in saliva was determined using a
time-resolved immunoassay with fluorometric detection. Inter- and intra-assay coefficients of
variance were below 10% for all analytes. In regards to psychometric measures, several
questionnaires were used in order to allow for comparison of relevant parameters between the
randomized groups. The first was the Trier Inventory of Chronic Stress (TICS), and this measure
was used to assess perceived chronic stress. The subjects were required to indicate how often
they individually experienced stressful situations throughout the past year. Trier Inventory of
Chronic Stress was constituted six subscales: work overload, work discontent, social stress, lack
of social recognition, worries, and intrusive memories. The second questionnaire was the
Competence and Control Orientation (FKK). This was comprised of thirty-two items that
assessed the following personality traits: “self-concept of own competence”, “internality”,
“powerful others control”, and “chance control”. The third questionnaire included in the study
was called Stress susceptibility (MESA). This was a thirty-six-item questionnaire, which
assessed stress susceptibility on six different subscales. Psychometric pre and post evaluation of
the stress inoculation training and the control-waiting condition was performed with the
Perceived Stress Scale (PSS). A German translation of the Perceived Stress Scale was used to
assess the degree to which situations in life experienced during the previous month are perceived
as stressful. Items in the PSS were designed to assess how predictable, uncontrollable, and
overloading participants find their own individual lives. The Primary Appraisal Secondary
Appraisal Scale (PASA) was the questionnaire that assessed anticipatory cognitive appraisal
processes in the TSST. This scale was specifically constructed to assess cognitive appraisal
processes in the TSST according to the transactional stress theory. The Primary Appraisal
Secondary Appraisal Scale is composed of four situation-specific subscales assessing primary
appraisals such as “Challenge” and “Perceived Threat”, as well as secondary appraisals like
“Self-Concept of Own Competence” and “Control Expectancy”. In order to assess anticipatory
cognitive appraisals, the PASA was administered at a time between the introduction and the
actual TSST. After collecting the data, statistical analyses were made. ANCOVAs and ANOVAs
for repeated measures were computed in order to analyze endocrine responses between groups,
controlling for differences in endocrine baseline levels when indicated. All reported results were
corrected by the Greenhouse-Geisser procedure where appropriate, and correlations were
computed as Pearson product-moment correlations. For all endocrine parameters, areas under
the total response curve (AUC), expressed as area under all samples, were calculated using the
trapezoidal method. Data were tested for normal distribution and homogeneity of variance using
a Kolmogorov–Smirnov and Levene’s test before statistical procedures were applied. The
optimal total sample size of N = 48 to detect an expected large effect size of f2 = 0.35
(representing a large effect size) with a power 0.85 and α = 0.05 was calculated a priori with the
statistical software G-Power (Buchner et al., 1997). For all analyses, significance level was α =
5%. Unless indicated, all results shown are means ± standard error of means (SEM).”
The Trier Social Stress Test had significant results involving salivary free cortisol
responses. The first saliva cortisol sample as covariate, ANCOVA, proved that baseline
differences between the groups did not substantially influence endocrine stress response. It was
found that groups had significant differences in their salivary free cortisol stress responses over
time, with subjects in the stress inoculation training group showing an attenuated salivary free
cortisol response. Also, subjects in the stress inoculation training group had a significantly lower
integrated salivary free cortisol response. In order to determine whether group differences in
cognitive appraisal of the Trier Social Stress Test had an influence on the salivary free cortisol
stress response, the PASA scales were included in the calculations as covariates. ANCOVA
results suggested that primary stress appraisal had a notable influence on the salivary free
cortisol stress response. The fact that this psychological factor was included was important
because it eliminated the observed significant group differences in the salivary free cortisol
response over time and the integrated salivary free cortisol response. It can also be concluded
that there was no significant association between the number of days between the stress
inoculation training and the Trier Social Stress Test and the integrated salivary free cortisol
response. It is also important to note that the groups differed significantly in their anticipatory
cognitive appraisal of the TSST. In comparison with controls, subjects in the stress inoculation
training group had lower primary stress appraisal and higher self efficacy appraisal. Groups did
not differ much in their perception of Novelty, with stress inoculation participants demonstrating
a decrease in perceived stress post treatment levels.
This study concluded that short, group-based, cognitive-behavioral stress management
training reduces the salivary free cortisol stress response to an acute stressor in healthy male
participants. These endocrine response differences were affected by the observed differences in
the cognitive appraisal of the situation. Subjects in the treatment group appraised the situation as
less stressful and displayed more competence in coping with the situation. It was found that all
reported effect sizes for significant endocrine and psychometric group differences in the Trier
Social Stress Test were large. On the other hand, the pre and post changes in perceived stress
were only of medium effect size.
The salivary free cortisol responses observed in our sample is somewhat higher than
those published by other groups using the TSST. This could be a consequence of the altered
TSST protocol we used in order to obtain data concerning the anticipatory appraisal processes.
However, this difference in the response magnitude does not seem to be a result of group
differences, since groups did not differ significantly in the basal cortisol levels and the respective
psychometric scales.
Female subjects were excluded from this study because had they been included, their
menstrual cycle phases would have to be controlled, along with the use of oral birth control. The
research team did this aware that it may have weakened the external validity of the study,
however they did it anyways in order to enhance the internal validity. However, since gender
differences of HPA axis stress responses seem to be mediated through differences in sex
hormone levels and the observed response differences in our study were mediated through
differences in the cognitive appraisal, the researchers were confident that the stress inoculation
training has similar neuroendocrine effects in females.
This is the first study to report that short, group-based, cognitive–behavioral stress
management training attenuates the endocrine and psychological response to acute stress in
healthy subjects. Alterations of HPA axis functioning have been linked to the development and
maintenance of psychosomatic and psychiatric disorder and somatic illness. According to the
concept of allostatic load, which represents a marker of cumulative biological burden exacted on
the body through attempts to adapt to life’s demands, several conditions of how stress leads to
alterations of the HPA axis can be distinguished. These include repeated activation during
chronic stress and failure to habituate to repeated stressors. With the observed attenuation of the
neuroendocrine stress response and the changes in cognitive appraisal of the stress situation, it is
possible that group-based, cognitive–behavioral stress management training could prove useful
in preventing detrimental consequences of stress-induced neuroendocrine responses, such as the
risk of developing hypertension and metabolic syndrome. However, it is important to note that
we have not assessed the effects of short, group-based, cognitive–behavioral stress management
training on markers of allostatic load, but rather on mechanisms that have been discussed to lead
to the development of allostatic load. There is consensus that the relation between HPA axis
parameters and health is not linear, thus both too much and too little HPA axis activity and
reactivity can be linked to disease and health complaints. As a consequence, the findings of a
reduced neuroendocrine stress response should not be considered to be protective per se, but
rather with regard to its possible role in the development of stress-related health complaints.
Since cortisol has been considered a primary mediator in the development of allostatic load,
further studies are necessary in order to evaluate possible long-term effects of the
neuroendocrine response differences that were observed.
In one study, it was found that brief meditation training does, in fact, have the ability to
positively affect an individual’s perceived stress levels and mood. (Lane, 2007)They found that
all four outcome measures improved significantly after the meditation training. These findings
are very relevant and important as they provide insight on which stress management techniques
are best for the participants (in this case, meditation). (Lane, 2007)

“Meditation Programs for Psychological Stress and Well-being: A Systematic Review and
Meta-analysis”
The purpose of this meta-analysis, conducted by Madhav Goyal, a doctor at Johns
Hopkins University, was to determine the effectiveness of mediation programs in improving
stress-related outcomes such as anxiety, depression, stress/distress, positive mood, mental health,
attention, substance use, eating habits, sleep, pain, and weight, in diverse adult clinical
populations. (Goyal, 2014) Their work was very important, since many people meditate to
reduce psychological stress and stress-related health problems. In order for patients to be
counseled appropriately, doctors and physicians must be aware of what the evidence says
regarding the health benefits of meditation. (Goyal, 2014) In summary, randomized clinical trials
with active controls for placebo effects through November 2012 from a variety of sources (e.g.
Medline, PsycINFO, Scopus, the Cochrane Library, etc.) were identified. (Goyal, 2014) Citations
were screened and data was extracted by two independent reviewers. (Goyal, 2014) Afterwards,
the strength of evidence was graded using four domains (risk of bias, precision, directness,
consistency), and the magnitude and direction of effect was determined by calculating the
relative difference between groups in change from baseline. (Goyal, 2014) Meta-analyses were
conducted using standardized mean differences as much as possible in order to obtain aggregate
estimates of effect size with 95% confidence intervals. (Goyal, 2014)
In order to find articles that could be used for this meta-analysis, the team developed a
Medline search strategy using PubMed medical subject heading terms and the text words of key
articles. (Goyal, 2014) Similar strategies were used through the other online sources. They
reviewed the reference lists of included articles, relevant review articles, and related systematic
reviews for the purpose of identifying articles that may have missed in the database searches, and
they did not restrict their analysis based on language or date of publication. (Goyal, 2014)
However, they did include randomized controlled trials in which the control group was matched
in time and attention to the intervention group, and they required that studies included subjects
with a clinical condition, broadly defined in order to include mental health and psychiatric
conditions (e.g. back pain, heart disease, old age). (Goyal, 2014)
To manage the screening process, they used a systematic review software. (Goyal, 2014)
For each meditation program, they extracted information on measures of intervention fidelity,
including dose, training, and receipt of intervention. (Goyal, 2014) The duration and maximal
hours of structured training in meditation, the amount of home practice recommended,
description of instructor qualifications, and description of participant adherence, if any, were
recorded. (Goyal, 2014) Due to the fact that numerous scales measured negative or positive
affect, we chose scales that were common to the other trials and the most clinically relevant to
make comparisons more meaningful. (Goyal, 2014)
To display the outcome data, they calculated the relative difference in change scores (i.e.
the change from baseline in the treatment group minus the change from baseline in the control
group, divided by the baseline score in the treatment group). (Goyal, 2014) Also, they used the
relative difference in change scores to estimate the direction and approximate magnitude of
effect for all outcomes. (Goyal, 2014) However, a relative difference in change score for six
outcomes owing to incompletely reported data for statistically insignificant findings were unable
to be calculated. (Goyal, 2014) They considered a 5% relative difference in change score to be
potentially clinically significant, since the studies examined short-term interventions and
relatively low doses of meditation. (Goyal, 2014) In total, 18,753 unique citations and 1,651
full-text articles were screened. Of those, forty-seven trails met the necessary criteria to be
included in the meta-analysis.(Goyal, 2014)
Conclusively, this review indicated that meditation programs can, in fact, reduce the
negative dimensions of psychological stress. (Goyal, 2014) In particular, mindfulness meditation
programs were shown to slightly alleviate anxiety, depression, and pain with moderate evidence.
(Goyal, 2014) On the other hand, mantra meditation programs did not improve any of the
outcomes examined, but there was low to insufficient evidence for this claim. (Goyal, 2014) It
was also found that the evidence from some studies did not show any positive effects on
well-being for any meditation program, despite that the main purpose of most meditation
programs is to seek positive health improvement. (Goyal, 2014) Additionally, its relevant to note
that there was no evidence that the meditation programs harmed any individuals. (Goyal, 2014)
Another study conducted by Vidya Anderson in 1999 supported Goyal’s conclusions. They
found that standardized meditation significantly reduced teachers’ perceived stress levels.
(Anderson, 1999)
The ESs were small but significant for some of the individual outcomes and were seen
across a broad range of clinical conditions. (Goyal, 2014) During the course of 2 to 6 months, the
mindfulness meditation program ES estimates ranged from 0.22 to 0.38 for anxiety symptoms
and 0.23 to 0.30 for depressive symptoms. (Goyal, 2014) These small effects are comparable
with what would be expected from the use of an antidepressant in a primary care population but
without the associated toxicities. (Goyal, 2014) These findings are extremely important, as they
could open a window to alternate treatment options for those with depression and other related
mental illnesses. (Goyal, 2014) Overall, the evidence was insufficient to indicate that meditation
programs alter health-related behaviors affected by stress, and low-grade evidence suggested that
meditation programs do not influence weight. (Goyal, 2014) Although uncontrolled studies have
usually found a benefit of meditation, very few controlled studies have found a similar benefit
for the effects of meditation programs on health-related behaviors affected by stress. (Goyal,
2014)
A number of observations provide context to the conclusions. (Goyal, 2014) First, very
few mantra meditation programs met their inclusion criteria. (Goyal, 2014) This significantly
limited their ability to draw inferences regarding the effects of mantra meditation programs on
psychological stress–related outcomes, which did not change when transcendental meditation
were evaluated separately from other mantra training.(Goyal, 2014) Second, differences may
have existed between trials for which the outcomes are a primary vs a secondary focus, although
no evidence of this was found. (Goyal, 2014) The samples included in these trials resembled a
general primary care population, and there may not be room to measure an effect if symptom
levels of the outcomes are low to start with (ie, a floor effect). (Goyal, 2014) This limitation may
explain the null results for mantra meditation programs because 3 transcendental meditation
trials enrolled patients with cardiac disease, whereas only 1 enrolled patients with anxiety.
(Goyal, 2014) Third, the lack of effect on stress-related outcomes may relate to the way the
research community conceptualizes meditation programs, the challenges in acquiring such skills
or meditative states, and the limited duration of RCTs. (Goyal, 2014) Historically, meditation
was not conceptualized as an expedient therapy for health problems. (Goyal, 2014) Meditation
was a skill or state one learned and practiced over time to increase one’s awareness and through
this awareness to gain insight and understanding into the various subtleties of one’s existence.
(Goyal, 2014) Training the mind in awareness, in nonjudgmental states, or in the ability to
become completely free of thoughts or other activity are daunting accomplishments. (Goyal,
2014) The interest in meditation that has grown during the past 30 years in Western cultures
comes from Eastern traditions that emphasize lifelong growth. (Goyal, 2014) The translation of
these traditions into research studies remains challenging. (Goyal, 2014) Long-term trials may be
optimal to examine the effect of meditation on many health outcomes, such as those trials that
have evaluated mortality. (Goyal, 2014) However, many of the studies included in this review
were short term (eg, 2.5 h/wk for 8 weeks), and the participants likely did not achieve a level of
expertise needed to improve outcomes that depend on mastery of mental and emotional
processes. (Goyal, 2014) Finally, none of our conclusions yielded a high strength of-evidence
grade for a positive or null effect. (Goyal, 2014) Thus, further studies in primary care and
disease-specific populations are indicated to address uncertainties caused by inconsistencies in
the body of evidence, deficiencies in power, and risk of bias. (Goyal, 2014)
Each of the studies previously discussed provide critical insight on potential impacts. The
first, most evident potential impact is associated with health and safety. Chronic stress is one of
the most prevalent health disorders, especially within the United States. The conclusions drawn
from each of the sources stress the importance of maintaining low stress levels, and some
identify specific strategies to do so. Utilizing these stress management techniques have the
potential to reduce stress and physical symptoms of stress. Secondly, there are also educational
impacts. Informing the public on stress and how it can be reduced is crucial in maintaining
healthy populations. In addition to health and education, there are also technical impacts. The
results from the studies investigating different forms of stress management can be analyzed and
used to create biomedical technology that could potentially help patients reduce stress in their
everyday lives.

METHODS

In order to yield the most accurate results regarding the amounts of stress present in the
human body, researchers will take measures of heart rate, body temperature, and respiration rate.
These vitals will be measured because they are natural indicators of stress in the body.
Measuring multiple stress indicators, as opposed to just one, is important for the success of this
experiment in order to ensure that the most accurate results regarding each individual
participant’s stress level are collected. The stress levels of each participant will be measured
twice. The preliminary experiment will first include measures of heart rate, body temperature,
and respiration rate prior to the stress inducement while the subjects are sitting down in a chair,
facing a wall. After the vitals are recorded, participants will be given a copy of the Subjective
Units of Distress Scale (SUDS) Thermometer, which is a subjective stress scale. Participants will
be asked to rate their current stress level according to the scale. Resting heart rate, body
temperature, and respiration rate will serve as the control variable in this experiment because at
that point, the participants will not be doing any physical activity and will not be experiencing
any potentially stressful situations.
The decided method of stress inducement for this experiment is the Sing-a-Song Stress
Test (SSST), an experimental paradigm developed by Anne-Marie Brouwer and Maarten A.
Hogervorst. The Sing-a-Song Stress Test has been shown to induce mental stress in a quick and
easy way, while still adhering to ethical and safety requirements. After the participants’ baseline
measurements have been recorded, one participant at a time will be presented with a slideshow
of neutral messages telling them to complete simple tasks (30 seconds per slide/task), and there
will be an audience of ten random students not participating as subjects in the study. An example
of a simple task would be “Introduce yourself and say two interesting facts about yourself.” The
last simple task they will be presented with will be to sing a song. For our study, the song chosen
was the United States National Anthem because it is a song that is familiar with most of the
participants. The presence of others will likely make them nervous and potentially induce mental
stress.
Immediately following the stress inducement, their heart rate, body temperature, and
respiration rate will be measured again. After the final vitals are measured and recorded,
participants will be given the same subjective stress scale (SUDS Thermometer) they were given
prior to the stress inducement, and they will be asked to rate their stress level according to the
scale once again. Measurements of body temperature, heart rate, respiration rate, and the use of
the subjective stress scale will be taken before and after to observe in what ways the stress
inducement affected each participant, which is a critical aspect of this project. Without taking
measurements before and after, there would be no way to see if or how stress levels were altered.
Furthermore, in doing this, it will provide the researchers with quantitative data that can be
utilized for data analysis. The participants used in this experiment will be teenagers of the ages
15, 16, and 17 years old. These teenage participants will be required to be in good health,
without any medical conditions that would significantly affect body temperature, heart rate, and
respiration rates. Being in good health is a requirement for participants in this study because
different medical conditions can impact the vitals that are being measured. Taking measurements
from a participant with poor health can result in discrepancies and sources of error in the
collected data.

Materials
In order to determine the stress levels of all participants, the researchers will need to
utilize several materials that will help to record the desired measurements. The first material
needed is a thermometer for measuring body temperature. The researchers used a forehead
thermometer, since it could be easily sanitized after each use, and because it is the least invasive
option, which is important when using humans as experimental subjects. The name of the
specific thermometer utilized by the researchers in this experiment is the Exergen Temporal
Scanner TAT-2000 Forehead Thermometer. Another needed material for this study is a heart rate
monitor. The researchers in this study decided not to use a sphygmomanometer, which is an
inflatable cuff that is placed on the arm that is utilized for measuring blood pressure, because it
can cause lightheadedness and other undesired side effects. The researchers, as previously stated,
wanted to use the safest possible method of data collection for the subjects. Therefore, the
researchers utilized the Easy at Home Areta Fingertip Pulse Oximeter, which measures heart rate
using the fingertip. Again, this technique is non-invasive. The researchers in this experiment
decided to use 32 test subjects because having large sets of data helps improve accuracy and data
analysis. This experiment yields two heart rate monitors and two thermometers. Measuring
respiration rate does not require any physical materials besides a stopwatch. Participants will
count the number of breaths they take in a 15-second time period and that number will be
multiplied by four to get each individual’s respiration rate in breaths per minute.

Hypothesis/Independent Variable/Dependent Variables

This project involves the utilization of stress inducement (SSST) to induce acute mental
stress on 32 healthy teenage participants. The collected data from this experiment came in the
forms of measurements of heart rate, body temperature, and respiration rate, and also their
subjective stress levels using the SUDS Thermometer. Heart rate, body temperature, and
respiration rate were collected before and after the inducement of mental stress to observe the
effects that the SSST had on the body. Before conducting any type of experimentation, it was
hypothesized that if stress was induced via the SSST on teenage participants, then heart rate,
body temperature, and respiration rate would increase because they are natural indicators of
stress in the body (American Psychological Association, n.d.). If hypothesized correctly, the data
will show that after the mental task was administered, heart rate, body temperature, and
respiration rate increased in the majority of the participants when compared to the control, and
the participants’ initial measurements. The dependent variables in this experiment would be heart
rate, body temperature, respiration rate, and number on SUDS Thermometer indicating stress
level of each participant, because these vitals depend on the effect that the stress inducement,
which is the independent variable, has on the body.

Limitations/Constraints/Biases
One of the restraints of this experiment is that the data could observe different trends
based on the conditions of the participants. For example, if one participant is overweight, it is
likely their heart rate would be generally higher. Or, if one of the participants had a pre-existing
health issue like asthma, they could have both a higher body temperature, a higher heart rate, and
a higher respiration rate. To combat the effects that health can have on the accuracy of the
collected data, the researchers plan on being selective of the participants that are chosen for the
project. This means that the experimenters would pick an even amount of males and females that
are in good health at the time of experimentation. Another constraint of this experiment would be
that the participants will come into testing with different levels of hydration; some will be
dehydrated, and some will be overhydrated. This can have a negative impact on data, because
being in the state of dehydration causes rapid heart rate and fluctuation in body temperature. To
combat the negative effects of dehydration on this study, the experimenters will provide each
participant with a water bottle before testing to ensure that everyone is hydrated. Another
limitation of this project is that it will not provide any data on how people of older age groups
are affected by stress. For this project, it was decided that mental stress in teenagers would be the
primary focus, since focusing on one age group with the small sample size we have would result
in the least number of confounding variables, as opposed to studying people of all ages.

Safety/Ethical Constraints
Since this experiment only requires the measurements of vitals and the use of a subjective
stress scale, it does not pose any safety concerns. The mental stress that the experimenters are
inducing is in a safe, harmless manner and will not inflict any intolerable discomfort on the
participants. One ethical concern can appear when appealing to the Scientific Review Committee
(SRC) to justify the use of human participants in the project. Although humans are involved in
the study, the researchers have ensured that there were no potential safety concerns that would
negatively affect any participant. Another potential ethical concern involves the selection process
of the participants. For the data to be as accurate as possible, the researchers will need to study
teenagers in good physical conditions that do not have any severe medical conditions that could
potentially affect their body temperature, heart rate, or respiration rate. This selection of
participants can act as an ethical concern, because outside influences, such as a group of
experimenters, are not allowed to know a person’s private medical information due to laws like
HIPAA (Health Insurance Portability and Accountability Act) that provide protection to a
person’s medical records. All of the safety and ethical concerns associated with this project
depend on the decisions that are made by the Scientific Review Committee.
Data Analysis
To analyze the data, the research team in this experiment will calculate the averages and
medians for each experimental group. From there, graphs, such as bar graphs, will be created in
order to depict the best possible representations of the collected data. Graphs for each studied
variable, which includes average heart rates, body temperatures, and respiration rates for both
before and after stress inducement will then be compared in order to observe any changes and
why those changes are relevant to the purpose of this project. There will also be graphs
comparing the average changes in each measurement in both the control and experimental
groups.
Conclusion
The purpose of this project is to further investigate the physiological effects of mental
stress in teenagers. By conducting this research, we will contribute valuable data regarding the
correlation of mental stress and negative health effects that could potentially be used in future
studies to discover ways these physiological effects could be prevented. This is tremendously
important, for the majority of the world’s most deadly illnesses are stress-related: cardiovascular
disease, depression, gastrointestinal issues, and even Alzheimer’s disease. The research
conducted in this experiment provides the basis of other potentially life-saving research.
 The hypothesis is as follows: if stress is induced via a mental task on adolescent
participants, then heart rate, body temperature, and respiration rate would all increase because
they are natural indicators of stress in the body. In order for the hypothesis to be supported, the
average difference between initial and final measures needs to increase (indicates positive
change).
The expected outcome of our study is to observe positive changes in stress indicator
measurements from initial measure before stress inducement to the final measure after stress
inducement. For example, expected results would be heart rate raising from 80 beats per minute
(before stress inducement) to 88 beats per minute (after stress inducement). These results are
relevant to the project because it can be seen that stress inducement does indeed have negative
effects on the body. An unexpected outcome that may occur could be that we see no changes in
measurements of any of the stress-indicating variables. Although it would reject the researchers’
initial thoughts and hypothesis, in the event of this outcome, the data would be thoroughly
analyzed and subsequently discussed, stating that mental stress had no physical effects on the
human body. These potential outcomes have been considered, and whether the data supports or
rejects the hypothesis, the research will nonetheless be insightful to future studies involving
mental stress and its effects on humans.
Subsequent to gathering all the data, data analyses will be conducted. Statistical
calculations including averages and medians of stress indicator levels (heart rate, body
temperature, respiration rate) will be calculated. It is paramount that these calculations are
conducted in order to accurately observe the differences in initial and final measurements. Once
the calculations are completed, they can be inputted into graphs for a more visual analysis of the
results. Afterwards, changes in measurements for each stress indicator can be observed. From
there, individuals can have their stress levels analyzed and they can receive proper stress
management techniques.
After this experiment has been completely conducted, it has been hypothesized that the
data will display that inducing stress caused increases in all of the factors being measures, which
are body temperature, heart rate, and respiration rate. It was hypothesized by the researchers in
this study that stress will have these negative impacts on the body based on previously conducted
research. From analyzing similar studies, it was found that body temperature, heart rate, and
respiration rate all increased when under the presence of stress. It is believed that overall, the
conclusions from this study will show that stress does indeed cause negative health effects on
health, and will further urge the need for future, more in-depth research, as well as promote
awareness regarding the potentially severe effects of mental stress and why it is paramount to
manage one’s stress levels.
 RESULTS

Heart Rate:

Figure 1: Changes in Initial vs. Final Heart Rate in Control and Experimental Groups
Graph above shows the average change in heart rate in control group and the average change in
heart rate before and after stress inducement in experimental group.

The stress inducement had significant effects on heart rate for the experimental group. Initial
average heart prior to stress inducement was 76.61 BPM. After stress inducement, final average
heart rate increased to 91.59 BPM. This was a significant change and demonstrated that the
stress inducement resulted in increased heart rates. In the control group, initial average heart rate
was 93 BPM and final average heart rate was 91.58 BPM, resulting in a slight decrease of 6.11
BPM. As shown in Figure 1, the average change in heart rate for the experimental group was
almost quadruple the change in heart rate for the control group.
Breathing Rate:

Figure 2: Changes in Initial vs. Final Breathing Rate in Control and Experimental Groups
Graph above shows the average change in breathing rate in control group and the average change
in breathing rate before and after stress inducement in experimental group.

The stress inducement also had significant effects on breathing rate for the experimental group.
Initial average breathing rate prior to stress inducement was 18.36 BPM. After stress
inducement, final average breathing rate increased to 27.8 BPM. This was a significant change
and demonstrated that the stress inducement resulted in increased breathing rates. In the control
group, initial average breathing rate was 19 BPM and the final average breathing rate was 18.55
BPM, resulting in a slight decrease of 0.45 BPM. As shown in Figure 2, the average change in
breathing rate for the experimental group was extremely higher than in the control group.
Body Temperature:

Figure 3: Changes in Initial vs. Final Body Temperature in Control and Experimental
Groups
Graph above shows the average change in body temperature in control group and the average
change in body temperature before and after stress inducement in experimental group.

The stress inducement did not have any significant effects on body temperature for the
experimental group. Initial average body temperature prior to stress inducement was 97.68
degrees Fahrenheit. After stress inducement, final average body temperature increased slightly to
97.98 degrees Fahrenheit. This was a very insignificant change and demonstrated that the stress
inducement resulted in minimal changes in body temperature. In the control group, initial
average body temperature was 97 degrees and the final average body temperature was 97.26
degrees, resulting in a slight increase of 0.26 degrees. As shown in Figure 3, the average change
in body temperature for the experimental group was only slightly higher than the average change
in body temperature in the control group.
Subjective Units of Distress (SUDS):

Figure 4: Changes in Initial vs. Final SUDS Rate in Control and Experimental Groups
The graph above shows the average change in subjective units of distress in control group and
the average change in subjective units of distress before and after stress inducement in
experimental group.

The stress inducement did have substantial effects on subjective levels of stress for the
experimental group. Initial average subjective units of distress prior to stress inducement was
18.86, which according to the SUDS Thermometer, indicates very minimal anxiety/distress.
After stress inducement, final average subjective units of distress increased to 64.77, which
according to the SUDS Thermometer, indicates considerable anxiety/distress that interferes with
functioning. This was a significant change and demonstrated that the stress inducement resulted
in increased subjective stress levels. In the control group, initial average subjects units of distress
was 1.8 and the final average subjective units of distress was 0, resulting in a slight decrease of
1.8 units. As shown in Figure 2, the average change in subjective units of distress for the
experimental group was significantly higher than in the control group.
 DISCUSSION

According to the results of the study, it was found that mental stress did prove to have

physiological effects. With the use of the subjective units of distress scale in our experimental

group, an average increase of 45.51 subjective units of distress from before the stress inducement

to after the stress inducement was recorded. This significant increase in the participants’

subjective stress levels demonstrates the chosen method of mental stress inducement was very

effective. Thus, the results found regarding heart rate, respiratory rate, and body temperature can

be validated, for if the participants felt that the mental task was not stressful, the data collected

for the physiological symptoms of stress would not have any significance.

Heart rate was found to be impacted the most by mental stress. The average increase after

the stress inducement in the experimental group was 23 beats per minute, as opposed to the 6.11

decrease in beats per minute in the control group. The heart rates of the majority of the

participants in the experimental group increased, which shows that increased levels of mental

stress can be correlated with increased heart rate. If an individual is chronically mentally

stressed, as millions worldwide are, they can be at risk of developing tachycardia, a type of

arrhythmia in which one’s heart rate is abnormally rapid. Tachycardic individuals have

significantly increased risks of stroke, heart disease, sudden cardiac arrest, and even death. This

is very important because by acknowledging the potentially severe effects of mental stress,

awareness about these effects and why it is extremely important to manage stress levels as much

as possible can be spread, and action can be taken accordingly in medical professional settings.

Increased respiratory rates were also found to be positively correlated with mental stress.

The average increase of 9.44 breaths per minute for respiratory rate in the experimental group is
significant. This shows that individuals who are mentally stressed are likely to have increased

respiratory rates, and are at a higher risk of developing tachypnea, a medical condition

characterized by an abnormally high respiratory rate. Our study showed that chronically stressed

individuals could potentially develop other health issues as a result of rapid respiratory rates.

Tachypnea has been known to lead to several, more serious conditions such as lung-related

diseases, hyperventilation, and metabolic acidosis. If mentally stressed individuals do not take

preventative action to lower their stress levels, complications such as those listed above are

possible.

Body temperature was not a strong indicator of mental stress according to the results of

the study. In the experimental group, there was a slight increase of 0.3 degrees Fahrenheit. This

change from before to after the stress inducement was very minimal. Therefore, there is a very

weak positive correlation between mental stress levels and body temperature.

CONCLUSION

In this study, the physiological effects of mental stress were investigated. For the control

group, participants sat quietly in a classroom and their initial and final heart rates, respiratory

rates, and body temperatures were recorded. For the experimental group, the participants’ body

measurements were recorded before and after the mental stress inducement, a presentation-based

task in front of a small audience. After analyzing the data, it can be concluded that mental stress

does have effects on the human body. From the measurements that were taken from the

participants, heart rate and respiratory rate were impacted the most. Heart rate in the
experimental group had an average increase of 23 beats per minute, and respiratory rate had an

average increase of 9.44 breaths per minute. The change between initial and final measurements

for body temperature in the experimental group were minimal, a slight increase of 0.3 degrees

Fahrenheit. Thus, these results supported the hypothesis that the mentals stress inducement

would result in increased heart rate, respiratory rate, and body temperature. Future researchers

should increase the sample size and conduct multiple trials to attain more accurate results.

Another suggestion would be to take salivary samples to measure the participants’ changes in

cortisol levels in order to see how the body’s stress hormone reacts to mental stress.

Conclusively, mental stress has the potential to have significant negative physiological effects,

and medical professionals should consider this and promote awareness regarding stress and the

importance of lowering it to avoid health complications in the future.

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