Exhaustion is associated with reduced habituation of free cortisol responses to repeated acute psychosocial stress
Introduction
Accumulating evidence from animal (Brodish and Odio, 1989, Akana et al., 1992, Pecoraro et al., 2004) and human data (McEwen and Stellar, 1993, Chrousos, 1995) show that chronic stress can modulate the functioning of the hypothalamus–pituitary–adrenal (HPA) axis. Furthermore, dysregulation of the HPA axis have been associated with onset and course of several psychosomatic and psychiatric disorders (Holsboer, 1989, Chrousos and Gold, 1992, Tsigos and Chrousos, 1994, Björntorp and Rosmond, 1999, Heim et al., 2000, Raison and Miller, 2003). A psychological state that is viewed as a potential consequence of long-term, chronic stress is vital exhaustion (VE). VE is characterized by unusual fatigue, loss of mental and physical energy, increased irritability, and a feeling of demoralization (Appels et al., 1987, Appels and Mulder, 1988). In epidemiological studies, VE has been established as an independent risk factor for coronary artery disease (CAD; Appels et al., 1993, Kop et al., 1994, Koertge et al., 2002). To date, only few studies investigated whether exhaustion affects the responsiveness of the HPA axis to stressful situations. Previous research points to altered HPA axis functioning in exhaustion. Nicolson and van Diest (2000) observed a pattern of lower basal salivary cortisol levels throughout the day, with significant differences in the evening in vitally exhausted subjects versus healthy controls. However, a single exposure to a laboratory speech task did not reveal any differences in cortisol stress responses between groups (Nicolson and van Diest, 2000). Kristenson et al., 1998, Kristenson et al., 2001 compared Lithuanian versus Swedish men in a cross-cultural comparison and found that low peak cortisol responses to a standardized laboratory stress battery were significantly related to vital exhaustion and high baseline cortisol levels. Recently, Dahlgren et al. (2004) reported on higher workload, fatigue, and exhaustion levels in a group of white-collar workers with lowered cortisol levels in a high stress condition.
A hallmark of the adaptive propensity of the human HPA axis stress response is the rapid habituation to repeated exposure to the same stimulus (Levine, 1978, Gunnar et al., 1989, Deinzer et al., 1997, Pruessner et al., 1999, Gerra et al., 2001). An insufficient ability to adjust or habituate to repeated exposure to the same stressor is considered as one of four different scenarios that leads to allostatic load (namely repeated “hits”, lack of adaptation, prolonged response, or inadequate response; McEwen, 1998, McEwen and Seeman, 1999). Allostasis means ‘maintaining stability through change’ (Sterling and Eyer, 1988) and allostatic load is the cumulative long-term effect of the physiological systems’ attempts to adapt to life's demands (McEwen and Stellar, 1993, McEwen, 1998). The proposed allostatic load index consists of at least 10 biological parameters including cortisol (Seeman et al., 1997, Seeman et al., 2001, Schnorpfeil et al., 2003). Failing to habituate – or the loss of allostasis, might lead to a higher susceptibility to disease or declines in physical and cognitive functioning (Seeman et al., 2001, Karlamangla et al., 2002). We hypothesized that exhaustion might impair an individuals’ ability to show habituation. In this analysis, we, therefore, investigated the association between exhaustion as measured by the Maastricht-Vital-Exhaustion-Questionnaire and repeated exposure to acute psychosocial stress using the Trier Social Stress Test (TSST). The TSST is a standardized and validated stress protocol for laboratory settings, which reliably elicits endocrine stress responses in the majority of individuals (Kirschbaum et al., 1993, Dickerson and Kemeny, 2004, Kudielka et al., 2004a). A general habituation effect has been consistently reported for a variety of stress paradigms including the Trier Social Stress Test (Pruessner et al., 1999, Schommer et al., 2003, Federenko et al., 2004, Wüst et al., 2005). In sum, the aim of the present study was to elucidate whether exhaustion attenuates the endocrine stress response habituation to psychosocial stress in healthy adults.
Section snippets
Study design and recruitment of participants
The study protocol was formally approved by the ethics committee of the Federal Institute of Technology (ETH), Zurich, Switzerland. All participants gave written consent.
As part of a large survey on “Work and Health”, the permanent non-faculty employees of the Federal Institute of Technology, older than 35 years were invited to participate in a written health assessment. The questionnaire inquired about the personal and family medical history. It assessed a range of data including demographic
Sample characteristics
As summarized in Table 1, the present study sample held middle to high socioeconomic status and showed favorable health behaviors. Due to the chosen recruitment procedure, all subjects were employees of the ETH aged 38–59 years. VE scores ranged between 0 and 17 with a mean of 6.0 ± 4.5 (S.D.). The majority of the sample (56%) showed mild to moderate exhaustion, while 32% did not report any exhaustion. Three subjects (12%) had exhaustion scores above 10.
Cortisol stress responses, habituation and exhaustion
GLM with repeated measures resulted in: (a)
Discussion
The present study addresses for the first time the question whether exhaustion, a common sequela of chronic distress, affects the habituation of the HPA axis response to repeated acute psychosocial stress. Vital exhaustion was assessed by the Maastricht-Vital-Exhaustion-Questionnaire. VE is characterized by unusual fatigue, loss of energy, sleep disturbance, and irritability and has prospectively been linked to cardiovascular disease (Appels et al., 1993, Kop et al., 1994, Koertge et al., 2002
Acknowledgements
This work was supported by Grant 32-68277 from the Swiss National Science Foundation (SNF) and by the Federal Institute of Technology (ETH), Zurich, Switzerland. Since October 2004, BMK is supported by grants from the German Research Foundation (DFG grant KU1404/4-1).
References (61)
- et al.
Fatigue and heart disease: the association between ‘vital exhaustion’ and past, present and future coronary heart disease
Journal of Psychosomatic Research
(1989) - et al.
A questionnaire to assess premonitory symptoms of myocardial infarction
International Journal of Cardiology
(1987) - et al.
Vital exhaustion as risk indicator for myocardial infarction in women
Journal of Psychosomatic Research
(1993) - et al.
Adrenocortical responses to repeated parachute jumping and subsequent h-CRH challenge in inexperienced healthy subjects
Physiology and Behavior
(1997) - et al.
Neuroendocrine responses to experimentally-induced psychological stress in healthy humans
Psychoneuroendocrinology
(2001) - et al.
The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders
Psychoneuroendocrinology
(2000) - et al.
Allostatic load as a predictor of functional decline: MacArthur studies of successful aging
Journal of Clinical Epidemiology
(2002) - et al.
Vital exhaustion, temperament, and cardiac reactivity in task-induced stress
Biological Psychology
(2004) - et al.
Relationships between the pituitary-adrenal hormones, insulin, and glucose in middle-aged men: moderating influence of psychosocial stress
Metabolism
(1998) - et al.
Cortisol and vital exhaustion in relation to significant coronary artery stenosis in middle-aged women with acute coronary syndrome
Psychoneuroendocrinology
(2002)
HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender
Psychoneuroendocrinology
Acute HPA axis responses, heart rate, and mood changes to psychosocial stress (TSST) in humans at different times of day
Psychoneuroendocrinology
Cortisol changes following repeated experiences with parachute training
Salivary cortisol patterns in vital exhaustion
Journal of Psychosomatic Research
Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change
Psychoneuroendocrinology
Endocrine responses to stressful psychological events: advances in psychoneuroendocrinology
The Psychiatric Clinics of North America
Allostatic load and working conditions
Social Science and Medicine
Physiology of the hypothalamic–pituitary–adrenal axis in health and dysregulation in psychiatric and autoimmune disorders
Endocrinology and Metabolism Clinics of North America
The relation of type A behavior and vital exhaustion with physiological reactions to real life stress
Journal of Psychosomatic Research
Habituation of cortisol responses to repeated psychosocial stress—further characterization and impact of genetic factors
Psychoneuroendocrinology
Feedback sensitivity of the rat hypothalamo–pituitary–adrenal axis and its capacity to adjust to exogenous corticosterone
Endocrinology
Excess fatigue as a precursor of myocardial infarction
European Heart Journal
Hypothalamic origin of the metabolic syndrome X
Annals of the New York Academy of Sciences
Age-dependent effects of chronic stress on ACTH and corticosterone responses to an acute novel stress
Neuroendocrinology
The hypothalamic–pituitary–adrenal axis and immune-mediated inflammation
New England Journal of Medicine
The concepts of stress and stress system disorders: overview of physical and behavioral homeostasis
The Journal of the American Medical Association
Individual differences in the diurnal cortisol response to stress
Chronobiology International
Evidence for and pathophysiologic implications of hypothalamic–pituitary–adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome
Annals of the New York Academy of Sciences
Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research
Psychological Bulletin
A context dependent heritability of hypothalamus pituitary adrenal responses to psychosocial stress
The Journal of Clinical Endocrinology and Metabolism
Cited by (93)
Biomarkers of stress and disease
2023, Encyclopedia of Mental Health, Third Edition: Volume 1-3Dysregulated by stigma: Cortisol responses to repeated psychosocial stress in gay and heterosexual men
2021, PsychoneuroendocrinologyCitation Excerpt :Being defined as a progressive decline in the magnitude of cortisol response to homotypic stressor, it can already be observed after second exposure and is thought to be normative (Kudielka et al., 2006b; Manigault et al., 2019). Reduced habituation to repeated stress may be indicative of HPA axis dysregulation and has been linked with symptoms of poor health such as vital exhaustion (Kudielka et al., 2006b; Manigault et al., 2019). It has also been predicted by greater post-stress rumination (Gianferante et al., 2014).
Childhood adversity and cortisol habituation to repeated stress in adulthood
2021, Psychoneuroendocrinology