Publications by authors named "Silja Bellingrath"

26 Publications

  • Page 1 of 1

Mindfulness Training for Improving Attention Regulation in University Students: Is It Effective? and Do Yoga and Homework Matter?

Front Psychol 2020 29;11:719. Epub 2020 Apr 29.

Department of Psychology, University of Duisburg-Essen, Essen, Germany.

The present study examined the effects of mindfulness training on attention regulation in university students and whether the potential benefits of implementation are influenced by the yoga component of mindfulness-based interventions (MBIs) and/or by MBI homework practice. In a non-randomized trial with pre- and post-assessments, = 180 university students were allocated to either mindfulness training (experimental groups), awareness activities (active control group), or no training (passive control group). Mindfulness was taught through two MBIs, one including yoga and the other excluding yoga. Attention regulation was operationalized via behavioral indicators, namely sustained attention, cognitive flexibility, cognitive inhibition, and data-driven information processing. With the exception of speed in a cognitive flexibility task, the results indicated no systematic or differential advantage arising from mindfulness training, with or without yoga, regarding the aspects of attention regulation. There was no consistent influence of homework quantity or quality. The implications for mindfulness training in academic contexts are discussed.
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http://dx.doi.org/10.3389/fpsyg.2020.00719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202325PMC
April 2020

Improving emotion regulation and mood in teacher trainees: Effectiveness of two mindfulness trainings.

Brain Behav 2019 09 22;9(9):e01390. Epub 2019 Aug 22.

Department of Psychology, University of Duisburg-Essen, Essen, Germany.

Background/objective: The present research investigated potential effects of mindfulness training on emotion regulation and mood of future schoolteachers in a nonrandomized pre-post design, and whether these are influenced by the yoga component of mindfulness-based stress reduction (MBSR) and/or by homework practice.

Method: N = 169 university students received either mindfulness training (experimental groups), awareness activities (active control group), or no training (passive control group), in the context of university seminars. Allocation to groups was bound by the seminar chosen by participants, and in that sense was self-selected. Mindfulness was trained in two adapted MBSR courses, one of which including yoga, and the other excluding yoga.

Results: Specific benefits of both mindfulness training groups were observed for emotion regulation in terms of an increase in cognitive reappraisal and a reduction in symptom-focused rumination as well as depressive mood. No benefits of mindfulness training were observed for reductions in expressive suppression, self-focused rumination, anxious, and negative mood or an increase in distraction and positive mood respectively. Mindfulness training with and without yoga was mostly equally effective. Outcomes were largely not moderated by practice quantity or quality, but reductions in depressive mood were mediated by gains in reappraisal and distraction.

Conclusions: Mindfulness training can be implemented in the context of university seminars to foster advantageous emotion regulation strategies and lower depressive mood in future schoolteachers. Discontinuing yoga within mindfulness interventions does not seem to reduce training benefits.
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http://dx.doi.org/10.1002/brb3.1390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749600PMC
September 2019

HPA axis responses to psychological challenge linking stress and disease: What do we know on sources of intra- and interindividual variability?

Psychoneuroendocrinology 2019 07 29;105:86-97. Epub 2018 Oct 29.

Department of Medical Psychology, Psychological Diagnostics and Research Methodology, University of Regensburg, Germany. Electronic address:

Stress is an ubiquitous phenomenon with significant impact on human physiology when it lasts too long, when it is too intense, or when it hits vulnerable individuals. Examining the mechanisms linking stress exposure with health and disease is an important endeavor in psychoneuroendocrine research. Empirical evidence so far revealed large intra- as well as inter-individual variability in hypothalamic-pituitary-adrenal (HPA) axis responses to acute psychosocial stress, showing that the HPA axis is a highly adaptive system. Thus, the characterization of intra- und inter-individual patterns of HPA axis reactivity is of high scientific interest and forms the basis on which mechanistic links between stress response (dys)regulation and health impairments can be examined. To date, basic knowledge has been, and still is, accumulated on demographic, biological (including genetic and epigenetic) factors, lifestyle behavioral variables, consumption of substances and medication, psychological and personality factors, as well as on methodological aspects. Besides this, there is also very recent progress in respect to the development of laboratory stress paradigms that can be applied in virtual reality or inside an MRI-scanner. In sum, the present review updates our current knowledge on moderating and intervening factors as sources of intra- und inter-individual variability in human cortisol stress responses and offers recommendations for future research designs.
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http://dx.doi.org/10.1016/j.psyneuen.2018.10.027DOI Listing
July 2019

Psychosocial Hazard Analysis in a Heterogeneous Workforce: Determinants of Work Stress in Blue- and White-Collar Workers of the European Steel Industry.

Front Public Health 2017 17;5:210. Epub 2017 Aug 17.

Work and Organizational Psychology, University of Duisburg-Essen, Essen, Germany.

The European steel industry's workforce is highly heterogeneous and consists of various occupational groups, presumably facing different psychosocial stressors. The few existing studies on the subject mainly focused on physical constraints of blue-collar workers, whereas the supposable psychosocial workload received only little research attention. This is remarkable considering the challenges associated with statutory required risk assessment of psychosocial hazards. Valid measures of hazard analysis must account for various stressors and reliably identify them, also between occupational groups. The present study, based on a sample of blue- and white-collar workers ( = 124) from the European steel industry, aims to provide a first insight into psychosocial stressors and strain at work in this rarely researched industrial sector. Furthermore, two well-known theoretical roadmaps in job analysis are examined regarding their utility for risk assessment in heterogeneous workforces: the German standard version of the Copenhagen Psychosocial Questionnaire (COPSOQ) and the short version of the effort-reward imbalance questionnaire. Hierarchical multiple regression analyses revealed that the COPSOQ was better suited to predict various strain indices in the present sample. Especially stressors relating to socioemotional aspects, such as work-privacy conflict, revealed a reasonable impact, indicating the need for comprehensive solutions at the organizational level instead of solutions focusing on single workplaces. To conclude, a broadly diversified and validated approach in psychosocial risk assessment is needed to adequately assess the variety of psychosocial factors at work and in different occupational groups.
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http://dx.doi.org/10.3389/fpubh.2017.00210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562717PMC
August 2017

Cognitive Effects of Mindfulness Training: Results of a Pilot Study Based on a Theory Driven Approach.

Front Psychol 2016 12;7:1037. Epub 2016 Jul 12.

Department of Psychology, University of Duisburg-Essen Essen, Germany.

The present paper reports a pilot study which tested cognitive effects of mindfulness practice in a theory-driven approach. Thirty-four fifth graders received either a mindfulness training which was based on the mindfulness-based stress reduction approach (experimental group), a concentration training (active control group), or no treatment (passive control group). Based on the operational definition of mindfulness by Bishop et al. (2004), effects on sustained attention, cognitive flexibility, cognitive inhibition, and data-driven as opposed to schema-based information processing were predicted. These abilities were assessed in a pre-post design by means of a vigilance test, a reversible figures test, the Wisconsin Card Sorting Test, a Stroop test, a visual search task, and a recognition task of prototypical faces. Results suggest that the mindfulness training specifically improved cognitive inhibition and data-driven information processing.
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http://dx.doi.org/10.3389/fpsyg.2016.01037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940413PMC
July 2016

Deficiencies of the T and natural killer cell system in major depressive disorder: T regulatory cell defects are associated with inflammatory monocyte activation.

Brain Behav Immun 2016 May 8;54:38-44. Epub 2015 Dec 8.

Department of Immunology, Erasmus MC, Rotterdam, The Netherlands.

Background: In a previous study, we found an up-regulated inflammatory monocyte gene expression profile in major depressive disorder (MDD) patients aged ⩾ 28 years and a down-regulated inflammatory gene expression profile in MDD patients aged<28 years. In the same sample of patients, we aimed to investigate immune dysregulation in the lymphocyte arm of the immune system, particularly in the context of the described monocyte (de-)activation states.

Methods: From deep frozen leukocytes, circulating percentages of monocytes, lymphocytes, B, T, and natural killer (NK) cells, and various functional subsets of T and T helper (Th) cells (Th1, Th2, Th17, and natural T regulatory cells) were measured in N=50 MDD patients and N=58 age- and gender-matched healthy controls (HC). In addition, serum levels of interleukin (IL)-6, sCD25, IL-7, IL-3, SCF, IGF-BP2, and EGF were evaluated.

Results: MDD patients were in general characterized by an impaired maturation of Th2 cells, Th17 cells, and NK cells and by decreased serum levels of IL-7 and sCD25. MDD patients aged ⩾ 28 years additionally exhibited decreased percentages of CD4(+)CD25(high)FoxP3(+) T regulatory cells, next to signs of the above described partial T cell defects. Natural T regulatory cells were inversely associated with the pro-inflammatory state of the monocytes (r=-.311; p=.034) that characterized this patient subgroup.

Conclusions: Deficiencies of the NK and T (regulatory) cell system and inflammatory monocyte immune activation co-occur as partly interrelated phenomena within the same MDD patients.
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http://dx.doi.org/10.1016/j.bbi.2015.12.003DOI Listing
May 2016

Clinical characteristics of inflammation-associated depression: Monocyte gene expression is age-related in major depressive disorder.

Brain Behav Immun 2015 Feb 20;44:48-56. Epub 2014 Aug 20.

Department of Psychiatry and Psychotherapy, University of Münster, Germany.

Increased inflammatory activation might only be present in a subgroup of depressed individuals in which immune processes are especially relevant to disease development. We aimed to analyze demographic, depression, and trauma characteristics of major depressive disorder (MDD) patients with regard to inflammatory monocyte gene expression. Fifty-six naturalistically treated MDD patients (32 ± 12 years) and 57 healthy controls (HC; 31 ± 11 years) were analyzed by the Inventory of Depressive Symptomatology (IDS) and by the Childhood Trauma Questionnaire (CTQ). We determined the expression of 38 inflammatory and immune activation genes including the glucocorticoid receptor (GR)α and GRβ genes in purified CD14(+) monocytes using quantitative-polymerase chain reaction (RT-qPCR). Monocyte gene expression was age-dependent, particularly in MDD patients. Increased monocyte gene expression and decreased GRα/β ratio were only present in MDD patients aged ⩾ 28 years. Post hoc analyses of monocyte immune activation in patients <28 years showed two subgroups: a subgroup with a severe course of depression (recurrent type, onset <15 years) - additionally characterized by panic/arousal symptoms and childhood trauma - that had a monocyte gene expression similar to HC, and a second subgroup with a milder course of the disorder (73% first episode depression, onset ⩾15 years) - additionally characterized by the absence of panic symptoms - that exhibited a strongly reduced inflammatory monocyte activation compared to HC. In conclusion, monocyte immune activation was not uniformly raised in MDD patients but was increased only in patients of 28 years and older.
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http://dx.doi.org/10.1016/j.bbi.2014.08.004DOI Listing
February 2015

The interplay of matching and non-matching job demands and resources on emotional exhaustion among teachers.

Appl Psychol Health Well Being 2013 Jul 18;5(2):171-92. Epub 2013 Jan 18.

Jacobs University Bremen, Bremen, Germany.

Background: We investigated how matching and non-matching demands and resources are related to emotional exhaustion (EE) in teachers. Theoretically, we draw on the Demand-Induced Strain Compensation (DISC) model that proposes that demands, resources, and strains are multidimensional and comprise emotional, cognitive, and physical components. We first tested whether resources compensate aversive effects of demands. Second, as proposed by the triple-match principle, we tested whether interaction effects between job demands and resources are most likely if demands, resources, and outcomes relate to the same dimension.

Methods: We retrieved data from 177 school teachers; a subsample was re-examined after a time lag of about 21 month (N = 56).

Results: Linear regression analyses reveal concurrent and longitudinal main and interaction effects of teacher-specific emotional and cognitive job demands and resources on EE.

Conclusion: Results support the compensation principle and triple-match principle. Therefore, the DISC model seems to provide a valuable framework for the study of interaction effects in job stress research and, in particular, for interventions to reduce job strain in teachers.
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http://dx.doi.org/10.1111/aphw.12002DOI Listing
July 2013

Effort-reward-imbalance in healthy teachers is associated with higher LPS-stimulated production and lower glucocorticoid sensitivity of interleukin-6 in vitro.

Biol Psychol 2013 Feb 16;92(2):403-9. Epub 2012 Dec 16.

Institute of Psychology, University of Duisburg-Essen, Berliner Platz 6-8, 45127 Essen, Germany.

Background: According to the effort-reward-imbalance (ERI) model, a lack of reciprocity between costs and gains at work increases the risk for adverse health outcomes. Inflammation has been shown to play a crucial role in a variety of stress-related diseases and alterations in immune system glucocorticoid sensitivity may help to explain the increased risk for cardiovascular disease (CVD) and depression related to chronic work stress.

Methods: Changes in lipopolysaccharide (LPS)-induced interleukin (IL)-6 production and inhibition of IL-6 production by dexamethasone in reaction to the Trier Social Stress Test (TSST) were assessed in forty-six healthy school teachers to test whether chronic work stress is accompanied by alterations in inflammatory activity and glucocorticoid sensitivity of the innate immune system.

Results: High ERI was associated with an increase in pro-inflammatory potential, reflected in elevated IL-6 production before and after stress and with a lower capacity of dexamethasone to suppress IL-6 production in vitro over all measurement time points. ERI was not associated with stress-related changes in GC sensitivity.

Conclusion: The present findings suggest a less effective anti-inflammatory regulation by glucocorticoids in teachers suffering from chronic work stress.
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http://dx.doi.org/10.1016/j.biopsycho.2012.12.003DOI Listing
February 2013

Emotional exhaustion and cognitive performance in apparently healthy teachers: a longitudinal multi-source study.

Stress Health 2013 Oct 22;29(4):297-306. Epub 2012 Oct 22.

Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Bremen, Germany.

We investigate how emotional exhaustion (EE), the core component of burnout, relates to cognitive performance, job performance and health. Cognitive performance was assessed by self-rated cognitive stress symptoms, self-rated and peer-rated cognitive impairments in everyday tasks and a neuropsychological test of learning and memory (LGT-3); job performance and physical health were gauged by self-reports. Cross-sectional linear regression analyses in a sample of 100 teachers confirm that EE is negatively related to cognitive performance as assessed by self-rating and peer-rating as well as neuropsychological testing (all p < .05). Longitudinal linear regression analyses confirm similar trends (p < .10) for self-rated and peer-rated cognitive performance. Executive control deficits might explain impaired cognitive performance in EE. In longitudinal analyses, EE also significantly predicts physical health. Contrary to our expectations, EE does not affect job performance. When reversed causation is tested, none of the outcome variables at Time 1 predict EE at Time 2. This speaks against cognitive dysfunctioning serving as a vulnerability factor for exhaustion. In sum, results underpin the negative consequences of EE for cognitive performance and health, which are relevant for individuals and organizations alike. In this way, findings might contribute to the understanding of the burnout syndrome.
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http://dx.doi.org/10.1002/smi.2467DOI Listing
October 2013

Cortisol responses to naturalistic and laboratory stress in student teachers: comparison with a non-stress control day.

Stress Health 2013 Apr 9;29(2):143-9. Epub 2012 Aug 9.

Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Bremen, Germany.

Ambulatory assessments of hypothalamus-pituitary-adrenal axis responses to acute natural stressors yield evidence on stress regulation with high ecological validity. Sampling of salivary cortisol is a standard technique in this field. In 21 healthy student teachers, we assessed cortisol responses to a demonstration lesson. On a control day, sampling was repeated at analogous times. Additionally, the cortisol awakening response (CAR) was assessed on both days. Participants were also exposed to a laboratory stressor, the Trier Social Stress Test, and rated their individual levels of chronic work stress. In pre-to-post-stress assessment, cortisol levels declined after the lesson. However, post-stress cortisol levels were significantly higher compared with those on the control day. Also, the Trier Social Stress Test yielded higher cortisol responses when using the control day as reference baseline. Associations between the CAR and chronic stress measures were observed solely on the control day. There were no significant associations between cortisol responses to the natural and laboratory stressors. Our results indicate that a control day might be an important complement in laboratory but especially in ambulatory stress research. Furthermore, associations between chronic stress measures and the CAR might be obscured by acute stress exposure. Finally, responses to the laboratory stressor do not seem to mirror natural stress responses.
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http://dx.doi.org/10.1002/smi.2439DOI Listing
April 2013

Associations between cognitive performance and cortisol reaction to the DEX/CRH test in patients recovered from depression.

Psychoneuroendocrinology 2013 Mar 26;38(3):447-54. Epub 2012 Jul 26.

Department of Psychiatry and Psychotherapy, University of Münster, 48149 Münster, Germany.

Background: Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis in major depression (MDD) is one of the most reliably reported neurobiological characteristics of affective disorders. Whether these alterations in HPA axis regulation are limited to the acute stage of MDD or whether they persist after recovery, remains ambiguous. A relationship between hypercortisolemia and cognitive dysfunction in acutely depressed patients has been repeatedly observed and it was also demonstrated in a number of studies that a discrete cognitive impairment often persists in the remitted state of depression. In the present study we were interested, whether these subtle impairments in cognitive functioning observed in patients recovered from depression compared to healthy control subjects are associated with HPA axis feedback sensitivity.

Methods: In 20 recovered patients and 20 matched healthy controls we assessed HPA axis feedback sensitivity with the combined dexamethasone suppression/corticotropin-releasing-hormone (DEX/CRH) challenge test. Furthermore cognitive performance was investigated with respect to the following domains: verbal memory (Auditory Verbal Learning Test, VLMT), attention and executive control (Trail Making Test, TMT-A/B) as well as verbal fluency (Controlled Oral Word Association Test, COWAT).

Results: Recovered patients showed a significantly poorer cognitive performance compared to healthy controls (all p<.05). With regard to HPA-axis activity, no overall difference was observed in the DEX/CRH test between recovered patients and controls. In recovered patients however, a significant association was observed between cortisol response and verbal memory (main effect VLMT trial 1-5: p=.046), attention (main effect TMT-A: p=.015) and executive functioning in terms of set shifting (interaction samples*TMT-B: p=.018). Poorer test performance was related to increased cortisol levels in response to challenge.

Conclusions: The present findings suggest that patients recovered from MDD are especially vulnerable toward detrimental effects of subtle HPA axis disturbances on cognitive performance.
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http://dx.doi.org/10.1016/j.psyneuen.2012.07.005DOI Listing
March 2013

Emotional exhaustion and overcommitment to work are differentially associated with hypothalamus-pituitary-adrenal (HPA) axis responses to a low-dose ACTH1-24 (Synacthen) and dexamethasone-CRH test in healthy school teachers.

Stress 2013 Jan 16;16(1):54-64. Epub 2012 May 16.

Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Bremen, Germany.

Evidence for a detrimental impact of chronic work stress on health has accumulated in epidemiological research. Recent studies indicate altered hypothalamus-pituitary-adrenal (HPA) axis regulation as a possible biological pathway underlying the link between stress and disease. However, the direction of dysregulation remains unclear, with reported HPA hyper- or hyporeactivity. To disentangle potential effects on different functional levels in the HPA axis, we examined responses using two pharmacological stimulation tests in 53 healthy teachers (31 females, 22 males; mean age: 49.3 years; age range: 30-64 years): a low-dose adrenocorticotrophic hormone (ACTH(1-24), Synacthen) test was used to assess adrenal cortex sensitivity and the combined dexamethasone-corticotropin releasing hormone (DEX-CRH) test to examine pituitary and adrenal cortex reactivity. Blood and saliva samples were collected at - 1,+15,+30,+45,+60,+90,+120 min. Emotional exhaustion (EE), the core dimension of burnout, was measured with the Maslach Burnout Inventory. Overcommitment (OC) was assessed according to Siegrist's effort-reward-imbalance model. We found a significant association between EE and higher plasma cortisol profiles after Synacthen (p = 0.045). By contrast, OC was significantly associated with attenuated ACTH (p = 0.045), plasma cortisol (p = 0.005), and salivary cortisol (p = 0.023) concentrations following DEX-CRH. Results support the notion of altered HPA axis regulation in chronically work-stressed teachers, with differential patterns of hyper- and hyporeactivity depending on individual stress condition and the tested functional level of the HPA axis.
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http://dx.doi.org/10.3109/10253890.2012.683465DOI Listing
January 2013

The cortisol awakening response (CAR) across the female menstrual cycle.

Psychoneuroendocrinology 2011 Jul 14;36(6):905-12. Epub 2011 Jan 14.

Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Bremen, Germany.

The cortisol awakening response (CAR) has been established as a useful marker of hypothalamus-pituitary-adrenal (HPA) axis activity and has become a standard tool for stress research in ambulatory settings. Although much knowledge has been accumulated on a variety of factors modulating the CAR, the impact of the female menstrual cycle, especially during ovulation, still remains unclear. To the best of our knowledge, this is the first study that measured the CAR during menses, the follicular phase, ovulation and the luteal phase in a repeated measurement design. For this purpose, a final sample of 29 naturally cycling, healthy, non-smoking, and medication-free women collected saliva samples directly after awakening as well as 30, 45, and 60 min later during each of the four different phases. To determine the timing of ovulation, an ambulatory chromatographic ovulation test kit was applied. A repeated measurements ANOVA resulted in a significant interaction effect sample × cycle phase (p=0.04), with the highest awakening response during ovulation. While awakening cortisol levels were comparable across the four cycle phases (p=n.s.), the net increase was significantly elevated during ovulation (p=0.05). Our data also confirmed earlier cross-sectional results reporting no differences in the CAR between the follicular and luteal phase. Finally, a concurrent assessment of mood applying the POMS (Profile of Mood States) yielded no differences across the four cycle phases (all p=n.s.). In sum, the present data points to the idea that the CAR is elevated during ovulation, an effect which is presumably mediated by elevated sex steroid levels during the ovulation period.
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http://dx.doi.org/10.1016/j.psyneuen.2010.12.006DOI Listing
July 2011

Human mineralocorticoid receptor (MR) gene haplotypes modulate MR expression and transactivation: implication for the stress response.

Psychoneuroendocrinology 2011 Jun 20;36(5):699-709. Epub 2010 Nov 20.

Division of Medical Pharmacology, Leiden/Amsterdam Center for Drug Research, Leiden University Medical Center, Leiden, The Netherlands.

Stress causes activation of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in secretion of corticosteroids which facilitate behavioural adaptation. These effects exerted by corticosteroids are mediated by two brain corticosteroid receptor types, the mineralocorticoid receptor (MR), with a high affinity already occupied under basal conditions and the glucocorticoid receptor (GR), with a low affinity only activated during stress. Here, we studied MR gene haplotypes constituted by the two single nucleotide polymorphisms MR-2G/C (rs2070951) and MRI180V (rs5522). The haplotypes showed differences in cortisol-induced gene transcription and protein expression while the structural variant MRI180V did not affect ligand binding. Moreover, in a well characterized cohort of 166 school teachers these haplotypes have been associated with perceived chronic stress (Trier Inventory for the Assessment of Chronic Stress, TICS) and, in a subgroup of 47 subjects, with ACTH, cortisol and heart rate responses to acute psychosocial stress (Trier Social Stress Test, TSST). MR haplotypes were significantly associated with the TICS scales "excessive demands at work" and "social overload". Subjects homozygous for haplotype MR-2C/MRI180, which in vitro showed highest expression and transactivational activity, displayed the highest salivary cortisol (p<0.001), plasma cortisol (p=0.010), plasma ACTH (p=0.003) and heart rate (p=0.018) responses. It is concluded that the investigated MR haplotypes modulate cortisol-induced gene transcription in vitro. Moreover, these haplotypes may contribute to individual differences in perceived chronic stress as well as neuroendocrine and cardiovascular stress responses.
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http://dx.doi.org/10.1016/j.psyneuen.2010.10.003DOI Listing
June 2011

Healthy working school teachers with high effort-reward-imbalance and overcommitment show increased pro-inflammatory immune activity and a dampened innate immune defence.

Brain Behav Immun 2010 Nov 3;24(8):1332-9. Epub 2010 Jul 3.

Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Campus Ring 1, 28759 Bremen, Germany.

To test whether chronic work stress is accompanied by altered immune functioning, changes in lymphocyte subsets and in lymphocyte production of cytokines were examined in reaction to acute psychosocial stress. Work stress was measured according to Siegrist's effort-reward-imbalance (ERI) model. ERI reflects stress due to a lack of reciprocity between costs and gains at work. Overcommitment (OC) is conceptualized as a dysfunctional coping pattern mainly characterized by the inability to withdraw from work obligations. Fifty-five healthy teachers (34 women, 21 men, mean age 50.0 ± 8.47 years) were exposed to a standardized laboratory stressor (Trier Social Stress Test). Lymphocyte subset counts and lymphocyte production of tumor-necrosis-factor (TNF)-α, interferon (IFN)-γ, interleukin (IL)-2, -4, -6 and -10 were measured before and after challenge. High levels of ERI and OC were associated with lower natural killer (NK) cell (CD16+/56+) numbers whereas high levels of OC were related to a lower increase in T-helper cells (CD4+) after stress. Furthermore, subjects with higher ERI showed an overall increased pro-inflammatory activity, with higher TNF-α production at both time points and elevated pre-stress IL-6 production. IL-10 production decreased with higher ERI after stress. The ratios of TNF-α/IL-10 and IL-6/IL-10 were significantly increased in subjects high on ERI. Finally, OC was associated with higher IL-2 production post-stress. The present findings suggest a dampened innate immune defence, reflected in lower NK cell numbers together with an increased pro-inflammatory activity in teachers high on ERI and OC. Such pathways could partly be responsible for the increased vulnerability for stress-related diseases in individuals suffering from chronic work stress.
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http://dx.doi.org/10.1016/j.bbi.2010.06.011DOI Listing
November 2010

Association of vital exhaustion and depressive symptoms with changes in fibrin D-dimer to acute psychosocial stress.

J Psychosom Res 2009 Jul 31;67(1):93-101. Epub 2009 Mar 31.

Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, Switzerland.

Objective: Vital exhaustion and depression are psychosocial risk factors of coronary artery disease. A hypercoagulable state in response to acute psychosocial stress contributes to atherothrombotic events. We aimed to investigate the hypothesis that vital exhaustion and depression correlate with stress-induced changes in the hypercoagulability marker D-dimer.

Methods: Thirty-eight healthy and nonsmoking school teachers (mean age 50+/-8 years, 55% women) completed the nine-item Maastricht Vital Exhaustion Questionnaire and the seven-item depression subscale of the Hospital Anxiety and Depression Scale. Within 1 week, subjects twice underwent the Trier Social Stress Test (i.e., preparation phase, mock job interview, and mental arithmetic that totaled 13 min). Plasma D-dimer levels were determined at five time points during the protocol.

Results: Vital exhaustion (P=.022; eta(2)=.080) and depressive symptoms (P=.011; eta(2)=.090) were associated with stress-induced changes in D-dimer levels over time controlling for sex and age. Elevated levels of vital exhaustion (r=-.46, P=.005) and of depression (r=-.51, P=.002) correlated with reduced D-dimer increase from pre-stress to immediately post-stress. Also, elevated vital exhaustion (r=.34, P=.044) and depression (r=.41, P=.013) were associated with increase (i.e., attenuated recovery) of D-dimer levels between 20 and 45 min post-stress. Controlling for stress hormone and blood pressure reactivity did not substantially alter these results.

Conclusion: The findings suggest an attenuated immediate D-dimer stress response and delayed recovery of D-dimer levels post-stress with elevated vital exhaustion and depressive symptoms. In particular, the prolonged hypercoagulability after stress cessation might contribute to the atherothrombotic risk previously observed with vital exhaustion and depression, even at subclinical levels.
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http://dx.doi.org/10.1016/j.jpsychores.2008.12.009DOI Listing
July 2009

Association between longitudinal changes in depressive symptoms and plasma fibrinogen levels in school teachers.

Psychophysiology 2009 May 4;46(3):473-80. Epub 2009 Mar 4.

Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.

Depression and anxiety previously predicted coronary artery disease (CAD) risk. Inflammation contributes to CAD and shows an association with depression. We followed 57 teachers (mean 49+/-8 years) over 21 months and investigated whether changes in depressive and anxiety symptoms relate to those in the CAD risk and inflammation marker fibrinogen and vice versa. Increase in depressive symptoms and in fibrinogen levels were significantly correlated. While controlling for baseline depression rendered the association between changes in depression and fibrinogen nonsignificant, taking into account baseline fibrinogen levels maintained the predictive value of fibrinogen change for depression change. Anxiety and fibrinogen changes were not significantly correlated. This dynamic relationship between depression and the inflammatory biomarker fibrinogen might advance our knowledge about psychobiological mechanisms underlying both CAD and sickness behavior.
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http://dx.doi.org/10.1111/j.1469-8986.2009.00788.xDOI Listing
May 2009

Overcommitment but not effort-reward imbalance relates to stress-induced coagulation changes in teachers.

Ann Behav Med 2009 Feb 30;37(1):20-8. Epub 2009 Jan 30.

Division of Psychosomatic Medicine, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland.

Background: Stress-related hypercoagulability might link job stress with atherosclerosis.

Purpose: This paper aims to study whether overcommitment, effort-reward imbalance, and the overcommitment by effort-reward imbalance interaction relate to an exaggerated procoagulant stress response.

Methods: We assessed job stress in 52 healthy teachers (49 +/- 8 years, 63% women) at study entry and, after a mean follow-up of 21 +/- 4 months, when they underwent an acute psychosocial stressor and had coagulation measures determined in plasma. In order to increase the reliability of job stress measures, entry and follow-up scores of overcommitment and of effort-reward imbalance were added up to total scores.

Results: During recovery from stress, elevated overcommitment correlated with D-dimer increase and with smaller fibrinogen decrease. In contrast, overcommitment was not associated with coagulation changes from pre-stress to immediately post-stress. Effort-reward imbalance and the interaction between overcommitment and effort-reward imbalance did not correlate with stress-induced changes in coagulation measures.

Conclusions: Overcommitment predicted acute stress-induced hypercoagulability, particularly during the recovery period.
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http://dx.doi.org/10.1007/s12160-009-9082-yDOI Listing
February 2009

Chronic work stress and exhaustion is associated with higher allostastic load in female school teachers.

Stress 2009 Jan;12(1):37-48

Department of Theoretical and Clinical Psychobiology, Graduate School of Psychobiology, University of Trier, D-54290 Trier, Germany.

Epidemiological studies have shown that chronic work stress or unfavourable psychosocial work conditions are prospectively associated with different adverse health outcomes. The aim of the present cross-sectional study was to investigate the relationship between work-related chronic stress as well as exhaustion and a cumulative measure of physiological wear-and-tear called allostastic load (AL). AL could be a possible biological pathway for how chronic work stress and exhaustion lead to health impairments in the long run. As the teaching profession has been proposed to be a potentially high stressful occupation, chronic work stress (effort-reward-imbalance) and exhaustion were assessed in 104 female school teachers. AL was first analyzed according to McEwen's classical model comprised of ten parameters including cortisol, epinephrine and norepinephrine, dehydroepiandrosterone-sulphate (DHEA-S), waist/hip-ratio (WHR), glycosylated haemoglobin (HbA1c), high-density lipoprotein (HDL), total cholesterol/HDL-ratio, and systolic and diastolic blood pressure. Additionally it was extended to include tumor-necrosis-factor-alpha (TNF-alpha), C-reactive protein (CRP), fibrinogen, D-dimer, percent-body-fat, triglycerides, and glucose levels. A substantial proportion of our sample was highly exhausted whereas relatively few teachers showed high effort-reward-imbalance. AL scores were significantly higher in women high on effort-reward-imbalance or suffering from exhaustion. Although all teachers had been in a good health status, chronic work stress as well as exhaustion appears to be associated with changes in a multi-system summary indicator of physiological risk.
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http://dx.doi.org/10.1080/10253890802042041DOI Listing
January 2009

Effort-reward-imbalance and overcommitment are associated with hypothalamus-pituitary-adrenal (HPA) axis responses to acute psychosocial stress in healthy working schoolteachers.

Psychoneuroendocrinology 2008 Nov 5;33(10):1335-43. Epub 2008 Sep 5.

Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Campus Ring 1, 28759 Bremen, Germany.

In this study, we examined HPA axis responses to acute psychosocial stress in relation to effort-reward-imbalance (ERI) and overcommitment (OC) to test whether chronic stress at work is accompanied by altered HPA axis stress responses in teachers. According to Siegrist's work stress model, ERI reflects stress due to a lack of reciprocity between personal costs and gains at work, whereas OC is conceptualized as a personality trait mainly characterized by the inability to withdraw from work obligations. Fifty-three medication-free, non-smoking, healthy teachers (33 women, 20 men, 29-63 years, mean age 49.9+/-8.58 years) were confronted with the Trier Social Stress Test (TSST), a widely used standardized stress protocol to induce acute psychosocial stress in the laboratory. ACTH (five samples), total plasma (six samples) and free salivary cortisol (eight samples) were repeatedly measured before and after challenge. In the total group, ERI and OC were only marginally associated with HPA axis responses to acute stress. However, in the subgroup of responders (N=30) high levels of OC were significantly associated with lower ACTH (p=0.03) as well as plasma (p=0.02) and salivary cortisol (p<0.001) responses and results remained significant controlling for depressive symptoms. When additionally controlling for acute perceived stressfulness of the TSST, significant associations between OC and HPA axis responses emerged in responders as well as the total study sample. In respect to ERI, higher stress levels were solely related to significantly stronger plasma cortisol increases after TSST exposure, but this effect became non-significant controlling for depressive symptomatology. In sum, our findings support the notion of HPA axis hyporeactivity in highly overcommitted schoolteachers.
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http://dx.doi.org/10.1016/j.psyneuen.2008.07.008DOI Listing
November 2008

Association between burnout and circulating levels of pro- and anti-inflammatory cytokines in schoolteachers.

J Psychosom Res 2008 Jul 22;65(1):51-9. Epub 2008 May 22.

Division of Psychosomatic Medicine, Inselspital, Bern University Hospital and University of Bern, Switzerland.

Objective: The burnout syndrome has been associated with an increased risk of cardiovascular disease. The physiological mechanisms potentially involved in this link are underexplored. Knowing that a chronic low-grade systemic inflammatory state contributes to atherosclerosis, we investigated circulating cytokine levels in relation to burnout symptoms.

Methods: We studied 167 schoolteachers (median, 48 years; range, 23-63 years; 67% women) who completed the Maslach Burnout Inventory with its three subscales emotional exhaustion (EE), lack of accomplishment (LA), and depersonalization (DP). Levels of the proinflammatory cytokine tumor necrosis factor (TNF)-alpha and of the anti-inflammatory cytokines interleukin (IL)-4 and IL-10 were determined in fasting morning plasma samples. The TNF-alpha/IL-4 ratio and the TNF-alpha/IL-10 ratio were computed as two indices of increased inflammatory activity. Analyses were adjusted for demographic factors, medication, lifestyle factors (including sleep quality), metabolic factors, and symptoms of depression and anxiety.

Results: Higher levels of total burnout symptoms aggregating the EE, LA, and DP subscales independently predicted higher TNF-alpha levels (DeltaR(2)=.024, P=.046), lower IL-4 levels (DeltaR(2)=.021, P=.061), and a higher TNF-alpha/IL-4 ratio (DeltaR(2)=.040, P=.008). Higher levels of LA predicted decreased IL-4 levels (DeltaR(2)=.041, P=.008) and a higher TNF-alpha/IL-4 ratio (DeltaR(2)=.041, P=.007). The categorical dimensions of the various burnout scales (e.g., burnout yes vs. no) showed no independent relationship with any cytokine measure.

Conclusion: Burnout was associated with increased systemic inflammation along a continuum of symptom severity rather than categorically. Given that low-grade systemic inflammation promotes atherosclerosis, our findings may provide one explanation for the increased cardiovascular risk previously observed in burned-out individuals.
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http://dx.doi.org/10.1016/j.jpsychores.2008.02.007DOI Listing
July 2008

Circulating fibrinogen but not D-dimer level is associated with vital exhaustion in school teachers.

Stress 2008 Jul;11(4):250-8

Department of Theoretical and Clinical Psychobiology, Graduate School of Psychobiology, University of Trier, Trier, Germany.

Meta-analyses have established elevated fibrinogen and D-dimer levels in the circulation as biological risk factors for the development and progression of coronary artery disease (CAD). Here, we investigated whether vital exhaustion (VE), a known psychosocial risk factor for CAD, is associated with fibrinogen and D-dimer levels in a sample of apparently healthy school teachers. The teaching profession has been proposed as a potentially high stressful occupation due to enhanced psychosocial stress at the workplace. Plasma fibrinogen and D-dimer levels were measured in 150 middle-aged male and female teachers derived from the first year of the Trier-Teacher-Stress-Study. Log-transformed levels were analyzed using linear regression. Results yielded a significant association between VE and fibrinogen (p = 0.02) but not D-dimer controlling for relevant covariates. Further investigation of possible interaction effects resulted in a significant association between fibrinogen and the interaction term "VE x gender" (p = 0.05). In a secondary analysis, we reran linear regression models for males and females separately. Gender-specific results revealed that the association between fibrinogen and VE remained significant in males but not females. In sum, the present data support the notion that fibrinogen levels are positively related to VE. Elevated fibrinogen might be one biological pathway by which chronic work stress may impact on teachers' cardiovascular health in the long run.
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http://dx.doi.org/10.1080/10253890701714831DOI Listing
July 2008

Cortisol dysregulation in school teachers in relation to burnout, vital exhaustion, and effort-reward-imbalance.

Biol Psychol 2008 Apr 2;78(1):104-13. Epub 2008 Feb 2.

Department of Theoretical and Clinical Psychobiology, Graduate School of Psychobiology, University of Trier, Johanniterufer 15, D-54290 Trier, Germany.

We analyzed whether burnout and vital exhaustion or job-related chronic stress is associated with hypothalamic-pituitary-adrenal (HPA) axis dysregulation in school teachers (N=135; 25-63 years; mean age 46.1+/-9.20 years). Participants collected seven saliva samples (0, 30, 45, and 60 min after awakening, 11a.m., 3 p.m., 8 p.m.) on 2 working days, 1 leisure day, and after pre-medication with 0.25mg dexamethasone (very low-dose dexamethasone suppression test) to assess basal cortisol day profiles and HPA axis negative feedback sensitivity. No associations were found between basal cortisol activity and burnout (Maslach burnout inventory, teacher burnout scale), vital exhaustion (Appels vital exhaustion questionnaire), or any component of Siegrist's effort-reward-imbalance model. However, after dexamethasone higher burnout and vital exhaustion and lower reward were significantly related to stronger cortisol suppression, pointing to altered HPA axis negative feedback sensitivity. Though, all teachers were working and in a good health status, burnout/exhaustion as well as facets of the ERI model appear to be associated with subtle dysregulation, manifested as heightened HPA axis negative feedback although not in basal cortisol day profiles.
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http://dx.doi.org/10.1016/j.biopsycho.2008.01.006DOI Listing
April 2008

Further support for higher salivary cortisol levels in "morning" compared to "evening" persons.

J Psychosom Res 2007 May;62(5):595-6

Department of Theoretical and Clinical Psychobiology, University of Trier, Trier, Germany.

We analyzed free cortisol daytime levels in a "3-days-7-samples-a-day" protocol in relation to morningness in 112 middle-aged male and female adults derived from the first year of data of the Trier Teacher Stress Study using a one-item proxy for the assessment of chronotype. First, log-transformed cortisol levels were analyzed by a repeated-measures approach controlling for relevant covariates. Results yielded an almost significant main effect of morningness (P=.06). Subsequent within-day analyses, additionally controlling for awakening time, resulted in (marginally) significant main effects of morningness at Day 1 (P=.06) and Day 3 (P=.05) and a significant interaction of sample-by-morningness at Day 2 (P=.04). In sum, the present data seem to corroborate the idea of higher daytime cortisol levels in morning relative to evening types in a sample of healthy middle-aged male and female adults.
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http://dx.doi.org/10.1016/j.jpsychores.2007.03.016DOI Listing
May 2007