The Standardized Mental Stress Test Protocol: Test‐Retest Reliability and Comparison with Ambulatory Blood Pressure Monitoring

Abstract

The mental stress test protocol is used extensively in research, but different laboratories often employ different stress tasks, utilize different dependent variables to index the stress response, and perform different transformations on the gathered data. The present study determined the test‐retest reliability of 11 cardiovascular dependent variables during a resting baseline and three common stress tasks: playing a video game, performing a choice reaction‐time test, and performing a cold‐pressor test. Sixty healthy, middle‐aged males underwent testing twice, approximately three months apart. Instructions were delivered via videotape and data were gathered on‐line by computer to ensure a standard laboratory environment. Each task elicited significant increases in blood pressure, vascular rigidity, LVET, heart rate, and stroke volume. In addition, the cold‐pressor test led to increases in total systemic resistance and mean systolic ejection rate. The absolute levels of the 11 dependent variables were correlated across tasks (partial r, baseline removed, = .06 to .69, 32 of 33 comparisons significant at p<.05), indicating that reactivity to stress generalizes across alternate test forms. The absolute levels also showed significant test‐retest reliability (r= .32 to .82; 40 of 44 comparisons significant at p<.05). In addition, for 19 of 33 comparisons, absolute levels showed greater test‐retest reliability than change scores derived by subtracting the initial resting baseline value from the stress‐task value. Finally, blood pressures taken during the stress tests were more highly correlated with the average blood pressures measured via ambulatory monitoring than casual office pressures, suggesting that such stress values may more accurately reflect average blood pressure.

Effects of race and marginally elevated blood pressure on responses to stress.

“…Research evaluating the association between high cardiovascular reactivity to laboratory psychological stressors and real-life events using ambulatory monitoring has begun, and this line of evidence will also help clarify this issue. 37 ' 38 However, additional longitudinal studies on the long-term significance of high reactivity to psychological stress in blacks and whites are still needed and appear well warranted. These investigations may be more productive if the cardiovascular reactivity factor is evaluated in interaction with indices of stressful life demands, such as occupation, socioeconomic status, and family situation.…”

Maintenance and generalizability of laboratory-based heart rate reactivity control training

“…Although van Doornen (1986) examined students' HRR to an examination, and Matthews et al (1986a) measured adolescents' HRR to giving a speech, neither of those studies collected data on the frequency of HRR during typical daily events. Thus, although there are several studies of the generalizability of laboratory based blood pressure reactivity to ambulatory blood pressure taken over several hours (e.g., Harshfield et al, 1988;McKinney et al, 1985;Watson et aL, 1980), the issue of the generalizability of laboratory-based HRR to everyday life events in terms of frequency of occurrence has received little attention.…”

Laboratory psychophysiological assessment and imagery exposure in panic disorder patients

“…First, we did not randomize the order of psychophysiological tasks. However, previous research suggested that the reliability of psychophysiological tests in nonrandomized protocols is satisfactory [McKinney et al, 1985]. Second, imagery exposure may not be strong enough to evoke anxiety about specific situations.…”