@Article{info:doi/10.2196/32280,
author="Norden, Matthias
and Hofmann, Amin Gerard
and Meier, Martin
and Balzer, Felix
and Wolf, Oliver T
and B{\"o}ttinger, Erwin
and Drimalla, Hanna",
title="Inducing and Recording Acute Stress Responses on a Large Scale With the Digital Stress Test (DST): Development and Evaluation Study",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="15",
volume="24",
number="7",
pages="e32280",
keywords="stress induction; smartphone; stress reactivity; Trier Social Stress Test; TSST; remote; video recording; acute stress; digital health; mobile health; mHealth; mobile phone",
abstract="Background: Valuable insights into the pathophysiology and consequences of acute psychosocial stress have been gained using standardized stress induction experiments. However, most protocols are limited to laboratory settings, are labor-intensive, and cannot be scaled to larger cohorts or transferred to daily life scenarios. Objective: We aimed to provide a scalable digital tool that enables the standardized induction and recording of acute stress responses in outside-the-laboratory settings without any experimenter contact. Methods: On the basis of well-described stress protocols, we developed the Digital Stress Test (DST) and evaluated its feasibility and stress induction potential in a large web-based study. A total of 284 participants completed either the DST (n=103; 52/103, 50.5{\%} women; mean age 31.34, SD 9.48 years) or an adapted control version (n=181; 96/181, 53{\%} women; mean age 31.51, SD 11.18 years) with their smartphones via a web application. We compared their affective responses using the international Positive and Negative Affect Schedule Short Form before and after stress induction. In addition, we assessed the participants' stress-related feelings indicated in visual analogue scales before, during, and after the procedure, and further analyzed the implemented stress-inducing elements. Finally, we compared the DST participants' stress reactivity with the results obtained in a classic stress test paradigm using data previously collected in 4 independent Trier Social Stress Test studies including 122 participants overall. Results: Participants in the DST manifested significantly higher perceived stress indexes than the Control-DST participants at all measurements after the baseline (P<.001). Furthermore, the effect size of the increase in DST participants' negative affect (d=0.427) lay within the range of effect sizes for the increase in negative affect in the previously conducted Trier Social Stress Test experiments (0.281-1.015). Conclusions: We present evidence that a digital stress paradigm administered by smartphone can be used for standardized stress induction and multimodal data collection on a large scale. Further development of the DST prototype and a subsequent validation study including physiological markers are outlined. ",
issn="1438-8871",
doi="10.2196/32280",
url="https://www.jmir.org/2022/7/e32280",
url="https://doi.org/10.2196/32280",
url="http://www.ncbi.nlm.nih.gov/pubmed/35838765"
}