Health Psychology, 2nd Edition

oxygen reaching the heart. In addition, this person may experience leg cramps because
of lack of oxygen to the legs. However, more seriously, if the coronary arteries
supplying the heart become ‘blocked’, which may happen if increased blood pressure
in a narrowed artery sheers off a section of plaque, this can lead to a myocardial
infarction (or heart attack) where part of the heart muscle (deprived of oxygen) dies.
If blood flow to the brain is obstructed, this can result in a stroke where part of the
brain dies.
We will consider evidence linking stress with cardiovascular disease in more detail
in Chapter 3. Research has found that acute (i.e. short-lived) and chronic (long-lasting)
stress are both associated with the development of cardiovascular disease. For example,
Matthews and Gump (2002) examined the impact of different work stressors and
marital breakdown (a major stressor in its own right) on coronary heart disease mortality
during a 9-year follow-up period. These researchers found that an increasing number
of different work stressors and being divorced were associated with an increased risk
of cardiovascular-related deaths during the study. Another study investigating the
impact of an acute stressor found that admissions to hospitals in England increased on
the day following England losing to Argentina in a penalty shoot-out in the 1998
Football World Cup (Carroll et al., 2002). The authors argue that their results suggest
myocardial infarction can be triggered by emotional upset, such as watching your
football team lose an important match! More recently, a meta-analysis of five studies
showed that the risk of having a cardiac event was increased 2.5 times if preceded by
a period of emotional stress (Steptoe and Kivimaki, 2013). Another study by Mostofsky
and colleagues (2012) reported that the risk of having an acute myocardial infarction
increased 21-fold following the death of a significant person in one’s life.

BIOPSYCHOSOCIAL PATHWAYS 25

How to induce stress in the laboratory: the Trier Social

Stress Test (TSST)

The Trier Social Stress Test (TSST) was developed in 1993 by Kirschbaum, Pirke and

Helhammer at the University of Trier. The aim was to develop a stress paradigm that

would reliably stimulate the HPA axis. Previous techniques had yielded inconsistent

results, therefore a standardized protocol was deemed necessary.

After arriving in the laboratory (room A), participants rest for between 10 and 30

minutes depending on whether hormones are being measured in saliva (using

salivettes) or in blood (using an intravenous catheter). Participants are then taken to

a different room (room B) where they are introduced to three individuals sitting in a

panel and asked to stand by a microphone. Next the investigator explains that the

participant is to take the role of a job applicant who will be interviewed by the

panel. As part of the interview process, the participants are given 10 minutes to

prepare a 5-minute free speech in which they must convince the interview panel

that they are the perfect applicant for the vacant position. The participant is

informed that the presentation will be video-taped and evaluated for non-verbal

RESEARCH METHODS 2.1