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Stress reactivity to the Trier Social Stress Test in traditional and virtual environments: A meta-analytic comparison.

OBJECTIVE
The traditional Trier Social Stress Test (TSST) is a widely used standardized stress induction protocol, and has recently been adapted in a variety of virtual reality environments (V-TSST). Research has demonstrated the ability of V-TSST to induce a stress reactivity response measured via cortisol, heart rate, and self-report. However, research comparing stress reactivity induced via the V-TSST to the traditional TSST across neuroendocrine, cardiovascular, and self-report variables has not yet been systematically and quantitatively reviewed.


METHODS
In this meta-analytic review, the existing studies that utilized V-TSST were gathered and each was age- and sex-matched with samples employing the traditional TSST. These studies were then meta-analytically synthesized to determine if there was a moderating effect of TSST type (traditional TSST or V-TSST) on multiple measures of stress reactivity (i.e., cortisol, heart rate, and self-report).


RESULTS
Examining the pre-post stress induction, the V-TSST studies demonstrated comparable effect sizes (ES) for stress reactivity (cortisol ES = 0.61, heart rate ES = 0.98, self-reported stress ES = 0.94) to traditional TSST study effect sizes (cortisol ES = 0.79, heart rate ES = 0.85, self-reported stress ES = 0.85).


CONCLUSIONS
The TSST type differences between effect sizes were not statistically significant, indicating that V-TSST is as effective as traditional TSST at eliciting a physiological and self-reported stress reactivity response. Implications and limitations of this meta-analysis are discussed, and recommendations for future research are provided.