Induction of acute stress through an internet-delivered Trier Social Stress Test as assessed by photoplethysmography on a smartphone

Recent studies have demonstrated the feasibility of administering the Trier Social Stress Test (TSST) through the internet, with major implications for promoting inclusivity in research participation. However, online TSST studies to date are limited by a lack of control groups and the need for biological measures of stress reactivity that can be fully implemented online. Here, we test smartphone-based photoplethysmography as a measure of heart rate reactivity to an online variant of the TSST. Results demonstrate significant acceleration in heart rate and heightened self-reported stress and anxiety in the TSST condition relative to a placebo version of the TSST. The placebo condition led to a significant increase in self-reported stress and anxiety relative to baseline levels, but this increase was smaller in magnitude than that observed in the TSST condition. These findings highlight the potential for smartphone-based photoplethysmography in internet-delivered studies of cardiac reactivity and demonstrate that it is critical to utilize random assignment to a control or stressor condition when administering acute stress online.