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The analysis of hair glucocorticoid levels became an instrument of particular interest in stress-related psychoneuroendocrine research. In comparison to conventional methods of measuring long-term glucocorticoid levels in humans, the quantification of hair cortisol is feasible, reliable, and time-efficient. Yet, previous research was hardly able to detect a consistent relationship between hair cortisol and perceived (chronic) stress. Specifically, whether and how past life events shape this relationship is still an unresolved question. Almost nothing is known about the potential modulatory role of differences in psychosocial stress reactivity and its habituation across multiple exposures. Thus, the present study is aimed at clarifying the relationship between hair cortisol concentration, stressful life events, and psychosocial stress habituation. The study consists of one kick-off session and three further appointments scheduled for approximately 1.5 hours at the same time in weekly intervals. At the first appointment, participants are asked to complete questionnaires covering sociodemographic data, recently perceived stress and stressful life events. Additionally, a sample of hair is extracted for glucocorticoid analysis. At the other appointments, participants undergo the Trier Social Stress Test (TSST; Kirschbaum et al., 1993), a well-established method for psychosocial stress inducement. Before, during, and after the TSST of each session, various physiological measures such as salivary cortisol and heart rate as well as self-report data on perceived stress are assessed.

Background Cognitive behavioral therapy is the first-line treatment for patients with panic disorder (PD) and agoraphobia (AG). Yet, many patients remain untreated due to limited treatment resources. Digital self-guided short-term treatment applications may help to overcome this issue. While some therapeutic applications are already supported by health insurance companies, data on their efficacy is limited. The current study investigates the effect of self-guided digital treatment comprising psychoeducation and virtual reality exposure therapy (VRET). Methods Thirty patients diagnosed with PD, AG, or panic disorder with agoraphobia (PDA) will be randomly assigned to either the experimental group (EG) or the control group (CG). Participants of both groups will undergo baseline diagnostics in the first two sessions. The subsequent treatment for the EG consists of a self-guided 6-week phase of application-based psychoeducation, one therapy session preparing for the VRET, and 4 weeks of application-based self-guided VRET. To control for the potential effects of the therapy session with the therapist, the CG will receive relaxation and stress-reduction training instead. All patients will then undergo a closing session which terminates with the post-assessment (~ 10 weeks after baseline assessment) and a follow-up assessment 6 weeks following the closing session. Symptom severity (primary outcome) will be assessed at baseline, interim, post-treatment, and follow-up. Additionally, remission status (secondary outcome) will be obtained at follow-up. Both measures will be compared between the groups. Discussion The current study aims at providing insights into the efficacy of short-term treatment applications including psychoeducation and self-guided VRET. If successful, this approach might be a feasible and promising way to ease the burden of PD, AG, and PDA on the public health system and contribute to a faster access to treatment.

Background Social anxiety disorder (SAD) is a highly prevalent mental disorder associated with enormous stress and suffering. Cognitive behavior therapy (CBT) is the first-line treatment for SAD, yet its accessibility is often constrained with long waiting times. Digital therapeutic applications, including psychoeducation and self-guided behavioral experiments in virtual reality (VR), could facilitate access and reduce waiting times. The study aims to investigate if ultra-short-time therapy involving self-guided digital therapeutic applications with VR components can reduce the severity of SAD. Methods Forty SAD patients will participate in this randomized controlled trial. Half will get access to a self-guided, digital therapeutic application with exposure-based behavioral experiments in VR, while the other half will receive a control treatment. Both treatments include four therapeutic appointments. Changes in the severity of SAD will be measured after each appointment and on a 6-week follow-up assessment and will be compared between groups, with the change in SAD measured at baseline- and post-assessment as primary outcome. Discussion Self-guided digital therapeutic applications including ultra-short-time therapy combined with VR could help reduce the waiting time for patients and relieve the health system. The results of this study may inform psychotherapists regarding the potential of self-guided digital therapeutic applications including exposure-based behavioral experiments in VR for SAD and will provide important insight for future research on VR therapy.