PSYCHOPHYSIOLOGICAL REACTIVITY TO MENTAL STRESS IN HEALTHY INDIVIDUALS: THE INFLUENCE OF PERSONALITY TYPE D, DEPRESSION LEVEL AND COPING STRATEGIES

Highlights

A study was conducted that examined the relationship between personality type D, as well as other personality profile parameters, and psychophysiological reactivity when exposed to stress using a biofeedback complex for a number of physiological parameters that had not previously been monitored in similar studies. According to the results of the trial, representatives of personality type D have higher activation rates of the sympathetic-adrenal system of stress exposure compared to the rest of the population. When developing stress-limiting effects, these data should be taken into account. The possibility of using a set of psychophysiological parameters in biofeedback programs for individuals with personality type D requires further study.

Aim. To examine the influence of personality type D, depression level, preferred coping strategies on changes in psychophysiological parameters during mental stress tests.

Methods. The study involved 79 students of Kemerovo State Medical University aged 18 to 32 years (mean age 20.7 ± 2.4 years). The patients’ psychological status was assessed (DS-14, HADS, WCQ and CSI questionnaires) with an assessment of personality type D, depression level and prevailing coping strategies. Psychophysiological diagnostics was performed using the BOSLAB complex, electromyogram, electrocardiogram, body temperature, respiration, galvanic skin response and photoplethysmogram were recorded. The stress testing protocol included a mental arithmetic test and a Stroop test. The results of the stress tests were compared in groups with/without type D and depression.

Results. All subjects showed markers of sympathetic activation during stress testing to the following parameters: increased heart rate and shortening of R-R intervals (p < 0.001), increased skin conductivity (p < 0.001). There was a significantly greater increase in Indicator of the Adequacy of processes of Regulation (IAPR) when performing the mental arithmetic test (p = 0,026) and the Stroop test (p = 0,031) in individuals with personality type D. The presence of both type D and depression predisposed to the choice of maladaptive coping strategies.

Conclusion. A high prevalence of personality type D and depression was revealed among the surveyed cohort. Representatives of personality type D have higher activation rates of the sympathetic-adrenal system of stress exposure compared to the rest of the population. This should be taken into account when developing stress-limiting effects. The possibility of using a set of psychophysiological parameters in biofeedback programs for individuals with personality type D requires further study.

1. Belialov F.I., Sumin A.N., Garganeeva N.P., at al. Mental disorders and cardiovascular diseases: guidelines of the baikal psychosomatic association and the siberian psychosomatic association. Complex Issues of Cardiovascular Diseases. 2024; 13, (3S), 222-253. https://doi.org/10.17802/2306-1278-2024-13-3S-222-253

2. O’ Riordan, A., Howard, S., & Gallagher, S. Blunted cardiovascular reactivity to psychological stress and prospective health: a systematic review. Health psychology review, 2023; 17(1), 121–147. https://doi.org/10.1080/17437199.2022.2068639

3. Allen M. T. Integrative commentary: implications of blunted reactivity. International journal of psychophysiology: official journal of the International Organization of Psychophysiology, 2013; 90(2), 95–98. https://doi.org/10.1016/j.ijpsycho.2013.07.012

4. Bibbey, A., Carroll, D., Ginty, A. T., & Phillips, A. C. Cardiovascular and cortisol reactions to acute psychological stress under conditions of high versus low social evaluative threat: associations with the type D personality construct. Psychosomatic medicine, 2015; 77(5), 599–608. https://doi.org/10.1097/PSY.0000000000000194

5. Yuenyongchaiwat, K., Baker, I. S., & Sheffield, D. Symptoms of anxiety and depression are related to cardiovascular responses to active, but not passive, coping tasks. Revista brasileira de psiquiatria (Sao Paulo, Brazil: 1999), 2017; 39(2), 110–117. https://doi.org/10.1590/1516-4446-2016-1935

6. Bourassa, K. J., & Sbarra, D. A. Cardiovascular reactivity, stress, and personal emotional salience: Choose your tasks carefully. Psychophysiology,2022; 59(8), e14037. https://doi.org/10.1111/psyp.14037

7. Parra-Gaete, C., & Hermosa-Bosano, C. A pilot exploration of the relationships between optimism, affect, and car-diovascular reactivity. Frontiers in psychology, 2023; 14, 1233900. https://doi.org/10.3389/fpsyg.2023.1233900

8. Wilkowska, A., Rynkiewicz, A., Wdowczyk, J., & Landowski, J. Morning and afternoon serum cortisol level in patients with post-myocardial infarction depression. Cardiology journal, 2019; 26(5), 550–554. https://doi.org/10.5603/CJ.a2017.0123.

9. Gecaite, J., Burkauskas, J., Brozaitiene, J., & Mickuviene, N. Cardiovascular Reactivity to Acute Mental Stress: the importance of type D personality, trait anxiety, and depression symptoms in patients after acute coronary syndromes. Journal of cardiopulmonary rehabilitation and prevention, 2019; 39(6), E12–E18. https://doi.org/10.1097/HCR.0000000000000457

10. Costache, A., Riza, A. L., Ioana, M., Glavan, D. G., Dinca, M. E., Vladu, I. M., Popescu, M., & Udristoiu, I. Circulating Cortisol in a Cohort of Depressive Patients. Current health sciences journal, 2020; 46(1), 11–15. https://doi.org/10.12865/CHSJ.46.01.02.

11. Lee, Y. S., Suchday, S., & Wylie-Rosett, J. Perceived social support, coping styles, and Chinese immigrants’ cardio-vascular responses to stress. International journal of behavioral medicine, 2012; 19(2), 174–185. https://doi.org/10.1007/s12529-011-9156-7

12. Schwerdtfeger, A. R., & Rathner, E. M. The ecological validity of the autonomic-subjective response dissociation in repressive coping. Anxiety, stress, and coping, 2016; 29(3), 241–258. https://doi.org/10.1080/10615806.2015.1048237.

13. Cavanagh, L., & Obasi, E. M. The Moderating Role of Coping Style on Chronic Stress Exposure and Cardiovascular Reactivity Among African American Emerging Adults. Prevention science: the official journal of the Society for Prevention Re-search, 2021; 22(3), 357–366. https://doi.org/10.1007/s11121-020-01141-3.

14. Günther, V., Strukova, M., Pecher, J., Webelhorst, C., Engelmann, S., Kersting, A., Hoffmann, K. T., Egloff, B., Okon-Singer, H., Lobsien, D., & Suslow, T. Cognitive Avoidance Is Associated with Decreased Brain Responsiveness to Threat Distractors under High Perceptual Load. Brain sciences, 2023; 13(4), 618. https://doi.org/10.3390/brainsci13040618.

15. Exner, A., Kampa, M., Finke, J. B., Stalder, T., Klapperich, H., Hassenzahl, M., Kleinke, K., & Klucken, T. Repressive and vigilant coping styles in stress and relaxation: evidence for physiological and subjective differences at baseline, but not for dif-ferential stress or relaxation responses. Frontiers in psychology, 2023; 14, 1196481. https://doi.org/10.3389/fpsyg.2023.1196481.

16. Allen, S. F., Wetherell, M. A., & Smith, M. A. An experimental investigation into cardiovascular, haemodynamic and salivary alpha amylase reactivity to acute stress in Type D individuals. Stress (Amsterdam, Netherlands), 2019; 22(4), 428–435. https://doi.org/10.1080/10253890.2019.1583741.

17. Bahari, A., Hasani, J., & Mashhadi Akbar Boojar, M. (2021). Childhood trauma and type D personality: The endocrine and cardiovascular effects on stress reactivity. Journal of health psychology, 26(14), 2861–2875. https://doi.org/10.1177/1359105320934181.

18. Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosomatic medicine, 2005; 67(1), 89–97. https://doi.org/10.1097/01.psy.0000149256.81953.49.

19. Yetişir, A., Sariyildiz, A., Coskun Benlidayi, I., & Özbek, S. Type D personality and social inhibition: drivers of car-diovascular risk and reduced physical activity in psoriatic arthritis. Clinical rheumatology, 2025; 44(3), 1163–1171. https://doi.org/10.1007/s10067-025-07312-3.

20. Lodder, P., Wicherts, J. M., Antens, M., Albus, C., Bessonov, I. S., Condén, E., Dulfer, K., Gostoli, S., Grande, G., Hedberg, P., Herrmann-Lingen, C., Jaarsma, T., Koo, M., Lin, P., Lin, T. K., Meyer, T., Pushkarev, G., Rafanelli, C., Raykh, O. I., Schaan de Quadros, A., … Kupper, N. Type D Personality as a Risk Factor for Adverse Outcome in Patients With Cardiovascular Disease: An Individual Patient-Data Meta-analysis. Psychosomatic medicine, 2023; 85(2), 188–202. https://doi.org/10.1097/PSY.0000000000001164.

21. Sumin, A. N., & Shcheglova, A. V. Pathogenetic Mechanisms Underlying Major Adverse Cardiac Events in Personality Type D Patients after Percutaneous Coronary Intervention: The Roles of Cognitive Appraisal and Coping Strategies. Diagnostics (Basel, Switzerland), 2023; 13(21), 3374. https://doi.org/10.3390/diagnostics13213374.

22. Sánchez-Díaz, M., Montero-Vílchez, T., Quiñones-Vico, M. I., Sierra-Sánchez, Á., Ubago-Rodríguez, A., Sanabria-de la Torre, R., Molina-Leyva, A., & Arias-Santiago, S. Type D Personality as a Marker of Poorer Quality of Life and Mood Status Dis-turbances in Patients with Skin Diseases: A Systematic Review. Acta dermato-venereologica, 2023; 103, adv00846. https://doi.org/10.2340/actadv.v103.2741.

23. Pedersen, S. S., Johansen, J. B., Nielsen, J. C., Larroude, C. E., Riahi, S., Melchior, T. M., Vinther, M., Skovbakke, S. J., & Skov, O. (2025). Anxiety and depression in patients with an implantable cardioverter defibrillator: Do personality and ICD expectations play a role?. General hospital psychiatry, 94, 145–149. https://doi.org/10.1016/j.genhosppsych.2025.03.002.

24. Whitehead, D. L., Perkins-Porras, L., Strike, P. C., Magid, K., & Steptoe, A. Cortisol awakening response is elevated in acute coronary syndrome patients with type-D personality. Journal of psychosomatic research, 2007; 62(4), 419–425. https://doi.org/10.1016/j.jpsychores.2006.11.005.

25. Diaz-Ramos, R. E., Gomez-Cravioto, D. A., Trejo, L. A., López, C. F., & Medina-Pérez, M. A. Towards a Resilience to Stress Index Based on Physiological Response: A Machine Learning Approach. Sensors (Basel, Switzerland), 2021; 21(24), 8293. https://doi.org/10.3390/s21248293.

26. Figueroa, C., Ayala, A., Trejo, L. A., Ramos, B., Briz, C. L., Noriega, I., & Chávez, A. Measuring the Effectiveness of a Multicomponent Program to Manage Academic Stress through a Resilience to Stress Index. Sensors (Basel, Switzerland), 2023; 23(5), 2650. https://doi.org/10.3390/s23052650.

27. Pushkarev, G.; Kuznetsov, V.; Yaroslavskaya, E.I.; Bessonov, A.C. Reliability and validity of Russian version of DS14 score for Ischemic Heart Disease patients. Russ. J. Cardiol. 2016; 21(6), 50–54. https://doi.org/10.15829/1560-4071-2016-6-50-54.

28. Andrjushhenko A.V., Drobizhev M.Ju., Dobrovol’skij A.V. Comparative evaluation of the scales CES-D, BDI and HADS (D) in the diagnosis of depression in general medicine, Zhurnal nevrologii i psihiatrii im. S.S.Korsakova. 2003; 5, 11–18.

29. Wasserman, L.I.; Iovlev, B.V.; Isaeva, E.R.; Trifonova, E.A.; SHCHelkova, O.Y.; Novozhilova, M.Y.; Vuks, A.Y.A. Technique for Psychol. Diagnostics of Ways to Cope with Stressful and Problematic Situations for a Person; NIPNI V.M. Bekhtereva: St. Petersburg, Russia; 2008 (In Russ).

30. Dukhnovsky, S.V. Diagnostics of Interpersonal Relationships; Rech: St. Petersburg, Russia; 2010 (In Russ).

31. Sumin, A. N., Prokashko, I. Y., & Shcheglova, A. V. Evaluation of Coping Strategies among Students with Type D Personality. International journal of environmental research and public health, 2022; 19(8), 4918. https://doi.org/10.3390/ijerph19084918.

32. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. (1996). Circulation, 93(5), 1043–1065.

33. Gerritsen, R. J. S., & Band, G. P. H. (2018). Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Frontiers in human neuroscience, 12, 397. https://doi.org/10.3389/fnhum.2018.00397

34. Park, J., Seok, H. S., Kim, S. S., & Shin, H. (2022). Photoplethysmogram Analysis and Applications: An Integrative Review. Frontiers in physiology, 12, 808451. https://doi.org/10.3389/fphys.2021.808451

35. Pluess, M., Conrad, A., & Wilhelm, F. H. (2009). Muscle tension in generalized anxiety disorder: a critical review of the literature. Journal of anxiety disorders, 23(1), 1–11. https://doi.org/10.1016/j.janxdis.2008.03.016

36. Boucsein, W., Fowles, D. C., Grimnes, S., Ben-Shakhar, G., roth, W. T., Dawson, M. E., Filion, D. L., & Society for Psychophysiological Research Ad Hoc Committee on Electrodermal Measures (2012). Publication recommendations for electrodermal measurements. Psychophysiology, 49(8), 1017–1034. https://doi.org/10.1111/j.1469-8986.2012.01384.x

37. Vinkers, C. H., Penning, R., Hellhammer, J., Verster, J. C., Klaessens, J. H., Olivier, B., & Kalkman, C. J. (2013). The effect of stress on core and peripheral body temperature in humans. Stress (Amsterdam, Netherlands), 16(5), 520–530. https://doi.org/10.3109/10253890.2013.807243.

38. Williams, L., O’Carroll, R. E., & O’Connor, R. C. Type D personality and cardiac output in response to stress. Psy-chology & health, 2009; 24(5), 489–500. https://doi.org/10.1080/08870440701885616.

39. Kupper, N., Pelle, A., & Denollet, J. Association of Type D personality with the autonomic and hemodynamic response to the cold pressor test. Psychophysiology, 2013; 50(12), 1194–1201. https://doi.org/10.1111/psyp.12133.

40. Kupper, N., Denollet, J., Widdershoven, J., & Kop, W. J. Type D personality is associated with low cardiovascular reactivity to acute mental stress in heart failure patients. International journal of psychophysiology: official journal of the Interna-tional Organization of Psychophysiology, 2013; 90(1), 44–49. https://doi.org/10.1016/j.ijpsycho.2013.01.011.

41. Kelly-Hughes, D. H., Wetherell, M. A., & Smith, M. A. Type D personality and cardiovascular reactivity to an eco-logically valid multitasking stressor. Psychology & health, 2014; 29(10), 1156–1175. https://doi.org/10.1080/08870446.2014.915970.

42. O’Riordan, A., Howard, S., Keogh, T. M., & Gallagher, S. Type D personality is associated with lower cardiovascular reactivity to stress in women. Psychology & health, 2023; 38(11), 1515–1535. https://doi.org/10.1080/08870446.2021.2025239.

43. O’Riordan, A., Gallagher, S., & Howard, S. Type D personality and cardiovascular reactivity to acute psychological stress: A systematic review and meta-analysis. Health psychology: official journal of the Division of Health Psychology, American Psychological Association, 2023; 42(9), 628–641. https://doi.org/10.1037/hea0001328.

44. Riordan, A. O., Howard, S., & Gallagher, S. Social Context and Sex Moderate the Association Between Type D Per-sonality and Cardiovascular Reactivity. Applied psychophysiology and biofeedback, 2019; 44(4), 321–330. https://doi.org/10.1007/s10484-019-09447-x.

45. Williamson, T. J., Thomas, K. S., Eisenberger, N. I., & Stanton, A. L. Effects of Social Exclusion on Cardiovascular and Af-fective Reactivity to a Socially Evaluative Stressor. International journal of behavioral medicine, 2018; 25(4), 410–420. https://doi.org/10.1007/s12529-018-9720-5

46. Sumin, A.N., Sumina, L.Y., Krasilova, T.A., Barbarash, N.A. Endothelial stress response in hypertensive patients with type D personality. Arterial’naya Gipertenziya, 2011; 17(5), 467-473. https://doi.org/ 10.18705/1607-419X-2011-17-5-467-473

47. Denollet, J., van Felius, R. A., Lodder, P., Mommersteeg, P. M., Goovaerts, I., Possemiers, N., Vanhees, L., Beckers, P., Pattyn, N., & Van Craenenbroeck, E. M. Predictive value of Type D personality for impaired endothelial function in patients with coronary artery disease. International journal of cardiology, 2018; 259, 205–210. https://doi.org/10.1016/j.ijcard.2018.02.064.

48. Molloy, G. J., Perkins-Porras, L., Strike, P. C., & Steptoe, A. Type-D personality and cortisol in survivors of acute coronary syndrome. Psychosomatic medicine, 2008; 70(8), 863–868. https://doi.org/10.1097/PSY.0b013e3181842e0c.

49. Koutnik, A. P., Sanchez-Gonzalez, M. A., May, R. W., Hughes, R. M., & Fincham, F. D. Impact of psychological distress on cardiovagal reactivation after a speech task. Journal of human hypertension, 2014; 28(6), 399–401. https://doi.org/10.1038/jhh.2013.127.

50. Blinova, N. G., Igisheva, L. N., Litvinova, N.A. & Fedorov, A.I. (2000). Practicum on psychophysiological diagnostics, Moskva: Vlados. 128p.

51. Dubinina E.E., Shedrina L.V, & Mazo G.E. The Basic Biochemical Aspects of the Pathogenesis of Depresion. Part 1. Uspekhi fiziologicheskih nauk, 2018; 49(1), 28-49.

52. Kim, A. Y., Jang, E. H., Choi, K. W., Jeon, H. J., Byun, S., Sim, J. Y., Choi, J. H., & Yu, H. Y. Skin conductance responses in Major Depressive Disorder (MDD) under mental arithmetic stress. PloS one, 2019; 14(4), e0213140. https://doi.org/10.1371/journal.pone.0213140.

53. Thurner, C., Horing, B., Zipfel, S., Stengel, A., & Mazurak, N. Autonomic changes as reaction to experimental social stress in an inpatient psychosomatic cohort. Frontiers in psychiatry, 2022; 13, 817778. https://doi.org/10.3389/fpsyt.2022.817778.

54. Kriklenko, E. A., Kovaleva, A. V., & Likhomanova, E. N. An Individualized Approach to Skin Conductance As-sessment during Execution of Tasks of Different Complexities. Bulletin of experimental biology and medicine, 2024; 176(3), 310–314. https://doi.org/10.1007/s10517-024-06014-1.

55. Kroll, S. L., Mayo, L. M., Asratian, A., Yngve, A., Perini, I., & Heilig, M. Negative self-evaluation induced by acute stress indexed using facial EMG. Psychoneuroendocrinology, 2021; 133, 105402. https://doi.org/10.1016/j.psyneuen.2021.105402.

56. Liang, W. M., Xiao, J., Ren, F. F., Chen, Z. S., Li, C. R., Bai, Z. M., & Rukšenas, O. (2023). Acute effect of breathing exercises on muscle tension and executive function under psychological stress. Frontiers in psychology, 2023; 14, 1155134. https://doi.org/10.3389/fpsyg.2023.1155134.

57. Sadora, J., Vilsmark, E., Bashara, A., Burton, D., Paschali, M., Pester, B., Curiel, M., Edwards, R., & Lazaridou, A. Electromyography-biofeedback for chronic low back pain: A qualitative cohort study. Complementary therapies in medicine, 2023; 73, 102922. https://doi.org/10.1016/j.ctim.2023.102922.

58. Cao, X., Wong, E. M., Chow Choi, K., Cheng, L., & Ying Chair, S. Interventions for Cardiovascular Patients with Type D Personality: A Systematic Review. Worldviews on evidence-based nursing, 2016; 13(4), 314–323. https://doi.org/10.1111/wvn.12153.

59. Lee, S. J., Koh, S., Kim, B. O., Kim, B., & Kim, C. Effect of Type D Personality on Short-Term Cardiac Rehabilitation in Patients With Coronary Artery Disease. Annals of rehabilitation medicine, 2018; 42(5), 748–757. https://doi.org/10.5535/arm.2018.42.5.748.

60. O’Riordan, A., Costello, A. M., & Hill, T. D. Religious and Spiritual Coping Mediates the Association between Trait Extra-version and Cardiovascular Reactivity to Acute Psychological Stress. Journal of religion and health, 2025; 10.1007/s10943-025-02392-6. Advance online publication. https://doi.org/10.1007/s10943-025-02392-6

61. Beevor, H. J., Ginty, A. T., Veldhuijzen van Zanten, J. J. C. S., & Williams, S. E. Mastery imagery ability moderates the relationship between heart rate reactivity to acute psychological stress and perceptions of stress and physiological arous-al. Psychophysiology, 2024; 61(4), e14486. https://doi.org/10.1111/psyp.14486

62. Lodder, P., Kupper, N., Antens, M., & Wicherts, J. M. A systematic review comparing two popular methods to assess a Type D personality effect. General hospital psychiatry, 2021; 71, 62–75. https://doi.org/10.1016/j.genhosppsych.2021.04.002.https://doi.org/10.1016/j.genhosppsych.2021.04.002.

63. Sumin A.N., Shcheglova A.V. Association of personality type D and depression level with coping strategies in patients with chronic coronary syndrome. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2024;30(3):304-317. (In Russ.) https://doi.org/10.18705/1607-419X-2024-2305.