Gender Differences in Response to Emotional Stress: An Assessment Across Subjective, Behavioral, and Physiological Domains and Relations to Alcohol Craving

Women and men are at risk for different types of stress-related disorders, with women at greater risk for depression and anxiety and men at greater risk for alcohol- use disorders (Kajantie and Phillips, 2005; Kessler et al., 1993). Although the specific basis for gender differences in prevalence of these disorders have not been well studied, it has been suggested that gender differences in emotional and craving responses to stress may underlie the differential risk for these psychological disorders (Kajantie and Phillips, 2005; Levenson et al., 1987; Sinha and Rounsaville, 2002; Taylor et al., 2006; Zahn-Waxler, 2000). Studies of subjective emotion experience find that women report greater sadness (Brebner, 2003; Fischer et al., 2004) and anxiety/fear (Feingold, 1994; Fischer et al., 2004; Ollendick et al., 1995) than men. Studies of behavioral/bodily indicators of emotion are limited. The few existing studies show that women express greater sadness and anxiety behaviorally and in their bodies than men while interacting with a spouse (Barnes and Buss, 1985) or viewing a sad film (Rottenberg et al., 2002). In contrast to subjective and behavioral studies, studies of physiological markers of emotional response to stress find that men have greater blood pressure (BP) response than women (Allen et al., 1993; Stoney et al., 1988), although women show greater heart rate (HR) response than men (Allen et al., 1993; Stoney et al., 1988). Also, while previous research has shown that stress increases drinking behavior (Cooper et al., 1992; Lang et al., 1989; Marlatt et al., 1975; Sinha, 2001a; Tucker et al., 1981), few laboratory studies have assessed gender differences in the urge to drink following stress. Previous research on gender differences in responses to stress has primarily focused on 1 domain of response (either subjective, behavioral, or physiological) and the association between emotional response and the urge to drink has rarely been explored. Furthermore, previous studies of physiological stress responses (discussed above) commonly utilize stressors that are more relevant for men than women, specifically achievement-related stressors (see Stroud et al., 2002; for discussion). Therefore as pointed out by Taylor et al. (2000), less is known about stress responses in women than men. Studies are needed that examine stress response to stressors that are equivalent in distress experience for men and women. The present study will address the question of whether there are gender differences in emotional stress responses measured across subjective, behavioral/bodily, and physiological (cardiovascular) domains in social drinkers when they are exposed to stressful, alcohol-cue, and neutral-relaxing conditions. We induced these conditions using an individually calibrated guided imagery procedure adapted from the work of Lang and his colleagues (Lang, 1979; McNeil et al., 1993; Miller et al., 1987) and used extensively in our studies examining the effects of stress on addictive processes (Fox et al., 2005, 2006; Sinha et al., 1999, 2000, 2003, 2006). Alcohol-cue conditions were examined to determine whether these social drinkers, particularly men, would show a craving response to the drinking-related stories. Alcohol cues can also lead to arousal, for example, alcoholics show increases in subjective anxiety and fear in the cue condition (Fox et al., 2007). As such, we wanted to examine gender differences in the cue condition in addition to the stress condition in social drinkers in the present study. On the basis of research cited in earlier sections, we hypothesized that women will report greater subjective sad and anxious experience and greater behavioral/bodily arousal in response to stress than men. We predict, however, that women will show lower physiological arousal in response to stress than men, as indicated by lower cardiovascular response, especially for BP. Further, we predict that men will show greater craving in response to stress than women. We will also explore gender differences in the alcohol-cue and neutral-relaxing conditions, in which alcohol craving and positive emotion were likely. Lastly, we will examine correlations among subjective, behavioral, cardiovascular, and alcohol-craving systems during stress and alcohol-cue conditions for men and women.