Combining mental and physical stress: Synergy or interference?

•Orthogonal variation of physical (CPT) and mental (PASAT) stress induction protocols.•Concurrent PASAT enhances cardiovascular, yet not cortisol reactivity to cold stress.•Decreased cognitive performance during CPT, but no attenuation of cold pain by PASAT.•Increased concordance between blood pressure and other reactivity measures.•No evidence for interference, but rather specific additive effects on stress response. Both cognitive stressors (such as mental arithmetic tasks) and physical stressors (such as the cold pressor test, CP) are among the most widely employed tools in acute stress research, and there is growing evidence for a high degree of stimulus-response specificity, rather than uniformity, in the human stress response. However, little is known about potential synergistic or interfering effects during concurrent administration. While cognitive tasks have been hypothesized to attenuate pain perception during CP, they are also thought to enhance physiological reactivity. Conversely, physical stress might interfere with effective stress induction by cognitive challenges. To address these questions, 56 participants underwent either the CP (3-min ice-water immersion of feet) or a warm-water control condition. In half of the sample, the Paced Auditory Serial Addition Task (PASAT) was performed simultaneously (fully crossed interventions). Salivary cortisol, cardiovascular parameters, and subjective ratings as well as voice pitch (F0) were assessed. Results show that cortisol responses, self-reported pain and subjective arousal were mainly driven by cold exposure, which also led to increased F0. The PASAT incrementally enhanced cardiovascular reactions, but did not affect pain ratings nor cortisol responses to the CP. However, intra-individual concordance between elevated blood pressure and other reactivity measures was enhanced by PASAT administration during the CP. Importantly, performance decrements in the mental-arithmetic task were not associated with diminished stress responses. In conclusion, our results speak against any strong interference when administering cognitive and painful physical stressors simultaneously, pointing rather to specific additive effects, particularly regarding cardiovascular reactivity.