Adding to the burden: The tendency to resonate with others’ stress is linked to higher PTSD symptom severity in individuals with war-related trauma

Adding to the burden: The tendency to resonate with others’ stress is linked to higher PTSD symptom severity in individuals with war-related trauma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Adding to the burden: The tendency to resonate with others’ stress is linked to higher PTSD symptom severity in individuals with war-related trauma Christiane Wesarg-Menzel, Mathilde Gallistl, Michael Niconchuk, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4082505/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Aug, 2025 Read the published version in Translational Psychiatry → Version 1 posted 8 You are reading this latest preprint version Abstract Many refugees experience multiple traumatic events, which set them at increased risk to develop post-traumatic stress disorder (PTSD). To refine interventions aimed at improving refugees’ mental health, a better understanding of the factors modulating vulnerability to war-related trauma is needed. In the present study, we focused on stress resonance as a potential vulnerability factor. Stress resonance reflects the empathic sharing of others’ subjective and physiological stress experience. Sixty-seven participants who came from Arabic-speaking countries and had entered Germany as refugees or migrants took part in an empathic stress test, in which they observed a native German speaker undergo a psychosocial laboratory stressor. Meanwhile, different stress markers (subjective stress, heart rate, heart rate variability, and cortisol release) were simultaneously captured in the stressed targets and passive observers. Moderation analyses did not support our hypothesis that the extent to which someone resonates with others’ stress is a vulnerability factor in the development of PTSD symptoms after trauma exposure. Rather, higher levels of subjective and autonomic stress resonance were main predictors of PTSD symptom severity when controlling for sex, age, and trauma exposure. Our findings suggest that heightened stress resonance may constitute a malleable correlate of PTSD rather than a trait modulating health risk. In the future, efforts should be made to test whether individuals with a history of war-related trauma would benefit from interventions aimed to reduce the tendency to excessively share others’ stress. Health sciences/Biomarkers/Diagnostic markers Biological sciences/Physiology Figures Figure 1 Figure 2 Introduction During interactions, the perception of another individual’s state automatically stimulates a corresponding representation in the observer, leading to common physiological states in which the observer unintentionally matches the emotion, facial expression, or other behaviors of the interaction partner 1 . This physiological linkage between individuals has been studied under the terms “empathy”, “bio-behavioral synchrony”, or “resonance”, and is thought to facilitate social connection and coordination 1–3 . Although the adaptive value of resonating with others has been shown in non-threatening contexts such as parent-child interactions during play 4–6 , resonance may come at the expense of health in the context of stress or other adverse experiences 3,7 . This is of particular relevance for individuals who are exposed to others’ stress and suffering on a daily basis, as is the case for individuals living in or fleeing from areas of war. Due to war and persecution, the number of refugees has shown a steady increase in the past decades, reaching an estimate of 36.4 million refugees at mid-2023 8 . Traumatic events that refugees are exposed to are highly prevalent and diverse, ranging from lack of accommodation or necessities, to experiencing or witnessing violence, torture, and loss of loved ones 9,10 . With the settlement in a new country, the accumulation of stressful experiences often continues due to difficulties in proving asylum claims and integrating in a new society 11,12 . These experiences set refugees at higher risk to develop post-traumatic stress disorder (PTSD), which ranges with a prevalence of around 31.5% among the most commonly diagnosed psychiatric disorders in refugees 13 . War-related traumatic experiences are inherently embedded in a social context. Next to their own suffering, refugees are confronted with the suffering of family members and friends, as well as of strangers in their surroundings. Hence, apart from being victims of trauma inducing firsthand stress, refugees likely witness the trauma of others 14 , which can induce additional second-hand (empathic) stress 3 . Importantly, the mere observation of another individual experiencing stress can trigger a full-blown stress response in the observing individual, apparent through activation of the autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis 15,16 . While prolonged exposure to firsthand stress can lead to dysregulation of these neurobiological stress systems 17 , such effects may be exacerbated in individuals with a strong tendency to resonate with others’ stress. In turn, dysregulation of the stress systems has been shown to underlie heightened vulnerability to psychopathology after trauma 18,19 . Transferred to the reality of the lives of refugees, this would imply that despite being exposed to similar first- and second-hand traumatic experiences, one individual may be more likely to develop mental health problems than another based on inter-individual differences in the tendency to resonate with others’ stress. Previous research has distinguished stress resonance from vicarious stress as two possible response patterns to observing another individual under stress: Vicarious stress refers to an observer’s own stress response irrespective of whether the target directly exposed to acute stress shows a stress response. In contrast, stress resonance is present when the observer’s stress response is proportional to the one of the acutely stressed target 16 . Whereas vicarious stress reactivity is thought to reflect an individual’s general stress sensitivity, stress resonance is closely linked conceptually and empirically to empathy 3,16,20 . While previous studies have shown that stress sensitivity is an important vulnerability factor underlying heightened risk for the development of psychopathology 21,22 , we here turn attention to stress resonance as a potential vulnerability factor in the context of trauma. Indirect evidence for this hypothesis stems from a study in disaster volunteers, in which those with a stronger tendency to feel discomfort and anxiety in response to others’ distress (reflecting trait levels of empathy) experienced higher increases in depression, anger, and fatigue from pre- to post-relief work 23 . Examining the role of stress resonance in the etiology of PTSD symptoms after trauma exposure bears clinical implications, as it could inform efforts to advance intervention research dedicated to improving refugees’ mental health. Based on a sample of refugees and migrants from Syria and other Arabic-speaking countries, we examined in the current work whether stress resonance would constitute a vulnerability factor for developing PTSD symptoms after war-related trauma. Next to subjective stress resonance, we focused on three different markers of the stress systems: 1) cortisol as a neuroendocrine marker of the HPA axis, as well as 2) heart rate and 3) heart rate variability as physiological markers of sympathetic and parasympathetic nervous system (SNS, PNS) functioning. As a strong paradigm that reliably triggers stress resonance even in strangers, we used the empathic Trier Social Stress Test (TSST 16,24 ). In this paradigm, native Arabic-speaking participants watched native German-speakers undergo a standardized psychosocial stress test. The different stress markers were simultaneously captured in the stressed targets and passive observers. In a previous data set stemming from the same study, we found a moderate positive association between trauma exposure and PTSD symptoms 25 . In the present work, we draw on data from a subsample of this earlier study. Based on the above literature, we expected that stress resonance would moderate the link between trauma exposure and PTSD symptomatology, such that the positive association between trauma and PTSD symptoms would be stronger in individuals exhibiting high stress resonance. Methods Participants Our sample consisted of N = 66 targets (55 females) taking part in a stress test, and N = 67 observers of the opposite sex (11 females) watching the targets during the stress test. In the first testing session, two observers simultaneously watched one target. Given implementation of COVID-19 contact restrictions after testing of this first triad, all subsequent testing sessions were executed in a one-to-one observation set-up (i.e., dyads). Targets were German (age M = 26.0 years, SD = 5.22 years), and observers Arabic native speakers (age M = 28.7 years, SD = 4.85 years). Of the observers, 35 had entered Germany as refugees (age M = 30.4 years, SD = 4.59 years) and 32 as migrants (age M = 26.9 years, SD = 4.53 years). The majority of refugees and migrants came from Syria (88.6% and 71.9%, respectively; see Table S1 for countries of origin). Participants were recruited through social media advertisement and by distributing flyers. Trained students conducted a structured telephone screening to determine participants’ eligibility. All participants needed to be aged between 20 and 40 years. Targets were required to speak German as the native language. Observers needed to speak Arabic as the native language and German at an intermediate (B1) level, come from an Arabic-speaking country of origin, and live for at least six months in Germany. Within observers, we further differentiated between refugees and migrants based on definitions of UNHCR 8 : Individuals who had been forced to flee their home countries because of conflict or persecution were considered as refugees. In contrast, individuals who had chosen to leave their home to work, study, or join family in a new country were considered as migrants. Refugees were included if they reported a war-related trauma (i.e., they had fled war, violence, or persecution) in the absence of other major trauma (e.g., child maltreatment, severe accident). In contrast, migrants were supposed to be free of any major traumatic experience. 1 Of note, the two groups were chosen given an initial plan to test whether individuals with war-related trauma (refugees) would differ in empathy from individuals without war-related trauma with a similar cultural background (migrants). Group allocation was based on an initial telephone screening of all participants. However, analyses of a more detailed trauma questionnaire—the Harvard Trauma Questionnaire 40 —revealed that also migrants were exposed to considerable war-related trauma. Given known effects of weight on autonomic activity 27 , an additional exclusion criterion for participants of both target and observer groups was a BMI of less than 18 or more than 30. We further excluded participants reporting chronic illnesses (including psychiatric disorders) or using medication, hormone-based birth control, or other substances with known effects on HPA axis or autonomic activity 28,29 . Refugees were not excluded if they had a diagnosis of PTSD or depression during the last two years. To facilitate recruitment, we further decided to include regular cigarette smokers in the observer group due to high prevalence of smoking in many Middle Eastern countries 30 . Procedure The study was approved by the Ethics Board of the medical faculty of Leipzig University, Germany (ethics number: 405/18-ek). Observers came to the lab for a first visit lasting about 2.5 hours, in which they provided informed consent, filled out online questionnaires, and completed an empathy task (EmpaToM 31 ; not subject to the current manuscript). For a second lab visit lasting about 4.5 hours, observers were invited back together with an unfamiliar target person of opposite sex. This visit was scheduled in the early afternoon to control for variation in diurnal cortisol secretion 32 . Upon arrival at the laboratory, targets and observers were placed in separate rooms. Participants first underwent a rapid drug test to screen for recreational drug use. To equalize blood sugar levels, they were offered a snack and a glass of juice. To avoid saliva sample contamination, participants were instructed to not eat or drink anything other than water throughout the remainder of the testing session. Then, participants were equipped with a chest belt recording an electrocardiogram (ECG) to measure SNS and PNS activity. After a resting period of 40 min, participants were guided into either the testing or the adjacent observation room. While targets attended the TSST 24 , observers passively watched the procedure through a one-way mirror. Targets were aware of being observed during their performance, although they did not know by whom. After the TSST, target and observer separately left their rooms, and rested alone during the 60 min recovery phase. The TSST is a standardized laboratory paradigm that reliably elicits social-evaluative stress 33,34 . It consists of a preparatory anticipation phase (5 min), followed by a video-recorded mock job interview (5 min) and a mental arithmetic task (5 min) in front of an evaluation committee. Given safety rules due to the COVID-19 pandemic, for 60.6% of the testing sessions, the committee members were sitting in a separate room from the participant. Their image was projected via live video feed at large-scale on the wall facing the target. During the TSST instruction period, the committee members shortly entered the TSST testing room to demonstrate their actual presence in the laboratory and thus the realness of the video situation. Throughout the testing period, ten ratings of subjective stress experience and ten cortisol samples were collected simultaneously from targets and observers. In addition, a continuous ECG was collected from 50 min prior to 50 min post stressor onset (for assessment timeline, see Fig. 1 ). Participants received financial compensation for study participation. The study was performed in agreement with the Declaration of Helsinki. All participants gave their written informed consent and could withdraw from the study at any time. Measures of Acute Stress Reactivity Subjective Stress Experience In both targets and observers, we assessed participants’ subjective stress experience at ten times throughout the test session using a 7-point Likert scale asking for the level of currently experienced stress (“How stressed do you feel at this moment?”). Assessments took place 20 min prior to stressor onset (baseline), after stress anticipation (2 min prior to stressor onset), and at 10, 20, 25, 30, 40, 50, 60 and 70 min after stressor onset (see Fig. 1 ). Salivary Cortisol In parallel to the assessments of subjective stress experience, participants collected ten salivary samples for cortisol analysis using Salivettes (Sarstedt, Nümbrecht, Germany; Fig. 1 ). Participants placed the collection swab in their mouth for 2 min and refrained from chewing. Salivettes were stored at -20°C until analysis. Cortisol levels were assessed using a time-resolved fluorescence immunoassay with intra- and inter-assay variabilities of less than 10% and 12%, respectively 35 . Heart Rate and Heart Rate Variability All participants wore a Zephyr Bioharness 3 chest belt (Zephyr Technology, Annapolis, Maryland, USA), which recorded a continuous ECG at a frequency of 250 Hz for altogether 100 min (from − 50 min to + 50 min relative to stressor onset). A trained student manually corrected artifacts in the ECG raw data using python-based in-house software. Two students re-checked all corrections made. For further analysis, each ECG recording was split into 5-min timeframes related to specific phases of the testing protocol (Fig. 1 ). The baseline phase was represented by timeframes 1 and 2 (from − 40 to − 30 min), the anticipation phase by timeframe 3 (from − 7 to − 2 min), the stress phase by timeframes 4 and 5 (from 0 to + 10 min), and the recovery phase by timeframes 6 to 12 (from + 15 to + 50 min). For each timeframe, we calculated averages for heart rate (HR) and heart rate variability (HRV; specifically the root mean of the square successive differences [RMSSD]) per participant using the python package “hrv-analysis” 36 . To ensure sufficient data quality, we excluded timeframes in which more than 10% of the recording had to be cut. Questionnaires Trauma Trauma was measured with the official Arabic (“Iraqi”) version of the trauma events section of the Harvard Trauma Questionnaire (HTQ 40,41 ). Participants indicated whether they had experienced each of 42 traumatic events (e.g., oppression, imprisonment, combat exposure) before coming to Germany. Trauma scores were calculated by a sum of “yes” responses. In our study, the trauma events section of the HTQ demonstrated excellent reliability (Cronbach’s α = .92). PTSD We assessed PTSD symptom severity with the first 16 items of the trauma symptom section of the HTQ 41 , which correspond to symptoms of PTSD according to the DSM-IV. Participants indicated the degree to which they were distressed in the past week by trauma symptoms such as “feeling detached or withdrawn from people” or “trouble sleeping” on a Likert scale ranging from 1 (“not at all”) to 4 (“extremely”). Higher mean scores indicated more severe PTSD symptoms. The HTQ manual recommends a cut-off score of 2.5 to identify clinically significant levels of PTSD 40 , which was the case in five observers. Reliability was good (Cronbach’s α = .89). Personal distress As a specific facet of empathy potentially linked to stress resonance, we assessed trait personal distress based on the Interpersonal Reactivity Index (IRI 43 ). The IRI was translated into Arabic by a native, bilingual speaker and back-translated by another bilingual individual to ensure linguistic equivalence 44 . The personal distress scale measures self-oriented feelings such as discomfort, anxiety and worry when being confronted with others’ negative emotional states or situations. It consists of seven items rated on a Likert scale from 1 (“does not describe me well”) to 5 (“describes me very well”), aggregated to a sum score. In the current study, reliability was relatively poor (Cronbach’s α = .49). Data Analysis Data Processing and Computation of Stress Measures. To approach normal distribution, cortisol, HR, and HRV data were log-transformed and subsequently winsorized to three standard deviations 28 . For all participants and stress markers, we calculated change scores from baseline to stress peak. While change scores indicated stress reactivity in targets, they reflected vicarious stress (i.e., stress reactivity independent of target stress) in observers. For cortisol, the baseline level (sample 1 at − 20 min) was subtracted from the individual peak level chosen from samples at + 10, +20, + 25, +30, or + 40 min (samples 3 − 7), since cortisol typically peaks within this timeframe after stressor onset 45, 46 . A significant physiological stress response was defined as a cortisol increase of at least 1.5 nmol/l above baseline levels 47 . For HR, the mean of timeframes 1 and 2 (baseline) was subtracted from the maximum of timeframes 3 (anticipation), 4 and 5 (stress task). For HRV, the minimum of timeframes 3 − 5 was subtracted from the mean of timeframe 1 and 2 (baseline). This was done because other than HR, HRV decreases with stress experience 48 . Hence, higher change scores indicated stronger increases in cortisol and HR, and stronger decreases in HRV in response to stress. If HR / HRV data was only available for the anticipation phase, but missing for the stress phase, we refrained from computing a change score, as it was impossible to verify whether the anticipation sample represented peak reactivity. For subjective stress, we subtracted the baseline rating (at − 20 min) from the peak level chosen from ratings at − 2 and + 10 min. Given that baseline levels influence reactivity of physiological parameters (law of initial value 49 ), we adjusted cortisol, HR, and HRV change scores for baseline levels by extracting the standardized change score residuals from a regression model. To gain a measure of physiological and subjective stress resonance, we subtracted observer change scores from the corresponding target’s change scores, and computed an absolute value of this difference. By doing so, we obtained a measure of how closely the observer’s stress reactivity resembled the one of the target. The absolute difference score was multiplied by (-1), such that higher values indicated higher stress resonance. Missing Data. Data on vicarious stress and stress resonance was complete for subjective stress and cortisol. Due to technical issues, HR and HRV data was missing for two observers and two targets (of whom one observer and one target belonged to the same dyad). In addition, HR and HRV data quality was too low (i.e., > 10% needed to be cut) in one observer during both baseline and stress timeframes, and in one target during both stress timeframes, precluding the computation of change scores. Thus, overall, data on HR and HRV vicarious stress was missing for three observers, and data on HR and HRV stress resonance was missing for five observers. Descriptives. We first examined the number of targets and observers showing a significant cortisol stress response (cortisol increase > 1.5 nmol/L from baseline 47 ). Given that the observers were either migrants or refugees, we compared both groups with regard to their vicarious stress responses and stress resonance across all four stress markers, as well as regarding trauma experience and PTSD symptoms. Logistic Regression Modeling. Regression analyses were carried out to test for the influence of stress resonance on PTSD symptoms. We initially planned to conduct multiple linear regression analyses, but given that assumptions were violated in most models, we applied multiple logistic regressions. To this end, we created a dichotomous outcome measure of PTSD symptoms above and below the sample mean. All continuous predictors were z -standardized to handle possible issues of multicollinearity. For each stress markers, the base model included trauma and the covariates sex and age as predictors of PTSD symptoms. In a second step, we tested whether adding stress resonance (operationalized as the absolute value of the difference between target and observer change scores) and its interaction with trauma would improve model fit, which was evaluated by comparing both models using analysis of variance. This procedure resulted in one model per stress marker (subjective stress, cortisol, HR, HRV), yielding four final models. Given multiple testing, we applied Bonferroni correction, such that p -values were compared to a significance threshold of α = .0125. Sensitivity Analyses. Given significant correlations between observers’ stress resonance and vicarious stress for subjective stress, HR, and HRV, we re-computed analyses by introducing vicarious stress instead of stress resonance as a moderator to the regression models. Results Descriptives Concerning firsthand stress, 47 out of 66 targets (71.2%) demonstrated a significant physiological stress response, defined as a cortisol increase of > 1.5 nmol/l over baseline levels 47 . Among the 67 observers, 12 (17.9%; 5 refugees, 7 migrants) showed a physiologically significant increase in cortisol levels after passively watching a target undergoing the TSST. The difference in responder rates between migrants and refugees was not significant, χ²(1,67) = 0.65, p = .42. Intriguingly, 9 out of 67 observers (13.4%) showed a higher cortisol change score than the according target, indicating that the observer’s vicarious stress response in some cases surpassed the target’s firsthand stress response. Taking all four stress markers (i.e., subjective stress, cortisol, HR, and HRV) into consideration, there were no significant differences between refugees and migrants in either vicarious stress or stress resonance (see Table 1). Average subjective stress, cortisol, HR, and HRV levels throughout the testing session per group are shown in Figure 2. Analyses of variance showed significant group differences for baseline subjective, but not physiological stress levels (see Table S2). A post-hoc Tukey test revealed that refugees reported higher levels of subjective stress at baseline than migrants ( p = 0.037), while targets did not differ in their baseline subjective stress from migrants ( p = 0.680) or refugees ( p = 0.104; see Table S2). Refugees reported more traumatic events and higher levels of PTSD symptoms than migrants (see Table 1). A full correlation matrix is shown in Table 2. Table 1. Comparison of refugees and migrants on trauma, PTSD, and empathic stress measures Refugees N = 35 Migrants N = 32 M ( SD ) M ( SD ) t, p Trauma 16.23 (7.61) 8.41 (7.37) t = -4.27, p < .001*** PTSD 1.89 (0.49) 1.52 (0.46) t = -3.13, p = .003** Vicarious stress ∆ Subjective stress 1.60 (1.4) 1.62 (1.79) t = 0.06, p = .949 ∆ Cortisol a 0.09 (0.24) 0.03 (0.24) t = -1.09, p = .282 ∆ HR a 0.01 (0.03) 0.00 (0.03) t = -0.94, p = .353 ∆ HRV a 0.01 (0.17) 0.02 (0.12) t = 0.19, p = .850 Stress resonance Subjective stress resonance 2.43 (1.52) 2.66 (1.66) Cortisol resonance 0.40 (0.28) 0.49 (0.29) t = 1.28, p = .230 HR resonance 0.14 (0.06) 0.12 (0.07) t = -0.72, p = .476 HRV resonance 0.30 (0.24) 0.32 (0.23) t = 0.33, p = .742 a Change scores based on log-transformed and winsorized data. ** p < .01; *** p < .001 Table 2. Full correlation matrix SexO a AgeO Trauma PTSD PD SSO SSRes SST CO CRes CT HRO HRRes HRT HRVO HRVRes AgeO -.04 Trauma -.28* .14 PTSD .23 .26* .40*** PD .25* -.10 -.02 .39** SSO .06 .02 .02 .24* .40*** SSRes .28* -.07 .02 .30** .32** .49*** SST -.41*** -.06 .06 -.19 -.09 .05 -.54*** CO -.05 .10 -.07 .14 .07 -.10 .02 -.18 CRes -.13 .19 .04 .05 -.06 .11 .02 -.09 .23 CT .22 -.14 -.13 -.14 .12 -.24 -.06 -.05 -.10 -.73*** HRO -.33** .02 .14 -.02 .10 .09 -.01 .13 .15 .16 -.14 HRRes -.12 -.25 .02 .13 .13 -.02 -.07 .18 .11 .25 -.38** .54*** HRT -.05 .29* .06 -.18 -.09 .08 .10 -.16 -.05 -.21 .37** -.15 -.91*** HRVO -.18 -.09 .09 .02 .22 .10 .03 -.05 .15 -.11 .05 .50*** .18 .03 HRVRes -.10 -.25 .13 .25* .33** .17 .08 .02 .14 .21 -.34** .43*** .70*** -.61*** .55*** HRVT -.03 .25* -.06 -.28* -.26* -.09 -.02 -.09 -.05 -.30* .40** -.22 -.74*** .76*** -.09 -.87*** Note. AgeO = age of observer; CO = cortisol reactivity of observer; CRes = cortisol resonance; CT = cortisol reactivity of target; HRO = heart rate reactivity of observer; HRRes = heart rate resonance; HRT = heart rate reactivity of target; HRVO = heart rate variability reactivity of observer; HRVRes = heart rate variability resonance; HTVT = heart rate variability reactivity of target; PD = personal distress; PTSD = post-traumatic stress disorder; SexO = sex of observer; SSO = subjective stress of observer; SST = subjective stress of target; SSRes = subjective stress resonance. a Sex coded as 0 = male, 1 = female * p < .05; ** p < .01; *** p < .001 Logistic Regression Analyses Table 3 presents the base models with trauma, sex, and age as predictors of PTSD symptom severity (divided into above vs. below average), as well as four extended models in which stress resonance (subjective, cortisol, HR, and HRV) was added. In the base model, trauma exposure and female sex were the most important risk factors of PTSD symptoms. In the extended models, increasing resonance in the markers of subjective stress, HR, and HRV, but not cortisol, were associated with increasing odds for reporting above average PTSD symptoms (significance evaluated against Bonferroni-corrected threshold of α = .0125). Table 3. Logistic regression analyses predicting PTSD symptoms B (SE) p OR (95% CI) Base model ( N = 67) Intercept -0.65 (0.32) .042 Trauma 0.81 (0.31) .009* 2.25 (1.26, 4.34) Sex 3.03 (0.99) .002* 20.61 (3.58, 193.02) Age 0.62 (0.32) .054 1.86 (1.02, 3.66) R 2 (Nagelkerke) = 0.336. Model X 2 (3) = 19.44, p < .001* Models including stress resonance ( N = 67) Subjective stress Cortisol B (SE) p OR (95% CI) B (SE) p OR (95% CI) Intercept -0.71 (0.36) .051 -0.66 (0.32) .042 Trauma 0.76 (0.35) .029 2.13 (1.11, 4.43) 0.85 (0.32) .008* 2.34 (1.29, 4.63) Sex 2.60 (1.05) .013 13.42 (2.06, 144.13) 3.13 (1.01) .002* 22.83 (3.83, 225.83) Age 0.77 (0.37) .035 2.16 (1.11, 4.77) 0.53 (0.33) .112 1.70 (0.90, 3.39) Stress resonance 1.07 (0.39) .006* 2.93 (1.45, 6.77) 0.36 (0.31) .243 1.43 (0.80, 2.72) Trauma*Stress resonance 0.32 (0.41) .433 1.37 (0.63, 3.18) 0.12 (0.27) .657 1.13 (0.66, 2.01) Model fit R 2 (Nagelkerke) = 0.485. Model X 2 (5) = 30.21, p < .001* R 2 (Nagelkerke) = 0.363. Model X 2 (5) = 21.25, p < .001* Delta model fit X 2 (2) = 10.77, p = .005* X 2 (2) = 1.82, p = .404 Base model based on sub-sample with complete autonomic resonance data ( N = 62) B (SE) p OR (95% CI) Intercept -.56 (.32) .082 Trauma .75 (.31) .016 2.11 (1.18, 4.04) Sex 2.59 (1.02) .011* 13.38 (2.18, 130.37) Age 0.58 (0.31) .066 1.78 (0.99, 3.45) R 2 (Nagelkerke) = 0.288. Model X 2 (3) = 15.04, p = .002* Models including stress resonance ( N = 62) HR HRV B (SE) p OR (95% CI) B (SE) p OR (95% CI) Intercept -0.61 (0.35) .084 -0.73 (0.37) .047 Trauma 0.73 (0.34) .031 2.09 (1.10, 4.30) 0.65 (.34) .058 1.91 (1.01, 3.92) Sex 3.09 (1.14) .007* 22.04 (2.97, 280.32) 3.52 (1.26) .005* 33.65 (3.70, 571.64) Age 0.90 (0.37) .016 2.45 (1.25, 5.50) 1.11 (0.43) .010* 3.04 (1.41, 7.76) Stress resonance 0.93 (0.36) .010* 2.53 (1.30, 5.51) 1.05 (0.41) .010* 2.87 (1.39, 7.07) Trauma*Stress resonance 0.51 (0.34) .131 1.66 (0.89, 3.45) 0.26 (0.35) .452 1.30 (0.65, 2.60) Model fit R 2 (Nagelkerke) = 0.432. Model X 2 (5) = 24.23, p < .001* R 2 (Nagelkerke) = 0.437. Model X 2 (5) = 24.60, p < .001* Delta model fit X 2 (2) = 9.20, p = .010* X 2 (2) = 9.57, p = .008* Note . HR = heart rate; HRV = heart-rate variability (indexed via RMSSD) * p < .0125 Sensitivity Analyses We re-ran analyses by introducing vicarious stress instead of stress resonance as a moderator to the regression models. In all four models on subjective stress, cortisol, HR, and HRV, vicarious stress was neither a significant main predictor of PTSD symptoms nor a significant moderator of the trauma-PTSD link when applying a Bonferroni-corrected threshold of α = 0.0125 to evaluate significance (see Table S3). Discussion As a proxy for the role of empathy in the risk for PTSD, we assessed stress resonance in a sample of individuals from Arabic-speaking countries with varying levels of war-related trauma exposure. We did not find evidence to support our hypothesis that the extent to which someone resonates with others’ stress is a vulnerability factor in the development of PTSD symptoms after trauma exposure. Rather, higher levels of subjective and autonomic stress resonance were main predictors of PTSD symptom severity when controlling for sex, age, and trauma exposure. Our findings hence suggest that heightened empathic stress resonance may constitute a malleable correlate of PTSD rather than a trait modulating health risk. We further observed that subjective and HRV stress resonance were moderately related to trait levels of empathy, as assessed with the personal distress scale of the IRI 43 . In other words, individuals who indicated to have the tendency to feel uneasiness or worry when exposed to the negative experiences of others also showed higher levels of stress resonance in a naturalistic situation in which they watched a stranger exposed to acute stress. Given the scarcity of studies on stress resonance in prior trauma and PTSD research, we discuss our findings primarily against the backdrop of studies assessing personal distress, which correlated with stress resonance in our study. In line with our finding of higher subjective and autonomic stress resonance being linked to higher PTSD symptom severity, disaster workers who reported higher trait levels of personal distress also reported higher post-traumatic stress responses and general psychological distress after engaging in relief activities following a typhoon 51 . Moreover, Parlar et al. 52 showed that women with PTSD related to childhood trauma reported higher levels of personal distress compared to healthy control women. Higher levels of personal distress were further observed in individuals with PTSD related to various other types of trauma (man-made trauma, accidental trauma or natural catastrophes) compared to a non-traumatized control group 53 . In this specific study, the PTSD group further showed lower levels of empathic resonance measured as contagion to yawning and laughing than the control group 53 . Although this finding may seem contradictory to our observed positive association between PTSD symptom severity and resonance, the inconsistency may be explained by the context represented in the different tasks. While laughing and yawning are positive and relatively neutral stimuli, respectively, we focused on the negative context of stress. Taken together, it may be that PTSD symptoms relate to higher resonance in negative settings, and lower resonance in positive settings. In support of this assumption, previous research has shown that emotional deficits associated with PTSD include a hyper-responsivity to negative stimuli and an increased threshold for responsivity to positive stimuli 54 . Also, young adults reporting higher trait personal distress experienced higher levels of negative and lower levels of positive emotions in the initial stage of the COVID-19 pandemic 55 . Apart from PTSD, higher levels of personal distress have been observed in the context of various other psychiatric disorders, including major depressive disorder, bipolar disorder, borderline personality disorder, and schizophrenia 56–60 . Given the link between personal distress and stress resonance observed in our study, we speculate that the empathic tendency to pick up on and resonate with the adverse state of others may portray an unspecific symptom across psychiatric disorders. In our study, individuals’ stress resonance was unrelated to their trauma exposure. It hence seems that alterations in stress resonance were not a direct reaction to the trauma, but may have been provoked by common sequelae of trauma implicated in PTSD development. These can include alterations in attentional processes such as hypervigilance, reduced attentional control, difficulty to disengage attention from threat, and inhibition problems 61–64 . In addition, individuals with PTSD often show difficulties in emotion regulation 65,66 , which may predispose them to experience heightened personal distress when being confronted with others’ negative experiences 67 . Further support for a close link of personal distress with psychopathology rather than trauma exposure per se stems from a study by Dittrich et al. 58 who observed no significant association between early-life maltreatment and personal distress when controlling for participants’ diagnosis of major depressive or borderline personality disorder. In contrast, a recent study observed that increased personal distress in adults was associated with higher levels of childhood maltreatment 68 . Yet, as acknowledged by the authors, participants were not excluded based on any psychopathologies they may have had, which prevented testing for a potential confounding of symptoms of psychopathology in explaining the link between trauma and personal distress. We did not find higher cortisol stress resonance to relate to either subjective and autonomic stress resonance, or PTSD symptoms. We explain the lack of association between different stress markers mainly by the multifaceted and complex structure of the stress system 69 . Whereas subjective stress and ANS allow for quick responses within milliseconds (the ANS through synaptic transmissions by SNS and PNS), HPA axis activation occurs in a delayed manner 70 . Stress research therefore regularly encounters this lack of covariance between different dimensions of the stress system 71–73 . Regarding the correlation of cortisol stress resonance with PTSD symptoms, our assessment in earlier studies had been that, compared to the ANS, the delayed cortisol response may be more prone to capture stress resonance and its correlates 16 . Recent studies are showing the opposite, however, suggesting that the prompt reactivity of the ANS may facilitate the assessment of resonance 15 . Although it has previously been theorized that heightened stress resonance and associated physiological over-activation may lead to detrimental health effects in the long-term 3 , empirical evidence for such a link is still sparse. Consistent with this theory, higher levels of HRV resonance during a conflict discussion were shown to predict higher levels of inflammation and greater negative affect reactivity in couples 7 . Our finding of stress resonance being linked to PTSD symptom severity further aligns with this theory, as does the solid body of literature relating personal distress to negative health outcomes 59,75–78 . However, these findings do not necessarily suggest that a complete lack of stress resonance is desirable. Potential adaptive functions of stress resonance are the mobilization of energy to protect oneself from the stressor at hand, to help those in distress, and to allow for a deeper understanding of others’ experiences 3 . Future studies may wish to consider non-linear associations between stress resonance and adaptivity. Our findings have clinical implications, offering the possibility that a training aimed at reducing stress resonance may lead to reductions in PTSD symptom severity in individuals with a history of trauma exposure. By fostering positive affect and strengthening the activation of brain networks implicated in affiliation and reward 79,80 , particularly the training of compassion (defined as the feeling of concern for the suffering of others associated with the motivation to help) may be a resource against the excessive sharing of others’ negative states. Indeed, mindfulness- and compassion-based trainings have recently been shown effective in promoting well-being, trauma recovery and coping with post-migration living difficulties among refugees 81 . These interventions typically target maladaptive self-evaluative emotional responses to trauma and stress by fostering self-compassion, self-acceptance, and nonjudgmental awareness 82–86 , and by increasing emotional flexibility 87 —all of which may be beneficial when coping with the suffering of others. Moreover, it seems plausible that learning how to control one’s empathic tendencies also involves the promotion of self-regulation skills, which may enable better coping with first-hand stressors in daily life 88,89 . Limitations of our study constitute the relatively small sample size, the restricted age range of participants to early and middle adulthood, and the disproportionate low number of female participants, limiting generalizability of our findings. Further, we cannot draw causal conclusions on whether heightened stress resonance preceded or followed the development of PTSD symptoms due to the cross-sectional design of our study. Moreover, we only tested participants’ resonance in the negative context of stress. Testing whether subjective and physiological resonance is altered also in positive settings, for example when sharing joy in social interactions, may be an important endeavor for future investigations. Finally, we did not assess the year in which our participants came to Germany, although the duration of time spent in the host country may have influenced the association between stress resonance and PTSD symptoms. In sum, we found that higher subjective and autonomic stress resonance were related to PTSD symptom severity in a sample of individuals from Arabic-speaking countries with varying levels of war-related trauma exposure. This means that the tendency to empathically share the emotional and physiological states of others may be either a precursor, an accompanying factor, or a consequence of the emergence of PTSD. To advance intervention science dedicated to improving refugees’ and migrants’ mental health, efforts should be made to test whether individuals with a history of war-related trauma would benefit from interventions aimed at reducing the extent to which they share others’ negative experiences. Declarations Acknowledgements We cordially thank Beyond Conflict (Boston, MA, USA) and the Max Planck Institute for Human Cognitive and Brain Sciences (Leipzig, Germany) for financial support of the study. We further thank Elisabeth Murzik and Sylvia Tydecks for their involvement in study organization and coordination, and Henrik Grunert for technical assistance. We also thank our participants and all students of the Social Stress and Family Health Research Group at the Max Planck Institute for Human Cognitive and Brain Sciences involved in recruitment and data collection. Conflict of Interest We have no conflict of interest to declare. References Preston SD, de Waal FB. Empathy: Its ultimate and proximate bases. Behav Brain Sci . Feb 2002;25(1):1-20; discussion 20-71. doi:10.1017/s0140525x02000018 Feldman R. Bio-behavioral synchrony: A model for integrating biological and microsocial behavioral processes in the study of parenting. 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Group allocation was based on an initial telephone screening of all participants. However, analyses of a more detailed trauma questionnaire—the Harvard Trauma Questionnaire 40 —revealed that also migrants were exposed to considerable war-related trauma. Additional Declarations The authors have declared there is NO conflict of interest to disclose Supplementary Files SupplementTranslPsych.docx Cite Share Download PDF Status: Published Journal Publication published 30 Aug, 2025 Read the published version in Translational Psychiatry → Version 1 posted Editorial decision: revise 11 Dec, 2024 Review # 1 received at journal 14 Jun, 2024 Reviewer # 1 agreed at journal 06 Jun, 2024 Reviewers invited by journal 05 Jun, 2024 Submission checks completed at journal 14 Mar, 2024 First submitted to journal 13 Mar, 2024 Unknown event 13 Mar, 2024 Editor assigned by journal 12 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4082505","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":310811008,"identity":"2e7046fe-9228-4920-9606-375ea6ff0a32","order_by":0,"name":"Christiane Wesarg-Menzel","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0001-7861-1723","institution":"Jena University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Christiane","middleName":"","lastName":"Wesarg-Menzel","suffix":""},{"id":310811009,"identity":"450d962e-a259-4353-9879-403ceed0efec","order_by":1,"name":"Mathilde Gallistl","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Mathilde","middleName":"","lastName":"Gallistl","suffix":""},{"id":310811010,"identity":"317822c2-1ecc-444f-aaff-3f0994a1dd21","order_by":2,"name":"Michael Niconchuk","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Niconchuk","suffix":""},{"id":310811011,"identity":"847bfd63-8564-485a-873c-d1f7527c8f95","order_by":3,"name":"Veronika Engert","email":"","orcid":"https://orcid.org/0000-0001-5317-933X","institution":"Jena University Clinic","correspondingAuthor":false,"prefix":"","firstName":"Veronika","middleName":"","lastName":"Engert","suffix":""}],"badges":[],"createdAt":"2024-03-12 09:37:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4082505/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4082505/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41398-025-03548-4","type":"published","date":"2025-08-30T04:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":59053519,"identity":"b252e75b-a488-480a-8bbf-c954cca06a08","added_by":"auto","created_at":"2024-06-25 20:28:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56494,"visible":true,"origin":"","legend":"\u003ch2\u003eAssessment timeline\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e Anticip. = Anticipation phase.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4082505/v1/8358a298cf85c4b521b07593.png"},{"id":59054266,"identity":"8a57900b-1888-4e6e-b243-665d93338649","added_by":"auto","created_at":"2024-06-25 20:36:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":300643,"visible":true,"origin":"","legend":"\u003cp\u003eMean levels of subjective stress, cortisol, HR, and HRV throughout the testing session per group\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote. \u003c/em\u003e\u0026nbsp;LogCortisol = logarithmized cortisol; LogHR = logarithmized heart rate; LogHRV = logarithmized heart rate variability.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4082505/v1/a7b197d5f40e2202379aa6e7.png"},{"id":90249304,"identity":"1f415a60-c21f-471a-bd7b-a21fe08046f4","added_by":"auto","created_at":"2025-08-31 07:07:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1589156,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4082505/v1/de383dc7-3af8-4dba-9926-03a159094cd5.pdf"},{"id":59053521,"identity":"4586c2fb-1fe1-4a90-bc4e-be79459127ea","added_by":"auto","created_at":"2024-06-25 20:28:47","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22164,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"SupplementTranslPsych.docx","url":"https://assets-eu.researchsquare.com/files/rs-4082505/v1/0e26519f49e8c2faca0ed312.docx"}],"financialInterests":"The authors have declared there is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose","formattedTitle":"Adding to the burden: The tendency to resonate with others’ stress is linked to higher PTSD symptom severity in individuals with war-related trauma","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDuring interactions, the perception of another individual\u0026rsquo;s state automatically stimulates a corresponding representation in the observer, leading to common physiological states in which the observer unintentionally matches the emotion, facial expression, or other behaviors of the interaction partner\u003csup\u003e1\u003c/sup\u003e. This physiological linkage between individuals has been studied under the terms \u0026ldquo;empathy\u0026rdquo;, \u0026ldquo;bio-behavioral synchrony\u0026rdquo;, or \u0026ldquo;resonance\u0026rdquo;, and is thought to facilitate social connection and coordination\u003csup\u003e1\u0026ndash;3\u003c/sup\u003e. Although the adaptive value of resonating with others has been shown in non-threatening contexts such as parent-child interactions during play\u003csup\u003e4\u0026ndash;6\u003c/sup\u003e, resonance may come at the expense of health in the context of stress or other adverse experiences\u003csup\u003e3,7\u003c/sup\u003e. This is of particular relevance for individuals who are exposed to others\u0026rsquo; stress and suffering on a daily basis, as is the case for individuals living in or fleeing from areas of war.\u003c/p\u003e \u003cp\u003eDue to war and persecution, the number of refugees has shown a steady increase in the past decades, reaching an estimate of 36.4\u0026nbsp;million refugees at mid-2023\u003csup\u003e8\u003c/sup\u003e. Traumatic events that refugees are exposed to are highly prevalent and diverse, ranging from lack of accommodation or necessities, to experiencing or witnessing violence, torture, and loss of loved ones\u003csup\u003e9,10\u003c/sup\u003e. With the settlement in a new country, the accumulation of stressful experiences often continues due to difficulties in proving asylum claims and integrating in a new society\u003csup\u003e11,12\u003c/sup\u003e. These experiences set refugees at higher risk to develop post-traumatic stress disorder (PTSD), which ranges with a prevalence of around 31.5% among the most commonly diagnosed psychiatric disorders in refugees\u003csup\u003e13\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWar-related traumatic experiences are inherently embedded in a social context. Next to their own suffering, refugees are confronted with the suffering of family members and friends, as well as of strangers in their surroundings. Hence, apart from being victims of trauma inducing firsthand stress, refugees likely witness the trauma of others\u003csup\u003e14\u003c/sup\u003e, which can induce additional second-hand (empathic) stress\u003csup\u003e3\u003c/sup\u003e. Importantly, the mere observation of another individual experiencing stress can trigger a full-blown stress response in the observing individual, apparent through activation of the autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis\u003csup\u003e15,16\u003c/sup\u003e. While prolonged exposure to firsthand stress can lead to dysregulation of these neurobiological stress systems\u003csup\u003e17\u003c/sup\u003e, such effects may be exacerbated in individuals with a strong tendency to resonate with others\u0026rsquo; stress. In turn, dysregulation of the stress systems has been shown to underlie heightened vulnerability to psychopathology after trauma\u003csup\u003e18,19\u003c/sup\u003e. Transferred to the reality of the lives of refugees, this would imply that despite being exposed to similar first- and second-hand traumatic experiences, one individual may be more likely to develop mental health problems than another based on inter-individual differences in the tendency to resonate with others\u0026rsquo; stress.\u003c/p\u003e \u003cp\u003ePrevious research has distinguished stress resonance from vicarious stress as two possible response patterns to observing another individual under stress: Vicarious stress refers to an observer\u0026rsquo;s own stress response \u003cem\u003eirrespective\u003c/em\u003e of whether the target directly exposed to acute stress shows a stress response. In contrast, stress resonance is present when the observer\u0026rsquo;s stress response is \u003cem\u003eproportional\u003c/em\u003e to the one of the acutely stressed target\u003csup\u003e16\u003c/sup\u003e. Whereas vicarious stress reactivity is thought to reflect an individual\u0026rsquo;s general stress sensitivity, stress resonance is closely linked conceptually and empirically to empathy\u003csup\u003e3,16,20\u003c/sup\u003e. While previous studies have shown that stress sensitivity is an important vulnerability factor underlying heightened risk for the development of psychopathology\u003csup\u003e21,22\u003c/sup\u003e, we here turn attention to stress resonance as a potential vulnerability factor in the context of trauma. Indirect evidence for this hypothesis stems from a study in disaster volunteers, in which those with a stronger tendency to feel discomfort and anxiety in response to others\u0026rsquo; distress (reflecting trait levels of empathy) experienced higher increases in depression, anger, and fatigue from pre- to post-relief work\u003csup\u003e23\u003c/sup\u003e. Examining the role of stress resonance in the etiology of PTSD symptoms after trauma exposure bears clinical implications, as it could inform efforts to advance intervention research dedicated to improving refugees\u0026rsquo; mental health.\u003c/p\u003e \u003cp\u003eBased on a sample of refugees and migrants from Syria and other Arabic-speaking countries, we examined in the current work whether stress resonance would constitute a vulnerability factor for developing PTSD symptoms after war-related trauma. Next to subjective stress resonance, we focused on three different markers of the stress systems: 1) cortisol as a neuroendocrine marker of the HPA axis, as well as 2) heart rate and 3) heart rate variability as physiological markers of sympathetic and parasympathetic nervous system (SNS, PNS) functioning. As a strong paradigm that reliably triggers stress resonance even in strangers, we used the empathic Trier Social Stress Test (TSST\u003csup\u003e16,24\u003c/sup\u003e). In this paradigm, native Arabic-speaking participants watched native German-speakers undergo a standardized psychosocial stress test. The different stress markers were simultaneously captured in the stressed targets and passive observers. In a previous data set stemming from the same study, we found a moderate positive association between trauma exposure and PTSD symptoms\u003csup\u003e25\u003c/sup\u003e. In the present work, we draw on data from a subsample of this earlier study. Based on the above literature, we expected that stress resonance would moderate the link between trauma exposure and PTSD symptomatology, such that the positive association between trauma and PTSD symptoms would be stronger in individuals exhibiting high stress resonance.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipants\u003c/h2\u003e\n \u003cp\u003eOur sample consisted of \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;66 targets (55 females) taking part in a stress test, and \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;67 observers of the opposite sex (11 females) watching the targets during the stress test. In the first testing session, two observers simultaneously watched one target. Given implementation of COVID-19 contact restrictions after testing of this first triad, all subsequent testing sessions were executed in a one-to-one observation set-up (i.e., dyads). Targets were German (age \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26.0 years, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.22 years), and observers Arabic native speakers (age \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;28.7 years, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.85 years). Of the observers, 35 had entered Germany as refugees (age \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30.4 years, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.59 years) and 32 as migrants (age \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26.9 years, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.53 years). The majority of refugees and migrants came from Syria (88.6% and 71.9%, respectively; see Table \u003cspan class=\"InternalRef\"\u003eS1\u003c/span\u003e for countries of origin).\u003c/p\u003e\n \u003cp\u003eParticipants were recruited through social media advertisement and by distributing flyers. Trained students conducted a structured telephone screening to determine participants\u0026rsquo; eligibility. All participants needed to be aged between 20 and 40 years. Targets were required to speak German as the native language. Observers needed to speak Arabic as the native language and German at an intermediate (B1) level, come from an Arabic-speaking country of origin, and live for at least six months in Germany. Within observers, we further differentiated between refugees and migrants based on definitions of UNHCR\u003csup\u003e8\u003c/sup\u003e: Individuals who had been \u003cem\u003eforced\u003c/em\u003e to flee their home countries because of conflict or persecution were considered as refugees. In contrast, individuals who had \u003cem\u003echosen\u003c/em\u003e to leave their home to work, study, or join family in a new country were considered as migrants. Refugees were included if they reported a war-related trauma (i.e., they had fled war, violence, or persecution) in the absence of other major trauma (e.g., child maltreatment, severe accident). In contrast, migrants were supposed to be free of any major traumatic experience.\u003csup\u003e1\u003c/sup\u003e\u003ca href=\"#_ftnref1\" name=\"_ftn1\" title=\"\"\u003e\u003c/a\u003e Of note, the two groups were chosen given an initial plan to test whether individuals with war-related trauma (refugees) would differ in empathy from individuals without war-related trauma with a similar cultural background (migrants). Group allocation was based on an initial telephone screening of all participants. However, analyses of a more detailed trauma questionnaire\u0026mdash;the Harvard Trauma Questionnaire\u003csup\u003e40\u003c/sup\u003e\u0026mdash;revealed that also migrants were exposed to considerable war-related trauma.\u003c/p\u003e\n \u003cp\u003e\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e Given known effects of weight on autonomic activity\u003csup\u003e27\u003c/sup\u003e, an additional exclusion criterion for participants of both target and observer groups was a BMI of less than 18 or more than 30. We further excluded participants reporting chronic illnesses (including psychiatric disorders) or using medication, hormone-based birth control, or other substances with known effects on HPA axis or autonomic activity\u003csup\u003e28,29\u003c/sup\u003e. Refugees were not excluded if they had a diagnosis of PTSD or depression during the last two years. To facilitate recruitment, we further decided to include regular cigarette smokers in the observer group due to high prevalence of smoking in many Middle Eastern countries\u003csup\u003e30\u003c/sup\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eProcedure\u003c/h2\u003e\n \u003cp\u003eThe study was approved by the Ethics Board of the medical faculty of Leipzig University, Germany (ethics number: 405/18-ek). Observers came to the lab for a first visit lasting about 2.5 hours, in which they provided informed consent, filled out online questionnaires, and completed an empathy task (EmpaToM\u003csup\u003e31\u003c/sup\u003e; not subject to the current manuscript). For a second lab visit lasting about 4.5 hours, observers were invited back together with an unfamiliar target person of opposite sex. This visit was scheduled in the early afternoon to control for variation in diurnal cortisol secretion\u003csup\u003e32\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003eUpon arrival at the laboratory, targets and observers were placed in separate rooms. Participants first underwent a rapid drug test to screen for recreational drug use. To equalize blood sugar levels, they were offered a snack and a glass of juice. To avoid saliva sample contamination, participants were instructed to not eat or drink anything other than water throughout the remainder of the testing session. Then, participants were equipped with a chest belt recording an electrocardiogram (ECG) to measure SNS and PNS activity. After a resting period of 40 min, participants were guided into either the testing or the adjacent observation room. While targets attended the TSST\u003csup\u003e24\u003c/sup\u003e, observers passively watched the procedure through a one-way mirror. Targets were aware of being observed during their performance, although they did not know by whom. After the TSST, target and observer separately left their rooms, and rested alone during the 60 min recovery phase.\u003c/p\u003e\n \u003cp\u003eThe TSST is a standardized laboratory paradigm that reliably elicits social-evaluative stress\u003csup\u003e33,34\u003c/sup\u003e. It consists of a preparatory anticipation phase (5 min), followed by a video-recorded mock job interview (5 min) and a mental arithmetic task (5 min) in front of an evaluation committee. Given safety rules due to the COVID-19 pandemic, for 60.6% of the testing sessions, the committee members were sitting in a separate room from the participant. Their image was projected via live video feed at large-scale on the wall facing the target. During the TSST instruction period, the committee members shortly entered the TSST testing room to demonstrate their actual presence in the laboratory and thus the realness of the video situation.\u003c/p\u003e\n \u003cp\u003eThroughout the testing period, ten ratings of subjective stress experience and ten cortisol samples were collected simultaneously from targets and observers. In addition, a continuous ECG was collected from 50 min prior to 50 min post stressor onset (for assessment timeline, see Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Participants received financial compensation for study participation. The study was performed in agreement with the Declaration of Helsinki. All participants gave their written informed consent and could withdraw from the study at any time.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eMeasures of Acute Stress Reactivity\u003c/h2\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003eSubjective Stress Experience\u003c/h2\u003e\n \u003cp\u003eIn both targets and observers, we assessed participants\u0026rsquo; subjective stress experience at ten times throughout the test session using a 7-point Likert scale asking for the level of currently experienced stress (\u0026ldquo;How stressed do you feel at this moment?\u0026rdquo;). Assessments took place 20 min prior to stressor onset (baseline), after stress anticipation (2 min prior to stressor onset), and at 10, 20, 25, 30, 40, 50, 60 and 70 min after stressor onset (see Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n \u003ch2\u003eSalivary Cortisol\u003c/h2\u003e\n \u003cp\u003eIn parallel to the assessments of subjective stress experience, participants collected ten salivary samples for cortisol analysis using Salivettes (Sarstedt, N\u0026uuml;mbrecht, Germany; Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Participants placed the collection swab in their mouth for 2 min and refrained from chewing. Salivettes were stored at -20\u0026deg;C until analysis. Cortisol levels were assessed using a time-resolved fluorescence immunoassay with intra- and inter-assay variabilities of less than 10% and 12%, respectively\u003csup\u003e35\u003c/sup\u003e.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eHeart Rate and Heart Rate Variability\u003c/h2\u003e\n \u003cp\u003eAll participants wore a Zephyr Bioharness 3 chest belt (Zephyr Technology, Annapolis, Maryland, USA), which recorded a continuous ECG at a frequency of 250 Hz for altogether 100 min (from \u0026minus;\u0026thinsp;50 min to +\u0026thinsp;50 min relative to stressor onset). A trained student manually corrected artifacts in the ECG raw data using python-based in-house software. Two students re-checked all corrections made. For further analysis, each ECG recording was split into 5-min timeframes related to specific phases of the testing protocol (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The baseline phase was represented by timeframes 1 and 2 (from \u0026minus;\u0026thinsp;40 to \u0026minus;\u0026thinsp;30 min), the anticipation phase by timeframe 3 (from \u0026minus;\u0026thinsp;7 to \u0026minus;\u0026thinsp;2 min), the stress phase by timeframes 4 and 5 (from 0 to +\u0026thinsp;10 min), and the recovery phase by timeframes 6 to 12 (from +\u0026thinsp;15 to +\u0026thinsp;50 min). For each timeframe, we calculated averages for heart rate (HR) and heart rate variability (HRV; specifically the root mean of the square successive differences [RMSSD]) per participant using the python package \u0026ldquo;hrv-analysis\u0026rdquo;\u003csup\u003e36\u003c/sup\u003e. To ensure sufficient data quality, we excluded timeframes in which more than 10% of the recording had to be cut.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eQuestionnaires\u003c/h2\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003eTrauma\u003c/h2\u003e\n \u003cp\u003eTrauma was measured with the official Arabic (\u0026ldquo;Iraqi\u0026rdquo;) version of the trauma events section of the Harvard Trauma Questionnaire (HTQ\u003csup\u003e40,41\u003c/sup\u003e). Participants indicated whether they had experienced each of 42 traumatic events (e.g., oppression, imprisonment, combat exposure) before coming to Germany. Trauma scores were calculated by a sum of \u0026ldquo;yes\u0026rdquo; responses. In our study, the trauma events section of the HTQ demonstrated excellent reliability (Cronbach\u0026rsquo;s \u0026alpha;\u0026thinsp;=\u0026thinsp;.92).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003ePTSD\u003c/h2\u003e\n \u003cp\u003eWe assessed PTSD symptom severity with the first 16 items of the trauma symptom section of the HTQ\u003csup\u003e41\u003c/sup\u003e, which correspond to symptoms of PTSD according to the DSM-IV. Participants indicated the degree to which they were distressed in the past week by trauma symptoms such as \u0026ldquo;feeling detached or withdrawn from people\u0026rdquo; or \u0026ldquo;trouble sleeping\u0026rdquo; on a Likert scale ranging from 1 (\u0026ldquo;not at all\u0026rdquo;) to 4 (\u0026ldquo;extremely\u0026rdquo;). Higher mean scores indicated more severe PTSD symptoms. The HTQ manual recommends a cut-off score of 2.5 to identify clinically significant levels of PTSD\u003csup\u003e40\u003c/sup\u003e, which was the case in five observers. Reliability was good (Cronbach\u0026rsquo;s \u0026alpha;\u0026thinsp;=\u0026thinsp;.89).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003ePersonal distress\u003c/h2\u003e\n \u003cp\u003eAs a specific facet of empathy potentially linked to stress resonance, we assessed trait personal distress based on the Interpersonal Reactivity Index (IRI\u003csup\u003e43\u003c/sup\u003e). The IRI was translated into Arabic by a native, bilingual speaker and back-translated by another bilingual individual to ensure linguistic equivalence\u003csup\u003e44\u003c/sup\u003e. The personal distress scale measures self-oriented feelings such as discomfort, anxiety and worry when being confronted with others\u0026rsquo; negative emotional states or situations. It consists of seven items rated on a Likert scale from 1 (\u0026ldquo;does not describe me well\u0026rdquo;) to 5 (\u0026ldquo;describes me very well\u0026rdquo;), aggregated to a sum score. In the current study, reliability was relatively poor (Cronbach\u0026rsquo;s \u0026alpha;\u0026thinsp;=\u0026thinsp;.49).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eData Analysis\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eData Processing and Computation of Stress Measures.\u003c/strong\u003e To approach normal distribution, cortisol, HR, and HRV data were log-transformed and subsequently winsorized to three standard deviations\u003csup\u003e28\u003c/sup\u003e. For all participants and stress markers, we calculated change scores from baseline to stress peak. While change scores indicated stress reactivity in targets, they reflected vicarious stress (i.e., stress reactivity independent of target stress) in observers.\u003c/p\u003e\n \u003cp\u003eFor cortisol, the baseline level (sample 1 at \u0026minus;\u0026thinsp;20 min) was subtracted from the individual peak level chosen from samples at +\u0026thinsp;10, +20, +\u0026thinsp;25, +30, or +\u0026thinsp;40 min (samples 3\u0026thinsp;\u0026minus;\u0026thinsp;7), since cortisol typically peaks within this timeframe after stressor onset\u003csup\u003e45, 46\u003c/sup\u003e. A significant physiological stress response was defined as a cortisol increase of at least 1.5 nmol/l above baseline levels\u003csup\u003e47\u003c/sup\u003e. For HR, the mean of timeframes 1 and 2 (baseline) was subtracted from the maximum of timeframes 3 (anticipation), 4 and 5 (stress task). For HRV, the minimum of timeframes 3\u0026thinsp;\u0026minus;\u0026thinsp;5 was subtracted from the mean of timeframe 1 and 2 (baseline). This was done because other than HR, HRV \u003cem\u003edecreases\u003c/em\u003e with stress experience\u003csup\u003e48\u003c/sup\u003e. Hence, higher change scores indicated stronger increases in cortisol and HR, and stronger decreases in HRV in response to stress. If HR / HRV data was only available for the anticipation phase, but missing for the stress phase, we refrained from computing a change score, as it was impossible to verify whether the anticipation sample represented peak reactivity. For subjective stress, we subtracted the baseline rating (at \u0026minus;\u0026thinsp;20 min) from the peak level chosen from ratings at \u0026minus;\u0026thinsp;2 and +\u0026thinsp;10 min. Given that baseline levels influence reactivity of physiological parameters (law of initial value\u003csup\u003e49\u003c/sup\u003e), we adjusted cortisol, HR, and HRV change scores for baseline levels by extracting the standardized change score residuals from a regression model.\u003c/p\u003e\n \u003cp\u003eTo gain a measure of physiological and subjective stress resonance, we subtracted observer change scores from the corresponding target\u0026rsquo;s change scores, and computed an absolute value of this difference. By doing so, we obtained a measure of how closely the observer\u0026rsquo;s stress reactivity resembled the one of the target. The absolute difference score was multiplied by (-1), such that higher values indicated higher stress resonance.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMissing Data.\u003c/strong\u003e Data on vicarious stress and stress resonance was complete for subjective stress and cortisol. Due to technical issues, HR and HRV data was missing for two observers and two targets (of whom one observer and one target belonged to the same dyad). In addition, HR and HRV data quality was too low (i.e., \u0026gt;\u0026thinsp;10% needed to be cut) in one observer during both baseline and stress timeframes, and in one target during both stress timeframes, precluding the computation of change scores. Thus, overall, data on HR and HRV vicarious stress was missing for three observers, and data on HR and HRV stress resonance was missing for five observers.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDescriptives.\u003c/strong\u003e We first examined the number of targets and observers showing a significant cortisol stress response (cortisol increase\u0026thinsp;\u0026gt;\u0026thinsp;1.5 nmol/L from baseline\u003csup\u003e47\u003c/sup\u003e). Given that the observers were either migrants or refugees, we compared both groups with regard to their vicarious stress responses and stress resonance across all four stress markers, as well as regarding trauma experience and PTSD symptoms.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLogistic Regression Modeling.\u003c/strong\u003e Regression analyses were carried out to test for the influence of stress resonance on PTSD symptoms. We initially planned to conduct multiple linear regression analyses, but given that assumptions were violated in most models, we applied multiple logistic regressions. To this end, we created a dichotomous outcome measure of PTSD symptoms above and below the sample mean. All continuous predictors were \u003cem\u003ez\u003c/em\u003e-standardized to handle possible issues of multicollinearity. For each stress markers, the base model included trauma and the covariates sex and age as predictors of PTSD symptoms. In a second step, we tested whether adding stress resonance (operationalized as the absolute value of the difference between target and observer change scores) and its interaction with trauma would improve model fit, which was evaluated by comparing both models using analysis of variance. This procedure resulted in one model per stress marker (subjective stress, cortisol, HR, HRV), yielding four final models. Given multiple testing, we applied Bonferroni correction, such that \u003cem\u003ep\u003c/em\u003e-values were compared to a significance threshold of \u0026alpha;\u0026thinsp;=\u0026thinsp;.0125.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSensitivity Analyses.\u003c/strong\u003e Given significant correlations between observers\u0026rsquo; stress resonance and vicarious stress for subjective stress, HR, and HRV, we re-computed analyses by introducing vicarious stress instead of stress resonance as a moderator to the regression models.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003ch2\u003eDescriptives\u003c/h2\u003e\n\u003cp\u003eConcerning firsthand stress, 47 out of 66 targets (71.2%) demonstrated a significant physiological stress response, defined as a cortisol increase of \u0026gt; 1.5 nmol/l over baseline levels\u003csup\u003e47\u003c/sup\u003e. Among the 67 observers, 12 (17.9%; 5 refugees, 7 migrants) showed a physiologically significant increase in cortisol levels after passively watching a target undergoing the TSST. The difference in responder rates between migrants and refugees was not significant, \u0026chi;\u0026sup2;(1,67) = 0.65, \u003cem\u003ep\u003c/em\u003e = .42. Intriguingly, 9 out of 67 observers (13.4%) showed a higher cortisol change score than the according target, indicating that the observer\u0026rsquo;s vicarious stress response in some cases surpassed the target\u0026rsquo;s firsthand stress response. Taking all four stress markers (i.e., subjective stress, cortisol, HR, and HRV) into consideration, there were no significant differences between refugees and migrants in either vicarious stress or stress resonance (see Table 1). Average subjective stress, cortisol, HR, and HRV levels throughout the testing session per group are shown in Figure 2. Analyses of variance showed significant group differences for baseline subjective, but not physiological stress levels (see Table S2). A post-hoc Tukey test revealed that refugees reported higher levels of subjective stress at baseline than migrants (\u003cem\u003ep\u003c/em\u003e = 0.037), while targets did not differ in their baseline subjective stress from migrants (\u003cem\u003ep\u003c/em\u003e = 0.680) or refugees (\u003cem\u003ep\u003c/em\u003e = 0.104; see Table S2). Refugees reported more traumatic events and higher levels of PTSD symptoms than migrants (see Table 1). A full correlation matrix is shown in Table 2.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Comparison of refugees and migrants on trauma, PTSD, and empathic stress measures\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003eRefugees\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e = 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003eMigrants\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e = 32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et, p\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eTrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e16.23 (7.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e8.41 (7.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e = -4.27, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003ePTSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e1.89 (0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e1.52 (0.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e = -3.13, \u003cem\u003ep\u003c/em\u003e = .003**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVicarious stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e∆\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSubjective stress\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e1.60 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e1.62 (1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e = 0.06, \u003cem\u003ep\u003c/em\u003e = .949\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e∆\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eCortisol \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e0.09 (0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e0.03 (0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e = -1.09, \u0026nbsp;\u003cem\u003ep\u003c/em\u003e = .282\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e∆\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eHR \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e0.00 (0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e = -0.94, \u003cem\u003ep\u003c/em\u003e = .353\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e∆\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eHRV \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e = 0.19, \u003cem\u003ep\u003c/em\u003e = .850\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStress resonance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eSubjective stress resonance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e2.43 (1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e2.66 (1.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eCortisol resonance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e0.40 (0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e0.49 (0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e = 1.28, \u003cem\u003ep\u003c/em\u003e = .230\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eHR resonance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e0.14 (0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e0.12 (0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e = -0.72, \u003cem\u003ep\u003c/em\u003e = .476\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eHRV resonance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e0.30 (0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.008403361344538%\" valign=\"top\"\u003e\n \u003cp\u003e0.32 (0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e = 0.33, \u003cem\u003ep\u003c/em\u003e = .742\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Change scores based on log-transformed and winsorized data.\u003c/p\u003e\n\u003cp\u003e** \u003cem\u003ep\u003c/em\u003e \u0026lt; .01; *** \u003cem\u003ep\u003c/em\u003e \u0026lt; .001 \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Full correlation matrix\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1090\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"top\"\u003e\n \u003cp\u003eSexO \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"top\"\u003e\n \u003cp\u003eAgeO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"top\"\u003e\n \u003cp\u003eTrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"top\"\u003e\n \u003cp\u003ePTSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"top\"\u003e\n \u003cp\u003ePD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"top\"\u003e\n \u003cp\u003eSSO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"top\"\u003e\n \u003cp\u003eSSRes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"top\"\u003e\n \u003cp\u003eSST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"top\"\u003e\n \u003cp\u003eCO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"top\"\u003e\n \u003cp\u003eCRes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"top\"\u003e\n \u003cp\u003eCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"top\"\u003e\n \u003cp\u003eHRO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"top\"\u003e\n \u003cp\u003eHRRes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"top\"\u003e\n \u003cp\u003eHRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"top\"\u003e\n \u003cp\u003eHRVO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"top\"\u003e\n \u003cp\u003eHRVRes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n \u003cp\u003eAgeO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n \u003cp\u003eTrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.28*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n \u003cp\u003ePTSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.26*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.40***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n \u003cp\u003ePD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.25*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.39**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n \u003cp\u003eSSO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.24*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.40***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n \u003cp\u003eSSRes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.28*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.30**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.32**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.49***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n 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width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n 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width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n \u003cp\u003eCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.73***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n 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width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.38**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.54***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n 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width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n \u003cp\u003eHRVO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.50***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n \u003cp\u003eHRVRes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.25*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.33**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.34**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.43***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.70***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.61***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.55***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.899724011039559%\" valign=\"top\"\u003e\n \u003cp\u003eHRVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e.25*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.28*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.26*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.30*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.40**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.74***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.979760809567617%\" valign=\"bottom\"\u003e\n \u003cp\u003e.76***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.151793928242871%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.371665133394664%\" valign=\"bottom\"\u003e\n \u003cp\u003e-.87***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e AgeO = age of observer; CO = cortisol reactivity of observer; CRes = cortisol resonance; CT = cortisol reactivity of target; HRO = heart rate reactivity of observer; HRRes = heart rate resonance; HRT = heart rate reactivity of target; HRVO = heart rate variability reactivity of observer; HRVRes = heart rate variability resonance; HTVT = heart rate variability reactivity of target; PD = personal distress; PTSD = post-traumatic stress disorder; SexO = sex of observer; SSO = subjective stress of observer; SST = subjective stress of target; SSRes = subjective stress resonance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Sex coded as 0 = male, 1 = female\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e* \u003cem\u003ep\u003c/em\u003e \u0026lt; .05; ** \u003cem\u003ep\u003c/em\u003e \u0026lt; .01; *** \u003cem\u003ep\u003c/em\u003e \u0026lt; .001\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eLogistic Regression Analyses\u003c/h2\u003e\n\u003cp\u003eTable 3 presents the base models with trauma, sex, and age as predictors of PTSD symptom severity (divided into above vs. below average), as well as four extended models in which stress resonance (subjective, cortisol, HR, and HRV) was added. In the base model, trauma exposure and female sex were the most important risk factors of PTSD symptoms. In the extended models, increasing resonance in the markers of subjective stress, HR, and HRV, but not cortisol, were associated with increasing odds for reporting above average PTSD symptoms (significance evaluated against Bonferroni-corrected threshold of \u0026alpha; = .0125).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Logistic regression analyses predicting PTSD symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"680\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eB (SE)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eOR (95% CI)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"12\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBase model (\u003cem\u003eN\u003c/em\u003e = 67)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.65 (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003eTrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.81 (0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.009*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.25 (1.26, 4.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e3.03 (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e20.61 (3.58, 193.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.62 (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.86 (1.02, 3.66)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"75%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e (Nagelkerke) = 0.336. Model \u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e(3) = 19.44, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.382352941176471%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.61764705882353%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"75%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModels including stress resonance (\u003cem\u003eN\u003c/em\u003e = 67)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.382352941176471%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.61764705882353%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.02496328928047%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubjective stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.91336270190896%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCortisol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eB (SE)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eOR (95% CI)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eB (SE)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eOR (95% CI)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.71 (0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.66 (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003eTrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.76 (0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.13 (1.11, 4.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.85 (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.008*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e2.34 (1.29, 4.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.60 (1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e13.42 (2.06, 144.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e3.13 (1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e22.83 (3.83, 225.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.77 (0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.16 (1.11, 4.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.53 (0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e1.70 (0.90, 3.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003eStress resonance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.07 (0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.93 (1.45, 6.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.36 (0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e1.43 (0.80, 2.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.035190615835777%\" valign=\"top\"\u003e\n \u003cp\u003eTrauma*Stress resonance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.32 (0.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.821114369501466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.37 (0.63, 3.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.929618768328446%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.12 (0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.357771260997067%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.56891495601173%\" valign=\"top\"\u003e\n \u003cp\u003e1.13 (0.66, 2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eModel fit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.02496328928047%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e (Nagelkerke) = 0.485. Model \u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e(5) = 30.21, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.91336270190896%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e (Nagelkerke) = 0.363. Model \u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e(5) = 21.25, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eDelta model fit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.02496328928047%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e(2) = 10.77, \u003cem\u003ep\u003c/em\u003e = .005*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.91336270190896%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e(2) = 1.82, \u003cem\u003ep\u003c/em\u003e = .404\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"12\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBase model based on sub-sample with complete autonomic resonance data (\u003cem\u003eN\u003c/em\u003e = 62)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eB (SE)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eOR (95% CI)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e-.56 (.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eTrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e.75 (.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.11 (1.18, 4.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e2.59 (1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e13.38 (2.18, 130.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e0.58 (0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.78 (0.99, 3.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"12\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e (Nagelkerke) = 0.288. Model \u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e(3) = 15.04, \u003cem\u003ep\u003c/em\u003e = .002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"12\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModels including stress resonance (\u003cem\u003eN\u003c/em\u003e = 62)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.23494860499266%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.70337738619677%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHRV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eB (SE)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eOR (95% CI)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eB (SE)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eOR (95% CI)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e-0.61 (0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.73 (0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eTrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e0.73 (0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.09 (1.10, 4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.65 (.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.91 (1.01, 3.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e3.09 (1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.007*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e22.04 (2.97, 280.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e3.52 (1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e33.65 (3.70, 571.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e0.90 (0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.45 (1.25, 5.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.11 (0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.010*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e3.04 (1.41, 7.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eStress resonance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e0.93 (0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.010*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.53 (1.30, 5.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.05 (0.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.010*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.87 (1.39, 7.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eTrauma*Stress resonance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.069016152716593%\" valign=\"top\"\u003e\n \u003cp\u003e0.51 (0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.79588839941263%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.66 (0.89, 3.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.481644640234949%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.26 (0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.370044052863436%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.851688693098385%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.30 (0.65, 2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eModel fit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.23494860499266%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e (Nagelkerke) = 0.432. Model \u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e(5) = 24.23, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001* \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.70337738619677%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e (Nagelkerke) = 0.437. Model \u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e(5) = 24.60, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001* \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.061674008810574%\" valign=\"top\"\u003e\n \u003cp\u003eDelta model fit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.23494860499266%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e(2) = 9.20, \u003cem\u003ep\u003c/em\u003e = .010*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.70337738619677%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e(2) = 9.57, \u003cem\u003ep\u003c/em\u003e = .008*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote\u003c/em\u003e. HR = heart rate; HRV = heart-rate variability (indexed via RMSSD)\u003c/p\u003e\n\u003cp\u003e* \u003cem\u003ep\u003c/em\u003e \u0026lt; .0125\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eSensitivity Analyses\u003c/h2\u003e\n\u003cp\u003eWe re-ran analyses by introducing vicarious stress instead of stress resonance as a moderator to the regression models. In all four models on subjective stress, cortisol, HR, and HRV, vicarious stress was neither a significant main predictor of PTSD symptoms nor a significant moderator of the trauma-PTSD link when applying a Bonferroni-corrected threshold of \u0026alpha; = 0.0125 to evaluate significance (see Table S3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs a proxy for the role of empathy in the risk for PTSD, we assessed stress resonance in a sample of individuals from Arabic-speaking countries with varying levels of war-related trauma exposure. We did not find evidence to support our hypothesis that the extent to which someone resonates with others\u0026rsquo; stress is a vulnerability factor in the development of PTSD symptoms after trauma exposure. Rather, higher levels of subjective and autonomic stress resonance were main predictors of PTSD symptom severity when controlling for sex, age, and trauma exposure. Our findings hence suggest that heightened empathic stress resonance may constitute a malleable correlate of PTSD rather than a trait modulating health risk. We further observed that subjective and HRV stress resonance were moderately related to trait levels of empathy, as assessed with the personal distress scale of the IRI\u003csup\u003e43\u003c/sup\u003e. In other words, individuals who indicated to have the tendency to feel uneasiness or worry when exposed to the negative experiences of others also showed higher levels of stress resonance in a naturalistic situation in which they watched a stranger exposed to acute stress.\u003c/p\u003e \u003cp\u003eGiven the scarcity of studies on stress resonance in prior trauma and PTSD research, we discuss our findings primarily against the backdrop of studies assessing personal distress, which correlated with stress resonance in our study. In line with our finding of higher subjective and autonomic stress resonance being linked to higher PTSD symptom severity, disaster workers who reported higher trait levels of personal distress also reported higher post-traumatic stress responses and general psychological distress after engaging in relief activities following a typhoon\u003csup\u003e51\u003c/sup\u003e. Moreover, Parlar et al.\u003csup\u003e52\u003c/sup\u003e showed that women with PTSD related to childhood trauma reported higher levels of personal distress compared to healthy control women. Higher levels of personal distress were further observed in individuals with PTSD related to various other types of trauma (man-made trauma, accidental trauma or natural catastrophes) compared to a non-traumatized control group\u003csup\u003e53\u003c/sup\u003e. In this specific study, the PTSD group further showed lower levels of empathic resonance measured as contagion to yawning and laughing than the control group\u003csup\u003e53\u003c/sup\u003e. Although this finding may seem contradictory to our observed positive association between PTSD symptom severity and resonance, the inconsistency may be explained by the context represented in the different tasks. While laughing and yawning are positive and relatively neutral stimuli, respectively, we focused on the negative context of stress. Taken together, it may be that PTSD symptoms relate to higher resonance in negative settings, and lower resonance in positive settings. In support of this assumption, previous research has shown that emotional deficits associated with PTSD include a hyper-responsivity to negative stimuli and an increased threshold for responsivity to positive stimuli\u003csup\u003e54\u003c/sup\u003e. Also, young adults reporting higher trait personal distress experienced higher levels of negative and lower levels of positive emotions in the initial stage of the COVID-19 pandemic\u003csup\u003e55\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eApart from PTSD, higher levels of personal distress have been observed in the context of various other psychiatric disorders, including major depressive disorder, bipolar disorder, borderline personality disorder, and schizophrenia\u003csup\u003e56\u0026ndash;60\u003c/sup\u003e. Given the link between personal distress and stress resonance observed in our study, we speculate that the empathic tendency to pick up on and resonate with the adverse state of others may portray an unspecific symptom across psychiatric disorders.\u003c/p\u003e \u003cp\u003eIn our study, individuals\u0026rsquo; stress resonance was unrelated to their trauma exposure. It hence seems that alterations in stress resonance were not a direct reaction to the trauma, but may have been provoked by common sequelae of trauma implicated in PTSD development. These can include alterations in attentional processes such as hypervigilance, reduced attentional control, difficulty to disengage attention from threat, and inhibition problems\u003csup\u003e61\u0026ndash;64\u003c/sup\u003e. In addition, individuals with PTSD often show difficulties in emotion regulation\u003csup\u003e65,66\u003c/sup\u003e, which may predispose them to experience heightened personal distress when being confronted with others\u0026rsquo; negative experiences\u003csup\u003e67\u003c/sup\u003e. Further support for a close link of personal distress with psychopathology rather than trauma exposure per se stems from a study by Dittrich et al.\u003csup\u003e58\u003c/sup\u003e who observed no significant association between early-life maltreatment and personal distress when controlling for participants\u0026rsquo; diagnosis of major depressive or borderline personality disorder. In contrast, a recent study observed that increased personal distress in adults was associated with higher levels of childhood maltreatment\u003csup\u003e68\u003c/sup\u003e. Yet, as acknowledged by the authors, participants were not excluded based on any psychopathologies they may have had, which prevented testing for a potential confounding of symptoms of psychopathology in explaining the link between trauma and personal distress.\u003c/p\u003e \u003cp\u003eWe did not find higher cortisol stress resonance to relate to either subjective and autonomic stress resonance, or PTSD symptoms. We explain the lack of association between different stress markers mainly by the multifaceted and complex structure of the stress system\u003csup\u003e69\u003c/sup\u003e. Whereas subjective stress and ANS allow for quick responses within milliseconds (the ANS through synaptic transmissions by SNS and PNS), HPA axis activation occurs in a delayed manner\u003csup\u003e70\u003c/sup\u003e. Stress research therefore regularly encounters this lack of covariance between different dimensions of the stress system\u003csup\u003e71\u0026ndash;73\u003c/sup\u003e. Regarding the correlation of cortisol stress resonance with PTSD symptoms, our assessment in earlier studies had been that, compared to the ANS, the delayed cortisol response may be more prone to capture stress resonance and its correlates\u003csup\u003e16\u003c/sup\u003e. Recent studies are showing the opposite, however, suggesting that the prompt reactivity of the ANS may facilitate the assessment of resonance\u003csup\u003e15\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough it has previously been theorized that heightened stress resonance and associated physiological over-activation may lead to detrimental health effects in the long-term\u003csup\u003e3\u003c/sup\u003e, empirical evidence for such a link is still sparse. Consistent with this theory, higher levels of HRV resonance during a conflict discussion were shown to predict higher levels of inflammation and greater negative affect reactivity in couples\u003csup\u003e7\u003c/sup\u003e. Our finding of stress resonance being linked to PTSD symptom severity further aligns with this theory, as does the solid body of literature relating personal distress to negative health outcomes\u003csup\u003e59,75\u0026ndash;78\u003c/sup\u003e. However, these findings do not necessarily suggest that a complete lack of stress resonance is desirable. Potential adaptive functions of stress resonance are the mobilization of energy to protect oneself from the stressor at hand, to help those in distress, and to allow for a deeper understanding of others\u0026rsquo; experiences\u003csup\u003e3\u003c/sup\u003e. Future studies may wish to consider non-linear associations between stress resonance and adaptivity.\u003c/p\u003e \u003cp\u003eOur findings have clinical implications, offering the possibility that a training aimed at reducing stress resonance may lead to reductions in PTSD symptom severity in individuals with a history of trauma exposure. By fostering positive affect and strengthening the activation of brain networks implicated in affiliation and reward\u003csup\u003e79,80\u003c/sup\u003e, particularly the training of compassion (defined as the feeling of concern for the suffering of others associated with the motivation to help) may be a resource against the excessive sharing of others\u0026rsquo; negative states. Indeed, mindfulness- and compassion-based trainings have recently been shown effective in promoting well-being, trauma recovery and coping with post-migration living difficulties among refugees\u003csup\u003e81\u003c/sup\u003e. These interventions typically target maladaptive self-evaluative emotional responses to trauma and stress by fostering self-compassion, self-acceptance, and nonjudgmental awareness\u003csup\u003e82\u0026ndash;86\u003c/sup\u003e, and by increasing emotional flexibility\u003csup\u003e87\u003c/sup\u003e\u0026mdash;all of which may be beneficial when coping with the suffering of others. Moreover, it seems plausible that learning how to control one\u0026rsquo;s empathic tendencies also involves the promotion of self-regulation skills, which may enable better coping with first-hand stressors in daily life\u003csup\u003e88,89\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eLimitations of our study constitute the relatively small sample size, the restricted age range of participants to early and middle adulthood, and the disproportionate low number of female participants, limiting generalizability of our findings. Further, we cannot draw causal conclusions on whether heightened stress resonance preceded or followed the development of PTSD symptoms due to the cross-sectional design of our study. Moreover, we only tested participants\u0026rsquo; resonance in the negative context of stress. Testing whether subjective and physiological resonance is altered also in positive settings, for example when sharing joy in social interactions, may be an important endeavor for future investigations. Finally, we did not assess the year in which our participants came to Germany, although the duration of time spent in the host country may have influenced the association between stress resonance and PTSD symptoms.\u003c/p\u003e \u003cp\u003eIn sum, we found that higher subjective and autonomic stress resonance were related to PTSD symptom severity in a sample of individuals from Arabic-speaking countries with varying levels of war-related trauma exposure. This means that the tendency to empathically share the emotional and physiological states of others may be either a precursor, an accompanying factor, or a consequence of the emergence of PTSD. To advance intervention science dedicated to improving refugees\u0026rsquo; and migrants\u0026rsquo; mental health, efforts should be made to test whether individuals with a history of war-related trauma would benefit from interventions aimed at reducing the extent to which they share others\u0026rsquo; negative experiences.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe cordially thank Beyond Conflict (Boston, MA, USA) and the Max Planck Institute for Human Cognitive and Brain Sciences (Leipzig, Germany) for financial support of the study. We further thank Elisabeth Murzik and Sylvia Tydecks for their involvement in study organization and coordination, and Henrik Grunert for technical assistance. We also thank our participants and all students of the Social Stress and Family Health Research Group at the Max Planck Institute for Human Cognitive and Brain Sciences involved in recruitment and data collection.\u003c/p\u003e\n\u003ch2\u003eConflict of Interest\u003c/h2\u003e\n\u003cp\u003eWe have no conflict of interest to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePreston SD, de Waal FB. Empathy: Its ultimate and proximate bases. \u003cem\u003eBehav Brain Sci\u003c/em\u003e. Feb 2002;25(1):1-20; discussion 20-71. doi:10.1017/s0140525x02000018\u003c/li\u003e\n\u003cli\u003eFeldman R. Bio-behavioral synchrony: A model for integrating biological and microsocial behavioral processes in the study of parenting. \u003cem\u003eParenting: Science and Practice\u003c/em\u003e. 2012;12(2-3):154-164. \u003c/li\u003e\n\u003cli\u003eEngert V, Linz R, Grant JA. 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Development and socialization of self-regulation from infancy to adolescence: A meta-review differentiating between self-regulatory abilities, goals, and motivation. \u003cem\u003eDevelopmental Review\u003c/em\u003e. 2023;69(101090)\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Of note, the two groups were chosen given an initial plan to test whether individuals with war-related trauma (refugees) would differ in empathy from individuals without war-related trauma with a similar cultural background (migrants). Group allocation was based on an initial telephone screening of all participants. However, analyses of a more detailed trauma questionnaire\u0026mdash;the Harvard Trauma Questionnaire\u003csup\u003e40\u003c/sup\u003e\u0026mdash;revealed that also migrants were exposed to considerable war-related trauma.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"translational-psychiatry","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"tp","sideBox":"Learn more about [Translational Psychiatry](http://www.nature.com/tp/)","snPcode":"41398","submissionUrl":"https://mts-tp.nature.com/cgi-bin/main.plex","title":"Translational Psychiatry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4082505/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4082505/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMany refugees experience multiple traumatic events, which set them at increased risk to develop post-traumatic stress disorder (PTSD). To refine interventions aimed at improving refugees\u0026rsquo; mental health, a better understanding of the factors modulating vulnerability to war-related trauma is needed. In the present study, we focused on stress resonance as a potential vulnerability factor. Stress resonance reflects the empathic sharing of others\u0026rsquo; subjective and physiological stress experience. Sixty-seven participants who came from Arabic-speaking countries and had entered Germany as refugees or migrants took part in an empathic stress test, in which they observed a native German speaker undergo a psychosocial laboratory stressor. Meanwhile, different stress markers (subjective stress, heart rate, heart rate variability, and cortisol release) were simultaneously captured in the stressed targets and passive observers. Moderation analyses did not support our hypothesis that the extent to which someone resonates with others\u0026rsquo; stress is a vulnerability factor in the development of PTSD symptoms after trauma exposure. Rather, higher levels of subjective and autonomic stress resonance were main predictors of PTSD symptom severity when controlling for sex, age, and trauma exposure. Our findings suggest that heightened stress resonance may constitute a malleable correlate of PTSD rather than a trait modulating health risk. In the future, efforts should be made to test whether individuals with a history of war-related trauma would benefit from interventions aimed to reduce the tendency to excessively share others\u0026rsquo; stress.\u003c/p\u003e","manuscriptTitle":"Adding to the burden: The tendency to resonate with others’ stress is linked to higher PTSD symptom severity in individuals with war-related trauma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-25 20:28:42","doi":"10.21203/rs.3.rs-4082505/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2024-12-11T13:46:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2024-06-14T14:43:44+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2024-06-06T21:18:15+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2024-06-05T08:56:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-14T11:15:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Translational Psychiatry","date":"2024-03-13T18:16:00+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2024-03-13T10:54:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-12T09:33:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"translational-psychiatry","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"tp","sideBox":"Learn more about [Translational Psychiatry](http://www.nature.com/tp/)","snPcode":"41398","submissionUrl":"https://mts-tp.nature.com/cgi-bin/main.plex","title":"Translational Psychiatry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"54be0238-34ae-4ff5-b391-e646a4657069","owner":[],"postedDate":"June 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":32845987,"name":"Health sciences/Biomarkers/Diagnostic markers"},{"id":32845988,"name":"Biological sciences/Physiology"}],"tags":[],"updatedAt":"2025-08-31T07:06:51+00:00","versionOfRecord":{"articleIdentity":"rs-4082505","link":"https://doi.org/10.1038/s41398-025-03548-4","journal":{"identity":"translational-psychiatry","isVorOnly":false,"title":"Translational Psychiatry"},"publishedOn":"2025-08-30 04:00:00","publishedOnDateReadable":"August 30th, 2025"},"versionCreatedAt":"2024-06-25 20:28:42","video":"","vorDoi":"10.1038/s41398-025-03548-4","vorDoiUrl":"https://doi.org/10.1038/s41398-025-03548-4","workflowStages":[]},"version":"v1","identity":"rs-4082505","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4082505","identity":"rs-4082505","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}