Assessing response to stressful emotions: a controlled crossover study using pupillometry
Noronha, Ana Carolina; Castro Mendes, Francisca; Carvalho, Pedro; Fonseca, Mafalda; Paciência, Inês; Moreira, André
Wolters Kluwer
Noronha, A. C., Castro Mendes, F., Carvalho, P., Fonseca, M., Paciência, I., & Moreira, A. (2025). Assessing response to stressful emotions: A controlled crossover study using pupillometry. Porto Biomedical Journal, 10(1), e279. https://doi.org/10.1097/j.pbj.0000000000000279
https://creativecommons.org/licenses/by-nc-nd/4.0/
Copyright © 2025 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of PBJ-Associação Porto Biomedical/Porto Biomedical Society. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
https://creativecommons.org/licenses/by-nc-nd/4.0/
Copyright © 2025 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of PBJ-Associação Porto Biomedical/Porto Biomedical Society. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
https://creativecommons.org/licenses/by-nc-nd/4.0/
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:oulu-202501301401
https://urn.fi/URN:NBN:fi:oulu-202501301401
Tiivistelmä
Abstract
Background:
Fear and horror induce autonomic protective responses, acting as “survival intelligence.” Pupillometry is an innovative method that captures real-time autonomic nervous system reactions to stress.
Objective:
To evaluate the feasibility of pupillometry to assess the acute response to a passive real-life stressor—viewing a truthful war scene.
Methods:
Thirteen medical students (10 women) with an average age of 20.4 years were enrolled in a nonrandomized controlled crossover trial. Selected clips from two different audiovisual stimuli (M1: Saving Private Ryan as a fear and horror inducer and M2: Life Is Beautiful as a control) were watched for 15 minutes, separated by a washout period of 48–72 hours. The differences in pupillometry parameters between the exposure movie and the assessment time (T0 and T1 for M1 and T0 and T1 for M2) were evaluated using a Wilcoxon test. The Wilcoxon test was also used to assess the difference between M1 and M2 within each assessment time point (T0 and T1).
Results:
A significant difference in response to acute fear and horror-induced stress was observed in pupillometry parameters {baseline [6.90 (5.95; 7.40) vs. 6.60 (5.55; 7.10), P = 0.030] and final pupil diameter [4.50 (3.90; 5.20) vs. 4.10 (3.50; 4.60), P = 0.012]} between M1 and M2 in T1, suggesting the acute increase in sympathetic parameters. Although not significant, there was also a difference in pupillometry parameters (final pupil diameter [P = 0.060], average constriction velocity [P = 0.059]) after watching M1 compared with T0.
Conclusion:
Our proof-of-concept study suggests that pupillometry may be used to evaluate changes in the activity of the autonomic nervous system induced by an acute passive stress stimulus.
Background:
Fear and horror induce autonomic protective responses, acting as “survival intelligence.” Pupillometry is an innovative method that captures real-time autonomic nervous system reactions to stress.
Objective:
To evaluate the feasibility of pupillometry to assess the acute response to a passive real-life stressor—viewing a truthful war scene.
Methods:
Thirteen medical students (10 women) with an average age of 20.4 years were enrolled in a nonrandomized controlled crossover trial. Selected clips from two different audiovisual stimuli (M1: Saving Private Ryan as a fear and horror inducer and M2: Life Is Beautiful as a control) were watched for 15 minutes, separated by a washout period of 48–72 hours. The differences in pupillometry parameters between the exposure movie and the assessment time (T0 and T1 for M1 and T0 and T1 for M2) were evaluated using a Wilcoxon test. The Wilcoxon test was also used to assess the difference between M1 and M2 within each assessment time point (T0 and T1).
Results:
A significant difference in response to acute fear and horror-induced stress was observed in pupillometry parameters {baseline [6.90 (5.95; 7.40) vs. 6.60 (5.55; 7.10), P = 0.030] and final pupil diameter [4.50 (3.90; 5.20) vs. 4.10 (3.50; 4.60), P = 0.012]} between M1 and M2 in T1, suggesting the acute increase in sympathetic parameters. Although not significant, there was also a difference in pupillometry parameters (final pupil diameter [P = 0.060], average constriction velocity [P = 0.059]) after watching M1 compared with T0.
Conclusion:
Our proof-of-concept study suggests that pupillometry may be used to evaluate changes in the activity of the autonomic nervous system induced by an acute passive stress stimulus.
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