Individual cortisol response to acute stress influences neural processing of sexual cues

Abstract

Background and aims: Problematic pornography use can be conceptualized as an impulse control disorder or alternatively as a behavioral addiction. Stress is an important trigger in addiction, but less is known about the neural effect of stress in problematic pornography use. Therefore, we aimed at investigating the effect of stress during the anticipation and viewing of sexually explicit material while considering person characteristics related to potentially being at risk for developing problematic pornography use.

Methods: In an fMRI study (n = 157 men, age: mean = 25.46, SD = 4.11) we used a sexual incentive delay task. A social stress test was used to induce stress in half of the participants. Salivary cortisol was repeatedly measured and person characteristics were considered moderating the effects of cortisol response.

Results: We found no group differences in the neural responses during the anticipation phase, but a higher reactivity to sexual stimuli in the dACC in the stress group. Acute stress activated a pronounced cortisol response, which positively correlated with neural activations in the reward system (NAcc, dACC) to sexual cues. Further, the individual time spent on pornography use moderated the effect of cortisol in some regions of the reward system (dACC, mOFC).

Discussion and conclusions: Our results suggest that acute stress related increases in cortisol can enhance the incentive value of cues announcing sexual stimuli. This might explain why acute stress is considered a trigger of pornography use and relapse and why individual stress response might be a risk factor for developing a problematic pornography use.

Keywords: compulsive sexual behavior disorder; nucleus accumbens; problematic pornography use; reward system; sexual cues; sexual incentive delay task.

Fig. 1.

Scheme of trials in the sexual incentive delay task (SIDT). Note. During the anticipation phase, the participants saw a cue (geometric figure). Following a variable time interval, a target was presented for a short time, to which the participants were asked to react as quickly as possible by pressing a button. If the cue in the anticipation phase was a CueSEM or a CueControl, a corresponding video could be obtained by reacting quickly to the target (see also Klein et al., 2020; Markert et al., 2021).

Fig. 2.

Cortisol levels of stress and NoStress groups at different time points of the experiment. Note. T₀ = before TSST and placebo-TSST, respectively; T₁ = after stress induction; T₂ = before entering the scanner; T₃ = after sexual incentive delay task (SIDT); T₄ = after leaving the scanner; T₅: after filling in questionnaires. Error bars depict standard errors. * indicates significant post-hoc tests (P < 0.05). The fMRI bar shows the time window of the fMRI experiment reported.

Fig. 3.

Correlation Between Contrast Values and Cortisol Response in the left and the right NAcc. Note. On the left, the linear regression of the contrast CueSEM minus CueControl on CortisolResponse is displayed. On the right, the contrast CueSEM minus CueControl is plotted against the CortisolResponse. Below, a sagittal section (y = 14) of the t-map of the contrast CueSEM minus CueControl is shown.

Fig. 4.

Moderation of the regression of fMRI contrasts on cortisol response by average time spent on of pornography use per month. Note. Solid lines show the regression of fMRI contrasts on CortisolResponse if time spent on pornography use (Time_PU) is one SD above mean, dashed lines if Time_PU is one SD below mean. x/y/z = MNI coordinates; mOFC = medial orbitofrontal cortex; dACC = dorsal anterior cingulate cortex.