The effect of shame on endothelial function: discussing potential mechanisms and future directions.

In their letter to the editor, Craig and colleagues discuss a paper that we recently published (McGarity-Shipley et al., [1]) in which we found that shame, a specific form of psychosocial stress, negatively impacted endothelial function but surprisingly did not elevate cortisol or the pro-inflammatory marker soluble tumour necrosis factor- receptor 2 (sTNF RII). Therefore, it is likely that for us to understand the full picture of how stress alters human physiology and health, the effects of different kinds of stress and stress-inducing protocols need to be appreciated and explored. We agree with Craig and colleagues that our shame protocol likely increased sympathetic nervous system activity since there was an increase in mean arterial pressure after the shame protocol compared with the control protocol. [Extracted from the article]