Cited by 298Stress Responses and CortisolNeuroendocrine regulation and behaviorAttachment and Relationship Dynamics

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Psychobiology of social support: The social dimension of stress buffering

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Ditzen, Beate, Heinrichs, Markus·2014·Restorative Neurology and Neuroscience

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Abstract

Social integration and social support have a substantial influence on individual health and longevity, an effect assumed to be mediated through reduced stress reactivity in support recipients. However, considerable variability in individual responses to social support has been documented, suggesting that the beneficial effect of social support interacts with early experiences, genetically influenced differences in biological systems mediating social behavior, personality traits, and psychopathology. Here we outline the historical background of social support research, including epidemiological studies, laboratory studies, and field studies on the subject of social support and health, with regard to different psychobiological effector systems. Most recent research has focused on brain mechanisms which link social integration or social support with reduced neural threat responses. As numerous mental disorders are associated with considerable social impairment, understanding the potentially underlying mechanisms of neural plasticity in relation to social support, stress buffering and health in these disorders can help tailor new diagnostic and treatment strategies. Thus, theories of socially-driven emotional learning and memory, as presented in this review, might eventually lead to psychobiology-based treatment concepts for mental disorders involving social deficits.

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“The stress-mediating effects of social support are well documented for adults [35], yet findings referring to adolescence are somewhat more mixed [36,37].”
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Background
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Paltell, K. C., Smith, R. L., Kansky, J., Cox, C. M., Amstadter, A. B., Dick, D. M., The Spit for Science Working Group, Salvatore, J. E., & Berenz, E. C. (2019) · Addictive Behaviors · doi:10.1016/j.addbeh.2019.106216 · Cited by 17
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InfluentialSelf-citation
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Self-citation
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“Ditzen and Heinrichs refer to experiences of social support as safety signals that affect the biological response to a stressful situation [71].”
Background
Childhood unpredictability is associated with increased risk for long- and short-term depression and anhedonia symptoms following combat deployment
Hunt, C., Vinograd, M., Glynn, L. M., Davis, E. P., Baram, T. Z., Stern, H. S., Nievergelt, C. M., Cuccurazzu, B., Napan, C., Delmar, D., et al. (2023) · Journal of Mood and Anxiety Disorders · doi:10.1016/j.xjmad.2023.100045 · Cited by 11
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“Perceived social support plays a critical role in buffering stress and promoting psychological well-being [45-47].”
Background
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Background
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Background
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BackgroundSelf-citation
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BackgroundSelf-citation
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“Previous studies revealed that compared to received support, perceived support has a more significant impact in reducing traumatic events’ negative consequences (Gottlieb & Bergen, 2010) and is a better predictor of health-related outcomes (Ditzen & Heinrichs, 2014).”
Result
Emotions in Times of Pandemic Crisis among Italian Children: A Systematic Review
Bonvino, A., Calvio, A., Stallone, R., Marinelli, C. V., Quarto, T., Petito, A., Palladino, P., & Monacis, L. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20126168 · Cited by 13
“Indeed, previous investigations based on neuroendocrine methods documented the positive effects of social integration and social support on reward-relevant and anxiety-reducing structures and transmitter systems, which can, in turn, reduce biological stress reactivity [17,18].”
Background
The Influence of Social Dynamics on Biological Aging and the Health of Historically Marginalized Populations: A Biopsychosocial Model for Health Disparities
Tam, L. M., Hocker, K., David, T. M., & Williams, E. M. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21050554 · Cited by 13
“Receiving social support on a daily basis can positively modulate the neural mechanisms that facilitate the learning process of interpreting social interaction as rewarding and the unlearning process of stress reactivity in response to negative emotional stimuli (e.g., fear and pain) [143].”
Background
Prevalence of social and economic stressors among transgender veterans with alcohol and other drug use disorders
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“…Theory such that the daily lived experience of transphobic discrimination, which impacts both stressors and substance use, may make the direct impacts of SUD on social and economic stressors less obvious among transgender people compared to cisgender people (Ditzen & Heinrichs, 2014; Meyer, 2003).”
Background
Covariation of psychobiological stress regulation with valence and quantity of social interactions in everyday life: disentangling intra- and interindividual sources of variation
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Self-citation
Cumulative risk and adolescent emotional distress: A longitudinal moderated mediation analysis focusing on perceived stress and social support
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Evaluation von Stressprävention und Stressbewältigung mittels epigenetischer Marker
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Self-citation
Social Support Effects on Neural Stress and Alcohol Reward Responses
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“Other studies of trauma, social support and self-esteem [21] also supported that improving social support and self-evaluation led to higher meaning in life.”
Social anxiety influences the stress-buffering potential of social presence: Evidence from cardiovascular and affective reactivity under stress
Maffei, A., Scarpa, E., Patron, E., & Sessa, P. (2025) · PLoS ONE · doi:10.1371/journal.pone.0325303 · Cited by 10
“This influence has been observed and studied primarily in primates, humans included, but research on this topic spans also the psychophysiology of other mammals, as well as, other non-mammalian vertebrates ( i.e., birds and fish) [3,5,8,9].”
Influential
Psychological Resilience and Sleep Quality Among the Elderly: The Mediating Role of Social Support
Li, J., Zhang, J., Hou, Y., Cui, Y., Wang, Q., Ouyang, A., Cai, M., & Hua, Y. (2025) · Nature and Science of Sleep · doi:10.2147/nss.s536878 · Cited by 7
“54 Specifically, a positive family environment can provide patients with more family resources.”
Teaching social skill acquisition to adolescent students with autism: A systematic review of peer-mediated interventions published between 2010 and 2020
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Gnanadesikan, G. E., Carranza, E., King, K. M., Flyer, A. C., Ossello, G., Smith, P. G., Steklis, N. G., Steklis, H. D., Connelly, J. J., Barnett, M. A., et al. (2024) · Hormones and Behavior · doi:10.1016/j.yhbeh.2024.105523 · Cited by 8
Perceived Discrimination and Incident Dementia Among Older Adults in the United States: The Buffering Role of Social Relationships
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“Social support may reduce the perceived threat of stressors and mitigate the physiological response to stress, such as dampening the activation of the HPA axis and reducing the increase in allostatic load (Ditzen & Heinrichs, 2014; Juster et al., 2010).”
Background
Overnight Social Isolation in Pigs Decreases Salivary Cortisol but Does Not Impair Spatial Learning and Memory or Performance in a Decision-Making Task
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“, stress reactivity in the isolation condition may have been dampened in all pigs, albeit through different mechanisms (53).”
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The Long-Term Efficacy of “Social Buffering” in Artificial Social Agents: Contextual Affective Perception Matters
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“, 1993), and by “buffering” the activation of an internal stress (autonomic nervous) system (Ditzen and Heinrichs, 2014; Uno et al., 2002).”
Background
Association of Stressful Life Events With Oral Health Among Japanese Workers
Aoki, J., Zaitsu, T., Oshiro, A., & Aida, J. (2023) · Journal of Epidemiology · doi:10.2188/jea.je20220225 · Cited by 8
“28 Social support is obtained from social relationships, and an intervention that aims to increase social relationships reports a positive health e ﬀ ect.”
Background
BAŞA ÇIKMA STRATEJİLERİNİN ALGILANAN SOSYAL DESTEĞE GÖRE İNCELENMESİ
Bedel, A., & Kutlu, A. (2018) · Bingöl Üniversitesi Sosyal Bilimler Enstitüsü Dergisi · doi:10.29029/busbed.378121 · Cited by 7
Systemic Practitioner Research – Some (Epistemological) Considerations and Examples
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Recovery identity as a buffer: mitigating trauma's impact on recovery capital in collegiate recovery programs
Francis, M. W., Smith, R. L., Miola, R., Yang, Y., Bannard, T., Burns, V. F., Cleveland, M. J., Karimova, K., LaBelle, O. P., Murphy, D. G., et al. (2025) · Frontiers in Adolescent Medicine · doi:10.3389/fradm.2025.1602130 · Cited by 6
Promoting Child Wellness: A Narrative Review of Positive Childhood Experiences
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“Taken together, these findings suggest a possible mechanistic pathway by which social support contributes to resilience: social support may reduce dACC activity, thereby attenuating stress responses (a mechanism discussed in reviews such as Ditzen & Heinrichs, 2014).”
Titi monkey father-daughter bond-related behaviors explain stress response variability
Witczak, L. R., Samra, J., Dufek, M. E., Goetze, L. R., Freeman, S. M., Razo, R. A., BAXTER, A. B., Karaskiewicz, C. L., Lau, A. R., Rothwell, E. S., et al. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106362 · Cited by 5
“These findings are similar to those found in humans that have demonstrated that strong attachment relationships are able to buffer children and adults from stressors (Ditzen and Heinrichs, 2014).”
Result
Social support and perceived partner responsiveness have complex associations with salivary cortisol in married couples
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“…the effects of actual received support and the perception of support (Haber et al., 2007), the in ﬂ uence of motivated cognition on support processes (Lemay & Clark, 2015), and the generally more robust associations of perceived support with health-related outcomes (Ditzen & Heinrichs, 2014).”
Background
Using Wearables to Study Biopsychosocial Dynamics in Couples Who Cope With a Chronic Health Condition: Ambulatory Assessment Study
Pauly, T., Lüscher, J., Wilhelm, L. O., Amrein, M. A., Boateng, G., Kowatsch, T., Fleisch, E., Bodenmann, G., & Scholz, U. (2024) · JMIR mhealth and uhealth · doi:10.2196/49576 · Cited by 6
“In laboratory stress paradigms, social support (eg, in the form of physical touch) buffers physiological stress reactivity and speeds up recovery, for example, as assessed by heart rate and salivary cortisol levels [12,13].”
Background
Interpersonal Psychotherapy for Depression in Parkinson’s Disease: A Feasibility Study
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“IPT’s emphasis on building and strengthening supportive relationships has relevance for PD because the disorder and its treatment are chronic stressors and adequate social supports can have stress-buffering effects.(21) PD patients with limited or poor social supports have been found to be at increased risk for depres…”
Background
Learning and brain plasticity in mental disorders
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“Furthermore, from a stress-response perspective, research has demonstrated that social support can lower cortisol responses to stress, providing a buffering effect that reduces an individual ’ s reaction to chronic stress (84, 85).”
Adverse childhood experiences and internalizing symptoms: the moderating role of neural responses to threat
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“For example, it would be interesting to investigate the role of social support in protecting mal-treated individuals with heightened P300/LPP complex from developing anxiety in response to unpleasant stimuli (Auerbach et al., 2011; Ditzen and Heinrichs, 2014; Taylor, 2011; Turner and Brown, 2010).”
Spousal emotional support and relationship quality buffers pupillary response to horror movies
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“Ditzen and Heinrichs [9] explain that autonomic activation can be assessed through various physiological markers, such as PR, BP, or skin conductance, but that these measures do not necessarily correlate.”
Background
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“To a certain extent, social support can help patients increase their confidence in fighting cancer [11].”
Perceived social support and relationship quality predict loneliness in older adults: a social network approach
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“Prior research has shown that, when measured together, perceived and received support are generally unrelated (Flor et al., 2014; Haber et al., 2007), suggesting that they may capture different constructs.”
The centrality of resourcefulness in explaining wellbeing among financially challenged single mothers
Kulik, L. (2020) · Journal of Family Social Work · doi:10.1080/10522158.2020.1819500 · Cited by 5
“Moreover, studies point to a negative relation between social support and daily stress experience (Ditzen & Heinrichs, 2014).”
Background
The case for social support in social marketing
Baptista, N., Alves, H., & Pinho, J. C. (2021) · RAUSP Management Journal · doi:10.1108/rausp-08-2020-0193 · Cited by 12
The direct effect of basic need services, and social support on positive mental health among institutionalized children: the mediating role of psychological capital
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Effect of self-efficacy on self-management ability for colorectal cancer patients with stoma: a path analysis
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“Social support can buffer the impact of negative events in life on the individual, thus strengthening the patient’s tolerance for disease and confidence in cure [26].”
Modelling a Mutual Support Network for Coping with Stress
Medeiros, L., Sikkes, R., & Jan Treur, A. (2016) · Lecture notes in computer science · doi:10.1007/978-3-319-45243-2_6 · Cited by 5
Animal Models to Investigate Social Support Induced Anxiety Reductions
Majumdar, S., Lungwitz, E. A., Andrews, K. D., Chambers, J. E., & Truitt, W. A. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-813693-5.00012-5 · Cited by 5
Social Support as a Stress Buffer or Stress Amplifier and the Moderating Role of Implicit Motives: Protocol for a Randomized Study
Haufler, A., Ditzen, B., & Schüler, J. (2022) · JMIR Research Protocols · doi:10.2196/39509 · Cited by 11
“Other moderators that are discussed to influence participants’ responses to social support are sex and gender [ 8,40,41].”
Self-citation
Pre-Anesthetic Consultation, Stress and Preoperative Anxiety in Risk Pregnant Women
da Cunha, A. C. B., Gribel, G. P. D. C., Akerman, L. P. F., & Rocha, A. C. (2018) · Gynecology & Obstetrics Case report · doi:10.21767/2471-8165.1000063 · Cited by 5
“The employment, associated with marital status, educational level and prenatal care, is a protective mechanism against prenatal stress [22,24].”
Background
Chronically Lonely Consumers Avoid Rather than Seek Out Interpersonal Touch-Related Services Because of Lack of Interpersonal Trust and Comfort with Interpersonal TouchPreprint
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The role of "Social" in the TSST: Social support and social motives partly moderate psychobiological stress responses in addition to biological sex.
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“Contrary to previous findings (Ditzen et al., 2008, Ditzen and Heinrichs, 2014, Heinrichs et al., 2003) no further effects of social support on stress were found, raising the question of whether the social support manipulation functioned effectively.”
Self-citation
The moderated mediation effect of caregiving stress and social support in the relationship between behavioral and psychological symptoms of dementia and caregiver burden in Oman: a cross-sectional study
AL-Ghammari, A., Min, G., Sinawi, H. A., Harthi, H. H. A., Yin, Y., Niu, S., Shan, E., & Li, X. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-06677-z · Cited by 4
“Research demonstrates that caregivers with robust social networks report lower levels of stress and better mental health [24].”
Pavlovian threat conditioning can generate intrusive memories that persist over time
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Authors: Ditzen, B., & Heinrichs, M.
Affiliations: University of Zurich (CH)
University of Freiburg (DE)
Corresponding author: Ditzen, Beate
Heinrichs, Markus
ORCID: Ditzen, Beate
Heinrichs, Markus
Venue: Restorative Neurology and Neuroscience
Publisher: SAGE Publications
Published: 2014-02
Volume: 32
Issue: 1
Pages: 149-162
ISSN: 0922-6028 (ISSN-L)
1878-3627
DOI: 10.3233/rnn-139008
OpenAlex: W1671710112
Cited by: 298
References: 130
Citations by year: 2026: 22 · 2025: 31 · 2024: 23 · 2023: 26 · 2022: 28 · 2021: 39 · 2020: 35 · 2019: 20 · 2018: 26 · 2017: 17 · 2016: 15 · 2015: 12 · 2014: 2
FWCI: 7.52
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (unspecified)
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Restorative Neurology and Neuroscience (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
Research Bank (Australian Catholic University) (submittedVersion)
FreiDok plus (Universitätsbibliothek Freiburg) (submittedVersion)
Funders: National Science Foundation
Deutsche Forschungsgemeinschaft (5310/1-1)
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (108392, 124627)
Universität Zürich
Topics: Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroendocrine regulation and behavior
Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
Keywords: social support, stress buffering, psychobiology, social integration, stress reactivity, neuroplasticity, social-emotional learning, social memory, mental illness, social dysfunction, genetic factors, personality traits, psychopathology, longevity
MeSH terms: Humans, Social Support, Stress, Psychological

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Psychobiology of social support: The social dimension of stress buffering

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