The TSST goes virtual: conceptual development, current evidence and future directions

The Trier Social Stress Test (TSST) has become a foundational paradigm in experimental stress research, shaping the study of acute psychosocial stress for more than three decades. Over the past two decades, efforts to translate the TSST into immersive virtual reality (VR) environments have opened new avenues for stress research while also raising important methodological and conceptual questions. In this narrative review, we summarize the development of VR-based versions of the TSST, highlight their applications across psychoneuroendocrinology and related disciplines, and evaluate empirical evidence comparing VR adaptations with the original in-person paradigm. Across studies, TSST-VR paradigms reliably elicit subjective stress responses and often autonomic activation, whereas endocrine responses, particularly cortisol reactivity, are frequently attenuated and less robust than in the traditional TSST. We therefore discuss key challenges of virtual implementation, including reduced stress-control specificity, variability in presence and immersion, and potential confounds related to the VR context itself, such as novelty and cybersickness. At the same time, VR offers important advantages, including greater standardization, experimental control, efficiency, scalability, and compatibility with multimodal assessment. Finally, we outline future directions for VR-based stress research, including interactive and AI-driven evaluators, hybrid and lower-threshold formats, multimodal integration, and augmented or mixed-reality paradigms. We argue that TSST virtualization is best understood as an extension of the original paradigm's logic, expanding the methodological repertoire of experimental stress research while preserving its core focus on social-evaluative threat and uncontrollability.