Author(s):
Marwa S. Hamza, Mohamed S. Selim, Amira Taha, Asmaa Amr, Eman M. Younes, Gannat Gamal, Heba Khamis, Rana Ahmed, Rawan Mahmoud, Waleed Fathy, Yomna R. ElBallal, Mervat M. Omran
Email(s):
marwa.hamza@bue.edu.eg , mohamed.selim@bue.edu.eg
DOI:
10.52711/0974-360X.2026.00644
Address:
Marwa S. Hamza1, Mohamed S. Selim1, Amira Taha2, Asmaa Amr2, Eman M. Younes2, Gannat Gamal2, Heba Khamis2, Rana Ahmed2, Rawan Mahmoud2, Waleed Fathy2, Yomna R. ElBallal2, Mervat M. Omran3
1Clinical Pharmacy Practice Department, Faculty of Pharmacy, The British University in Egypt, Cairo, Egypt.
2Graduate, Faculty of Pharmacy, The British University in Egypt, Cairo, Egypt.
3Pharmacology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
*Corresponding Author
Published In:
Volume - 19,
Issue - 10,
Year - 2026
ABSTRACT:
This study investigates the hormonal responses to academic stress by measuring Oxytocin (OXT) and cortisol levels in saliva among male university students. This research discusses how academic examination is a form of stress influencing the levels of hormones associated with general and social anxiety. The male participants involved in this experiment were between the ages of 20 and 26 years and met the highest criteria in terms of health. There were saliva collections, first during the non-examination period and then during an examination period. Cortisol and OXT levels were quantified using ELISA. Anxiety was assessed using Westside Test Anxiety Scale and the Liebowitz Social Anxiety Scale (LSAS). Results implied a significant rise in cortisol level in exams, especially among high-anxiety students, indicating a large amount of developed stress. Conversely, OXT levels decreased during exams, where the biggest decline occurred among high anxiety individuals. Data support the inverse association of anxiety level and OXT pointing toward the role of oxytocin as an anxiolytic. These results emphasize both the physiological impacts of academic stress and the differential involvement of cortisol and OXT in the responses to stress and anxiety, especially in highly anxious individuals. These effects should be further explored according to gender and during extended time under stress.
Cite this article:
Marwa S. Hamza, Mohamed S. Selim, Amira Taha, Asmaa Amr, Eman M. Younes, Gannat Gamal, Heba Khamis, Rana Ahmed, Rawan Mahmoud, Waleed Fathy, Yomna R. ElBallal, Mervat M. Omran. Stress, Exams and Anxiety: Unraveling Oxytocin and Cortisol Responses in University Students. Research Journal Pharmacy and Technology. 2026;19(10):4630-6. doi: 10.52711/0974-360X.2026.00644
Cite(Electronic):
Marwa S. Hamza, Mohamed S. Selim, Amira Taha, Asmaa Amr, Eman M. Younes, Gannat Gamal, Heba Khamis, Rana Ahmed, Rawan Mahmoud, Waleed Fathy, Yomna R. ElBallal, Mervat M. Omran. Stress, Exams and Anxiety: Unraveling Oxytocin and Cortisol Responses in University Students. Research Journal Pharmacy and Technology. 2026;19(10):4630-6. doi: 10.52711/0974-360X.2026.00644 Available on: https://rjptonline.org/AbstractView.aspx?PID=2026-19-10-20
REFERENCES:
1. Maria Morena, S.P., Jaideep S Bains, Matthew N Hill, National Library of Medicine in National Library of medicine website 2015.
2. Karra E.Hannibal, M.D.B., NIH, in NIH Website. 2014.
3. Thau L, G.J., Sharma S. Physiology, Cortisol. 2021: StatPearls Publishing.
4. Ramamoorthy, S. and J.A. Cidlowski. Corticosteroids: Mechanisms of Action in Health and Disease. Rheum Dis Clin North Am. 2016. 42(1): 15-31, vii DOI: 10.1016/j.rdc.2015.08.002.
5. Maeda, S., T. Sato, H. Shimada, and H. Tsumura. Post-event Processing Predicts Impaired Cortisol Recovery Following Social Stressor: The Moderating Role of Social Anxiety. Frontiers in Psychology. 2017; 8 DOI: 10.3389/fpsyg.2017.01919.
6. Budnick, C.J., E.M. Anderson, A.M. Santuzzi, A.J. Grippo, and L. Matuszewich. Social anxiety and employment interviews: does nonverbal feedback differentially predict cortisol and performance? Anxiety, Stress, & Coping. 2019; 32(1): 67-81 DOI: 10.1080/10615806.2018.1530349.
7. van den Bos, E., M. Tops, and P.M. Westenberg. Social anxiety and the cortisol response to social evaluation in children and adolescents. Psychoneuroendocrinology. 2017; 78: 159-167 DOI: 10.1016/j.psyneuen.2017.02.003.
8. Hofmann, S.G. and L.A. Andrews, Social Anxiety and Social Anxiety Disorder, in The Wiley Encyclopedia of Personality and Individual Differences. 2020: 55-60.
9. Ito, E., R. Shima, and T. Yoshioka. A novel role of oxytocin: Oxytocin-induced well-being in humans. Biophysics and Physicobiology. 2019; 16: 132-139.
10. Gimpl, G. and F. Fahrenholz, The oxytocin receptor system: structure, function, and regulation. Physiological Reviews. 2001; 81(2): 629-683.
11. Jones, C., I. Barrera, S. Brothers, R. Ring, and C. Wahlestedt. Oxytocin and social functioning. Dialogues in clinical neuroscience, 2022.
12. Heinrichs, M., T. Baumgartner, C. Kirschbaum, and U. Ehlert. Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biological Psychiatry. 2003; 54(12): 1389-1398.
13. Amico, J., R. Mantella, R. Vollmer, and X. Li. Anxiety and stress responses in female oxytocin deficient mice. Journal of Neuroendocrinology. 2004; 16(4): 319-324.
14. Windle, R., N. Shanks, S.L. Lightman, and C.D. Ingram. Central oxytocin administration reduces stress-induced corticosterone release and anxiety behavior in rats. Endocrinology. 1997; 138(7): 2829-2834.
15. Sabihi, S., S.M. Dong, S.D. Maurer, C. Post, and B. Leuner. Oxytocin in the medial prefrontal cortex attenuates anxiety: Anatomical and receptor specificity and mechanism of action. Neuropharmacology. 2017; 125: 1-12 DOI: 10.1016/j.neuropharm.2017.06.024.
16. Yoshida, M., Y. Takayanagi, K. Inoue, et al. Evidence that oxytocin exerts anxiolytic effects via oxytocin receptor expressed in serotonergic neurons in mice. J Neurosci. 2009; 29(7): p. 2259-71 DOI: 10.1523/jneurosci.5593-08.2009.
17. Lindley Baron-Cohen, K., R. Feldman, P. Fearon, and P. Fonagy. Intranasal oxytocin administration improves mood in new mothers with moderate low mood but not in mothers with elevated symptoms of postnatal depression: A randomised controlled trial. J Affect Disord. 2022; 300: 358-365 DOI: 10.1016/j.jad.2021.11.062.
18. Jang, M., T. Jung, M. Kang, J. Kim, and J. Noh. Oxytocin-induced anxiogenic behavior in juvenile male rats. 2021; 25(6): 369-376 DOI: 10.1080/19768354.2021.1995485.
19. Seltzer, L.J., T.E. Ziegler, and S.D. Pollak. Social vocalizations can release oxytocin in humans. Proceedings of the Royal Society B: Biological Sciences. 2010; 277(1694): 2661-2666.
20. Asif, S., A. Mudassar, T.Z. Shahzad, M. Raouf, and T. Pervaiz. Frequency of depression, anxiety and stress among university students. Pakistan Journal of Medical Sciences. 2020; 36(5): 971.
21. Khandagale, C. An Exploratory Study to assess Social Anxiety among Adolescents Studying in Higher Secondary Schools of Pune City. Asian J. Nur. Edu. and Research. 2015; 5(2): 8 DOI: doi: 10.5958/2349-2996.2015.00052.X.
22. Singh, N. and C. Kohli. Stress Reaction and Coping Strategies among Nursing Students in Delhi. Asian Journal of Nursing Education and Research. 2015; 5(2): 274-278 DOI: 10.5958/2349-2996.2015.00054.3.
23. Rathore, I., The Prevalence and Pattern of Self Medication among Nursing Students in a Private Nursing Institution at Oachghat, Solan (HP) in 2016. Asian Journal of Research in Pharmaceutical Sciences. 2017; 7(3): 125-131 DOI: 10.5958/2231-5659.2017.00020.0.
24. Hamzah, F., K. Che Mat, V. Bhagat, S. Amaran, and H. Hassan. Assessing Test Anxiety among the First Year Nursing Students’ of University Sultan Zainal Abidinb. Research Journal of Pharmacy and Technology. 2018; 11: 1448 DOI: 10.5958/0974-360X.2018.00270.6.
25. Driscoll, R., Westside Test Anxiety Scale Validation. Education Resources Information Center, 2006.
26. Heimberg, R.G., K.J. Horner, H.R. Juster, et al. Psychometric properties of the Liebowitz Social Anxiety Scale. Psychol Med. 1999; 29(1): 199-212 DOI: 10.1017/s0033291798007879.
27. Forni dos Santos, L., S.R. Loureiro, J.A. Crippa, and L. Osório Fde. Psychometric validation study of the liebowitz social anxiety scale - self-reported version for Brazilian Portuguese. PLoS One. 2013; 8(7): e70235 DOI: 10.1371/journal.pone.0070235.
28. Liebowitz, M.R. Social phobia. Mod Probl Pharmacopsychiatry. 1987; 22: 141-73 DOI: 10.1159/000414022.
29. Albano, A.M., L.E. Alden, D. Amado, et al. Contributors, in Social Anxiety (Third Edition), S.G. Hofmann and P.M. DiBartolo, Editors. 2014, Academic Press: San Diego. p. xxi-xxiii.
30. Mennin, D.S., D.M. Fresco, R.G. Heimberg, F.R. Schneier, S.O. Davies, and M.R. Liebowitz, Screening for social anxiety disorder in the clinical setting: using the Liebowitz Social Anxiety Scale. Journal of Anxiety Disorders. 2002; 16(6): 661-673.
31. Sareen, L. and M. Stein, A review of the epidemiology and approaches to the treatment of social anxiety disorder. Drugs. 2000; 59(3): 497-509 DOI: 10.2165/00003495-200059030-00007.
32. Letamendi, A.M., D.A. Chavira, and M.B. Stein. Issues in the assessment of social phobia: a review. The Israel Journal of Psychiatry and Related Sciences. 2009; 46(1): 13.
33. Kusturica, J., A. Hajdarević, H. Nikšić, A. Skopljak, Z. Tafi, and A. Kulo. Neuroenhancing Substances Use, Exam Anxiety and Academic Performance in Bosnian-Herzegovinian First-Year University Students. Acta Medica Academica, 2019. 48(3).
34. Santhipriya Monterio, A.K., Aneena Noushad E, Blessy Sara A, Dilna CP, Dilna M, Roshni R Nair, Toniya Tomy, Vaishnavi T. A Study to assess the level of social anxiety among adolescents in a selected college in Mangaluru. Int. J. Nur. Edu. and Research. 2020; 8(3): 4 DOI: 10.5958/2454-2660.2020.00072.1.
35. Hamzah, F., V. Bhagat, N.S. Mahyiddin, and K. Che Mat. Test Anxiety and its Impact on first year University Students and the over View of mind and body Intervention to Enhance coping Skills in Facing Exams. Research Journal of Pharmacy and Technology. 2018; 11: 2220-2228 DOI: 10.5958/0974-360X.2018.00411.0.
36. Singh, R., M. Goyal, S. Tiwari, A. Ghildiyal, S.M. Nattu, and S. Das. Effect of examination stress on mood, performance and cortisol levels in medical students. Indian J Physiol Pharmacol. 2012; 56(1): 48-55.
37. Frisch, J.U., J.A. Häusser, and A. Mojzisch. The Trier Social Stress Test as a paradigm to study how people respond to threat in social interactions. Front Psychol. 2015; 6: 14 DOI: 10.3389/fpsyg.2015.00014.
38. W., S. Emotional Support Focused Nurse Directed Intervention – Face to Face Confrontation on Serum Cortisol –A Dose Response Effect among Breast Cancer Survivors. Int. J. Nur. Edu. and Research. 2015; 3(1): 3.
39. Bayazit, V. Evaluation of Cortisol and Stress in Captive Animals. 2009.
40. Nandakumar, G.S. Cortisol in Saliva of Uncontrolled Diabetes Patients and Adrenal Stress Index. Research Journal of Pharmacy and Technology, 2016; 9(10): 1786-1788 DOI: 10.5958/0974-360x.2016.00361.9.
41. Schneider, E., L.E. Müller, B. Ditzen, S.C. Herpertz, and K. Bertsch. Oxytocin and social anxiety: Interactions with sex hormones. Psychoneuroendocrinology. 2021; 128: 105224 DOI: 10.1016/j.psyneuen.2021.105224.
42. Veiga, L., E. Carolino, I. Santos, et al. Depressive symptomatology, temperament and oxytocin serum levels in a sample of healthy female university students. BMC Psychol. 2022; 10(1): 36 DOI: 10.1186/s40359-022-00744-5.
43. Scantamburlo, G., M. Hansenne, S. Fuchs, et al. Plasma oxytocin levels and anxiety in patients with major depression. Psychoneuroendocrinology. 2007; 32(4): 407-10 DOI: 10.1016/j.psyneuen.2007.01.009.
44. Ozsoy, S., E. Esel, and M. Kula. Serum oxytocin levels in patients with depression and the effects of gender and antidepressant treatment. Psychiatry Res. 2009; 169(3): 249-52 DOI: 10.1016/j.psychres.2008.06.034.
45. Gordon, I., O. Zagoory-Sharon, I. Schneiderman, J.F. Leckman, A. Weller, and R. Feldman. Oxytocin and cortisol in romantically unattached young adults: associations with bonding and psychological distress. Psychophysiology. 2008; 45(3): 349-52 DOI: 10.1111/j.1469-8986.2008.00649.x.
46. Engel, S., S. Laufer, C. Knaevelsrud, and S. Schumacher. The endogenous oxytocin system in depressive disorders: A systematic review and meta-analysis. Psychoneuroendocrinology. 2019; 101: 138-149 DOI: 10.1016/j.psyneuen.2018.11.011.
47. Labuschagne, I., K.L. Phan, A. Wood, et al. Oxytocin attenuates amygdala reactivity to fear in generalized social anxiety disorder. Neuropsychopharmacology. 2010; 35(12): 2403-13 DOI: 10.1038/npp.2010.123.
48. Hoge, E.A., M.H. Pollack, R.E. Kaufman, P.J. Zak, and N.M. Simon. Oxytocin levels in social anxiety disorder. CNS Neurosci Ther. 2008; 14(3): 165-70 DOI: 10.1111/j.1755-5949.2008.00051.x.
49. Ehrlich, I., Y. Humeau, F. Grenier, S. Ciocchi, C. Herry, and A. Lüthi. Amygdala inhibitory circuits and the control of fear memory. Neuron. 2009; 62(6): 757-771.
50. Takayanagi, Y. and T. Onaka. Roles of oxytocin in stress responses, allostasis and resilience. International Journal of Molecular Sciences. 2021; 23(1): 150.
51. Kou, J., Y. Zhang, F. Zhou, et al. Anxiolytic Effects of Chronic Intranasal Oxytocin on Neural Responses to Threat Are Dose-Frequency Dependent. Psychother Psychosom. 2022; 91(4): 253-264. DOI: 10.1159/000521348.