Differential upregulation of metabolic demands and functional integration of the default mode network during stress

Psychosocial stress engages coordinated physiological and neural responses that enable adaptation to environmental challenges. However, maladaptive stress and reduced resilience are major risk factors for psychiatric and neurodegenerative disorders. As the brains metabolic response to stress remains largely unexplored, we used simultaneous [18F]FDG PET/MRI during performance of the Montreal Imaging Stress Task to assess cerebral glucose metabolism, BOLD activation and functional connectivity. On top of activation in relation to cognitive processing, psychosocial stress specifically recruits the posterior cingulate cortex (PCC) with increased glucose metabolism and attenuated BOLD deactivations. This was accompanied by reduced PCC integration within the default mode network and increased influence onto frontoparietal and dorsal attention networks. Moreover, individuals exhibiting an endocrine stress response showed lower resilience scores, failed to downregulate anterior cingulate cortex (ACC) metabolism during stress, and displayed an inverse relationship between ACC glucose metabolism and anterior insula functional connectivity. Together, these results demonstrate that acute psychosocial stress induces coordinated alterations in brain metabolism and large-scale network organization. Our findings show that metabolic imaging provides complementary information, revealing stress-related brain responses not captured by hemodynamics alone, thereby providing a multimodal framework for understanding human stress processing and individual vulnerability to stress-related psychiatric disorders.