Endogenous in-session cortisol during exposure therapy predicts symptom improvement: Preliminary results from a scopolamine-augmentation trial

Kuhlman, Kate R.; Treanor, Michael; Imbriano, Gabriella; Craske, Michelle G.

doi:10.1016/j.psyneuen.2020.104657

Cited by 5 publications

(4 citation statements)

References 58 publications

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“…Interestingly, the included studies were consistent in showing declines in cortisol over the course of CBT for generalised anxiety disorder [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. The only study published since the systematic review [ 31 ] investigated social anxiety disorder and confirmed an earlier null-finding regarding changes of cortisol during CBT [ 45 ].…”

Section: Cortisolsupporting

confidence: 55%

“…In contrast, the systematic review revealed consistent evidence for higher cortisol levels during the initial exposure sessions to predict better therapy outcomes [ 27 ]. One study in social anxiety disorder, which was published since the systematic review, reported a somewhat counterintuitive finding, namely that higher cortisol averaged across all exposure sessions predicted reduced improvement in fear [ 31 ]. Complementing the line of research on endogenous cortisol, a study in panic disorder and agoraphobia revealed that exposure sessions scheduled at later times during the day, when cortisol is low, were linked with fewer treatment gains than were sessions scheduled at earlier times during the day, when cortisol is high [ 32 ].…”

Section: Cortisolmentioning

confidence: 99%

“…Interestingly, confronting patients with phobic stimuli has generally not been found to elicit a significant cortisol response [ 27 , 44 , 45 , 48 ]. A notable exception is a recent study in social anxiety disorder, which observed significant increases in cortisol within exposure sessions; however, these increases appeared to be driven by less than a third of the patients [ 31 ]. Interestingly, in a study in which patients with agoraphobia and their therapists were analysed concomitantly, differential trajectories of cortisol were observed across exposure sessions: whereas patients’ cortisol levels were highest 60 min after exposure, the therapists’ cortisol levels were highest shortly before exposure, with steady declines thereafter [ 51 ].…”

Section: Cortisolmentioning

confidence: 99%

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Why Does Psychotherapy Work and for Whom? Hormonal Answers

Fischer

Zilcha‐Mano

2022

Biomedicines

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The questions of for whom and why psychotherapy is effective have been the focus of five decades of research. Most of this knowledge is based on self-report measures. Following the biopsychosocial model of mental disorders, this article explores the potential of hormones in answering these questions. The literature on cortisol, oxytocin, and oestradiol in psychotherapy was systematically searched, focusing on (a) baseline hormonal predictors of who may benefit from psychotherapy and (b) hormonal changes as indicators of therapeutic change. The search was limited to depression and anxiety disorders. In sum, the findings show that, of all three hormones, the role of cortisol is most established and that both cortisol and oxytocin are implicated in psychotherapy, although a causal role is still waiting to be demonstrated. Moreover, there is a differential role of hormones in the psychotherapy of depression versus anxiety. The directions of research mapped in this article may elucidate how psychotherapy can be selected to match patients’ endocrine states and how hormonal levels can be manipulated to improve outcomes.

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Section: Cortisolsupporting

confidence: 55%

Section: Cortisolmentioning

confidence: 99%

Section: Cortisolmentioning

confidence: 99%

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Why Does Psychotherapy Work and for Whom? Hormonal Answers

Fischer

Zilcha‐Mano

2022

Biomedicines

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“…Thus, it is perhaps unsurprising that numerous augmentations to exposure therapy have been examined. Although a complete review of augmentations for exposure therapy is beyond the scope of this paper, some enhancements examined to date include drug augmentations such as d-Cycloserine, which is thought to enhance memory consolidation [ 21 ], as well as scopolamine [ 22 ] and caffeine [ 23 ]. Additionally, several non-pharmacological augmentations have been explored, including virtual reality [ 10 ], aerobic exercise [ 24 ], attention training [ 25 ], power posing [ 26 ], and strategies informed by inhibitory learning/retrieval principles [ 11 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Pilot Study of Self-Distancing Augmentation to Exposure Therapy for Youth Anxiety

Bilek

Meyer

Tomlinson

et al. 2023

Child Psychiatry Hum Dev

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This pilot examines a self-distancing augmentation to exposure. Nine youth with anxiety (ages 11–17; 67% female) completed treatment. The study employed a brief (eight session) crossover ABA/BAB design. Exposure difficulty, engagement with exposure, and treatment acceptability were examined as primary outcome variables. Visual inspection of plots indicated that youth completed more difficult exposures during augmented exposure sessions [EXSD] than classic exposure sessions [EX] by therapist- and youth-report and that therapists reported higher youth engagement during EXSD than EX sessions. There were no significant differences between EXSD and EX on exposure difficulty or engagement by therapist- or youth-report. Treatment acceptability was high, although some youth reported that self-distancing was “awkward”. Self-distancing may be associated with increased exposure engagement and willingness to complete more difficult exposures, which has been linked to treatment outcomes. Future research is needed to further demonstrate this link, and link self-distancing to outcomes directly.

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Endogenous Cortisol Levels, Sleep or Vigilance: Which Factors Contribute to Better Exposure Therapy Outcomes in the Morning?

Sopp,

Schäfer,

Michael

et al. 2024

Cogn Ther Res

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Background Research suggests that exposure therapy delivered in the morning is more successful than delivered in the evening, which is often explained by higher diurnal endogenous cortisol levels. However, this “morning exposure effect” might also be explained by other factors such as sleep or vigilance. Methods The current study aimed to disentangle these effects by assessing the impact of video-based exposure therapy delivered in the morning or in the evening, whilst considering pre-exposure sleep quality, vigilance, and cortisol levels. To this end, 80 snake fearful individuals were randomly assigned to receive exposure treatment in the morning or evening. Results Contrary to previous findings, groups did not differ in their pre-post and post-follow up decrease of snake anxiety. However, higher vigilance was found to be associated with a greater pre-post and post-follow-up decrease in snake anxiety. Moreover, pre-exposure sleep efficiency moderated the post-follow-up decrease in snake anxiety across groups: In individuals with high pre-exposure sleep efficiency, those receiving exposure in the morning were estimated to show a stronger decrease in snake anxiety than those receiving exposure in the evening. The opposite pattern was found in individuals with low pre-exposure sleep efficiency. Conclusions The results of this study illustrate that diurnal effects on exposure therapy might be more complex than previously assumed. Trial Registration The study was prospectively preregistered at the German Clinical Trial Register (https://drks.de/search/en/trial/DRKS00016183).

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Endogenous in-session cortisol during exposure therapy predicts symptom improvement: Preliminary results from a scopolamine-augmentation trial

Cited by 5 publications

References 58 publications

Why Does Psychotherapy Work and for Whom? Hormonal Answers

Why Does Psychotherapy Work and for Whom? Hormonal Answers

Pilot Study of Self-Distancing Augmentation to Exposure Therapy for Youth Anxiety

Endogenous Cortisol Levels, Sleep or Vigilance: Which Factors Contribute to Better Exposure Therapy Outcomes in the Morning?

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