Persistent effects of cognitive-behavioral stress management on cortisol responses to acute stress in healthy subjects—A randomized controlled trial

doi:10.1016/j.psyneuen.2005.08.007

Psychoneuroendocrinology

Volume 31, Issue 3, April 2006, Pages 333-339

https://doi.org/10.1016/j.psyneuen.2005.08.007 Get rights and content

Summary

Psychosocial stress leads to a release of cortisol. While this psychoneuroendocrine response helps to maintain physiological as well as psychological equilibrium under stress, exaggerated secretion of cortisol has been shown to have negative effects on somatic health and cognitive functioning. The study set out to examine the long-term effects of cognitive-behavioral stress management training on cortisol stress responses in healthy men and women.

Eighty-three healthy subjects were randomly assigned to cognitive-behavioral stress management (CBSM) training or a control condition. Four months after the CBSM, 76 subjects underwent a standardized psychosocial stress test. Salivary cortisol responses were assessed repeatedly before and after the stress test.

Subjects in the CBSM group showed significantly reduced cortisol stress responses. With regard to gender, this effect was observed in both men and women. However, the magnitude of the CBSM effect on cortisol responses was smaller in women than in men. Use of oral contraceptives in women influenced the cortisol response, but did not have an impact on the CBSM effect on cortisol.

The results show that the previously reported attenuation of cortisol stress responses through CBSM persists and are observable in both men and women. Since stress-induced alterations of hypothalamus pituitary adrenal axis functioning are discussed to be involved in the onset and maintenance of both somatic and psychiatric conditions, similar interventions could be used for prevention and therapy of these detrimental stress effects.

Introduction

In terms of its ubiquitous effects on important physiological systems, the hypothalamus–pituitary–adrenal (HPA) axis has been proposed as a major pathway linking psychosocial stress to its negative consequences on somatic and psychological well being (McEwen, 1998). There is accumulating evidence supporting a causal relation between increased activity and reactivity of HPA axis hormones and negative health outcomes.

For example, acute HPA axis responses to laboratory stressors have been shown to be linked to the risk for upper respiratory tract infection that is associated with stressors in the natural environment (Cohen et al., 2002). With respect to possible long-term effects, an abnormal cortisol pattern was shown to be prospectively associated with increased incidence of cardiovascular-related events and type 2 diabetes in men (Rosmond et al., 2003). Furthermore, results from the ‘MacArthur studies of successful aging’ provide evidence for long-term detrimental effects of elevated cortisol levels in the elderly, with higher baseline urinary free cortisol levels being related to declines in memory performance in women (Seeman et al., 1997) or higher incidence of fractures in men and women (Greendale et al., 1999).

In addition, cortisol is a primary mediator of allostatic load (representing the cumulative physiological burden exacted on the body through attempts to adapt to life's demands), which has been associated with significantly increased risk for 7-year mortality as well as declines in cognitive and physical functioning in the elderly (Seeman et al., 2001). Also, administration of cortisol before retrieval leads to a decrease in memory performance (Het et al., 2005).

The release of cortisol has been shown to be related to the experience or anticipation of stress (Smyth et al., 1998, Dickerson and Kemeny, 2004, Gaab et al., 2005). Therefore, interventions aiming to modulate the perception and appraisal as well as to improve stress-related coping strategies are possible means with which to modulate cortisol levels as a consequence of stressful experiences. In a randomized controlled trial study, our group reported attenuated cortisol responses to a standardized psychosocial stress test in healthy male subjects two weeks after a short, group-based cognitive-behavioral stress management training (CBSM) (Gaab et al., 2003). The current study set out to examine the stability over time and the generalizability with regard to gender of these endocrine effects of CBSM in healthy subjects.

Section snippets

Subjects and design

Three hundred and fifteen subjects (all 2nd-year psychology students of the University of Zurich in 2002) were invited to participate in the study through a letter to all 2nd-year psychology students of the University of Zurich. Recruitment was restricted to this population to reduce interintervidual differences in the frequencies and extent of external academic stressors. Interested subjects had the opportunity to enroll online. They then received a screening questionnaire, containing

Results

The TSST resulted in a significant cortisol stress response in all subjects (time effect: F(2.85/210.50)=44.83; P<0.001). Groups did not differ in their baseline cortisol levels (group effect at baseline: F(1/74)=0.001; P=0.97). Groups differed significantly in their endocrine stress response over time (group×time interaction effect: F(2.85/210.50)=6.10; P=0.001, effect size f²=0.21; Fig. 1), with subjects in the CBSM group showing an attenuated salivary cortisol response in comparison to

Discussion

This study set out to examine the stability and the generalizability of CBSM effects on cortisol stress responses in healthy subjects.

With regard to the stability of endocrine CBSM effects over time, the results show that the previously observed attenuation of cortisol stress responses 2 weeks after CBSM training (Gaab et al., 2003) can also be observed after 4 months. The attenuation of the cortisol response to stress is seen in both men and women, although it should be noted that these

Acknowledgements

This work was supported by Fonds zur Förderung des Akademischen Nachwuchses des Zürcher Universitätsvereins to Jens Gaab

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Persistent effects of cognitive-behavioral stress management on cortisol responses to acute stress in healthy subjects—A randomized controlled trial

Summary

Introduction

Section snippets

Subjects and design

Results

Discussion

Acknowledgements

Biol. Psychol.

Psychoneuroendocrinology

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Psychoneuroendocrinology

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Psychoneuroendocrinology

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Stress management and immune system reconstitution in symptomatic HIV- infected gay men over time: effects on transitional naive T cells (CD4(+)CD45RA(+)CD29(+))

Am. J. Psychiatry

Reactivity and vulnerability to stress-associated risk for upper respiratory illness

Psychosom. Med.