Cognitive behavioral therapy, mindfulness, and cortisol habituation: A randomized controlled trial

[Emotional Abuse in Childhood and Adolescence: Biological Embedding and Clinical Implications]

Emotional abuse, defined as degrading, manipulative, or neglectful behaviors by caregivers, represents a common adverse experience for children and adolescents, often co-occurring with other maltreatment types. Exposure to emotional abuse significantly affects mental health across the lifespan and is particularly associated with elevated depression risk.This review examinesmechanisms, by which emotional abuse influences brain development and the neuroendocrine stress response system and discusses the roles of genetic vulnerability and epigenetic processes in contributing to an elevated mental health risk. Emotional abuse has similar effects on brain networks responsible for emotion processing and regulation as other maltreatment types.Moreover, it uniquely affects networks related to self-relevant information and socio-cognitive processes. Furthermore, emotional abuse is associated with an impaired recovery of the neuroendocrine response to acute stress. Similar to other maltreatment types, emotional abuse is associated with epigenetic changes in genes regulating the neuroendocrine stress response system that are implicated in increased mental health risk.These findings suggest that emotional abuse has equally detrimental effects on children'smental health as physical or sexual abuse, warranting broader societal awareness and enhanced early detection efforts. Early interventions should prioritize emotion regulation, social cognition, self-esteemenhancement, and relationship- oriented approaches for victims of emotional abuse.

Cortisol as a Target for Treating Mental Disorders: A Promising Avenue for Therapy

Cortisol, commonly known as the "stress hormone," plays a critical role in the body's response to stress. Elevated cortisol levels have been associated with various mental disorders, including anxiety, depression, and post-traumatic stress disorder. Consequently, researchers have explored cortisol modulation as a promising avenue for treating these conditions. However, the availability of research on cortisol as a therapeutic option for mental disorders is limited, and existing studies employ diverse methodologies and outcome measures. This review article aimed to provide insights into different treatment approaches, both pharmacological and non-pharmacological, which can effectively modulate cortisol levels. Pharmacological interventions involve the use of substances, such as somatostatin analogs, dopamine agonists, corticotropin-releasing hormone antagonists, and cortisol synthesis inhibitors. Additionally, non-pharmacological techniques, including cognitivebehavioral therapy, herbs and supplements, transcranial magnetic stimulation, lifestyle changes, and surgery, have been investigated to reduce cortisol levels. The emerging evidence suggests that cortisol modulation could be a promising treatment option for mental disorders. However, more research is needed to fully understand the effectiveness and safety of these therapies.

Negative correlation between IL-1β, IL-12 and TNF-γ, and cortisol levels in patients with panic disorder

INTRODUCTION

Chronic exposure to stress is a major risk factor in anxiety disorders (ADs) and can be accompanied by an altered microbiome-gut-brain axis and a compromised immune system. In recent years, the study of inflammatory processes in AD has gained special attention. Continued stress causes the reactivity of the hypothalamic-pituitary-adrenal (HPA) axis, the alteration of the intestinal microbiota and the consequent release of pro-inflammatory cytokines, affecting the sensitivity to stress and the similar behavior of anxiety.

METHOD

The aim of the present study was to evaluate the interrelationships between measures of proinflammatory cytokines and cortisol in patients with panic disorder (PD).

RESULTS

The main results of the correlation analysis revealed that the levels of pro-inflammatory cytokines interleukin (IL)-1β, IL-12, and tumor necrosis factor gamma were negatively correlated with cortisol scores (area under the curve with respect to the ground).

CONCLUSIONS

These results suggest that the inflammatory response is associated with the reactivity of the HPA axis in patients with PD and may influence the maintenance of anxiety behavior.

Effects of hydrogen water and psychological treatment in a sample of women with panic disorder: a randomized and controlled clinical trial

Research suggests that inflammation is an important mediator in the pathophysiology of anxiety disorders. In addition, women are more likely to develop an anxiety and depression disorder, in comorbidity with a wide spectrum of diseases related to the immune system. In recent years, hydrogen-rich water has emerged as a promising therapeutic strategy to prevent and intervene in stress-related disorders, due to its antioxidant and anti-inflammatory properties. The present study aims to analyze the effects of psychological treatment and a hydrogen-rich drink on the severity of anxiety and depression, pro-inflammatory cytokine levels, the cortisol awakening response, and general health state in a sample of women with panic disorder. This is a completely randomized, placebo-controlled study. The treatment group simultaneously received psychological treatment and 1.5 L of hydrogenated water for three months, compared to the control group that received psychological treatment and placebo. The results show that the treatment group was not significantly better than the control group. But there was a further reduction in measured pro-inflammatory cytokine scores, improving body pain and physical health. When between-group treatment effects were removed, psychological treatment significantly decreased measured variables, including cytokines and cortisol. The results support the presence of a maladaptive inflammatory process in women with panic disorder.

Gender roles are related to cortisol habituation to repeated social evaluative stressors in adults: secondary analyses from a randomized controlled trial

Masculine and feminine gender roles influence stressor appraisals and coping in everyday life, but their effect on stress response systems like the hypothalamic-pituitary-adrenocortical axis is unclear. Accordingly, the present study tested the association between gender roles and cortisol responses to repeated stress as part of secondary analyses of data from a randomized controlled trial examining the effects of stress management interventions on cortisol habituation. Participants (N_final = 86; 72% female) completed a baseline survey assessing gender role endorsement using the Bem Sex Role Inventory, from which 4 groups were derived: masculine (n = 20), feminine (n = 20), androgynous (high masculinity, high femininity; n = 22), and undifferentiated (low masculinity, low femininity; n = 24). Following the stress management intervention (mindfulness-based stress reduction or cognitive-behavioral skills training) or waitlist period control, participants completed the Trier Social Stress Test on two laboratory visits (48 h apart). Salivary cortisol was assessed 0, 25, 35, and 60 min post-stressor during both laboratory visits. Androgynous and undifferentiated individuals both exhibited a significant decrease in total cortisol from visit 1 to visit 2 (i.e. habituation) whereas feminine and masculine individuals did not. Undifferentiated individuals exhibited greater habituation than feminine and masculine individuals, whereas androgynous individuals only exhibited greater habituation than the feminine group. Controlling for study condition assignment did not alter these results. Results imply that gender roles may be implicated in stress-related disease because of their association with HPA axis functioning during episodes of acute stress.

Dysregulated by stigma: Cortisol responses to repeated psychosocial stress in gay and heterosexual men

BACKGROUND

Research on pathways linking stigma with health inequalities affecting sexual minority populations, focused predominantly on exploring the hypothalamic-pituitary-adrenocortical (HPA) dysregulation profiles associated with chronic stress. One of such profiles reflecting a state of increased susceptibility to disease, and not yet studied among sexual minority individuals, is impaired habituation to repeated stress of the same type. In this study we explored whether sexual identity modulates endocrine stress responses and stress responses habituation in healthy heterosexual and gay men. We also explored the associations between perceived sexual minority stigma and cortisol response to stress in the latter group.

METHODS

Gay (N = 49) and heterosexual (N = 40) men, aged 24.4 years, were confronted twice with the Trier Social Stress Test and provided 5 salivary cortisol samples for each of the two testing sessions. A multilevel mixed-effects approach was used to model the cortisol curve throughout the two-day procedure. Habituation to repeated stress was conceptualized as the decrease in the total cortisol levels as well as the change in the cortisol curvilinearity between the first and the second testing session.

RESULTS

Gay participants were characterized by significantly higher cortisol levels throughout both laboratory visits. Their cortisol levels were also predicted by perceived rejection from family due to minority sexual identity, and stigma-related vicarious trauma. Although neither group showed habituation defined as the decrease in cortisol level, the shape of the cortisol curve changed between both visits only in the heterosexual participants.

CONCLUSIONS

Increased cortisol levels observed in gay men are predicted by minority stressors. Combined with non-habituation, the upregulation of the HPA axis may constitute a physiological pathway linking stigma to adverse health outcomes.

An Initial Development and Evaluation of a Culturally Responsive Police Interactions Training for Black Adolescents with Autism Spectrum Disorder

The purpose of the current study was to conduct a qualitative and experimental analysis of a culturally informed police safety skills training for adolescents with autism spectrum disorder (ASD). The current study focused primarily on meeting the unique training needs of Black adolescents with autism spectrum disorder (ASD). A single case design was used to evaluate the initial efficacy and acceptability of a culturally responsive training method. Preliminary evidence about the physiological ramifications of police contact were also collected to begin to examine the broader behavioral and psychophysiological nature of youth's experiences. The current experimental design included in-person simulated contexts that youth, and caregivers, endorsed as relevant to their normal lives, which greatly strengthened the ecological validity of the approach.

A study of mindfulness-based stress-reduction training effects on menopause-specific quality of life in postmenopausal women: A randomized controlled trial

OBJECTIVES

Physical and psychological changes in most postmenopausal women tend to lower their quality of life. Various medical/psychological interventions have been applied to improve the postmenopausal quality of life. This study set out to investigate the effect of Mindfulness Based Stress Reduction (MBSR) training on the Menopause-specific quality of life (MENQOL).

METHODS

This RCT was conducted on 66 postmenopausal women aged 47-62 in Iran. Participants were randomly assigned to either the MBSR or the control group. The menopause--specific quality of life was assessed in two groups via MENQOL questionnaire prior to, immediately and three months after the intervention.

RESULTS

The findings revealed a significant improvements in MENQOL (P < 0.001),as well as physical(P = 0.001), psychosocial(P = 0.001) and sexual(P < 0.001)dimensions of the intervention groups compared to the control group, immediately and 3 months after the intervention.

CONCLUSION

MBSR program can be safely applied to improve menopausal women's quality of life and curb the postmenopausal symptoms.

TRIAL REGISTRATION NUMBER

IRCT2015072523344N1.

Modulation of the hypothalamic-pituitary-adrenal (HPA) axis by plants and phytonutrients: a systematic review of human trials

INTRODUCTION

The hypothalamic-pituitary-adrenal (HPA) axis plays a central role in the stress response. Plants, herbs, spices, and plant-based nutrients may influence HPA-axis activity.

OBJECTIVE

To evaluate randomised controlled, human trials assessing the effects of single plants or phytonutrients on HPA-axis related hormones.

METHODS

A systematic review of PubMed, Cochrane library, and the Cumulative Index to Nursing and Allied Health Literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria comprised of human, randomised controlled studies with a control intervention examining the effects of a single herb, spice, plant, or extract on pre- and post-changes in blood, saliva, urine, or hair concentrations of cortisol, cortisone, corticotrophin-releasing hormone, or adrenocorticotropic hormone. Databases were searched from inception until October 2020.

RESULTS

Fifty-two studies were identified examining the effects of ashwagandha, Korean ginseng, St John's Wort, cannabidiol, Rhodiola rosea, curcumin, cherry juice, asparagus, Jiaogulan, Black cohosh, Siberian ginseng, Bacopa monnieri, blueberries, green tea, Caralluma fimbriata, cashew apple juice, melon, American ginseng, Ginkgo biloba, grape juice, grapefruit juice, rosella, hops, mangosteen, holy basil, and pomegranate juice. Due to significant variability in study designs, the effect of phytonutrients on HPA-axis activity in humans was unclear. The most consistent finding was a morning, cortisol-lowering effect from ashwagandha supplementation.

CONCLUSION

For most phytonutrients, the effects of supplementation on HPA-axis activity in humans is unclear. Before more definitive conclusions about the effects of phytonutrients on the HPA-axis can be made, further research is required.

Childhood adversity and cortisol habituation to repeated stress in adulthood

BACKGROUND

Childhood adversity is a robust predictor of poor health outcomes in adulthood and hypothalamic-pituitary-adrenocortical (HPA) axis dysfunction may be a key mechanism explaining this association. However, little is known about the influence childhood adversity may exhibit on adult HPA axis habituation (i.e., decreased cortisol output in response to a repeated stressor), where HPA axis dysfunction can be inferred if habituation deviates from normal patterns.

METHODS

The current study used data from a larger study that examined the effects of stress management interventions on cortisol habituation to repeated stress. Eighty-three adults reported childhood adversity with the Adverse Childhood Experience scale and completed the Trier Social Stress Test (TSST) twice (48 h apart) scheduled after a 6-wk intervention period. Salivary cortisol was assessed pre-stressor and +25, +35, and +60 mins post-stressor onset during both visits.

RESULTS

Results indicated that childhood adversity was associated with a marginally larger decrease in total cortisol from visit 1 to visit 2 among men (i.e., habituation), but not women (i.e. non-habituation).

CONCLUSIONS

These findings suggest that childhood adversity may alter HPA axis habituation to repeated stress later in life, with possible sex differences. Future research should investigate whether HPA axis habituation to repeated stress may be a pathway through which childhood adversity affects adult health, and how it may affect men and women differently.

To stress or not to stress: Brain-behavior-immune interaction may weaken or promote the immune response to SARS-CoV-2

The COVID-19 pandemic continues to strongly affect people with health disadvantages, creating a heavy burden on medical systems and societies worldwide. Research is growing rapidly and recently revealed that stress-related factors such as socio-economic status, may also play a pivotal role. However, stress research investigating the underlying psychoneuroimmune interactions is missing. Here we address the question whether stress-associated neuroendocrine-immune mechanisms can possibly contribute to an increase in SARS-CoV-2 infections and influence the course of COVID-19 disease. Additionally, we discuss that not all forms of stress (e.g. acute versus chronic) are detrimental and that some types of stress could attenuate infection-risk and -progression. The overall aim of this review is to motivate future research efforts to clarify whether psychosocial interventions have the potential to optimize neuroendocrine-immune responses against respiratory viral infections during and beyond the COVID-19 pandemic. The current state of research on different types of stress is summarized in a comprehensive narrative review to promote a psychoneuroimmune understanding of how stress and its mediators cortisol, (nor)adrenaline, neuropeptides and neurotrophins can shape the immune defense against viral diseases. Based on this understanding, we describe how people with high psychosocial stress can be identified, which behaviors and psychosocial interventions may contribute to optimal stress management, and how psychoneuroimmune knowledge can be used to improve adequate care for COVID-19 and other patients with viral infections.

Corroborative evidence for an association between initial hypothalamic-pituitary-adrenocortical axis reactivity and subsequent habituation in humans

BACKGROUND

The extant literature predicts that initial hypothalamic-pituitary-adrenocortical (HPA) axis response magnitude and subsequent habituation are associated with health, such that both heightened stress reactivity and non-habituation to repeated stressors are associated with disease. Yet, despite evidence for an association between initial HPA axis reactivity and subsequent habituation, the extant literature often considers health implications of these stress response patterns independently or make interpretations based on an initial response alone. This may be because past tests of the association between reactivity and habituation were subject to statistical bias (e.g., regression to the mean), and no prior work has examined the association between initial cortisol reactivity and subsequent habituation using analytic strategies capable of estimating the unbiased relationship between initial value (i.e., reactivity) and subsequent change (i.e., habituation). Accordingly, the present investigation drew from two previously published studies to test the association between initial HPA axis reactivity and subsequent habituation using analytic strategies capable of estimating the relationship between initial reactivity and subsequent habituation with minimal bias.

METHODS

We examined salivary cortisol and plasma ACTH responses to three repeated social-evaluative stressors (Study 1) and salivary cortisol responses to two repeated social-evaluative stressors (Study 2).

RESULTS

As predicted, results indicated a negative relationship (Pearson's r ranging from -0.27 to -0.91) where initial HPA axis reactivity was associated with subsequent habituation across both studies, even when using estimation procedures capable of producing an unbiased estimate of this relationship.

CONCLUSIONS

Results support the claim that initial HPA axis reactivity to acute stress is associated with subsequent habituation, such that initially high reactors are likely to habituate, whereas initially blunted reactors are likely to sensitize. In view of these results, hypothesized long-term health implications of acute cortisol reactivity and habituation patterns should be considered in tandem.

When enhanced awareness threatens: Interactive effects of domain-specific awareness and acceptance manipulations on cardiovascular indices of challenge and threat

Mindfulness includes acceptance and awareness subcomponents, and emerging theories imply that cultivating both acceptance and awareness may benefit health by diminishing stress reactivity. Yet, no prior work has examined the effects of mindful acceptance and awareness on cardiovascular markers of threat and challenge-cardiac output and total peripheral resistance-despite the unique insights these indices yield into stress-related evaluations and motivation. The current research integrates Monitor and Acceptance Theory with the Biopsychosocial Model of Challenge and Threat to elucidate how an awareness manipulation and a brief acceptance training are associated with cardiovascular stress responses underlying states of challenge and threat. Healthy young adults (N = 202) were enrolled in a 2 × 2 between-subjects experimental design manipulating both awareness (enhanced awareness vs. no enhanced awareness) and acceptance (acceptance training vs. no acceptance training) of physiological responses to a social-evaluative cold pressor test. Cardiovascular indices were recorded throughout. The combination of enhanced awareness and acceptance training led to higher cardiac output and lower total peripheral resistance (indexing greater challenge, less threat) to the cold pressor test than the combination of enhanced awareness and no acceptance training. However, the combination of no enhanced awareness and no acceptance training also led to higher cardiac output and lower total peripheral resistance than the combination of enhanced awareness and no acceptance training. These results add to a growing body of work suggesting that mindful awareness and acceptance subcomponents interact to influence stress reactivity and imply that enhanced stressor awareness without acceptance may lead to increased threat.