Association between perceived distress and salivary cortisol in veterans with mTBI

Meghan L Donovan; Jeri E Forster; Lisa M Betthauser; Christopher Stamper; Molly Penzenik; Theresa D Hernández; Nazanin Bahraini; Lisa A Brenner

doi:10.1016/j.cpnec.2022.100123

Association between perceived distress and salivary cortisol in veterans with mTBI

Compr Psychoneuroendocrinol. 2022 Feb 2:10:100123. doi: 10.1016/j.cpnec.2022.100123. eCollection 2022 May.

Authors

Meghan L Donovan^{1

2}, Jeri E Forster^{1

2}, Lisa M Betthauser^{1

2}, Christopher Stamper^{1

2}, Molly Penzenik¹, Theresa D Hernández^{1

2

3}, Nazanin Bahraini^{1

2

4}, Lisa A Brenner^{1

2

4

5}

Affiliations

¹ VA Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA.
² Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA.
³ Department of Psychology and Neuroscience, University of Colorado at Boulder, Muenzinger D244, 345 UCB, Boulder, CO, 80309, USA.
⁴ Department of Psychiatry, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA.
⁵ Department of Neurology, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA.

Abstract

Mild traumatic brain injury (mTBI) is one of the most common injuries experienced by Veterans and can frequently result in a variety of post-concussive symptoms. Post-concussive headaches (PCH), one of the most common symptoms, can persist for years after the injury occurred. The long-lasting impacts of PCH can be extremely distressing for Veterans, thus necessitating the need to find reliable biomarkers that directly relate to subjective feelings of distress. Yoga-based interventions have been shown to improve both subjective and objective markers of stress. Techniques used in yoga, such as the focus on releasing muscular tension, are also recommended as strategies for treating PCH. Thus, yoga-based interventions provide a unique context for the comparison of subjective and objective measures of distress in Veterans with PCH. In this secondary, exploratory analysis, we examined the relationship between perceived distress and cortisol in sixteen Veterans with mTBI and long-term PCH within the context of a yoga intervention feasibility study. The Visual Analogue Scale (VAS), a validated tool for measuring subjective distress, was administered to participants immediately before and after 75-min yoga classes, which occurred twice weekly over eight weeks. Participants also provided salivary cortisol (pre- and post-yoga) at in-person sessions (eight) to compare to changes in VAS scores. We found that VAS scores were significantly reduced within five of the eight assessed yoga classes, but there were no significant changes in cortisol levels. No significant correlations were found between VAS scores and salivary cortisol levels. When looking at how cortisol levels changed over time (i.e., over the series of eight yoga sessions), there was a significant downward trajectory in post-yoga cortisol, but not after taking pre-class cortisol into account (i.e., within yoga session cortisol change over time). Taken together, we found that subjective distress, but not cortisol was reduced by yoga classes. These data suggest that salivary cortisol did not match changes in perceived distress, thus emphasizing the ongoing challenges of relating subjective and objective measures.

Keywords: Cortisol; Mild traumatic brain injury; Objective markers of distress; Subjective distress; Yoga.