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

Andrew W Manigault; Ryan C Shorey; Katrina Hamilton; Matt C Scanlin; Alex Woody; Wilson S Figueroa; Christopher R France; Peggy M Zoccola

doi:10.1016/j.psyneuen.2019.03.009

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

Psychoneuroendocrinology. 2019 Jun:104:276-285. doi: 10.1016/j.psyneuen.2019.03.009. Epub 2019 Mar 18.

Authors

Andrew W Manigault¹, Ryan C Shorey², Katrina Hamilton³, Matt C Scanlin¹, Alex Woody⁴, Wilson S Figueroa⁵, Christopher R France¹, Peggy M Zoccola⁶

Affiliations

¹ Ohio University - Department of Psychology, Athens, OH 45701, USA.
² University of Wisconsin-Milwaukee - Department of Psychology, Milwaukee, WI 53211, USA.
³ Ohio University - Department of Psychology, Athens, OH 45701, USA; Ohio University - Heritage College of Osteopathic Medicine, Athens, OH 45701, USA.
⁴ Ohio State University - Institute for Behavioral Medicine Research, Columbus 43210, USA.
⁵ Ohio State University - Wexner Medical Center, Columbus 43210, USA.
⁶ Ohio University - Department of Psychology, Athens, OH 45701, USA. Electronic address: zoccola@ohio.edu.

PMID: 30917336
DOI: 10.1016/j.psyneuen.2019.03.009

Abstract

Background: Hypothalamic-pituitary-adrenocortical (HPA) axis dysregulation is associated with disease and may be indexed by poor cortisol habituation (i.e., a failure to show decreased responding with repeated stressor exposure). Thus, stress management training that can enhance HPA axis habituation may benefit health. To date, the effects of Mindfulness Based Stress Reduction (MBSR) and Cognitive Behavioral Therapy (CBT) interventions on HPA axis habituation remain untested. To test the effects of MBSR and CBT on HPA axis habituation, the present study used a parallel arm randomized controlled trial.

Methods: Healthy adults reporting moderate-to-high stress (n = 138) were randomly assigned to a 6-week MBSR intervention, a 6-week CBT intervention, or Waitlist control group. Post-intervention, participants completed a social-evaluative performance stressor during each of two laboratory visits scheduled 48-h apart. Salivary cortisol was collected pre-stressor, and 25, 35, and 60 min post-stressor onset during each visit. Final analyses included 86 participants who completed procedures up to the first laboratory visit.

Results: Relative to the control condition, both MBSR and CBT groups showed greater cortisol habituation. The MBSR group exhibited marginally greater habituation than the Waitlist group in cortisol samples corresponding to the recovery time points (35 and 60 min post-stressor onset). In contrast, the CBT group showed greater habituation than the Waitlist across all sampling timepoints collected (pre-stressor, 25, 35, and 60 min post-stressor onset). Yet, the CBT group also demonstrated elevated pre-stressor cortisol during the first visit.

Conclusions: Results suggest that MBSR and CBT interventions promote greater HPA axis habituation relative to no training, but do not reduce overall cortisol output (i.e., across both visits). Observed differences between CBT and MBSR training in relation to cortisol habituation are discussed.

Keywords: Behavioral; Cognitive; Cortisol; Habituation; Mindfulness; Stress.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cognitive Behavioral Therapy / methods*
Female
Habituation, Psychophysiologic / physiology*
Humans
Hydrocortisone / analysis
Hydrocortisone / metabolism
Hypothalamo-Hypophyseal System / chemistry
Male
Mindfulness / methods*
Pituitary-Adrenal System / chemistry
Saliva / chemistry
Stress, Psychological / psychology
Stress, Psychological / therapy

Substances

Hydrocortisone